cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2020-2405cardiovascular-2405Research ArticleОБЗОРЫREVIEWSСвязь обструктивного апноэ сна и сердечно-сосудистых заболеваний с позиций доказательной медицины. Часть 1The relationship of obstructive sleep apnea and cardiovascular diseases from the perspective of evidence-based medicine. Part 1https://orcid.org/0000-0002-4982-628XАгальцовМ. В.AgaltsovМ. V.

Агальцов Михаил Викторович — кандидат медицинских наук, старший научный сотрудник отдела фундаментальных и прикладных аспектов ожирения

Москва

agaltsov@rambler.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна — доктор медицинских наук, профессор, член-корреспондент РАН, руководитель отдела фундаментальных и прикладных аспектов ожирения, директор

Москва

ODrapkina@gnicpm.ruФГБУ “Национальный медицинский исследовательский центр терапии и профилактической медицины” Минздрава РоссииNational Medical Research Center for Therapy and Preventive Medicine20200105202019324052405Copyright © Агальцов М.В., Драпкина О.М., 20202020Агальцов М.В., Драпкина О.М.Agaltsov М.V., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2405

Проанализированы результаты проспективных исследований, метаанализов и систематических обзоров, посвященных ассоциациям обструктивного апноэ сна (ОАС) с различными сердечнососудистыми заболеваниями (ССЗ). В настоящее время достигнуто понимание широкой распространенности нарушений дыхания во сне среди общей популяции экономически развитых стран, показан рост числа заболевших ОАС при динамическом наблюдении. Взаимосвязь между ОАС и ССЗ нашла широкое подтверждение в больших когортных исследованиях. В первой части обзора рассматривается связь артериальной гипертензии (АГ) и различных форм сердечных аритмий: фибрилляции предсердий (ФП), брадиаритмий, желудочковой экстрасистолии, в т.ч.  внезапной смерти во сне, с обструктивными нарушениями дыхания во сне. Эти группы сердечно-сосудистых нозологий в настоящее время демонстрируют наиболее доказанную взаимосвязь с апноэ сна. Помимо одномоментных исследований, свидетельствующих о широкой распространенности ОАС у  пациентов с  АГ и  ФП, часть наблюдательных исследований говорит о росте числа пациентов с АГ и с пароксизмальной формой ФП, имевших нелеченое апноэ сна. Отдельно анализируются современные тенденции выделения фенотипически разных форм ОАС (в частности, REM-зависимое апноэ сна при АГ) из имеющихся баз данных, как определение наиболее неблагоприятных факторов, влияющих на кардиоваскулярную систему.

The results of prospective studies, meta-analyzes and systematic reviews on the associations of obstructive sleep apnea (OSA) with various cardiovascular diseases (CVD) were analyzed. Currently, the mechanisms related to high prevalence of breathing-related sleep disorders among population of economically developed countries are clear, and an increase in the number of OSA patients has been shown. The relationship between OSA and CVD has been widely confirmed in large cohort studies. The first review part discusses the relationship of hypertension (HTN) and various heart arrhythmias (atrial fibrillation (AF), bradyarrhythmias, premature ventricular contraction, sudden death during sleep) with breathing-related sleep disorders. These groups of cardiovascular disorders currently show the most proven relationship with sleep apnea. In addition to cross-sectional studies indicating the high prevalence of OSA in patients with HTN and AF, some observational studies indicate an increase in the number of patients with HTN and paroxysmal AF with history of untreated sleep apnea. An analysis of the current issues of OSA phenotypes (in particular, REM-related OSA in hypertensive patients) as the most unfavorable cardiovascular factors is carried out.

