Sleep Apnea Syndrome: More Than Benign Snoring. Implications for the Cardiovascular System
DOI:
https://doi.org/10.2015/hc.v6i4.385Abstract
Sleep disordered breathing is a rather common problem in the general population. Apnea during sleep can be divided into three types: central, obstructive and mixed. In central apneas there is lack of both airflow and respiratory efforts. It is recognized by its waxing-waning pattern of respiration called Cheyne- Stokes respiration. Central sleep apnea is most commonly seen in patients with heart failure and its prevalence among this group of patients is estimated to be as high as 30-40%. Obstructive sleep apnea occurs approximately in 5-15% of the general population. It usually affects middle-aged men with an increased body-mass index and a large neck circumference. It is characterized by repetitive complete or partial obstruction of the upper airway during sleep, which is followed by increasing and ineffective respiratory efforts.
Sleep fragmentation in patients with sleep apnea syndrome results in sleepiness, fatigue, morning headaches and depression. This daytime presentation together with loud snoring, choking and pauses of respiration during sleep should make primary care physicians suspicious of sleep disordered breathing. The best method used for the diagnosis of sleep apnea syndrome is overnight polysomnography.
The pathophysiologic mechanisms, which take place in sleep apnea, include sympathetic activation, hypercoagulability, inflammation and production of pro-inflammatory cytokines, endothelial dysfunction, oxidative stress and metabolic dysfunction. All these mechanisms are associated with the development and progression of cardiovascular disease. There is a strong linkage between sleep apnea and hypertension, systolic and diastolic dysfunction of the left ventricle, congestive heart failure, coronary artery disease, cardiac arrhythmias, stroke and pulmonary disease.
Given the increased morbidity and mortality of patients with sleep apnea, an effective treatment must be started as soon as possible after the diagnosis is made. Currently, nasal continuous positive airway pressure constitutes first line therapy. This therapy improves both quality of sleep and cardiovascular and general outcomes.
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
