Article PDF (Українська)


obstructive sleep apnea syndrome, cardiovascular diseases, coronary artery disease, arterial hypertension, continuous positive airway pressure (CPAP)

Abstract views: 20
PDF Downloads: 11

How to Cite

Mostbauer , H., Bezrodnyi , A., Rokyta , O., Moskalenko , Y., & Shevchyk , M. (2023). CARDIOVASCULAR DISEASES AND OBSTRUCTIVE SLEEP APNEA SYNDROME. REVIEW. Medical Science of Ukraine (MSU), 19(1), 115-126.


Background.  Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality among adults worldwide. On another hand, obstructive sleep apnea syndrome (OSAS) is common in patients with CVD, and can worsen the patients prognosis due to late diagnosis. 

Aim: to analyze and summarize the published researches about interrelation between CVD and OSAS, its influence on CVD, and the effects of continuous airway pressure (CPAP) treatment of OSAS on CVD in order to pay attention to OSAS potential risks, improve the investigation of this syndrome and management.

Materials and methods. Review of scientific literature in the international electronic scientometric databases PubMed, Google Scholar by key words for the period 2008-2023. The search was carried out by two independent authors. 150 sources were selected, 48 English–language articles of which met all the search criteria and  were used for analysis.

Results. OSAS is one of the widespread sleep disorders that frequently occurs in patients with CVD, impairs quality of life. Its increases cardiovascular and all-cause mortality and cardiovascular morbidity. OSAS is observed in patients with arterial hypertension in 30-83%, coronary heart disease in 38-65%, stroke in 57-65%, heart failure in 12-55%, heart rhythm disorders - in 20-50%. In addition, the relationship between OSAS and diabetes, metabolic syndrome, insulin resistance, depression, and cognitive impairment has been established. OSAS is often not diagnosed or not diagnosed in time. Thus, there are data that 86-95% OSAS, clinically manifestated, were  missed diagnosis, that  worsens the prognosis of such patients.

Conclusions. OSAS is a common sleep breathing disorder in patients with CVD that is often diagnosed late. Most studies have shown that OSAS worsens the CVD course and outcomes. Therefore early diagnosis and timely appropriate treatment reduce morbidity and mortality.
Article PDF (Українська)


Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, Goldberg AN, Long C, Gerstenfeld EP, Yeghiazarians Y. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc. 2019;8(1):e010440. DOI: 10.1161/JAHA.118.010440

Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8. DOI: 10.5665/sleep/31.8.1071

Fietze I, Laharnar N, Obst A, Ewert R, Felix SB, Garcia C, Gläser S, Glos M, Schmidt CO, Stubbe B, Völzke H, Zimmermann S, Penzel T. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res. 2019;28(5):e12770. DOI: 10.1111/jsr.12770

Arnaud C, Bochaton T, Pépin JL, Belaidi E. Obstructive sleep apnoea and cardiovascular consequences: Pathophysiological mechanisms. Arch Cardiovasc Dis. 2020;113(5):350-358. DOI: 10.1016/j.acvd.2020.01.003

Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R, Bozkurt B, Ndumele CE, Somers VK. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;144(3):e56-e67. DOI: 10.1161/CIR.0000000000000988

Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD, Somers VK, Lavie L, Pépin JL. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015 Jun 25;1:15015. DOI: 10.1038/nrdp.2015.15

Chen X, Wang R, Zee P, Lutsey PL, Javaheri S, Alcántara C, Jackson CL, Williams MA, Redline S. Racial/ethnic differences in sleep disturbances: the Multi-Ethnic Study of Atherosclerosis (MESA). Sleep. 2015;38(6):877-88. DOI: 10.5665/sleep.4732

Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, Malhotra A, Martinez-Garcia MA, Mehra R, Pack AI, Polotsky VY, Redline S, Somers VK. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol. 2017;69(7):841-858. DOI: 10.1016/j.jacc.2016.11.069

Kolanis S, Pilavakis M, Sofogianni A, Tziomalos K. Is There a Role for Continuous Positive Airway Pressure Treatment in the Management of Obstructive Sleep Apnea-related Hypertension? Curr Hypertens Rev. 2017;13(2):89-92. DOI: 10.2174/1573402113666170612094750

McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS. SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med. 2016;375(10):919-31. DOI: 10.1056/NEJMoa1606599

Jehan S, Zizi F, Pandi-Perumal SR, McFarlane SI, Jean-Louis G, Myers AK. Obstructive sleep apnea, hypertension, resistant hypertension and cardiovascular disease. Sleep Med Disord. 2020;4(3):67-76.

