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(Circulation. 2003;108:9.)
© 2003 American Heart Association, Inc.

Clinician Update

Sleep-Disordered Breathing and Cardiovascular Disease

Robert Wolk, MD, PhD; Tomas Kara, MD; Virend K. Somers, MD, PhD

From the Mayo Clinic, Rochester, Minn.

Correspondence to Virend Somers, MD, PhD, Divisions of Cardiovascular Diseases and Hypertension, Department of Medicine, Mayo Foundation, 200 First St SW, Rochester, MN 55902. E-mail somers.virend@mayo.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Sleep apnea is defined as repetitive episodes of decreased or total cessation of respiratory airflow during sleep, leading to a fall in oxygen saturation of ≥4% and sleep fragmentation. Sleep apnea can be central or obstructive. Central sleep apnea (CSA) is characterized by apneas secondary to diminution or cessation of thoraco-abdominal respiratory movements (due to dysfunction of central respiratory control mechanisms). Obstructive sleep apnea (OSA) is caused by upper airway collapse during inspiration and is accompanied by strenuous breathing efforts. When defined as >5 episodes of apnea or hypopnea per hour of sleep, OSA is relatively common, affecting 24% and 9% of middle-aged men and women, respectively.¹ CSA is primarily seen in patients with congestive heart failure (CHF), although it occasionally may occur in healthy normal subjects, in people at high altitudes, and in association with central neural lesions. Sleep apnea constitutes a major public health problem because of its high prevalence and its emerging association with cardiovascular morbidity.

Central Sleep Apnea
CSA is especially relevant to CHF. The prevalence of CSA in CHF patients is dependent on various factors, such as heart failure etiology, gender, age, ejection fraction, and hemodynamic status, and has been estimated at 40% to 60%.^2,3 Cheyne-Stokes respiration occurs during CSA and is a distinct pattern of periodic breathing with alternating crescendo-decrescendo sequences of hyperventilation and apnea (ie, complete breathing cessation).

CSA may have an important influence on prognosis, in that its presence is associated with increased mortality in CHF patients.³ This effect appears to be independent of other . . . [Full Text of this Article]

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