A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease

Abstract

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.

Sustained apnea induces endothelial activation

“…This might be explained by the high interindividual variety of the divers and/or due to the limited number of athletes. Nevertheless, even usually used cardiac biomarkers for obstructive sleep apnea (ie, N‐terminal pro‐brain natriuretic peptide and brain natriuretic peptide) show weak or no correlation with severity . Further studies with bigger cohorts are needed.…”

“…Nevertheless, even usually used cardiac biomarkers for obstructive sleep apnea (ie, N-terminal pro-brain natriuretic peptide and brain natriuretic peptide) show weak or no correlation with severity. 39,40 Further studies with bigger cohorts are needed.…”

Sleep‐disordered breathing in heart failure: facts and numbers

“…Likewise, OSA is also more prevalent in patients with HF as compared with the general population 1, 24. It is also its own risk factor for cardiovascular disease 4, 49, 50, 51. The presence of OSA fundamentally contributes to myocardial failure and earlier mortality in patients with HF 4.…”

Impact of the obstructive sleep apnea syndrome on left ventricular remodeling among people with different body weight

“…Obstructive sleep apnea syndrome (OSAS) characterized by recurrent episodes of complete or partial obstruction of the upper airway during sleep, has widely gained interest since its initial description more than 40 years ago [1]. OSAS is associated with hypertension, insulin resistance, atrial fibrillation, stroke, and increased cardiovascular disease (CVD) morbidity and mortality.…”

“…OSAS is associated with hypertension, insulin resistance, atrial fibrillation, stroke, and increased cardiovascular disease (CVD) morbidity and mortality. Disruption of sleep leads to increased sympathetic activation, metabolic changes, vasoconstriction, acute tachycardia, acute blood pressure elevation that results in increased left ventricular (LV) after load [1]. Left ventricular hypertrophy (LVH) is one of the well-knowing CVD risk factors and of ten associate with OSAS [2].…”