Clinicians Should Hold a High Suspicion for OSA in Patients With CVD
ORLANDO—As the prevalence of obstructive sleep apnea (OSA) rises, clinicians should especially maintain a high index of suspicion for OSA in patients with cardiovascular disease (CVD), according to Jeremy D. McConnell, MD, who presented today at Consultant360’s Cardiometabolic Risk Summit 2019.
Dr McConnell said that clinicians should hold this suspicion because OSA incidence is very high in CVD comorbidity.
According to Dr McConnell, OSA contributes to multiple pathways that lead to CVD, including sympathetic activation, vascular endothelial dysfunction, oxidative stress and inflammation, hypercoagulability, and metabolic effects.
For instance, repeated hypoxia may damage the endothelium and trigger the release of pro-inflammatory cytokines. Additionally, OSA is associated with glucose intolerance and insulin resistance, independent of potential confounders.
Dr McConnell also highlighted the cardiovascular effects of OSA, including:
- Systemic hypertension
- Pulmonary hypertension
- Nocturnal arrythmias
- Coronary artery disease
- Congestive heart failure
- Transient ischemic attack/stroke
According to Dr McConnell, 15% to 70% of individuals with OSA have pulmonary arterial hypertension, and men with severe OSA (defined as having an Apnea–Hypopnea Index more than 30) are 58% more likely to have heart failure (HF).
However, treating patients for OSA may be an effective way to manage these cardiovascular effects.
According to Dr McConnell, using a continuous positive airway pressure machine is associated with a mild, but significant, reduction in blood pressure. Furthermore, studies have shown that the treatment of OSA in HF can improve patients’ functional capacity.
As clinicians keep their suspicion for OSA in CVD high, Dr McConnell emphasizes that the screening for and diagnosis of OSA is simple and readily available, reminding practitioners to be watchful for OSA symptoms such as snoring, restless sleep, morning headaches, and nocturia.
McConnell JD. Obstructive sleep apnea and cardiometabolic risk. Talk presented at: Consultant360’s Cardiometabolic Risk Summit 2019; October 24-26, 2019; Orlando, FL.