Cardiovascular Disease

Approximately 1 in 3 adults in the U.S. have cardiovascular disease (CVD); estimated costs were $475 billion in 2008.1 The connections between sleep apnea and cardiovascular disease have been well-established. A number of association guidelines recommend evaluating at-risk patients for sleep apnea, including:

  • American Heart Association/American Society of Anesthesiologists Guideline: Primary Prevention of Ischemic Stroke
  • Heart Failure Society of America: Comprehensive Heart Failure Practice Guideline
  • Seventh Report of the Joint National Committee: Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Diabetes Abstract Cover

During healthy sleep, heart rate, blood pressure, and cardiac output are reduced. The sleep fragmentation and recurring intermittent hypoxia associated with sleep apnea lead to swings in intrathoracic pressure and increased sympathetic activity, resulting in elevated blood pressure and heart rate.2 These effects have the potential to impair cardiovascular function. Numerous studies highlight the association between sleep apnea and CVD.

  • The risk of developing CVD is increased in patients with sleep apnea, independent of hypertension, age, BMI and smoking.3
  • In a 10-year study, severe sleep apnea was associated with increased risk of fatal and nonfatal cardiovascular events.4
  • Recurrence of atrial fibrillation after cardioversion is higher than 80% in patients with untreated sleep apnea compared to 50% in controls, independent of confounding factors.5
  • The magnitude of nocturnal oxygen desaturation, an important physiological consequence of sleep apnea, is an independent risk factor for the incidence of atrial fibrillation in people under 65 years of age.6
  • In a population-based sample, the adjusted hazard ratio for mortality associated with cardiovascular disease in subjects with untreated moderate-to-severe sleep apnea was 5.2.7

Sleep Apnea and Heart Failure

Heart failure affects 5.7 million people in the US. In 2009, the estimated cost of heart failure in the US is $37 billion.8

  • The Sleep Health Heart Study found that sleep apnea was associated with a 2.4-fold increased risk of heart failure independent of other risk factors.9
  • Epidemiological studies found prevalence rates of sleep apnea of up to 37% in patients with heart failure; in addition, heart failure patients with sleep apnea exhibited a higher prevalence of atrial fibrillation and ventricular arrhythmias than heart failure patients without sleep apnea.10, 11, 12

Effects of Treatment

Treatment of sleep apnea can mitigate risk of cardiovascular disease.

  • The incidence of fatal cardiovascular events is significantly higher in patients with untreated sleep apnea compared to patients using continuous positive airway pressure (CPAP) therapy to treat their sleep apnea.13 Even in patients with mild sleep apnea, CPAP therapy was associated with a 64% reduction in risk of CVD.14
  • In a 7-year cohort follow-up study, researchers demonstrated that effective CPAP treatment reduces the risk of CVD. Study subjects were free of hypertension, indicating that the CPAP-mediated reduction in CVD was independent of blood pressure control.15
  • Effective treatment of sleep apnea with CPAP has been shown to reduce blood pressure by a mean of 10 mm Hg.16 This level of reduction is sufficient to reduce risk of a coronary heart disease event by 37%.17
  • Effective CPAP treatment has been shown to decrease the incidence of new cardiovascular events in patients with coronary artery disease.18
  • CPAP treatment improved left ventricular function in heart failure patients with sleep apnea.19

Sleep apnea is strongly associated, in a dose-dependent manner, with hypertension, independent of other risk factors. Read more about sleep apnea and hypertension.

Numerous studies have shown that patients suffering from sleep apnea have an increased risk of stroke. Read more about sleep apnea and stroke.

1 American Heart Association. Heart Disease and Stroke Statistics—2009 Update
2 Leung RST and Bradley TD. Am J Respir Crit Care Med 2001;164:2147-65
3 Peker Y et al. Am J Respir Crit Care Med 2002;166:159-65
4 Marin JM et al. The Lancet 2005;365:1046-53
5 Kanagala R et al.. Circulation 2003;107:2589-94
6 Gami AS et al. J Am Coll Cardio 2007;l 49:565-71
7 Young T et al. SLEEP 2008; 31:1071-8
8 American Heart Association. Heart Disease and Stroke Statistics—2009 Update.
9 Shahar E et al. Am J Respir Crit Care Med 2001;163:19-25
10 Javaheri S et al. Circulation 1998;97:2154-59
11 Sin DD et al. Am J Respir Crit Care Med 1999;160:1101-06
12 Oldenburg O et al. Eur J Heart Failure 2007;9:251-57
13 Marin J et al. Lancet 2005 ;365:1046-53
14 Buchner NJ et al. Am J Respir Crit Care Med 2007;176:1274-80
15 Peker Y et al. Sleep 1997;20:645-53
16 Becker HF et al. Circulation 2003;107:68-73
17 Becker HF et al. Circulation 2003;107:68-73
18 Milleron O et al. Eur Heart J 2004;25:728-34
19 Kanecko Y et al. N Engl J Med 2003;348:1233-41