обструктивное апноэ снаартериальная гипертензиябрадиаритмиифибрилляция предсердийжелудочковая экстрасистолияREM-зависимое апноэ снаobstructive sleep apneahypertensionbradyarrhythmiasatrial fibrillationpremature ventricular contractionREM-related obstructive sleep apneaReferencesAmerican Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine. 2014; doi:10.1378/chest.14-0970.American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014 doi: 10.1378/chest.14-0970Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006-14. doi:10.1093/aje/kws342.Peppard PE, Young T, Barnet JH, et al.Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14. doi: 10.1093/aje/kws342Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5. doi:10.1056/NEJM199304293281704.Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults.N Engl J Med 1993;328:1230-5.Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proc Am Thor Soc. 2008;5:136-43. doi:10.1513/pats.200709-155MG.Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society 2008;5:136-43. doi: 10.1513/pats.200709-155MG.Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleepdisordered breathing in the general population: the Hypno Laus study. Lancet Respir Med. 2015;3:310-8. doi:10.1016/S2213-2600(15)00043-0.Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the Hypno Laus study. Lancet Respir Med 2015;3:310-8 doi: 10.1016/S2213-2600(15)00043-0.Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. EurRespir J. 2009;33:907-14. doi:10.1183/09031936.00180108.Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing.EurRespir J 2009;33:907-14. doi: 10.1183/09031936.00180108.Tilkian AG, Guilleminault C, Schroeder J, et al. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med. 1977;63(3):348-58. doi:10.1016/0002-9343(77)90272-8.Tilkian, A. G., Guilleminault, C., Schroeder, J et al. Sleep-induced apnea syndrome. The American Journal of Medicine, 1977; 63(3): 348–358.Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490-4. doi:10.1016/0002-9149(83)90013-9.Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52: 490-4.Koskenvuo M, Partinen M, Sarna S, et al. Snoring as a risk factor for hypertension and angina pectoris. Lancet. 1985;1:893-6. doi:10.1016/s0140-6736(85)91672-1.Koskenvuo M, Partinen M, Sarna S, et al. Snoring as a risk factor for hypertension and angina pectoris.Lancet 1985;1:893-6.Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-84. doi:10.1056/NEJM200005113421901.Peppard PE, Young T, Palta M, et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl J Med 2000;342:1378-84.Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep- Disordered Breathing and Mortality: A Prospective Cohort Study. PLoSMed. 2009;6:e1000132. doi:10.1371/journal.pmed.1000132.Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep- Disordered Breathing and Mortality: A Prospective Cohort Study. PLoSMed 2009;6:e1000132. doi: 10.1371/journal.pmed.1000132.Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122:352-60. doi:10.1161/CIRCULATIONAHA.109.901801.Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010;122:352-60. doi: 10.1161/CIRCULATIONAHA.109.901801Javaheri S, Blackwell T, Ancoli-Israel S, et al. Sleep-disordered breathing and incident of heart failure in older men. Am J Respir Crit Care Med. 2016;193:561-8. doi:10.1164/rccm.201503-0536OC.Javaheri S, Blackwell T, Ancoli-Israel S, et al. Sleep-disordered breathing and incident of heart failure in older men. Am J Respir Crit Care Med 2016;193:561-8. doi: 10.1164/rccm.201503-0536OC.Baguet JP, Levy P, Barone-Rochette G, et al. Masked hypertension in obstructive sleep apnea syndrome. J Hypertens. 2008;26:885- 92. doi:10.1097/HJH.0b013e3282f55049.Baguet JP, Levy P, Barone-Rochette G, et al. Masked hypertension in obstructive sleep apnea syndrome. J Hypertens 2008;26:885-92. doi: 10.1097/HJH.0b013e3282f55049.Gonçalves SC, Martinez D, Gus M, et al. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest. 2007;132:1858-62. doi:10.1378/chest.07-1170.Gonçalves SC, Martinez D, Gus M, et al. