People with sleep apnea stop breathing while they sleep. The condition can impact a person’s health, and experts now recognize a link between cholesterol and sleep apnea.
Sleep apnea disrupts a person’s sleep, which can have negative health effects over time. Researchers have linked obstructive sleep apnea (OSA) and high cholesterol, but it is not clear why the link exists.
It is likely a variety of factors explaining the connection. Some of these may be physiological changes, such as disturbed sleep affecting the liver enzymes that break down fats. Others may be lifestyle factors. For example, people who are chronically tired may be more likely to choose processed foods high in cholesterol and fat and less likely to exercise.
This article looks at cholesterol and sleep apnea, risk factors, and treatment options.
Yes, there is a link between high cholesterol and sleep apnea.
A large study of 8,592 participants investigated this connection. The participants did not have diagnosed high blood lipid levels, and they were not taking lipid-lowering drugs beforehand.
It is important to note that 69% of the participants were male, and the study did not detail racial demographics.
The researchers found a significant relationship between high total cholesterol, harmful low-density lipoprotein (LDL) cholesterol, triglycerides, and sleep apnea.
They also noted that people with more severe sleep apnea had lower levels of high-density lipoprotein (HDL), also known as “good” cholesterol. This type of cholesterol is important because it helps the body eliminate excess LDL, also known as “bad” cholesterol.
Quality, uninterrupted sleep is important for overall health. It also appears to impact cholesterol levels.
However, researchers are still trying to understand how sleep affects cholesterol. While some studies, such as this 2018 analysis, showed a link, others found no significant connection.
For example, a 2019 study of 2,705 participants found an association between shorter sleep duration, high triglycerides, and low HDL (good) cholesterol. However, sleep duration did not appear to affect LDL (bad) cholesterol levels. These results mean that while a lack of sleep relates to lower levels of good cholesterol, it was not shown to increase bad cholesterol.
However, a large 2019 study in China found that males with OSA had an increased risk of high LDL and low HDL cholesterol levels.
Experts have suggested multiple possible explanations for these conflicting findings. Some suggest that because sleep affects certain hormone levels, there may be differences between males and females. Others suggest disturbed sleep contributes to changes in liver enzymes that convert cholesterol into bile acids, which may then increase blood lipid levels.
Overall, disturbed and shorter sleep duration appears to negatively impact blood lipid profiles, but it is not clear exactly why or how it does.
Besides disturbing an individual’s sleep, sleep apnea may contribute to a range of complications, including:
Besides sleep apnea, certain factors can increase an individual’s risk of high cholesterol, including:
- Health conditions: Type 2 diabetes and obesity can affect an individual’s blood lipid profile and lead to low HDL and high LDL cholesterol levels.
- Behaviors: Eating a diet high in saturated fat, smoking tobacco, and low physical activity levels can contribute to high cholesterol and heart disease.
- Age and sex: The risk of high cholesterol increases with age. Typically, females have lower LDL cholesterol levels than men until they reach age 55 years or menopause. Males generally have lower HDL cholesterol levels than females.
Additionally, some individuals have an inherited condition called familial hypercholesterolemia. This causes high LDL cholesterol levels even at a young age. If an individual does not receive treatment for the condition, cholesterol levels continue to increase as they age.
Doctors may recommend various treatments for both high cholesterol and sleep apnea. For example, individuals can lower cholesterol levels with lifestyle changes and medications.
Lifestyle changes for lower cholesterol
A doctor may recommend:
- Heart-healthy eating: People should limit saturated and trans fats and choose nutrient-dense foods such as fruits, vegetables, whole grains, and lean meats.
- Weight management: If a person has excess weight, working to reach a moderate weight may help lower LDL cholesterol levels. Weight management is particularly critical for individuals with metabolic syndrome, meaning they have high triglycerides, low HDL cholesterol levels, and have overweight with a waist measurement over 40 inches (in) for men and 35 in for women. This cluster of conditions increases the risk of heart disease, stroke, and type 2 diabetes.
- physical activity: The Centers for Disease Control and Prevention (CDC) recommends 150 minutes of physical activity each week.
- Stress management: Chronic stress can lead to increased LDL and decreased HDL cholesterol levels, so individuals can try including stress-relieving activities in their day. These may include meditation, exercise, and connecting with friends.
- Acknowledgment smoking: When people stop smoking, their HDL cholesterol may increase, helping to lower harmful LDL cholesterol.
Medications for lower cholesterol
Doctors may recommend medications to manage cholesterol levels. Options include:
- Statins to block LDL cholesterol production in the liver
- bile acid sequestrants to decrease the amount of fat the body absorbs from food
- cholesterol absorption inhibitors to lower triglycerides and decrease cholesterol absorption from food
- nicotinic acid to decrease LDL cholesterol and triglycerides and increase HDL cholesterol
Sleep apnea treatment options
The most effective treatment for obstructive sleep apnea is a continuous positive airway pressure (CPAP) machine. These devices allow a steady stream of air into the nose and mouth as someone sleeps, keeping the airways open and helping people breathe correctly.
If an individual does not have success with a CPAP machine, a doctor may suggest other options, including:
- Oral devices: A custom-fitted device that resembles a mouthguard or orthodontic retainer can help maintain open airways by bringing the jaw forward and relieving obstructions. This option is typically best for people with mild to moderate sleep apnea.
- positioning device: If an individual has sleep apnea when they sleep on their back, a positioning device can keep them on their side and prevent them from rolling over.
- Surgery: The main treatment for OSA in children is surgery to remove tonsils or adenoids. Surgical options also exist for adults, but these are typically for severe OSA and those unable to tolerate other treatments.
- Hypoglossal nerve stimulation: This involves surgically implanting a small electrical device to stimulate the nerves of the airways.
Read more about sleep apnea treatment options.
Sleep apnea makes a person stop breathing while they sleep. The condition can impact an individual’s overall health and may link to high cholesterol levels.
Because high cholesterol often has no warning signs, people should get regular screenings. Individuals who notice they are excessively tired during the day and snore loudly at night should discuss the possibility of sleep apnea with a doctor.