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09.01.2020 | Sleep Breathing Physiology and Disorders • Review

Obstructive sleep apnea and cardiovascular disease, a story of confounders!

Sleep and Breathing
Jacob Collen, Christopher Lettieri, Emerson Wickwire, Aaron Holley
Wichtige Hinweise
Statement and Declarations:
All authors have seen and approve the manuscript. All authors participated in development of the manuscript and final revisions.
Jacob Collen (JC) has received consulting fees for Jazz Pharmaceuticals and GlaxoSmithKline. Christopher Lettieri (CL) is a paid employee of GlaxoSmithKline. Emerson Wickwire (EMW) has received research support from AASM Foundation, Department of Defense, Merck, and ResMed. EMW has served as a scientific consultant to DayZz, Eisai, Merck, and Purdue, and is an equity shareholder in WellTap. Aaron Holley (AH) has nothing to disclose.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Obstructive sleep apnea (OSA) syndrome is increasingly common among middle aged and older adults and is frequently linked to most cardiovascular diseases (CVD). Sleep-disordered breathing and CVD share a number of common risk factors and comorbid conditions including obesity, male gender, advancing age, metabolic syndrome, and hypertension. OSA appears to be associated with worsened CVD outcomes, sleep-related symptoms, quality of life, and risk of motor vehicle accidents. Demonstrating a cause-and-effect relationship between CVD and OSA has been challenging due to shared comorbidities. Strong evidence demonstrating clinically significant benefit for OSA treatments on OSA-related CVD outcomes are limited. In this review, we evaluate potential pathophysiologic mechanisms that link OSA to CVD and focus on specific treatments for OSA, including positive airway pressure (PAP), dental devices, and surgeries with regard to OSA-related CVD outcomes.

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