Managing comorbid cardiovascular disease and sleep apnea with pharmacotherapy

ABSTRACT

Introduction: Highly prevalent sleep disordered breathing (SDB) has been recognized as an independent cardiovascular disease (CVD) risk factor. Although these two entities often coexist, there is a shortage of sufficiently-powered studies testing the interplay between the course of sleep apnea and CVD pharmacotherapy. The mutual relationship between treated/untreated obstructive sleep apnea (OSA) with ongoing cardiovascular pharmacotherapies is an evident gap in clinical expertise.

Areas covered: In this article, the authors review the available evidence and outline future research directions concerning the reciprocal relationship between the pharmacological treatment of CVD and SDB. Several attempts have been made to identify the most efficacious hypotensive agents for patients with both OSA and hypertension. Various cardiovascular drugs are also evaluated in terms of their influence on sleep apnea severity.

Expert opinion: The question of whether OSA should be included in cardiovascular pharmacotherapy individualization algorithms is a matter of debate and more evidence is needed. Cautious intensification of diuretics with the use of aldosterone receptor antagonists deserves attention when both high blood pressure and sleep apnea coexist.

KEYWORDS:

• Sleep disordered breathing
• obstructive sleep apnea
• central sleep apnea
• Hunter-Cheyne-Stokes respiration
• heart failure
• hypertension
• atrial fibrillation
• CPAP

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

Article highlights

• Sleep disordered breathing is widely prevalent in cardiovascular disease, markedly exceeding rates observed in the general population.

• There is insufficient evidence pharmacotherapy targeting sleep apnea is safe and effective.

• Recent studies suggest that strict fluid control with diuretics administered to hypertensive or heart failure patients may reduce sleep apnea severity, both obstructive and central.

• Along with diuretics, beta-1-adrenergic antagonists appear to be the most effective BP-lowering agents for hypertension control in OSA patients.

• Obstructive sleep apnea is a novel thromboembolic risk factor, yet the current guidelines do not include SDB in the algorithms designed for anticoagulant therapy initiation. This box summarizes key points contained in the article.

This box summarizes key points contained in the article.

Additional information

Funding

This manuscript was supported by the Medical University of Gdańsk, Poland.