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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
AN UPDATE ON OBSTRUCTIVE SLEEP APNEA SYNDROME
Minerva Pneumologica 2007 September;46(3):167-81
Obstructive sleep apnea syndrome and cardiovascular diseases
Mazza M., Busetto L.
Unit of Medical and Surgical Therapy of Obesity Department of Medicine I University of Padua, Padua, Italy
The prevalence of obesity, metabolic syndrome and breathing related sleep disorders is increasing in the general population. Several data suggest that obstructive sleep apnoea syndrome (OSAS) may be an independent risk factor of cardiovascular disease. In this paper, the amount of literature available in support of the relationship between OSAS and cardiovascular diseases will be reviewed. This association is particular strong for hypertension, ischemic heart disease, stroke and cerebrovascular diseases, congestive heart failure, and cardiac arrhythmias (including atrial fibrillation and sudden death). The pathogenetic links between OSAS and cardiovascular diseases will be also reviewed. The pathogenesis of cardiovascular disease in OSAS is probably multifactorial and involves a large number of mechanisms, including sympathetic nervous system overactivity (characterized by an increase of blood pressure with blood pressure variability and an high heart rate with low heart rate variability), selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation (insulin resistance and disordered lipid metabolism). Moreover, apnoea events cause important direct physiopatologic effects on the cardiovascular system, by hypoxia, hypercapnia and by the increase of intrathoracic pressure. All these abnormalities may further contribute to the development of cardiovascular diseases.