Advertisement

Obstructive Sleep Apnea

Chapter

Abstract

The prevalence of sleep apnea in general population varies from 5 to 10 %. In general population and in patients with cardiovascular diseases, obstructive sleep apnea (OSA) is two to three times more common in men than in women and in older than in the young. In hypertensive subjects the diagnosis of obstructive sleep apnea OSA is based on polysomnography – it is confirmed when apnea-hypopnea index (AHI) exceeds 15 events/h. OSA is the most common disease associated with resistant hypertension – according to abovementioned definition it was diagnosed in 64 % of patients. In hypertensive patients OSA is associated with obesity. However in patients with heart failure and stroke direct relationship between body mass index and OSA severity was not firmly proved.

Keywords

Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Obstructive Sleep Apnea Patient Resistant Hypertension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation. 2012;126:1495–510.PubMedCrossRefGoogle Scholar
  3. 3.
    Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LKG, Amaro ACS, Amodeo C, Bortolotto LA, Krieger EM, Bradley TD, Lorenzi-Filho G. Obstructive sleep apnea. The most common cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Yumino D, Wang H, Floras JS, Newton GE, Mak S, Ruttanaumpawan P, Parker JD, Bradley TD. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail. 2009;15:279–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37:967–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Arzt M, Young T, Peppard PE, Finn L, Ryan CM, Bayley M, Bradley TD. Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke. Stroke. 2010;41:e129–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD. High prevalence of unrecognized sleep apnea in drug-resistant hypertension. J Hypertens. 2001;19:2271–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010;7:677–85.PubMedGoogle Scholar
  9. 9.
    Alonso-Fernandez A, Garcia-Rio F, Arias MA, Hernanz A, de la Pena M, Pierola J, Barcelo A, Lopez-Collazo E, Agusti A. Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomized trial. Thorax. 2009;64:581–6.PubMedCrossRefGoogle Scholar
  10. 10.
    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;365:1046–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Bradley TD, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet. 2009;373:82–93.PubMedCrossRefGoogle Scholar
  12. 12.
    Kasai T, Arcand J, Allard JP, Mak S, Azevedo ER, Newton GE, Bradley TD. Relationship between sodium intake and sleep apnea in patients with heart failure. J Am Coll Cardiol. 2011;58:1970–4.PubMedCrossRefGoogle Scholar
  13. 13.
    DiBona GF, Esler M. Translational medicine: the antihypertensive effect of renal denervation. Am J Physiol Regul Integr Comp Physiol. 2010;298:R245–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM, Calhoun DA. Spironolactone reduces severity of obstructive sleep apnea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010;24:532–7.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Chiu KL, Ryan CM, Shiota S, Ruttanaumpawan P, Arzt M, Haight JS, Chan CT, Floras JS, Bradley TD. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med. 2006;174:1378–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Shiota S, Ryan CM, Chiu KL, Ruttanaumpawan P, Haight J, Arzt M, Floras JS, Chan C, Bradley TD. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax. 2007;62:868–72.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Redolfi S, Yumino D, Ruttanaumpawan P, Yau B, Su MC, Lam J, Bradley TD. Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med. 2009;179:241–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Redolfi S, Arnulf I, Pottier M, Lajou J, Koskas I, Bradley TD, Similowski T. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med. 2012;184:1062–6.CrossRefGoogle Scholar
  19. 19.
    Tang SC, Lam B, Ku PP, Leung WS, Chu CM, Ho YW, Ip MS, Lai KN. Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol. 2006;17:2607–16.PubMedCrossRefGoogle Scholar
  20. 20.
    Tang SC, Lam B, Lai AS, Pang CB, Tso WK, Khong PL, Ip MS, Lai KN. Improvement in sleep apnea during nocturnal peritoneal dialysis is associated with reduced airway congestion and better uremic clearance. Clin J Am Soc Nephrol. 2009;4:410–8.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med. 2001;344:102–7.PubMedCrossRefGoogle Scholar
