Hanyang Med Rev.  2013 Nov;33(4):221-226. 10.7599/hmr.2013.33.4.221.

Sleep Apnea Syndrome and the Cardiovascular Diseases

• Shin J

• KMID: 2284438
• DOI: http://doi.org/10.7599/hmr.2013.33.4.221

Abstract

Sleep apnea syndrome (SAS) has known to be associated with obesity, hypoxemia, sympathetic activation, and hypertension. In addition, SAS is associated with various mechanisms involved in cardiovascular diseases, such as oxidative stress, dyslipidemia, smoking, and psychological stress. In recent prospective observation studies, SAS is known to be a risk factor for cardiovascular diseases, i.e., heart failure, stroke, and coronary artery diseases. The association with heart failure was most evident. In some participants in the longitudinal study applied with continuous positive airway pressure (CPAP) treatment, SAS was not associated with prognosis. With the viewpoints in the current standard of cardiovascular medicine, there seems to be few evidence showing that CPAP treatment could prevent or improve cardiovascular outcome. Detailed review of the limitations of the prospective observational studies suggests that more sophisticated measurement of the clinical outcomes and adjustment of confounding factors will be required in the future studies. And for the clinical application, more evidence of CPAP treatment on the cardiovascular outcomes are mandatory.

Keyword

Sleep Apnea Syndromes; Myocardial Infarction; Stroke; Heart Failure; Hypertension

MeSH Terms

Anoxia
Cardiovascular Diseases*
Continuous Positive Airway Pressure
Coronary Artery Disease
Dyslipidemias
Heart Failure
Hypertension
Longitudinal Studies
Myocardial Infarction
Obesity
Oxidative Stress
Prognosis
Risk Factors
Sleep Apnea Syndromes*
Smoke
Smoking
Stress, Psychological
Stroke
Smoke

Reference

1. Lavie P. Nothing new under the moon. Historical accounts of sleep apnea syndrome. Arch Intern Med. 1984; 144:2025–2028.

2. Remmers JE, de Groot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol. 1978; 44:931–938.

3. Tkacova R, Rankin F, Fitzgerald FS, Floras JS, Bradley TD. Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation. 1998; 98:2269–2275.

4. Ljunggren M, Lindahl B, Theorell-Haglow J, Lindberg E. Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women. Sleep. 2012; 35:1521–1527.

5. Orban M, Bruce CJ, Pressman GS, Leinveber P, Romero-Corral A, Korinek J, et al. Dynamic changes of left ventricular performance and left atrial volume induced by the mueller maneuver in healthy young adults and implications for obstructive sleep apnea, atrial fibrillation, and heart failure. Am J Cardiol. 2008; 102:1557–1561.

6. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000; 160:2289–2295.

7. 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.

8. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011; 365:2277–2286.

9. Barbe F, Duran-Cantolla J, Capote F, de la Pena M, Chiner E, Masa JF, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010; 181:718–726.

10. Goyal SK, Sharma A. Atrial fibrillation in obstructive sleep apnea. World J Cardiol. 2013; 5:157–163.

11. Pepin JL, Tamisier R, Barone-Rochette G, Launois SH, Levy P, Baguet JP. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010; 182:954–960.

12. Dernaika TA, Kinasewitz GT, Tawk MM. Effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea. J Clin Sleep Med. 2009; 5:103–107.

13. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, Merino-Sanchez M, Gonzalez-Benitez MA, Beltran-Robles M, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest. 2006; 129:1459–1467.

14. Drager LF, Pedrosa RP, Diniz PM, Diegues-Silva L, Marcondes B, Couto RB, et al. The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea. Hypertension. 2011; 57:549–555.

15. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens. 2012; 30:633–646.

16. Kallianos A, Trakada G, Papaioannou T, Nikolopouloss I, Mitrakou A, Manios E, et al. Glucose and arterial blood pressure variability in obstructive sleep apnea syndrome. Eur Rev Med Pharmacol Sci. 2013; 17:1932–1937.

17. Drager LF, Lorenzi-Filho G. Is CPAP preventing the long-term progression of arterial stiffness in patients with obstructive sleep apnea? Hypertens Res. 2010; 33:788–789.

18. Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep. 2008; 31:795–800.

19. Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007; 50:417–423.

20. Davies RJ, Stradling JR. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J. 1990; 3:509–514.

21. Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem. 2008; 114:211–223.

