What is the prognosis of sleep-disordered breathing (SDB)?

Updated: Feb 13, 2020
  • Author: Vittorio Rinaldi, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Excessive daytime sleepiness resulting from SDB can impact focus and concentration, causing decreased work effectiveness. Even mild-to-moderate SDB increases reaction time, causing performance decreases similar to alcohol intoxication. This can lead to motor vehicle accidents and other serious accidents in situations where alertness is required for safety (eg, heavy machinery operators).

Moderate-to-severe OSA is associated with earlier death. The cardiovascular sequelae of untreated OSA include hypertension, cor pulmonale, arrhythmias, and increased risk of myocardial infarction or stroke. [25, 26, 27, 28, 29] SDB is associated with higher levels of IL-6, a marker of myocardial infarction risk and mortality. [30] Adiposity may mediate the increased levels of C-reactive protein (CRP), fibrinogen, intercellular adhesion molecule (ICAM)-1, and P-selectin observed in SDB. [30]

OSA is associated with difficult-to-control hypertension. [31] CPAP also reduces markers of hypercoagulability, and this is a potential mechanisms by which it can reduce the rate of cardiovascular morbidity and mortality in OSAS patients. [32]

In heart failure patients with sleep apnea, studies have not shown the use of PAP to reduce the risks of cardiovascular outcomes or death; however, such therapy has been associated with some improvements in OSA symptoms. [33]

Treatment of OSA may reduce new first-time cerebrovascular events and recurrences. [34]  A study by Gupta et al suggested that in patients with stroke and OSA, CPAP treatment can yield significantly better stroke outcomes and statistically nonsignificant favorable outcomes in terms of recurrence of vascular events. [35]

Many of the studies examining the relation between OSA and glucose tolerance have shown a direct and independent relation between OSA and diabetes. The Wisconsin Sleep Study Cohort showed a greater prevalence of diabetes in subjects with increasing levels of OSA. [36]  Several studies have shown a beneficial effect of CPAP therapy on insulin resistance or glucose levels. [37, 38, 39]

The probable mechanisms connecting OSA with glucose tolerance and type 2 diabetes mellitus includes increased sympathetic activity, sympathovagal dysfunction, alterations in neuroendocrine function (especially in growth hormone [GH] and cortisol levels), and a high inflammatory state with an increase in the release of proinflammatory cytokines. [40, 38, 39, 41, 42]


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