This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Teramoto, S. Articles by Somers, V. K. Search for Related Content PubMed PubMed Citation Articles by Teramoto, S. Articles by Somers, V. K.

(Circulation. 1999;100:e136.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Does the Altered Cardiovascular Variability Associated With Obstructive Sleep Apnea Contribute to Development of Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome?

Shinji Teramoto, MD; Takeshi Matsuse, MD; Yasuyoshi Ouchi, MD

Department of Geriatric Medicine, Tokyo University Hospital, Tokyo, Japan

	Introduction

 
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 diseases.² A recent experimental study also suggests that apnea, but not hypoxia or arousal, is responsible for the development of HT.³ However, similar conditions have also been observed in patients who snore in the absence of OSA, ie, upper-airway resistance syndrome (UARS).

Thus, although there is a significant link between OSA and the altered cardiovascular variability, the association between OSA/UARS and HT/cardiovascular disease may depend on repetitive arousals, repetitive hypoxia, and increased sympathetic nervous system activity rather than the impaired cardiovascular variability.^{2 3 4} Furthermore, it has been reported . . . [Full Text of this Article]

Krzysztof Narkiewicz, MD, PhD; Philippe van de Borne, MD, PhD; Mark E. Dyken, MD

Cardiovascular Division, University of Iowa, Iowa City, Iowa

Nicola Montano, MD; Chiara Cogliati, MD

Centro L.I.T.A.-Vialba, Centro Ricerche Cardiovascolari, CNR, Medicina Interna II, Ospedalè L. Sacco, Università degli Studi di Milano, Milano, Italy

Virend K. Somers, MD, PhD

Divisions of Hypertension and Cardiology Department of Internal Medicine, Mayo Clinic, Rochester, Minn, ,

This article has been cited by other articles:

				S. Teramoto, H. Kume, Y. Yamaguchi, H. Yamamoto, M. Ishii, T. Ishii, and Y. Ouchi Heart rate variation analysis may not effectively detect sleep apnoeas in heart failure. Eur. Respir. J., August 1, 2006; 28(2): 457 - 458. [Full Text] [PDF]

				S. Teramoto, H. Kume, T. Matsuse, and Y. Fukuchi The risk of future cardiovascular diseases in the patients with OSAS is dependently or independently associated with obstructive sleep apnoea Eur. Respir. J., March 1, 2001; 17(3): 573 - 574. [Full Text] [PDF]