Sleep deprivation, sleep apnea and cardiovascular diseases.
Sleep dramatically influences cardiovascular regulation. Changes in sleep duration or quality as seen in sleep disorders may prevent blood pressure to fall during sleep as expected in human physiology. This supports the increased prevalence of hypertension and drug-resistant hypertension in those with sleep loss. Other cardiovascular outcomes i.e. coronary lesions seem to be associated with sleep duration. Systemic inflammation, oxidative stress and endothelial dysfunction seem to be associated with both sleep loss and sleep disorders. The most critical example is Obstructive Sleep Apnea (OSA). Sympathetic activation, oxidative stress and systemic inflammation are the main intermediary mechanisms associated with sleep apnea and intermittent hypoxia. There are now convincing data regarding the associations between hypertension, arrhythmias, stroke, coronary heart disease, increased cardiovascular mortality and OSA. There are also data in OSA and in animal models supporting the link between sleep apnea and atherosclerosis and dysmetabolism. Whether treating sleep apnea enables the reversal of chronic cardiovascular and metabolic consequences of OSA, remains to be studied in adequately designed studies, particularly in comparison with usual treatment strategies.
INSERM U 1042, Hypoxia PathoPhysiology Laboratory, Joseph Fourier University, Grenoble, France. PLevy@chu-grenoble.fr
Patrick
P
Levy
Renaud
R
Tamisier
Claire
C
Arnaud
Denis
D
Monneret
Jean Philippe
JP
Baguet
Francoise
F
Stanke-Labesque
Maurice
M
Dematteis
Diane
D
Godin-Ribuot
Christophe
C
Ribuot
Jean-Louis
JL
Pepin
D002318:Cardiovascular Diseases; D006801:Humans; D012891:Sleep Apnea Syndromes; D012892:Sleep Deprivation