Abstract
Sleep apnea is very common in patients with cardiovascular disease, especially in patients with hypertension. Over the last few decades a number of discoveries have helped support a causal relationship between the two and even resistant hypertension. The role neurogenic mechanisms play has gathered more attention in the recent past due to their immediate bedside utility. Several innovative discoveries in pathogenesis including those exploring the role of baroreflex gain, cardiovascular variability, chemoreceptor reflex activation and the sympathetic nervous system have emerged. In this review, we discuss the epidemiology of sleep apnea and hypertension and the pathogenic mechanisms contributing to neurogenic hypertension. Furthermore, recent management strategies in addition to continuous positive airway pressure (CPAP), such as upper airway stimulation and renal denervation that target these pathogenic mechanisms, are also discussed.
Highlights
Sleep has far reaching implications for overall health and wellbeing
[2] Sleep apnea has especially been implicated in increased blood pressure (BP), including a strong association with resistant hypertension. [3,4] This review explores the role neural mechanisms play in the way sleep apnea contributes to the genesis and development of systemic hypertension in adults, and reviews possible treatment strategies
Xie et al [37] assessed the role of chronic hypoxia in humans, where the effect of this stimuli was assessed in nine healthy individuals where they observed that sympathetic nerve burst frequency remained elevated even after withdrawal of the hypoxic stimuli, in contrast to hypercapnia whose withdrawal reduced sympathetic burst frequency
Summary
Sleep has far reaching implications for overall health and wellbeing. Obstructive sleep apnea (OSA), has been implicated in adverse outcomes ranging from decreased daytime alertness and quality to life to increased hospitalization [1]. Patients with sleep apnea are at an increased risk for a broad range of cardiovascular conditions, including high blood pressure, ischemic heart disease, cardiac arrhythmias, heart failure and strokes. [2] Sleep apnea has especially been implicated in increased blood pressure (BP), including a strong association with resistant hypertension. [3,4] This review explores the role neural mechanisms play in the way sleep apnea contributes to the genesis and development of systemic hypertension in adults, and reviews possible treatment strategies Patients with sleep apnea are at an increased risk for a broad range of cardiovascular conditions, including high blood pressure, ischemic heart disease, cardiac arrhythmias, heart failure and strokes. [2] Sleep apnea has especially been implicated in increased blood pressure (BP), including a strong association with resistant hypertension. [3,4] This review explores the role neural mechanisms play in the way sleep apnea contributes to the genesis and development of systemic hypertension in adults, and reviews possible treatment strategies
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