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Journal of the American College of... Feb 2017Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include... (Review)
Review
Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.
Topics: Cardiovascular Diseases; Humans; Sleep Apnea Syndromes
PubMed: 28209226
DOI: 10.1016/j.jacc.2016.11.069 -
European Respiratory Review : An... Jun 2021Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in... (Review)
Review
INTRODUCTION
Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in metabolism and the microbiome may serve as biomarkers for OSA. Herein, we review the literature on the metabolomic and microbiome changes associated with OSA, and identify the metabolites and microorganisms involved.
METHODS
We searched the PUBMED and EMBASE electronic databases using the following terms: "obstructive sleep apnea", "OSA", "sleep disordered breathing", "SDB", "intermittent hypoxia", "sleep fragmentation", and either "metabolomics" or "microbiome". In total, 273 papers were identified, of which 28 were included in our study.
RESULTS
Changes in the levels of certain metabolites related to fatty acid, carbohydrate and amino acid metabolism were associated with the incidence of OSA. The diversity and abundance of microflora, particularly Firmicutes and Bacteroidetes, were altered in humans and rodents with OSA.
CONCLUSIONS
Certain changes in metabolism and the microbiota play an integral role in the pathophysiology of OSA and OSA-induced cardiovascular complications. Metabolomic and microbiome biomarkers shed light on the pathogenesis of OSA, and facilitate early diagnosis and treatment.
Topics: Biomarkers; Humans; Metabolomics; Microbiota; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33980666
DOI: 10.1183/16000617.0220-2020 -
Respirology (Carlton, Vic.) Jul 2020One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor... (Review)
Review
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
Topics: Age Factors; Artificial Intelligence; Comorbidity; Ethnicity; Global Burden of Disease; Global Health; Humans; Obesity; Prevalence; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32436658
DOI: 10.1111/resp.13838 -
Sleep Medicine Clinics Dec 2021Sleep studies have typically followed criteria established many decades ago, but emerging technologies allow signal analyses that go far beyond the scoring rules for... (Review)
Review
Sleep studies have typically followed criteria established many decades ago, but emerging technologies allow signal analyses that go far beyond the scoring rules for manual analysis of sleep recordings. These technologies may apply to the analysis of signals obtained in standard polysomnography in addition to novel signals more recently developed that provide both direct and indirect measures of sleep and breathing in the ambulatory setting. Automated analysis of signals such as electroencephalogram and oxygen saturation, in addition to heart rate and rhythm, provides a wealth of additional information on sleep and breathing disturbances and their potential for comorbidity.
Topics: Humans; Oximetry; Polysomnography; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34711382
DOI: 10.1016/j.jsmc.2021.08.001 -
Stroke and Vascular Neurology Dec 2016Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said "Sleep or watchfulness exceeding that which is customary, augurs... (Review)
Review
Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said "Sleep or watchfulness exceeding that which is customary, augurs unfavorably". Modern medicine has been able to disentangle some of the phenomena that disturb sleep. Among the most notable offenders is sleep apnoea that has gained prominence in the past few decades. It is being proposed as one of the potentially modifiable risk factors for vascular diseases including stroke. The pathological mechanisms linking sleep apnoea to vascular risk factors include hypoxia, cardiac arrhythmias, dysautonomia, impaired glucose tolerance, hypertension, dyslipidaemia and inflammation. In this article, we review literature linking sleep apnoea and stroke, including sleep apnoea as a risk factor for primary prevention with the potential to improve outcome after acute stroke and as a secondary risk factor, amenable to modification and hence vascular risk reduction.
Topics: Autonomic Nervous System; Humans; Lung; Primary Prevention; Respiration; Risk Assessment; Risk Factors; Secondary Prevention; Sleep; Sleep Apnea Syndromes; Stroke
PubMed: 28959482
DOI: 10.1136/svn-2016-000038 -
The European Respiratory Journal May 2022Heart failure and sleep disordered breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades....
Heart failure and sleep disordered breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades. Obstructive sleep apnoea (OSA) may result in myocardial damage due to intermittent hypoxia that leads to increased sympathetic activity and transmural pressures, low-grade vascular inflammation, and oxidative stress. On the other hand, central sleep apnoea and Cheyne-Stokes respiration (CSA-CSR) occurs in heart failure, irrespective of ejection fraction, either reduced (HFrEF), preserved (HFpEF) or mildly reduced (HFmrEF). The pathophysiology of CSA-CSR relies on several mechanisms leading to hyperventilation, breathing cessation and periodic breathing. Pharyngeal collapse may result at least in part from fluid accumulation in the neck, owing to daytime fluid retention and overnight rostral fluid shift from the legs. Although both OSA and CSA-CSR occur in heart failure, the symptoms are less suggestive than in typical (non-heart failure-related) OSA. Overnight monitoring is mandatory for a proper diagnosis, with accurate measurement and scoring of central and obstructive events, since the management will be different depending on whether the sleep apnoea in heart failure is predominantly OSA or CSA-CSR. SDB in heart failure is associated with worse prognosis, including higher mortality, than in patients with heart failure but without SDB. However, there is currently no evidence that treating SDB improves clinically important outcomes in patients with heart failure, such as cardiovascular morbidity and mortality.