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest 2007;132:1858-62.Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19:2271-7. doi:10.1097/00004872-200112000-00022.Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001;19:2271-7.Calandra-Buonaura G, Provini F, Guaraldi P, et al. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev. 2016;26:43-56. doi:10.1016/j.smrv.2015.05.005.Calandra-Buonaura G, Provini F, Guaraldi P, et al. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016;26:43-56 doi: 10.1016/j.smrv.2015.05.005.Parati G, Lombardi C, Hedner J, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523-38. doi:10.1183/09031936.00226711.Parati G, Lombardi C, Hedner J, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 2013;41:523-38. doi: 10.1183/09031936.00226711.Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157:1746-52.Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997;157:1746-52.Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large communitybased study. Sleep Heart Health Study. JAMA. 2000;283:1829-36. doi:10.1001/jama.283.14.1829Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-36.).Haas DC, Foster GL, Nieto FJ, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005;111:614-21. doi:10.1161/01.CIR.0000154540.62381.CF.Haas DC, Foster GL, Nieto FJ, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation 2005;111:614-21.Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160:2289- 95. doi:10.1001/archinte.160.15.2289.Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000;160:2289-95.Glasser M, Bailey N, McMillan A, et al. Sleep apnoea in older people. Breathe 2011 7: 248-256; doi:10.1183/20734735.021910.Glasser M, Bailey N, McMillan A, et al. Sleep apnoea in older people. Breathe 2011;7:248.Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479-82. doi:10.1136/bmj.320.7233.479.Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 2000;320:479-82Tkacova R, McNicholas WT, Javorsky M, et al. Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. Eur Respir J. 2014;44:931 doi:10.1183/09031936.00225113.Tkacova R, McNicholas WT, Javorsky M, et al. Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. Eur Respir J 2014;44:931 doi: 10.1183/09031936.00225113.Marin JM, Agusti A, VillarI, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307:2169-76. doi:10.1001/jama.2012.3418.Marin J M, Agusti A, VillarI, etal.Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 2012;307:2169-76. doi: 10.1001/jama.2012.3418.O’Connor GT, Caffo B, Newman AB, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179:1159-64. doi:10.1164/rccm.200712-1809OC.O'Connor GT, Caffo B, Newman AB, et al.Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J RespirCritCareMed 2009;179:1159-64. doi: 10.1164/rccm.200712-1809OC.Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, et al. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med. 2011;184:1299-304. doi:10.1164/rccm.201101-0130OC.Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, et al. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J RespirCritCareMed 2011;184:1299-304. doi: 10.1164/rccm.201101-0130OC.Mokhlesi B, Finn L A, Hagen E W, et al. Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort. Am J Respir Crit Care Med. 2014;190:1158-67. doi:10.1164/rccm.201406-1136OC.Mokhlesi B, Finn L A, Hagen E W, et al. Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort. Am J Respir Crit Care Med 2014;190:1158-67. doi: 10.1164/rccm.201406-1136OC.Appleton SL, Vakulin A, Martin SA, et al. Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep. Ches.t 2016;150:495-505. doi:10.1016/j.chest.2016.03.010.Appleton SL, Vakulin A, Martin SA, et al. Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep. Chest 2016;150:495-505. doi: 10.1016/j.chest.2016.03.010.Van Ryswyk E, Mukherjee S, Chai-Coetzer CL, et al. Sleep Disorders, Including Sleep Apnea, and Hypertension. Am J Hypertens. 2018;31:857-64. doi:10.1093/ajh/hpy082.VanRyswyk E, Mukherjee S, Chai-Coetzer CL, et al. Sleep Disorders, Including Sleep Apnea, and Hypertension. Am J Hypertens 2018;31:857-64. doi: 10.1093/ajh/hpy082.Genta PR, Drager LF, Lorenzi Filho G. Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation. Sleep Med Clin. 2017;12:99-105. doi:10.1016/j.jsmc.2016.10.009.Genta PR, Drager LF, Lorenzi Filho G. Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation. Sleep Med Clin 2017;12:99-105. doi: 10.1016/j.jsmc.2016.10.009.Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173:910-6. doi:10.1164/rccm.200509-1442OC.Mehra R, BenjaminEJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006;173:910-6.Costa LE, Uchôa CH, Harmon RR, et al. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart. 2015;101:1288-92. doi:10.1136/heartjnl-2014-307276.Costa LE, Uchôa CH, Harmon RR, et al. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart 2015;101:1288-92. doi: 10.1136/heartjnl-2014-307276Linz D, McEvoy RD, Cowie MR, et al. Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review. JAMA Cardiol. 2018;3:532-40. doi:10.1001/jamacardio.2018.0095.Linz D, McEvoy RD, Cowie MR, et al. Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review. JAMA Cardiol 2018;3:532-40 doi: 10.1001/jamacardio.2018.0095.May AM, Van Wagoner DR, Mehra R. OSA and Cardiac Arrhythmogenesis: Mechanistic Insights. Chest. 2017;151:225-41. doi:10.1016/j.chest.2016.09.014.May AM, Van Wagoner DR, Mehra R. OSA and Cardiac Arrhythmogenesis: Mechanistic Insights. Chest 2017;151:225-41. doi: 10.1016/j.chest.2016.09.014.Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47-112. doi:10.1152/physrev.00043.2008.Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev 2010;90:47-112. doi: 10.1152/physrev.00043.2008.Patel N, Donahue C, Shenoy A, et al. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol. 2017;228:967-70. doi:10.1016/j.ijcard.2016.11.137.Patel N, Donahue C, Shenoy A, et al. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol 2017;228:967-70. doi: 10.1016/j.ijcard.2016.11.137.Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis. 1996;7:475-8.Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 1996;7:475-8.Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154-9. doi:10.1161/01.cir.97.21.2154.Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 1998;97:2154-9.).Stevenson IH, Teichtahl H, Cunnington D, et al. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J. 2008;29:1662-9. doi:10.1093/eurheartj/ehn214.Stevenson IH, Teichtahl H, Cunnington D, et al.Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. EurHeart J 2008;29:1662-9. doi: 10.1093/eurheartj/ehn214.Zhao E, Chen S, Du Y, et al. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A MetaAnalysis of Cohort Study. Biomed Res Int. 2018;52:158-68. doi:10.1155/2018/5215868.Zhao E, Chen S, Du Y, et al. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. Biomed Res Int 2018; 52:158-68. doi: 10.1155/2018/5215868.Youssef I, Kamran H, Yacoub M, et al. Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis. J Sleep Disord Ther. 2018;7(1):282. doi:10.4172/2167-0277.1000282.Youssef I, Kamran H, Yacoub M et al. Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis. J Sleep Disord Ther. 2018 ; 7(1):282. doi: 10.4172/2167-0277.1000282.Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49:565-71. doi:10.1016/j.jacc.2006.08.060.Gami AS, Hodge D O, Herges R M, etal. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J AmCollCardiol 2007;49:565-71.Ng CY, Liu T, Shehata M, et al. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108:47-51. doi:10.1016/j.amjcard.2011.02.343.Ng CY, Liu T, Shehata M, et al.Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation.Am J Cardiol 2011;108:47-51. doi: 10.1016/j.amjcard.2011.02.343.Rossi VA, Stradling JR, Kohler M. Effects of obstructive sleep apnoea on heart rhythm. Eur Respir J. 2013;41:1439-51. doi:10.1183/09031936.00128412.Rossi VA, Stradling JR, Kohler M. Effects of obstructive sleep apnoea on heart rhythm. EurRespir J 2013;41:1439-51. doi: 10.1183/09031936.00128412.Maeno K, Kasai A, Setsuda M, et al. Advanced atrioventricular block induced by obstructive sleep apnea before oxygen desaturation. Heart Vessels. 