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Q: Any correlation among hypertension, tinnitus and sleep problems? ( Answered,   0 Comments )
Subject: Any correlation among hypertension, tinnitus and sleep problems?
Category: Health > Conditions and Diseases
Asked by: gt06-ga
List Price: $50.00
Posted: 29 Aug 2006 15:34 PDT
Expires: 28 Sep 2006 15:34 PDT
Question ID: 760607
I have been recently (1 year) affected in the same time by a set of symptoms:
1) One day my left leg suddenly swelled; following tests gave no sign of any 
bood circulation problem. This fact recurred in a 6-8 months timeframe and
was possibly triggered by some heavy dinner or alcoohol consumption the day before.
2) Hypertension. Strangely, it tops when I am in bed (horizontal position?)
3) Tinnitus (bilateral). An MRI scan found a neuroma in right ear. 
My personal opinion is that neuroma has always been there (since a
child) and is NOT the primary cause of tinnitus.
4) Sleep apnea diagnosed with 23 obstructive events per night.

It's useless to say that in this last year stress was very high due to
work issues (but when one is NOT stressed?)

I'd like to know if anyone had the same correlated symptoms and suspects that 
sleep apnea or other sleep related issues could be the primary cause
(eventually triggering pressure-related cascades).

Thanks, GT
(PS: I am a male, 58 years)
Subject: Re: Any correlation among hypertension, tinnitus and sleep problems?
Answered By: boquinha-ga on 31 Aug 2006 18:52 PDT
Hello gt06-ga!

I?m sorry to hear of all the health issues and stress that you?ve been
experiencing recently. It must be frustrating to experience all of
this not knowing for sure what?s causing it. I was able to find a
number of articles discussing one or all of the problems that you have
mentioned. It is interesting to see how interrelated they can all be.
This answer is not intended to substitute for the opinion of a
qualified health professional that you trust. If you have any specific
concerns or questions you should discuss them with him or her. Here is
the information that I found.

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There are a number of studies that show a link between Obstructive
Sleep Apnea (OSA) and hypertension. Below are a number of excerpts
from articles discussing this connection.

?A recent large, cross-sectional study indicates that sleep apnea is
independently associated with systemic hypertension in middle-aged and
older persons. Even stronger evidence of a link was obtained in a new
prospective study.

The cross-sectional study is part of the Sleep Heart Health Study
(SHHS), sponsored by the National Heart, Lung, and Blood Institute.
SHHS is a multicenter examination of the cardiovascular consequences
of sleep apnea in participants recruited from ongoing population-based
cohort studies. The team conducting this study was led by F. Javier
Nieto, MD, PhD, an associate professor in the department of
epidemiology at Johns Hopkins School of Hygiene and Public Health in
Baltimore. They analyzed data on more than 6,000 participants, thereby
conducting the largest cross-sectional study to date of the
association between SDB and hypertension in apparently healthy
middle-aged and older adults.

The prospective study was performed by Paul E. Peppard, PhD, and
colleagues from the department of preventive medicine at the
University of Wisconsin School of Medicine in Madison. They followed
709 subjects from the Wisconsin Sleep Cohort Study, a
population-based, longitudinal study of the natural history of SDB in

?Several large cross-sectional studies have demonstrated that OSAHS
[obstructive sleep apnea-hypopnea syndrome] is a risk factor for
developing hypertension independent of obesity, age, alcohol intake,
and smoking. . . . More recently, people in the Wisconsin Cohort Study
were prospectively monitored for the development of hypertension. The
investigators found a dose-response relationship between the degree of
OSAHS and the presence of hypertension 4 years . . . independent of
confounding variables.?

Here is a 2003 article from the medical journal ?Hypertension.? It
also discusses the connection between sleep apnea and hypertension.

