Obstructive Sleep Apnea and Coronary Artery Disease: From Pathophysiology to Clinical Implications

Abstract

Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients.

Impact of Obstructive Sleep Apnea on Cardiovascular Outcomes in Patients Treated With Percutaneous Coronary Intervention: Rationale and Design of the Sleep and Stent Study

“…The preliminary data of the first 785 Sleep and Stent Study patients show that the prevalence of OSA in our cohort of CAD patients undergoing PCI is similar to that reported in existing literature . The demographic and clinical profile of our patients is also similar to current literature .…”

Sleep-Disordered Breathing and Coronary Artery Disease

“…[64][65][66] These alterations have also been found to be attenuated after CPAP treatment. [66][67][68] Cardioprotective mechanisms of SDB Remote ischemic conditioning (e.g. by brief inflation and deflation of a blood pressure cuff) protects against endothelial dysfunction and myocardial injury in percutaneous coronary interventions, coronary artery bypass graft surgery, and reperfused acute MI.…”

Long‐term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea

“…Obstructive sleep apnea (OSA), characterized by repetitive upper‐airway obstruction during sleep, is highly prevalent in coronary artery disease (CAD) and is associated with poor long‐term prognosis in this patient population . Continuous positive airway pressure therapy (CPAP) is effective in eliminating apneas and hypopneas, improving quality of life, and reducing potential cardiovascular (CV) consequences when used consistently .…”