Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review

Martin R. Cowie*, Dominik Linz, Susan Redline, Virend K. Somers, Anita K. Simonds

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Citations (Web of Science)

Abstract

Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials. (C) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.

Original languageEnglish
Pages (from-to)608-624
Number of pages17
JournalJournal of the American College of Cardiology
Volume78
Issue number6
DOIs
Publication statusPublished - 10 Aug 2021

Keywords

  • cardiovascular disease
  • diagnosis
  • prognosis
  • sleep apnea
  • treatment
  • POSITIVE AIRWAY PRESSURE
  • CHEYNE-STOKES RESPIRATION
  • ADAPTIVE SERVO-VENTILATION
  • CORONARY-HEART-DISEASE
  • ATRIAL-FIBRILLATION RECURRENCE
  • ROSTRAL FLUID SHIFT
  • BLOOD-PRESSURE
  • RESISTANT HYPERTENSION
  • RISK-FACTOR
  • VENTRICULAR-ARRHYTHMIAS

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