Apneia do sono e problemas cardiovasculares
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Apneia do sono e problemas cardiovasculares

Uma infinidade de pesquisas se concentrou na relação entre apneia do sono e problemas cardiovasculares ou cardíacos. Algumas das principais descobertas incluem:

  • Causa hipóxia, aumento das oscilações de pressão intratorácica (devido às tentativas de respirar durante a apneia) e ativação do sistema nervoso simpático – sendo que tudo isso traz várias consequências negativas para o sistema cardiovascular.1-4
  • Está intimamente associada à hipertensão, independente de todos os fatores de risco relevantes.5-8
  • Está presente em mais de 30% dos pacientes com hipertensão.9
  • Ocorre em 80% dos pacientes com hipertensão resistente a medicamentos.10
  • Tratada com CPAP pode resultar numa queda clinicamente significativa da pressão arterial. Essa queda é suficiente para reduzir o risco de um evento de doença cardíaca coronária em 37% e de acidente vascular cerebral em 56%.11,12,13
  • Os pacientes têm um risco relativo de insuficiência cardíaca 2,4 vezes maior, independente de outros fatores de risco conhecidos.14
  • O tratamento com CPAP em pacientes que também têm insuficiência cardíaca melhora a função ventricular esquerda.15
  • É comum em pacientes com doença cardiovascular e ocorre em 50% dos pacientes com fibrilação atrial.16
  • Os pacientes têm níveis maiores de marcadores inflamatórios, oxidativos e de função endotelial vascular, que estão associados à aterogênese. Esses marcadores são melhorados quando a apneia do sono é tratada com CPAP.17-20
  • Quando graves, aumenta significativamente o risco de eventos cardiovasculares. O tratamento com CPAP reduz esse risco.21,22

A insuficiência cardíaca é frequentemente associada à Respiração de Cheyne-Stokes (RCS), que fragmenta o sono do paciente e está associada à redução da sobrevida.

Referências

  1. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-14.
  2. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003;41:1429-37.
  3. Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation 2003;107:1671-8.
  4. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 2002;166:159-165.
  5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.
  6. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ 2000;320:479-82.
  7. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newman AB, Lebowitz MD, Pickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 2000;283:1829-1836.
  8. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, Kales A. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000;160:2289-95.
  9. 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.
  10. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RS, Bradley TD. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001;19:2271-7.
  11. Logan AG, Tkacova R, Perlikowski SM, Leung RS, Tisler A, Floras JS, Bradley TD. Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Eur Respir J 2003;21:241-7.
  12. Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, Peter JH. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003;107:68-73.
  13. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJ. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002;359:204-10.
  14. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O'Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19-25.
  15. Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, Ando S, Bradley TD. Cardiovascular effects of continuous positive airway pressure in patients with heart hailure and obstructive sleep apnea. N Engl J Med 2003;348:1233-1241.
  16. Lanfranchi PA, Braghiroli A, Bosimini E, Mazzuero G, Colombo R, Donner CF, Giannuzzi P. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation 1999;99:1435-40.
  17. Teschler H, Dohring J, Wang YM, Berthon-Jones M. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 2001;164:614-9.
  18. Pepperell JC, Maskell NA, Jones DR, Langford-Wiley BA, Crosthwaite N, Stradling JR, Davies RJ. A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. J Respir Crit Care Med 2003;168:1109-14.
  19. Topfer V, El-Sebai M, Wessendorf TE, Moraidis I, Teschler H.[ Adaptive servoventilation: effect on Cheyne-Stokes-Respiration and on quality of life ]Pneumologie 2004;58:28-32.
  20. Schadlich S, Konigs I, Kalbitz F, Blankenburg T, Busse HJ, Schutte W.[ Cardiac efficiency in patients with Cheyne-Stokes respiration as a result of heart insufficiency during long-term nasal respiratory treatment with adaptive servo ventilation (AutoSet CS) ]Z Kardiol 2004;93:454-62.
  21. Philippe C; Stoica-Herman M; Drouot X; Raffestin B; Escourrou P; Hittinger L; Michel P-L; Rouault S; d'Ortho M-P. Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period. Heart 2006;92(3):337-42.
  22. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf J, Ammash N, Friedman P, Somers VK. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004;110(4):364-7.
  23. Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004;169:348-53.
  24. Ip MSM, Lam B, Chan LY, Zheng L, Tsang KWT, Fung PCW, Lam WK. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000;162:2166–2171.
  25. Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002;105:2462-4..
  26. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 2002;165:934-9.
  27. 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(9464):1046-53.
  28. Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 2005;127(6):2076-84.