Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities: Fig. 1—

Jan 2, 2007The European respiratory journal

Sleep apnea as a separate risk factor for heart and blood vessel disease: current evidence, key causes, and research needs

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Abstract

Obstructive sleep apnoea syndrome (OSAS) is significantly associated with cardiovascular disease, especially systemic arterial hypertension.

There is evidence supporting an independent association between OSAS and several cardiovascular conditions, including ischaemic heart disease, stroke, heart failure, atrial fibrillation, and cardiac sudden death.
The mechanisms linking OSAS to cardiovascular disease may involve sympathetic nervous system overactivity and activation of inflammatory pathways.
Endothelial dysfunction and abnormal blood clotting may also play roles in this association.
Metabolic dysregulation, particularly insulin resistance and disordered lipid metabolism, could be contributing factors.
Future research should focus on large-scale studies to explore these mechanisms and their interactions with conditions like obesity and diabetes.

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Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death. The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies. Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder.

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Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities: Fig. 1—

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