This topic was reviewed in JACC. The full text is only available to subscribers but the audio summary is open access.
Here are a few points of interest:
Obstructive sleep apnea (OSA) is common in the general population.
Central sleep apnea (CSA) is largely confined to patients who already have cardiovascular disease, largely heart failure. It is particularly associated with heart failure with reduced ejection fraction. It is also associated with stroke and atrial fibrillation.
OSA is a cause of multiple cardiovascular disorders. CSA, though a result of certain cardiovascular disorders, can in turn contribute to further cardiovascular dysfunction, resulting in a vicious cycle of reciprocal cause and effect.
Although OSA is largely a disorder of obesity, in which fatty deposits in the upper airway are contributory, 20-30% of OSA is in non-obese individuals. In such cases upper airway dilator muscle dysfunction is believed to be at play.
Among the many consequences of sleep apnea are the metabolic effects of hypoxemia, increased sympathetic output, cytokine activation, endothelial dysfunction, insulin resistance, systemic and pulmonary hypertension and atrial fibrillation.
Treatment of OSA with CPAP ameliorates many of these, though treatment of CSA with positive pressure modalities has been disappointing and may be detrimental.