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Panminerva Medica 2021 Mar 12

DOI: 10.23736/S0031-0808.21.04273-7


lingua: Inglese

Sleep apnoea, the ugly duckling of the Cinderellas in cardiovascular prevention and rehabilitation

Carlos A. RIVAS-ECHEVERRÍA 1, 2 , Celeste THIRLWELL 3, Lizmar I. MOLINA 4, Francklin I. RIVAS 5, Racely E. SÁNCHEZ 2, Solange B. GONZÁLEZ 2, Carlos A. RIVAS 6

1 The Glenfield Surgery, NHS, Leicester, UK; 2 Clínica del Sueño y Terapia Repiratoria SLEEPCARE, Venezuela and Spain; 3 Sleep Wake Awareness Program SWAP, Toronto, Canada; 4 Salud Castilla y León, Soria, Spain; 5 Departamento de Informática, Universidad Técnica Federico Santa María, Valparaíso, Chile; 6 Facultad de Medicina, Universidad de Navarra, Pamplona, Spain


Cardiovascular Diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care. Prevention and rehabilitation strategies are nearly neglected, therefore “the Cinderellas”, in the health-care budget. The World Health Organization has proposed cost-effective interventions to reduce the impact of Cardiovascular Diseases that include polydrug treatment for hypertension and diabetes, counselling, diet, exercise, and others. Obstructive Sleep Apnoea is not even mentioned among these interventions; consequently, it could be the “Ugly Duckling of the Cinderellas”. Obstructive Sleep Apnoea is characterised by the presence of obstructive apnoea or hypopnea during sleep, accompanied by hypoxia; and it is a highly prevalent but underdiagnosed condition. Although awareness of sleep apnoea has recently increased most facts about it remains ignored by many. Robust evidence suggests that Obstructive Sleep Apnoea is associated with, or is an independent risk factor for, hypertension, cerebrovascular disease, ischaemic heart disease, heart failure and arrhythmias and that its prevalence among some of these Cardiovascular Diseases is higher than 60%. The efficacy of continuous positive airway pressure (CPAP) treatment for Obstructive Sleep Apnoea has been established. If Obstructive Sleep Apnoea plays a significant role in Cardiovascular Diseases, then screening and timely appropriate treatment could reduce morbidity and mortality. Thus, the public health and economic impact of these conditions could be included in the “best buy” list of interventions. This narrative review discusses the relationship between Obstructive Sleep Apnoea and Cardiovascular Diseases and how neglected the link is.

KEY WORDS: Obstructive sleep apnea; Cardiovascular diseases; Continuous Positive Airway Pressure; Diagnosis; Disease management; Prevention and control; Cost of illness; Resource allocation; Hypertension; Cerebrovascular disease; Ischaemic heart disease; Heart failure; Arrhythmias; Neglected diseases

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