Study Implies Interwoven Relationship Between Sleep Symptoms and Cardiovascular Disease

How and to what degree are sleep disorders associated with patients with cardiovascular disease at the biochemical and functional level?

Bottom Line: Cardiology clinic patients had a higher frequency of obstructive sleep apnea (OSA) than the general U.S. population, a majority of them experienced at least one sleep symptom, and insomnia symptoms were associated with multiple cardiovascular measures.

Background: Treatment of OSA improves cardiovascular outcomes and, therefore, early detection is important. Yet patients with cardiovascular disease are not routinely screened for OSA. Moreover, other sleep symptoms such as insomnia could be associated with cardiovascular disease and with objective measures such as echocardiography and laboratory values.

Study design: Cross-sectional survey and retrospective chart review.

Setting: Department of Otolaryngology-Head and Neck Surgery, Department of Neurology, and Department of Medicine, Emory University School of Medicine, Atlanta, Ga.

Synopsis: A total of 193 English-speaking adult patients with a mean age of 60.8 years and a mean BMI of 29.1 completed questionnaires related to OSA, restless legs syndrome (RLS), snoring, insomnia, sleep duration, and daytime sleepiness. The participants, 43% female and all with underlying cardiovascular conditions, also consented to a retrospective chart review that included all past medical history, recent blood pressure readings, laboratory data, polysomnography results, and echocardiography and electrocardiography results. The study showed 21% of patients had a previous diagnosis of OSA, higher than in the general population, and that a majority were experiencing sleep symptoms. Associations were found between clinically significant insomnia and heart failure, and between symptoms of RLS with hypertension and peripheral artery disease. The authors note that future studies should be aimed at using diagnostic and quantitative measures of sleep symptoms and determination of the cause–effect relationship with cardiovascular disease, and how cardiovascular interventions play a role in sleep. Questionnaire data were limited by both its sectional and subjective nature.

Citation: Oh MS, Bliwise DL, Smith AL, et al. Obstructive sleep apnea, sleep symptoms, and their association with cardiovascular disease [published online ahead of print, Sept. 18, 2019]. Laryngoscope. doi:10.1002/lary.28293.