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Semin Thromb Hemost 2011; 37(3): 280-297
DOI: 10.1055/s-0031-1273092
© Thieme Medical Publishers

Obstructive Sleep Apnea Syndrome and Cardiovascular Diseases

Cristiano Fava1 , Martina Montagnana2 , Emmanuel J. Favaloro3 , Gian Cesare Guidi2 , Giuseppe Lippi4
  • 1Sezione di Medicina interna C, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Verona, Italy
  • 2Sezione di Chimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università di Verona, Verona, Italy
  • 3Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, Australia
  • 4U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy
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Publication History

Publication Date:
31 March 2011 (online)

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ABSTRACT

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or complete upper airway collapse and obstruction during sleep, associated with intermittent oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Increasing focus is being placed on the relationship between OSAS and all-cause and cardiovascular disease–related mortality, but it still largely unclear whether this association is causative or simply speculative and epidemiological. Basically, reliable clinical evidence supports the hypothesis that OSAS might be associated with essential and resistant hypertension, as well as with an incremental risk of developing stroke, cardiac rhythm perturbations (e.g., atrial fibrillation, bradyarrhythmias, supraventricular and ventricular arrhythmias), coronary artery disease, acute myocardial infarction, and heart failure. Although it is still unclear whether OSAS might represent an independent risk factor for several acute or chronic conditions, or rather might trigger cardiovascular disease in the presence of traditional cardiovascular risk factors (e.g., obesity, diabetes, and dyslipidemia), there is a plausible biological background underlying this association, in that most of the mechanisms implicated in the pathogenesis of OSAS (i.e., hypoxia, hypercapnia, negative intrathoracic pressure, micro-arousal, sympathetic hyperactivity, metabolic and hormonal changes, oxidative stress, phlogosis, endothelial dysfunction, hypercoagulability, and genetic predisposition) might also be involved in the pathogenesis of cardiovascular disorders. In this article we discuss the different aspects of the relationship between OSAS and pathogenically different conditions such as systemic hypertension, coronary artery disease, stroke, metabolic abnormalities, arrhythmias, and heart failure, and we also discuss the kaleidoscope of phenomena implicated in the pathogenesis of this challenging disease.

KEYWORDS

Sleep apnea - cardiovascular disease - hypertension - stroke - acute myocardial infarction

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Cristiano FavaM.D. Ph.D. 

Department of Medicine, Division of Internal Medicine C

Piazza LA Scuro 10, 37134 Verona, Italy

Email: cristiano.fava@med.lu.se

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