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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Global risk assessment is the standard of care for coronary artery disease management. In this setting, sleep apnea syndrome, which includes obstructive sleep apnea and central sleep apnea, is being increasingly recognized as a potentially modifiable risk factor for coronary artery disease. Emerging evidence points toward a cause and effect relationship between sleep apnea syndrome and medical conditions like insulin resistance, hypertension, heart failure, and myocardial ischemia. The effects of sleep apnea on coronary artery disease can be independent of many traditional risk factors. Continuous positive airway pressure has been shown to decrease inflammatory markers that are elevated in sleep apnea syndrome. Well-designed randomized controlled clinical trials are needed to better establish the role of sleep apnea in the genesis and progression of coronary artery disease.
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PMID:Sleep apnea syndrome: implications on cardiovascular diseases. 1905 Apr 22

Obstructive sleep apnea syndrome (OSA) is a highly prevalent breathing disorder in sleep affecting at least 2-4% of the adult population. A large number of studies have demonstrated that OSA is an independent risk factor of cardiovascular morbidity and mortality. Sleep apnea was shown to be associated with hypertension, ischemic heart disease, stroke, pulmonary hypertension, cardiac arrhythmia, and cardiovascular mortality. The association of OSA with subclinical signs of cardiovascular morbidity such as endothelial dysfunction and vasculature remodeling on the one hand, and with oxidative stress, activation of inflammatory pathways and increased leukocytes/endothelial cells adhesion on the other, implicate that atherogenesis plays a major role in cardiovascular sequela of OSA. Results demonstrating that effective treatment of the syndrome can abort and even reverse the atherogenic process suggest that OSA should be diagnosed and treated as early as possible in order to prevent cardiovascular sequlea.
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PMID:Cardiovascular morbidity and mortality in obstructive sleep apnea. 1907 22

Disturbances in cardiovascular neural regulation, influencing both disease course and survival, progress as heart failure worsens. Heart failure due to left ventricular systolic dysfunction has long been considered a state of generalized sympathetic activation, itself a reflex response to alterations in cardiac and peripheral hemodynamics that is initially appropriate, but ultimately pathological. Because arterial baroreceptor reflex vagal control of heart rate is impaired early in heart failure, a parallel reduction in its reflex buffering of sympathetic outflow has been assumed. However, it is now recognized that: 1) the time course and magnitude of sympathetic activation are target organ-specific, not generalized, and independent of ventricular systolic function; and 2) human heart failure is characterized by rapidly responsive arterial baroreflex regulation of muscle sympathetic nerve activity (MSNA), attenuated cardiopulmonary reflex modulation of MSNA, a cardiac sympathoexcitatory reflex related to increased cardiopulmonary filling pressure, and by individual variation in nonbaroreflex-mediated sympathoexcitatory mechanisms, including coexisting sleep apnea, myocardial ischemia, obesity, and reflexes from exercising muscle. Thus, sympathetic activation in the setting of impaired systolic function reflects the net balance and interaction between appropriate reflex compensatory responses to impaired systolic function and excitatory stimuli that elicit adrenergic responses in excess of homeostatic requirements. Recent observations have been incorporated into an updated model of cardiovascular neural regulation in chronic heart failure due to ventricular systolic dysfunction, with implications for the clinical evaluation of patients, application of current treatment, and development of new therapies.
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PMID:Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. 1962 11

Sleep affects brain function and may contribute to vascular cerebral pathology through a diversity of direct and indirect mechanisms. Circadian rhythm investigation shows increased incidence of stroke between 6 AM and 12 noon. Risk factors for stroke such as high blood pressure, ischemic heart disease, and diabetes are modified by sleep and sleep apnea. Epidemiological studies have shown a dose-response relationship between the severity of sleep apnea and the odds ratio for development of systemic hypertension. There is now evidence of a causal relationship between sleep apnea and stroke. Following stroke, both in the acute and chronic stages, patients have a high prevalence of sleep apnea that reduces the potential for rehabilitation, further increases the risk of secondary stroke, and heightens mortality. Successful correction of sleep apnea with noninvasive positive airway pressure ventilation lowers mean blood pressure, and indirectly lowers the risk of stroke. Unfortunately, patients with stroke tolerate positive noninvasive ventilation poorly, and other means of correcting sleep apnea need to be investigated.
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PMID:Sleep and stroke. 1974 18

Hypoxia-inducible factor-1 (HIF-1) is a nuclear transcription factor that is upregulated in hypoxia and co-ordinates the adaptive response to hypoxia by driving the expression of over 100 genes. In facilitating tissues to adapt to hypoxia, HIF-1 may have a role in reducing the cellular damage induced by ischaemia, such as that seen in peripheral arterial disease (PAD), or following acute ischaemic insults such as stroke and myocardial infarction. This therefore raises the possibility of HIF-1 modulation in such contexts to reduce the consequences of ischaemic injury. HIF1 has further been implicated in the pathogenesis of atherosclerosis, abdominal aortic aneurysm (AAA) formation, pulmonary hypertension and systemic hypertension associated with obstructive sleep apnoea. Through a better understanding of the role of HIF-1 in these disease processes, novel treatments which target HIF-1 pathway may be considered. This review summarises the role of HIF-1 in arterial disease, specifically its role in atherosclerosis, ischaemic heart disease, in-stent restenosis following coronary revascularisation, stroke, PAD, AAA formation, pulmonary artery hypertension and systemic hypertension. The potential for exploiting the HIF-1 signalling pathway in developing therapeutics for these conditions is discussed, including progress made so far, with attention given to studies looking into the use of prolyl-hydroxylase inhibitors.
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PMID:Hypoxia-inducible factor-1 in arterial disease: a putative therapeutic target. 2080 88