Mahajan SK, Mahajan K, Sharma S. Obstructive sleep apnea and coronary artery disease: An unholy nexus or a holy alliance? Lung India. 2022;39(5):460-465. DOI: 10.4103/lungindia.lungindia_597_21

Cao W, Luo J, Huang R, Xiao Y. The Association Between Sleep Breathing Impairment Index and Cardiovascular Risk in Male Patients with Obstructive Sleep Apnea. Nat Sci Sleep. 2022;14:53-60. DOI: 10.2147/NSS.S343661

Qu H, Guo M, Zhang Y, Shi DZ. Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies. Sleep Breath. 2018;22(1):33-40. DOI: 10.1007/s11325-017-1503-8

Xie C, Zhu R, Tian Y, Wang K. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. 2017;7(12):e013983. DOI: 10.1136/bmjopen-2016-013983

Lin YS, Liu PH, Chu PH. Obstructive Sleep Apnea Independently Increases the Incidence of Heart Failure and Major Adverse Cardiac Events: A Retrospective Population-Based Follow-Up Study. Acta Cardiol Sin. 2017;33(6):656-663. DOI: 10.6515/ACS20170825A

Wang X, Fan J, Guo R, Hao W, Gong W, Yan Y, Zheng W, Ai H, Que B, Hu D, Ma C, Ma X, Somers VK, Nie S. Association of obstructive sleep apnoea with cardiovascular events in women and men with acute coronary syndrome. Eur Respir J. 2023;61(1):2201110. DOI: 10.1183/13993003.01110-2022

Lee CH, Sethi R, Li R, Ho HH, Hein T, Jim MH, Loo G, Koo CY, Gao XF, Chandra S, Yang XX, Furlan SF, Ge Z, Mundhekar A, Zhang WW, Uchôa CH, Kharwar RB, Chan PF, Chen SL, Chan MY, Richards AM, Tan HC, Ong TH, Roldan G, Tai BC, Drager LF, Zhang JJ. Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention. Circulation. 2016;133(21):2008-17. DOI: 10.1161/CIRCULATIONAHA.115.019392

Tveit RL, Lehmann S, Bjorvatn B. Prevalence of several somatic diseases depends on the presence and severity of obstructive sleep apnea. PLoS One. 2018;13(2):e0192671. DOI: 10.1371/journal.pone.0192671

Labarca G, Schmidt A, Dreyse J, Jorquera J, Enos D, Torres G, Barbe F. Efficacy of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH): Systematic review and meta-analysis. Sleep Med Rev. 2021;58:101446. DOI: 10.1016/j.smrv.2021.101446

Makarem N, Alcántara C, Williams N, Bello NA, Abdalla M. Effect of Sleep Disturbances on Blood Pressure. Hypertension. 2021;77(4):1036-1046. DOI: 10.1161/HYPERTENSIONAHA.120.14479

Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis. J Clin Med. 2019;8(9):1367. DOI: 10.3390/jcm8091367

Hou H, Zhao Y, Yu W, Dong H, Xue X, Ding J, Xing W, Wang W. Association of obstructive sleep apnea with hypertension: A systematic review and meta-analysis. J Glob Health. 2018;8(1):010405. DOI: 10.7189/jogh.08.010405

Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484

Shah NA, Yaggi HK, Concato J, Mohsenin V. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath. 2010;14:131–136. DOI: 10.1007/s11325-009-0298-7

Mahajan SK, Verma BS, Sharma S, Mahajan K, Singh B. Prevalence of obstructive sleep apnoea among patients admitted with acute coronary syndrome in a hill state of northern India. Natl Med J India. 2021;34(6):337-340. DOI: 10.25259/NMJI_413_21

Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352-60. DOI: 10.1161/CIRCULATIONAHA.109.901801

Sánch-ez-de-la-Torre M, Sánchez-de-la-Torre A, Bertran S, Abad J, Duran-Cantolla J, Cabriada V, Mediano O, Masdeu MJ, Alonso ML, Masa JF, Barceló A, de la Peña M, Mayos M, Coloma R, Montserrat JM, Chiner E, Perelló S, Rubinós G, Mínguez O, Pascual L, Cortijo A, Martínez D, Aldomà A, Dalmases M, McEvoy RD, Barbé F; Spanish Sleep Network. Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial. Lancet Respir Med. 2020;8(4):359-367. DOI: 10.1016/S2213-2600(19)30271-1

Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. the RICCADSA randomized controlled trial. Am J Respir Crit Care Med. 2016;194:613–620. DOI: 10.1164/rccm.201601-0088OC