2009;24:236-40. doi:10.1007/s00380-008-1113-2.Maeno K, Kasai A, Setsuda M, et al. Advanced atrioventricular block induced by obstructive sleep apnea before oxygen desaturation. Heart Vessels 2009;24:236-40Becker HF, doi: 10.1007/s00380-008-1113-2.Koshino Y, Satoh M, Katayose Y, et al. Association of SleepDisordered Breathing and Ventricular Arrhythmias in Patients Without Heart Failure. Am J Cardiol. 2008;101:882-6. doi:10.1016/j.amjcard.2007.10.056.Koshino Y, Satoh M, Katayose Y, et al. Association of Sleep-Disordered Breathing and Ventricular Arrhythmias in Patients Without Heart Failure. Am J Cardiol 2008;101:882-6. doi: 10.1016/j.amjcard.2007.10.056.Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol. 2012;45:508-12. doi:10.1016/j.jelectrocard.2012.03.003.Olmetti F, La Rovere MT, Robbi E, et al. Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea. Sleep Med 2008;9:475-80.Cioffi G, Russo TE, Stefenelli C, et al. Severe obstructive sleep apnea elicits concentric left ventricular geometry. J Hypertens. 2010;28:1074-82. doi:10.1097/hjh.0b013e328336c90a.Garvey JF, Pengo MF, Drakatos P, et al. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis 2015;7:920-9. doi: 10.3978/j.issn.2072-1439.2015.04.52.Gami AS, Howard DE, Olson EJ, et al. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352:1206- 14. doi:10.1056/NEJMoa041832.Lévy P, Ryan S, Oldenburg O, et al. Sleep apnoea and the heart. Eur Respir Rev 2013;22:333-52. doi: 10.1183/09059180.00004513.Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013;62:610-6. doi:10.1016/j.jacc.2013.04.080.Ludka O, Stepanova R, Vyskocilova M et al. Sleep apnea prevalence in acute myocardial infarction—the Sleep Apnea in Post-acute Myocardial Infarction Patients (SAPAMI) Study. Int J Cardiol. 2014;176:13–19. doi: 10.1016/j.ijcard.2014.06.020.Buchner S, Satzl A, Debl K, et al. Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction. Eur Heart J 2014;35:192-9 doi: 10.1093/eurheartj/eht450.Buchner S, Satzl A, Debl K, et al. Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction. Eur Heart J 2014;35:192-9 doi: 10.1093/eurheartj/eht450.Lee CH, Sethi R, Li R, Ho HH, Hein T, Jim MH, et al. Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation. 2016;133:2008–2017 doi: 10.1161/CIRCULATIONAHA.115.019392.Lee CH, Sethi R, Li R, Ho HH, Hein T, Jim MH, et al. Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation. 2016;133:2008–2017 doi: 10.1161/CIRCULATIONAHA.115.019392.Leão S, Conde B, Fontes P, et al. Effect of obstructive sleep apnea in acute coronary syndrome. Am J Cardiol. 2016;117:1084–1087 doi: 10.1016/j.amjcard.2015.12.053Leão S, Conde B, Fontes P, et al. Effect of obstructive sleep apnea in acute coronary syndrome. Am J Cardiol. 2016;117:1084–1087 doi: 10.1016/j.amjcard.2015.12.053Birkbak J, Clark AJ, Rod NH. The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review. J Clin Sleep Med 2014;10:103-8. doi: 10.5664/jcsm.3376.Birkbak J, Clark AJ, Rod NH. The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review. J Clin Sleep Med 2014;10:103-8. doi: 10.5664/jcsm.3376.Capampangan DJ, Wellik KE, Parish JM, et al. Is obstructive sleep apnea an independent risk factor for stroke? A critically appraised topic. Neurologist 2010;16:269-73. doi: 10.1097/NRL.0b013e3181e5a66c.Capampangan DJ, Wellik KE, Parish JM, et al. Is obstructive sleep apnea an independent risk factor for stroke? A critically appraised topic. Neurologist 2010;16:269-73. doi: 10.1097/NRL.0b013e3181e5a66c.Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016;87:1407-16 doi: 10.1212/WNL.0000000000003037Hermann DM, Bassetti CL. Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery. Neurology 2016;87:1407-16 doi: 10.1212/WNL.0000000000003037Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2014;45:2160-236. doi: 10.1161/STR.0000000000000024.Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2014;45:2160-236. doi: 10.1161/STR.0000000000000024.Marshall NS, Wong KK, Cullen SR, et al. Snoring is not associated with all-cause mortality, incident cardiovascular disease, or stroke in the Busselton Health Study. Sleep 2012;35:1235-40. doi: 10.5665/sleep.2076.Marshall NS, Wong KK, Cullen SR, et al. Snoring is not associated with all-cause mortality, incident cardiovascular disease, or stroke in the Busselton Health Study. Sleep 2012;35:1235-40. doi: 10.5665/sleep.2076.Lee SA, Amis TC, Byth K, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008;31:1207-13.Lee SA, Amis TC, Byth K, et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 2008;31:1207-13.Dong R, Dong Z, Liu H, et al. Prevalence, Risk Factors, Outcomes, and Treatment of Obstructive Sleep Apnea in Patients with Cerebrovascular Disease: A Systematic Review. J Stroke Cerebrovasc Dis 2018;27:1471-80 doi: 10.1016/j.jstrokecerebrovasdis.2017.12.048.Dong R, Dong Z, Liu H, et al. Prevalence, Risk Factors, Outcomes, and Treatment of Obstructive Sleep Apnea in Patients with Cerebrovascular Disease: A Systematic Review. J Stroke Cerebrovasc Dis 2018;27:1471-80 doi: 10.1016/j.jstrokecerebrovasdis.2017.12.048.Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010;6:131-7Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010;6:131-7Harbison J, Ford GA, James OF, et al. Sleep-disordered breathing following acute stroke. QJM 2002;95:741-7.Harbison J, Ford GA, James OF, et al. Sleep-disordered breathing following acute stroke. QJM 2002;95:741-7.Muñoz R, Durán-Cantolla J, Martinez-Vila E, et al. Central sleep apnea is associated with increased risk of ischemic stroke in the elderly. Acta Neurol Scand 2012;126:183-8 doi: 10.1111/j.1600-0404.2011.01625.x.Muñoz R, Durán-Cantolla J, Martinez-Vila E, et al. Central sleep apnea is associated with increased risk of ischemic stroke in the elderly. Acta Neurol Scand 2012;126:183-8 doi: 10.1111/j.1600-0404.2011.01625.x.Siccoli MM, Valko PO, Hermann DM, et al. Central periodic breathing during sleep in 74 patients with acute ischemic stroke - neurogenic and cardiogenic factors. J Neurol 2008;255:1687-92.. doi: 10.1007/s00415-008-0981-9.Siccoli MM, Valko PO, Hermann DM, et al. Central periodic breathing during sleep in 74 patients with acute ischemic stroke - neurogenic and cardiogenic factors. J Neurol 2008;255:1687-92.. doi: 10.1007/s00415-008-0981-9.Loke YK, Brown JWL, Kwok CS, et al. Association of Obstructive Sleep Apnea With Risk of Serious Cardiovascular Events. Circ Cardiovasc Qual Outcomes 2012;5:720.Loke YK, Brown JWL, Kwok CS, et al. Association of Obstructive Sleep Apnea With Risk of Serious Cardiovascular Events. Circ Cardiovasc Qual Outcomes 2012;5:720.Yaranov DM, Smyrlis A, Usatii N, et al. Effect of Obstructive Sleep Apnea on Frequency of Stroke in Patients With Atrial Fibrillation. Am J Cardiol 2015;115:461-5. doi: 10.1016/j.amjcard.2014.11.027.Yaranov DM, Smyrlis A, Usatii N, et al. Effect of Obstructive Sleep Apnea on Frequency of Stroke in Patients With Atrial Fibrillation. Am J Cardiol 2015;115:461-5. doi: 10.1016/j.amjcard.2014.11.027.Brown DL, Shafie-Khorassani F, Kim S,et al. Sleep-Disordered Breathing Is Associated With Recurrent Ischemic Stroke. Stroke.2019;50:571-576 doi: 10.1161/STROKEAHA.118.023807.Brown DL, Shafie-Khorassani F, Kim S,et al. Sleep-Disordered Breathing Is Associated With Recurrent Ischemic Stroke. Stroke.2019;50:571-576 doi: 10.1161/STROKEAHA.118.023807.Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 2008;168:297-301. doi: 10.1001/archinternmed.2007.70.Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 2008;168:297-301. doi: 10.1001/archinternmed.2007.70.Herrscher TE, Akre H, Øverland B, et al. High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. J Card Fail 2011;17:420-5 doi: 10.1016/j.cardfail.2011.01.013.Herrscher TE, Akre H, Øverland B, et al. High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. J Card Fail 2011;17:420-5 doi: 10.1016/j.cardfail.2011.01.013.JelicS, LeJemtelTH. Sleep-disordered breathing in acute decompensated heart failure.CurrHeartFailRep 2009;6:169-75JelicS, LeJemtelTH. Sleep-disordered breathing in acute decompensated heart failure.CurrHeartFailRep 2009;6:169-75Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J 2016;37:1695-703. doi: 10.1093/eurheartj/ehv624.Oldenburg O, Wellmann B, Buchholz A, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J 2016;37:1695-703. doi: 10.1093/eurheartj/ehv624.Bitter T, Faber L, Hering D, et al. