Obstructive sleep apnea

Obstructive sleep apnea remains an important public health problem because of its neurocognitive sequelae. Detailed characterization of physiologic pathways and cardiovascular disease mechanisms suggest an important role of obstructive sleep apnea in systemic disease, particularly of the cardiovascular system. Rigorous studies with a refined diagnostic approach to obstructive sleep apnea are needed to identify the relative importance of apneas, hypopneas, blood gas abnormalities, arousals, and sleep deprivation in the initiation of cardiovascular disease. An added challenge will be disentangling the influence of multiple comorbid conditions that are often present in patients with obstructive sleep apnea. Small interventional studies suggest that CPAP reverses some of the important pathophysiologic pathways in obstructive sleep apnea, but this finding has not been clinically validated by large-scale randomized, controlled trials. Further clarification of physiologic and pathologic pathways may help to identify novel mechanism-based therapies that interrupt or delay progression of pathophysiologic processes related to obstructive sleep apnea.