Sleep-disordered breathing and cardiovascular disease

Untreated sleep apnea is a risk factor for hypertension, and CPAP treatment effects a blood pressure reduction comparable to that of pharmacologic monotherapy. Nevertheless, many current papers addressing the rapid increase in prevalence of hypertension and purporting to outline its management do not mention looking for or treating sleep apnea as a strategy. In addition to hypertension, virtually every adverse cardiovascular condition has been strongly associated with sleep disordered breathing in cross-sectional studies. There are also small prospective studies of the relationship between sleep-disordered breathing (SDB) and coronary heart disease and atrial fibrillation. Further, treatment studies show improvement or reduced risk of most cardiovascular sequelae of SDB with CPAP treatment. Beyond hypertension, which is well established, the strongest relationships between SDB and cardiovascular disease appear to be with congestive heart failure and bradyarrhythmias. Prospective studies are needed to confirm these relationships and to further delineate the risk.