Sleep Apnea and Cardiovascular Disease: Risks, Mechanisms, Complications, and Management

Sleep apnea is a common sleep disorder characterized by recurrent episodes of breathing cessation and resumption during sleep. The three main types are obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea (MSA), the latter of which is often used interchangeably with complex sleep apnea (CompSA). OSA, the most prevalent form, results from upper airway obstruction during sleep. Globally, nearly one billion adults aged 30-69 are affected by OSA, with approximately 425 million having moderate to severe disease, making sleep apnea a major global health burden affecting roughly one in eight individuals. Sleep apnea is associated with numerous serious comorbidities and health complications, most notably cardiovascular disease (CVD). The adverse consequences of sleep apnea on cardiovascular health arise from intermittent hypoxia and inflammation, which contribute to hypertension, coronary artery disease (CAD), heart failure (HF), cardiac arrhythmias such as atrial fibrillation (AF), pulmonary arterial hypertension (PAH), stroke or cerebrovascular accident (CVA), and sudden cardiac arrest (SCA), potentially culminating in sudden cardiac death (SCD). Effective treatment of sleep apnea and its deleterious cardiovascular sequelae is critical to preventing ongoing harm. Thus, this review discusses institutionally sponsored and guideline-directed medical therapies aimed at reducing mortality in patients with sleep apnea and CVD, including continuous positive airway pressure (CPAP), pharmacological strategies, and other interventions to manage sleep apnea and its cardiovascular-related comorbidities. This review also highlights screening for sleep apnea using the STOP-BANG questionnaire and emphasizes the importance of a multidisciplinary management approach, which is crucial for preventing further physiological damage that can lead to CVD.