Sleep Disordered Breathing and Cardiovascular Disease

Highlights

• SDB is common and associated with an increased risk of cardiovascular disease.

• Weight loss, exercise, and positive airway pressure therapy improve daytime drowsiness and quality of life in patients with OSA, but positive airway pressure has not been proven to improve cardiovascular outcomes, possibly because of potentially adverse effects in patients with heart failure.

• Future research should focus on identifying high-risk patients with SDB and developing individualized therapeutic strategies that improve cardiovascular outcomes.

Abstract

Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.