Indian Journal of Sleep Medicine

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VOLUME 8 , ISSUE 1 ( January-March, 2013 ) > List of Articles


Cardiovascular consequences of obstructive sleep apnea

M. K. Sen

Citation Information : Sen MK. Cardiovascular consequences of obstructive sleep apnea. Indian Sleep Med 2013; 8 (1):16-21.

DOI: 10.5958/j.0974-0155.8.1.003

License: NA

Published Online: 01-12-2018

Copyright Statement:  NA


The impact of obstructive sleep apnea syndrome on cardiovascular morbidity and mortality is phenomenal. There is a strong evidence base in terms of several longitudinal as well as cross-sectional studies in support of this fact. However, the evidence in favor of its association with hypertension is stronger than with coronary artery disease, arrhythmias and stroke. Prevalence studies on OSAHS have demonstrated an increased odds ratio for hypertension above the background population. Also, prevalence of hypertension is known to increase proportionate to the severity of sleep disordered breathing. Cross-sectional prevalence studies on cardiovascular disease and OSAHS have shown an increased risk of coronary artery disease (CAD) amongst patients with OSAHS. Prevalence of OSA is significantly higher in patients with atrial fibrillation (AF) than in patients without past or current AF. Pulmonary arterial hypertension, congestive heart failure and sudden cardiac death are also commonly associated with OSAHS. Interventional studies clarify the role of effective treatment of this disorder with CPAP. Therapy with CPAP, therefore, should be expected to impact the prognosis of cardiovascular consequences of this syndrome.

