Pathophysiology of Obstructive Sleep Apnea

Pashayan, Annette G.; Passannante, Anthony N.; Rock, Peter

doi:10.1016/j.atc.2005.02.004

Cited by 18 publications

(10 citation statements)

References 76 publications

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“…The increased ventilatory effort that results from obstructed breathings in apneic or hypopneic episodes causes frequent arousals (7). More frequent arousals in the patients with severe symptoms might prevent them from falling into deep sleep, and it can also explain increased limb movements in this group.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with OSAS usually present excessive daytime sleepiness, unrefreshing sleep, fatigue, and even depression, and these symptoms may lead them to serious work or car accidents (2, 3). It has been reported that OSAS has numerous comorbidities, such as obesity, diabetes mellitus, coronary heart disease, stroke, congestive heart failure, cardiac arrhythmia, and gastroesophageal reflux (4-7). In addition, it is also an independent risk factor for hypertension (6, 8) and has a close relationship with atherosclerotic cardiovascular disease (7).…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that OSAS has numerous comorbidities, such as obesity, diabetes mellitus, coronary heart disease, stroke, congestive heart failure, cardiac arrhythmia, and gastroesophageal reflux (4-7). In addition, it is also an independent risk factor for hypertension (6, 8) and has a close relationship with atherosclerotic cardiovascular disease (7). Although the exact pathophysiological mechanisms are not yet fully understood, repetitive reduction of blood oxygen saturation, increased efforts to breathe, increased sympathetic tone and subsequent rennin-angiotension-aldosterone system are considered to be involved in the development of cardiovascular diseases (7).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, it is also an independent risk factor for hypertension (6, 8) and has a close relationship with atherosclerotic cardiovascular disease (7). Although the exact pathophysiological mechanisms are not yet fully understood, repetitive reduction of blood oxygen saturation, increased efforts to breathe, increased sympathetic tone and subsequent rennin-angiotension-aldosterone system are considered to be involved in the development of cardiovascular diseases (7). Therefore, the assessment of cardiac functions in OSAS patients is an essential step in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

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Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

et al. 2008

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The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflex-related fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4± 11.7 yr, apnea-hypopnea index [AHI]=43.2±23.4 events per hour, and AHI >15). Moderate (mean age 47.1±9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5±12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (rp=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

et al. 2008

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“…Clinically, this syndrome has considerable influence on personal health, causing excessive sleepiness during daytime, narcolepsy, mental disorders including cognitive decline, and displeasure or depression, as well as physical complications such as obesity, diabetes, gastroesophageal reflux, stroke, pulmonary hypertension, systematic hypertension, coronary artery disease, and cardiac arrhythmia 2-4. Impairment of cardiovascular system control can also occur in OSAS patients 5. Significant changes in heart rate variability (HRV) and blood pressure can be observed in OSAS patients, which seem to increase the risk of cardiovascular disease 6-8…”

Section: Introductionmentioning

confidence: 99%

The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

Song

Ryu

et al. 2012

Psychiatry Investig

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ObjectiveThis study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS).Methods176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices.ResultsThe partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis.ConclusionThe NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.

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Thoracic Anesthesia for Morbidly Obese Patients and Obese Patients with Obstructive Sleep Apnea

Brodsky

2011

Principles and Practice of Anesthesia for Thoracic Surgery

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Pathophysiology of Obstructive Sleep Apnea

Cited by 18 publications

References 76 publications

Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

Correlation between the Severity of Obstructive Sleep Apnea and Heart Rate Variability Indices

The Effect of Aging and Severity of Sleep Apnea on Heart Rate Variability Indices in Obstructive Sleep Apnea Syndrome

Thoracic Anesthesia for Morbidly Obese Patients and Obese Patients with Obstructive Sleep Apnea

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