Obstructive sleep apnea and cardiovascular comorbidities: a large epidemiologic study

Hanna Gilat, Shlomo Vinker, Inon Buda, Ethan Soudry, Michal Shani, Gideon Bachar, Hanna Gilat, Shlomo Vinker, Inon Buda, Ethan Soudry, Michal Shani, Gideon Bachar

Abstract

Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic cessation of airflow for 10 seconds or more. There is growing awareness that OSA is related to the development and progression of cardiovascular disease. However, only a few studies have associated OSA directly to major cardiovascular events. The aim of this study was to evaluate the relationship between OSA and cardiovascular morbidity in a well defined population of patients.The electronic database of the central district of a major health management organization was searched for all patients diagnosed with OSA in 2002-2010. For each patient identified, an age- and sex-matched patient was randomly selected from the members of the same health management organization who did not have OSA. Data on demographics, socioeconomic status, and relevant medical parameters were collected as well.The study population included 2797 patients, average age 58.1, in which 76.6% were males. There was a significant correlation between OSA and the presence of ischemic heart disease (P < 0.001), pulmonary hypertension (P < 0.001), congestive heart failure (P < 0.001), cardiomyopathy (P = 0.003), and arrhythmia (P < 0.001). OSA was also significantly correlated with low socioeconomic status (P < 0.001).OSA and cardiovascular disease were strongly correlated. As such, early diagnosis and treatment of OSA may change the course of both diseases. We suggest that sleep disordered breathing should be routinely assessed in patients with cardiovascular problems. An ear-nose-throat evaluation may also be important to rule out anatomic disorders that cause upper airway obstruction.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

