SLEEP DISORDERED BREATHING (SDB) AND CARDIOVASCULAR HEALTH

Abstract

Sleep is important for health and breathing is essential for life. Disturbances inbreathing during sleep - sleep disordered breathing (SDB) has been recognizedas of paramount importance having immense effects on human health and healthcare system. Sleep apnea is a potentially life-threatening chronic disease thataffects more than 12% U.S. adults. Two recent white papers commissioned bythe American Academy of Sleep Medicine (AASM) provide a detailed analysis ofthe huge economic burden associated with undiagnosed and untreatedobstructive sleep apnea among adults in the United States. The white paper,“Hidden Health Crisis Costing America Billions,” based on longitudinal datasuggests that the estimated prevalence of OSA has increased substantially overthe last two decades, and utilizing Frost & Sullivan's modeling and forecastingexpertise, the paper estimates that OSA afflicts 29.4 million adults in the U.S. Theestimated cost of diagnosing and treating OSA in the U.S. in 2015 wasapproximately $12.4 billion where as the estimated cost burden of undiagnosedOSA among U.S. adults was an astounding $149.6 billion in 2015.

SDB is of great importance in the world of cardiology as this has been implied in causation and acceleration of coronary heartdisease, systemic hypertension, pulmonary hypertension and arrhythmias. Prevalence of OSA in cardiovascular patients is 2 to3 times higher than in reference populations without CVD. Population-based epidemiology studies and observations of OSApatients show that prevalence of hypertension, type II diabetes, cardiovascular disease, and stroke to be higher in people withOSA. The prevalence of SDB in CAD patients is up to 2-fold higher.

We as cardiologists have to recognize that this area is in need of dedicated research to broaden the knowledge base. Specificquestions that need answers include whether sleep apnea can initiate development of cardiac and vascular disease, whethersleep apnea in established cardiovascular disease patients accelerates disease progression, and whether treatment of sleepapnea will result in clinical improvement, fewer cardiovascular events and reduced mortality.