Cardiovascular Implications in the Treatment of Obstructive Sleep Apnea |
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Authors: | Olivier M Vanderveken An Boudewyns Quan Ni Bhavani Kashyap Johan Verbraecken Wilfried De Backer Paul Van de Heyning |
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Institution: | (1) Department of ENT, Head and Neck Surgery, University of Antwerp, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium;(2) Inspire Medical Systems, Inc., Maple Grove, MN 55369, USA;(3) Department of Pulmonary Medicine, University of Antwerp, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium |
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Abstract: | Epidemiological studies provide strong evidence that obstructive sleep apnea (OSA) is associated with cardiovascular complications
such as systemic hypertension, congestive heart failure, and atrial fibrillation. Successful OSA treatment with continuous
positive airway pressure (CPAP) has resulted in coincident reductions in systemic hypertension, improvements in left ventricular
systolic function, and reductions in sympathetic nervous activity. These data suggest that successful treatment of OSA may
reduce cardiovascular morbidity in such patients. Although CPAP is the more successful treatment for OSA when used properly
and consistently, its clinical success is often limited by poor patient and partner acceptance, which leads to suboptimal
compliance. Oral appliances or upper airway surgeries are considered a second line of treatment for patients with mild to
moderate OSA who do not comply with or refuse long-term CPAP treatment. Oral devices such as mandibular repositioning appliances
were recently shown to improve arterial hypertension in OSA patients. Electrical stimulation of the hypoglossal nerve is a
new investigational therapy for patients with moderate to severe OSA. This new treatment option, if proven effective, may
provide cardiovascular benefits secondary to treating OSA. |
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