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Vol. 36. Issue 4.
Pages 234-242 (July - August 2024)
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Vol. 36. Issue 4.
Pages 234-242 (July - August 2024)
Review article
Obstructive sleep apnea and cardiovascular risk
Apnea obstructiva del sueño y riesgo cardiovascular
Gerard Torresa,b,
Corresponding author
gtorres@gss.cat

Corresponding author.
, Manuel Sánchez de la Torreb,c,d, Lucia Pinillab,c,d, Ferran Barbéa,b
a Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
b CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
c Precision Medicine in Chronic Diseases, Hospital Universitari de Santa Maria, IRBLleida, Lleida, Spain
d Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
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Table 1. Effect of CPAP treatment of OSA on cardiovascular risk. Prospective randomised clinical studies and meta-analysis.
Abstract

Patients with obstructive sleep apnea (OSA) experience repetitive episodes of upper airway obstruction due to recurrent collapse during sleep. This leads to intermittent hypoxia episodes, which, through complex pathophysiological mechanisms, trigger sympathetic overactivation, endothelial dysfunction, hypercoagulation, and metabolic dysregulation. Consequently, other cardiovascular risk factors such as hypertension, metabolic syndrome, and diabetes are induced. Furthermore, this enhances target organ damage, affecting the heart, arteries, and kidneys, leading to an increased risk of cardiovascular morbidity and mortality. Among the various treatments for OSA, Continuous Positive Airway Pressure (CPAP) has been extensively studied. To date, this treatment has shown mild benefits in reducing blood pressure, particularly noticeable in patients with resistant hypertension. Furthermore, CPAP treatment appears to reduce cardiovascular events, both in primary and secondary prevention, though this benefit is limited to individuals with good compliance (CPAP use ≥4h/night). Future research perspectives in OSA seem to focus on identifying patients in whom the condition significantly influences cardiovascular risk, thus determining those who would benefit the most from treatment in the reduction of cardiovascular risk.

Keywords:
Obstructive sleep apnea
Cardiovascular risk
Hypertension
Resumen

Los sujetos con apnea obstructiva del sueño (AOS) sufren episodios repetidos de obstrucción de la vía aérea superior durante el sueño, debido a su colapso recurrente, que condicionan fenómenos de hipoxia intermitente. Esta, a través de mecanismos fisiopatológicos complejos, desencadena una hiperactivación simpática, disfunción endotelial, estado de hipercoagulabilidad y desregulación metabólica. Como resultado, se ve facilitada la aparición de otros factores de riesgo cardiovascular, como la hipertensión, síndrome metabólico o diabetes, se ve potenciada la lesión de órganos diana en corazón, arterias y riñones, así como un mayor riesgo de eventos y morbilidad cardiovascular. De entre las medidas terapéuticas del AOS, la más estudiada respecto a su potencial en reducción del riesgo cardiovascular, es el tratamiento con presión positiva continua sobre la vía aérea, la CPAP. Hasta la fecha, esta ha demostrado beneficios muy moderados en reducción de presión arterial, más evidentes en sujetos con hipertensión resistente, así como beneficios en reducción de eventos, tanto en prevención primaria como secundaria, aunque restringidos a aquellos sujetos con buena adherencia al tratamiento (uso ≥ 4h/ noche). Las nuevas vías de investigación sobre el AOS parecen centrase en buscar nuevos medios que permitan identificar a aquellos sujetos, en los que esta patología, es más determinante en el riesgo cardiovascular y que más se podrían beneficiar con su tratamiento, en términos reducción del mismo.

Palabras clave:
Apnea obstructiva del sueño
Riesgo vascular
Hipertensión

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