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Obstructive sleep apnea: implications for cardiac and vascular disease
Abu S M Shamsuzzaman1, Bernard J Gersh, Virend K Somers
1Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
JAMA
|October 9, 2003
Summary
Obstructive sleep apnea (OSA) is common and linked to cardiovascular disease progression. Early diagnosis and treatment of OSA are crucial for managing heart conditions and improving patient outcomes.
Area of Science:
- Cardiology
- Sleep Medicine
- Internal Medicine
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized as a significant factor in the development and worsening of cardiovascular diseases.
- The prevalence of OSA is substantial, with approximately 20% of adults having mild OSA and 15% having moderate OSA.
Purpose of the Study:
- To conduct a systematic review of the scientific literature examining the intricate relationship between OSA and cardiovascular pathophysiology and diseases.
- To synthesize current knowledge on how OSA influences the mechanisms underlying cardiovascular damage and disease progression.
Main Methods:
- A comprehensive search of the MEDLINE database (1966-2003) was performed using relevant keywords related to sleep, sleep apnea, and various cardiovascular conditions.
- Studies prioritized for inclusion were large prospective cohort studies and randomized controlled trials to ensure robust evidence.
- Data from 154 identified investigations and reviews were extracted and analyzed for relevance to the study's objectives.
Main Results:
- Repetitive apneic events in OSA disrupt normal cardiovascular-sleep interactions, leading to sleep fragmentation.
- OSA is associated with physiological abnormalities including increased sympathetic activation, endothelial dysfunction, oxidative stress, inflammation, and metabolic dysregulation.
- Evidence strongly suggests OSA contributes to hypertension, cardiac ischemia, heart failure, arrhythmias, and potentially stroke.
Conclusions:
- Obstructive sleep apnea is a prevalent, diagnosable, and treatable condition that often coexists with cardiovascular disease.
- OSA activates pathophysiological pathways known to cause cardiac and vascular damage, potentially hindering treatment efficacy.
- While large-scale trial data are pending, individualized assessment of OSA diagnosis and treatment benefits is recommended for patients with cardiovascular disease.
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