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Obstructive sleep apnea, hypertension and cardiovascular risk

  • How to identify? Presented by W T McNicholas (Dublin, IE) - Slides
  • Relation to hypertension, presented by G Parati (Milano, IT)
  • Increased risk of stroke and arrhythmias, presented by K Narkiewicz (Gdansk, PL) - Slides
  • Cardiovascular effects of treatment, presented by P Levy (Grenoble, FR) - Slides

Obstructive sleep apnea (OSA) is defined as the presence of apneas during sleep (> 5/hour), associated with daytime symptoms, particularly sleepiness, due to obstruction of oropharynx. Diagnosis of OSA requires both clinical assessment and objective sleep monitoring. However the gold standard for diagnosis remains the polysomnography. There are data supporting association between sleep apnea and hypertension, stroke, arrhythmias, coronary artery disease as well as cardiovascular mortality. The combination of OSA and hypertension is highly prevalent; roughly 50% of patients with hypertension have OSA. Among mechanisms responsible for the association of OSA and hypertension hypoxia induced chemoreflex activation with subsequent increase in sympathetic nerve activity and reduction in baroreflex sensitivity plays an important role. OSA is present in 70% of patients with stroke or TIA. OSA diagnosed after a stroke predicts worse functional outcome and is associated with greater mortality. Nocturnal arrhythmias have been shown to occur in up to 50% of OSA patients. The most common arrhythmias are non-sustained ventricular tachycardia, sinus arrest, 2nd degree AV-block, and frequent premature ventricular contractions. OSA predisposes to atrial fibrillation and increases the risk of sudden cardiac death. Therapeutic interventions to counteract the blood pressure elevation in OSA and the occurrence of apneic events in hypertensive patients include CPAP with proper drug therapy, as well as maneuvers such as postural therapy, use of bytes, surgical interventions and interventions on lifestyle, mainly weight reduction




Obstructive sleep apnea, hypertension and cardiovascular risk

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.