Cardiovascular consequences of sleep disturbances

Growing evidence is showing important health impacts of sleep disruption. Sleep restriction is becoming increasingly common in today’s 24/7 society. Evidence from epidemiological studies suggest that reduced sleep duration is associated with important health impacts such as obesity, diabetes, myocardial infarction and mortality. Mechanistic research is underway to define the important causal pathways. Obstructive sleep apnea is a common disorder with major cardiovascular sequelae. Repetitive upper airway collapse accompanied by hypoxemia and hypercapnia plus catecholamine surges and swings in intrathoracic pressure all contribute to the deleterious effects on cardiac function. At present the data are less compelling that treatment of sleep apnea prevents heart attack or stroke, although large scale trials are ongoing. Patients with heart failure commonly experience sleep disordered breathing in the form of either obstructive or central apnea. Randomized trials are ongoing to define the optimal therapy for these individuals beyond maximization of medical therapy. Through onoing research, new therapeutic targets/strategies are likely to emerge which will help to minimize the impact of sleep disturbance on afflicted patients.