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Obstructive sleep apnea and cardiovascular disease

J. o-Dee L. Lattimore, MBChB, FRACP^*,*, David S. Celermajer, MBBS, MSc, PhD, FRACP^* and Ian Wilcox, BMedSci, MBBS, PhD, FRACP, FCCP^*

^* Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
Department of Medicine, University of Sydney, Sydney, Australia

View larger version (38K): [in a new window]   Figure 1 Polysomnography: an overnight summary. The graphs from the top are: 1) hypnogram: the sleep stage report (MOV AWK = movement when awake; REM = rapid eye movement; 1 to 4 = non-rapid eye movement sleep); 2) arousals: each is a single mark; 3) SaO2 = percentage oxygen saturation; 4) apnea score: each is a single mark (Cn.A = central apnea; Ob.A = obstructive apnea; Mx.A = mixed apnea; Hyp = hypopnea; Uns = unscored); 5) PLMs = paroxysmal limb movements; 6) heart rate versus time (beats/minute); 7) body position; this subject remained on his back throughout the study; and 8) time (h).

View larger version (11K): [in a new window]   Figure 2 Dose-response relationship between the severity of obstructive sleep apnea based on apnea-hypopnea index and the adjusted odds ratio of hypertension, defined as blood pressure >140/90 mm Hg or current treatment with antihypertensive medications. Odds ratio was adjusted for baseline hypertension status, age, gender, habitus, and weekly alcohol and cigarette use. p = 0.002 for linear trend of the logistic regression coefficients. Data from Peppard et al. (25).

View larger version (47K): [in a new window]   Figure 3 Sympathetic nerve activity increases through the obstructive apnea, resulting in marked vasoconstriction followed by increased systolic and diastolic blood pressure. Continuous positive airway pressure (CPAP) stabilizes both sympathetic activity and blood pressure surges. BP = blood pressure (mm Hg); OSA = obstructive sleep apnea; REM = rapid eye movement; RESP = respiration; SNA = sympathetic nerve activation. Adapted from Somers et al. (67) with permission.

View larger version (24K): [in a new window]   Figure 4 Schema illustrating the risk factor clustering of obstructive sleep apnea (OSA) and the proposed links to both acute and chronic vascular disease. Solid line = proven risk factor; dashed line = potential risk factor.

View larger version (19K): [in a new window]   Figure 5 Prevalence of obstructive sleep apnea (OSA) in patients with cardiovascular and cerebrovascular disease. The figures used are approximations from published data and are unadjusted for baseline variables (1 to 4): 1. Parati G, Ongaro G, Bonsignore MR, Glavina F, Di Rienzo M, Mancia G. Sleep apnoea and hypertension. Curr Opin Nephrol Hypertens 2002;11:201–14; 2. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999;160:1101–6; 3. Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999;22:217–23; and 4. Peker Y, Kraiczi H, Hedner J, Loth S, Johansson A, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 1999;14:179–84.