Skip to main content

Evidence and Mechanisms Linking Obstructive Sleep Apnea to Cardiovascular Disease

  • Chapter
Primary Care Sleep Medicine

Part of the book series: Current Clinical Practice ((CCP))

  • 1100 Accesses

Abstract

Obstructive sleep apnea (OSA) has been recognized as a cause of sleep disruption and daytime somnolence. During the past two decades, emerging evidence has implicated OSA as a comorbidity in a number of cardiovascular disease conditions (1). More recently, the effects of OSA have been linked to the activation of a number of mechanisms that may contribute to the development and progression of cardiovascular disease. Treatment of OSA in patients with existing cardiovascular disease conditions has been associated with improvements in these disease conditions. However, much of the evidence is still circumstantial and etiological evidence for OSA in initiating cardiovascular damage remains debatable. This review will examine the possible mechanisms by which sleep apnea may contribute to cardiovascular dysfunction and disease, those cardiovascular disease conditions that frequently exist as comorbidities with OSA, and the effects of treatment of sleep apnea on these cardiovascular disease conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Shamsuzzaman ASM, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290:1906–1914.

    Article  PubMed  CAS  Google Scholar 

  2. Somers VK, Dyken ME, Clary MP, et al. (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904.

    PubMed  CAS  Google Scholar 

  3. Narkiewicz K, van de Borne PJ, Montano N, et al. (1998) Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation 97:943–945.

    PubMed  CAS  Google Scholar 

  4. Narkiewicz K, Montano N, Cogliati C, et al. (1998) Altered cardiovascular variability in obstructive sleep apnea. Circulation 98:1071–1077.

    PubMed  CAS  Google Scholar 

  5. Singh JP, Larson MG, Tsuji H, et al. (1998) Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension; the Framingham Heart Study. Hypertension 32:293–297.

    PubMed  CAS  Google Scholar 

  6. Somers VK, Zavala DC, Mark AL, et al. (1989) Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol 67:2095–2100.

    PubMed  CAS  Google Scholar 

  7. Somers VK, Zavala DC, Mark AL, et al. (1989) Contrasting effects of hypoxia and hypercapnia on ventilation and sympathetic activity in humans. J Appl Physiol 67:2101–2106.

    PubMed  CAS  Google Scholar 

  8. Carlson JT, Rangemark C, Hedner JA (1996) Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertension 14:577–584.

    Article  CAS  Google Scholar 

  9. Kato M, Roberts-Thomson P, Phillips BG, et al. (2000) Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102:2607–2610.

    PubMed  CAS  Google Scholar 

  10. Kraiczi H, Hedner J, Peker Y, et al. (2000) Increased vasoconstrictor sensitivity in obstructive sleep apnea. J Appl Physiol 89:493–498.

    PubMed  CAS  Google Scholar 

  11. Ip MS, Tse H, Tsang KW, et al. (2003) Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 169:348–353.

    Article  PubMed  Google Scholar 

  12. Otto ME, Svatikova A, Barretto R, et al. (2004) Early morning attenuation of endothelial function. Circulation 109:2507–2510.

    Article  PubMed  Google Scholar 

  13. Hartmann G, Tschop M, Fischer R, et al. (2000) High altitude increases circulating interleukin-6, interleukin-1 receptor antagonist and C-reactive protein. Cytokine 12:246–262.

    Article  PubMed  CAS  Google Scholar 

  14. Meier-Ewert HK, Ridker PM, Rifai N, et al. (2004) Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 43:678–683.

    Article  PubMed  CAS  Google Scholar 

  15. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464.

    Article  PubMed  CAS  Google Scholar 

  16. Chin K, Nakamura T, Shimizu K, et al. (2000) Effects of nasal continous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med 109:562–567.

    Article  PubMed  CAS  Google Scholar 

  17. Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 165:934–939.

    PubMed  Google Scholar 

  18. El-Solh AA, Mador MJ, Sikka P, et al. (2002) Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest 121:1541–1547.

    Article  PubMed  CAS  Google Scholar 

  19. Svatikova A, Wolk R, Shamsuzzaman AS, et al. (2003) Serum amyloid A in obstructive sleep apnea. Circulation 108:1451–1454.

    Article  PubMed  CAS  Google Scholar 

  20. Schulz R, Mahmoudi S, Hattar K, et al. (2000) Enhanced release of Superoxide from polymorphonuclear neutrophils in obstructive sleep apnea: impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med 162:566–570.

