Advertisement

The Link Between Obstructive Sleep Apnea and Cardiovascular Disease

  • Fré Bauters
  • Ernst R. Rietzschel
  • Katrien B. C. Hertegonne
  • Julio A. ChirinosEmail author
Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Heart Disease

Abstract

Obstructive sleep apnea (OSA) is common in the general population and highly prevalent in patients with cardiovascular disease. In this paper, we review (1) the pathophysiological mechanisms of OSA that may causally contribute to cardiovascular disease; (2) current evidence regarding the association between OSA and hypertension, stroke, ischemic heart disease, heart failure, atrial fibrillation, and cardiovascular mortality; and (3) the impact of continuous positive airway pressure (CPAP) treatment on cardiovascular risk factors and outcomes. We emphasize the importance of obesity as a comorbidity of OSA and a confounder in the association between OSA and cardiovascular disease. We also discuss the importance of addressing obesity in patients with OSA, as a strategy to reduce the burden of cardiovascular risk factors in this population. Implications for the approach of patients’ OSA in clinical practice and future research directions are discussed.

Keywords

Obstructive sleep apnea Cardiovascular disease Continuous positive airway pressure Hypertension Obesity Inflammation 

Notes

Compliance with Ethical Standards

Conflict of Interest

Fré Bauters, Ernst R. Rietzschel, and Katrien B.C. Hertegonne declare that they have no conflict of interest.

