Cardiovascular diseases in obstructive sleep apnea

Obstrüktif uyku apne (OSA) orta yaştaki erişkinlerde yaklaşık olarak erkeklerin %15’ini, kadınların %5’ini etkiler ve istenmeyen sağlık sonuçlarıyla ilişkilidir. Kardiyovasküler bozukluklar OSA’nın en ciddi komplikasyonlarıdır. Bu komplikasyonlar, kalp yetersizligi, sol/sağ ventrikül disfonksiyonu, akut miyokard infarktüsü, aritmiler, inme, sistemik ve pulmoner hipertansiyonu içerir. Tüm bu kardiyovasküler komplikasyonlar OSA’nın morbidite ve mortalitesini arttırmaktadır. Çeşitli epidemiyolojik çalışmalarda, uykuyla ilişkili solunum bozukluklarının, olasılıkla uykuda tekrarlayan hipoksi ve hiperkapniler, arousaller, artmış sempatik aktivite ve bozulmuş barorefleks kontrolü mekanizmalarıyla oluşan hipertansiyon için bağımsız bir risk faktörü olduğu gösterilmiştir. Sol ventrikül disfonksiyonunun bağımsız belirleyicileri olan arteryel hipertansiyon, obezite, diabetes mellitus ve koroner arter hastalığı (KAH) sıklıkla OSA’ya eşlik eder. Özellikle diyastolik disfonksiyonu olan ciddi OSA hastaları, diyastolik ve sistolik disfonksiyon birarada bulunabildiğinden, kalp yetersizliği için artmış riske sahiptir. Kalp yetersizliği ve ölüme ilerleyişi önlemek için, ventrikül disfonksiyonunun erken tanı ve uygun tedavisi önerilmektedir. Belirgin kalp yetersizliği olmaksızın özellikle apne ve hipoksemisi olan akut miyokard infarktüslü hastalar, uyku bozuklukları açısından değerlendirilmelidir. KAH olan hastalar OSA ve OSA’lı hastalar da KAH açısından değerlendirilmelidir. OSA’nın erken tanı ve tedavisi kardiyovasküler fonksiyonları düzeltebilir. Nazal CPAP uygulaması, hastalığın tedavisi ve komplikasyonlarının önlenmesinde halen altın standart yöntemdir.

Obstrüktif uyku apnede kardiyovasküler hastalıklar

Obstructive sleep apnea (OSA) affects approximately 5% of women and 15% of men in the middle-aged adults, and associated with adverse health outcomes. Cardiovascular disturbances are the most serious complications of OSA. These complications include heart failure, left/right ventricular dysfunction, acute myocardial infarction, arrhythmias, stroke, systemic and pulmonary hypertension. All these cardiovascular complications increase morbidity and mortality of OSA. Several epidemiologic studies have demonstrated that sleep related breathing disorders are an independent risk factor for hypertension, probably resulting from a combination of intermittent hypoxia and hypercapnia, arousals, increased sympathetic activity, and altered baroreflex control during sleep. Arterial hypertension, obesity, diabetes mellitus and coronary artery disease (CAD) which are independent predictors of left ventricular dysfunction, often have coexistince with OSA. Especially severe OSA patients having diastolic dysfunction might have an increased risk of heart failure, since diastolic dysfunction might be combined with systolic dysfunction. Early recognition and appropriate therapy of ventricular dysfunction is advisable to prevent further progression to heart failure and death. Patients with acute myocardial infarction, especially if they had apneas and hypoxemia without evident heart failure should be evaluated for sleep disorders. So, patients with CAD should be evaluated for OSA and vice versa. Early recognition and treatment of OSA may improve cardiovascular functions. Continuous positive airway pressure (CPAP) applied by nasal mask, is still the gold standard method for treatment of the disease and prevention of complications.

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