Obstructive sleep apnea and the risk of cardiovascular disease

Authors: Magomedova N.M., Golukhova E.Z.

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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DOI: https://doi.org/10.15275/kreatkard.2016.03.03

For citation: Magomedova N.M., Golukhova E.Z.. Obstructive sleep apnea and the risk of cardiovascular disease. Kreativnaya Kardiologiya. 2016; 10 (3): 201-209 (in Russian)

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Abstract

The review is on the relationship of obstructive sleep apnea syndrome and cardiovascular disease. The causes of sleep apnea are described – the mechanism of stopping breath during sleep and the possible consequences of this disorder. In patients with coronary heart disease with cardiac arrhythmias, hypertension, obesity, respiratory disorders during sleep are very common. There are data on influence of sleep apnea on risk of adverse cardiovascular events. An analysis of randomized trials results is presented, which reveals positive effect of CPAP therapy for the treatment of these categories of patients. It is noted that the treatment effect is higher in patients with better adherence to CPAP therapy. There are still on the studies on reducing risk of myocardial infarction, unstable angina, stroke, cardiac arrhythmias, heart failure, diabetes mellitus in patients with concomitant obstructive sleep apnea by continuous positive airway pressure therapy.

References

  1. McEvoy R.D., Antic N.A., Heeley E. et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N. Engl. J. Med. 2016; 375: 919–93. DOI: 10.1056/NEJMoa1606599.
  2. Torres-Alba F., Gemma D., Armada-Romero E. et al. Obstructive sleep apnea and coronary artery disease: from pathophysiology to clinical implications. Pulm. Med. 2013; 20: 768064. DOI: 10.1155/2013/ 768064.
  3. Young T., Evans L., Finn L. et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997; 20: 705–6.
  4. Redline S., Sotres-Alvarez D., Loredo J. et al. Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos. Am. J. Respir. Crit. Care Med. 2014; 189: 335–44.
  5. Bravata D.M., Concato J., Fried T. et al. Autotitrating CPAP for patients with acute transient ischemic atack: a randomized feasibility trial. Stroke. 2010; 41: 1464–70.
  6. Yaggi H.K., Mohsenin V. Obstructive sleep apnea and stroke. Lancet Neurol. 2004; 3: 333–42.
  7. Marin J.M., Carrizo S.J., Vicente E., Agusti A.G. 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.
  8. Shah N.A.,Yaggi H.K., Concato J. et al. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath. 2010; 14: 131–6.
  9. Redline S., Yenokyan G., Gottlieb D.J. et al. Obstructive sleep apnea hypopnea and incident stroke: the sleep heart health study. Am. J. Respir. Crit. Care Med. 2010; 182: 269–77.
  10. Selim B., Won C., Yaggi H.K. Cardiovascular consequences of sleep apnea. Clin. Chest. Med. 2010; 31: 203–20.
  11. Guimara~es C.I., Martins M.V., Vaz Rodrigues L. et al. Epworth sleepiness scale in obstructive sleep apnea syndrome – an underestimated subjective scale. Rev. Port. Pneumol. 2012; 18 (6): 267–71. DOI: 10.1016/j.rppneu.2012.04.009.
  12. Peker Y., Glantz H., Eulenburg C., Wegscheider K., Herlitz J., Thunström E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA randomized controlled trial. Am. J. Respir. Crit. Care Med. 2016; 194 (5): 613–20. DOI: 10.1164/rccm.201601-0088OC.
  13. McNicholas W.T., Bonsigore M.R. Management Committee of EU COST ACTION B26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur. Respir. J. 2007; 29 (1): 156–78.
  14. Duong-Quy S. Endothelial dysfunction in patients with obstructive sleep apnea (OSA). J. Vasc. Med. Surg. 2015; 3: e116. DOI: 10.4172/ 2329-6925.1000 e116.
  15. Kadohira T., Kobayashi Y., Iwata Y. et al. Coronary artery endothelial dysfunction associated with sleep apnea. Angiology. 2011; 62 (5): 397–400.
  16. Kasai T., Floras J.S., Bradley T.D. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation. 2012; 126: 1495–510.
  17. Bliwise D., Kryger M.H., Roth Т. et al. Principles and practice of sleep medicine. Philadelphia: Saunders Company; 2005: 22–38.
  18. Koskenvuo М., Kaprio J., Telakivi T. et at. Snoring as a risk factor for ischemic heart disease and stroke in men. Br. Med. J. 1987; 294: 16–19.
  19. Peppard P.E. et al. Longitudinal study of moderate weight change and sleep disordered breathing. JAMA. 2000; 282: 3015–21.
  20. Mokhlesi B., Ayas N.T. Cardiovascular events in obstructive sleep apnea – can CPAP therapy SAVE lives? N. Engl. J. Med. 2016; 375: 994–6. DOI: 10.1056/NEJMe1609704.
