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Obstructive sleep apnea and coronary artery disease: An unholy nexus or a holy alliance?

Sanyam K Mahajan1, Kunal Mahajan2, Sunil Sharma3

  • 1Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Lung India : Official Organ of Indian Chest Society
|January 11, 2023
PubMed

Insights

Obstructive sleep apnea (OSA) is an emerging cardiovascular risk factor linked to atherosclerosis. Paradoxically, OSA may promote collateral circulation, potentially mitigating coronary artery disease (CAD) severity.

Area of Science:

  • Cardiology
  • Sleep Medicine
  • Vascular Biology

Background:

  • Coronary artery disease (CAD) is a leading global cause of death, with traditional risk factors including hypertension, dyslipidemia, diabetes, and smoking.
  • Obstructive sleep apnea (OSA), characterized by airway collapse and intermittent hypoxia, is increasingly recognized as a non-traditional cardiovascular risk factor.
  • The cyclical hypoxia and reoxygenation in OSA trigger oxidative stress and vascular inflammation, promoting atherosclerotic cardiovascular disease (CVD).

Purpose of the Study:

  • To explore the complex relationship between obstructive sleep apnea (OSA) and coronary artery disease (CAD).
  • To investigate OSA's role as a non-traditional cardiovascular risk factor.
  • To examine the paradoxical effect of OSA-induced collateral circulation on CAD severity.

Main Methods:

  • Literature review and synthesis of existing research on OSA and CAD.
  • Analysis of pathophysiological mechanisms linking OSA to atherosclerosis.
  • Evaluation of studies reporting on collateral circulation in OSA patients with CAD.

Main Results:

  • Untreated OSA is associated with significant long-term health issues, including CVD, metabolic disorders, cognitive impairment, and depression.
  • Repetitive nocturnal hypoxia in OSA patients can induce oxidative stress and vascular inflammation, contributing to atherosclerosis.
  • Some studies suggest OSA may paradoxically reduce CAD severity through enhanced collateral circulation development.

Conclusions:

  • OSA represents a significant, non-traditional risk factor for cardiovascular disease, driving atherosclerosis through hypoxia-induced inflammation.
  • The development of collateral circulation in response to repetitive hypoxia in OSA patients presents a complex, potentially protective mechanism against severe CAD.
  • Further research is warranted to fully elucidate the dual role of OSA in CAD pathogenesis and progression.

Keywords:
Acute coronary syndromecoronary artery diseasesleep apnea.

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