Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences

By Cardio

State-of-the-art review

Sleep Apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease.

Evidence supports a causal association of Sleep Apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke.

Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea via sleep apnea home test devices, have accumulated in recent years. In this review, authors discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and outcomes.

Review also includes recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.

Key takeaways

  • The high prevalence of obstructive sleep apnea (OSA), which affects 34% of men and 17% of women and is largely undiagnosed
  • OSA is a modifiable CVD risk factor
  • OSA is a cause of systemic hypertension (HTN) and is associated with an increased incidence of stroke, heart failure (HF), atrial fibrillation (AF), and coronary heart disease (CHD)
  • OSA, particularly when severe, is associated with increased all-cause and cardiovascular (CV) mortality
  • A sleep apnea subtype, central sleep apnea (CSA) is rare in the general population, but is common in patients with HF, stroke, and AF. Recent data suggests that CSA is also a risk factor for incident AF and HF

Javaheri, S.  et al. J Am Coll Cardiol. 2017;69(7):841–58