title: The impact of obstructive sleep apnoea on the aorta.
abstract: Obstructive sleep apnoea (OSA) has been shown to be a causal factor in the pathogenesis of vascular dysfunction and hypertension, conditions which can promote dilation and subsequent aortic dissection and rupture. The objective of this review is to summarise the current literature on the possible association between OSA and aortic disease and delineate the underlying mechanisms.Relevant studies were found by searching for terms including "obstructive sleep apnoea" in combination with "aortic aneurysm, dissection, and dilation" in the MEDLINE and EMBASE databases.Observational studies consistently reported that OSA is highly prevalent among patients with aortic aneurysms and aortic dissections. Patients with co-occurring OSA and Marfan's syndrome as well as patients at the more severe end of the spectrum of OSA seem to be especially vulnerable to aortic disease.Several mechanisms are discussed concerning the link between OSA and aortic disease: nocturnal negative intrathoracic pressure surges leading to mechanical stretching of the aorta and ultimately aortic distension; arousal-induced reflex sympathetic activation with subsequent hypertension; and intermittent hypoxia associated with autonomic nervous system activation and consequently increased oxidative stress. Further well controlled studies are needed in order to define the exact role of OSA as a risk factor for aortic disease.
authors.affiliation: Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaisl
authors.affiliation: Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bratton
authors.affiliation: Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland Malcolm.Kohler@usz.ch.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D001014:Aortic Aneurysm / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D000860:Hypoxia / Q000503:physiopathology; D008382:Marfan Syndrome / Q000150:complications*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D013564:Sympathetic Nervous System / Q000503:physiopathology