The evidence supporting the association between OSA [obstructive sleep
apnea] and chronic, long-standing hypertension is compelling and is
provided by several cross-sectional, longitudinal, and treatment
studies. Several reports have shown that the prevalence of
hypertension is greater in patients with OSA and vice versa. In the
largest of those cross-sectional studies, with a total of 6132
participants, an elevated odds ratio for hypertension was found in
subjects with sleep-disordered breathing after adjusting for
demographics, anthropometric measurements (including BMI, neck
circumference, and waist-to-hip ratio), alcohol consumption, and
smoking. In stratified analyses, the association between
sleep-disordered breathing and hypertension was seen in men and women,
older and younger ages, all ethnic groups, and among normal-weight and
overweight individuals. Similarly, in a retrospective analysis of 182
men without any cardiovascular disease at baseline and with follow-up
information obtained 7 years after the baseline measures, incompletely
treated OSA was found to be an independent predictor of cardiovascular
disease, including hypertension. Perhaps the most convincing
prospective data in support of a causal relation between OSA and
hypertension have been provided by the Wisconsin Sleep Cohort Study.
This study demonstrated an independent dose-response relation between
sleep-disordered breathing at baseline and the development of new
hypertension 4 years later. . . .

In addition to established daytime hypertension, OSA also causes acute
nocturnal surges in blood pressure in response to chemoreflex-mediated
hypoxic stimulation of sympathetic activity, with a resultant increase
in peripheral vascular resistance. These nocturnal increases in blood
pressure may reach levels as high as 240/120 mm Hg and are readily
reversed by CPAP. It is possible that OSA, at least in part,
contributes to the nocturnal ?nondipping? pattern of hypertension,
which may be associated with an adverse cardiovascular prognosis.?

A patient education article from the University of Utah Health
Sciences Center website gives a short list of the risks of sleep

?Early recognition and treatment of sleep apnea is important, as it
may be associated with the following:

* irregular heartbeat
* high blood pressure (hypertension)
* heart attack
* stroke?

?Hypertension and heart failure are strongly linked with sleep apnea.
OSA appears to be a cause of hypertension. It appears that sleep can
be either a cause or an effect of heart failure. Recent trials have
demonstrated that treating sleep apnea in patients with heart failure
is beneficial.?

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While there are a number of conditions that can cause tinnitus, and
tinnitus can exist alone, hypertension is one thing that can make
tinnitus more noticeable and troublesome. Here are a number of
references discussing this.

?A small percentage of tinnitus cases arise from medical conditions. 
Hypertension (high blood pressure), acoustic neuroma (tumor on the
hearing nerve), thyroid disease, vascular disorder, temporomandibular
joint (TMJ) disorder, ear infection, impacted cerumen (ear wax),
nutritional deficiency, aneurysm, multiple sclerosis and other
disorders can produce the symptom of tinnitus.?

Here is an excerpt from an article discussing sensorineural tinnitus,
one type of ear ringing.

?Sensorineural tinnitus originates in the inner ear. It is difficult
to assess and is therefore not very well understood. It usually causes
ringing, humming, or 'white noise' sounds which cannot be heard by an
examiner. Constant, bilateral sounds are usually related to
degeneration and are very common in aged persons. Unilateral or
fluctuating sounds may be related to a specific cause, such as
Meniere's disease, industrial deafness (from machinery), loud music or
trauma. Risk factors for sensorineural tinnitus include hypertension
and obesity. Psychological or stress-related factors may also
contribute to tinnitus. Alcohol, nicotine, caffeine, aminoglycosides,
salicylates and quinine are known to exacerbate sensorineural

?Sensorineural tinnitus generally comes from damage to the microscopic
nerve endings in the inner ear. This is usually associated with
hearing loss. One of the leading causes of sensorineural tinnitus is
exposure to loud noise. Other causes of this type of tinnitus include
abnormal blood pressure [hypertension], allergy, diabetes, aging,
thyroid conditions, ototoxic medications, head & neck injury and
tumors of the inner ear.?

?Hypertension and factors that increase blood pressure, such as
stress, alcohol and caffeine, can make the sound more noticeable.
Repositioning your head usually causes the sound to disappear.?