Julio A. Chirinos declares personal consulting fees from Brystol Myers Squibb, OPKO Healthcare, Fukuda Denshi, and Merck; grants from National Institutes of Health, American College of Radiology Network, and Fukuda Denshi; and a device loan from Atcor Medical and declares a patent pending with U. of Penn for the use of inorganic nitrates/nitrites for the treatment of HFpEF.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA :J Am Med Assoc. 2004;291(16):2013–6.CrossRefGoogle Scholar
  2. 2.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.CrossRefPubMedGoogle Scholar
  3. 3.
    He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest. 1988;94(1):9–14.CrossRefPubMedGoogle Scholar
  4. 4.
    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(4):352–60.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    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(2):269–77.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O’Connor GT, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    McNicholas WT, Bonsigore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J. 2007;29(1):156–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Ryan S, Taylor CT, McNicholas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J. 2009;85(1010):693–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Jones A, Vennelle M, Connell M, McKillop G, Newby DE, Douglas NJ, et al. Arterial stiffness and endothelial function in obstructive sleep apnoea/hypopnoea syndrome. Sleep Med. 2013;14(5):428–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–904.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Beaudin AE, Waltz X, Pun M, Wynne-Edwards KE, Ahmed SB, Anderson TJ, et al. Human intermittent hypoxia-induced respiratory plasticity is not caused by inflammation. Eur Respir J. 2015.Google Scholar
  13. 13.
    Sahlman J, Miettinen K, Peuhkurinen K, Seppa J, Peltonen M, Herder C, et al. The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea. J Sleep Res. 2010;19(2):341–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):625–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, 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(8):1129–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Ryan S, Taylor CT, McNicholas WT. Predictors of elevated nuclear factor-kappaB-dependent genes in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2006;174(7):824–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Ishida K, Kato M, Kato Y, Yanagihara K, Kinugasa Y, Kotani K, et al. Appropriate use of nasal continuous positive airway pressure decreases elevated C-reactive protein in patients with obstructive sleep apnea. Chest. 2009;136(1):125–9.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.••
    Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370(24):2265–75. This randomized controlled trial demonstrated that weight loss alone but not CPAP alone is associated with reductions in CRP levels, insulin resistance, and serum triglyceride levels in obese patients with OSA. There was incremental benefit of weight loss combined with CPAP versus CPAP only on these end points, but there was no incremental benefit of combined therapy over weight loss only. In contrast, both weight loss and CPAP reduced blood pressure, and the combination was more effective than either therapy alone. PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.•
    Kritikou I, Basta M, Vgontzas AN, Pejovic S, Liao D, Tsaoussoglou M, et al. Sleep apnoea, sleepiness, inflammation and insulin resistance in middle-aged males and females. Eur Respir J. 2014;43(1):145–55. RCT on the impact of short-term CPAP on inflammatory markers and insulin resistance.CrossRefPubMedGoogle Scholar
  20. 20.
    Sharma SK, Mishra HK, Sharma H, Goel A, Sreenivas V, Gulati V, et al. Obesity, and not obstructive sleep apnea, is responsible for increased serum hs-CRP levels in patients with sleep-disordered breathing in Delhi. Sleep Med. 2008;9(2):149–56.CrossRefPubMedGoogle Scholar
  21. 21.••
    Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, Babineau DC, et al. CPAP versus oxygen in obstructive sleep apnea. N Engl J Med. 2014;370(24):2276–85. Recent RCT demonstrated that in patients with CVD or multiple CV risk factors, CPAP but not nocturnal oxygen reduced blood pressure. Hypoxia alone does not explain high blood pressure in sleep apnea. PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Mansukhani MP, Kara T, Caples SM, Somers VK. Chemoreflexes, sleep apnea, and sympathetic dysregulation. Curr Hypertens Rep. 2014;16(9):476.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Xie A, Skatrud JB, Puleo DS, Morgan BJ. Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol. 2001;91(4):1555–62.PubMedGoogle Scholar
  24. 24.
