Locations:
Search IconSearch
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.

Advertisement

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.

Advertisement

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.

Advertisement

Related Articles

dr. daniel ontaneda against a decorative background
October 2, 2024/Neurosciences/Podcast
Takeaways From the New Diagnostic Criteria for Multiple Sclerosis (Podcast)

A co-author explains some of the key McDonald criteria revisions

Dr. Imad Najm against a decorative background
September 16, 2024/Neurosciences/Podcast
Temporal Lobe Epilepsy and the Potential of Gene Therapy (Podcast)

Investigational gene approaches offer hope for a therapeutically challenging condition

alison stout, DO, against a decorative backdrop
August 9, 2024/Neurosciences/Podcast
Evaluation and Interventional Treatment of Axial Lumbar Back Pain (Podcast)

This common condition remains tough to work up and diagnose, and treatment options are limited

Dr. Amy Kunchok against decorative background
July 16, 2024/Neurosciences/Podcast
What to Know About Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) (Podcast)

It’s time to get familiar with this emerging demyelinating disorder

receptor activity for myasthenia gravis medications
July 3, 2024/Neurosciences/Podcast
Myasthenia Gravis: Unmet Needs and Efforts to Address Them (Podcast)

An overview of associated antibodies, therapies for antibody-positive disease and the outlook for atypical forms of MG

adult female figure suffering headache
June 17, 2024/Neurosciences/Podcast
Migraine Relief: Providing Preventive and Abortive Therapies (Podcast)

A close look at the growing array of options for episodic and chronic migraine

woman grabbing her back in pain
June 3, 2024/Neurosciences/Podcast
Shedding Light on Stiff Person Syndrome (Podcast)

Heightened awareness of this rare disorder may lead to better diagnosis and treatment progress

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

Ad