Title:Obstructive Sleep Apnea and Cardiovascular Disease - A New Target for Treatment
Volume: 21
Issue: 24
Author(s): Giuseppe Schillaci, Francesca Battista, Giuseppe Fiorenzano, Maria Cristina Basili, Mariano Crapa, Yahya Alrashdi and Giacomo Pucci
Affiliation:
Keywords:
Cardiovascular diseases, coronary heart disease, endothelial dysfunction, heart failure, hypertension, obstructive sleep apnea,
stroke.
Abstract: Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete
interruption (apnea) in breathing during sleep due to airway collapse in the oral or pharyngeal region. Prospective
studies have established the adverse cardiovascular consequences of OSA, including an increased risk for developing
hypertension, coronary artery disease, stroke, and heart failure. However, more studies are needed to better assess
the impact of OSA, and possible benefit of treatment with continuous positive airway pressure (CPAP) on cardiovascular
mortality. The leading pathophysiological mechanisms involved in the changes triggered by OSA include
intermittent hypoxemia and re-oxygenation, arousals and changes in intrathoracic pressure. Hypertension is
strongly related with activation of the sympathetic nervous system, stimulation of the renin-angiotensin-aldosterone
system and endothelial dysfunction. OSA should be suspected in hypertensive individuals, particularly in patients
with resistant hypertension. CPAP treatment reduces blood pressure, and its effects are more pronounced in patients with high baseline
blood pressure and elevated treatment compliance. At present, no clear evidence supports CPAP treatment for primary or secondary cardiovascular
disease prevention.
