Can occur with short-term sleep deprivation.[225]Vgontzas AN, Bixler EO, Chrousos GP. Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med. 2003 Jul;254(1):32-44.
https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2003.01177.x?sid=nlm%3Apubmed
http://www.ncbi.nlm.nih.gov/pubmed/12823641?tool=bestpractice.com
Risk of hypertension, dysrhythmia, stroke, coronary artery disease, and chronic kidney disease is elevated with OSA.[12]Chang JL, Goldberg AN, Alt JA, et al. International consensus statement on obstructive sleep apnea. Int Forum Allergy Rhinol. 2023 Jul;13(7):1061-482.
https://onlinelibrary.wiley.com/doi/10.1002/alr.23079
http://www.ncbi.nlm.nih.gov/pubmed/36068685?tool=bestpractice.com
[25]Mehra R, Chung MK, Olshansky B, et al. Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association. Circulation. 2022 Aug 30;146(9):e119-e136.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001082
http://www.ncbi.nlm.nih.gov/pubmed/35912643?tool=bestpractice.com
[161]Peker Y, Hedner J, Norum J, et al. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med. 2002 Jul 15;166(2):159-65.
http://www.atsjournals.org/doi/full/10.1164/rccm.2105124#.UtPPGdJdURE
http://www.ncbi.nlm.nih.gov/pubmed/12119227?tool=bestpractice.com
[217]Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005 Mar 19-25;365(9464):1046-53.
http://www.ncbi.nlm.nih.gov/pubmed/15781100?tool=bestpractice.com
[218]Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015 Sep;70(9):888-95.
https://thorax.bmj.com/content/70/9/888.long
http://www.ncbi.nlm.nih.gov/pubmed/26038534?tool=bestpractice.com
[219]Bassetti CLA, Randerath W, Vignatelli L, et al. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol. 2020 Jul;27(7):1117-36.
https://onlinelibrary.wiley.com/doi/10.1111/ene.14201
http://www.ncbi.nlm.nih.gov/pubmed/32314498?tool=bestpractice.com
[220]Gottesman RF, Lutsey PL, Benveniste H, et al. Impact of sleep disorders and disturbed sleep on brain health: a scientific statement from the American Heart Association. Stroke. 2024 Mar;55(3):e61-76.
https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000453
http://www.ncbi.nlm.nih.gov/pubmed/38235581?tool=bestpractice.com
A possible common mechanism is oxidative stress secondary to hypoxia, endothelial dysfunction, and sympathetic autonomic activation.
Sleepiness and decreased attention are common with OSA, and motor vehicle accident risk rate is higher than normal. The patient may report a history of motor vehicle accidents due to sleepiness while driving.[26]Bonsignore MR, Randerath W, Schiza S, et al. European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir J. 2021 Feb;57(2):2001272.
https://erj.ersjournals.com/content/57/2/2001272.long
http://www.ncbi.nlm.nih.gov/pubmed/33008939?tool=bestpractice.com
[27]Das AM, Chang JL, Berneking M, et al. Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2022 Oct 1;18(10):2467-70.
https://jcsm.aasm.org/doi/10.5664/jcsm.9670
http://www.ncbi.nlm.nih.gov/pubmed/34534065?tool=bestpractice.com
long term
high
Lower arousal, alertness, executive attention, and intelligence.[222]Naegele B, Thouvard V, Pepin JL, et al. Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep. 1995 Jan;18(1):43-52.
http://www.ncbi.nlm.nih.gov/pubmed/7761742?tool=bestpractice.com
Potentially attributed to sleep fragmentation and/or oxidative stress.
OSA has also been associated with increased risk of all-cause dementia, Alzheimer’s disease and Parkinson's disease dementia.[220]Gottesman RF, Lutsey PL, Benveniste H, et al. Impact of sleep disorders and disturbed sleep on brain health: a scientific statement from the American Heart Association. Stroke. 2024 Mar;55(3):e61-76.
https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000453
http://www.ncbi.nlm.nih.gov/pubmed/38235581?tool=bestpractice.com
[223]Guay-Gagnon M, Vat S, Forget MF, et al. Sleep apnea and the risk of dementia: a systematic review and meta-analysis. J Sleep Res. 2022 Oct;31(5):e13589.
http://www.ncbi.nlm.nih.gov/pubmed/35366021?tool=bestpractice.com
Neuroimaging studies have identified central nervous system lesions in OSA patients.[224]Zimmerman ME, Aloia MS. A review of neuroimaging in obstructive sleep apnea. J Clin Sleep Med. 2006 Oct 15;2(4):461-71.
http://www.ncbi.nlm.nih.gov/pubmed/17557478?tool=bestpractice.com
long term
medium
Predominantly due to cardiovascular disease.[164]Marti S, Sampol G, Munoz X, et al. Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment. Eur Respir J. 2002 Dec;20(6):1511-8.
http://erj.ersjournals.com/cgi/content/full/20/6/1511
http://www.ncbi.nlm.nih.gov/pubmed/12503712?tool=bestpractice.com
[226]Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008 Aug;31(8):1079-85.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542953/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/18714779?tool=bestpractice.com
[227]Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep. 2008 Aug;31(8):1071-8.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542952/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/18714778?tool=bestpractice.com
[228]Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest. 2005 Aug;128(2):624-33.
http://www.ncbi.nlm.nih.gov/pubmed/16100147?tool=bestpractice.com