Advertisement

Efficacy of Continuous Positive Airway Pressure in Cardiovascular Complications of Obstructive Sleep Apnea

  • Ahmed S. BaHammamEmail author
  • Mohammed K. A. Chaudhry
Chapter

Abstract

Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) that is characterized by intermittent complete or partial collapse of the upper airway. This pattern of breathing has been considered a cause for several cardiovascular diseases, such as systemic hypertension, heart failure, arrhythmias, myocardial infarction, and pulmonary hypertension. The prevalence of OSA in the middle-aged population was first estimated in 1993 by the ongoing population-based Wisconsin Sleep Cohort Study [1] in a sample of 625 employed adults. The investigators found that 9% of women and 24% of men had at least five or more apneas or hypopneas per hour of sleep [1]. When the presence of extreme daytime sleepiness was included as a criterion, the prevalence was estimated to be 2% in women and 4% in men [1]. The incidence of SDB is independently influenced by age, sex, waist–hip ratio, and body mass index (BMI). The correlation between OSA and cardiovascular diseases has been well studied, and a linear relationship between severity of OSA and the comorbidities has been reported [2, 3]. The famous Sleep Heart Health Study revealed that the relative odds of heart failure, stroke, and coronary artery disease (CAD) (upper vs. lower apnea–hypopnea index [AHI] quartile) were 2.38, 1.58, and 1.27, respectively [3]. In this chapter, we review the best-available evidence supporting the use of continuous positive airway pressure (CPAP) in OSA patients with hypertension, CAD, heart failure, pulmonary hypertension, and stroke.

