Obstructive Sleep Apnea and Heart Disease

Abstract

Obstructive sleep apnea (OSAS) is characterized by recurrent episodes of complete and partial obstruction of the upper airways, leading to intermittent hypoxemia, autonomic fluctuations, and sleep fragmentation. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disorders are common and underdiagnosed among middle-aged and older adults, and prevalence varies by race/ethnicity, gender, and degree of obesity. The prevalence of OSA reaches 40-80% in patients with arterial hypertension, heart failure, coronary heart disease, pulmonary hypertension, atrial fibrillation and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stress and adverse cardiovascular outcomes, OSA is often unrecognized and untreated in cardiovascular practice. We recommend screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after cardioversion or ablation. In patients with New York Heart Association class II–IV heart failure and suspected sleep apnea or excessive daytime sleepiness, a formal sleep assessment is appropriate. In patients with tachybradia or ventricular tachycardia syndrome, or in survivors of sudden cardiac death who are suspected of having sleep apnea after a comprehensive sleep assessment, evaluation of sleep apnea should be considered. After a stroke, there is a clinical balance regarding screening and treatment. Patients with angina pectoris, myocardial infarction, arrhythmias, or related shocks from implanted cardioverter-defibrillators may especially often have comorbid sleep apnea. All patients with OSAS should be considered for treatment, including behavior modification and weight loss as indicated. Continuous positive airway pressure should be offered to patients with severe OSA, while oral devices may be considered for patients with mild to moderate OSA or those who cannot tolerate continuous positive airway pressure. Follow-up sleep testing should be performed to evaluate the effectiveness of treatment.