Obstructive Sleep Apnea, Hypertension, and Cardiovascular Disease

Globally, cardiovascular disease (CVD) contributes majorly to increased morbidity and mortality. In addition to the research directed toward the development of newer and more effective treatments, there is also serious thought and research toward modifying risk factors for primary and secondary prevention of CVD. In the ongoing search for such modifiable risk factors, obstructive sleep apnea (OSA) is one main risk factors for several CVDs such as hypertension (HTN), cardiac failure (CF), cardiac arrhythmias, and coronary artery disease.[1] In a society, where there is an ever-increasing aging population compounded with the obesity epidemic, OSA prevalence has increased by 30% and thereby its increased association with CVD. OSA is the repeated stoppage of inspiratory airflow due to oropharyngeal obstruction during sleep. It affects 34% of males and 17% of females in the USA.[2] This upper airway obstruction results in lack of oxygen, disturbance to sleep, and adrenergic nervous system stimulation. Consequently, there is a rise in blood pressure with tachycardia, vascular dysfunction, widespread inflammation, and resistance to insulin. All these changes are said to contribute to the development of CVD.[3] A large volume of evidence has accumulated in favor of OSA linking it to drugresistant HTN, coronary artery disease, congestive CF, and atrial fibrillation [Table 1].