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Current Atherosclerosis Reports
Published in: Current Atherosclerosis Reports 2/2011

01-04-2011

Obstructive Sleep Apnea and the Risk for Cardiovascular Disease

Authors: Puja Kohli, Jay S. Balachandran, Atul Malhotra

Published in: Current Atherosclerosis Reports | Issue 2/2011

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Abstract

Obstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. It is estimated that more than one quarter of the population is at risk for OSA, with increased prevalence noted in populations with hypertension, coronary artery disease, stroke, and atrial fibrillation. A number of epidemiologic and mechanistic studies have recently generated interest in the role of OSA in the pathophysiology of cardiovascular disease, a link that continues to require extensive investigation. This chapter reviews these epidemiologic studies, the current understanding of the mechanisms by which OSA may contribute to the progression of cardiovascular diseases, and the effects of OSA treatment on cardiovascular disease outcomes.
Literature
1.
2.
Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Annals of internal medicine. 2005;142(3):187–197.PubMed
3.
Rosthchild, et al. Production of the anginal syndrome by induced general anoxemia. American heart journal. 1933;8:729–744.
4.
Barach, et al. The physiologic action of oxygen and carbon dioxide on the coronary circulation as shown by the blood gas and electrocardiogram studies. American heart journal. 1941;22:13–34.
5.
Khatri IM, Freis ED. Hemodynamic changes during sleep. J Appl Physiol. 1967;22(5):867–873.PubMed
6.
Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. The New England journal of medicine. 1993;328(5):303–307.PubMedCrossRef
7.
Guilleminault C, Pool P, Motta J, Gillis AM. Sinus arrest during REM sleep in young adults. The New England journal of medicine. 1984;311(16):1006–1010.PubMedCrossRef
8.
Pickering TG, Johnston J, Honour AJ. Comparison of the effects of sleep, exercise and autonomic drugs on ventricular extrasystoles, using ambulatory monitoring of electrocardiogram and electroencephalogram. The American journal of medicine. 1978;65(4):575–583.PubMedCrossRef
9.
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society. 2008;5(2):136–143.PubMedCrossRef
10.
•• Punjabi NM, Newman AB, Young TB, Resnick HE, Sanders MH. Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. Am J Respir Crit Care Med. 2008;177(10):1150–1155. This study investigated the criteria used to define breathing abnormalities during sleep. Many prior recommendations had been based on expert opinion rather than outcome data. These data provided evidence for the current definitions and initiated a discussion regarding the predictive value of various OSA definitions for predicting different outcome measures.PubMedCrossRef
11.
Young T, Peppard P, Gottlieb D. The epidemiology of obstructive sleep apnea: a population health perspective. Am. J. Respir. Crit. Care Med. 2002;165:1217–1239.PubMedCrossRef
12.
Sharma SK, Ahluwalia G. Epidemiology of adult obstructive sleep apnoea syndrome in India. The Indian journal of medical research. 2010;131:171–175.PubMed
13.
Gottlieb DJ, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159(2):502–507.PubMed
14.
Jellinek H, Krenn H, Oczenski W, Veit F, Schwarz S, Fitzgerald R. Influence of positive airway pressure on the pressure gradient for venous return in humans. J. Appl. Physiol. 2000;88:926–932.PubMed
15.
Fessler HE. Heart-lung interactions: applications in the critically ill. Eur Respir J. 1997;10(1):226–237.PubMedCrossRef
16.
Malhotra A, Muse V, Mark E. Clinical Pathological Case. New Engl. J. Med. 2002:in press.
17.
Marrone O, Bellia V, Ferrara G, Milone F, Romano L, Salvaggio A, Stallone A, Bonsignore G. Transmural pressure measurements. Importance in the assessment of pulmonary hypertension in obstructive sleep apneas. Chest. 1989;95(2):338–342.PubMedCrossRef
18.
Gomez A, Mink S. Interaction between effects of hypoxia and hypercapnia on altering left ventricular relaxation and chamber stiffness in dogs. Am Rev Respir Dis. 1992;146(2):313–320.PubMed
19.
Kusuoka H, Weisfeldt ML, Zweier JL, Jacobus WE, Marban E. Mechanism of early contractile failure during hypoxia in intact ferret heart: evidence for modulation of maximal Ca2 + -activated force by inorganic phosphate. Circulation research. 1986;59(3):270–282.PubMed
