Obstructive sleep apnea and cardiovascular disease, a story of confounders!

Sleep Breath. 2020 Dec;24(4):1299-1313. doi: 10.1007/s11325-019-01945-w. Epub 2020 Jan 9.

Abstract

Obstructive sleep apnea (OSA) syndrome is increasingly common among middle aged and older adults and is frequently linked to most cardiovascular diseases (CVD). Sleep-disordered breathing and CVD share a number of common risk factors and comorbid conditions including obesity, male gender, advancing age, metabolic syndrome, and hypertension. OSA appears to be associated with worsened CVD outcomes, sleep-related symptoms, quality of life, and risk of motor vehicle accidents. Demonstrating a cause-and-effect relationship between CVD and OSA has been challenging due to shared comorbidities. Strong evidence demonstrating clinically significant benefit for OSA treatments on OSA-related CVD outcomes are limited. In this review, we evaluate potential pathophysiologic mechanisms that link OSA to CVD and focus on specific treatments for OSA, including positive airway pressure (PAP), dental devices, and surgeries with regard to OSA-related CVD outcomes.

Keywords: Atrial fibrillation; Cardiovascular disease; Cerebrovascular accident; Cerebrovascular disease; Congestive heart failure; Continuous positive airway pressure; Coronary artery disease; Hypertension; Obstructive sleep apnea; Positive airway pressure; Pulmonary hypertension.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / physiopathology*
  • Continuous Positive Airway Pressure
  • Humans
  • Risk Factors
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / physiopathology*
  • Sleep Apnea, Obstructive / therapy*
  • Treatment Outcome