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Obstructive sleep apnea and cardiovascular disease, a story of confounders!

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Abstract

Obstructive sleep apnea (OSA) syndrome is increasingly common among middle aged and older adults and is frequently linked to most cardiovascular diseases (CVD). Sleep-disordered breathing and CVD share a number of common risk factors and comorbid conditions including obesity, male gender, advancing age, metabolic syndrome, and hypertension. OSA appears to be associated with worsened CVD outcomes, sleep-related symptoms, quality of life, and risk of motor vehicle accidents. Demonstrating a cause-and-effect relationship between CVD and OSA has been challenging due to shared comorbidities. Strong evidence demonstrating clinically significant benefit for OSA treatments on OSA-related CVD outcomes are limited. In this review, we evaluate potential pathophysiologic mechanisms that link OSA to CVD and focus on specific treatments for OSA, including positive airway pressure (PAP), dental devices, and surgeries with regard to OSA-related CVD outcomes.

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Abbreviations

AASM:

American Academy of Sleep Medicine

AF:

Atrial fibrillation

AHI:

Apnea Hypopnea Index

aPAP:

Auto-PAP (auto-adjustable continuous positive airway pressure)

CAD:

Coronary artery disease, coronary heart disease, atherosclerotic vascular disease

CHF:

Congestive heart failure

CPAP:

Continuous positive airway pressure

CVA:

Cerebrovascular accident (cerebrovascular disease)

CVD:

Cardiovascular disease (umbrella term for AF, CVA, HTN, CHF, PHTN, CAD)

DCCV:

Direct current cardioversion (for atrial fibrillation)

ESS:

Epworth Sleepiness Scale

FOSQ:

Functional Outcomes of Sleep Questionnaire

FSS:

Fatigue Severity Scale

HTN:

Hypertension (systemic hypertension)

mPAP:

Mean pulmonary arterial pressure

OAT:

Oral appliance therapy (refers to custom, adjustable, titratable, oral appliance)

OSA:

Obstructive sleep apnea

PAP:

Positive airway pressure

PHTN:

Pulmonary hypertension

PSG:

Polysomnography

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Acknowledgments

All of the study authors contributed equally to writing the manuscript and have reviewed the final manuscript. Dr. Collen is the guarantor of the final article and is responsible for the integrity of the contents of this manuscript from article inception to publication of the final product.

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Correspondence to Jacob Collen.

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All authors have seen and approve the manuscript. All authors participated in development of the manuscript and final revisions.

Jacob Collen (JC) has received consulting fees for Jazz Pharmaceuticals and GlaxoSmithKline. Christopher Lettieri (CL) is a paid employee of GlaxoSmithKline. Emerson Wickwire (EMW) has received research support from AASM Foundation, Department of Defense, Merck, and ResMed. EMW has served as a scientific consultant to DayZz, Eisai, Merck, and Purdue, and is an equity shareholder in WellTap. Aaron Holley (AH) has nothing to disclose.

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Collen, J., Lettieri, C., Wickwire, E. et al. Obstructive sleep apnea and cardiovascular disease, a story of confounders!. Sleep Breath (2020) doi:10.1007/s11325-019-01945-w

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Keywords

  • Obstructive sleep apnea
  • Cardiovascular disease
  • Coronary artery disease
  • Atrial fibrillation
  • Hypertension
  • Cerebrovascular disease
  • Cerebrovascular accident
  • Congestive heart failure
  • Pulmonary hypertension
  • Continuous positive airway pressure
  • Positive airway pressure