The Relationship Between Obstructive Sleep Apnea, Hypopnea and Cardiovascular Disease

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of complete or partial upper airway obstruction during sleep, resulting in intermittent hypoxia, sleep fragmentation, and marked fluctuations in intrathoracic pressure. Increasing evidence has established OSA and hypopnea as significant contributors to cardiovascular morbidity and mortality, with their effects extending beyond respiratory dysfunction to influence multiple physiological systems. The repetitive cycles of oxygen desaturation and reoxygenation initiate oxidative stress, systemic inflammation, endothelial dysfunction, autonomic imbalance, and metabolic disturbances, creating a favorable environment for the development and progression of cardiovascular disease. These mechanisms are closely associated with hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, and other adverse cardiovascular outcomes. The severity of sleep-disordered breathing, commonly assessed using the apnea-hypopnea index, correlates with increasing cardiovascular risk, although recent evidence suggests that measures of hypoxic burden may provide a more accurate assessment of disease impact. Continuous positive airway pressure remains the primary treatment for moderate-to-severe OSA and has consistently demonstrated improvements in symptoms, blood pressure control, endothelial function, and overall quality of life. Cardiovascular benefits are influenced by treatment adherence, disease severity, and the presence of coexisting cardiometabolic conditions, emphasizing the importance of individualized management strategies. Despite advances in diagnostic techniques and therapeutic interventions, OSA remains substantially underdiagnosed because of limited awareness, restricted access to polysomnography, shortages of sleep specialists, and socioeconomic barriers that disproportionately affect underserved populations. Home sleep apnea testing, validated screening questionnaires, and telemedicine have emerged as valuable approaches to improving diagnostic accessibility and facilitating earlier intervention. Recognition of the close relationship between OSA, hypopnea, and cardiovascular disease underscores the importance of integrating sleep health into cardiovascular risk assessment and long-term disease management. Strengthening screening programs, expanding access to diagnostic services, and promoting multidisciplinary collaboration have the potential to reduce cardiovascular complications and improve health outcomes among individuals affected by sleep-disordered breathing.