Morbidité cardiovasculaire associée au syndrome d’apnée obstructive du sommeil

Apr 23, 2014Revue des maladies respiratoires

Heart and blood vessel problems linked to obstructive sleep apnea

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Abstract

Untreated obstructive sleep apnoea syndrome (OSAS) is associated with a 2.87 times higher odds of fatal cardiovascular events.

OSAS significantly raises the risk of both fatal and non-fatal cardiovascular events.
The prevalence of hypertension among OSAS patients ranges from 35 to 80%.
Complications are linked to intermittent oxygen deprivation caused by repeated breathing interruptions during sleep.
Mechanisms contributing to cardiovascular risks include increased sympathetic activity, vascular inflammation, and oxidative stress.
Continuous positive airway pressure treatment can help prevent cardiovascular events, despite limited effects on blood pressure.

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INTRODUCTION: The obstructive sleep apnoea syndrome (OSAS) had become a major public health concern in modern society due to its high prevalence but, above all, to its associated morbidity, especially cardiovascular.

BACKGROUND: Untreated OSAS is associated with an increased incidence of fatal (myocardial infarction and stroke) (odds ratio: 2.87) and non-fatal cardiovascular events (myocardial infarction, stroke, coronary artery bypass surgery and coronary angiography) (odds ratio: 3.17). Moreover, the prevalence of hypertension in patients with OSAS is high, between 35 and 80%. The pathophysiological mechanisms leading to these complications are mainly due to intermittent hypoxia secondary to repeated episodes of apnoea/hypopnoea during sleep. These mechanisms include sympathetic hyperactivation, impairment of vasomotor reactivity, vascular inflammation, oxidative stress and metabolic disorders. In patients with OSAS, the impact of continuous positive pressure is proven in terms of prevention of cardiovascular events although blood pressure reduction is limited. Obviously these effects are proportional to observance.

CONCLUSION: OSAS does increase the cardiovascular risk, independently of other risk factors. Although the impact of treatment is relatively low in decreasing blood pressure, it seems essentially effective in preventing cardiovascular morbidity. Therefore, OSAS screening, and the association of specific treatments in cardio-metabolic patients and OSAS patients respectively, should be included in clinical strategies.

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Morbidité cardiovasculaire associée au syndrome d’apnée obstructive du sommeil

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