Sleep Disordered Breathing and Cardiovascular Diseases

Abstract

Sleep disordered breathing (SDB), which causes sleep deprivation, intermittent hypoxia, and negative intrathoracic pressure swings, can be accompanied by other harmful pathophysiologies relating to cardiovascular diseases (CVD), including sudden death, atrial fibrillation, stroke, and coronary artery disease leading to heart failure. Continuous positive airway pressure (CPAP) therapy for SDB has been reported to provide favorable effects such as lowered systemic blood pressure and improved endothelial function. However, in recent randomized controlled trials, CPAP has failed to demonstrate its beneficial prognostic impact on the primary or secondary setting of CVD. In this review article, we describe the characteristics of SDB complicated with CVD, the prognostic impacts of SDB in CVD, and the beneficial effects of CPAP on CVD. strate its beneficial prognostic impact on the primary or secondary setting of CVD 18, 23-27). In this review article, we describe the characteristics of SDB complicated with CVD, prognostic impacts of SDB in CVD, and beneficial effects of CPAP on CVD. Diagnosis, Definition and Classification of SDB Overnight polysomnography, which includes assessments of electroencephalogram, electrooculogram, electrocardiogram, and electromyogram, as well as the nasal and oral airflows, respiratory movement (thorax and abdominal respiratory effort), snore, oxygen saturation, body position, and sleep stage, is the gold standard test for SDB (Fig. 2) 1, 28). Apnea is the absence of inspiratory airflow for at least 10 s. Hypopnea, a decrease in airflow lasting 10 s or longer, is associated with a drop in arterial oxygen saturation and/or an electroencephalographic arousal.1, 28 The total counts of apnea or hypopnea per hour are defined as the apnea hypopnea index (AHI), and is used to determine SDB: normal, AHI 5/h; mild, 5 ≤ AHI 15/ h; moderate, 15 ≤ AHI 30/h; severe, AHI ≥ 30/h. Apnea and hypopnea are classified as obstructive or central, but they both result from an absence or reduc-Copyright©2019 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

The Incidence and Associated Factors of Sudden Death in Patients on Hemodialysis: 10-Year Outcome of the Q-Cohort Study

“…Although a recent randomized controlled trial in Japanese hemodialysis patients suggested that oral VDRA did not reduce the risk of cardiovascular events, including sudden death 44) , the proportion of sudden death among all cardiovascular events is small (18 of 188), and the effect of VDRA on different genders is death were not evaluated. In particular, serum potassium levels, which could be a strong contributor of sudden death, other dialysis parameters, except for dialysis session length and Kt/V (e.g., blood flow rate and ultrafiltration rate), nutritional parameters, except albumin and body mass index, echocardiographic, and electrocardiographic data (e.g., ejection fraction, left ventricular hypertrophy, and QT interval), cardiac biomarker data, (e.g., troponins and atrial/brain natriuretic peptides), and data of commodity such as sleep apnea syndrome, which is one of the important causes of sudden death 51) , and medical treatment (e.g., antiplatelet agents and -blockers) were missing. Finally, the detailed timing of sudden death (i.e., if deaths occurred in the hours before or after dialysis) is unclear.…”

Prognostic impacts of changes in left ventricular ejection fraction in heart failure patients with preserved left ventricular ejection fraction

“…Hyperuricaemia was defined as regular usage of antihyperuricemic agents or serum uric acid levels of over 7 mg/dL 19. Sleep-disordered breathing (SDB) was defined as apnoea–hypopnoea index of >5 times/hour, and included both central and obstructive SDB, determined by a portable sleep monitor, polysomnography and/or from medical records 20–22. Chronic obstructive pulmonary disease was defined as forced expiratory volume in one second/forced vital capacity of <70% by spirometry according to the Global Initiative for Chronic Obstructive Lung Disease, the American Thoracic Society/European Respiratory Society guidelines, and/or from medical records 23.…”

Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

“…The relationship between HF and sleep is, again, likely bi-directional. Sleep disturbance is associated with several cardiovascular disease risk factors, and cardiovascular disease, in addition to higher sympathetic activity [153][154][155]. With this considered, sleep disturbance may lie along the causal pathway for forms of HF, or potentially exacerbate the condition.…”