Cardiology Advisor spoke with a cardiologist and a sleep medicine specialist, both from Johns Hopkins University School of Medicine.

Cardiology Advisor: What is known about the link between sleep apnea and CVD, including proposed underlying mechanisms?

Dr Martin: Epidemiological studies have linked sleep apnea with a host of bad cardiovascular disease (CVD) outcomes, ranging from coronary heart disease to stroke to heart failure to AF. The underlying cardiometabolic mechanisms include increased sympathetic nervous system activity, inflammation, endothelial dysfunction, and abnormal metabolism of insulin, leptin, and lipoproteins.

Dr Salas: The [evidence for a] relationship between sleep apnea and heart disease is getting stronger. CVD such as high blood pressure, heart failure, and stroke are more common in patients with sleep apnea. It remains unclear whether sleep apnea causes heart disease (the chicken or the egg phenomena).