الفهرس | Only 14 pages are availabe for public view |
Abstract Obstructive sleep apnea is common in the general population and has been implicated in adverse cardiovascular effects. It is associated with hypertension. Continuous positive airway pressure (CPAP) reduces both nocturnal and daytime blood pressure, in part by attenuating sympathetic nervous activity. Obstructive sleep apnea appears to be a potential risk factor for ischemic heart disease. It has been associated with nocturnal ST-segment depression in patients with coronary heart disease, and may affect outcome adversely in patients with coronary artery disease. Sleep-disordered breathing, both obstructive and central, is seen commonly in patients with CHF and is associated with an increased risk of arrhythmias (atrial fibrillation). Daytime sleepiness and snoring are the most common symptoms. OSAS is considered a risk for traffic accidents due to sleepiness. It has also been suggested that sleep apnea is a risk factor for cardiovascular disease, diabetes mellitus and early death. The most common treatments are continuous positive airway pressure (CPAP), mandibular repositioning appliances and various surgical modalities. A number of other treatments and lifestyle modifications have been suggested. A diversity of portable simplified diagnostic equipment has been introduced due to the high cost of overnight polysomnograms. The apnoea-hypopnoea index (AHI) is the mean number of apneas and hypopneas per hour of sleep, and an AHI greater than 5 is considered pathological. Overnight polysomnography–including respiratory monitoring, pulse oximetry, electrocardiogram (ECG) and sleep staging with electroencephalogram (EEG) – is the reference diagnostic procedure. Summary and Conclusion 81 Treatment of OSA with CPAP improves ejection fraction in patients with CHF. Obstructive sleep apnea may be associated with ventricular arrhythmias, pulmonary hypertension; several mechanisms could explain the relationship of OSA with the development of atherosclerosis, including abnormalities in various inflammatory and metabolic factors that have been associated with endothelial dysfunction and the development of atherosclerosis. On the basis of the evidence accumulated in the literature, it appears that OSA is an important risk factor for the development of cardiovascular disease. Clinicians caring for patients with cardiovascular should be aware of these associations and should attempt to identify patients with OSA. |