Obstructive Sleep Apnea Syndrome and its Comorbid Medical Conditions
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Obstructive sleep apnea syndrome (OSAS) is a common global health disorder which carries multiple medical and social impacts. OSAS is characterized by periodic complete or partial upper airway obstruction during sleep, causing intermittent cessations of breathing (apnea) or reductions in airflow (hypopnea) despite ongoing respiratory effort. It is associated with sleep disorder symptoms including loud snoring, disturbed and frequent wake-up during sleep and excessive daytime sleepiness. Apnea is a Greek word means “without breath”. The disorder is associated with hypertension [1], cardiovascular diseases [2], decreased libido [3] and emotional problems [4]. Unsurprisingly, this disorder has been linked to heart failure [5], myocardial infarction [6], chronic obstructive pulmonary disease (COPD) [7], stroke [8] and motor vehicle crashes [9,10]. Systemic hypertension is very common among the OSAS patients. It constitutes about 56% of OSAS patient having hypertension [11]. Cyclic intermittent hypoxia as experienced at night by OSAS patient leads to sympathetic activation [12]. This sustained sympathoexcitation through augmentation of peripheral chemoreflex sensitivity and stimulation on central sympathetic regulator causing increases of heart rate, cardiac output, peripheral vascular resistance and systemic arterial pressure thus increases the blood pressure [13,14]. Lavie et al. [15] monitored 24 hour blood pressure (BP) on 38 OSAS patients and their results revealed that diastolic, systolic and mean BP were significantly related to the severity of sleep apnea syndrome. Few hemodynamic studies on OSAS patients showed the systemic arterial pressure increases and remains at higher level during apnea episode compared to wakefulness [16-18]. The blood pressure can rise by 25% of the baseline during apnea episode and systolic and diastolic pressure can exceed 200 mmHg and 120 mmHg respectively [17]. Studies by Lies et al. [19], Sanner et al. [20] and Tun et al. [21] showed significant improvement in blood pressure in OSAS patient treated by CPAP which proves the causal relationship between systemic hypertension and OSAS.