Aortic diseases and obstructive sleep apnea.

INTRODUCTION

Obstructive sleep apnea (OSA), particularly moderate-to-severe OSA, increases all-cause mortality as well as cardiovascular events, and continuous positive airway pressure (CPAP) therapy can reduce cardiovascular events and mortality. In 2003, it was first shown that patients with thoracic aortic dissection (AD) presented a high prevalence of previously undiagnosed and frequently severe OSA. Since then, a number of authors have investigated the association of aortic diseases (including thoracic and abdominal aortic aneurysm as well as AD) with OSA.

EVIDENCE ACQUISITION

In the present article, we reviewed, with a systematic literature search through May 2015, currently available clinical studies investigating the association of aortic diseases with OSA.

EVIDENCE SYNTHESIS

It is suggested that OSA is highly prevalent in patients with aortic diseases and associated with aortic expansion. Through the nocturnal perturbations of intermittent hypoxia, intrathoracic pressure swings, and increased sympathetic neural activation, OSA patients appear to be at increased risk for vascular changes related to oxidative stress, inflammation, and endothelial dysfunction, which may present as risks for aortic diseases. Despite currently available findings, it remains unclear whether common etiology leads to both OSA and aortic diseases or whether OSA itself causes aortic diseases.

CONCLUSIONS

The following types of studies with long-term follow-up would be required: 1) a prospective cohort study comparing the incidence of aortic diseases in OSA patients with that in non-OSA subjects and 2) a randomized controlled trial determining whether CPAP therapy for OSA reduces the incidence of aortic diseases.