The impact of obstructive sleep apnoea on the aorta

Abstract

Obstructive sleep apnoea (OSA) has been shown to be a causal factor in the pathogenesis of vascular dysfunction and hypertension, conditions which can promote dilation and subsequent aortic dissection and rupture. The objective of this review is to summarise the current literature on the possible association between OSA and aortic disease and delineate the underlying mechanisms.Relevant studies were found by searching for terms including "obstructive sleep apnoea" in combination with "aortic aneurysm, dissection, and dilation" in the MEDLINE and EMBASE databases.Observational studies consistently reported that OSA is highly prevalent among patients with aortic aneurysms and aortic dissections. Patients with co-occurring OSA and Marfan's syndrome as well as patients at the more severe end of the spectrum of OSA seem to be especially vulnerable to aortic disease.Several mechanisms are discussed concerning the link between OSA and aortic disease: nocturnal negative intrathoracic pressure surges leading to mechanical stretching of the aorta and ultimately aortic distension; arousal-induced reflex sympathetic activation with subsequent hypertension; and intermittent hypoxia associated with autonomic nervous system activation and consequently increased oxidative stress. Further well controlled studies are needed in order to define the exact role of OSA as a risk factor for aortic disease. @ERSpublications Several studies have shown an association between obstructive sleep apnoea and aortic aneurysms/dissections http://ow.ly/Nh9jc

Assessment of regional right ventricular systolic function in patients with obstructive sleep apnea syndrome using velocity vector imaging

“…[3] OSAS leads to systemic hypertension [4] and associates with a variety of cardiovascular disorders, including right ventricular (RV) dysfunction, arrhythmia, hypertrophy, coronary artery disease, and heart failure. [5–8] …”

Obstructive sleep apnoea and quality of life in Ehlers-Danlos syndrome: a parallel cohort study

“…We previously hypothesised an adverse impact of OSA on aortic disease in patients with EDS 15. A study has reported a 28% prevalence of aortic root dilation among patients with classical and hypermobile EDS subtype 22.…”

“…Recently, we suggested that patients with connective tissue disorders (eg, EDS, Marfan's syndrome) might be especially vulnerable to cardiovascular consequences of OSA, particularly along the aorta 15. Based on the evidence from studies on Marfan's syndrome,16–21 where OSA is highly prevalent and associated with distinct craniofacial phenotypes and cardiovascular consequences, and the fact that patients with EDS are also at high risk to develop aortic aneurysms,22 the same association between OSA and aortic disease could be true for patients with EDS.…”

CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

“…[5][6][7] Population-based and sleep-clinicbased cohort studies have shown an association between obstructive sleep apnea and cardiovascular events, [8][9][10][11][12][13][14][15][16] particularly stroke. 17 Randomized, controlled trials have shown that treatment with continuous positive airway pressure (CPAP) lowers systolic blood pressure by 2 to 3 mm Hg in patients with normotensive obstructive sleep apnea 18 and by 6 to 7 mm Hg in patients with resistant hypertension, 19 improves endothelial function, 20 and increases insulin sensitivity.…”