Topics: Cheyne-Stokes Respiration; Heart Failure; Humans; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive; Stroke Volume
PubMed: 34949696
DOI: 10.1183/13993003.01640-2021 -
The European Respiratory Journal Jul 2022Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the...
BACKGROUND
Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of comorbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA and all-cause mortality risk.
METHODS
Insomnia was defined as difficulties falling asleep, maintaining sleep and/or early morning awakenings from sleep ≥16 times per month, and daytime impairments. OSA was defined as an apnoea-hypopnoea index ≥15 events·h. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazards models were used to determine the association between COMISA and all-cause mortality (n=1210) over 15 years of follow-up.
RESULTS
5236 participants were included. 2708 (52%) did not have insomnia/OSA (reference group), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (OR 2.00, 95% CI 1.39-2.90) and cardiovascular disease (CVD) (OR 1.70, 95% CI 1.11-2.61) compared with the reference group. Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not CVD compared with the reference group. Compared with the reference group, COMISA was associated with a 47% (hazard ratio 1.47, 95% CI 1.06-2.07) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia.
CONCLUSIONS
COMISA was associated with higher rates of hypertension and CVD at baseline, and an increased risk of all-cause mortality compared with no insomnia/OSA.
Topics: Cardiovascular Diseases; Humans; Hypertension; Polysomnography; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders
PubMed: 34857613
DOI: 10.1183/13993003.01958-2021 -
Journal of Cardiology Aug 2012Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA,... (Review)
Review
Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from upper airway collapse, whereas CSA arises from reductions in central respiratory drive. In patients with OSA, blood pressure is frequently elevated as a result of sympathetic nervous system overactivation. The generation of exaggerated negative intrathoracic pressure during obstructive apneas further increases left ventricular (LV) afterload, reduces cardiac output, and may promote the progression of HF. Intermittent hypoxia and post-apneic reoxygenation cause vascular endothelial damage and possibly atherosclerosis and consequently coronary artery disease and ischemic cardiomyopathy. CSA is also characterized by apnea, hypoxia, and increased sympathetic nervous activity and, when present in HF, is associated with increased risk of death. In patients with HF, abolition of coexisting OSA by continuous positive airway pressure (CPAP) improves LV function and may contribute to the improvement of long-term outcomes. Although treatment options of CSA vary compared with OSA treatment, CPAP and other types of positive airway ventilation improve LV function and may be a promising adjunctive therapy for HF patients with CSA. Since HF remains one of the major causes of mortality in the industrialized countries, the significance of identifying and managing sleep apnea should be more emphasized to prevent the development or progression of HF.
Topics: Heart Failure; Humans; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 22824295
DOI: 10.1016/j.jjcc.2012.05.013 -
The Medical Clinics of North America Mar 2015Epidemiologic studies have shown that approximately 50% of older adults have sleep problems, many of which carry deleterious consequences that affect physical and mental... (Review)
Review
Epidemiologic studies have shown that approximately 50% of older adults have sleep problems, many of which carry deleterious consequences that affect physical and mental health and also social functioning. However, sleep problems in late life are often unrecognized, and are inadequately treated in clinical practice. This article focuses on the diagnosis and treatment of the 2 most common sleep problems in older patients: sleep apnea and insomnia.
Topics: Aged; Humans; Prevalence; Quality of Life; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders
PubMed: 25700593
DOI: 10.1016/j.mcna.2014.11.013 -
Respiratory Care Aug 2019Sleep-disordered breathing affects a significant portion of the population worldwide. It is associated with many comorbid conditions, including heart failure and... (Review)
Review
Sleep-disordered breathing affects a significant portion of the population worldwide. It is associated with many comorbid conditions, including heart failure and depression. Advances in the field regarding the diagnosis and treatment of sleep-disordered breathing are occurring on an increasing basis. This review will discuss the latest findings in the field with an emphasis on people who have obstructive sleep apnea.
Topics: Cardiovascular Diseases; Comorbidity; Depression; Disease Management; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 31346075
DOI: 10.4187/respcare.07063