Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2011 Nov;26(6):541-7.
doi: 10.1097/HCO.0b013e32834b806a.

Role of obstructive sleep apnea in cardiovascular disease

Ken Monahan  1 , Susan Redline
Affiliations
Review

Role of obstructive sleep apnea in cardiovascular disease

Ken Monahan et al. Curr Opin Cardiol. 2011 Nov.

Abstract

Purpose of review: To provide an update on the connection between obstructive sleep apnea (OSA) and cardiovascular disease.

Recent findings: Large prospective studies have established that OSA is associated with an increased incidence of hypertension and, in men, of coronary disease, stroke, and heart failure. Advances in understanding the pathophysiologic basis for these associations include identification of a role for OSA in inducing abnormalities in hepatic lipid-metabolizing enzymes, endothelial dysfunction, and upregulation of pro-inflammatory and pro-thrombotic mediators. A large body of data implicates OSA as playing a significant role in the occurrence and resistance to treatment of atrial fibrillation. Clinical trials have shown small-to-modest improvements in blood pressure associated with continuous positive airway pressure (CPAP) use, with smaller or uncontrolled studies suggesting that CPAP may improve cardiovascular outcomes or intermediate markers.

Summary: OSA and cardiovascular disease commonly co-aggregate. Multiple studies indicate that OSA contributes to or exacerbates cardiovascular disease, and thus may be a novel target for cardiovascular risk reduction. Although the evidence supports screening and treatment of OSA in patients at risk for cardiovascular disease, it also underscores a need for well powered clinical trials to examine the role of CPAP and other therapies in these populations.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

Dr Monahan reports no conflicts.

References

Background

    1. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5. - PubMed
    1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39. - PubMed
    1. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–1836. - PubMed
    1. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep–disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. - PubMed
    1. Marin JM, Corrizo SJ, Vicente E, Agusti AGN. 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;365:1046–53. - PubMed

CHD risk factors

    1. Sulit L, Storfer-Isser A, Kirchner HL, Redline S. Differences in polysomnography predictors for hypertension and impaired glucose tolerance. Sleep. 2006;29:777–83. - PubMed
    1. Gonzaga CC, Gaddam KK, Ahmed MI, et al. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med. 2010;6:363–8. - PMC - PubMed
    1. DiMurro A, Petramala L, Cotesta D, et al. Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism. J Renin Angiotensin Aldosterone Syst. 2010;11:165–72. - PubMed
    1. Gaddam K, Pimenta E, Thomas SJ, et al. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010;24:532–7. Pilot study demonstrating that in those with hyperaldosteronism and OSA, treatment with spironolactone can reduce AHI and improve nocturnal hypoxia, even in the absence of CPAP therapy. - PMC - PubMed
    1. Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;121:1598–605. Provocative demonstration of how nocturnal displacement of fluid from the legs to the neck worsens OSA in those with heart failure; the effect is attenuated by CPAP. Thus, the study points to a new mechanism that may link, bi-directionally, the association between heart failure and OSA. - PubMed

CHD AND Stroke

    1. Konecny T, Kuniyoshi FAS, Orban M, et al. Under-diagnosis of sleep apnea in patients after acute myocardial infarction. J Am Coll Cardiol. 2010;56:742–3. - PMC - PubMed
    1. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med. 2009;6:e1000132. A key SHHS outcome study demonstrating that OSA is associated with an increase in all-cause and CHD-related mortality in men. - PMC - PubMed
    1. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the Sleep Heart Health Study. Circulation. 2010;122:352–60. Akey outcome study from the SHHS that demonstrated an increased risk of incident coronary events and heart failure dueto OSA, particularly in middle-aged men. - PMC - PubMed
    1. Shah NA, Yaggi HK, Concato J, Mohsenin V. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath. 2010;14:131–6. - PubMed
    1. Chami HA, Resnick HE, Quan SF, Gottlieb DJ. Association of incident cardiovascular disease with progression of sleep-disordered breathing. Circulation. 2011;123:1280–6. - PMC - PubMed

Heart Failure/Cardiomyopathy

    1. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154–9. - PubMed
    1. Sin DD, Fitzgerald F, Parker JD, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160:1101–6. - PubMed
    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;49:1625–31. - PubMed
    1. Arias MA, Garcia-Rio F, Alonso-Fernandez A, et al. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005;112:375–383. - PubMed
    1. Kaneko Y, Floras JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348:1233–41. - PubMed

Arrhythmia

    1. Monahan K, Storfer-Isser A, Mehra R, et al. Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol. 2009;54:1797–1804. Novel application of case-cross over analysis that identified a temporal connection between apneic/hypopneic events and the occurrence of paroxysms of AF and NSVT. - PMC - PubMed
    1. Hoyer FF, Lickfett LM, Mittmann-Braun E, et al. High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol. 2010;29:37–41. - PubMed
    1. Chilukuri K, Dalal D, Gadrey S, et al. A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2010;21:521–5. - PubMed
    1. Patel D, Mohanty, DiBiase L, et al. Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circ Arrhythm Electrophysiol. 2010;3:445–51. Large prospective study establishing OSA as a contributor to failure of AF ablation and the improvement of procedural success rates withCPAP therapy. - PubMed
    1. Ng CY, Liu T, Shehata M, et al. Meta-analysis of obstructive sleep apnea as a predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108:47–51. - PubMed

MeSH terms