Obstructive Sleep Apnea and Atherosclerosis
Section snippets
General Mechanisms of Atherosclerosis
Coronary heart disease and stroke, both resulting from atherosclerosis (fatty deposits), account for 80% of deaths from cardiovascular diseases. Age-specific incidence rates for cardiovascular disease have fallen by half for the past 30 years in the economically advanced European nations, as a result of better prevention and treatments based on growing knowledge of vascular biology. Although these measures are becoming widely disseminated, an additional dramatic effect on cardiovascular disease
Atherosclerosis in Animal Models of Intermittent Hypoxia
Sleep apnea syndrome is a multicomponent disease including intermittent hypoxia (IH), respiratory efforts, and sleep fragmentation. Intermittent hypoxia has been proposed in rodents to mimic one of the major consequences of sleep apnea. As a partial model of sleep apnea, IH allows to test the specific role of IH on atherogenesis and to assess both plasma and tissue alterations that may contribute to atherosclerosis development and progression.
Atherosclerotic remodeling as evidenced by plaques
Clinical and Biological Findings in OSA
There have been significant efforts in this field of clinical research in reducing the number of confounding factors and comorbid conditions. In 2005, 3 reports were published nearly at the same time evidencing that sleep apnea may lead to early atherosclerosis as reflected at the carotid level by increase in IMT and occurrence of plaques, in the absence of any significant comorbidity.7, 8, 74 In our series of patients, severity of oxygen desaturation and BP status were the best predictors for
Conclusions
Sleep apnea and IH are associated with early vascular changes. There are both animal and clinical data supporting a specific role for IH in promoting cellular changes at the vascular wall level thus triggering atherosclerosis. These early changes as evidenced by subclinical markers in OSA patients are also seen in rodents exposed to IH for only several weeks. Lesions seem to be partly reversible as far as the inflammatory component is concerned. In OSA, CPAP impact needs certainly to be studied
References (96)
- et al.
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study
Lancet
(2005) - et al.
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial
Lancet
(2002) - et al.
The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence
Chest
(2005) Leukocyte-endothelial cell recognition: three (or more) steps to specificity and diversity
Cell
(1991)- et al.
Recurrent obstructive apneas trigger early systemic inflammation in a rat model of sleep apnea
Respir Physiol Neurobiol
(2007) - et al.
The relative importance of vascular structure and function in predicting cardiovascular events
J Am Coll Cardiol
(2004) - et al.
Simvastatin attenuates plaque inflammation: evaluation by fluorodeoxyglucose positron emission tomography
J Am Coll Cardiol
(2006) - et al.
Functional assessment of vascular reactivity after chronic intermittent hypoxia in the rat
Respir Physiol Neurobiol
(2006) - et al.
Vascular reactivity to norepinephrine and acetylcholine after chronic intermittent hypoxia in mice
Respir Physiol Neurobiol
(2003) Effect of episodic hypoxia on sympathetic activity and blood pressure
Respir Physiol
(2000)
Sleep apnea is a manifestation of the metabolic syndrome
Sleep Med Rev
Chronic intermittent hypoxia activates nuclear factor-kappaB in cardiovascular tissues in vivo
Biochem Biophys Res Commun
Sleep-apnea–related intermittent hypoxia and atherogenesis: adhesion molecules and monocytes/endothelial cells interactions
Atherosclerosis
Hematocrit levels in sleep apnea
Chest
Chronic intermittent hypoxia increases haematocrit and causes right ventricular hypertrophy in the rat
Respir Physiol
Obstructive sleep apnoea syndrome—an oxidative stress disorder
Sleep Med Rev
Increased 8-isoprostane and interleukin-6 in breath condensate of obstructive sleep apnea patients
Chest
HDL dysfunction in obstructive sleep apnea
Atherosclerosis
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander
N Engl J Med
Should all sleep apnoea patients be treated? Yes
Sleep Med Rev
Early signs of atherosclerosis in obstructive sleep apnea
Am J Respir Crit Care Med
Mortality in sleep apnea patients: a multivariate analysis of risk factors
Sleep
All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age
Eur Respir J
Obstructive sleep apnea as a risk factor for stroke and death
N Engl J Med
Inflammation, atherosclerosis, and coronary artery disease
N Engl J Med
Inflammation in atherosclerosis
Nature
Atherosclerosis
Nature
Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1
J Appl Physiol
Circulating ICAM-1 and VCAM-1 levels in patients with obstructive sleep apnea syndrome
Respiration
Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome
J Appl Physiol
Leukocyte recruitment in atherosclerosis: potential targets for therapeutic approaches
Cell Mol Life Sci
Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging
Circulation
Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006
Cerebrovasc Dis
Ultrasonographically assessed carotid morphology and the risk of coronary heart disease
Arterioscler Thromb
Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group
N Engl J Med
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
J Hypertens
Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis
Circulation
Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE)
Circulation
Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial
Circulation
Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus
N Engl J Med
Expert consensus document on arterial stiffness: methodological issues and clinical applications
Eur Heart J
Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study
Circulation
Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults
Circulation
Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study
Ann Intern Med
Chronic intermittent hypoxia induces atherosclerosis
Am J Respir Crit Care Med
Augmented endothelin vasoconstriction in intermittent hypoxia-induced hypertension
Hypertension
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Exosomes, sleep apnea, and cardiovascular disease: Implications for pathogenesis and promises for prevention
2022, Sleep Medicine ReviewsThe connection between obstructive sleep apnea and peripheral artery disease
2020, Journal of Vascular NursingCitation Excerpt :The process behind OSA and the subsequent development of atherosclerosis remains incompletely understood. The presence of intermittent hypoxia during the periods of apnea and hypopnea is considered to be the primary mechanism behind the cardiovascular alterations.11–14 Atherosclerosis is believed to represent a state of increased oxidative stress and inflammation.12