Sleep Apnea and Cardiovascular Disease: Association, Causation, and Implication

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Obstructive sleep apnea (OSA), a widely prevalent disease, is the most frequent form of sleep-disordered breathing encountered by adults of all age groups and is associated with serious medical, public health, and economic sequelae. During the last 2 decades, the cardiovascular consequences associated with OSA continue to unfold. These include hypertension, coronary artery disease, congestive heart failure, arrhythmia, stroke, insulin resistance/diabetes, and pulmonary hypertension. The association with systemic hypertension is most compelling and believed to be causal. Increasing evidence accrues for the remaining cardiovascular spectrum. Myocardial infarction, stroke, arrhythmia, and death appear to be more common or premature in those afflicted with OSA than the general population. Although the mechanisms underpinning the relationships with cardiovascular disease are not fully elucidated, investigators propose that the consequences of chronic, intermittent hypoxemia, and repetitive apnea include fluctuations in sympathetic drive, endothelial dysfunction, and inflammatory mediators. A large proportion of patients remain undiagnosed and untreated despite an increasing understanding of the deleterious health and economic effects of OSA.

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