22. Volna J, Kemlink D, Kalousova M, Vavrova J, Majerova V, Mestek O, et al. Biochemical oxidative stress-related markers in patients with obstructive sleep apnea. Med Sci Monit. 2011; 17:Cr491–Cr497.

23. de Lima AM, Franco CM, de Castro CM, Bezerra Ade A, Ataide L Jr, Halpern A. Effects of nasal continuous positive airway pressure treatment on oxidative stress and adiponectin levels in obese patients with obstructive sleep apnea. Respiration. 2010; 79:370–376.

24. Simiakakis M, Kapsimalis F, Chaligiannis E, Loukides S, Sitaras N, Alchanatis M. Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS) patients. PLoS One. 2012; 7:e39172.

25. Wang HL, Wang Y, Zhang Y, Chen YD, Wang XC, Liu ZX, et al. Changes in plasma angiotensin II and circadian rhythm of blood pressure in hypertensive patients with sleep apnea syndrome before and after treatment. Chin Med Sci J. 2011; 26:9–13.

26. Carneiro G, Togeiro SM, Ribeiro-Filho FF, Truksinas E, Ribeiro AB, Zanella MT, et al. Continuous positive airway pressure therapy improves hypoadiponectinemia in severe obese men with obstructive sleep apnea without changes in insulin resistance. Metab Syndr Relat Disord. 2009; 7:537–542.

27. Kawano Y, Tamura A, Kadota J. Association between the severity of obstructive sleep apnea and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol. Metabolism. 2012; 61:186–192.

28. Kim KS, Kim JH, Park SY, Won HR, Lee HJ, Yang HS, et al. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J Clin Sleep Med. 2012; 8:367–374.

29. Lavie L, Lavie P. Smoking interacts with sleep apnea to increase cardiovascular risk. Sleep Med. 2008; 9:247–253.

30. Lin YN, Li QY, Zhang XJ. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J (Engl). 2012; 125:3150–3156.

31. Trenchea M, Deleanu O, Suta M, Arghir OC. Smoking, snoring and obstructive sleep apnea. Pneumologia. 2013; 62:52–55.

32. Tuomilehto H, Gylling H, Peltonen M, Martikainen T, Sahlman J, Kokkarinen J, et al. Sustained improvement in mild obstructive sleep apnea after a diet- and physical activity-based lifestyle intervention: postinterventional follow-up. Am J Clin Nutr. 2010; 92:688–696.

33. Collen JF, Lettieri CJ, Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea. J Clin Sleep Med. 2012; 8:667–672.

34. Azevedo Da Silva M, Singh-Manoux A, Shipley MJ, Vahtera J, Brunner EJ, Ferrie JE, et al. Sleep duration and sleep disturbances partly explain the association between depressive symptoms and cardiovascular mortality: the Whitehall II cohort study. J Sleep Res. 2013.

35. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163:19–25.

36. Wachter R, Luthje L, Klemmstein D, Luers C, Stahrenberg R, Edelmann F, et al. Impact of obstructive sleep apnoea on diastolic function. Eur Respir J. 2013; 41:376–383.

37. 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; 365:1046–1053.

38. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008; 31:1071–1078.

39. Shah NA, Yaggi HK, Concato J, Mohsenin V. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath. 2010; 14:131–136.

40. Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010; 122:352–360.

41. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010; 182:269–277.

42. Yeboah J, Redline S, Johnson C, Tracy R, Ouyang P, Blumenthal RS, et al. Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis. 2011; 219:963–968.

43. Johansson P, Alehagen U, Ulander M, Svanborg E, Dahlstrom U, Brostrom A. Sleep disordered breathing in community dwelling elderly: associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up. Sleep Med. 2011; 12:748–753.

44. Mehra R, Principe-Rodriguez K, Kirchner HL, Strohl KP. Sleep apnea in acute coronary syndrome: high prevalence but low impact on 6-month outcome. Sleep Med. 2006; 7:521–528.

45. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012; 156:115–122.

46. Martinez-Garcia MA, Campos-Rodriguez F, Catalan-Serra P, Soler-Cataluna JJ, Almeida-Gonzalez C, De la Cruz Moron I, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med. 2012; 186:909–916.

47. Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009; 180:36–41.

48. Garcia-Rio F, Alonso-Fernandez A, Armada E, Mediano O, Lores V, Rojo B, et al. CPAP effect on recurrent episodes in patients with sleep apnea and myocardial infarction. Int J Cardiol. 2013; 168:1328–1335.

49. Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol. 2011; 57:119–127.

50. Sjöström L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012; 307:56–65.