    Tamisier R, Pepin JL, Remy J, Baguet JP, Taylor JA, Weiss JW, et al. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J. 2011;37(1):119–28.CrossRefPubMedGoogle Scholar
  25. 25.
    Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009;373(9657):82–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Imadojemu VA, Mawji Z, Kunselman A, Gray KS, Hogeman CS, Leuenberger UA. Sympathetic chemoreflex responses in obstructive sleep apnea and effects of continuous positive airway pressure therapy. Chest. 2007;131(5):1406–13.CrossRefPubMedGoogle Scholar
  27. 27.
    Ringler J, Basner RC, Shannon R, Schwartzstein R, Manning H, Weinberger SE, et al. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol (1985). 1990;69(6):2143–8.Google Scholar
  28. 28.
    Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569–76.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Yang D, Liu Z, Yang H, Luo Q. Effects of continuous positive airway pressure on glycemic control and insulin resistance in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath = Schlaf Atmung. 2013;17(1):33–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Lindberg E, Theorell-Haglow J, Svensson M, Gislason T, Berne C, Janson C. Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample. Chest. 2012;142(4):935–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Pamidi S, Wroblewski K, Broussard J, Day A, Hanlon EC, Abraham V, et al. Obstructive sleep apnea in young lean men: impact on insulin sensitivity and secretion. Diabetes Care. 2012;35(11):2384–9.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Adedayo AM, Olafiranye O, Smith D, Hill A, Zizi F, Brown C, et al. Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism. Sleep Breath = Schlaf Atmung. 2014;18(1):13–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia: implications for atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2010;17(2):161–5.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004;169(3):348–53.CrossRefPubMedGoogle Scholar
  36. 36.
    Jelic S, Lederer DJ, Adams T, Padeletti M, Colombo PC, Factor PH, et al. Vascular inflammation in obesity and sleep apnea. Circulation. 2010;121(8):1014–21.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Kohler M, Craig S, Nicoll D, Leeson P, Davies RJ, Stradling JR. Endothelial function and arterial stiffness in minimally symptomatic obstructive sleep apnea. Am J Respir Crit Care Med. 2008;178(9):984–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Namtvedt SK, Hisdal J, Randby A, Agewall S, Stranden E, Somers VK, et al. Impaired endothelial function in persons with obstructive sleep apnoea: impact of obesity. Heart. 2013;99(1):30–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Tavil Y, Kanbay A, Sen N, Ulukavak Ciftci T, Abaci A, Yalcin MR, et al. The relationship between aortic stiffness and cardiac function in patients with obstructive sleep apnea, independently from systemic hypertension. J Am Soc Echocardiograph : Off Public Am Soc Echocardiograph. 2007;20(4):366–72.CrossRefGoogle Scholar
  40. 40.
    Keles T, Durmaz T, Bayram NA, Ciftci B, Yeter E, Akcay M, et al. Effect of continuous positive airway pressure therapy on aortic stiffness in patients with obstructive sleep apnea syndrome. Echocardiography. 2009;26(10):1217–24.CrossRefPubMedGoogle Scholar
  41. 41.
    Phillips CL, Butlin M, Wong KK, Avolio AP. Is obstructive sleep apnoea causally related to arterial stiffness? A critical review of the experimental evidence. Sleep Med Rev. 2013;17(1):7–18.CrossRefPubMedGoogle Scholar
  42. 42.
    Stein JH, Stern R, Barnet JH, Korcarz CE, Hagen EW, Young T, et al. Relationships between sleep apnea, cardiovascular disease risk factors, and aortic pulse wave velocity over 18 years: the Wisconsin Sleep Cohort. Sleep & breathing = Schlaf & Atmung. 2015.Google Scholar
  43. 43.
    Koshino Y, Villarraga HR, Orban M, Bruce CJ, Pressman GS, Leinveber P, et al. Changes in left and right ventricular mechanics during the Mueller maneuver in healthy adults: a possible mechanism for abnormal cardiac function in patients with obstructive sleep apnea. Circulat Cardiovasc Imag. 2010;3(3):282–9.CrossRefGoogle Scholar
  44. 44.
    Tkacova R, McNicholas WT, Javorsky M, Fietze I, Sliwinski P, Parati G, et al. Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. Eur Respir J. 2014;44(4):931–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA : J Am Med Assoc. 2000;283(14):1829–36.CrossRefGoogle Scholar
  46. 46.
    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(19):1378–84.CrossRefPubMedGoogle Scholar
  47. 47.
    Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA :J Am Med Assoc. 2012;307(20):2169–76.CrossRefGoogle Scholar
  48. 48.
    Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, Miranda-Serrano E, Rubio R, Martinez-Null C, et al. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med. 2011;184(11):1299–304.CrossRefPubMedGoogle Scholar
  49. 49.
    O’Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179(12):1159–64.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Brooks D, Horner RL, Kozar LF, Render-Teixeira CL, Phillipson EA. Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. J Clin Invest. 1997;99(1):106–9.PubMedCentralCrossRefPubMedGoogle Scholar
  51. 51.
    Pinto JM, Garpestad E, Weiss JW, Bergau DM, Kirby DA. Hemodynamic changes associated with obstructive sleep apnea followed by arousal in a porcine model. J Appl Physiol (1985). 1993;75(4):1439–43.Google Scholar
  52. 52.
    O’Donnell CP, King ED, Schwartz AR, Robotham JL, Smith PL. Relationship between blood pressure and airway obstruction during sleep in the dog. J Appl Physiol (1985). 1994;77(4):1819–28.Google Scholar
  53. 53.
    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(2):417–23.CrossRefPubMedGoogle Scholar
  54. 54.•
    Duran-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Teran-Santos J, Aguirregomoscorta JI, et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010;341:c5991. RCT in patients with OSA (AHI >15 per hour) and hypertension, randomized in CPAP versus control (sham-CPAP) treatment for 3 months. Small but significant reductions in blood pressure were observed. CrossRefPubMedGoogle Scholar
  55. 55.••
    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(7):718–26. Randomized trial in hypertensive OSA patients receiving CPAP versus conservative therapy for 1 year. BP only decreased in patients using their CPAP for at least 5.6 h per night. CrossRefPubMedGoogle Scholar
  56. 56.
    Jones A, Vennelle M, Connell M, McKillop G, Newby DE, Douglas NJ, et al. The effect of continuous positive airway pressure therapy on arterial stiffness and endothelial function in obstructive sleep apnea: a randomized controlled trial in patients without cardiovascular disease. Sleep Med. 2013;14(12):1260–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective SC. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.CrossRefPubMedGoogle Scholar
  58. 58.
    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(3):549–55.CrossRefPubMedGoogle Scholar
  59. 59.
    Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med : JCSM : Off Public Am Acad Sleep Med. 2010;6(2):131–7.Google Scholar
  60. 60.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.CrossRefPubMedGoogle Scholar
  61. 61.
    Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med. 2008;168(3):297–301.CrossRefPubMedGoogle Scholar
  62. 62.
    Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37(4):967–72.CrossRefPubMedGoogle Scholar
  63. 63.
    Parra O, Sanchez-Armengol A, Bonnin M, Arboix A, Campos-Rodriguez F, Perez-Ronchel J, et al. Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial. Eur Respir J. 2011;37(5):1128–36.CrossRefPubMedGoogle Scholar
  64. 64.•
    Parra O, Sanchez-Armengol A, Capote F, Bonnin M, Arboix A, Campos-Rodriguez F, et al. Efficacy of continuous positive airway pressure treatment on 5-year survival in patients with ischaemic stroke and obstructive sleep apnea: a randomized controlled trial. J Sleep Res. 2015;24(1):47–53. RCT on effect of CPAP on cardiovascular outcomes and mortality in stroke patients with AHI ≥20 per hour.CrossRefPubMedGoogle Scholar
  65. 65.
    Xie W, Zheng F, Song X. Obstructive sleep apnea and serious adverse outcomes in patients with cardiovascular or cerebrovascular disease: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2014;93(29):e336.CrossRefGoogle Scholar
  66. 66.
    Yumino D, Tsurumi Y, Takagi A, Suzuki K, Kasanuki H. Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol. 2007;99(1):26–30.CrossRefPubMedGoogle Scholar
  67. 67.
    Peker Y, Hedner J, Kraiczi H, Loth S. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med. 2000;162(1):81–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Lee CH, Khoo SM, Chan MY, Wong HB, Low AF, Phua QH, et al. Severe obstructive sleep apnea and outcomes following myocardial infarction. J Clin Sleep Med : JCSM : Off Public Am Acad Sleep Med. 2011;7(6):616–21.Google Scholar
  69. 69.
    Lee CH, Khoo SM, Tai BC, Chong EY, Lau C, Than Y, et al. Obstructive sleep apnea in patients admitted for acute myocardial infarction. Prevalence, predictors, and effect on microvascular perfusion. Chest. 2009;135(6):1488–95.CrossRefPubMedGoogle Scholar
  70. 70.
    Won CH, Chun HJ, Chandra SM, Sarinas PS, Chitkara RK, Heidenreich PA. Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury. Sleep Breath = Schlaf Atmung. 2013;17(1):85–91.CrossRefPubMedGoogle Scholar
  71. 71.
