Sleep Disorders and
its impact on
Cardiovascular System
Dr Ajay Gopinath
Assistant Professor
Bharathi College of Pharmacy
Objectives
2. Impact of sleep
1. Introduction to 3. Management
apnea on
sleep apnea strategies
cardiovascular system
Objectives
• 1. Cardiovascular complications of Sleep Apnea
• 2. Factors that lead to these complications
• 3. How to manage these complications ?
Sleep Apnea and CV
problems
1. Hypertension
2. Arrhythmia
3. CAD
4. Stroke
5. Pulmonary hypertension
6. Heart failure
7. Sudden cardiac death
Hypertension
Nearly half of patients with Sleep Apnea have underlying high blood pressure
Blood pressure is generally resistant to medications
Nocturnal hypertension
Presence of hypertension in addition to co-existing co-morbidities increase
the risk of CV events as well as mortality.
CAD and Stroke
Risk of CAD increases by 30%
Risk of stroke increases by 60%
They occur prematurely
SA apnea increases the CV mortality risk
OSA - CAD and
Stroke
1. Co-existing co-morbidities / consequence of OSA > Obesity , DM , HPN
2. AF predisposes to ischemic stroke
3. Incidence of subarachnoid hemorrhage is higher
4. Pre-dispose to fatal and non-fatal MI
5. Studies show higher incidence of revascularization in patients with OSA
6. CV mortality is higher
OSA - CAD and Stroke
7. Severity of OSA directly co-relate with CV
complications and mortality
8. Presence of OSA increase peri-operative (non
cardiac surgery) CV complications and CV mortality
8. OSA and its severity should be included as a risk
marker for future CV events
Sleep Apnea
and Heart
Failure
• Sleep Apnea and Heart Failure
are inter-related
• At least 50% of patients with HF
have OSA or CSA
• Sleep apnea increases the risk of
heart failure by 140%
• The exact prevalence and
pathophysiology of HF in Sleep
Apnea is not known
Age above 60
Male
Sleep
Apnea in
HF NYHA Class III and IV
patients:
For unknown reason sleep apnea is not
commonly seen in female HF patients
Associated HTN, AF
Factors Sympathetic overdrive
influenc
ing HF
Increase pre-load due to decreased intra-thoracic
pressure
in Sleep Increase afterload leading to increase left ventricular
end diastolic pressure (LVeDP) and impaired LV systolic
Apnea function
Increased pulmonary artery pressure pre-dispose to right
heart failure
Heart failure and Sleep Apnea
co-exist
Central sleep apnea in HF
patients is independent risk
HF & marker of mortality
SA Presence of HF and sleep apnea
together worsens mortality
Sudden • Obstructive sleep apnea (OSA) raises the risk
of sudden cardiac death (SCD) by 300–
Cardiac 400% depending on the severity of OSA.
Death in
Sleep Apnea
1. Weight loss
2. CPAP
Managem
ent
3. ASV (Adaptive Servo Ventilation)
strategie for CSA = SERVE-HF trial
s
4. Stimulants – Theophylline,
Acetazolamide , Amphetamine
CPAP and CV
benefits
Using CPAP as
management strategy
CPAP and CV benefits
• 1. Improve oxygenation
• 2. Reduce oxidative stress
• 3. Reduce endothelial dysfunction
• 4. Reduce pre-load and afterload by increasing intra-thoracic
pressure.
• 5. Reduce sympathetic overdrive
• 6. Reduce HPN , Arrhythmia
Sleep Apnea is common but often go
undiagnosed.
Sleep Apnea leads to cardiovascular
complications and adverse CV events
Summar Once suspected, diagnosis is not difficult
y
Applying right management strategies can
lead to life changing as well as life saving
experience.
