Obstructive sleep apnea–Hypopnea and cardiovascular diseases in adults

Abstract

Cardiovascular diseases (CVDs) are the main cause of death worldwide representing 30% of all global deaths. Obstructive sleep apnea–hypopnea (OSAH) has been associated with several serious cardiovascular comorbidities. OSAH occurs in 17%–24% of North American adults that increase the risk of sudden cardiac deaths between 12 midnight and 6 am. OSAH is considered as an independent risk factor for CVD such as systemic hypertension (HTN), pulmonary arterial HTN, coronary artery disease, stroke, cardiac arrhythmias, heart failure, which raise both cardiovascular morbidity and mortality and the increase demand for health-care resources. Several mechanisms have been suggested to link OSAH and vascular diseases including increases in sympathetic activation, oxidative stress, inflammation, endothelial dysfunction, coagulation, and metabolic dysregulation. This review will provide insights on mechanisms by which OSAH might contribute to the pathogenesis of CVD. Continuous positive airway pressure (CPAP) is considered the gold standard in the treatment of OSAH with improved metabolic and CV endpoints. To a lesser extent, oral appliance therapy and upper airway or mandibular advancement surgery are palliative measures that leave the patient with significant residual apnea–hypopnea. There is increasing evidence that adequate CPAP therapy leads to a significant reduction in cardiovascular morbidity. Moderate-to-severe OSAH not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

Keywords

• Arousals
• cardiac remodeling
• cardiovascular diseases
• continuous positive airway pressure
• obstructive sleep apnea–hypopnea