Cardiovascular consequences of obstructive sleep apnea.

PURPOSE OF REVIEW: There is an increased awareness of obstructive sleep apnea (OSA) and its potential impact on cardiovascular diseases (CVDs). The number of patients diagnosed with OSA is likely to increase as the obesity epidemic continues to grow. We review recent publications that have examined the links between OSA and CVD.

RECENT FINDINGS: The cardiovascular consequences of OSA include hypertension, strokes, atrial fibrillation, and heart failure. It is likely that these are related to OSA-induced changes in endothelial dysfunction, oxidative stress, and systemic inflammation. The mainstay of treatment of OSA remains positive airway pressure devices (PAP), but issues of adherence continue to plague effective management. Oral appliances may also be a suitable alternative and may have a similar effect on blood pressure as PAP. To date, randomized trials have verified a significant (though relatively modest) impact of PAP on blood pressure, and some have shown an improvement in glucose control in diabetic individuals. However, it is unclear whether PAP prevents cardiovascular events in patients with OSA, although patients well managed and adherent with PAP seem to do better than those who are nonadherent.

SUMMARY: The mortality and morbidity associated with OSA are reduced in patients well managed with PAP. However, we await the results of large randomized clinical trials to definitely determine whether PAP reduces the rate of cardiovascular events. Current efforts aimed at identifying biomarkers in OSA may offer a strategy for personalized treatment plans of OSA patients.