A Scoping Review of Sleep Apnea: Where Do We Stand?

Abstract

Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk.

The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review

“…Additionally, the decrease in intrathoracic pressure during apnea leads to a transient increase in venous return to the heart and filling of the right atrium. The baroreceptors sensed this increase in cardiac preload, leading to increased parasympathetic afferent activity and reduced heart rate [ 32 , 72 ]. As bradycardia can be observed in healthy individuals during sleep, the bradycardia is generally more pronounced and significant in individuals with OSA during apneic episodes [ 73 ].…”

“… First Degree Heart Block and Sinus Arrest: Prolonged PR interval and prolonged sinus arrest occur in patients with OSA to a greater degree than in the general population [ 32 ]. Similarly to the mechanisms of underlying bradycardia in OSA patients, these rhythm variations occur primarily because of the autonomic effects associated with prolonged apnea, oxygen desaturation, changes in cardiac hemodynamics, and variations in intrathoracic pressure [ 32 , 72 ]. Premature Ventricular Complexes (PVCs): Patients with OSA have been shown to experience a higher percentage of ventricular ectopy, including frequent PVCs and significant PVC burden during level 3 polysomnography compared to the general population [ 74 ].…”

“…First Degree Heart Block and Sinus Arrest: Prolonged PR interval and prolonged sinus arrest occur in patients with OSA to a greater degree than in the general population [ 32 ]. Similarly to the mechanisms of underlying bradycardia in OSA patients, these rhythm variations occur primarily because of the autonomic effects associated with prolonged apnea, oxygen desaturation, changes in cardiac hemodynamics, and variations in intrathoracic pressure [ 32 , 72 ].…”

Resolution of Obstructive Sleep Apnea in a Patient with Goiter after Thyroidectomy: A Case Report

“…Obstructive sleep apnea (OSA) is characterized by repeated episodes of complete or partial occlusion of the upper airways during sleep [1][2][3]. Its prevalence ranges from 9 to 38% in general population [4].…”

“…Obesity is a major risk factor for OSA, partially explaining its increased prevalence in our society. Other risk factors include age, male gender, tonsillar hypertrophy and craniofacial abnormalities that narrow the upper airway [1][2][3].…”