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  1. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-1904
  2. Dimsdale J.E., Coy T., Ziegler M.G.: The effect of sleep apnea on plasma and urinary catecholamines. Sleep 1995; 18:377-381.
  3. Davies CWH, Crosby JH, Mullins RL, Barbour C, Davies RJO, Stradling JR. Casre control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax 2000;55:736-740
  4. Obstructive Sleep Apnea As A Cause Of Systemic Hypertension –Evidence From A Canine Model. Brooks D., Horner R.L., Kozar L.F., Render-Teixeira C.L., Phillipson E.A., et al. J Clin Invest, 1997. 99:106-109, 1997
  5. Levi L. Obstructive sleep apnoea syndrome- an oxidative stress disorder, Sleep Medicine Rev 2003; 7:35-51.
  6. Jelic S, Lederer DJ, Adams T, Padeletti M, Colombo PC, factor P, Le Jemtel TH. Endothelial repair capacity and apoptosis are inversely related in obstructive sleep apnea.. Vascular Health and Risk Management 2009:5 909–920
  7. Hla KM, Young T, Finn L, et al. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin sleep Cohort study. Sleep 2008; 31(6):795–800.
  8. Peppard PE, 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
  9. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, Kales A. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000 Aug 14-28; 160(15):2289-95.
  10. Nieto FJ, Young TB, et al.. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 2000; 283:1829-1836.
  11. Grote L., Ploche T., Hetmann J, Knaack L, Penzel T, Peter JH. Sleep related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med 1999;160:1875-1882
  12. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension Journal of Hypertension Dec 2001 19(12) 2271-2227
  13. Gonçalves SC, Martinez M, Gus et al. Chest 2007;132;1858-1862
  14. Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167:757–764.
  15. L.A., Khan Z., Reynolds K., He J.Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Bazzano Hypertension. 2007; 50: 417-423
  16. Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E, Ryan CF, Fleetham J, Choi P and Ayas NT. Impact of Continuous Positive Airway Pressure Therapy on Blood Pressure in Patients with Obstructive Sleep Apnea Hypopnea: A Meta-analysis of Randomized Controlled Trials- A meta-analysis. Lung 2007; Volume 185, Number 2, 67-72
  17. Continuous positive airway pressure therapy as treatment of hypertensionin people with obstructive sleep apnea: randomized controlled trial. Duran-Cantolla J., Azipuru F., Montserrat J.M., Ballester E., Teran-Santos J. Aguirregomoscorta J.I., Gonzalez M., et al.. BMJ, 2010. 341:p c5991
  18. Andrén A, Sjöquist M, Tegelberg A. Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance – a three-year followup. J Oral Rehab. 2009:36: 719-725.
  19. Arias et al. Arias MA, Garcý ‘a-Rý’o F, Alonso-Fern´ndez A, Martý'nez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure. A randomized, controlled crossover study. Eur Heart J 2006;27:1106–1113
  20. Benjamin JA, Lewis KE. Sleep disordered breathing and cardiuovascular disease. Postgrad Med J 2008; 84:15-22
  21. Hedner J, Bengktsson-Bostrom K, Peker Y, Grote L, Rastam L, Lindblad U. Hypertension prevalence in obstructive sleep apnea and sex: a population based case controlled study. Eur Resir J 2006; 27:564-570.
  22. Marin JM,Carrizo SJ,Vicente E, Agusti AGN.Long term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046– 1053.
  23. Kuniyoshi et al. Kuniyoshi FH, Garcia-Touchard A, Gami AS, Romero-Corral A, van der Walt C, Pusalavidyasagar S, Kara T, Caples SM, Pressman GS, Vasquez EC, Lopez- Jimenez F, Somers VK. Day-night variation of acute myocardial infarction in obstructive sleep apnea. J Am Coll Cardiol 2008; 52:343-346
  24. Sorajja D, Gami AS, Somers VK, Behrenbeck TR, Garcia- Touchard A, Lopez-Jiminez F. Independent association between obstructive sleep apnea and coronary artery disease. Chest 2008;133:927-933
  25. Yumino D, Tsurumi Y,Takagi A,Suzuki K, Kasanuki H. Impact of OSA on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol 2007; 99:2630
  26. Stephan S, Schueller PO, Hennersdorf MG, Behrendt D, Strauer B. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respiratory Research 2008, 9:50
  27. Sachdev Sudip S., Suri J C., Jain A K., Khalid Anita, Isser H S., Mittal M K. Cardiovascular morbidity in subjects with Obstructive sleep apnea and Its correlation with the severity of disease. Indian J of Sleep Medicine; 2009: 4:(2):49-60.
  28. E Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O'Connor GT, Boland LL, Schwartz JE, Samet JM for The Sleep Heart Health Study Research Group. Sleep disordered breathing and cardiovascular disease-Cross sectional results of Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163:19–25.
  29. Egea CJ, Aizpuru F, Pinto JA. et al. cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multi-center study. Sleep Med 2008;9:660-666
  30. Arias MA, Garcia-Rio F, Alonzo-Fernandez et al. Obstructive sleep apnea affects left ventricle diastolic function : effects of nasal continuous positive pressure in men. Circulation 2005;112:375-383
  31. Suri J. C., Sharma Manish, Kampani Geeta, Sen M. K. Prevalence and profile of sleep disordered breathing amongst patients with congestive heart failure. Indian J of Sleep Medicine;2010:5:(4):120-127
  32. Bhattacharya D., Sen M. K., Chakrabarti S. Gupta N. K., Suri J. C. An interesting case of central and obstructive sleep apnea in a patient of congestive heart failure with unmasking of CSA's following CPAP use. Indian J of Sleep Medicine; 2006:1 :(2):109-117.
  33. Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahdevan J, Redline S. Association of nocturnal arrythmias with sleep disordered breathing. Am J Respir Crit Care Med. 2006 ;15: 173(8): 910–916.
  34. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE,Malouf JF, Ammash NM, Freidman PA, Sommers VK. Association of atrial fibrillation and OSA. Circulation 2004, 110:364-367.
  35. Braga B. Sleep disordered atrial fibrillation and chronic atrial fibrillation. Sleep Med, 2009; 10(2): 212-6 doi: 10.1016/j.sleep.2007.12.007
  36. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. Gami et al. J Am Coll Cardiol 2007; 49: 565-571
  37. Garrigue S, Pepin JL, Defaye P, Murgatroyd F, Poezevara Y, Clemente J, Levy P. High prevalence of sleep apnea syndrome in patients with long-term pacing- A European multicentre study. Circulation. 2007;115:1703-1709
  38. Kanagala R, Murali NS, Freidman PA, Ammash NM, Gersh BJ, Gallman KV, Shamsuszzaman ASM, Sommers VS. Obstructive sleep apnea and recurrence of atrial fibrillation. Circulation 2003, 107:2589-2594
  39. Mohsenin V. Sleep related breathing disorders and risk of stroke. Stroke 2001, 32:1271-1278
  40. Yaggi HK, Concato J, Kernan WN, Litchman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death N Engl J Med 2005;353:2034-41.
  41. Martý'nez-Garcý'a MA, Solar-Cataluna JJ, Ejarque- Martinez L, Soriano Y, Roman-Sanchez P, Barbella F, Canal MM, Duran-Cantolla J. Continuous positive airway pressure treatment reduces mortalityin patients with ischemic stroke and obstructive sleep apnea: a 5-year follow up study. Am J Respir Crit Care Med Vol 180. pp 36–41, 2009
  42. Young T, Finn L, Peppard PE, Szkio-Coxa M, Austin D, et al. Sleep disordered breathing and mortality: eighteen year follow up of the Wisconsin Sleep Cohort Sleep 2008; 31:1071-1078
  43. Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM. Sleep disorxdered breathing and mortality: a prospective cohort al. PLoS Med 2009;6:e1000132
  44. Gami AS, Howard DE, Olson EJ, Sommers VK. Day-night pattern of sudden death in OSA. N Engl J Med 2005;352:1206-14.
  45. Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, Ruttanaumpawan P, Tomlinson G, Bradley TD. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol;2007:49:15.
  46. Kasai T, Narui K, Dohi T, Yanagisawa N, Ishiwata S, Ohno M, Yamaguchi T, Momomura S. Prognosis of Patients With Heart Failure and Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure* Chest 2008;133:690-696
  47. Milleron, O. Pilliere R, Foucher A, de Roquefeuil F. Benefits of obstructive sleep apnea treatment in coronary artery disease : a long term follow up study. et al Eur Heart J 2004 25:728-734.
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