Obstructive sleep apnea and its effects on cardiovascular diseases: a narrative review

Abstract

Obstructive sleep apnea (OSA) occurs in 5%-14% of adults but is often undiagnosed. Apneas cause acute physiological changes, including alveolar hypoventilation and pulmonary artery vasoconstriction; they also promote chronic vascular disease secondary to increased platelet adhesiveness, endothelial dysfunction, and accelerated atherosclerosis. The Sleep Heart Health Study demonstrated that OSA is a risk factor for stroke and that an increase of 1 unit in the apnea-hypopnea index increases stroke risk by 6% in men. Patients with OSA frequently have atrial fibrillation (AF). Patients with OSA and AF have an increased incidence of stroke compared with patients with only OSA. The treatment of OSA with CPAP reduces the incidence of stroke and decreases the recurrence rate of AF in patients undergoing pulmonary vein ablation procedures. Undertreated OSA has the potential to complicate the postoperative course of patients undergoing cardiac surgery and increase the frequency of arrhythmias and ischemic events. However, one prospective study demonstrated that OSA did not increase complications during the first 30 days following surgery but increased complications during the long-term follow-up. OSA is associated with increased atherosclerotic coronary disease and the development of coronary events and congestive heart failure. In summary, patients with OSA have an increased frequency of stroke and AF The treatment of these patients with CPAP reduces the frequency of stroke and AF recurrence rate in patients with AF undergoing either medical management or invasive procedures. However, well-designed clinical trials are necessary to answer critical questions regarding the management of OSA in patients with cardiovascular diseases.

Pathologic and hemodynamic changes of common carotid artery in obstructive sleep apnea hypopnea syndrome in a porcine model

“…Independent studies have shown that patients with OSAHS are at increased risk of ischemic heart disease, atherosclerotic coronary disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, and cardiovascular mortality [6][7][8][9]. Moreover, OSAHS patients have increased frequency of stroke and arterial fibrillation [10]. The application of continuous positive airway pressure to increase air pressure in the throat and prevent its collapse could reverse or attenuate OSA and its associated cardiovascular effects [11].…”

Chronic intermittent hypoxia disturbs insulin secretion and causes pancreatic injury via the MAPK signaling pathway

“…Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive occlusion of upper airway during sleep, generally defined as breathing pause lasting for ≥10 s and the apnea-hypopnea index (AHI) of ≥5 events/h during sleep (Rivas et al 2015). The morbidity of OSA is 5-14% in adults, and higher in older people (Rivas et al 2015).…”

Relationship Between Obstructive Sleep Apnoea, Oxygen Desaturation and Cardiovascular Risk

“…Divided OSAS patients into groups according to FRS score determined the identification of a low-risk group (with FRS < 10) and non-low-risk group (with FRS ≥ 10) [11]. Recent studies demonstrate that OSA is a common treatable cause of drug-resistant hypertension, risk factor for paroxysmal supraventricular tachycardia and atrial fibrillation, is an independent risk factor for ischemic stroke [15,16]. OSAS comorbidities are not fully identified, but cardiovascular diseases (treatmentresistant hypertension, arrhythmias, myocardial infarction, even sudden death), metabolic diseases (obesity and diabetes), obstructive lung diseases (COPD and asthma), neurological diseases, psychiatric disorders are considered pathological consequences, that can be prevented [17][18][19][20] in order to preserve the social integration and professional activity [8].…”