    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(6):521–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.CrossRefPubMedGoogle Scholar
  73. 73.
    Ludka O, Stepanova R, Vyskocilova M, Galkova L, Mikolaskova M, Belehrad M, et al. Sleep apnea prevalence in acute myocardial infarction--the Sleep Apnea in Post-acute Myocardial Infarction Patients (SAPAMI) Study. Int J Cardiol. 2014;176(1):13–9.PubMedCentralCrossRefPubMedGoogle Scholar
  74. 74.
    Milleron O, Pilliere R, Foucher A, de Roquefeuil F, Aegerter P, Jondeau G, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J. 2004;25(9):728–34.CrossRefPubMedGoogle Scholar
  75. 75.
    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(2):1328–35.CrossRefPubMedGoogle Scholar
  76. 76.
    Capodanno D, Milazzo G, Cumbo M, Marchese A, Salemi A, Quartarone L, et al. Positive airway pressure in patients with coronary artery disease and obstructive sleep apnea syndrome. J Cardiovasc Med (Hagerstown). 2014;15(5):402–6.CrossRefGoogle Scholar
  77. 77.
    Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52(5):490–4.CrossRefPubMedGoogle Scholar
  78. 78.
    Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6.PubMedCentralCrossRefPubMedGoogle Scholar
  79. 79.
    Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565–71.CrossRefPubMedGoogle Scholar
  80. 80.
    Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589–94.PubMedGoogle Scholar
  81. 81.
    Ng CY, Liu T, Shehata M, Stevens S, Chugh SS, Wang X. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108(1):47–51.CrossRefPubMedGoogle Scholar
  82. 82.
    Fein AS, Shvilkin A, Shah D, Haffajee CI, Das S, Kumar K, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2013;62(4):300–5.CrossRefPubMedGoogle Scholar
  83. 83.
    Holmqvist F, Guan N, Zhu Z, Kowey PR, Allen LA, Fonarow GC, et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2015;169(5):647–54. e2.CrossRefPubMedGoogle Scholar
  84. 84.
    Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49(15):1625–31.CrossRefPubMedGoogle Scholar
  85. 85.
    Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, et al. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015;36(23):1463–9.CrossRefPubMedGoogle Scholar
  86. 86.
    Nakamura S, Asai K, Kubota Y, Murai K, Takano H, Tsukada YT, et al. Impact of sleep-disordered breathing and efficacy of positive airway pressure on mortality in patients with chronic heart failure and sleep-disordered breathing: a meta-analysis. Clin Res Cardiol. 2015;104(3):208–16.CrossRefPubMedGoogle Scholar
  87. 87.
    Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348(13):1233–41.CrossRefPubMedGoogle Scholar
  88. 88.
    Yoshinaga K, Burwash IG, Leech JA, Haddad H, Johnson CB, deKemp RA. The effects of continuous positive airway pressure on myocardial energetics in patients with heart failure and obstructive sleep apnea. J Am Coll Cardiol. 2007;49(4):450–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Egea CJ, Aizpuru F, Pinto JA, Ayuela JM, Ballester E, Zamarron C, et al. Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study. Sleep Med. 2008;9(6):660–6.CrossRefPubMedGoogle Scholar
  90. 90.
    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(9464):1046–53.CrossRefPubMedGoogle Scholar
  91. 91.
    Jennum P, Tonnesen P, Ibsen R, Kjellberg J. All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment: a registry study with 10 years of follow-up. Nat Sci Sleep. 2015;7:43–50.PubMedCentralCrossRefPubMedGoogle Scholar
  92. 92.
    Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.CrossRefPubMedGoogle Scholar
  93. 93.
    Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace : Europ Pacing, Arrhythmias, Cardiac Electrophysiol : J Work Groups Cardiac Pacing, Arrhythmias, Cardiac Cell Electrophysiol Europ Soc Cardiol. 2012;14(4):528–606.CrossRefGoogle Scholar
  94. 94.
    Yaggi HK. Science as observation and experiment: examining the role of sleep apnea and continuous positive airway pressure treatment in cardiovascular outcomes. Am J Respir Crit Care Med. 2014;189(12):1459–60.CrossRefPubMedGoogle Scholar
  95. 95.
    Rietzschel ER, De Buyzere ML, Bekaert S, Segers P, De Bacquer D, Cooman L, et al. Rationale, design, methods and baseline characteristics of the Asklepios Study. Europ J Cardiovasc Prevent Rehab : Off J Europ Soc Cardiol, Work Groups Epidemiol & Prevent Cardiac Rehab Exer Physiol. 2007;14(2):179–91.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Fré Bauters
    • 1
  • Ernst R. Rietzschel
    • 1
  • Katrien B. C. Hertegonne
    • 1
  • Julio A. Chirinos
    • 1
    • 2
    Email author
  1. 1.Ghent University HospitalGhentBelgium
  2. 2.Hospital of the University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations