Beyond continuous positive airway pressure for cardiovascular risk reduction in patients with obstructive sleep apnea

An accumulating body of evidence suggests a bidirectional relationship between sleep and cardiovascular (CV) health. A high level of evidence has linked obstructive sleep apnea (OSA) with cardiovascular disease (CVD). Accordingly, clinical sleep medicine emphasizes the diagnosis and treatment of OSA in the context of promoting CV health. While continuous positive airway pressure (CPAP), the mainstay treatment for OSA, is effective in improving several sleep-related quality-of-life outcomes and leads to modest reductions in blood pressure, there is currently insufficient evidence to justify using CPAP alone for improving CVD outcomes in OSA. Sleep physicians are uniquely positioned to expand their focus beyond the evaluation of OSA and administering CPAP, in efforts to enhance the CV health of sleep patients. Herein, we suggest the role of sleep physicians as CV preventionists. Key focus areas for managing CV risk beyond CPAP therapy in OSA include identifying comorbid disorders that are vital for optimizing CV health. This involves risk-stratifying patients and providing appropriate counseling, referrals, and treatment as appropriate for comorbid sleep conditions such as insomnia and insufficient sleep, comorbid CV risk factors including hypertension, dyslipidemia, metabolic dysfunction-associated steatohepatitis, as well as counseling for weight management programs, smoking, and alcohol cessation. We urge sleep clinicians to play an active and integral role in optimizing the CV health of patients with sleep disorders.