Shah N, Redline S, Yaggi HK, Wu R, Zhao CG, Ostfeld R, Menegus M, Tracy D, Brush E, Appel WD, Kaplan RC. Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning? Sleep Breath. 2013;17(2):819-26. DOI: 10.1007/s11325-012-0770-7

Linz D, McEvoy RD, Cowie MR, Somers VK, Nattel S, Lévy P, Kalman JM, Sanders P. Associations of obstructive sleep apnea with atrial fibrillation and continuous positive airway pressure treatment: a review. JAMA Cardiol. 2018;3:532–540. DOI: 10.1001/jamacardio.2018.0095

Laczay B, Faulx MD. Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review. J Clin Med. 2021;10(17):3785. DOI: 10.3390/jcm10173785

Blackwell JN, Walker M, Stafford P, Estrada S, Adabag S, Kwon Y. Sleep Apnea and Sudden Cardiac Death. Circ Rep. 2019;1(12):568-574. DOI: 10.1253/

Youssef I, Kamran H, Yacoub M, Patel N, Goulbourne C, Kumar S, Kane J, Hoffner H, Salifu M, McFarlane SI. Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis. J Sleep Disord Ther. 2018;7(1):282. DOI: 10.4172/2167-0277.1000282

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. DOI: 10.1093/eurheartj/ehaa612

Deep Singh T. Abnormal Sleep-Related Breathing Related to Heart Failure. Sleep Med Clin. 2022;17(1):87-98. DOI: 10.1016/j.jsmc.2021.10.007

Holt, A, Bjerre, J, Zareini, B, Koch, H, Tønnesen, P, Gislason, GH, Nielsen, OW, Schou, M, Lamberts, M. Sleep apnea, the risk of developing heart failure, and potential benefits of continuous positive airway pressure (CPAP) therapy. J Am Heart Assoc. 2018;7:e008684. DOI: 10.1161/JAHA.118.008684

Oldenburg O, Wellmann B, Buchholz A, Bitter T, Fox H, Thiem U, Horstkotte D, Wegscheider K. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J. 2016;37(21):1695-703. DOI: 10.1093/eurheartj/ehv624

Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, Pleister A, Abraham WT. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015;36(23):1463-9. DOI: 10.1093/eurheartj/ehu522

Kholdani C, Fares WH, Mohsenin V. Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology. Pulm Circ. 2015;5(2):220-7. DOI: 10.1086/679995

Shah FA, Moronta S, Braford M, Greene N. Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature. Cureus. 2021;13(4):e14575. DOI: 10.7759/cureus.14575

Sateia M.J. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387-1394. DOI: 10.1378/chest.14-0970

Chen Y, Chen Y, Wen F, He Z, Niu W, Ren C, Li N, Wang Q, Ren Y, Liang C. Does continuous positive airway pressure therapy benefit patients with coronary artery disease and obstructive sleep apnea? A systematic review and meta-analysis. Clin Cardiol. 2021;44(8):1041-1049. DOI: 10.1002/clc.23669.

Martínez-García MA, Capote F, Campos-Rodríguez F, Lloberes P, Díaz de Atauri MJ, Somoza M, Masa JF, González M, Sacristán L, Barbé F, et al; Spanish Sleep Network. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310:2407–2415. DOI: 10.1001/jama.2013.281250

Muxfeldt ES, Margallo V, Costa LM, Guimarães G, Cavalcante AH, Azevedo JC, de Souza F, Cardoso CR, Salles GF. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial. Hypertension. 2015;65(4):736-42. DOI: 10.1161/HYPERTENSIONAHA.114.04852

Shukla A, Aizer A, Holmes D, Fowler S, Park DS, Bernstein S, Bernstein N, Chinitz L. Effect of Obstructive Sleep Apnea Treatment on Atrial -Fibrillation Recurrence: A Meta-Analysis. JACC Clin Electrophysiol. 2015;1(1-2):41-51. DOI: 10.1016/j.jacep.2015.02.014.

Yancy, CW, Jessup, M, Bozkurt, B, Butler, J, Casey, DE, Jr, Colvin, MM, Drazner, MH, Filippatos, GS, Fonarow, GC, Givertz, MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–e161. DOI: 10.1161/CIR.0000000000000509

Lisan, Q, Van Sloten, T, Marques Vidal, P, Haba Rubio, J, Heinzer, R, Empana, JP. Association of positive airway pressure prescription with mortality in patients with obesity and severe obstructive sleep apnea: the Sleep Heart Health Study. JAMA Otolaryngol Head Neck Surg. 2019;145:509–515. DOI: 10.1001/jamaoto.2019.0281

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.