Sleep apnoea: the missing piece in cardiometabolic care

Patients come to clinic with hard-to-control blood pressure, unstable blood glucose or persistent fatigue, but few think about their sleep. Yet obstructive sleep apnoea may be an important part of the problem.

A hidden condition

Obstructive sleep apnoea (OSA) occurs when the upper airway repeatedly collapses during sleep, causing drops in blood oxygen and fragmented sleep. Most patients do not know they have it. Loud snoring, morning headaches and tiredness are often dismissed as normal.

Importantly, not everyone with OSA feels sleepy during the day. In patients with cardiometabolic disease, waiting for daytime sleepiness before considering OSA means missing many people at high risk.

Why cardiologists and endocrinologists should care

OSA is closely linked to hypertension, especially resistant hypertension, as well as arrhythmias, coronary disease, stroke, type 2 diabetes and obesity. Repeated nightly hypoxia activates the sympathetic nervous system and drives inflammation and metabolic disturbance. Current cardiovascular recommendations support OSA screening in these high-risk groups. Treating blood pressure or glucose while ignoring sleep may mean treating only the symptoms.

The biggest barrier: diagnosis

In-laboratory polysomnography is the gold standard, but capacity is limited, costs are high and patients are reluctant to spend a night in hospital. As a result, most people with OSA in Vietnam remain undiagnosed.

Home sleep testing: a feasible way forward

The first multicentre study in Vietnam of a home sleep testing model for OSA screening in patients with cardiovascular disease, diabetes and obesity, led by Professor Duong Quy Sy with my colleagues and me as co-investigators and published as an abstract in Sleep Medicine in 2026, indicates that this is a feasible approach for early detection in high-risk patients. Testing at home is more comfortable for patients, lowers costs and extends screening beyond major centres.

Three recommendations for practice

• Ask about sleep at every cardiometabolic visit: use the STOP-BANG questionnaire for initial screening (snoring, tiredness, observed apnoeas, blood pressure, BMI, age, neck circumference, sex) rather than asking only about daytime sleepiness.
• Prioritise sleep testing for high-risk patients: resistant hypertension, atrial fibrillation, diabetes with obesity, or a high STOP-BANG score.
• Work across specialties: cardiology, endocrinology, respiratory medicine, ENT and sleep medicine should build a shared care pathway, from screening and diagnosis to treatment and follow-up.

At Vinmec Da Nang, Professor Duong Quy Sy has held a monthly clinic since August 2026 for patients with sleep disorders, many of whom also live with cardiometabolic disease.

Conclusion

Comprehensive cardiometabolic care cannot ignore sleep.

A simple question such as “Do you snore?” can open a path to treatment that changes a patient’s outlook.