20.
Horner RL, Brooks D, Kozar LF, Gan K, Phillipson EA. Respiratory-related heart rate variability persists during central apnea in dogs: mechanisms and implications. J Appl Physiol. 1995;78(6):2003–2013.PubMed
21.
Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. The Journal of clinical investigation. 1995;96(4):1897–1904.PubMedCrossRef
22.
Brooks D, Horner RL, Kozar LF, Render-Teixeira CL, Phillipson EA. Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model . Journal of Clinical Investigation. 1997;99(1):106–109.PubMedCrossRef
23.
• Lavie L. Oxidative stress—a unifying paradigm in obstructive sleep apnea and comorbidities. Progress in cardiovascular diseases. 2009;51(4):303–312. This is an excellent review regarding the basic science underlying oxidative stress and how sleep apnea mechanisms, including hypoxemia with re-oxygenation, may contribute to oxidative stress.PubMedCrossRef
24.
Atkeson A, Yeh SY, Malhotra A, Jelic S. Endothelial function in obstructive sleep apnea. Progress in cardiovascular diseases. 2009;51(5):351–362.PubMedCrossRef
25.
Rahangdale S, Yim Yeh S, Novack V, Stevenson K, Barnard M, Furman M, Malhotra A. The influence of intermittent hypoxemia on platelet activation in obese obstructive sleep apnea patients,. Journal of Clinical Sleep Medicine. in press.
26.
Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes care. 2009;32(6):1017–1019.PubMedCrossRef
27.
Punjabi N, Sorkin J, Katzel L, Goldberg A, Schwartz A, Smith P. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir and Crit Care Med. 2002;165:677–682.
28.
•• Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181(5):507–513. This study shows the impact of sleep apnea on glycemic control in patients with diabetes. The data show worsening glycemic control with increasing sleep apnea severity.PubMedCrossRef
29.
Pimenta E, Calhoun DA, Oparil S. Sleep apnea, aldosterone, and resistant hypertension. Progress in cardiovascular diseases. 2009;51(5):371–380.PubMedCrossRef
30.
Peppard P, Young, T, Palta, M, Skatrud, J. Prospective study of the association between sleep disordered breathing and hypertension. N. Engl. J. Med. 2000;342:1378–1384.PubMedCrossRef
31.
O’Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S, Resnick HE, Samet J, Shahar E. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179(12):1159–1164.PubMedCrossRef
32.
Logan A, Tkacova R, Perlikowski S, Leung R, Tisler A, Floras J, Bradley T. Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Europ. Respir. J. 2003;21:241–247.CrossRef
33.
Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airway pressure: a systematic review of the research evidence. Bmj. 1997;314(7084):851–860.PubMed
34.
Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001;164(12):2147–2165.PubMed
35.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., Jones DW, Materson BJ, Oparil S, Wright JT, Jr., Roccella EJ. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560–2572.PubMedCrossRef
36.
Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJ. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002;359(9302):204–210.PubMedCrossRef
37.
Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, Merino-Sanchez M, Gonzalez-Benitez MA, Beltran-Robles M, Almeida-Gonzalez C. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest. 2006;129(6):1459–1467.PubMedCrossRef
38.
Robinson GV, Smith DM, Langford BA, Davies RJ, Stradling JR. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J. 2006;27(6):1229–1235.PubMedCrossRef
39.
Barbe F, Duran-Cantolla J, Capote F, de la Pena M, Chiner E, Masa JF, Gonzalez M, Marin JM, Garcia-Rio F, de Atauri JD, Teran J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;181(7):718–726.PubMedCrossRef
40.
Gotsopoulos H, Kelly JJ, Cistulli PA. Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep. 2004;27(5):934–941.PubMed
41.
Pepin JL, Tamisier R, Barone-Rochette G, Launois SH, Levy P, Baguet JP. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;182(7):954–960.PubMedCrossRef
42.
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.PubMed
43.
MacDonald M, Fang J, Pittman SD, White DP, Malhotra A. The current prevalence of sleep disordered breathing in congestive heart failure patients treated with beta-blockers. J Clin Sleep Med. 2008;4(1):38–42.PubMed
