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People with obstructive sleep apnea are far more likely die suddenly in their sleep from heart-related problems than the rest of the population, according to researchers at the Mayo Clinic in Rochester, Minnesota. They found that the pattern for people with obstructive sleep apnea is actually opposite that of the general population, who are more likely to die from a heart attack, cardiac arrest, or other heart-related incidents during the day.

In a study published in the New England Journal of Medicine, the researchers reviewed the death certificates of 112 Minnesota residents who had been tested for sleep apnea and who died suddenly from cardiac causes between the period of July 1987 and July 2003.

Of those who died between the hours of midnight and 6 a.m., 46% had obstructive sleep apnea, compared with 21% who had other diagnoses. Among the general population, only 16% die from cardiac causes during the specified hours, the authors note.

The study also found that the likelihood of dying of cardiac causes overnight correlated directly with the severity of obstructive sleep apnea.

The overnight hours are generally thought to be a period of reduced risk of sudden death from cardiac causes because sleep minimizes the stresses that can trigger heart attacks and other problems. In fact, in the general population or among people with other diagnoses, the risk of suddenly dying from a heart-related incident peaks between the hours of 6 a.m. and noon, the researchers say.

Sleep apnea is a condition that causes sufferers to stop breathing for numerous brief periods during sleep. This causes oxygen levels in the body to drop and carbon dioxide levels to climb, straining the heart.

While the causes of sleep apnea can vary, the Mayo Clinic study dealt specifically with people who suffered from obstructive sleep apnea. An estimated 17% to 24% of North American adults suffer from this specific form of sleep apnea, which occurs when air can’t get into the lungs due to a blockage in the upper airway. This condition is most common in people who are overweight, though it can also occur in people of normal weight who have a physical characteristic, such as a large tongue, which can restrict airflow.

These interruptions in breathing typically cause the sleeping person to briefly wake up gasping for air, as many as hundreds of times during the night. Many people with sleep apnea are also loud snorers and tend to feel extremely tired in the daytime due to the pattern of repeated waking during the night.

But while these things may seem like an exhausting inconvenience (both to sleep apnea sufferers and their partners), the Mayo Clinic study is one of the first to highlight the risk that may be associated with this condition. A previous study found that habitual snorers were more likely than occasional snorers or people who don’t snore to die of cardiac causes during sleep, but it did not delve into the cause of the snoring.

But while this research underscores the danger, a majority of sleep apnea cases go undiagnosed. If you snore, are constantly tired during the day or wake up gasping for air, it’s important to talk to your doctor.

While there are no medications to treat sleep apnea, lifestyle modifications such as losing weight may help. People with sleep apnea can also wear a mask that supplies a constant airflow through the nose or special dental appliances that stop the throat from closing or the tongue from falling back. In some cases, surgery may be required to prevent overnight lapses in breathing.

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