October 4, 2011Current Opinion in Cardiology134 citationsOpen Access
Role of obstructive sleep apnea in cardiovascular disease
Key Result
Obstructive sleep apnea is associated with an increased incidence of hypertension, coronary disease, stroke, and heart failure, and contributes to the occurrence of atrial fibrillation.
Structured PICO
Does treatment of obstructive sleep apnea improve cardiovascular outcomes?
P
Population
Patients with or at risk for obstructive sleep apnea and cardiovascular disease
E
Exposure
Continuous positive airway pressure (CPAP) and other therapies
Obstructive sleep apnea is a significant contributor to cardiovascular disease and represents a potential target for cardiovascular risk reduction, though large clinical trials are still needed.
Limitations
- Need for well powered clinical trials to examine the role of CPAP and other therapies in these populations
Abstract
PURPOSE OF REVIEW: To provide an update on the connection between obstructive sleep apnea (OSA) and cardiovascular disease. RECENT FINDINGS: Large prospective studies have established that OSA is associated with an increased incidence of hypertension and, in men, of coronary disease, stroke, and heart failure. Advances in understanding the pathophysiologic basis for these associations include identification of a role for OSA in inducing abnormalities in hepatic lipid-metabolizing enzymes, endothelial dysfunction, and upregulation of pro-inflammatory and pro-thrombotic mediators. A large body of data implicates OSA as playing a significant role in the occurrence and resistance to treatment of atrial fibrillation. Clinical trials have shown small-to-modest improvements in blood pressure associated with continuous positive airway pressure (CPAP) use, with smaller or uncontrolled studies suggesting that CPAP may improve cardiovascular outcomes or intermediate markers. SUMMARY: OSA and cardiovascular disease commonly co-aggregate. Multiple studies indicate that OSA contributes to or exacerbates cardiovascular disease, and thus may be a novel target for cardiovascular risk reduction. Although the evidence supports screening and treatment of OSA in patients at risk for cardiovascular disease, it also underscores a need for well powered clinical trials to examine the role of CPAP and other therapies in these populations.