  22. 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. J Clin Invest. 1997;99:106–9.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Fletcher EC, Lesske J, Behm R, Miller III CC, Stauss H, Unger T. Carotid chemoreceptors, systemic blood pressure, and chronic episodic hypoxia mimicking sleep apnea. J Appl Physiol. 1992;72:1978–84.PubMedGoogle Scholar
  24. 24.
    Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.PubMedCrossRefGoogle Scholar
  25. 25.
    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;179:1159–64.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, Miranda-Serrano E, Rubio R, Martinez-Null C, de Miguel J, Egea C, Cancelo L, Alvarez A, Fernandez-Bolanos M, Barbe F. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria sleep cohort. Am J Respir Crit Care Med. 2012;184:1299–304.CrossRefGoogle Scholar
  27. 27.
    Sjostrom C, Lindberg E, Elmasry A, Hagg A, Svardsudd K, Janson C. Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. Thorax. 2002;57:602–7.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Shepard Jr JW. Cardiopulmonary consequence of obstructive sleep apnea. Mayo Clin Proc. 1990;65:1250–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Somers VK, Zavala DC, Mark AL, Abboud FM. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol. 1989;67:2095–100.PubMedGoogle Scholar
  30. 30.
    Somers VK, Zavala DC, Mark AL, Abboud FM. Contrasting effects of hypoxia and hypercapnia on ventilation and sympathetic activity in humans. J Appl Physiol. 1989;67:2101–6.PubMedGoogle Scholar
  31. 31.
    Somers VK, Mark AL, Abboud FM. Potentiation of sympathetic nerve responses to hypoxia in borderline hypertensive subjects. Hypertension (Dallas). 1988;11:608–12.CrossRefGoogle Scholar
  32. 32.
    Somers VK, Mark AL, Abboud FM. Sympathetic activation by hypoxia and hypercapnia-implications for sleep apnea. Clin Exp Hypertens Part A Theory Pract. 1988;A10 Suppl 1:413–22.CrossRefGoogle Scholar
  33. 33.
    Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96:1897–904.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Nauman J, Janszky I, Vatten LJ, Wisloff U. Temporal changes in resting heart rate and deaths from ischemic heart disease. JAMA. 2011;306:2579–87.PubMedCrossRefGoogle Scholar
  35. 35.
    Floras JS. Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. J Am Coll Cardiol. 2009;54:375–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Linz D, Mahfoud F, Schotten U, Ukena C, Neuberger H-R, Wirth K, Böhm M. Renal sympathetic denervation suppresses postapneic blood pressure rises and atrial fibrillation in a model for sleep apnea. Hypertension. 2012;60:172–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Franquini JVM, Medeiros ARS, Andrade TU, Araújo MTM, Moysés MR, Abreu GR, Vasquez EC, Bissoli NS. Influence of renal denervation on blood pressure, sodium and water excretion in acute total obstructive apnea in rats. Braz J Med Biol Res. 2009;42(2):214–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Witkowski A, Prejbisz A, Florczak E, Kądziela J, Śliwiński P, Bieleń P, Michałowska I, Kabat M, Warchoł E, Januszewicz M, Narkiewicz K, Somers VK, Sobotka PA, Januszewicz A. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension. 2011;58:559–65.PubMedCrossRefGoogle Scholar
  39. 39.
    Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373:1275–81.PubMedCrossRefGoogle Scholar
  40. 40.
    Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (the symplicity HTN-2 trial): a randomised controlled trial. Lancet. 2010;376:1903–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, Hoppe UC, Vonend O, Rump LC, Sobotka PA, Krum H, Esler M, Bohm M. Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation. 2011;123:940–1946.CrossRefGoogle Scholar
  42. 42.
    Kopp UC, Jones SY, DiBona GF. Afferent renal denervation impairs baroreflex control of efferent renal sympathetic nerve activity. Am J Physiol Regul Integr Comp Physiol. 2008;295:R1882–90.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Interventional Cardiology and AngiologyInstitute of CardiologyWarsawPoland

Personalised recommendations