Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review

Martin R. Cowie, Dominik Linz, Susan Redline, Virend K. Somers, Anita K. Simonds

Research output: Contribution to journalReview articlepeer-review


Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.

Original languageEnglish (US)
Pages (from-to)608-624
Number of pages17
JournalJournal of the American College of Cardiology
Issue number6
StatePublished - Aug 10 2021


  • cardiovascular disease
  • diagnosis
  • prognosis
  • sleep apnea
  • treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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