Comorbidity in patients with obstructive sleep apnea. Part 2. The most clinically significant comorbid interactions

The second part of literature review is devoted to in-depth analysis of clinical associations of obstructive sleep apnea (OSA) with cardiometabolic comorbid diseases. Objective. To systematize current concepts on individual variants of comorbid interactions in obstructive sleep apnea (OSA). Materials and methods. A systematic search was conducted in Scopus, PubMed, Web of Science, Google Scholar, CyberLeninka databases for 2014—2024 period using keywords specific for OSA and particular nosologies. Relevant publications were selected by authors manually based on the analysis of heading, abstract and full text. Results. The epidemiology and mechanisms of bilateral interaction of OSA with arterial hypertension, chronic heart failure, cardiac arrhythmias, obesity and type 2 diabetes mellitus are considered in detail. The role of key pathogenetic links in each of the comorbid interactions is shown. The role of OSA as a key link in the comorbidity structure providing «vicious circles» complex persistence underlying the cardiometabolic continuum is discussed based on the obtained data. It is noted that OSA therapy impact on the long-term outcomes of comorbid diseases does not always allow to achieve the desired results. Conclusion. The management of patients with obstructive sleep apnea and other comorbid diseases should be carried out using a comprehensive interdisciplinary approach.