Sleep-Disordered Breathing and Cardio- and Cerebrovascular Diseases: 2003 Update of Clinical Significance and Future Perspectives. Schlafbezogene Atmungsstorungen und kardio- und zerebrovaskulare Erkrankungen: Update 2003 der klinischen Bedeutung und zukunftiger Entwicklungen

Abstract

The purpose of this review is to summarize current knowledge about the link between sleepdisordered breathing (SDB) and cardiovascular and cerebrovascular diseases. Obstructive sleep apnoea (OSA) is a well-established risk factor for systemic arterial hypertension, and its treatment with continuous positive airway pressure leads to a decrease in daytime and night-time blood pressure profiles. Pulmonary arterial hypertension occurs in 20-30% of OSA patients and is usually mild. It is not yet clear if OSA per se leads to pulmonary hypertension or if the coexistence of chronic obstructive pulmonary disease with daytime and/or sleep-related hypoxaemia is required to provoke a persistent rise in pulmonary artery pressure. Furthermore, OSA is associated with nocturnal cardiac arrhythmias, especially cyclical fluctuations of the heart rate in response to recurrent apnoeas. Atrioventricular conduction blocks and ventricular premature beats are less often observed and seem to be confined to patients with severe OSA and those with accompanying ischaemic heart disease. The association between OSA and vaso-occlusive disease (i.e. atherosclerosis) is less clear. However, accumulating experimental and epidemiological data support such a link. Thus, OSA may lead to coronary artery disease (CAD) and stroke by promoting atherosclerosis. Correspondingly, patients with CAD or acute stroke show a high prevalence of SDB. Cheyne-Stokes respiration (CSR) is a specific pattern of central sleep apnoea occurring in patients with advanced congestive heart failure (CHF). If present, CSR clearly has a negative impact on the clinical course of CHF. Although the optimal treatment strategy for CSR is less well defined than that for OSA, the successful reversal of CSR might increase overall survival in affected patients.Keywords Sleep-disordered breathing -obstructive sleep apnoea -central sleep apnoea -Cheyne -Stokes breathing -pulmonary disease -cardiovascular disease -hypertensionstroke. ZusammenfassungZiel dieser Ü bersichtsarbeit ist die Darstellung aktueller Zusammenhänge zwischen schlafbezogenen Atmungsstö rungen und kardio-bzw. zerebrovaskulären Erkrankungen: Das obstruktive Schlafapnoe-Syndrom (OSAS) ist als unabhängiger Risikofaktor fü r die Entstehung einer arteriellen Hypertonie anzusehen. Die nasale Ü berdruck-Therapie (CPAP) fü hrt zu einer Senkung des Tages-und Nachtblutdruckes. Ca. 20-30% der Patienten mit OSAS weisen eine pulmonal-arterielle Hypertonie auf; unklar ist jedoch, ob eine zusätzliche Lungenerkrankung mit Tages-und/oder Nachthypoxämie eine notwendige Voraussetzung zur Entstehung der pulmonal-arteriellen Hypertonie bei diesen Patienten ist. Herzrhythmusstö rungen, insbesondere apnoebedingte Schwankungen der Herzfrequenz, treten bei OSAS gehäuft auf. Atrioventrikuläre Blockbilder oder ventrikuläre Extrasystolen sind seltener anzutreffen und scheinen auf schwere Formen des OSAS und solche mit zusätzlicher koronarer Herzkrankheit beschränkt zu sein. Die Zusammenhänge zwischen OSAS und der Entwicklung einer Arteriosklerose...

Radial basis function approach to nonlinear Granger causality of time series

“…There is growing evidence that suggests a causal link between sleep apnea and cardiovascular disease [22], although the exact mechanisms that underlie this relationship remain unresolved [23]. Figure 3 clearly shows that bursts of the patient breath and cyclical fluctuations of heart rate are interdependent.…”