Sindrome delle apnee ostruttive del sonno e rischio cardiovascolare

The obstructive sleep apnoea syndrome (OSAS) is a very common condition characterized by repeated alternation of episodes of apnoea and hypopnea during night, heavy snoring, sleep fragmentation and increased daytime sleepiness. Patients with OSAS experience recurrent episodes of cessation of breathing which expose the cardiovascular system to cycles of hypoxia, exaggerated negative intrathoracic pressure and arousals. The diagnosis of OSAS has important clinical and social implications, as the result of the impact on quality of life, the risk of traffic accidents and the strong association with cardiovascular disease. In patients with OSAS there are often conditions of high cardiovascular risk, such as hypertension, endothelial dysfunction, chronic low-grade inflammation, oxidative stress, dyslipidemia and insulin resistance. The cardiovascular risk is even higher when OSAS is associated with the metabolic syndrome. In milder forms, the main therapeutic objective is the reduction of body weight, which is able to improve the overall clinical picture. In more severe forms, there is an indication for positive airway pressure therapy (CPAP) which is able to correct oxygen desaturation and, consequently, to control the clinical and metabolic alterations and reduce cardiovascular risk. Major problems arise from the large number of undiagnosed OSA and low adherence to long term treatment with the CPAP.