OSA: it's not just a sleep disorder anymore

Excerpt

The elegant study, Long-term effects of nasal continuous positive airway pressure on vasodilatory endothelial function in obstructive sleep apnea syndrome, published in Sleep and Breathing by Duchna et al. [1] is an important example of an exciting body of research highlighting effects of OSA (obstructive sleep apnea) far beyond the bedroom. Cardiovascular sequelae, most dramatically expressed as increased mortality [2] have long been associated with OSA [3‐5]. Several studies have shown beneficial treatment effects of CPAP upon cardiovascular outcomes including mortality [6‐9]. The complex interactions of sleep disordered breathing and endocrine function have also been elucidated, as the body of knowledge has grown of the cardiovascular manifestations. Thirty years ago we thought patients snored because they were fat, now evidence suggests the reverse is true [10]. OSA causes insulin resistance, which reverses with CPAP therapy [11]. Sleep deprivation and OSA cause resistance to the hormone leptin, resulting in a defect of the feedback loop which controls the hunger/satiety cycle. Nasal CPAP therapy improves this leptin resistance [12]. OSA appears to be an important co-factor in the development of the metabolic syndrome in many of our patients. …