Can Sleep Apnea Kill You? An Honest Look at the Risks

Sleep apnea is a serious sleep condition. And if you’ve read anything about it after a diagnosis, you may have come across the information that sleep apnea can raise your risk for high blood pressure, diabetes, heart disease, and stroke. You may also be anxious about what it means knowing your breathing briefly pauses throughout the night. It’s reasonable to feel worried. 

Rest assured that while there are real long-term risks associated with sleep apnea, sudden cardiac death is relatively uncommon, and treatment of sleep apnea can decrease those risks. We’ll cover more about whether sleep apnea can be fatal, health problems linked to untreated sleep apnea, and how to find out whether you have sleep apnea, including testing at home. 

Can sleep apnea kill you?

Yes, it's possible to die from untreated sleep apnea. In severe cases, oxygen levels can dip down low enough to possibly put someone at risk of a cardiac death from a single sleep apnea event, says sleep neurologist Meredith Broderick, MD. However, in terms of life expectancy, physicians worry more about the long-term health risks of untreated sleep apnea more than the mortality risk during a single night.

What sleep apnea risk looks like during a single night

When you have sleep apnea, your breathing stops and restarts while you sleep, which impairs your body’s ability to get the oxygen it needs. Death from a single pause is rare. 

That said, interrupted breathing does reduce blood oxygen levels. When blood oxygen levels dip abnormally low, it's called nocturnal hypoxemia, and this has been shown to be a risk factor for sudden cardiac death in people who have obstructive sleep apnea (OSA), notes research in the American Journal of Translational Research.

In a meta-analysis of a dozen studies, the odds of experiencing sudden cardiac death was 41% higher in people with OSA, although this finding was not statistically significant, per a review in BMC Cardiovascular Disorders. In people with untreated OSA, the odds of sudden cardiac death were about 3.9 times higher,  according to that same research. People receiving CPAP treatment did not have a higher risk of death.

Sudden cardiac death can happen at any time of day, but the researchers in the review above point to past evidence that suggests people with OSA may have more fatal health events between midnight and early morning. That may be because low blood oxygen levels, nervous system dysregulation, and electrical problems in the heart that occur in OSA episodes can lead to a dangerously abnormal heart rhythm that can cause sudden cardiac arrest and death.

Still, we  need more research to fully understand the connection between OSA and sudden cardiac death. The authors in the above study noted that due to limitations with the data there's still no definitive association between OSA and sudden cardiac death. What they do know: Untreated sleep apnea is dangerous, no matter what, and mitigating your risk starts with a diagnosis. 

What sleep apnea risk looks like over many years

Sudden cardiac death is a frightening prospect. But the larger concern is the cumulative effect of untreated OSA. Untreated sleep apnea puts repeated nightly strain on the heart, blood vessels, and metabolic function, according to research in the journal Circulation. 

Then, there is excessive daytime sleepiness — a hallmark symptom of sleep apnea — which can present significant safety issues, as well as brain function impairment that increases your risk of dementia and stroke, among other health concerns.

Why does sleep apnea put strain on the body?

With obstructive sleep apnea, the upper airway collapses during sleep. This can stop airflow completely (apnea) or reduce it partially (hypopnea). In another type of sleep apnea called central sleep apnea, the pauses in breathing stem from neurological dysfunction with the brain’s signalling, rather than a closed airway.

These interruptions in breathing occur often. People who have moderate OSA have between 15 and 30 pauses per hour of sleep, while those with severe OSA have 30 or more. You can have hundreds of these pauses over the course of a night. And given that one apnea occurs for at least 10 seconds at a time, you can see why oxygen levels may drop overnight. 

Here’s more about why sleep apnea puts strain on your body, according to Dr. Broderick:

• Oxygen levels temporarily drop due to pauses in breathing

• Sleep becomes fragmented

• Your sympathetic nervous system (fight-or-flight response) is activated

• Oxidative stress increases

• Inflammation and endothelial (blood vessel lining) dysfunction occurs

“All of those factors contribute to the long-term consequences [of untreated sleep apnea],” says Dr. Broderick. 

What health risks are linked to untreated sleep apnea?

Untreated sleep apnea is dangerous. People with moderate-to-severe OSA are at an increased risk for:

• Coronary artery disease

• Hypertension (high blood pressure)

• Heart failure

• Stroke

• Insulin resistance

• Type 2 diabetes

• Fatty liver disease (metabolic dysfunction-associated steatotic liver disease, or MASLD)

• Cognitive dysfunction

• Mood disorders

There is also a more immediate life-threatening risk to your safety due to daytime sleepiness, says Dr. Broderick. “People with OSA have a much higher risk of getting in a car accident,” she says. One study in Sleep Medicine found a 17% higher risk of motor vehicle accidents when someone had OSA.

Who faces the highest risk?

People who have untreated sleep apnea face the highest risk of health complications from the sleep disorder. Your risk is elevated depending on the type of sleep apnea, its severity, any comorbidities, your age, certain medications or substances you take, and other factors.

Factors that influence your risk of death from sleep apnea include:

• Severity: A sleep study measures your apnea-hypopnea index (AHI), which is a measurement of how often your breathing is interrupted per hour. The greater your AHI number, the more severe your sleep apnea. People who have an AHI of more than 20 may also have a higher risk of sudden cardiac death, per research in Circulation.

