Sleep-disordered breathing and cardiovascular disease

Abstract

Sleep-disordered breathing (SDB) describes a group of disorders characterised by abnormalities in the frequency and/or depth of breathing while asleep. The most common type is the obstructive sleep apnoea/hypopnoea syndrome (OSAHS); it affects 2–4% of the adult population and is an independent risk factor for hypertension. Another type is central sleep apnoea (CSA), which includes Cheyne–Stokes respiration; it is most commonly seen in patients with congestive heart failure and other critical illnesses including cerebrovascular accidents. There is accumulating evidence that both these types of SDB are associated with cardiac failure, arrhythmias and coronary artery disease. Treatment of OSAHS with continuous positive airway pressure (CPAP) has lowered blood pressure, reduced the frequency and severity of some arrhythmias, and improved markers of endovascular inflammation. CPAP has had a mild positive effect on left ventricular function in chronic heart failure by treating co-existent SDB, but it has not improved mortality, possibly because it does not fully treat associated CSA. Clinicians need to be aware of the increasing associations of SDB, especially OSAHS, with cardiovascular dysfunction, as treatment of co-existent SDB will not only improve sleepiness, quality of life, and driving risk, but there is growing evidence that it may also improve cardiovascular risk itself, even in non-sleepy subjects.

Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women's Health Initiative era

“…It affects some 2%-4% of the adult population and is associated with elevated body weight. The treatment for obstructive apnea/hypopnea syndrome with continuous positive airway pressure lowers BP, reduces heart arrhythmia frequency, and improves endovascular inflammation marker levels (113).…”

Factores relacionados con la presencia de disfunción eréctil en pacientes con síndrome de apnea obstructiva del sueño

“…Por otra parte, debido a la colinealidad entre las condiciones clínicas y los tratamientos resultantes, sus efectos sobre la DE pueden generar confusió n. Ademá s de la edad, entre los factores de riesgo cardiovascular modificables, la hipercolesterolemia parece cobrar especial importancia. Tanto el SAOS como la DE comparten mecanismos y factores de riesgo con las enfermedades cardiovasculares, considerá ndose la DE como un marcador de futuros eventos cardiovasculares 3,11,23,24 . Por todo ello, es necesario profundizar en el conocimiento de los factores asociados a la alta prevalencia de DE en pacientes con SAOS, consensuar los mé todos de evaluació n de este problema de salud, así como analizar si el tratamiento del SAOS y el mejor control de los factores de riesgo conducen a una mejoría de la DE y, por ende, a un menor riesgo cardiovascular.…”

“…En mú ltiples estudios se ha relacionado el SAOS con otras enfermedades, concluyendo que este es causa independiente de hipertensió n arterial (HTA), y que puede producir enfermedad cardiovascular, ictus e incluso disfunció n del sistema endocrino [1][2][3] . En otros estudios se sugiere que el SAOS grave es un factor que contribuye al desarrollo de la disfunció n eré ctil (DE), a travé s de mecanismos hormonales, neuroló gicos, vasculares y psicoló gicos 2 .…”

Snoring Amplifies the Risk of Heart Failure and Mortality in Dialysis Patients

“…Sympathetic overactivation secondary to hypoxaemia increases afterload and worsens left ventricular failure in patients with a pre-existing HF [32]. Furthermore, SDB - a well-known trigger of nocturnal hypertension [33,34] - induces cyclical episodes of bradycardia/tachycardia, leading to ventricular tachycardia and sudden death during sleep [35]. …”