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Obstructive sleep apnoea as a risk factor for atherosclerosis - implication for preventive and personalised treatment.

Tuleta I, Pabst S, Juergens UR, Nickenig G, Skowasch D - EPMA J (2011)

Bottom Line: A growing body of evidence has associated OSA with vascular pathologies.Although the exact mechanisms involved are not known, the occurrence of intermittent hypoxia typical for OSA may lead to oxidative stress, inflammation, metabolic and neural changes which in turn are responsible for vessel dysfunction underlying atherosclerosis.This review summarises data resulting from epidemiological and clinical studies with emphasis on the possible mechanisms linking OSA with atherosclerosis, predictive biomarkers helping identify OSA patients at high cardiovascular risk and personalised treatment approaches.

View Article: PubMed Central - PubMed

Affiliation: University of Bonn, Bonn, Germany.

ABSTRACT
Atherosclerosis with its manifestations and associated diseases is a main cause of morbidity and mortality in industrial countries. The pathomechanisms underlying atherosclerosis are complex and comprise exogenous factors as well as genetic predisposition. Beyond the well-defined risk factors for the development of atherosclerosis, obstructive sleep apnoea (OSA) merits more and more attention. A growing body of evidence has associated OSA with vascular pathologies. Although the exact mechanisms involved are not known, the occurrence of intermittent hypoxia typical for OSA may lead to oxidative stress, inflammation, metabolic and neural changes which in turn are responsible for vessel dysfunction underlying atherosclerosis. It has been demonstrated that therapy with continuous positive airway pressure (CPAP) plays a vasoprotective role. This review summarises data resulting from epidemiological and clinical studies with emphasis on the possible mechanisms linking OSA with atherosclerosis, predictive biomarkers helping identify OSA patients at high cardiovascular risk and personalised treatment approaches.

No MeSH data available.


Related in: MedlinePlus

Therapeutic procedures in OSA according to the degree of OSA and accompanied symptoms and risk factors. AHI - Apnoe-Hypopnoe-Index, CPAP - continuous positive airway pressure
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Fig3: Therapeutic procedures in OSA according to the degree of OSA and accompanied symptoms and risk factors. AHI - Apnoe-Hypopnoe-Index, CPAP - continuous positive airway pressure

Mentions: Once OSA has been diagnosed, the decision of therapy start and treatment options depends on the polysomnography results, including severity of OSA, clinical symptoms, comorbidities and patients’ compliance. General therapy recommendations comprise common and sleep hygienic means, body weight reduction, physical activity, avoidance of alcohol and nicotine, training of sleep position, intraoral protrusion splints and operative methods. The gold standard is CPAP therapy, however the threshold value of AH-Index for therapy start is not known. Figure 3 shows therapeutic procedures in OSA that have not been tested in randomised trials and which must be optimised for individual patients. In particular, OSA patients at elevated risk for cardiovascular diseases benefit mostly from early diagnosis and appropriate treatment. However, the recognition of such patients is not easy as there are no standardised criteria for cardiovascular risk stratification in OSA. Many biomarkers described above have been proposed to be a useful tool for anticipation of a vessel disease. Further randomised studies are needed to prove their clinical relevance.Fig. 3


Obstructive sleep apnoea as a risk factor for atherosclerosis - implication for preventive and personalised treatment.

Tuleta I, Pabst S, Juergens UR, Nickenig G, Skowasch D - EPMA J (2011)

Therapeutic procedures in OSA according to the degree of OSA and accompanied symptoms and risk factors. AHI - Apnoe-Hypopnoe-Index, CPAP - continuous positive airway pressure
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3405376&req=5

Fig3: Therapeutic procedures in OSA according to the degree of OSA and accompanied symptoms and risk factors. AHI - Apnoe-Hypopnoe-Index, CPAP - continuous positive airway pressure
Mentions: Once OSA has been diagnosed, the decision of therapy start and treatment options depends on the polysomnography results, including severity of OSA, clinical symptoms, comorbidities and patients’ compliance. General therapy recommendations comprise common and sleep hygienic means, body weight reduction, physical activity, avoidance of alcohol and nicotine, training of sleep position, intraoral protrusion splints and operative methods. The gold standard is CPAP therapy, however the threshold value of AH-Index for therapy start is not known. Figure 3 shows therapeutic procedures in OSA that have not been tested in randomised trials and which must be optimised for individual patients. In particular, OSA patients at elevated risk for cardiovascular diseases benefit mostly from early diagnosis and appropriate treatment. However, the recognition of such patients is not easy as there are no standardised criteria for cardiovascular risk stratification in OSA. Many biomarkers described above have been proposed to be a useful tool for anticipation of a vessel disease. Further randomised studies are needed to prove their clinical relevance.Fig. 3

Bottom Line: A growing body of evidence has associated OSA with vascular pathologies.Although the exact mechanisms involved are not known, the occurrence of intermittent hypoxia typical for OSA may lead to oxidative stress, inflammation, metabolic and neural changes which in turn are responsible for vessel dysfunction underlying atherosclerosis.This review summarises data resulting from epidemiological and clinical studies with emphasis on the possible mechanisms linking OSA with atherosclerosis, predictive biomarkers helping identify OSA patients at high cardiovascular risk and personalised treatment approaches.

View Article: PubMed Central - PubMed

Affiliation: University of Bonn, Bonn, Germany.

ABSTRACT
Atherosclerosis with its manifestations and associated diseases is a main cause of morbidity and mortality in industrial countries. The pathomechanisms underlying atherosclerosis are complex and comprise exogenous factors as well as genetic predisposition. Beyond the well-defined risk factors for the development of atherosclerosis, obstructive sleep apnoea (OSA) merits more and more attention. A growing body of evidence has associated OSA with vascular pathologies. Although the exact mechanisms involved are not known, the occurrence of intermittent hypoxia typical for OSA may lead to oxidative stress, inflammation, metabolic and neural changes which in turn are responsible for vessel dysfunction underlying atherosclerosis. It has been demonstrated that therapy with continuous positive airway pressure (CPAP) plays a vasoprotective role. This review summarises data resulting from epidemiological and clinical studies with emphasis on the possible mechanisms linking OSA with atherosclerosis, predictive biomarkers helping identify OSA patients at high cardiovascular risk and personalised treatment approaches.

No MeSH data available.


Related in: MedlinePlus