Obstructive sleep apnea and comorbidities: a dangerous liaison

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

Knowledge, Awareness, and Attitudes Toward Obstructive Sleep Apnea among the Population of the Asir Region of Saudi Arabia in 2019

“…These disruptions may impair subjects' abilities to reach the desired deep, restful phases of sleep, with subjects likely feeling sleepy during waking hours. Subjects with OSA may be unaware that their sleep was interrupted, with many of these subjects thinking that they slept well throughout the night [3].…”

Therapeutic alternatives with CPAP in obstructive sleep apnea

“…A high prevalence of comorbidities in seen in OSA patients (17). There are specific patterns, with men more often affected by diabetes and ischemic hearts disease and women by hypertension and depression (18,19).…”

“…Recent studies have also shown that OSA is part of the MetS. The intermittent hypoxia and the sleep loss or fragmentation are involved in the pathogenesis of insulin resistance (17). In these conditions, OSA treatment with sufficient adherence (at least 4 hours/night) is required besides the implementation of lifestyle interventions and weight loss programs (22).…”

“…The association between OSA and chronic obstructive pulmonary disease (COPD), known as "overlap syndrome" from the early studies (23), has a prevalence of 1.0 to 3.6% in the general population, 8-56% in OSA patients, and 3-66% in COPD patients (24). In COPD patients who have consulted clinicians for pulmonary rehabilitation, a severe form of OSA has been diagnosed in 45% of the cases, with these patients having poor sleep quality and hypoventilation episodes during sleep (17,25). Moreover, overlapping patients have higher rates of mortality compared to OSA patients, and in this direction there is a protective effect of CPAP treatment (26).…”

“…Often, asthmatic patients present hypopneas. It appears that both asthma and OSA play a synergistic role in the upper airway inflammation, in part because the upper airways seem to be smaller in patients with asthma and OSA (17).…”