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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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“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]
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“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]
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“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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Metadata
- 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
- 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 (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pharmacology (medical) › 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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