In some studies, snoring has been associated with an increased risk of hypertension, ischemic heart disease and stroke. Although the mechanisms involved in these associations are unknown, they are probably mediated by obstructive sleep apnea. Nevertheless, most snorers do not have sleep apnea. Whether snoring itself increases the risk of cardiovascular disease remains controversial.
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PMID:[Consequences of untreated snoring]. 2094 78

Obstructive sleep apnea (OSA) is a form of sleep disordered breathing in which pharyngeal muscle relaxation leads to recurrent nighttime apneas and hypopneas that, through increased afterload, intermittent hypoxia, and excess sympathetic activity, weaken the already failing heart. This review presents the current evidence regarding the complex relationship between OSA and heart failure (HF), including support for OSA as both a cause and consequence of HF. The impact of OSA on other cardiovascular diseases, such as hypertension, ischemic heart disease and arrhythmias, as they relate to HF development or exacerbation, also are reviewed.
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PMID:Sleep apnea in congestive heart failure. 2095 52

In this retrospective analysis, all patients (n=714; male=590; female=124 and female male ratio = 1: 4.76) came to Pulsar, a sleep laboratory of Kolkata, for polysomnography during ten years period were analyzed. More than half (62.46%) cases were between 41-60 years and 14.43% cases between 61-80 years age group. Fifty-two percent cases were referred by pulmonologists, followed by internist (15%), and 7% cases were self referred. Though obstructive sleep apnea was responsible for increased cardiovascular mortality and resistant hypertension, only 4% cases were referred by cardiologists. We observed hypertension as co-morbidity in 52.63% cases and ischemic heart disease in 22.83% cases. Snoring was the presenting complain in 98.88% cases, chocking was present in 48.88% cases and excessive daytime sleepiness was found in 96.64% cases. Females showed comparatively higher frequency of sleep disordered breathing than males with increasing basal metabolic rate. Nocturnal fall of SPO2 below 90% was observed in 86.97% of study population. We found abnormal respiratory disturbance index (> 5/hr of sleep) in 84.59% of our patients, normal respiratory disturbance index (< or = 5/hr of sleep) in 9.94% cases and isolated nocturnal hypoxemia in 5.46% cases (74.36% of the last category having obstructive airway disease). Snoring with respiratory disturbance index (RDI) < or = 5/hr was observed in 102 cases, of them 81.37% had simple snoring without significant arousal whereas 18.63% had multiple sleep fragmentation. We estimated that 84.06% of males, 87.10% of females and 84.59% of study population had obstructive sleep apnea. Split night polysomnography was performed in 362 cases, and of them 15.47% cases could not tolerate continuous positive airway pressure (CPAP) due to local or psychological reasons. In the present one time split-night CPAP titration study, we could not correct OSA in 19.06% subjects. Inadequate correction of hypoxemia due to co-morbid condition like COPD, asthma, obesity, hypothyroidism was the main responsible factor (49.28%). Treatment with CPAP was effective in 68.23% cases in first attempt. More than half of the cases (62.42%) required 10 cm of H20 or less CPAP.
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PMID:Polysomnographic profile in a sleep laboratory in Kolkata: a retrospective analysis of 714 cases. 2112 Dec 4

Ankylosing spondylitis is a chronic inflammatory condition that usually affects young men. Cardiac dysfunction and pulmonary disease are well-known and commonly reported extra-articular manifestation, associated with ankylosing spondylitis (AS). AS has also been reported to be specifically associated with aortitis, aortic valve diseases, conduction disturbances, cardiomyopathy and ischemic heart disease. The pulmonary manifestations of the disease include fibrosis of the upper lobes, interstitial lung disease, ventilatory impairment due to chest wall restriction, sleep apnea, and spontaneous pneumothorax. They are many reports detailing pathophysiology, hypothesized mechanisms leading to these derangements, and estimated prevalence of such findings in the AS populations. At this time, there are no clear guidelines regarding a stepwise approach to screen these patients for cardiovascular and pulmonary complications.
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PMID:Cardiopulmonary manifestations of ankylosing spondylitis. 2154 38

Cerebral ischemia and ischemic heart diseases, common entities nowadays, are the main manifestation of circulatory diseases. Cardiovascular diseases, followed by stroke, represent the leading cause of mortality worldwide. Both entities share risk factors, pathophisiology and etiologic aspects by means of a main common mechanism, atherosclerosis. However, each entity has its own particularities. Ischemic stroke shows a variety of pathogenic mechanisms not present in ischemic heart disease. An ischemic stroke increases the risk of suffering a coronary heart disease, and viceversa. The aim of this chapter is to review data on epidemiology, pathophisiology and risk factors for both entities, considering the differences and similarities that could be found in between them. We discuss traditional risk factors, obtained from epidemiological data, and also some novel ones, such as hyperhomocisteinemia or sleep apnea. We separate risk factors, as clasically, in two groups: nonmodifiables, which includes age, sex, or ethnicity, and modifiables, including hypertension, dyslipidemia or diabetis, in order to discuss the role of each factor in both ischemic events, ischemic stroke and coronary heart disease.
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PMID:Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences. 2180 73


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