Obstructive sleep apnea and cardiovascular events in elderly patients

ABSTRACT

Introduction

In recent decades, life expectancy has increased considerably. The cardiovascular effects of Obstructive Sleep Apnea (OSA) in the elderly lead to patient disability and high resource consumption. Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular disease. However, chronic intermittent hypoxia may protect elderly patients from cardiovascular events (CVE) due to biological adaptation.

Areas covered

OSA patients are at increased risk of cardiovascular events. The severity of OSA increases cardiovascular risk, and this association also exists in the elderly. This article reviews the association between OSA, CPAP treatment, and CVE, particularly stroke and coronary heart disease (CHD), in the elderly. MEDLINE and the Cochrane Collaboration databases were searched from inception to July 2021.

Expert Commentary

Although a positive association between OSA and the incidence of cardiovascular disease in the elderly has been established, the role of sleep apnea in certain cardiovascular events remains controversial. Most authors agree that untreated OSA is a risk factor for stroke or worse stroke prognosis. However, the association between OSA and CHD is usually less pronounced than between OSA and stroke, especially in the elderly.

KEYWORDS:

• Sleep
• Apnea
• cardiovascular
• elderly
• Coronary Heart Disease
• Stroke

Article highlights

• Large studies with a high proportion of elderly patients have shown an increased risk of cardiovascular events in Obstructive Sleep Apnea (OSA) patients, and this association may intensify or attenuate with age. The severity of OSA increases the cardiovascular risk, and this association is also present in the elderly.

• Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular events. The relationship between these intermediate mechanisms and the development of each type of event is still not clear.

• Most authors agree that untreated OSA is a risk factor for stroke or a worse prognosis and that Continuous Positive Airway Pressure (CPAP) treatment seems to protect the patients from stroke.

• Despite the limited evidence available, CPAP treatment improves cardiovascular consequences of OSA in the elderly. Adherence to therapy, often low in OSA patients, influences the protective effect of the treatment.

• The association between OSA and coronary heart disease, when present, is usually less intense than the association between OSA and stroke, especially in the elderly.

• There is a lack of randomized clinical trials in the elderly. Studies focused on the elderly population are observational, and the outcomes analyzed are mostly a composite outcome of different types of cardiovascular disease.

Declaration of interest

X. Soler is a full-time employee of Regeneron Pharmaceuticals. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.