Sleep Apnea: New Insights

  • M. G. Bongiorni
  • G. Giannola
  • E. Gronchi
  • E. Soldati
  • G. Arena
  • E. Hoffmann
  • M. Mariani
Conference paper


Sleep apnea is the most common disorder of breathing during sleep. It is defined as repeated episodes of obstructive apnea and hypopnea during sleep, together with daytime sleepiness or altered cardiopulmonary function [1]. There are three syndromes of upper airway closure during sleep: obstructive sleep apnea (OSA), obstructive sleep hypopnea, and upper airway resistance. These three syndromes share two features: excessive daytime sleepiness and arousal associated with increased ventilatory effort in response to upper airway closure. The specific sites of narrowing or closure and upper airway dysfunction are influenced by the underlying neuromuscular tone, upper airway muscle synchrony, and the stage of sleep. Sleep apnea may be classified as two major forms: obstructive sleep apnea and central sleep apnea (CSA). Heart failure (HF) affects about 5 million people in the USA [2], and the largest epidemiologic studies in patients with HF found rates of prevalence of OSA of 37% and 11% respectively [3, 4]. Thus, OSA and CSA have a heavy impact on the health of these patients and on public health resources.


Obstructive Sleep Apnea Heart Rate Variability Sleep Apnea Right Ventricular Continuous Positive Airway Pressure 
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  1. 1.
    Strollo P, Rogers R (1996) Obstructive sleep apnea. N Engl J Med 334:99–104PubMedCrossRefGoogle Scholar
  2. 2.
    Hunt H, Baker D, Chin M et al (2001) ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/American Heart Association Task force on practice guidelines. Circulation 104:2996–3007PubMedCrossRefGoogle Scholar
  3. 3.
    Sinn D, Fitzgerald F, Parker J et al (1999) Risk factor for central and obstructive sleep apnea 1450 men and women with congestive heart failure. Am J Respir Crit Care Med 160:1101–1106Google Scholar
  4. 4.
    Javaheri S, Parker T, Liming J et al (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure: typrs and their prevalences, consequences, and presentations. Circulation 97:2154–2159PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley T, Floras J (2003) Sleep apnea and heart failure. Part I: obstructive sleep apnea. Circulation 107:1671–1678Google Scholar
  6. 6.
    Shamsuzzaman A, Winnicki M, Lanfranchi P et al (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464PubMedCrossRefGoogle Scholar
  7. 7.
    Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecule expression and production of reactive oxygen species in leukocites of sleep apnea patients. Am J Respir Crit Care Med 165:934–939PubMedGoogle Scholar
  8. 8.
    Carlson J, Rangemark C, Hedner J (1996) Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertens 14:577–584PubMedCrossRefGoogle Scholar
  9. 9.
    Bradley T, Floras J (2003) Sleep apnea and heart failure. Part II: central sleep apnea. Circulation 107:1822–1826Google Scholar
  10. 10.
    Lanfranchi P, Braghiroli A, Bosmini E et al (1999) Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation 99:1435–1440PubMedCrossRefGoogle Scholar
  11. 11.
    Arzt M, Harth M, Luchner A et al (2003) Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation 107:1998–2003PubMedCrossRefGoogle Scholar
  12. 12.
    Massie C, Hart R (2003) Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 123:1112–1118PubMedCrossRefGoogle Scholar
  13. 13.
    Mar J, Rueda J, Duran-Cantolla J et al (2003) The cost-effectiveness of nCPAP treatment in patients with moderate-to-severe obstructive sleep apnoea. Eur Respir J 21:515–522PubMedCrossRefGoogle Scholar
  14. 14.
    Pepperell J, Ramadassingh-Dow S, Crosthwate 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 359:204–210PubMedCrossRefGoogle Scholar
  15. 15.
    Flemons W (2002) Obstructive sleep apnea. N Engl J Med 347:498–504PubMedCrossRefGoogle Scholar
  16. 16.
    McMahon J, Foresman B, Chisholm R (2003) The influence of CPAP on the neuro-behavioral performance of patients with obstructive sleep apnea hypopnea syndrome: a systematic review. WMJ 102:36–43PubMedGoogle Scholar
  17. 17.
    Kaneko Y, Floras J, Usui K et al (2003) Cardiovascular effects of continous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348:1233–1241PubMedCrossRefGoogle Scholar
  18. 18.
    Gotsopoulos H, Chen C, Quian J et al (2002) Oral appliance therapy improves symptoms in obstrucive sleep apnea. Am J Respir Crit Care Med 166:743–748PubMedCrossRefGoogle Scholar
  19. 19.
    Engleman H, Mc Donald J, Graham D et al (2002) Continous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 166:855–859PubMedCrossRefGoogle Scholar
  20. 20.
    Meyer T, Woodson T (2003) Surgical management of snoring and obstructive sleep apnea. WMJ 102:28–31PubMedGoogle Scholar
  21. 21.
    Unal M, Ozturk L, Ozturk C et al (2003) The seroprevalence of Helicobacter pylori infection in patients with obstructive sleep apnoea: a preliminary study. Clin Otolaryngol 28:100–102PubMedCrossRefGoogle Scholar
  22. 22.
    Garrigue S, Bordier P, Jais P et al (2002) Benefit of atrial pacing in sleep apnea syndrome. N Engl J Med 346:404–412PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • M. G. Bongiorni
    • 1
  • G. Giannola
    • 1
  • E. Gronchi
    • 1
  • E. Soldati
    • 1
  • G. Arena
    • 1
  • E. Hoffmann
    • 2
  • M. Mariani
    • 1
  1. 1.Cardiothoracic DepartmentCisanello Hospital, University of PisaItaly
  2. 2.Division of CardiologyPoliclinic Hospital, University of PalermoItaly

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