[Heart and sleep: a strong team! : Cardiovascular effects of sleep-disordered breathing and its treatment]

Cardiovascular diseases and sleep-disordered breathing (SDB) often coexist and influence each other. Observational studies show a strong association between SDB and arterial hypertension (aHT), coronary heart disease (CHD), and heart failure (HF). Treatment of SDB is indicated in sleepy or otherwise symptomatic patients. However, randomized controlled trials (RCTs) testing the effects of positive airway pressure (PAP) treatment of SDB on hard cardiovascular endpoints have been conducted primarily in oligosymptomatic and non-sleepy patients. This narrative review aims to describe the relationship between SDB and individual cardiovascular diseases and their treatment. SDB is a common and potentially modifiable risk factor for cardiovascular disease. There is strong evidence in favor of PAP therapy as a supplement to antihypertensive medication in SDB and aHT. The effect of PAP therapy on blood pressure increases with the severity of SDB. Conversely, successful treatment of HF or CHD may also lead to an improvement in SDB. Patients with SDB and low daytime sleepiness can be phenotyped on the basis of alternative quantitative parameters from polygraphy or polysomnography (e.g., hypoxemic burden, heart rate response to apneas, etc.), allowing for a better assessment of the prognostic effectiveness of PAP therapy before treatment begins. The diagnosis and treatment of SDB is an important component of multimodal cardiovascular preventive medicine, and symptomatic improvement can be achieved in many patients.