Review article
Obstructive sleep apnea and cardiovascular disease

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Abstract

Obstructive sleep apnea (OSA) is a common disorder associated with an increased risk of cardiovascular disease and stroke. As it is strongly associated with known cardiovascular risk factors, including obesity, insulin resistance, and dyslipidemia, OSA is an independent risk factor for hypertension and has also been implicated in the pathogenesis of congestive cardiac failure, pulmonary hypertension, arrhythmias, and atherosclerosis. Obesity is strongly linked to an increased risk of OSA, and weight loss can reduce the severity of OSA. The current standard treatment for OSA—nasal continuous positive airway pressure (CPAP)—eliminates apnea and the ensuing acute hemodynamic changes during sleep. Long-term CPAP treatment studies have shown a reduction in nocturnal cardiac ischemic episodes and improvements in daytime blood pressure levels and left ventricular function. Despite the availability of effective therapy, OSA remains an underdiagnosed and undertreated condition. A lack of physician awareness is one of the primary reasons for this deficit in diagnosis and treatment.

Abbreviations

AHI
apnea-hypopnea index
BMI
body mass index
CI
confidence interval
CPAP
continuous positive airway pressure
CSA
central sleep apnea
OR
odds ratio
OSA
obstructive sleep apnea
PHT
pulmonary hypertension
RR
relative risk

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Dr. Lattimore is supported by a Cardiac Society of Australia and New Zealand Research Scholarship. Prof. Celermajer is supported by the Medical Foundation of Australia

Gottlieb Friesinger, MD, acted as the Guest Editor for this paper.