• Central sleep apnea: Although less common than OSA, central sleep apnea often occurs in people with heart conditions like atrial fibrillation (abnormal heart rhythm), coronary artery disease, stroke, and those who use certain medications. 

• Co-occurring heart or lung conditions: OSA is common in people who have heart failure, high blood pressure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke, but it remains underrecognized and undertreated, per research in Circulation.

• Older age: Common conditions that occur in aging and OSA share symptoms, which can make OSA more difficult to diagnose and aging itself can drive the development of OSA, per research in Sleep and Breathing. In addition those who experienced sudden cardiac death with severe OSA are more likely to be over 60 years old.

• Sedating substances: Alcohol and opioid use can worsen breathing pauses, per Sleep Medicine Reviews. Sedative medications can also worsen sleep apnea.

• Surgery and anesthesia: If you are undergoing anesthesia for surgery, let your physician know that you have OSA. OSA can increase the risk for complications.

• Untreated or stopped treatment: Given the health risks of sleep apnea, undiagnosed, untreated, or terminated treatment present possible serious long-term consequences. 

What should you do if you see someone stop breathing in their sleep?

If someone stops breathing in their sleep and you are concerned, you need to check for responsiveness. The American Red Cross recommends shouting the person's name, then tapping their shoulder if you get no response, and then shouting their name again. After 10 seconds if they do not respond, are not breathing, are gasping, or it is clear they have a life-threatening condition, you should call 9-1-1.

That said, if your partner has sleep apnea, you will become accustomed to what their apneas sound and/or look like, which can decrease the fear that something is wrong. For example, you might hear them stop breathing, then make a snort, snore, gasp, choking sound, or a jerky movement as they start breathing again. Understanding their normal pattern is important, but if you are concerned, call out their name and tap them on the shoulder. 

Many times, partners are the ones suggesting their loved one get evaluated for sleep apnea, according to the Journal of Clinical Sleep Medicine. When this conversation is had compassionately, it’s not just complaining about their snoring or strange nighttime sounds. Gently talking to them about what you’ve noticed and suggesting they seek a diagnosis is one of the best things you can do for their future wellbeing.  

When a breathing pause is an emergency

Most apneas come and go, but if someone has stopped breathing for a prolonged period of time, you may need to take action. Call 911 if the person:

Becomes limp

Has a seizure

Loses consciousness

Remains drowsy

Turns blue 

Does treating sleep apnea lower the risk?

Yes! This is the hopeful part: Sleep apnea treatment is health-protective. There are many treatments for sleep apnea, including continuous positive airway pressure (CPAP) and CPAP alternatives. These aim to keep the airway open so you can breathe continuously and keep oxygen levels steady. 

Research in ERJ Open Research found that people who used CPAP for more than five years were 5.63 times more likely to be alive after a 15-year follow-up compared to those who did not use a CPAP. In addition, people who did not use a CPAP had a higher risk of developing type 2 diabetes and ischaemic heart disease or having a heart attack compared to those who used one of these devices. 

How do you find out if you have sleep apnea?

You need to get a sleep test to find out if you have sleep apnea. If you’re not yet sure if it’s something to bring up to your provider, you can consult a sleep apnea self-check guide. But remember: only a sleep study can confirm a diagnosis. 

Testing can happen at home with tests like the Sunrise device, a rigorous test that boasts accuracy similar to an in-lab polysomnography. The Sunrise Sleep Test device uses data on mandibular jaw movements (MJM) to tell if you are awake or asleep. It sits on your chin, tracking how many times the jaw jerks open in response to a pause in breathing, and it’s been shown to provide reliable results over multiple nights.

Not everyone is a candidate for at-home sleep testing but meeting with a sleep provider at Dreem Health can help steer you toward the right care and testing for you. If you’re a candidate, Dreem Health can help you order at-home sleep testing with the Sunrise device. All results are reviewed by a sleep provider, with a clear path toward treatment if needed. Here’s how to book an appointment and learn more about Dreem Health’s sleep apnea treatment.

The bottom line

Worries about the dangers of untreated sleep apnea are understandable. It’s a serious sleep disorder that, in extreme cases, can put you at a higher risk for sudden cardiac death. The biggest risks usually come from the long-term consequences of unrecognized and untreated sleep apnea. There are studied links between sleep apnea and heart disease, dementia, stroke, and more. To reduce your risk, the first step is an evaluation for sleep apnea, which you can do virtually with a sleep provider at Dreem Health. If you’re a candidate, they can also set you up with at-home testing for sleep apnea — your first step toward improving your long-term health.

Frequently asked questions (FAQs)

Will I die from severe sleep apnea?

We can’t say for sure what the consequences of sleep apnea might be for you. But, untreated sleep apnea is associated with a range of increased health risks that may shorten your life, such as cardiovascular disease, stroke, heart attack, type 2 diabetes, and hypertension. 

Can untreated sleep apnea get worse?

Yes, untreated sleep apnea can worsen over time, especially with age and weight gain. If untreated, the condition progresses due to obesity, worsening breathing episodes, and the development of cardiometabolic comorbidities like high blood pressure, according to research in Sleep and Breathing. If you suspect you have sleep apnea, get an evaluation from a sleep provider who can recommend sleep testing to confirm a diagnosis.

Is it safe to take sleeping pills if you might have sleep apnea?

You should not take sleeping pills if you might have sleep apnea, as sedatives can worsen the condition. If you think you have sleep apnea, you need a sleep test. For many people, an at-home sleep test is a good option.