Somers - Figure 23
OSA Linkages to Cardio Diseases
FIG. 23: This Figure shows the various physiologic stresses associated with obstructive apnea.[11] In OSA (left hand column) hypoxemia results in subsequent reoxygenation, hypercapnia, intrathoracic pressure changes, and all this means the generation of negative intrathoracic pressure due to the subject’s trying to breathe in against a closed upper airway and arousals from sleep.
All of these stimuli seemed to be linked to intermediary mechanisms (middle column), including sympathetic activation, endothelial dysfunction, and inflammation (all covered in the preceding Figure); other mechanisms not covered include vascular oxidative stress, a heightened propensity to coagulation, and metabolic dysregulation.
Finally these intermediary mechanisms likely play a principal role in the subsequent development of established heart disease (right hand column) including high blood pressure, heart failure, cardiac arrhythmias, cardiac ischemia and cerebrovascular disease, and stroke.
References
Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003;290:1906–1914.
