Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is one of the best known and most prevalent sleep disorders. Recurring nightly apneic events are not only accompanied by severe impairment of the sleep pattern but also provoke acute and chronic changes in cardiovascular perf
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Introduction
Cardiovascular control is markedly affected by normal sleep [1]. A blood pressure (BP) profile correlates directly to the amount of deep sleep and inversely with markers of sleep fragmentation [2]. Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders known. Recurring nightly apneic events are not only accompanied by severe impairment of the sleep pattern, but also provoke acute and chronic changes in cardiovascular performance. Most high-risk cardiovascular patients should be routinely screened and treated for concurrent OSA. This position has been reflected in both European and US recommendations for the management of arterial hypertension.
10.2
Sleep Apnea
Sleep disordered breathing (SDB) comprises different patterns of abnormal respiratory control during sleep, among which OSA appears to be the most prevalent [3]. Diagnosis of SDB is based on an overnight polysomnographic (PSG) recording, which is usually preceded by preliminary tests (e.g., questionnaires). Severity assessment of the majority of SDB forms is possible with PSG-derived indices. In spite of some limitations, the apnea–hypopnea index (AHI) has been widely accepted as a disease marker used in clinical practice, epidemiology, and
J. Wolf (&) K. Narkiewicz Hypertension and Diabetology, Medical University of Gdan´sk, De˛binki 7C, 80-952 Gdan´sk, Poland e-mail: [email protected] K. Narkiewicz e-mail: [email protected] A. E. Berbari and G. Mancia (eds.), Special Issues in Hypertension, DOI: 10.1007/978-88-470-2601-8_10, Ó Springer-Verlag Italia 2012
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research. OSA may affect every fourth man and every tenth woman in adulthood [4]; however, records show that the condition remains highly under recognized, especially in the cardiovascular population [5]. There are no pathognomonic symptoms of different forms of SDB. A patient may present the full-blown disease or the symptoms may hardly be apparent, with no clear correlation with the disease severity denoted by AHI. Symptoms may also vary substantially within one type of SDB, such as OSA. Management of different forms of sleep apnea comprises various modalities; however, noninvasive, continuous positive airway pressure (CPAP) administered at night appears to be the one most widely implemented. CPAP treatment not only effectively reduces excessive daytime sleepiness (EDS) and other OSA symptoms, thereby improving quality of life, but also decreases OSA-related morbidity and mortality. Unfortunately, adherence to CPAP therapy varies considerably across the OSA population [6].
10.3
Cardiovascular Aspects of Sleep Apnea
Repetitive apneic episodes during sleep elicit multiple deleterious stimuli which altogether negatively interfere with various control systems. Presently, sleep apnea is no longer recognized as a condition related to daytime somnolence only, but also as a disorder negatively affecting cardiovascular performance, morbidity, and mortality [7, 8]. Untreated OSA poses a great, and usually underestimated, f
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