Obstructive sleep apnea and cardiovascular disease (original) (raw)
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Obstructive sleep apnea, hypertension and cardiovascular diseases
Journal of Human Hypertension, 2015
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) in breathing during sleep due to airway collapse in the pharyngeal region. OSA and its cardiovascular consequences have been widely explored in observational and prospective studies. Most evidence verifies the positive relationship between OSA and hypertension, coronary artery disease, atrial fibrillation, stroke and heart failure. However, more studies are needed to better assess the impact of OSA, and possible benefit of treatment with continuous positive airway pressure (CPAP) on dyslipidemia, type 2 diabetes, insulin resistance and cardiovascular mortality. The leading pathophysiological mechanisms involved in the changes triggered by OSA, include intermittent hypoxemia and re-oxygenation, arousals and changes in intrathoracic pressure. Hypertension is strongly related with activation of the sympathetic nervous system, stimulation of the renin-angiotensin-aldosterone system and impairment of endothelial function. The high prevalence of OSA in the general population, hypertensive patients and especially obese individuals and patients resistant to antihypertensive therapy, highlights the need for effective screening, diagnosis and treatment of OSA to decrease cardiovascular risk.
A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease
Vascular Health and Risk Management, 2016
Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.
Obstructive sleep apnea as a risk factor for cardiovascular diseases
Cardiology journal, 2007
Obstructive sleep apnea (OSA) is a common medical condition that occurs in approximately 5% to 15% of the population. It is usually associated with an increased risk of cardiovascular disease. Diagnosis of OSA is based on polysomnography, and its severity is measured with an apnea-hypopnea index. Most of the adverse effects of OSA on the cardiovascular system are reversible with treatment. In addition to continous positive airway pressure therapy, precautions such as weight loss, avoidance of central nervous system depressants, treatment of nasal congestion and sleeping in the lateral position may help to treat OSA. (Cardiol J 2007; 14: 534-537).
Noninvasive Mechanical Ventilation, 2010
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) that is characterized by intermittent complete or partial collapse of the upper airway. This pattern of breathing has been considered a cause for several cardiovascular diseases, such as systemic hypertension, heart failure, arrhythmias, myocardial infarction, and pulmonary hypertension. The prevalence of OSA in the middle-aged population was first estimated in 1993 by the ongoing population-based Wisconsin Sleep Cohort Study [1] in a sample of 625 employed adults. The investigators found that 9% of women and 24% of men had at least five or more apneas or hypopneas per hour of sleep . When the presence of extreme daytime sleepiness was included as a criterion, the prevalence was estimated to be 2% in women and 4% in men [1]. The incidence of SDB is independently influenced by age, sex, waist-hip ratio, and body mass index (BMI). The correlation between OSA and cardiovascular diseases has been well studied, and a linear relationship between severity of OSA and the comorbidities has been reported [2, 3]. The famous Sleep Heart Health Study revealed that the relative odds of heart failure, stroke, and coronary artery disease (CAD) (upper vs. lower apnea-hypopnea index [AHI] quartile) were 2.38, 1.58, and 1.27, respectively . In this chapter, we review the best-available evidence supporting the use of continuous positive airway pressure (CPAP) in OSA patients with hypertension, CAD, heart failure, pulmonary hypertension, and stroke.
Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article
Review Article, 2020
In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. OSA can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.
2010
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) that is characterized by intermittent complete or partial collapse of the upper airway. This pattern of breathing has been considered a cause for several cardiovascular diseases, such as systemic hypertension, heart failure, arrhythmias, myocardial infarction, and pulmonary hypertension. The prevalence of OSA in the middle-aged population was first estimated in 1993 by the ongoing population-based Wisconsin Sleep Cohort Study [1] in a sample of 625 employed adults. The investigators found that 9% of women and 24% of men had at least five or more apneas or hypopneas per hour of sleep . When the presence of extreme daytime sleepiness was included as a criterion, the prevalence was estimated to be 2% in women and 4% in men [1]. The incidence of SDB is independently influenced by age, sex, waist-hip ratio, and body mass index (BMI). The correlation between OSA and cardiovascular diseases has been well studied, and a linear relationship between severity of OSA and the comorbidities has been reported [2, 3]. The famous Sleep Heart Health Study revealed that the relative odds of heart failure, stroke, and coronary artery disease (CAD) (upper vs. lower apnea-hypopnea index [AHI] quartile) were 2.38, 1.58, and 1.27, respectively . In this chapter, we review the best-available evidence supporting the use of continuous positive airway pressure (CPAP) in OSA patients with hypertension, CAD, heart failure, pulmonary hypertension, and stroke.
Obstructive sleep apnea and blood pressure
American Journal of Hypertension, 2004
Background: There is increasing evidence that obstructive sleep apnea is an independent risk factor for arterial hypertension. Previous studies on the antihypertensive effects of positive airway pressure therapy on daytime blood pressure (BP) revealed inconsistent results.
Cardiac function and hypertension in patients with obstructive sleep apnea
Research Reports in Clinical Cardiology, 2014
Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA) is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed.