February 1, 2021/Neurosciences/Podcast

Obstructive Sleep Apnea’s Impact on Comorbid Conditions (Podcast)

Vascular remodeling leaves a multitude of long-term effects

New and emerging research is helping clinicians better understand the role of untreated obstructive sleep apnea in the development or worsening of comorbidities.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“The reason we treat sleep apnea is, number one, to improve quality of life and, number two, to improve cardiovascular health, although arguably there are other health benefits,” says Reena Mehra, MD, MS, Director of Sleep Disorders Research in Cleveland Clinic’s Sleep Disorders Center.

Dr. Mehra explains the link between sleep apnea and cardiovascular, neurological and metabolic comorbidities in the newest episode of Cleveland Clinic’s Neuro Pathways podcast. She also discusses:

  • Manifestations of obstructive sleep apnea
  • Treatment options, including continuous positive airway pressure (CPAP), oral appliances, upper airway surgery and hypoglossal nerve stimulation
  • Next steps for patients suspected of having obstructive sleep apnea
  • How to help patients adhere to CPAP treatment

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Mehra: Obstructive sleep apnea is characterized by upper airway collapse, which leads to cessation of breathing. When there’s cessation of breathing, oxygen levels decline. With the apneas and also partial upper airway closure (the hypopneas), there is sympathetic nervous system activation — alterations in the autonomic nervous system. During the event there’s enhanced parasympathetic tone, and then subsequent to the event there is sympathetic surge. So, there’s this juxtaposition of parasympathetic and sympathetic activation that occurs, and there are rises in carbon dioxide. Times of hypoxia and then resaturation are times of vulnerability to oxidative stress and increased systemic inflammation.


Taken together, these pathophysiologic consequences of obstructive sleep apnea confer risk not only immediately during sleep but also during the daytime. There are data to show that in those with severe sleep apnea over time, vascular remodeling occurs. This sets the stage for increased cardiovascular consequences because of alterations in the autonomic nervous system that can be increased in the setting of sleep apnea — hypoxia, hypercapnia, increased systemic inflammation, oxidative stress, a prothrombotic state. The vascular remodeling sets the stage for metabolic consequences as well, with insulin resistance. All of these taken together can increase the risk for cardiovascular events, meaning myocardial infarction, stroke, heart failure and, something our group has been very interested in, cardiac arrhythmia. Arrhythmogenesis likely increases partly due to remodeling the heart structurally and also electrically.

In terms of the neurologic aspects in addition to stroke, there are relationships between not only sleep apnea but also sleep disruption and sleep deprivation with neurodegeneration, in particular Alzheimer’s dementia. Some really compelling data has emerged over the last several years, showing that in experimental models curtailment of sleep impairs beta-synuclein clearance and causes buildup of this pathology and, therefore, can contribute to neurodegeneration. In addition, there are data to suggest that the progression of neurodegeneration over time may be related to the nocturnal hypoxia associated with sleep apnea.


Related Articles

pills, syringes and vials on a tabletop
May 15, 2024/Neurosciences/Podcast
Multiple Sclerosis Medications: Making the Most of a Multitude of Options (Podcast)

Insights on the decision process for selecting a treatment approach

doctor applying force to patient's forearm to test strength
Offering Rehabilitation Care to Oncology Patients (Podcast)

New oncologic rehab program is tailored to managing the effects of cancer and its treatments

syringe being prepared for injection
April 15, 2024/Neurosciences/Podcast
Balancing Benefits and Pitfalls of Neurotoxin Injections (Podcast)

Determining the right dose and injecting in the right muscle can be challenging

inflammation on a brain scan with a podcast button overlay
April 2, 2024/Neurosciences/Podcast
Diagnosis and Management of Cerebral Amyloid Angiopathy-Related Inflammation (Podcast)

New research sheds light on a potentially devastating condition that is reversible when properly managed

photo of a man sleeping at a desk, with a podcast icon overlay
March 15, 2024/Neurosciences/Podcast
Diagnosis and Management of Idiopathic Hypersomnia (Podcast)

Testing options and therapies are expanding for this poorly understood sleep disorder

series of digital-looking brain icons with a podcast button overlay on top
March 1, 2024/Neurosciences/Podcast
Harnessing the Power of AI in Medicine (Podcast)

Neurology is especially well positioned for opportunities to enhance clinical care and medical training

February 19, 2024/Neurosciences/Podcast
Central Sensitization Syndromes in Pediatric Patients (Podcast)

How functional restoration can help children with these conditions marked by unexplained pain with stigmatized symptoms

February 5, 2024/Neurosciences/Podcast
Diagnosis and Management of Neuromyelitis Optica Spectrum Disorder (Podcast)

Despite advancements, care for this rare autoimmune disease is too complex to go it alone