The Present and Future
State-of-the-Art Review
Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences

https://doi.org/10.1016/j.jacc.2016.11.069Get rights and content
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Abstract

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.

Key Words

central sleep apnea
hypertension
obstructive sleep apnea

Abbreviations and Acronyms

AF
atrial fibrillation
AHI
apnea-hypopnea index
CHD
coronary heart disease
CPAP
continuous positive airway pressure
CSA
central sleep apnea
CVD
cardiovascular disease
HF
heart failure
HTN
hypertension
OSA
obstructive sleep apnea
TIA
transient ischemic attack

Cited by (0)

Dr. Shahrokh Javaheri is a consultant for Respicardia, Philips, and Leva Nova Group. Dr. Barbe has received research grants from ResMed and Oxigen Salus; and has received a speaker’s fee from Philips. Dr. Khayat has received research grants through The Ohio State University from Philips Respironics. Dr. Mehra’s institution has received positive airway pressure machines and equipment from Philips Respironics and ResMed for research; and she has received royalties from Up to Date. Dr. Somers’ institution has received a gift from the Phillips Respironics Foundation for the study of sleep and cardiovascular disease; he was a consultant for Respicardia, ResMed, Sorin Inc., Biosense Webster, U-Health, Philips, Ronda Grey, Dane Garvin, and GlaxoSmithKline; and is working with Mayo Health Solutions and their industry partners on intellectual property related to sleep and cardiovascular disease. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.