Obstructive sleep apnea and acute coronary syndromes: etiology, risk, and management

Obstructive sleep apnea (OSA) is characterized by upper airway collapse and airflow reduction despite respiratory effort, resulting in intermittent hypoxia and arousals, leading to a cascade of hemodynamic, autonomic, inflammatory, and metabolic effects, responsible for its adverse cardiovascular effect. OSA is an independent risk factor for cardiovascular disease, and its prevalence in patients presenting with acute coronary syndromes is up to 69%. Furthermore, OSA has been associated with increased risk of adverse events after an acute coronary syndrome. Continuous positive airway pressure is considered the mainstay of treatment of OSA and has been shown to reduce the risk of cardiovascular events. However, the proper time to start treatment in the acute setting is unknown. A prospective randomized clinical trial is currently underway to answer this question.