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Obstructive sleep apnea (OSA) is a common sleeping disorder characterized by the intermittent blockage of airflow during sleep. This condition is correlated with other comorbidities, especially cardiovascular diseases, in different populations. Therefore, it is important to understand how OSA models cardiovascular dysfunction to come up with the appropriate intervention measures. The available research shows that oxygen desaturation that occurs at night due to OSA leads to the hypertrophy of left ventricular (LV), which is directly linked to increased risk for heart diseases (Korcarz et al., 2016). In children with Down syndrome (DS), incidence rates of hypertension and sleepiness are high, and the problem is compounded in the presence of OSA (Konstantinopoulou et al., 2016). This paper discusses three original research articles investigating the association between OSA and heart diseases. The three articles used in this paper indicate a strong correlation between OSA and different blood pressure complications.
Korcarz et al. (2016) conducted a cohort study to investigate the relationship between OSA and adverse cardiovascular conditions. The study measured the associations between OSA and the predisposing factors of cardiovascular disease (CVD). The authors used participants from the Wisconsin Sleep Cohort Study, which is a population-based longitudinal study of OSA conducted from 1988. In the 1988 study, 6,947 government workers from five different state agencies in Wisconsin were recruited for a longitudinal study regarding their demographics, health, and sleep habits. Seventy-two percent (72%) of the contacted participants were finally included in the study. A sampling frame was constructed to come up with a stratified random sample of 2,884, who has no underlying heart conditions, and they were involved in overnight polysomnography studies repeated after every four years. The current study randomly selected 601 participants from the baseline cohort to assess the link between OSA and CVD. The results indicated that OSA is causally associated with decreasing LV systolic function and reduced right ventricular (RV) function (Korcarz et., 2016). In other words, OSA is strongly correlated with CVD. Some of the confounding factors in this relationship include obesity and hypoxia, which stimulates hypertrophy in people with OSA.
Another study on the issue of OSA by Konstantinopoulou et al. (2016) sought to establish the relationship between OSA and cardiac problems and sleepiness in children with DS. OSA is normally associated with “hypoxemia, hypercapnia, intrathoracic volume shifts, and sleep fragmentation, all of which can affect cardiovascular function” (Konstantinopoulou et al., 2016, p. 18). Children with DS have systemic heart conditions directly linked with OSA, which is a major problem in this population. Therefore, the authors hypothesized that the presence of OSA is positively correlated with heart dysfunction in children with DS. The study recruited 23 children aged between 8 and 21 years with DS. Those with a history of continuous positive airway pressure (CPAP), lung diseases, and heart complications were excluded from the study. Participants who had “an obstructive apnea-hypopnea index (AHI) ≥ 5/h were randomized to CPAP or sham CPAP for four months in a double-blind fashion, whereas those with normal baseline polysomnograms (AHI < 1.5/h) were followed up without CPAP” (Konstantinopoulou et al., 2016, p. 19). After four months, polysomnography and other related baseline assessments were conducted to determine sleep patterns and cardiovascular outcomes. The results showed that in children with DS, the severity of OSA was directly associated with LV diastolic function. In other words, OSA contributes directly to heart complications in children with DS.
In another study, Pinto et al. (2016) wanted to establish the various major comorbidities associated with OSA. The authors used an observational retrospective cross-sectional approach by looking at charts of 100 patients who had been diagnosed with OSA. The study’s evaluation protocol included conditions, such as a complete otorhinolaryngological exam, anamnesis, and complete physical examination. Given that all the participants had OSA, the study compared the presence of other comorbidities, including diabetes, CVD, obesity, depression, asthma, and other related health conditions. Hypertension was the highest comorbidity, with 39% of all participants having it, followed by obesity and depression at 34 % and 19 %, respectively (Pinto et al., 2016).
The three selected articles for this paper had consistent results that OSA is directly linked to cardiovascular health problems. This correlation is not subject to age, gender, or underlying issues, even though some conditions, such as obesity and DS, are confounding factors. The study by Pinto et al. (2016) established that hypertension is the leading comorbid condition in people with OSA. Therefore, it suffices to argue that OSA and heart diseases are strongly correlated, and these findings have practice implications.
The results from the studies by Konstantinopoulou et al. (2016), Pinto et al. (2016), and Korcarz et al. (2016) have shed light on my general understanding of OSA. It is not enough to understand the causes and treatment of OSA – establishing how it contributes to other underlying conditions contributes significantly to the holistic health management of patients. I have learned that obesity is a major confounding factor in the relationship between OSA and heart diseases. My take away from this exercise is that health conditions should not be viewed in isolation because they are directly or indirectly causing or being caused by other underlying problems.
References
- Konstantinopoulou, S., Tapia, I. E., Kim, J. Y., Xanthopoulos, M. S., Radcliffe, J., Cohen, M. S., Hanna, B., Pipan, M., Cielo, C., Thomas, A., Zemel, B., Amin, R., Bradford, R., Traylor, J., Shults, J., & Marcus, C. (2016). Relationship between obstructive sleep apnea cardiac complications and sleepiness in children with Down syndrome. Sleep Medicine, 17, 18-24.
- Korcarz, C. E., Peppard, P. E., Young, T. B., Chapman, C. B., Hla, K. M., Barnet, J. H., Hagen, E., & Stein, J. H. (2016). Effects of obstructive sleep apnea and obesity on cardiac remodeling: The Wisconsin sleep cohort study. Sleep, 39(6), 1187-1195.
- Pinto, J. A., Ribeiro, D. K., da Silva Cavallini, A. F., Duarte, C., & Freitas, G. S. (2016). Comorbidities associated with obstructive sleep apnea: A retrospective study. International Archives of Otorhinolaryngology, 20(02), 145-150.
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