OSA and CV Disease Review

Somers - Figure 58

FIG. 58: In summary, the question this presentation has reviewed is, how prevalent is cardiovascular disease in patients with OSA, and how prevalent is sleep apnea in patients with established cardiovascular disease?

Looking at the mechanisms of disease, we addressed what it is about nighttime apnea that could trigger the development of daytime heart and blood vessel disease. We then looked at three fairly common cardiovascular conditions: hypertension, AF, myocardial ischemia and MI, and concluded with sudden cardiac death. Essentially what the data show is that sleep apnea is very prevalent in patients with high blood pressure, in patients with AF, and in patients with cardiac ischemia. Furthermore there is evidence that sleep apnea may worsen outcomes in these patients, and that perhaps treating sleep apnea may improve the likelihood of survival or reduced hospitalizations. However with regard to the latter, whether treating sleep apnea actually improves hard outcomes in patients with heart disease, the jury is still out and we have to wait for the randomized control trials to address this in a longitudinal manner.

The final topic concerning CVD and OSA was sudden cardiac death. Here it is worth mentioning that physicians should remind their patients, particularly in patients with implanted cardiac defibrillators, that if the patient’s defibrillator fires during sleep and causes an arousal from sleep, the physician and patient should consider the possibility that OSA may be present, because it is possible (although it remains to be proven) that treating the OSA may decrease the likelihood of arrhythmic events requiring firing of an implanted defibrillator.

Somers V. Chest 2016:00.

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