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OSA and Cardio vascular Disease

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Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is associated with a variety of cardiovascular diseases and is an established cardiovascular risk factor, while treatment with continuous positive airway pressure (CPAP) improves overall survival in patients with severe OSA. This chapter will provide an overview of the epidemiology, pathophysiology, and treatment of the most prevalent and important cardiovascular diseases in patients with OSA:

  • Arterial hypertension is encountered in 50%–60% of patients with OSA, and OSA is significant cause of resistant arterial hypertension. Besides lifestyle modification and pharmacological treatment, CPAP treatment can reduce blood pressure in these patients.

  • Around half of heart failure patients have sleep apnea, which is associated with higher cardiovascular events and mortality rates. CPAP treatment can improve left ventricular function, but randomized controlled trials failed to show a cardiovascular event-free survival benefit in these patients.

  • Atrial fibrillation is found in up to 20% of patients with severe OSA. Since atrial fibrillation is often paroxysmal, longer-term monitoring may be considered when screening for this condition. Rhythm control strategies, including pharmacological treatment, cardioversion, and ablation, have higher success rates if patients are treated with CPAP therapy.

  • OSA is associated with ventricular arrhythmia and sudden cardiac death. Observational data have shown that termination of CPAP is associated with higher all-cause mortality. However, further prospective randomized controlled trials are needed to confirm the survival benefit of CPAP therapy in patients with OSA.

These cardiovascular implications of OSA share common pathophysiological pathways, including autonomic dysfunction with increased sympathetic nerve activity, inflammation, metabolic dysregulation, hypoxia, oxidative stress, endothelial dysfunction, and intrathoracic pressure swings.

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Correspondence to Caroline M. Van De Heyning .

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Van De Heyning, C.M., Pype, L.L., Miljoen, H. (2023). OSA and Cardio vascular Disease. In: Baptista, P.M., Lugo Saldaña, R., Amado, S. (eds) Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-031-35225-6_9

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