, Bahri Akdeniz 2
, Servet Altay 3
, Baran Balcan 4
, Özcan Başaran 5
, Erkan Baysal 6
, Ahmet Çelik 7
, Dursun Dursunoğlu 8
, Neşe Dursunoğlu 9
, Selma Fırat 10
, Canan Gündüz Gürkan 11
, Önder Öztürk 12
, Mehmet Sezai Taşbakan 13
, Vedat Aytekin 14
2Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
3Department of Cardiology, Trakya University Faculty of Medicine, Edirne, Turkey
4Department of Pulmonary Medicine, Koç University Faculty of Medicine, İstanbul, Turkey
5Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
6Department of Cardiology, University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
7Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Turkey
8Department of Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
9Department of Pulmonary Medicine, Pamukkale University Faculty of Medicine, Denizli, Turkey
10Department of Pulmonary Medicine, University of Health Sciences, Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
11Department of Pulmonary Medicine, Süreyyapaşa Chest Diseases Training and Research Hospital, İstanbul, Turkey
12Department of Pulmonary Medicine, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
13Department of Pulmonary Medicine, Ege University Faculty of Medicine, İzmir, Turkey
14Department of Cardiology, Koç University Faculty of Medicine, İstanbul, Turkey
Abstract
Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea–hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context.