Cardiovascular Disease and Sleep Apnea

The Nov 10 issue of the New England Journal of Medicine had several interesting articles about sleep apnea.

Obstructive sleep apnea (OSA) is a risk factor for the development of hypertension. Increasing evidence also links OSA to ischemic heart disease and stroke. Yaggi HK and colleagues (N Engl J Med 2005;353:2034-41), in an observational cohort study, found that OSA significantly increases the risk of stroke or death from any cause. This increase in risk is independent of other risk factors, including hypertension.

Both obstructive and central sleep apnea are common in patients with CHF; central sleep apnea is present in up to 40% of patients with chronic heart failure. Bradley TD et al. (N Engl J Med 2005;353:2025-33) randomly assigned 258 patients with CHF and central sleep apnea to receive either CPAP or no CPAP. CPAP decreased apnea, increased the injection fraction, and improved nocturnal oxygenation, but did not increase survival.

Nasal CPAP is the standard treatment for OSA; other treatment modalities include oral appliances and ENT surgery. The first step in the management of central sleep apnea associated with heart failure is optimization of cardiac functioning. Other possible treatments include CPAP, BiPAP, supplemental oxygen, and theophylline.