44.
Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1994;149(2 Pt 1):416–422.PubMed
45.
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–1053.PubMed
46.
Kaneko Y, Floras J, Usui K, Plante J, Tkacova R, Kubo T, Ando S, Bradley T. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. New Engl. J. Med. 2003;348:1233–1241.PubMedCrossRef
47.
Mansfield D, Gollogly N, Kaye D, Richardson M, Bergin P, Naughton M. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am. J. Respir. Crit. Care Med. 2004;169:361–366.PubMedCrossRef
48.
Sajkov D, McEvoy RD. Obstructive sleep apnea and pulmonary hypertension. Progress in cardiovascular diseases. 2009;51(5):363–370.PubMedCrossRef
49.
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. The New England journal of medicine. 2005;352(12):1206–1214.PubMedCrossRef
50.
Buchner NJ, Sanner BM, Borgel J, Rump LC. Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med. 2007;176(12):1274–1280.PubMedCrossRef
51.
• Platt AB, Kuna ST, Field SH, Chen Z, Gupta R, Roche DF, Christie JD, Asch DA. Adherence to sleep apnea therapy and use of lipid-lowering drugs: a study of the healthy-user effect. Chest. 2010;137(1):102–108. This study shows that the use of statins is higher in patients adherent with CPAP as compared to patients non-adherent with CPAP. The findings provide reason for pause in the interpretation of observational studies in which CPAP adherence is associated with improved outcome and further they emphasize the need for randomized trials.PubMedCrossRef
52.
Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–916.PubMedCrossRef
53.
Garrigue S, Pepin JL, Defaye P, Murgatroyd F, Poezevara Y, Clementy J, Levy P. High prevalence of sleep apnea syndrome in patients with long-term pacing: the European Multicenter Polysomnographic Study. Circulation. 2007;115(13):1703–1709.PubMedCrossRef
54.
Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, Somers VK. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. Journal of the American College of Cardiology. 2007;49(5):565–571.PubMedCrossRef
55.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf JF, Ammash NM, Friedman PA, Somers VK. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364–367.PubMedCrossRef
56.
Djonlagic I, Malhotra A. Risk of stroke from sleep apnea in men and women. Expert review of neurotherapeutics. 2010;10(8):1267–1271.PubMedCrossRef
57.
Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862–865.PubMedCrossRef
58.
Kezirian EJ, Malhotra A, Goldberg AN, White DP. Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. Laryngoscope. 2010;120(7):1481–1488.PubMedCrossRef
59.
Weaver EM, Maynard C, Yueh B. Survival of veterans with sleep apnea: continuous positive airway pressure versus surgery. Otolaryngol Head Neck Surg. 2004;130(6):659–665.PubMedCrossRef
60.
Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, Wadden TA, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619–1626.PubMedCrossRef
61.
Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112(3):629–639.PubMedCrossRef
62.
H. Klar Yaggi, M. D., M.P.H., John Concato, M.D., M.P.H., Walter N. Kernan, M.D., Judith H. Lichtman, Ph.D., M.P.H., Lawrence M. Brass, M.D., and Vahid Mohsenin, M.D. (2005). “Obstructive Sleep Apnea as a Risk Factor for Stroke and Death.” N Engl J Med 353: 2034–2041.PubMedCrossRef
63.
Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010, 122(4):352–360.PubMedCrossRef
64.
Susan Redline, Gayane Yenokyan, Daniel J. Gottlieb, Eyal Shahar, George T. O'Connor, Helaine E. Resnick, Marie Diener-West, Mark H. Sanders, Philip A. Wolf, Estella M. Geraghty, Tauqeer Ali, Michael Lebowitz, and Naresh M: Obstructive Sleep Apnea–Hypopnea and Incident Stroke: The Sleep Heart Health Study. American Journal of Respiratory and Critical Care Medicine 2010, 182:269–277.PubMedCrossRef
65.
Bradley TD, Floras JS: Obstructive sleep apnea and its cardiovascular consequences. Lancet 2009, 373:82–93.PubMedCrossRef
Metadata
Title
Obstructive Sleep Apnea and the Risk for Cardiovascular Disease
Authors
Puja Kohli
Jay S. Balachandran
Atul Malhotra
Publication date
01-04-2011
Publisher
Current Science Inc.
Published in
Current Atherosclerosis Reports / Issue 2/2011
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-011-0161-8

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