How harmful is untreated sleep apnoea?

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1. 1

   Association of obstructive sleep apnoea with exercise capacity and mortality in a population-based study: results of SHIP-TREND.

   ERJ open research (Obst et al.)Published Jul 27, 2026Checked Oct 4, 2026

   “Associations between sleep and CPET measures, as well as mortality, were assessed using multivariable linear and Cox regression models.ResultsThe mean age of participants was 54 (range 44-63) years; 47.1% were women. The apnoea-hypopnoea index (AHI) was 4.9 (95% CI 1.4-13.7) events·h-1 and higher in men (7.9, 95% CI 2.6-18.8) than in women (2.6, 95% CI 0.7-9.2; pV'O2 peak) was lower in women (22 (95% CI 18-25) mL·min-1·kg-1) than in men (27 (95% 22-32) mL·min-1·kg-1; pV'O2 peak. Over a median 10.3-year follow-up, 73 deaths occurred. AHI was significantly associated with all-cause mortality across models (hazard ratio 1.31-1.72). Mediation analysis demonstrated a significant direct effect, whereas the indirect effect via V'O2 peak was not statistically significant.ConclusionsIn the SHIP-TREND-0 cohort, elevated AHI is associated with reduced V'O2 peak and increased all-cause mortality. Mediation analysis suggested a possible, but not statistically significant, contribution of impaired cardiopulmonary fitness to the relationship between sleep apnoea and mortality, highlighting a potential role of fitness that warrants further investigation.”

2. 2

   Obstructive Sleep Apnoea and Atrial Fibrillation: Current Evidence and Emerging Research Directions.

   Reviews in cardiovascular medicine (Basiukiewicz et al.)Published Aug 5, 2026Checked Oct 4, 2026

   “Obstructive sleep apnoea is highly prevalent among patients with atrial fibrillation and adversely affects rhythm-control outcomes. The interplay between these two conditions is of significant clinical importance, as obstructive sleep apnoea contributes to the development and progression of arrhythmias through multiple pathophysiological mechanisms: mechanical atrial stretch, immune activation and low-grade inflammation, autonomic dysregulation, oxidative stress, and systemic hypoxia. These mechanisms promote the initiation, maintenance, and treatment resistance of atrial fibrillation. Multimodal management strategies aimed at this harmful interplay may improve outcomes in patients with atrial fibrillation and include lifestyle and dietary interventions, pharmacometabolic therapies, particularly glucagon-like peptide-1 receptor agonists, continuous positive airway pressure therapy, and, in selected cases, catheter ablation strategies, potentially extended to the ganglionated plexi. Collectively, these approaches may contribute to the restoration and maintenance of sinus rhythm.”

3. 3

   Impact of obstructive sleep apnoea on nocturnal blood pressure: mechanisms and treatment responses - a narrative review.

   European respiratory review : an official journal of the European Respiratory Society (Gruber et al.)Published Jul 1, 2026Checked Oct 4, 2026

   “This narrative review summarises current evidence on the physiological regulation of nocturnal BP, the mechanisms by which OSA disrupts nocturnal BP control, the epidemiology and prognostic relevance of abnormal nocturnal BP patterns in OSA, and the effects of available therapies. Continuous positive airway pressure (CPAP) has the strongest evidence base and lowers nocturnal BP modestly on average, with greater effects in patients with uncontrolled or resistant hypertension and with better treatment adherence. By contrast, evidence for non-CPAP therapies, including mandibular advancement devices, supplemental oxygen, hypoglossal nerve stimulation and upper-airway surgery, remains limited and less consistent. In summary, nocturnal BP abnormalities are common, clinically important and frequently overlooked in OSA. Greater use of ambulatory BP monitoring and more precise identification of patients most likely to benefit from targeted treatment may improve cardiovascular risk stratification and management in OSA.”

4. 4

   Obstructive sleep apnoea and glucose dysregulation in type 2 diabetes: a systematic review of the literature.

   Frontiers in medicine (Shinalieva et al.)Published Sep 7, 2026Checked Oct 4, 2026

   “A PRISMA-based systematic review was conducted using major databases.ResultsIn total, eleven studies from Asia, Europe, Africa, and South America were included in this review. The results show that OSA was consistently associated with poorer glycemic control, increased insulin resistance, and adverse metabolic profiles, with several studies demonstrating severity-dependent effects. In addition, poor sleep quality and short sleep duration were also linked to adverse metabolic outcomes, although findings were less consistent. Finally, limited evidence suggested that continuous positive airway pressure (CPAP) therapy may improve some metabolic and renal outcomes.ConclusionOSA is consistently associated with impaired glucose metabolism and increased cardiometabolic risk in individuals with T2DM. Further longitudinal and interventional studies are needed to clarify causal pathways and the metabolic effects of OSA treatment.Systematic review registrationPROSPERO (CRD420261402284).”

5. 5

   Sleep apnea (Wikipedia)

   WikipediaPublished Sep 30, 2026Checked Oct 4, 2026

   “Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep result in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and often occurs many times a night. A choking or snorting sound may occur when breathing resumes. Common symptoms include daytime sleepiness, snoring, and non-restorative sleep despite adequate duration of sleep. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition. Sleep apnea may be categorized as obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two. OSA is the most common form. OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain).”

6. 6

   Association of Positive airway pressure adherence with mortality and cardiovascular events in high vs low risk sleep apnoea patients.

   The European respiratory journal (Bailly et al.)Published Sep 3, 2026Checked Oct 4, 2026

   “The primary composite outcome was defined using the first occurrence in SNDS of major adverse CV event (MACE). Cox models assessed the association between PAP adherence (mean PAP use ≥4 h/night) and MACE occurrence.ResultsOver a median follow-up of 9 years, 740 patients experienced a MACE. PAP adherence versus non-adherence was associated with a reduced risk of MACE (adjusted hazard ratio [HR] 0.53, 95% CI [0.46-0.62], pversus without (28.3%) high risk status (interaction HR 0.61 [0.43-0.87]; interaction p value =0.006). Similar findings were obtained using a simplified version of SASHB and ΔHR automatically derived from the single oximetry signal. The interaction of high-risk status between PAP adherence and MACE appeared stronger in non-sleepy patients.ConclusionsIn sleep-clinic, the association of PAP adherence with reduced MACE risk was stronger in high risk OSA. These findings support the integration of hypoxic and autonomic biomarkers into clinical decision pathways for CV risk reduction in OSA.”