Cardiovascular consequences of sleep disordered breathing: the role of CPAP treatment

Abstract

CPAP treatment decreases BP in OSA patients, especially in severe OSA, and in patients with poorly controlled BP. OSA adversely affects heart function and remodelling, but its role in the pathogenesis of HF remains unclear. Similarly, the impact of CPAP is uncertain, and results of the ongoing ADVENT-HF trial will provide more information. Several experimental studies in animals and humans indicate a central role of intermittent hypoxia in atherogenesis through multiple mechanisms. However, randomised controlled trials (RCTs) in patients with CAD and OSA found no difference in outcomes between CPAP-treated and untreated patients. The negative results of secondary prevention RCTs may be the result of exclusion of severely sleepy patients and poor compliance with CPAP treatment. In addition, room for improvement after substantial cardiac interventions may be very limited. Knowledge on arrhythmias in OSA has expanded in recent years, especially regarding AF and ventricular arrhythmias including sudden cardiac death. However, studies on the effects of CPAP are limited and controversial.