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J Am Coll Cardiol. 2017 Feb 21;69(7):841-858. doi: 10.1016/j.jacc.2016.11.069.

Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences.

Author information

1
Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, Ohio. Electronic address: shahrokhjavaheri@icloud.com.
2
Respiratory Department, Institut Ricerca Biomèdica de Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
3
Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain.
4
Department of Population Health Sciences and John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
5
Sleep Heart Program, the Ohio State University, Columbus, Ohio.
6
Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
7
Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California.
8
Respiratory Department, Hospital Universitario de Politecnico La Fe, Valencia, Spain.
9
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
10
Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
11
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
12
Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts.
13
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Abstract

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.

KEYWORDS:

central sleep apnea; hypertension; obstructive sleep apnea

PMID:
28209226
PMCID:
PMC5393905
DOI:
10.1016/j.jacc.2016.11.069
[Indexed for MEDLINE]
Free PMC Article

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