Sleep Apnea & Cardiovascular Disease
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Several scientific studies have indicated a connection between obstructive sleep apnea and cardiovascular disease. How serious is the condition, is it underdiagnosed?
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@mrinmayee According to Elizabeth Muxfeldt, MD, PhD, cardiologist and professor at the Federal University of Rio de Janeiro (UFRJ) and Estácio de Sá University, Rio de Janeiro, Brazil, the prevalence of obstructive sleep apnea among individuals with drug-resistant hypertension is around 80%. Leonardo Siqueira, MD, electrophysiologist at the UFRJ Clementino Fraga Filho Hospital, estimates that approximately half of patients with atrial fibrillation (AF) have some degree of obstructive sleep apnea.
Despite the prominence of the condition, obstructive sleep apnea remains underdiagnosed in the general population as well as among patients with cardiovascular diseases. In light of this fact, an alert was sounded during a virtual session of the 39th Congress of the State of Rio de Janeiro Society of Cardiology (SOCERJ), which took place in May.
At-Risk Populations
Many doctors still do not routinely assess the sleep quality of their patients. João Manoel Pedroso, MD, PhD, physician and professor at the UFRJ and moderator of the scientific session, believes that healthcare professionals need to ask patients about the quality of their sleep and provide guidance on sleep hygiene measures.According to Luiz Lazzarini, MD, PhD, pulmonologist at the Pro-Cardiac Hospital and professor at the UFRJ, it is up to physicians, cardiologists, and clinicians in other specialties to increase research into snoring and daytime sleepiness — two symptoms often related to obstructive sleep apnea. "This investigation can be conducted using simple questions such as, 'Do you snore and/or feel very sleepy during the day?' If the answer is yes to one or, especially, both of these questions, we must at least consider the presence of sleep apnea," Lazzarini emphasized during the debate.
It is essential to consider the diagnosis of obstructive sleep apnea, particularly for patients with risk factors for cardiovascular diseases. Although research into snoring and daytime sleepiness is relevant in the diagnosis of sleep apnea, some specific cases also call for investigation, regardless of the response to these questions. According to Muxfeldt, this applies, for example, to patients with drug-resistant hypertension, given the high prevalence of obstructive sleep apnea in this population.
Not only do most patients with drug-resistant hypertension have this sleep disorder as a comorbidity, but also more than half of these patients present with moderate to severe apnea, said Muxfeldt.
These days, it is well known that sleep apnea is the leading cause of secondary systemic hypertension, said Lazzarini. This means that, after genetic predisposition, obstructive sleep apnea is the main cause of hypertension.
Another group to which particular attention should be paid is patients with AF. According to Siqueira, it is crucial to study the occurrence of obstructive sleep apnea in this patient population, especially in cases of persistent AF or when other risk factors, such as hypertension and diabetes, are involved. Siqueira also noted that research is key for patients with bradyarrhythmia and sinus node dysfunction, particularly when pauses are noted on the Holter monitor throughout the night.