Palabras clave
Enfermedades Cardiovasculares
Terapéutica
Cómo citar
Copyright © | Todos los derechos reservados.
La revista posee los derechos de autor exclusivos para la publicación de este artículo en los términos de la ley brasileña 9610/98.
Reproducción parcial
El uso de partes de los textos, figuras y cuestionario del artículo es libre, siendo obligatoria la citación de los autores y revista.
Reproducción total
Está expresamente prohibido y debe ser autorizado por la revista.
Resumen
Objetivo: Describir la relación entre la apnea obstructiva del sueño (AOS) y el desarrollo de enfermedades cardiovasculares (ECV), enfatizando los mecanismos fisiopatológicos y las estrategias terapéuticas. Métodos: Revisión integradora realizada en las bases PubMed/MEDLINE, LILACS, SciELO, Embase y Scopus, utilizando los descriptores “Obstructive Sleep Apnea”, “Cardiovascular Diseases”, “Pathophysiology” y “Treatment”, combinados con el operador booleano “AND”. Se incluyeron artículos originales publicados entre 2017 y 2025, en portugués, inglés o español, con texto completo disponible. La selección de los estudios se realizó con apoyo del software Rayyan. Resultados: Se incluyeron trece estudios. La AOS se asoció con hipoxia intermitente, estrés oxidativo, inflamación sistémica, disfunción endotelial y activación simpática, contribuyendo a hipertensión arterial, fibrilación auricular e insuficiencia cardíaca. Factores como obesidad, edad y comorbilidades cardiovasculares modularon la expresión fisiopatológica y la respuesta terapéutica. El CPAP mostró beneficios principalmente en desenlaces intermedios, limitados por la baja adherencia. Estrategias alternativas presentaron resultados prometedores, aún sin confirmación en desenlaces cardiovasculares mayores. Consideraciones finales: La AOS constituye un factor de riesgo relevante para las ECV, y la individualización terapéutica puede reducir complicaciones cardiovasculares.
Referencias
ALDOSSARY M. Obstructive sleep apnea and cardiovascular complications: an updated review. Journal of Family & Community Medicine, 2020; 27(2): 103-112.
ALTERKI A, et al. Investigating the relationship between obstructive sleep apnoea, inflammation and cardio-metabolic diseases. International Journal of Molecular Sciences, 2023; 24(7): 6807.
ANDRÉ S, et al. Predictors of cardiovascular impact in patients with obstructive sleep apnea: an observational cohort. Sleep and Breathing, 2020; 24(4): 1687-1695.
BENJAFIELD AV, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet Respiratory Medicine, 2019; 7(8): 687-698.
CEDERBERG J, et al. Obstructive sleep apnea and subclinical vascular dysfunction: a cross-sectional analysis. Journal of Sleep Research, 2022; 31(6): e13755.
DANTAS AB, et al. Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression. Sleep and Breathing, 2023; 27(6): 2083-2109.
DIELTJENS M, et al. Cardiovascular effects of mandibular advancement device therapy in obstructive sleep apnea: a randomized controlled crossover trial. Chest, 2022; 162(3): 567-578.
ECKERT DJ, et al. Defining phenotypic causes of obstructive sleep apnea: identification of novel therapeutic targets. American Journal of Respiratory and Critical Care Medicine, 2013; 188(8): 996-1004.
GIOVANA M, et al. Comparison of mandibular advancement device and CPAP on cardiovascular and quality-of-life outcomes in obstructive sleep apnea. Journal of Clinical Sleep Medicine, 2024; 20(3): 325-334.
GOTTLIEB DJ. Sleep apnea and cardiovascular disease. Current Diabetes Reports, 2021; 21(12): 64.
HARAŃCZYK J, et al. Effect of CPAP adherence on endothelial function markers in patients with obstructive sleep apnea: a prospective cohort study. Polish Archives of Internal Medicine, 2021; 131(6): 481-488.