The student version of the British Medical Journal has a section on
tinnitus, including questions that practitioners should ask people
complaining of ringing in the ears. Cardiovascular disease, including
hypertension can cause tinnitus in some people.

?The most common cause of pulsatile tinnitus is arterial turbulence, a
noisy blood flow caused by plaques or kinks in the arteries in the
head or neck. It can be made worse if there is also hypertension. Many
forms of pulsatile tinnitus are treatable.?

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There are many articles online talking about leg swelling, a very
common condition. Hypertension is not usually felt to be a cause of
leg swelling. Here is some information about common causes of leg

?Foot, leg, and ankle swelling is common with the following situations:

* Prolonged standing
* Long airplane flights or automobile rides . . .
* Being overweight
* Increased age
* Injury or trauma to your ankle or foot

Swollen legs may be a sign of heart failure, kidney failure, or liver
failure. In these conditions, there is too much fluid in the body.

Other conditions that can cause swelling to one or both legs include:

* Blood clot
* Leg infection
* Venous insufficiency (when the veins in your legs are unable to
adequately pump blood back to the heart)
* Varicose veins
* Burns (including sunburn)
* Insect bite or sting
* Starvation or malnutrition
* Surgery to your leg or foot

Certain medications may also cause your legs to swell:

* Hormones like estrogen (in birth control pills or hormone
replacement therapy) and testosterone
* A group of blood pressure lowering drugs called calcium channel
blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and
* Steroids
* Antidepressants, including MAO inhibitors (such as phenelzine and
tranylcypromine) and tricyclics (such as nortriptyline, desipramine,
and amitriptyline)?

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So, putting it all together, tinnitus can be caused by a number of
conditions. Hypertension is one that can definitely make tinnitus
worse, and may even cause it. Sleep apnea is a well-documented cause
of hypertension, especially ?difficult to treat? cases. Given these
facts, it is reasonable to say that sleep apnea (or another sleep
disturbance) could be a major factor in developing both tinnitus and
hypertension. Of course, again the disclaimer pertains--if you have
specific concerns or questions, be sure to discuss them with a
qualified health practitioner that you trust. At least this gives you
a good amount of information on the various issues with which you are

- - - - - - - - - - - - - - - - - - - -

I hope that you find this information useful! And I hope you can find
relief from your health and stress issues soon. If you have any need
of further clarification, please let me know how I can help.


Search terms:

tinnitus hypertension
sensorineural tinnitus hypertension
"sleep apnea" hypertension
"sleep apnea" tinnitus
"sleep disorder" tinnitus
leg swelling causes

Request for Answer Clarification by gt06-ga on 04 Sep 2006 10:14 PDT
Hey Boquinha,
thanks for the quick and effective search. It's quite interesting, so
I'd like to ask you how can we go on with:
1- a deeper/longer search on same topic 
2- a new search on best treatment for OSA (Sleep apnea). 
If this is the main cause of all, I've seen from a short search that
treatments are far to be simple to choose.
One goes from "chinese herbs" to CPAP (i.e. hi-tech masks that inject
air) and finally to a surgical intervention (again: many different
A doctor (friend) even told me that "Didjeridoo playing " has been
found to be beneficial.
Which could be then the "best-treatment-in-town"?
I'm ready to do anything, in order to solve quickly this problem.

Clarification of Answer by boquinha-ga on 05 Sep 2006 09:20 PDT
Hi GT,

Thank you for your comment. I'm glad you like my answer! I can tell
that you're really taking charge of your health and looking for
resources and answers and I applaud that. I really think it's great
when people *do* something instead of sitting back and shrugging their

As for what to do next and the things you've described, I'm happy to
do further research for you on those topics! So, the next step is to
review the pricing guidelines for Google Answers (found here:, post a new question
accordingly, and put my name (Boquinha-ga) in the question title
itself. Be as specific as possible and I can provide you with further
information. We can continue to use the clarification feature to
communicate as well.

Thanks again for your comments! Again, I'm happy to continue working with you. :)

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