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Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension

Divisions of ¹ Pulmonary and Critical Care Medicine, ² Cardiovascular Diseases, and ³ Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota

Correspondence and requests for reprints should be addressed to Sean M. Caples, D.O., Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: caples.sean{at}mayo.edu

ABSTRACT

With the growing epidemic of obesity in an aging population, obstructive sleep apnea (OSA) is increasingly encountered in clinical practice. Given the acute cardiopulmonary stressors consequent to repetitive upper airway collapse, as well as evidence for cardiovascular homeostatic dysregulation in subjects with sleep apnea, there is ample biologic plausibility that OSA imparts increased cardiovascular risk, independent of comorbid disease. Indeed, observational studies have suggested strong associations with multiple disorders, such as systemic hypertension, heart failure, cardiac arrhythmias, and pulmonary hypertension. Further data in the form of longitudinal cohort studies and randomized controlled trials are accruing to add to the body of evidence. This review examines pathophysiologic mechanisms and explores current concepts regarding the impact of OSA and its treatment on selected clinical disease states.

Key Words: sleep-disordered breathing • positive airway pressure • arrhythmia • stroke

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