Revealing a dormant threat to Cardiovascular health

In Europe, there’s a dormant threat when it comes to cardiovascular health. It’s not fatty foods, a lack of exercise, or unlucky genes – though all these do certainly matter. The answer? It’s the quality of a person’s sleep. 

Across Europe, about 175 million^[1] people suffer from obstructive sleep apnoea, an often chronic sleep disorder where the airway repeatedly collapses during sleep, causing interruptions in breathing. A substantial body of scientific research shows that this can lead to serious health consequences if not effectively treated, including hypertension (and resistant hypertension), heart failure, coronary artery disease, and stroke, among many others.^[2] 

Despite the consensus about the long-term risks of sleep apnoea, there is a serious gap in detection and awareness across Europe, and very little by way of policy support or engagement. While patients regularly see their doctors for check-ups during which they are examined and have blood drawn, it’s rare for physicians to screen for sleep apnoea despite it being relatively low-cost and noninvasive. As a result, the majority of patients suffering from the disorder go undiagnosed, often for years or even decades.^[3] The outcome is clear: these people suffer what can be severe, life-threatening consequences while also bringing greater costs to our already strained national healthcare systems.^[4] 

Screening and treatment: a practical and proven solution 

The good news is that we already have simple, validated tools to detect sleep disorders that can be easily integrated into routine medical visits. Whether it’s a questionnaire, a physical exam, digital home-based testing, or a more comprehensive option done in an in-patient facility, there are numerous pathways to detect, and then treat sleep apnoea. 

Once doctors have a diagnosis, patients can be referred for treatment. A sizeable amount of research shows treatment makes a tangible, lasting difference in outcomes. In fact, science shows that when sleep apnoea is treated, patients suffer fewer recurrent cardiovascular events,^[5] a lower risk of mortality,^[6] and cause a lower burden on their health system.^[7] 

What can policymakers do now? 

Over the past year, the European Commission has been developing the EU Cardiovascular Health Plan, also known as the Safe Hearts Plan. The framework aims to reduce the burden of cardiovascular disease across Europe. It focuses on prevention, early detection and screening, treatment and care, with support from research and digital tools. Together, these elements mark a clear step forward for cardiovascular health in Europe.

Importantly, the Plan recognises sleep disorders, including obstructive sleep apnoea, as cardiovascular risk factors and identifies their early detection as part of a broader screening approach. This acknowledgement is a welcome and necessary starting point. It signals growing alignment between policy and the scientific evidence base on Europe’s number 1 killer: cardiovascular disease. 

The challenge now is to move from recognition to consistent action across Member States. The opportunity lies in translating this policy signal into routine practice, supported pathways, and measurable outcomes. 

Here’s what can be done now for the highest impact: 

1. Promote routine, widespread screening as part of regular primary care visits: 
   Validated sleep questionnaires should be a standard part of visits to general practitioners as well as cardiologists. Screening should also be a part of all appointments for diseases with known links to sleep disorders. Member States should be supported in their education and outreach work to convince doctors to include screening for sleep disorders.  

2. Embed sleep disorder screening more firmly within EU and national implementation tools: 
   The inclusion of sleep disorders in the Safe Hearts Plan provides a strong foundation. This should now be reflected in guidance, implementation frameworks, and funding mechanisms that help national administrations operationalise screening and follow-up pathways. 

3. Strengthen patient support and treatment adherence: 
   Europe needs to put the right structures in place to help patients diagnosed with sleep disorders to get and adhere to proper treatment, particularly as it relates to education, reimbursement and care coordination. 

Moving toward a brighter future 

With the publication of the Safe Hearts Plan, Europe has taken an important first step by formally recognising sleep disorders as part of the cardiovascular risk landscape. The next phase must focus on delivery: embedding screening into routine care, supporting Member States in implementation, and ensuring patients receive timely diagnosis and effective treatment. 
 
Sleep health has long been under-addressed relative to its impact, but the direction of travel is now clearer. Taking action does not require significant effort, just incremental changes along the patient pathways.  For the sake of all of our hearts, let’s not continue to sleep on this problem. 

Sources
[1] https://www.mdpi.com/2076-3417/13/6/3516
[2] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000988
[3] https://heart.bmj.com/content/101/16/1288
[4] https://onlinelibrary.wiley.com/doi/10.1016/j.wjorl.2015.08.001
[5] https://jamanetwork.com/journals/jama/fullarticle/2810031
[6] https://pubmed.ncbi.nlm.nih.gov/40118084/
[7] https://pubmed.ncbi.nlm.nih.gov/36735928/