Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation

Garvey, John; Taylor, Cormac T.; McNicholas, WT

doi:10.1183/09031936.00111208

Cited by 304 publications

(236 citation statements)

References 124 publications

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“…Second, consecutive intermittent hypoxic periods increase oxidative stress and inflammation markers, which in turn can damage the endothelial walls. Third, disrupted sleep increases sympathetic nervous activity, leading to an increase in blood pressure and heart rate, which demands cardiac activity at a time when the heart should be regenerating 2, 19, 20. In addition, several studies have shown that SA is associated with hypertension, coronary artery disease, arrhythmias, obesity, diabetes mellitus, and metabolic disturbances, all known to increase the risk of HF 2, 3, 21, 22.…”

Section: Discussionmentioning

confidence: 99%

Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy

Holt

Bjerre

Zareini

et al. 2018

JAHA

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BackgroundWhether there is an association between sleep apnea (SA) and the risk of developing heart failure (HF) is unclear. Furthermore, it has never been established whether continuous positive airway pressure (CPAP) therapy can prevent development of HF. We aimed to investigate SA patients’ risk of developing HF and the association of CPAP therapy.Methods and ResultsUsing nationwide databases, the entire Danish population was followed from 2000 until 2012. patients with SA receiving and not receiving CPAP therapy were identified and compared with the background population. The primary end point was first‐time hospital contact for HF and adjusted incidence rate ratios of HF were calculated using Poisson regression models. Among 4.9 million individuals included, 40 485 developed SA during the study period (median age: 53.4 years, 78.5% men) of whom 45.2% received CPAP therapy. Crude rates of HF were increased in all patients with SA relative to the background population. In the adjusted model, the incidence rate ratios of HF were increased in the untreated SA patients of all ages, compared with the background population. Comparing the CPAP‐treated patients with SA with the untreated patients with SA showed significantly lower incidence rate ratios of HF among older patients.ConclusionsIn this nationwide cohort study, SA not treated with CPAP was associated with an increased risk of HF in patients of all ages. Use of CPAP therapy was associated with a lower risk of incident HF in patients >60 years of age, suggesting a protective effect of CPAP therapy in the elderly.

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Section: Discussionmentioning

confidence: 99%

Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy

Holt

Bjerre

Zareini

et al. 2018

JAHA

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“…Moreover, hypoxemia reduces oxygen delivery to the myocardium, which may induce angina or arrhythmias (15,16). Lastly, frequent arousals from sleep due to respiratory events leads to sympathetic activity and a subsequent increase in catecholamine levels (17,18). Consequently, the adverse events of repetitive episodes of increased afterload on the heart during sleep may persist during the day.…”

Section: Cpap Treatment and Ecg Findings In Osasmentioning

confidence: 99%

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Seyis¹,

Usalan²

2017

Curr Res Cardiol

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OBJECTIVE: This study aims to evaluate the effects of continuous positive airway pressure (CPAP) treatment on intrinsicoid deflection time (R wave peak time) and P wave discrimination in severe obstructive sleep apnea syndrome (OSAS). METHODS:Fifty-five patients with severe OSAS (apnea-hypopnea index ≥ 30) and a healthy control group were included. Baseline electrocardiography (ECG), echocardiography (ECHO), and polysomnography parameters were recorded. All patients received CPAP treatment. ECG and ECHO echocardiography tests were repeated after one-year of CPAP therapy. RESULTS:A total of 55 OSAS patients (36 M, 19 F) with a mean age of 56.9 ± 7.6 years and 54 healthy controls (31 M, 23 F) with a mean age of 56.6 ± 5.7 years were included. There was a significant improvement in terms of intrinsicoid deflection time in lead V1 (76.2 ± 8.3 vs. 59.8 ± 7.2) and lead V6 (58.5 ± 8.0 vs. 49.8 ± 7.1), and P-wave dispersion (95.2 ± 12.8 vs. 39.8 ± 6.4) after one-year CPAP treatment (p<0.001). Cardiac volumes and diameters improved significantly.CONCLUSION: CPAP treatment significantly decreases intrinsicoid deflection time in leads V1 and V6, and improves P-wave dispersion. The results of this study indicate that long-term CPAP treatment had a strong protective effect on right or left cardiac functions in severe OSAS patients without any cardiac and pulmonary disease. KeyWords: CPAP; Intrinsicoid deflection time; OSAS; P-wave dispersion; PolysomnographyO bstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It is caused by temporary collapse of the upper airway, which results in nocturnal hypoxia and sleep disturbance (1,2). Many vascular diseases including hypertension, coronary heart disease, heart failure, cardiac arrhythmias, and stroke have been found to be associated with OSAS (3). Cardiovascular morbidity and mortality have been reported as high as 70% in patients with OSAS (4).Many studies have shown that OSAS is associated with changes in cardiac structure such as myocardial hypertrophy or increased left ventricular mass, which can widen the QRS complex on the electrocardiogram (ECG) (5-7). On the other hand, prolonged QRS duration is an independent predictor of mortality and cardiovascular diseases (e.g., hypertension and heart failure) in OSAS patients. It has also been shown that severe OSAS patients (AHI ≥ 30) have a four-fold higher frequency of atrial fibrillation (AF) (8). Arrhythmia and its improvement with continuous positive airway pressure (CPAP) therapy in OSAS patients have been reported as well (8). However, the relationship between OSAS and intrinsicoid deflection (ID) (i.e., R-wave peak time) is unknown.Continuous positive airway pressure is used as first line treatment modality in patients with severe OSAS (9). Regular use of CPAP may lead to reduction in cardiovascular risk in patients with heart failure. A reduction of blood pressure, an increase in left ventricular ejection fraction, and a decrease in left ventricular hypertrophia, and an improvement in cardiovascular function h...

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“…Intermittent hypoxia is different from the sustained hypoxia seen in patients with chronic lung diseases, and OSA is a unique model for intermittent hypoxia. The short repetitive cycles of hypoxia and re-oxygenation activate different inflammatory processes and release pro-inflammatory cytokines, chemokines and adhesion molecules, which may result in endothelial injury and dysfunction, leading to atherosclerosis 1112…”

mentioning

confidence: 99%

Obstructive Sleep Apnea: From Simple Upper Airway Obstruction to Systemic Inflammation

Bahammam

2011

Annals of Saudi Medicine

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Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation

Cited by 304 publications

References 124 publications

Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy

Sleep Apnea, the Risk of Developing Heart Failure, and Potential Benefits of Continuous Positive Airway Pressure (CPAP) Therapy

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Obstructive Sleep Apnea: From Simple Upper Airway Obstruction to Systemic Inflammation

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