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Heart Groups Acknowledge Apnea
Heart Groups Acknowledge Apnea
In the face of rising rates of obesity, hypertension, atrial fibrillation, and heart failure, physicians need to be mindful of the mounting evidence for a link between sleep apnea and cardiovascular disease when evaluating patients, according to a joint American Heart Association and American College of Cardiology Foundation scientific statement.
“We feel it is important to alert the cardiovascular community to the implications of this emerging area of research. It is possible that diagnosing and treating sleep apnea may prove to be an important opportunity to advance our efforts at preventing and treating heart disease,” Dr. Virend K. Somers said in a press statement. Dr. Somers chaired the joint statement writing committee.
Dr. Somers has received research support from Respironics and the ResMed Foundation; he is also a consultant to Respironics. Both companies make devices to treat sleep apnea. In addition, Dr. David P. White, committee cochair, is the chief medical officer for Respironics.
Sleep-related breathing disorders are very common among patients with established cardiovascular disease. Obstructive sleep apnea (OSA) affects a large proportion of patients with hypertension, coronary artery disease, stroke, and atrial fibrillation. Central sleep apnea (CSA), in contrast, occurs mainly in patients with heart failure.
Cardiologists are seeing more patients with sleep apnea diagnoses, according to Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco. “I have noticed an increase in the number of patients who tell me that they have a diagnosis of sleep apnea,” she said.
While the statement serves as something of a primer on the types of sleep apnea and its relevance to individuals who are at risk for, or who already have, cardiovascular disease, the authors acknowledge that there is much that is not known about the interactions between sleep apnea and cardiovascular disease.
“We need to more clearly define the cause-and-effect relationship between sleep apnea and cardiovascular diseases and risk factors,” Dr. Somers said.
Key questions include whether sleep apnea is a precipitating factor in the development of cardiac and vascular disease, whether sleep apnea accelerates cardiovascular disease progression, and if the treatment of sleep apnea results in clinical improvement, fewer cardiovascular events, and reduced mortality.
However, it will likely be difficult to disentangle the role of sleep apnea in the cardiovascular disease process because obesity is common among patients with sleep apnea, and this association “often obscures differentiation between the effects of obesity, the effects of OSA, and the effects of synergies between these conditions,” the authors wrote. Also, cardiovascular disease is often among several comorbidities of OSA. Hence, it is “unclear whether abnormalities evident in the sleep apnea patient with cardiovascular disease are secondary to the sleep apnea, the cardiovascular condition, or both,” the authors noted.
Given the number of unknowns about the interactions of sleep apnea and cardiovascular disease, and the limited number of randomized control trials, Dr. Redberg noted that she is unlikely to change her practice based on this scientific statement. “It's unclear how this would help my patients,” she said. She already encourages patients to make lifestyle changes aimed at reducing obesity, which is also strongly associated with OSA.
The statement authors noted that there are many challenges to the development of a best practices consensus for sleep apnea and cardiovascular disease. First, sleep medicine education is largely absent from cardiovascular training. In addition, sleep apnea treatment options vary, are predominantly device based, and are not well tolerated by patients. Lastly, it's unclear whether treating sleep apnea confers any real benefit in reducing cardiovascular events.
To complicate matters, there is no clear consensus on how to best quantify severity of sleep apnea, nor is it known what threshold of severity should trigger therapy. It's also not known if thresholds for treatment should be different for people with cardiovascular disease compared with healthy individuals.
PII: S0270-6644(08)70650-7
doi:10.1016/S0270-6644(08)70650-7
© 2008 Elsevier Inc. All rights reserved.
Copyright © 2009 Elsevier, Inc. All rights reserved | Privacy Policy | Terms & Conditions | Feedback | About Us | Help | Contact Us |
The content on this site is intended for health professionals.
In the face of rising rates of obesity, hypertension, atrial fibrillation, and heart failure, physicians need to be mindful of the mounting evidence for a link between sleep apnea and cardiovascular disease when evaluating patients, according to a joint American Heart Association and American College of Cardiology Foundation scientific statement.
“We feel it is important to alert the cardiovascular community to the implications of this emerging area of research. It is possible that diagnosing and treating sleep apnea may prove to be an important opportunity to advance our efforts at preventing and treating heart disease,” Dr. Virend K. Somers said in a press statement. Dr. Somers chaired the joint statement writing committee.
