Obstructive sleep apnea and cardiovascular disease
Masahiko Kato1, Taro Adachi, Yuki Koshino
1Department of Cardiovascular Medicine, Tottori University, Yonago, Japan. mkato@grape.med.tottori-u.ac.jp
Insights
Sleep apnea is increasingly linked to cardiovascular diseases like hypertension and stroke, even in non-obese Asian populations. While continuous positive airway pressure shows promise, more research is needed to confirm its effectiveness in preventing cardiac events.
Area of Science:
- Cardiology
- Sleep Medicine
- Epidemiology
Background:
- Sleep apnea is a significant risk factor for cardiovascular diseases, including hypertension, coronary artery disease, heart failure, and stroke.
- Its prevalence is noted even in non-obese Asian populations, differing from Western observations.
- The recognition of sleep apnea's role in clinical cardiology is growing globally.
Purpose of the Study:
- To review the epidemiology of sleep apnea.
- To explore the pathophysiological mechanisms linking sleep apnea to cardiovascular conditions.
- To examine the role of sleep apnea in the development and management of cardiovascular diseases.
Main Methods:
- Review of existing literature on sleep apnea epidemiology and cardiovascular implications.
- Analysis of potential disease mechanisms activated by sleep apnea (hypoxemia, apnea, disrupted sleep).
- Examination of sleep apnea's role in specific cardiovascular conditions' pathophysiology and treatment.
Main Results:
- Evidence strongly suggests sleep apnea is a causal factor in cardiovascular disease, particularly hypertension.
- Sleep apnea may be prevalent in Asian populations even at lower obesity levels.
- Continuous positive airway pressure (CPAP) treatment appears beneficial, but definitive evidence from randomized controlled trials is pending.
Conclusions:
- Sleep apnea is a significant, though not definitively proven, cause of cardiovascular diseases.
- Further research, especially randomized controlled trials, is necessary to confirm the causal role of sleep apnea and the efficacy of its treatment in preventing cardiovascular events.
Abstract:
Over the past few decades, sleep apnea has emerged as an important potential etiologic factor in a broad range of cardiac and vascular diseases. These disease conditions include hypertension, coronary artery disease, myocardial infarction, heart failure, and stroke. Recognition of the role of sleep apnea in clinical cardiology is also increasing in Japan. Although sleep apnea has been strongly linked to obesity in Western populations, in Japanese and other Asian populations there is evidence to indicate that sleep apnea may be prevalent even at lower levels of obesity. In this review we address the epidemiology of sleep apnea. Since sleep apnea includes the combined stresses of hypoxemia, apnea, and disrupted sleep, we also review briefly the potential disease mechanisms that may be activated as a consequence of sleep apnea. We further examine the role of sleep apnea in the pathophysiology and management of specific cardiovascular conditions. Overall, while the evidence of sleep apnea as a causal mechanism in cardiovascular disease is strong and increasing, definitive evidence of the etiologic role of sleep apnea has yet to be obtained. The evidence is most clear in patients with hypertension. Also remaining to be established is whether the treatment of sleep apnea prevents cardiac and vascular events. With regard to this question, although the available data strongly suggest that continuous positive airway pressure treatment is beneficial, randomized control trials are needed in order to confirm this.
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