Does the Altered Cardiovascular Variability Associated With Obstructive Sleep Apnea Contribute to Development of Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome?
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To the Editor:
In a recent issue of Circulation, Narkiewicz et al1 demonstrated that cardiovascular variability is altered in patients with obstructive sleep apnea (OSA). The authors concluded that abnormalities in cardiovascular variability might be implicated in the subsequent development of overt cardiovascular disease in patients with OSA. We basically agree with the authors that patients with OSA in the absence of hypertension (HT) or heart failure have an altered cardiovascular variability. However, the role of altered cardiovascular variability in the development of cardiovascular disease has not been determined. Although an association of OSA with HT has been documented, this association may also be affected by confounding factors such as age and obesity, which commonly occur along with both OSA and HT.2 3 4 Because OSA is associated with repetitive arousals, hypoxia, and a rise in catecholamine and sympathetic nervous system activity, all of which can lead to HT, there is no doubt that OSA is a risk factor for HT and other cardiovascular …