Cardiovascular disease and obstructive sleep apnoea

Transcription

1 Cardiovascular disease and obstructive sleep apnoea Dr. Raymond J.B. Massay M.B.B.S., F.R.C.P(London)., F.E.S.C., F.A.C.C

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3 Four basic drives in life 1. Eat 2. Drink 3. Reproduce 4. Sleep

4 Sleep is the biggest mistake the evolutionary process has ever made 1. Cannot gather food 2. Cannot socialize 3. Cannot find a mate and reproduce 4. Cannot nurture or protect your offspring 5. Worse still, sleep leaves you vulnerable to predation

5 Results of sleep deprivation Cardiovascular fitness Gut microbiome Brain Metabolism Immune system

6 Matthew Walker in Why we sleep A balanced diet and exercise are of vital importance, yes. But we now see sleep as the preeminent force in this healthy trinity

7 Psalm 127, verse 3 It is but lost labour that ye haste to rise up early, and so late take rest, and eat the bread of carefulness; for so he giveth his beloved sleep

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9 Definition of obstructive sleep apnoea Apnoea Hypopnoea Index (AHI) (# of apnoeas + # of Hypopnoeas)/ hours of sleep Categorization of AHI vaules: Normal <5 Mild 5-15 Moderate Severe >30

10 Clinical evaluation Symptoms Loud snoring Choking or gasping episodes Tiredness on waking Excessive daytime sleepiness Poor concentration and short-term memory Associated clinical findings Increased BMI Increased neck circumference Small erythematous oropharynx Systemic hypertension Congestive cardiac failure Pulmonary hypertension Cor pulmonale Atypical presentations Nocturnal palpitations Morning headaches Seizures Gastroesophageal reflux Nocturia Lattimore et al, 2003

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12 Cardiovascular conditions associated with obstructive sleep apnoea Hypertension Cardiac arrhythmias Bradycardia Sinus bradicardia Atrioventricular block Tachydysrhythmia Supraventricular tachycardia Atrial fibrillation Ventricular tachycardia Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Congestive heart failure Stroke Coronary heart disease Pulmonary hypertension Parish and Somers, 2004

13 Prevalence of OSA (a) The prevalences of OSA reported in 4 studies Kasai and Bradley, 2011 (b) Prevalence of OSA in left ventricular dysfunction Javaheri et al., 2017

14 Prevalence Lattimore et al., 2003

15 Girardin et al., 2008

16 Trends in obesity by ethnicity Girardin et al., 2008

17 Fluid retention in the legs and its rostral shift Kasai et al., 2012

18 Potential bidirectional relationship between obstructive and central sleep apnoea and heart failure Kasai et al., 2012

19 Parati et al., 2016

20 Worse survival of HF patients with untreated OSA (AHI > 15) than those with M-NSA ( AHI < 15) Kasai and Bradley, 2011

21 Treatment outcomes with CPAP Girardin et al., 2008

22 Baseline Changes First Author (Ref. #) Year Study Design n Duration (Months) AHI LVEF (%) ESS AHI LVEF (%) SBP/DBP (mm Hg) ESS Kaneko et al. (88) 2003 Mansfield et al. (92) 2004 Smith et al. (93) 2007 RCT Control / 2 NA CPAP / 3 NA RCT Mean BP Control CPAP RCT-double crossover Sham ACPAP NA 1.0 NA 2.0 ACPAP NA 1.0 NA 3.0 Egea et al. (91) 2008 RCT Sham CPAP / CPAP / Massay and Roach (nd) Unpublished data

23 Patient X

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26 Summary OSA has varying prevalence in cardiovascular disease

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29 Treatment outcomes with CPAP Girardin et al., 2008

30 Psalm 127, verse 3 It is but lost labour that ye haste to rise up early, and so late take nest, and eat the bread of carefulness; for so he giveth his beloved sleep