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TOP THINGS TO KNOW
Sleep Apnea and Cardiovascular Disease
1. Obstructive sleep apnea (OSA) is caused by repetitive interruptions of ventilation during sleep due to collapse of the pharyngeal airway.
2. Central sleep apnea (CSA) is caused by repetitive cessation of ventilation during sleep resulting from loss of ventilatory drive.
3. OSA affects 15 million adults, and is more prevalent in men, in obesity, and in patients with cardiovascular disease.
4. OSA has been linked to hypertension, heart failure, atrial fibrillation, stroke, myocardial infarction, and nocturnal sudden death.
5. Many studies confirm a likely role of OSA in hypertension but for other CV diseases, evidence remains circumstantial.
6. CPAP or other treatments including ICD pacing lowers BP modestly in OSA but there are few randomized controlled data of treating OSA in other CV diseases.
7. Whether treatment of OSA reduces cardiovascular events and cardiovascular mortality also remains to be determined.
8. CSA is more common in men, in the elderly, and in patients with heart failure, left ventricular dysfunction, and stroke.
9. Causes of CSA are not well understood, and presence of CSA in heart failure implies poor prognosis.
10. CPAP treatment of CSA in heart failure showed no mortality reduction - whether more effective therapy of CSA improves outcome in heart failure remains to be determined.