  21. Minnerup J., Ritter M., Wersching H., Kemmling A., Okegwo A., Schmidt A. et al. Continuous positive airway pressure ventilation for acute ischemic stroke: a randomized feasibility study. Stroke. 2012; 43: 1137–9.
  22. Monahan K., Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr. Op. Cardiol. 2011; 26 (6): 541–7.
  23. Peppard P.E., Young T., Palta M., Skatrud J. Prospective study of the association between sleepdisordered breathing and hypertension. N. Engl. J. Med. 2000; 342 (19): 1378–84.
  24. Reichmuth K.J., Austin D., Skatrud J.B. et al. Association of sleep apnea and type II diabetes: a population-based study. Am. J. Resp. Crit. Care Med. 2005; 172 (12): 1590–5.
  25. Adedayo A.M., Olafiranye O., Smith D. et al. Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism. Sleep Breath. 2014; 18 (1): 13–8. DOI: 10.1007/s11325-012-0760-9.
  26. Lam J.C., Mak J.C., Ip M.S. Obesity, obstructive sleep apnoea and metabolic syndrome. Respirology. 2012; 17 (2): 223–36.
  27. Mazaki T., Kasai T., Yokoi H. et al. Impact of sleepdisordered breathing on long-term outcomes in patients with acute coronary syndrome who have undergone primary percutaneous coronary intervention. J. Am. Heart Assoc. 2016; 5: e003270. DOI: 10.1161/JAHA.116.003270.
  28. Zhai A.B., Yip A., Haddad H. Heart failure and sleep-disordered breathing. Curr. Op. Cardiol. 2016; 31 (2): 224–8. DOI: 10.1097/ HCO.0000000000000263.
  29. Mehra R., Benjamin E.J., Shahar E. et al. Association of nocturnal arrhythmias with sleepdisordered breathing: The sleep heart health study. Am. J. Respir. Crit. Care Med. 2006; 173 (8): 910–6. .
  30. Yamauchi M., Nakano H., Maekawa J. et al. Oxidative stress in obstructive sleep apnea. Chest. 2005; 127 (5): 1674–9.
  31. Cintra F.D., Leite R.P., Storti L.J. et al. Sleep apnea and nocturnal cardiac arrhythmia: a populational study. Arg. Bras. Cardiol. 2014; 103 (5); 368–74.
  32. Fein A.S., Shvilkin A., Shah D., Haffajee C.I., Das S., Kumar K. et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence following catheter ablation. J. Am. Coll. Cardiol. 2013; 62 (4): 300–5.
  33. Mazza A., Bendini M.G., Cristofori M., Nardi S., Leggio M., de Cristofaro R. et al. Baseline apnoea/ hypopnoea index and high-sensitivity C-reactive protein for the risk of recurrence of atrial fibrillation after successful electrical cardioversion: a predictive model based upon the multiple effects of significant variables. Europace. 2009; 11: 902–9.
  34. Holmqvist F., Guan N., Zhu Z., Kowey P.R., Allen L.A., Fonarow G.C. et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am. Heart J. 2015; 169 (5): 647–54.e2. DOI: 10.1016/j.ahj.2014.12.024.
  35. Matiello M., Nadal M., Tamborero D. et al. Low efficacy of atrial fibrillation ablation in severe obstructive sleep apnoea patiens. Europace. 2010; 12 (8): 1084–9.
  36. Shukla А., Aizer A., Holmes D., Fowler S., Park D.S., Bernstein S. et al. Effect of obstructive sleep apnea treatment on atrial fibrillation recurrence. A meta-analysis. JACCCEP. 2015; 1 (1): 41–51. DOI: 10.1016/j.jacep.2015.02.014.
  37.  Fichter J., Bauer D., Arampatzis S. et al. Sleeprelated breathing disodersare associated with ventricular arrhythmias in patients with an implantable cardioverter-defibrillator. Chest. 2002; 122 (2): 558–61.
  38. Botros N., Concato J., Mohsenin V. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am. J. Med. 2009. 122 (12): 1122–7.
  39. Punjabi N.M., Shahar E., Redline S. et al. Sleepdisordered breathing, glucose intolerance, and insulin resistance: the sleep heart health study. Am. J. Epidemiol. 2004; 160 (6): 521–30.
  40. Cass A.R., Alonso W.J., Islam J., Weller S.C. Risk of obstructive sleep apnea in patients with type 2 diabetes mellitus. Fam. Med. 2013; 45 (7): 492–500.
  41. Rasche K., Keller T., Hader C., Leidag M., Prinz C. Impact of obstructive sleep apnoea on type 2 diabetes and vice versa. Eur. Endocrinol. 2013; 9 (2): 107–9. DOI: 10.17925/EE.2013.09.02.107.
  42.  Ge X., Han F., Huang Y. et al. Is obstructive sleep apnea associated with cardiovascular and all-cause mortality? PLoS One. 2013; 8 (7): e69432.
  43. Gami A.S., Howard D.E., Olson E.J. et al. Daynight pattern of sudden death in obstructive sleep apnea. N. Engl. J. Med. 2005; 352 (12): 1206–14.
  44.  Haentjens P., Van Meerhaeghe A., Moscariello A. et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch. Intern. Med. 2007; 167: 757–64.
  45. Yaggi H.K., Mittleman M.A., Bravata D.M. et al. Reducing cardiovascular risk through treatment of obstructive sleep apnea: two methodological approaches. Am. Heart J. 2015; 172: 135–43. DOI: 10.1016/j.ahj.2015.07.033.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery