Importance and Management of Chronic Sleep Apnoea in Cardiology

Perspective:

This review highlights current data on sleep apnea, including associated risks and management. In summary:

1. The prevalence of moderate sleep apnea (apnea-hypopnea index [AHI] >15) is between 1-14%, and one in five adults will have at least mild sleep apnea (AHI >5).

2. The risk for obstructive sleep apnea (OSA) increases with increasing body weight, tobacco use, increasing age, diabetes, alcohol use, and sedative use.

3. Central sleep apnea, also known as Cheyne-Stokes breathing, results in an enhanced chemoreceptor response to PaCO2 leading to large, sudden drops in PaCO2 below apneic thresholds, provoking apneas. It is common in heart failure (HF) and stroke patients.

4. Sleep apnea can lead to stimulation of the sympathetic nervous system, and can cause reactive pulmonary hypertension and high reactive oxygen species levels from hypoxia.

5. Sleep apnea is correlated with hyperlipidemia, hypertension, and nonalcoholic steatohepatitis, but these associations are confounded by obesity in the population.

6. In patients with coronary artery disease, sleep apnea is associated with a 10.7% absolute increase in death, cerebrovascular events, and myocardial infarctions. It is unknown if treatment of sleep apnea definitively reduces risk or reduces angina burden.

7. Sleep apnea is associated with atrial fibrillation, bradyarrhythmias, and ventricular arrhythmias, and patients with OSA are at increased risk for sudden death. Small studies suggest that electrical benefit may be gained from continuous positive airway pressure (CPAP) therapy.

8. Sleep apnea prevalence is 47-76% in patients with systolic and diastolic HF and the treatment of sleep apnea may improve HF symptoms and quality of life. Evidence showing impact of therapy on HF mortality, readmission, etc., is lacking.

9. The development of pulmonary hypertension is not solely related to the severity of sleep apnea. CPAP may have some benefit in reducing pulmonary pressures.

10. The gold standard for diagnosis is monitored polysomnography, but ambulatory systems have been devised with variable sensitivity and specificity.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure, Pulmonary Hypertension, Hypertension, Sleep Apnea

Keywords: Reactive Oxygen Species, Coronary Artery Disease, Hyperlipidemias, Coronary Disease, Weight Gain, Cheyne-Stokes Respiration, Hypertension, Pulmonary, Obesity, Tobacco Use, Hypertension, Death, Sudden, Cardiac, Myocardial Infarction, Stroke, Body Weight, Sleep Apnea Syndromes, Heart Diseases, Quality of Life, Continuous Positive Airway Pressure, Heart Failure, Bradycardia, Fatty Liver, Diabetes Mellitus


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