24 September 2021
Heart failure. Coronary artery disease. Arrhythmias. Hypertension.
What does any of this have to do with sleep?
World Heart Day
World Heart Day was created by the World Heart Federation to educate people on cardiovascular disease (CVD) and the actions they can take to prevent and control it. Some of these actions include reducing tobacco use, increasing physical activity and improving one’s diet – which coincidentally also lead to better sleep.
In recognition of World Heart Day coming up next week – Wednesday, 29-September 2021 we’re highlighting a completely new section of the European Sleep Research Society’s recently published Sleep Medicine Textbook, 2nd Edition, which specifically addresses the interconnection between sleep and CVD.
Sleep Medicine Textbook
“There is a bidirectional relationship between cardiovascular diseases (CVD), sleep-disordered breathing and quality of sleep. The repeated exposure to biological consequences of obstructive sleep apnea (OSA) including altered blood gas chemistry, arousals and large negative swings in intrathoracic/juxta-cardiac pressure will in the long run lead to a variety of cardiovascular disorders including hypertension, heart failure, arrhythmias, coronary artery disease, and stroke.
Randomized controlled trials (RCTs) have consistently shown that the treatment of OSA lowers blood pressure, particularly those with resistant hypertension and most adherent to therapy with continuous positive airway pressure (CPAP) devices. However, to date, RCTs have failed to show that therapy with CPAP improves downstream cardiovascular consequences. Notably, the Achilles tendon of these trials has been the lack of adequate adherence to CPAP.
Central sleep apnea (CSA) frequently occurs in subjects with left ventricular dysfunction, particularly those with heart failure and reduced ejection fraction. The acute consequences of CSA are qualitatively similar to OSA, although less severe. Multiple observational trials have shown the effectiveness of adaptive servoventilation in suppressing CSA. Yet, unlike OSA, a large RCT on cardiovascular outcomes was neutral or even detrimental, showing a lack of effectiveness of treatment with adaptive servoventilation when compared to usual care. Another trial using an adaptive servoventilation device with an updated algorithm is in progress.
This chapter intends to provide a comprehensive overview of the major cardiovascular consequences of sleep disturbances also pointing to research gaps and perspectives. Several observational studies have shown associations between sleep duration or quality and CVD. Yet, prospective data are not available and the observed relationships may be due to confounders.”
To dive even further into this topic, we invite you to purchase your very own copy of the Sleep Medicine Textbook 2nd Edition, now available in print and digital versions.Buy Now
Javaheri, S., Drager, L.F., Pevernagie, D.A., and Lorenzi-Filho, G. (2021). K. Sleep and Internal Medicine. 1. Cardiovascular diseases: Heart failure, coronary artery disease, arrhythmias, and hypertension. In Bassetti, C., McNicholas, W., Paunio, T., & Peigneux, P. (Eds.). Sleep Medicine Textbook (2nd ed., pp. 771-787). Regensburg: European Sleep Research Society.