Cardiovascular
Cardiovascular

Sleep apnoea and cardiovascular issues

Multiple studies indicate that SDB contributes to or exacerbates cardiovascular disease. SDB is associated with an increased incidence of hypertension, coronary artery disease, congestive heart failure, cardiac arrhythmias, stroke, and even death1,2 .

Treating OSA with CPAP has been shown to:  Increase left ventricular ejection fraction (LVEF); reduce blood pressure; and may reduce the risk of cardiovascular fatal and non-fatal events.3-6

Key research in the area of OSA and cardiovascular diseases has found that SDB:

  • Causes hypoxia, increased intrathoracic pressure swings due to the attempts to breathe during an apnoea, and activation of the sympathetic nervous system-all of which have many negative consequences for the cardiovascular system.7-10
  • Is strongly associated with hypertension, independent of all relevant risk factors.11-14
  • Is present in more than 30% of patients with hypertension.15
  • Occurs in 80% patients with drug resistant hypertension.16
  • Treated with CPAP may result in a clinically significant drop in blood pressure. This drop is sufficient to reduce risk of a coronary heart disease event by 37% and stroke risk by 56%.17-19
  • Patients have a 2.4 times increased relative risk of heart failure, independent of other known risk factors.20
  • Treatment with CPAP in patients who also have heart failure, improves left ventricular function.21
  • Is common in patients with cardiovascular disease and occurs in 50% atrial fibrillation patients.22
  • Patients have increased levels of inflammatory, oxidative and vascular endothelial effect markers, which are associated with atherogenesis. These markers are improved when the sleep apnoea is treated with CPAP.23-26
  • When severe, significantly increases the risk of cardiovascular events. Treatment with CPAP reduces this risk.27,28

References

  1. Monahan, K. and S. Redline, Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol, 2011. 26(6): p. 541-7.
  2. Shahar, E., et al., Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med, 2001. 163(1): p. 19-25.
  3. Kaneko, Y., et al., Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med, 2003. 348(13): p. 1233-41.
  4. Mansfield, D.R., et al., Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med, 2004. 169(3): p. 361-6.
  5.  
  6. Buchner, N.J., et al., Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med, 2007. 176(12): p. 1274-80.
  7. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-14.
  8. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003;41:1429-37.
  9. Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation 2003;107:1671-8.
  10. 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.
  11. 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.
  12. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ 2000;320:479-82.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.