The Clinical Advantage

Obstructive sleep apnea (OSA) has been the engine that has driven the remarkable growth of the sleep field over the last 25 years. Although the medical community and the general public have been interested in the performance and quality-of-life problems that result from sleep apnea, the real concern has been the potential relationship between OSA and the cardiovascular system. This goes back as far as the book “The Sleep Apnea Syndromes” (published in 1978 and edited by Christian Guilleminault and Bill Dement) which contained the proceedings of the Kroc Foundation meeting organized to discuss the newly identified disorder, OSA. In that book, the possibility that sleep apnea might lead to adverse cardiovascular events was raised as a real possibility. Since that time, the sleep research community has steadily toiled to determine if such a relationship actually exists using both clinical and basic science approaches. However, this question has not been answered to the satisfaction of many clinicians and scientists. That obstructive apnea can contribute to the development of systemic hypertension seems relatively clear despite the fact that treatment of the OSA does not always lead to improvements in blood pressure even in hypertensive patients. Whether sleep apnea leads to hard end point adverse events such as myocardial infarctions, strokes, or the development of congestive heart failure is still the subject of considerable debate.