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Review
. 2021 Aug 10;78(6):608-624.
doi: 10.1016/j.jacc.2021.05.048.

Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review

Martin R Cowie  1 , Dominik Linz  2 , Susan Redline  3 , Virend K Somers  4 , Anita K Simonds  5
Affiliations
Free article
Review

Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review

Martin R Cowie et al. J Am Coll Cardiol. .
Free article

Abstract

Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.

Keywords: cardiovascular disease; diagnosis; prognosis; sleep apnea; treatment.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Somers is supported by the National Institutes of Health (NIH) grants HL65176 and HL134885. Prof. Cowie has had research funding from and provided consultancy advice to ResMed. Dr Linz’s institution has received on his behalf lecture fees and/or consulting fees and/or research grants from Bayer, LivaNova, and Respicardia. Dr Redline has received grant funding from the NIH and Jazz Pharma; and has received consulting fees from Jazz Pharma, Eisai Inc, Respicardia Inc, and Apnimed Inc. Dr Somers has served as a consultant for Jazz Pharmaceuticals, Respicardia, Sleep Number, and Baker Tilly. Dr Simonds has received research funding from ResMed.

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