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Obstructive Sleep Apnea
Open accessAbstract
Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
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“where an increased risk of cardiopulmonary disease and mortality has been established (true positive)432–434”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [432]
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“Central adiposity is linked to the development of both OSA and the metabolic syndrome, with both sharing similar pathophysiological features (eg, systemic inflammation, endothelial dysfunction).47”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [47]
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“In addition, intermittent hypoxia of adipose tissue, sympathetic activation, induction of adipocytokines, and oxidative stress may promote the development of metabolic risk factors.47”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [47]
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Metadata
- Authors
- Drager, L. F., Togeiro, S. M., Polotsky, V. Y., & Lorenzi-Filho, G.
- Affiliations
- Universidade de São Paulo (BR)
- Universidade Federal de São Paulo (BR)
- Johns Hopkins University (US)
- Corresponding author
- Drager, Luciano F.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 62
- Issue
- 7
- Pages
- 569-576
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC4461232
- OpenAlex
- W82112906
- Semantic Scholar
- d934a572c944ea22e897140990fef8af7b39baa3
- Cited by
- 886
- References
- 87
- Citations by year
- 2026: 103 · 2025: 106 · 2024: 77 · 2023: 56 · 2022: 71 · 2021: 80 · 2020: 82 · 2019: 50 · 2018: 49 · 2017: 37 · 2016: 58 · 2015: 63 · 2014: 47 · 2013: 7
- FWCI
- 40.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- National Heart, Lung, and Blood Institute (R01HL080105)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology (medical) › Apelin-related biomedical research
- Keywords
- obstructive sleep apnea, obesity, metabolic syndrome, intermittent hypoxia, insulin resistance, non-alcoholic fatty liver disease, cardiovascular risk, continuous positive airway pressure, arterial stiffness, atherosclerosis, cardiovascular mortality, endothelial dysfunction, systemic inflammation, sympathetic activation
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Female, Humans, Hypertension, Insulin Resistance, Male, Middle Aged, Obesity, Prognosis, Comorbidity, Body Mass Index, Incidence, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Cross-Over Studies, Sleep Apnea, Obstructive, Metabolic Syndrome, Continuous Positive Airway Pressure
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