    PubMed  CAS  Google Scholar 

  21. Wali SO, Bahammam AS, Massaeli H, et al. (1998) Susceptibility of LDL to oxidative stress in obstructive sleep apnea. Sleep 21:290–296.

    PubMed  CAS  Google Scholar 

  22. Kourembanas S, Marsden PA, McQuillan LP, et al. (1991) Hypoxia induces endothelin gene expression and secretion in cultured human endothelium. J Clin Invest 88:1054–1057.

    Article  PubMed  CAS  Google Scholar 

  23. Phillips BG, Narkiewicz K, Pesek CA, et al. (1999) Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertension 17:61–66.

    CAS  Google Scholar 

  24. Svatikova A, Shamsuzzaman AS, Wolk R, et al. (2004) Plasma brain natriuretic peptide in obstructive sleep apnea. Am J Cardiol 94:529–532.

    Article  PubMed  CAS  Google Scholar 

  25. Coughlin S, Mawdsley L, Mugarza JA, et al. (2004) Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25:735–741.

    Article  PubMed  Google Scholar 

  26. Punjabi NM, Sorkin JD, Katzel LI, et al. (2002) Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 165:677–682.

    PubMed  Google Scholar 

  27. Ip MS, Lam B, Ng MM, et al. (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676.

    PubMed  Google Scholar 

  28. Phillips BG, Kato M, Narkiewicz K, et al. (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279:H234–H237.

    PubMed  CAS  Google Scholar 

  29. Leung RS, Bradley TD (2001) Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 164:2147–2165.

    PubMed  CAS  Google Scholar 

  30. Peppard PE, Young T, Palta M, et al. (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384.

    Article  PubMed  CAS  Google Scholar 

  31. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359:204–210.

    Article  PubMed  Google Scholar 

  32. Becker HF, Jerrentrup A, Ploch T, et al. (2003) Effect of nasal continous positive airway pressure on blood pressure in patients with obstructive sleep apnea. Circulation 107:68–73.

    Article  PubMed  Google Scholar 

  33. Malone S, Liu PP, Holloway R, et al. (1991) Obstructive sleep apnea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet 338:1480–1484.

    Article  PubMed  CAS  Google Scholar 

  34. Kaneko Y, Floras JS, Usui K, et al. (2003) Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348:1233–1241.

    Article  PubMed  Google Scholar 

  35. Mansfield DR, Gollogly NC, Kaye DM, et al. (2004) Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 169:361–366.

    Article  PubMed  Google Scholar 

  36. Mooe T, Gullsby S, Rabben T, et al. (1996) Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 7:475–478.

    Article  PubMed  CAS  Google Scholar 

  37. Garni AS, Pressman G, Caples SM, et al. (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367.

    Article  Google Scholar 

  38. Kanagala R, Murali N, Friedman P, et al. (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594.

    PubMed  Google Scholar 

  39. Franklin KA, Nilsson JB, Sahlin C, et al. (1995) Sleep apnoea and nocturnal angina. Lancet 345:1085–1087.

    Article  PubMed  CAS  Google Scholar 

  40. Peker Y, Hedner J, Kraiczi H, et al. (2000) Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med 162:81–86.

    PubMed  CAS  Google Scholar 

  41. Palomaki H, Partinen M, Erkinjuntti T, et al. (1992) Snoring, sleep apnea syndrome, and stroke. Neurology 42:75–81.

    PubMed  CAS  Google Scholar 

  42. Partinen M (1995) Ischaemic stroke, snoring and obstructive sleep apnoea. J Sleep Res 4:156–159.

    Article  PubMed  Google Scholar 

  43. Dyken ME, Somers VK, Yamada T, et al. (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407.

    PubMed  CAS  Google Scholar 

  44. Daly MD, Angell-James JE, Eisner R (1979) Role of carotid-body chemoreceptors and their reflex interactions in bradycardia and cardiac arrest. Lancet (1)8119:764–767.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Somers, V.K. (2007). Evidence and Mechanisms Linking Obstructive Sleep Apnea to Cardiovascular Disease. In: Pagel, J.F., Pandi-Perumal, S.R. (eds) Primary Care Sleep Medicine. Current Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-59745-421-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-421-6_10

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-992-5

  • Online ISBN: 978-1-59745-421-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics