Top Things to Know: Obstructive Sleep Apnea and Cardiovascular Disease

Published: June 21, 2021

  1. Obstructive sleep apnea (OSA) is characterized by recurrent complete (apneas) and partial (hypopneas) upper airway obstructive events, resulting in intermittent hypoxemia, autonomic fluctuation and sleep fragmentation.
  2. Approximately 34% and 17% of middle-aged men and women meet the diagnostic criteria for OSA, respectively.
  3. OSA prevalence is as high as 40 to 80% in patients with hypertension (HTN), heart failure (HF), coronary artery disease (CAD), pulmonary hypertension (PH), atrial fibrillation (AF), and stroke.
  4. These episodic cycles of breathing disruption cause acute and chronic physiological stressors.
  5. Male sex, older age and obesity are established risk factors for OSA, with additional risk associated with race/ethnicity, family history, and craniofacial dysmorphisms. The risk of OSA correlates with body mass index (BMI), and obesity remains the one major modifiable risk factor for OSA.
  6. There are several clinical manifestations linked to OSA including snoring, episodes of gasping, choking or witnessed apneas. OSA has been linking to an increased risk of job-related and motor vehicle accidents, more frequent health-related missed workdays, and decreased quality of life.
  7. Clinicians should take note of any abnormal cardiac or pulmonary exam findings as well as signs suggestive of conditions associated with an increased prevalence of OSA, such as heart failure, prior stroke, atrial fibrillation, hypertension and diabetes mellitus.
  8. Diagnostic evaluation – diagnostic testing is performed by overnight in-laboratory, multi-channel polysomnography or home sleep apnea tests. Diagnosis requires the patient to have (1) reported nocturnal breathing disturbances (snoring, snorting, gasping, or breathing pauses during sleep), or symptoms of daytime sleepiness or fatigue occurring despite sufficient opportunity to sleep and unexplained by other medical conditions; and (2) an AHI or Respiratory Event Index (REI) ≥ 5.
  9. Cardiovascular complications from OSA include: hypertension, AF and other arrhythmias, HF, CAD, stroke, PH, metabolic syndrome and type 2 diabetes, and an increase in cardiovascular mortality.
  10. OSA increases the risk of all-cause and cardiovascular mortality and is often underrecognized and undertreated in cardiovascular practice.
    1. Screen for OSA in patients with resistant or poorly controlled HTN, PH, recurrent AF after cardioversion or ablation.
    2. For patients with New York Health Association (NYHA) classification II-IV and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is warranted.
    3. Patients with nocturnally occurring angina, MI, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators, may be more likely to have comorbid sleep apnea.
    4. All OSA patients should be considered for treatment, including behavioral modifications and weight loss.


Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R, Bozkurt B, Ndumele CE, Somers VK; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Stroke Council; and Council on Cardiovascular Surgery and Anesthesia. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association [published online ahead of print June 21, 2021]. Circulation. doi: 10.1161/CIR.0000000000000988