Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science

Author(s)

Drager, Luciano F. ^{[1, 2, 3]} ; McEvoy, R. Doug ^{[4, 5, 6]} ; Barbe, Ferran ^{[7, 8]} ; Lorenzi-Filho, Geraldo ^[9] ; Redline, Susan ^{[10, 11]} ; Collab, INCOS-ACT Initiative Int

Affiliation:Show less -

^[1] Univ Sao Paulo, Sch Med, Hypertens Unit, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Inst Coracao, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Div Renal, Hypertens Unit, Sao Paulo - Brazil

^[4] Flinders Univ S Australia, Adelaide Inst Sleep Hlth, Coll Med & Publ Hlth, Adelaide, SA - Australia

^[5] Flinders Univ S Australia, Fac Med Nursing & Hlth Sci, Sch Med, Adelaide, SA - Australia

^[6] Southern Adelaide Local Hlth Network, Sleep Hlth Serv, Resp & Sleep Serv, Adelaide, SA - Australia

^[7] Inst Recerca Biomed Lleida, Resp Dept, Lleida - Spain

^[8] Ctr Invest Biomed Red Enfermedades Resp, Madrid - Spain

^[9] Univ Sao Paulo, Sch Med, Sleep Lab, Div Pulm, Sao Paulo - Brazil

^[10] Harvard Med Sch, Boston, MA - USA

^[11] Brigham & Womens Hosp, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 - USA

• Document type: Journal article
• Source: Circulation; v. 136, n. 19, p. 1840-1850, NOV 7 2017.
• Web of Science Citations: 74

Abstract

Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities. (AU)

• FAPESP's process: 12/02953-2 - Impact of obstructive sleep apnea and sleep duration on the progression of cardiovascular diseases
• Grantee: Luciano Ferreira Drager
• Support Opportunities: Research Grants - Young Investigators Grants