[Mechanisms of cardiovascular damage in obstructive sleep apnea].

Apr 22, 2009Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion

How Obstructive Sleep Apnea May Cause Heart and Blood Vessel Damage

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Abstract

Obstructive sleep apnea syndrome (OSAS) is associated with multiple cardiovascular risk mechanisms.

Intermittent hypoxemia in OSAS leads to cycles of low oxygen followed by reoxygenation.
These cycles are linked to oxidative stress, which can cause cardiovascular damage.
Increased chemoreflex sensitivity may result in heightened sympathetic nervous system activity.
Decreased baroreflex sensitivity is observed in individuals with OSAS.
Activation of systemic inflammation pathways may promote atherosclerosis and cardiovascular issues.
Treatment with CPAP is shown to positively affect many of these damaging mechanisms.

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Obstructive sleep apnea syndrome (OSAS) is an independent and modifiable risk factor for cardiovascular diseases; however, the pathophysiological mechanisms underlying this association are not yet fully understood. Intermittent hypoxemia, one of the physiological markers of OSAS, is characterized by transient periods of oxygen desaturation followed by reoxygenation. The cycles of hypoxia-reoxygenation are associated with oxidative stress that, in turn, triggers the activation of pathways that lead to cardiovascular damage. These pathways include an increased chemoreflex sensitivity that induces the over-activation of the sympathetic nervous system, decreased baroreflex sensitivity, the activation of systemic inflammation pathways mediated primarily by the nuclear transcriptional factor kappaB that favors the development of atherosclerosis through the synthesis of cytokines and the expression of adhesion molecules, endothelial dysfunction with a decreased availability of nitric oxide, dyslipidemia, insulin resistance and stimulation of the renin-angiotensin system. Other mechanisms proposed include arousals that increase sympathetic activity and exaggerated intrathoracic pressure changes that generate high transmural pressure. Most of these mechanisms respond favorably to treatment with CPAP. A better understanding of the mechanisms of cardiovascular damage opens the possibility of instituting new treatments that will contribute to limiting the cardiovascular consequences associated with OSAS.

[Mechanisms of cardiovascular damage in obstructive sleep apnea].

Abstract

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