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.
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References
Shamsuzzaman ASM, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290:1906–1914.
Somers VK, Dyken ME, Clary MP, et al. (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96:1897–1904.
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.
Narkiewicz K, Montano N, Cogliati C, et al. (1998) Altered cardiovascular variability in obstructive sleep apnea. Circulation 98:1071–1077.
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.
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.
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.
Carlson JT, Rangemark C, Hedner JA (1996) Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertension 14:577–584.
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.
Kraiczi H, Hedner J, Peker Y, et al. (2000) Increased vasoconstrictor sensitivity in obstructive sleep apnea. J Appl Physiol 89:493–498.
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.
Otto ME, Svatikova A, Barretto R, et al. (2004) Early morning attenuation of endothelial function. Circulation 109:2507–2510.
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.
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.
Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464.
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.
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.
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.
Svatikova A, Wolk R, Shamsuzzaman AS, et al. (2003) Serum amyloid A in obstructive sleep apnea. Circulation 108:1451–1454.
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.
Wali SO, Bahammam AS, Massaeli H, et al. (1998) Susceptibility of LDL to oxidative stress in obstructive sleep apnea. Sleep 21:290–296.
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.
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.
Svatikova A, Shamsuzzaman AS, Wolk R, et al. (2004) Plasma brain natriuretic peptide in obstructive sleep apnea. Am J Cardiol 94:529–532.
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.
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.
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.
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.
Leung RS, Bradley TD (2001) Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 164:2147–2165.
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.
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.
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.
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.
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.
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.
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.
Garni AS, Pressman G, Caples SM, et al. (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367.
Kanagala R, Murali N, Friedman P, et al. (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594.
Franklin KA, Nilsson JB, Sahlin C, et al. (1995) Sleep apnoea and nocturnal angina. Lancet 345:1085–1087.
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.
Palomaki H, Partinen M, Erkinjuntti T, et al. (1992) Snoring, sleep apnea syndrome, and stroke. Neurology 42:75–81.
Partinen M (1995) Ischaemic stroke, snoring and obstructive sleep apnoea. J Sleep Res 4:156–159.
Dyken ME, Somers VK, Yamada T, et al. (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407.
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.
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© 2007 Humana Press Inc., Totowa, NJ
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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
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DOI: https://doi.org/10.1007/978-1-59745-421-6_10
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