Sleep-Disordered Breathing and Cardiovascular Disease: Exploring Pathophysiology and Existing Data

Reena      Mehra

Abstract

Sleep-Disordered Breathing (SDB) is characterized by repetitive partial or complete upper airway occlusion during sleep with a high prevalence in the general community, and associated with considerable morbidity and mortality. In the US, approximately 12 million people 30 to 60 years of age have SDB, and 38,000 die each year from cardiovascular disease attributed to SDB. Substantial morbidity and economic costs are associated with untreated SDB, including those related to daytime sleepiness and hypertension, and cardiovascular co-morbidity. There is a crucial need to address the public health impact of this common condition, including the extent to which treatment of SDB may modify the course of other chronic health conditions such as cardiovascular disease. The public health impact of SDB in large part relates to the association of SDB with cardiovascular disease, a leading cause of mortality in the U.S. Several large epidemiological studies have clearly demonstrated that individuals with SDB have a higher prevalence of cardiovascular disease after controlling for potential confounders. These data, along with the high prevalence of SDB, support a high population attributable risk, suggesting that a high percentage of cardiovascular morbidity in the population may be due to SDB.

Keywords: Sleep apnea syndromes, cardiovascular disease, inflammation, oxidative stress, hypertension, arrhythmias, congestive heart failure, stroke