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Benzodiazepines depress central nervous system activity, including respiratory drive, and can weaken upper airway muscle tone. In sleep apnea, the airway already tends to collapse during sleep and gas exchange is compromised. The additional sedative effect can exacerbate airway obstruction and cause dangerous hypoxemia and hypercapnia, making these drugs contraindicated in sleep apnea.

Hypertension, diabetes, and obesity are not inherent contraindications to benzodiazepines, though use should still be individualized and monitored for other risks or interactions.