Dr. Somers has received research support from Respironics and the ResMed Foundation; he is also a consultant to Respironics. Both companies make devices to treat sleep apnea. In addition, Dr. David P. White, committee cochair, is the chief medical officer for Respironics.
Sleep-related breathing disorders are very common among patients with established cardiovascular disease. Obstructive sleep apnea (OSA) affects a large proportion of patients with hypertension, coronary artery disease, stroke, and atrial fibrillation. Central sleep apnea (CSA), in contrast, occurs mainly in patients with heart failure.
Cardiologists are seeing more patients with sleep apnea diagnoses, according to Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco. “I have noticed an increase in the number of patients who tell me that they have a diagnosis of sleep apnea,” she said.
While the statement serves as something of a primer on the types of sleep apnea and its relevance to individuals who are at risk for, or who already have, cardiovascular disease, the authors acknowledge that there is much that is not known about the interactions between sleep apnea and cardiovascular disease.
“We need to more clearly define the cause-and-effect relationship between sleep apnea and cardiovascular diseases and risk factors,” Dr. Somers said.
Key questions include whether sleep apnea is a precipitating factor in the development of cardiac and vascular disease, whether sleep apnea accelerates cardiovascular disease progression, and if the treatment of sleep apnea results in clinical improvement, fewer cardiovascular events, and reduced mortality.
However, it will likely be difficult to disentangle the role of sleep apnea in the cardiovascular disease process because obesity is common among patients with sleep apnea, and this association “often obscures differentiation between the effects of obesity, the effects of OSA, and the effects of synergies between these conditions,” the authors wrote. Also, cardiovascular disease is often among several comorbidities of OSA. Hence, it is “unclear whether abnormalities evident in the sleep apnea patient with cardiovascular disease are secondary to the sleep apnea, the cardiovascular condition, or both,” the authors noted.
Given the number of unknowns about the interactions of sleep apnea and cardiovascular disease, and the limited number of randomized control trials, Dr. Redberg noted that she is unlikely to change her practice based on this scientific statement. “It's unclear how this would help my patients,” she said. She already encourages patients to make lifestyle changes aimed at reducing obesity, which is also strongly associated with OSA.
The statement authors noted that there are many challenges to the development of a best practices consensus for sleep apnea and cardiovascular disease. First, sleep medicine education is largely absent from cardiovascular training. In addition, sleep apnea treatment options vary, are predominantly device based, and are not well tolerated by patients. Lastly, it's unclear whether treating sleep apnea confers any real benefit in reducing cardiovascular events.
To complicate matters, there is no clear consensus on how to best quantify severity of sleep apnea, nor is it known what threshold of severity should trigger therapy. It's also not known if thresholds for treatment should be different for people with cardiovascular disease compared with healthy individuals.
PII: S0270-6644(08)70650-7
doi:10.1016/S0270-6644(08)70650-7
© 2008 Elsevier Inc. All rights reserved.
Copyright © 2009 Elsevier, Inc. All rights reserved | Privacy Policy | Terms & Conditions | Feedback | About Us | Help | Contact Us |
The content on this site is intended for health professionals.
Views: 6
Replies to This Discussion
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Permalink Reply by susan mccord on
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Rock, thank you for posting this! Had "the conversation" with my new sleep doc re: my having both apnea and CAD. He seems to think there's a close relationship between the two, certainly worthy of attention. It's my impression, although I haven't asked him directly, that my cardiologist is of the same persuasion. He has certainly been attentive to this diagnostic process. Gotta say I'm concerned about it, 'specially given the fact that I know I've had apnea symptoms for many, many years, undiagnosed.
I've only recently learned of the potential for co-morbidity of these two diseases affecting mortality. Now that is a startling thing to contemplate for anyone who is dually-diagnosed....you're ahead of the pack bringing this to the attention of SG folks. I haven't heard anyone, except myself--Lord knows, I have a boatload of stuff to say about nearly everything!!--talk about having both heart disease and apnea. I wonder how many apnea &/or cardiac patients are even aware.......so thanks. Again.
Susan McCord :-)
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