Obstructive sleep apnea, hypertension and cardiovascular diseases

Abstract

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) in breathing during sleep due to airway collapse in the pharyngeal region. OSA and its cardiovascular consequences have been widely explored in observational and prospective studies. Most evidence verifies the positive relationship between OSA and hypertension, coronary artery disease, atrial fibrillation, stroke and heart failure. However, more studies are needed to better assess the impact of OSA, and possible benefit of treatment with continuous positive airway pressure (CPAP) on dyslipidemia, type 2 diabetes, insulin resistance and cardiovascular mortality. The leading pathophysiological mechanisms involved in the changes triggered by OSA, include intermittent hypoxemia and re-oxygenation, arousals and changes in intrathoracic pressure. Hypertension is strongly related with activation of the sympathetic nervous system, stimulation of the renin-angiotensin-aldosterone system and impairment of endothelial function. The high prevalence of OSA in the general population, hypertensive patients and especially obese individuals and patients resistant to antihypertensive therapy, highlights the need for effective screening, diagnosis and treatment of OSA to decrease cardiovascular risk.

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

“…8 OSA is related to multiple cardiovascular diseases, such as coronary heart diseases, hypertension, hypertrophic cardiomyopathy, heart failure, stroke, and atrial fibrillation. 6,7,[9][10][11] In addition, OSA is reported to be the most common secondary cause of resistant hypertension. 12 The severity of OSA is directly associated with the degree of BP elevation, which may suggest that treatment of OSA has the potential to improve BP control.…”

The relationship between apnoea hypopnoea index and Gensini score in patients with acute myocardial infarction undergoing emergency primary percutaneous coronary intervention

“…There are many reports regarding the effect of SAHS on high blood pressure (3,4) and arrhythmia (5,6). And most of researches support the opinion that hypertension and arrhythmia with SAHS can be cured or alleviated by continuous positive airway pressure (CPAP) (7)(8)(9).…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…It affects an estimated 9% of adult women and 24% of adult men and has been associated with an RR of 1.7 for CV morbidity and mortality. 181 Repetitive bursts of sympathetic activity, surges of BP and oxidative stress brought on by pain and episodic hypoxaemia associated with increased levels of mediators of inflammation are thought to promote endothelial dysfunction and atherosclerosis. 181 Screening for OSAS can be performed using the Berlin Questionnaire and daytime sleepiness can be assessed by the Epworth Sleepiness Scale and overnight oximetry.…”

“…181 Repetitive bursts of sympathetic activity, surges of BP and oxidative stress brought on by pain and episodic hypoxaemia associated with increased levels of mediators of inflammation are thought to promote endothelial dysfunction and atherosclerosis. 181 Screening for OSAS can be performed using the Berlin Questionnaire and daytime sleepiness can be assessed by the Epworth Sleepiness Scale and overnight oximetry. 182 Definitive diagnosis often requires polysomnography, usually during a night in a sleep laboratory during which multiple physiological variables are continuously recorded.…”