ISHAK A, et al. Obstructive sleep apnea and early markers of cardiac remodeling: a prospective cohort study. Sleep Medicine, 2025; 124: 45-53.
JAVAHERI S, et al. Interactions of obstructive sleep apnea with the pathophysiology of cardiovascular disease. Part 1: JACC state-of-the-art review. Journal of the American College of Cardiology, 2024; 84(13): 1208-1223.
JAVAHERI S, et al. Treatment of OSA and its impact on cardiovascular disease. Part 2: JACC state-of-the-art review. Journal of the American College of Cardiology, 2024; 84(13): 1224-1240.
KALHOUS S. Surgical treatment of obstructive sleep apnea and its impact on nocturnal blood pressure: a cohort analysis. Sleep and Breathing, 2022; 26(2): 765-773.
LAKADAMYALI H, et al. Impact of obstructive sleep apnea severity on myocardial strain parameters: an echocardiographic evaluation. Sleep and Breathing, 2018; 22(4): 1103-1110.
LEE C, et al. Long-term adherence to positive airway pressure therapy and cardiovascular outcomes in patients with obstructive sleep apnea: a cohort study. Chest, 2024; 165(5): 1120-1130.
MANIACI A, et al. Obstructive sleep apnea and cardiovascular risk: a comprehensive review of mechanisms and management strategies. Life, 2024; 14(2): 210.
McNICHOLAS WT. Obstructive sleep apnoea: focus on pathophysiology. Advances in Experimental Medicine and Biology, 2022; 1384: 31-42.
McNICHOLAS WT, PEVERNAGIE D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. Journal of Sleep Research, 2022; 31(4): e13616.
MELIANTE PG, et al. Molecular pathology, oxidative stress, and biomarkers in obstructive sleep apnea. International Journal of Molecular Sciences, 2023; 24(6): 5478.
MILLS A, et al. Obstructive sleep apnea: cardiovascular mechanisms and therapeutic implications. Frontiers in Cardiovascular Medicine, 2023; 10: 1165873.
MINAMI T, et al. Obstructive sleep apnea increases recurrence of atrial fibrillation after catheter ablation: a multicenter cohort study. Journal of the American College of Cardiology, 2025; 75(10): 1124-1134.
MOHAMED S, et al. Obstructive sleep apnea and cardiovascular disease: pathophysiological links and therapeutic implications. Journal of Clinical Medicine, 2023; 12(14): 4567.
MONNERET D, et al. Pathophysiological pathways linking obstructive sleep apnea to cardiometabolic diseases. Metabolism: Clinical and Experimental, 2019; 99: 153944.
REDLINE S, et al. Obstructive sleep apnoea heterogeneity and cardiovascular disease. Nature Reviews Cardiology, 2023; 20(8): 560-573.
SLOWIK JM, et al. Obstructive sleep apnea. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025.
SUBRAMANI Y, et al. Understanding phenotypes of obstructive sleep apnea: applications in anesthesia, surgery, and perioperative medicine. Anesthesia & Analgesia, 2017; 124(1): 179-191.
SUMMERER L, et al. Severe obstructive sleep apnea and coronary collateral circulation in patients with acute myocardial infarction. Sleep and Breathing, 2021; 25(4): 1939-1947.
TAVARES SM, et al. Cardiovascular consequences of obstructive sleep apnea: an integrative review. Revista Portuguesa de Cardiologia, 2021; 40(9): 679-688.
TUFIK S, et al. Obstructive sleep apnea syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Medicine, 2010; 11(5): 441-446.
WANG Y, et al. Continuous positive airway pressure improves arterial stiffness and inflammatory markers in patients with coronary artery disease and obstructive sleep apnea: a randomized controlled trial. Sleep Medicine, 2025; 120: 123-131.
XIE J, et al. Dapagliflozin reduces sleep apnea severity and improves cardiac function in patients with heart failure and obstructive sleep apnea: a randomized clinical trial. European Heart Journal, 2024; 45(7): 987-996.
YEGHIAZARIANS Y, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 2021; 144(3): e56-e67.