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Cardio Diabetes Medicine 2017 217

The pathogenesis of OSAS-related consequences in patients with OSAS.
is assumed to be chronic intermittent hypoxia (IH) Pusuroglu et al [26] have shown that Galectin-3 is
inducing alterations at the molecular level, oxidative associated with coronary plaque burden & OSAS se-
stress, persistent systemic inflammation, oxygen verity. Galectin-3 is a chemical that plays an import-
sensor activation and increase sympathetic activity ant role in the regulation of inflammation, develop-
[19].
ment of cardiac fibrosis and remodeling. The mean
New research is coming to fore about the mecha- Galectin-3 level was significantly higher with OSAS
nisms and effects of OSAS: patients compared to controls.
There has been a meta-analysis of OSAS on cardio-
Pathophysiology vascular events after percutaneous coronary inter-
May et al [20] looked at the mechanistic insights at vention [27], which revealed that OSAS could inde-
the production of cardiac arrhythmogenesis in OSAS. pendently increase the risk of cardiovascular events.
Abnormal sympathetic and parasympathetic fluctu- There have been many other studies on OSAS and its
ations, intermittent hypoxia and hypercapnia and association with the cardiovascular system:
structural changes such as ventricular hypertrophy
and fibrosis all play a part in the generation of car- - OSAS was common in peripheral arterial disease
diac arrhythmia. (PAD ) and the OSAS severity correlated with PAD
severity [28]
An et al [21] has strong evidence that microR-
NA-130a (miR-130A) may be involved in the progres- - OSAS is associated with increased readmission
sion of OSAS-associated pulmonary hypertension by in heart failure [29]. Sommerfield et al looked at
down-regulating the GAX gene. 344 patient encounters and found that heart fail-
ure patients with OSAS have an elevated rate of
Chen et al [22] concluded that the Oestrogen/ERR-al-
phaa signaling axis is associated with fiber-type readmission compare to the general heart failure
conversion of upper airway muscles in patients with population.
OSAS. This finding may represent an interesting ther- - Effects of OSAS on the response to hypertension
apeutic target , especially in postmenopausal women. therapy [30] . Because of the sympathetic over-
activity in OSAS, Beta1 blocker therapy may be
According to Chen et.al [23] there is an apparent required in these patients with resistant hyperten-
correlation between systemic inflammation and cere- sion.
bral perfusion in OSAS because of haemodynamic
alterations. [23] - Stroke and other cardiovascular events are more
common in patients with OSAS [31]. In this study,
Cardio Metabolic Complications 1100 individuals were studied and it was found
Epidemiological studies have documented the host that cardiovascular events were significantly high-
of cardiometabolic effects of OSAS including arterial er with increasing OSAS severity and untreated
and/or pulmonary hypertension, arrhythmias, isch- OSAS patients had more cardiac events
aemic heart disease, diabetes mellitus and metabolic - Occurrence of OSAS in patients with TIA [32].
syndrome. Over the past few years there have been It was found that there was a significant higher
many new findings about the effects of OSAS on the occurrence of OSAS in TIA patients compared to
cardiometabolic system. patients without a vascular diagnosis.
Ruchala et al [24] suggests that bony and endo- - The Pulmonary Artery Stiffness in patients with
crine abnormalities that occur in OSAS lead to seri- OSAS was evaluated in 52 patients. [33] . It was
ous consequences. The sex hormones, aldosterone, found that the elastic properties of the pulmonary
insulin, prolactin and corticosteroids, are all affected artery deteriorate with severity of OSAS and may
in OSAS. be responsible for right ventricular dysfunction in
There is also some evidence of haematological mark- OSAS.
ers as predictors of cardiovascular disease in OSAS, - Sommer field et al [34] showed that heart failure
according to Saygin et al [25] . In a study containing patients with OSAS have an elevated rate of read-
142 patients, it was found that red cell distribution mission particularly within the first 90 days after
width (RDW), could be used with other markers, espe- discharge.
cially other markers platelet count and platelet distri-
bution width, in prediction of cardiovascular disease

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