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail 2009;11:602-8. doi: 10.1093/eurjhf/hfp057.Bitter T, Faber L, Hering D, et al. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail 2009;11:602-8. doi: 10.1093/eurjhf/hfp057.Hla KM, Young T, Hagen EW, et al.Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. Sleep 2015;38:677-84.) doi: 10.5665/sleep.4654.Hla KM, Young T, Hagen EW, et al.Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. Sleep 2015;38:677-84.) doi: 10.5665/sleep.4654.Arzt M, Young T, Finn L, etal. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006;166:1716-22.Arzt M, Young T, Finn L, etal. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006;166:1716-22.Simonneau G, Gatzoulis MA, Adatia I, et al.Updated clinical classification of pulmonary hypertension.J AmCollCardiol 2013;62:D34-41. doi: 10.1016/j.jacc.2013.10.029.Simonneau G, Gatzoulis MA, Adatia I, et al.Updated clinical classification of pulmonary hypertension.J AmCollCardiol 2013;62:D34-41. doi: 10.1016/j.jacc.2013.10.029.Dumitrascu R, Tiede H, Eckermann J, et al. Sleep apnea in precapillary pulmonary hypertension. Sleep Med 2013;14:247-51 doi: 10.1016/j.sleep.2012.11.013.Dumitrascu R, Tiede H, Eckermann J, et al. Sleep apnea in precapillary pulmonary hypertension. Sleep Med 2013;14:247-51 doi: 10.1016/j.sleep.2012.11.013.Wong HS, Williams A, Mok Y. The relationship between pulmonary hypertension and obstructive sleep apnea. CurrOpinPulmMed 2017;23:517-21. doi: 10.1097/MCP.0000000000000421.Wong HS, Williams A, Mok Y. The relationship between pulmonary hypertension and obstructive sleep apnea. CurrOpinPulmMed 2017;23:517-21. doi: 10.1097/MCP.0000000000000421.Minai OA, Ricaurte B, Kaw R, et al. Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 2009;104:1300-6. doi: 10.1016/j.amjcard.2009.06.048.Minai OA, Ricaurte B, Kaw R, et al. Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 2009;104:1300-6. doi: 10.1016/j.amjcard.2009.06.048.Sajkov D, Wang T, Saunders NA, et al. Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease. Am J Respir Crit Care Med 1999;159:1518-26Sajkov D, Wang T, Saunders NA, et al. Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease. Am J Respir Crit Care Med 1999;159:1518-26Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol 2013;62:610-6. doi: 10.1016/j.jacc.2013.04.080.Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol 2013;62:610-6. doi: 10.1016/j.jacc.2013.04.080.Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-8.Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-8.Marin JM, Carrizo SJ, Vicente E, e tal. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.Marin JM, Carrizo SJ, Vicente E, e tal. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.Marshall NS, Wong KK, Cullen SR, et al. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort.J Clin Sleep Med 2014;10:355-62 doi: 10.5664/jcsm.3600.Marshall NS, Wong KK, Cullen SR, et al. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort.J Clin Sleep Med 2014;10:355-62 doi: 10.5664/jcsm.3600.Haba-Rubio J, Janssens JP, Rochat T, et al. Rapid eye movement–related disordered breathing: clinical and polysomnographic features. Chest. 2005;128:3350–3357.Haba-Rubio J, Janssens JP, Rochat T, et al. Rapid eye movement–related disordered breathing: clinical and polysomnographic features. Chest. 2005;128:3350–3357.Aurora RN, Crainiceanu C, Gottlieb DJ, et al. Obstructive Sleep Apnea during REM Sleep and Cardiovascular Disease. Am J Respir Crit Care Med 2018;197:653-60 doi: 10.1164/rccm.201706-1112OC.Aurora RN, Crainiceanu C, Gottlieb DJ, et al. Obstructive Sleep Apnea during REM Sleep and Cardiovascular Disease. Am J Respir Crit Care Med 2018;197:653-60 doi: 10.1164/rccm.201706-1112OC.

The authors declare that there are no conflicts of interest present.