Cardiovascular remodeling in obstructive sleep apnea: focus on arterial stiffness, left ventricular geometry and atrial fibrillation

ABSTRACT

Introduction

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is associated with increased risk of cardiovascular disease. The main interest of this clinical review is to discuss the cardiovascular consequences of OSA with a special focus on left ventricular (LV) function and structure, arterial stiffness and atrial fibrillation.

Area covered

We present an overview of the definition, prevalence, and risk factors of OSA and outline the association between OSA and cardiovascular complications. We then briefly discuss echocardiographic assessment in OSA with focus on the left atrium and LV. Finally, we highlight the importance of adherence to continuous positive airway pressure (CPAP) therapy with regard to reducing the risk of cardiovascular disease.

Expert commentary

Although OSA has a strong association with cardiovascular complications, it is often underdiagnosed and undertreated. Patients with resistant hypertension and atrial fibrillation with poor therapeutic success after cardioversion or catheter ablation should be more often screened for OSA. Patients with nocturnal adverse cardiovascular events (stroke, arrhythmias, angina, coronary events) should be closely assessed with regard to OSA, and if confirmed, timely treated by lifestyle modification, CPAP, and aggressive antihypertensive treatment. Adherence to CPAP in OSA patients is essential in terms of reducing the risk of cardiovascular events.

KEYWORDS:

• Apnea-hypopnea index
• atrial fibrillation
• arterial stiffness
• echocardiography
• hypertension
• obstructive sleep apnea

Funding

This paper was not funded.

Author contributions

Sahrai Saeed, Bjørn Bjorvatn, Sverre Lehman: conceptualization and design, data collection, analysis and interpretation, drafting of the manuscript, editing, and final approval. Andrea Romarheim, Eivind Solheim: writing, review, editing and final approval.

Article highlights

• Obstructive sleep apnea (OSA) is characterized by intermittent complete (apnea) or partial (hypopnea) collapse of the upper airways during sleep.

• The pathophysiology of OSA is complex and multifactorial.

• OSA is often underdiagnosed and undertreated.

• OSA has a strong association with cardiovascular disease, particularly hypertension, atrial fibrillation, stroke, coronary artery disease, and heart failure.

• OSA is a known predictor of atrial fibrillation recurrence.

• Recent, large-scale prospective studies suggest that hypertension but not OSA per se is associated with increased arterial stiffness.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Statement of ethics

Written informed consent was obtained from the patients for publication of this manuscript and any accompanying echocardiographic images.