Sleep Apnea
Open accessAbstract
Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.
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In a meta-analysis of 2,570 patients with heart failure with reduced ejection fraction and moderate to severe sleep apnea, central sleep apnea was the dominant phenotype in more than 70% of cases.
“However, in a meta-analysis of 2570 patients with HF with reduced ejection fraction and moderate to severe sleep apnea, CSA represented the dominant phenotype in >70% of cases.4”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [4]
The section “Prevalence of Sleep Apnea in HFrEF, HFpEF, and Acute HF” reports CSA as more common than OSA in two HFrEF groups totaling 2,570 patients; its figures imply roughly 70% CSA among those with moderate-to-severe sleep apnea. But 2,570 is the total number of HFrEF patients, not the number with moderate-to-severe sleep apnea, and the review does not describe these groups as one meta-analysis. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere is a need for additional treatment options for obstructive sleep apnea because patients are sometimes unable or unwilling to adhere to PAP treatment and PAP has not been shown to affect cardiovascular complications and death.
“Patients with obstructive sleep apnea are sometimes unable or unwilling to adhere to PAP treatment, and PAP has not been shown to affect cardiovascular complications and death in obstructive sleep apnea; therefore, there is a need for additional treatment options. 4-6,10”
From Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (2024) · cites this paper as [10]
The CPAP, CHD, CV Mortality, and Composite CV Outcomes section reports no significant reduction in the primary composite cardiovascular outcomes of three randomized trials. Future Directions identifies poor adherence as a major trial limitation and discusses alternatives to CPAP. The claim is too broad about cardiovascular complications and death: the paper also reports observational evidence of improved survival and cardiovascular benefits among patients who used CPAP for at least four hours per night. (LLM, conf=0.85)
Experimental — accuracy not yet measuredObstructive sleep apnea and obesity are two distinct but closely related diseases, and both have independent etiologic roles in the development of cardiovascular complications.
“Obstructive sleep apnea and obesity are two distinct but closely related diseases, and both have independent etiologic roles in the development of cardiovascular complications. 10”
From Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (2024) · cites this paper as [10]
The Pathogenesis of OSA section identifies obesity as a major risk factor for OSA, while the opening discussion identifies OSA as a cardiovascular risk factor. The Molecular Signatures section reports that weight loss and CPAP each reduced blood pressure in obese patients, but cautions that disentangling obesity’s effects from OSA’s is difficult. It does not establish independent etiologic roles for both across cardiovascular complications generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong adverse cardiovascular consequences, the evidence linking OSA and hypertension is the most robust.
“While OSA has been associated with several adverse CV consequences, the evidence linking OSA and HTN is the most robust.680,681”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [680]
Large swings in intrathoracic pressure due to inspiratory effort against a closed upper airway exert transmural pressures across the heart and great vessels, leading to increased afterload, reduced stroke volume, and increased myocardial oxygen consumption.
“Additionally, large swings in intrathoracic pressure due to inspiratory effort against a closed UA exert transmural pressures across the heart and great vessels, leading to increasing afterload, reduced stroke volume and increased myocardial oxygen consumption.680”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [680]
Although obesity-induced hypertension often occurs in the absence of obstructive sleep apnoea, the severity of hypertension is exacerbated when obstructive sleep apnoea coexists with obesity.
“Although obesity-induced hypertension often occurs in the absence of OSA, the severity of hypertension is exacerbated when OSA coexists with obesity183,185.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [185]
In patients with obstructive sleep apnoea, breathing 100% oxygen suppressed chemoreflex activity and reduced sympathetic nerve activity, heart rate and blood pressure.
“In patients with OSA, breathing 100% oxygen suppressed chemoreflex activity and reduced SNA, HR and BP183,185.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [185]
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Self-citationObstructive Sleep Apnea and Vascular Diseases
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Self-citationCardiovascular Effects of Sleep-Related Breathing Disorders
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Self-citationSystemic and Pulmonary Hypertension in Obstructive Sleep Apnea
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- Authors
- Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J. A., Khayat, R., Javaheri, S., Malhotra, A., Martinez-Garcia, M. A., Mehra, R., Pack, A. I., Polotsky, V. Y., Redline, S., & Somers, V. K.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Wisconsin–Madison (US)
- The Ohio State University (US)
- University of California San Diego (US)
- Cleveland Clinic Lerner College of Medicine (US)
- University of Pennsylvania (US)
- Johns Hopkins University (US)
- Mayo Clinic (US)
- Corresponding author
- Javaheri, Shahrokh
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 69
- Issue
- 7
- Pages
- 841-858
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC5393905
- OpenAlex
- W2592857683
- Semantic Scholar
- 1b7633dc393c45d020f11ca3c75214dac8fb23c7
- Cited by
- 1,434
- References
- 126
- Citations by year
- 2026: 166 · 2025: 169 · 2024: 183 · 2023: 202 · 2022: 172 · 2021: 160 · 2020: 129 · 2019: 111 · 2018: 92 · 2017: 45 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 12.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Ohio State University
- ResMed
- Respicardia
- National Heart, Lung, and Blood Institute (R01HL128970, T32HL134632, R01HL085188, K24HL132105, R01HL133100)
- National Institute of Environmental Health Sciences (P50ES018176)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pharmacology › Apelin-related biomedical research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- sleep apnea, cardiovascular disease, intermittent hypoxia, oxidative stress, sympathetic activation, endothelial dysfunction, hypertension, coronary artery disease, cardiac arrhythmias, heart failure, stroke, sleep apnea treatment, cardiac patients
- MeSH terms
- Cardiovascular Diseases, Humans, Sleep Apnea Syndromes
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