Expert Commentary
Obstructive sleep apnea syndrome is an important public health concern as it affects 2–4% of middle-aged adults. Recent years have noticed an increased awareness of this problem with an explosion of research publications in this field. The pathophysiological changes in OSA have been reported to be due to intermittent hypoxia, intermittent hypercapnia, oxidative stress, systemic inflammation, intrathoracic pressure changes, sympathetic activation, sleep fragmentation, metabolic dysregulation, endothelial dysfunction, hypercoagulation and neurohumoral changes. Important consequences of OSA are cardiovascular changes, such as systemic and pulmonary hypertension, cardiac arrhythmias, coronary artery disease, cardiac failure and stroke. Erectile dysfunction and occurrence of abdominal aortic aneurysms are other recently reported effects of OSA. Neurocognitive abnormalities observed have important personal and social consequences. The diagnosis of OSA is based on expensive polysomographic studies. A cost-effective diagnostic test is required to diagnose this condition in a large number of patients. CPAP treatment has been found to have beneficial effects in many of these consequences. However, longitudinal and interventional studies are required to establish a cause–effect relationship of OSA with many of the reported consequences of OSA and also to define the definite role of CPAP treatment in these situations. There is also a need to identify other modalities of treatment. Close interaction of basic, clinical and public health scientists are essential to unravel many of the unknown features of OSA to provide quality care to patients.
Expert Rev Resp Med. 2012;6(5):557-566. © 2012 Expert Reviews Ltd.