Keywords

Obstructive Sleep Apnea Left Ventricular Ejection Fraction Continuous Positive Airway Pressure Pulmonary Arterial Hypertension Obstructive Sleep Apnea Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  2. 2.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283(14):1829–1836PubMedCrossRefGoogle Scholar
  3. 3.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163(1):19–25PubMedGoogle Scholar
  4. 4.
    Lavie L (2003) Obstructive sleep apnoea syndrome – an oxidative stress disorder. Sleep Med Rev 7(1):35–51PubMedCrossRefGoogle Scholar
  5. 5.
    Somers V, Javaheri S (2005) Cardiovascular effects of sleep-related breathing disorders. In: Kryger MH, Roth T, Dement WC (eds) Principles and practices of sleep medicine, 4th edn. Saunders, Philadelphia, pp 1180–1191CrossRefGoogle Scholar
  6. 6.
    Ziegler MG, Mills PJ, Loredo JS, Ancoli-Israel S, Dimsdale JE (2001) Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest 120(3):887–893PubMedCrossRefGoogle Scholar
  7. 7.
    Ryan S, Taylor CT, McNicholas WT (2005) Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 112(17):2660–2667PubMedCrossRefGoogle Scholar
  8. 8.
    Ip MS, Tse HF, Lam B, Tsang KW, Lam WK (2004) Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 169(3):348–353PubMedCrossRefGoogle Scholar
  9. 9.
    Young T, Javaheri S (2005) Systemic and pulmonary hypertension in obstructive sleep apnea. In: Kryger MH, Roth T, Dement WC (eds) Principles and practices of sleep medicine, 4th edn. Saunders, Philadelphia, pp 1192–1202CrossRefGoogle Scholar
  10. 10.
    Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B et al (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157(15): 1746–1752PubMedCrossRefGoogle Scholar
  11. 11.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384PubMedCrossRefGoogle Scholar
  12. 12.
    Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR et al (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359(9302):204–210PubMedCrossRefGoogle Scholar
  13. 13.
    Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107(1):68–73PubMedCrossRefGoogle Scholar
  14. 14.
    Gami AS, Howard DE, Olson EJ, Somers VK (2005) Day–night pattern of sudden death in obstructive sleep apnea. N Engl J Med 352(12):1206–1214PubMedCrossRefGoogle Scholar
  15. 15.
    BaHammam A, Al-Mobeireek A, Al-Nozha M, Al-Tahan A, Binsaeed A (2005) Behaviour and time-course of sleep disordered breathing in patients with acute coronary syndromes. Int J Clin Pract 59(8):874–880PubMedCrossRefGoogle Scholar
  16. 16.
    Hanly P, Sasson Z, Zuberi N, Lunn K (1993) ST-segment depression during sleep in obstructive sleep apnea. Am J Cardiol 71(15):1341–1345PubMedCrossRefGoogle Scholar
  17. 17.
    Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P (1996) Sleep-disordered breathing in men with coronary artery disease. Chest 109(3):659–663PubMedCrossRefGoogle Scholar
  18. 18.
    Franklin KA, Nilsson JB, Sahlin C, Naslund U (1995) Sleep apnoea and nocturnal angina. Lancet 345(8957):1085–1087PubMedCrossRefGoogle Scholar
  19. 19.
    Drager LF, Bortolotto LA, Figueiredo AC, Krieger EM, Lorenzi GF (2007) Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 176(7):706–712PubMedCrossRefGoogle Scholar
  20. 20.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053PubMedGoogle Scholar
  21. 21.
    Doherty LS, Kiely JL, Swan V, McNicholas WT (2005) Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127(6):2076–2084PubMedCrossRefGoogle Scholar
  22. 22.
    Bradley TD, Floras JS (2003) Sleep apnea and heart failure: part I: obstructive sleep apnea. Circulation 107(12):1671–1678PubMedCrossRefGoogle Scholar
  23. 23.
    Vazir A, Hastings PC, Dayer M, McIntyre HF, Henein MY, Poole-Wilson PA et al (2007) A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 9(3):243–250PubMedCrossRefGoogle Scholar
  24. 24.
    Arias MA, Garcia-Rio F, Alonso-Fernandez A, Mediano O, Martinez I, Villamor J (2005) Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 112(3):375–383PubMedCrossRefGoogle Scholar
  25. 25.
    Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T et al (2003) Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 348(13):1233–1241PubMedCrossRefGoogle Scholar
  26. 26.
    Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT (2004) Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med 169(3):361–366PubMedCrossRefGoogle Scholar
  27. 27.
    Egea CJ, Aizpuru F, Pinto JA, Ayuela JM, Ballester E, Zamarron C et al (2008) Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study. Sleep Med 9(6):660–666PubMedCrossRefGoogle Scholar
  28. 28.
    Smith LA, Vennelle M, Gardner RS, McDonagh TA, Denvir MA, Douglas NJ et al (2007) Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial. Eur Heart J 28(10):1221–1227PubMedCrossRefGoogle Scholar
  29. 29.
    Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL et al (2007) Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 49(15): 1625–1631PubMedCrossRefGoogle Scholar
  30. 30.
    Rich S (ed) (1998) Primary pulmonary hypertension: executive summary from the world symposium on primary pulmonary hypertension. World Health Organization, GenevaGoogle Scholar
  31. 31.
    Arias MA, Garcia-Rio F, Alonso-Fernandez A, Martinez I, Villamor J (2006) Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J 27(9):1106–1113PubMedCrossRefGoogle Scholar
  32. 32.
    Campen MJ, Shimoda LA, O’Donnell CP (2005) Acute and chronic cardiovascular effects of intermittent hypoxia in C57BL/6J mice. J Appl Physiol 99(5):2028–2035PubMedCrossRefGoogle Scholar
  33. 33.
    Sajkov D, Wang T, Saunders NA, Bune AJ, McEvoy RD (2002) Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 165(2):152–158PubMedGoogle Scholar
  34. 34.
    Sforza E, Krieger J, Weitzenblum E, Apprill M, Lampert E, Ratamaharo J (1990) Long-term effects of treatment with nasal continuous positive airway pressure on daytime lung function and pulmonary hemodynamics in patients with obstructive sleep apnea. Am Rev Respir Dis 141(4 Pt 1):866–870PubMedGoogle Scholar
  35. 35.
    Arzt M, Young T, Finn L, Skatrud JB, Bradley TD (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172(11):1447–1451PubMedCrossRefGoogle Scholar
  36. 36.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041PubMedCrossRefGoogle Scholar
  37. 37.
    Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H et al (2008 Feb 11) Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 168(3):297–301PubMedCrossRefGoogle Scholar
  38. 38.
    Valham F, Mooe T, Rabben T, Stenlund H, Wiklund U, Franklin KA (2008) Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation 118(9):955–960PubMedCrossRefGoogle Scholar
  39. 39.
    Scala R, Turkington PM, Wanklyn P, Bamford J, Elliott MW (2009 Jan) Acceptance, effectiveness and safety of continuous positive airway pressure in acute stroke: a pilot study. Respir Med 103(1):59–66PubMedCrossRefGoogle Scholar
  40. 40.
    Palombini L, Guilleminault C (2006 Feb) Stroke and treatment with nasal CPAP. Eur J Neurol 13(2):198–200PubMedCrossRefGoogle Scholar
  41. 41.
    Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB et al (2009) Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 180(1):36–41PubMedCrossRefGoogle Scholar
  42. 42.
    Kohler M, Pepperell JC, Casadei B, Craig S, Crosthwaite N, Stradling JR et al (2008) CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J 32(6):1488–1496PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.University Sleep Disorders Center, Department of Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia

Personalised recommendations