References

    1. Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–689.
    1. Sorajja D, Gami AS, Somers VK, et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest. 2008;133:927–933.
    1. 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;20:705–706.
    1. Somers VK, White DP, Amir R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). J Am Coll Cardiol. 2008;52:686–717.
    1. Caples SM, Somers VK. Sleep disordered breathing and atrial fibrillation. Prog Cardiovasc Dis. 2009;51:411–415.
    1. Chobanian AV, Bakaris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. J Am Med Assoc. 2003;289:2560–2572.
    1. Haenjens 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 of a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167:757–764.
    1. Bazzano LA, Khan Z, Reynolds K, et al. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007;50:417–423.
    1. Alajmi M, Mulgrew AT, Fox J, et al. Impact of continuous positive airway pressure therapy on blood pressure in obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung. 2007;185:67–72.
    1. Deegan PC, McNicholas WT. Pathophysiology of obstructive sleep apnea. Eur Respir J. 1995;8:1161–1178.
    1. Guilleminault C, Tikian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–484.
    1. Stadling JR, Philipson EA. Breathing disorders during sleep. Q J Med. 1986;58:3–18.
    1. Reemers JE, DeGroot WJ, Sauerland EK, et al. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respirat Environ Exerc Physiol. 1978;44:931–938.
    1. Hudgel DW, Hendricks C, Hamilton HB. Characteristics of the upper airway pressure-flow relationship during sleep. J Apl Physiol. 1988;64:1930–1935.
    1. Gilat H, Shpitzer T, Guttman D, et al. Obstructive sleep apnea after radial forearm free flap reconstruction of the oral tongue. Laryngoscope. 2013;12:3223–3226.
    1. Khayat R, Patt B, Hayes D. Obstructive sleep apnea: the new cardiovascular disease. Part 1: obstructive sleep apnea and the pathogenesis of vascular disease. Heart Fail Rev. 2009;14:143–153.
    1. Arzt M, Kleiman J, Carrington M, et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med. 2006;166:1716–1722.
    1. Arzt M, Young T, Peppard PE, et al. Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke. Stroke. 2010;41:e129–e134.
    1. Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease. A bidirectional relationship. Circulation. 2012;126:1495–1510.
    1. Sjostrom C, Lindberg E, Elmasry A, et al. Prevalence of sleep apnoea and snoring in hypertensive men: a population-based study. Thorax. 2002;57:602–607.
    1. Logan AG, Peliikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;1:2271–2277.
    1. Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817.
    1. Logan AG, Tkacova R, Perlikowski SM, et al. Refractory hypertension and sleep apnea: effect of CPAP on blood pressure and baroreflex. Eur Respir J. 2003;21:241–247.
    1. Brooks D, Horner RL, Kozar LF, et al. Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. J Clin Invest. 1997;99:106–109.
    1. Fletcher EC, Lesske J, Behm R, et al. Carotid chemoreceptors, systemic blood pressure, and chronic episodic hypoxia mimicking sleep apnea. J Appl Physiol. 1992;72:1978–1984.
    1. Morgan BJ, Denahan T, Ebert TJ. Neurocirculatory consequences of negative intrathoracic pressure vs. asphyxia during voluntary apnea. J Appl Physiol. 1993;74:2969–2975.
    1. Clavin AD, Somers VK. Obstructive sleep apnea and cardiovascular disease. Curr Opin Cardiol. 2009;24:516–520.
    1. Somers VK, Dyken M, Clary M, et al. Sympathetic ceural mechanisms in obstructive sleep apnea. J Clin Investig. 1995;96:1897–1904.
    1. Chin K, Oji M, Kita H, et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1996;153:1972–1976.
    1. Rangrmark C, Hedner JA, Carlson JT, et al. Platelet function and fibrinolytic activity in hypertensive and normotensive sleep apnea patients. Sleep. 1995;18:188–194.
    1. von Känel R, Loredo JS, Ancoli-Israel S, et al. Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest. 2007;131:733–739.
    1. Shahar E, Whitney CW, Redline S, 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.
    1. Adegunsove A, Ramachandran S. Ethiopathogenic mechanisms of pulmonary hypertension in sleep-related breathing disorders. Pulm Med. 2012;2012:273591.
    1. Golbin JM, Somers VK, Caples SM. Obstructive sleep apnea, cardiovascular disease, and pulmonary hypertension. Proc Am Thor Soc. 2008;5:200–206.
    1. Tuder RM, Abman SH, Braun T, et al. Development and pathology of pulmonary hypertension. J Am Coll Cardiol. 2009;54:s3–s9.
    1. D’Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension: results from a national prospective registry. Ann Intern Med. 1991;115:343–349.
    1. Wang H, Parker JD, Newton GE, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49:1625–1631.
    1. Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol. 2012;45:508–512.
    1. Baranchuk A, Simpson CS, Redfearn DP, et al. It’s time to wake up! Sleep apnea and cardiac arrhythmias. Europace. 2008;10:666.
    1. Hersi AS. Obstructive sleep apnea and cardiac arrhythmias. Ann Thorac Med. 2010;6:10.
    1. Todd K, McIntyre WF, Baranchuk A. Obstructive sleep apnea and atrial fibrillation. Nat Sci Sleep. 2010;2:39.
    1. Kannel WB, Wolf PA, Benjamin EJ. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82:2N.
    1. Atwood CW, McCrory D, Garcia JGN, et al. Pulmonary artery hypertension and sleep-disordered breathing. Chest. 2004;126:72s.
    1. Yaggi KH, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. NEJM. 2005;353:2034–2041.
    1. Marin JM, Carrizo SJ, Vincente E, et al. 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;65:1046–1053.
    1. Melville NA. Average age at first stroke decreases in United States but not Italy. 2010. Accessed July 20, 2014.
    1. Tousignant P, Cosio MG, Levy RD, et al. Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep. 1994;17:52–60.
    1. Chin K, Ohi M, Kita H, et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1996;153:1972–1976.
    1. Kato M, Roberts-Thomson P, Phillips BG, et al. Impairment of endothelium dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation. 2000;102:2607–2610.
    1. Becker HF, Jerrentrup A, Ploch T, et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation. 2003;107:68–73.
    1. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. 2002;359:204–210.
    1. Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107:1129–1134.
    1. Somers VK, Dyken ME, Clary MP, et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96:1897–1904.
    1. Diomedi M, Placidi F, Cupini LM, et al. Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment. Neurology. 1998;51:1051–1056.
    1. Accessed August 10, 2012.

Source: PubMed

3
구독하다