February 1, 2021

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.

Advertisement

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.

Advertisement

Related Articles

23-NEU-4424571-CQD-Hero-650×450
February 19, 2024
Central Sensitization Syndromes in Pediatric Patients (Podcast)

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

23-NEU-4424570-CQD-Hero-650×450-Podcast
February 5, 2024
Diagnosis and Management of Neuromyelitis Optica Spectrum Disorder (Podcast)

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

23-NEU-4424569-CQD-Hero-650×450-Podcast-1179957802
January 16, 2024
Managing Neurological Disorders in Pregnancy (Podcast)

A discussion of special care considerations before, during and after pregnancy

23-NEU-4424568-CQD-Hero-650×450-Podcast
January 2, 2024
Harnessing the Power of Neuroengineering and AI to Improve Epilepsy Surgery (Podcast)

Data-driven methods may improve seizure localization and refine surgical decision-making

23-NEU-4311758-CQD-Hero-650×450-PodcastButton
December 15, 2023
Palliative Care for Parkinson’s Disease (Podcast)

When and how a multidisciplinary palliative care clinic can fill unmet needs for this population

23-NEU-4300122-mitochondria-podcast-650×450
December 5, 2023
Diagnosis and Management of Mitochondrial Diseases (Podcast)

Guidance on what should prompt a workup, current and emerging treatment options, and more

23-NEU-4292812-CQD-Hero-Podcast-650×450
November 2, 2023
Neuropsychiatric Challenges Facing Patients With Huntington’s Disease (Podcast)

Behavioral and cognitive symptoms often present early and may go unnoticed

23-NEU-4139531-CQD-Hero-Podcast-650×450
October 17, 2023
A Primer on Pediatric Sleep Disorders (Podcast)

Advice for diagnosing and managing sleep disturbances in children

Ad