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Snoring

African-American ethnicity

Increased body mass index

Smoking

Increased neck circumference

Alcohol use

Increasing age

Menopause

Male gender

Andropause

indicate that individuals with OSA show increased platelet activity and aggregation, increased levels of fibrinogen and plasminogen activating factors, and a decrease in fibrinolytic functions.23 Endothelial dysfunction also has been demonstrated, causing reduced endothelial-dependent vasodilation, while nCPAP therapy has been shown to improve nitric oxide release from the endothelium, improving the systemic endothelium-dependent vasodilation response.24

Sleep apnea is a risk factor for abnormal glucose metabolism, insulin resistance, and type 2 diabetes.

Cardiac Arrhythmias

Rates of both bradycardia and tachycardia are increased in individuals with sleep apnea. A large study performed on individuals with sleep apnea found that 48% had arrhythmias during nocturnal sleep.25 In addition, it has been shown that there is a direct correlation between increased frequency of arrhythmias and an increasing number of apneic events as well as a higher degree of oxygen desaturation.26 While awake, few of these individuals have cardiac arrhythmias. Tracheostomy has reduced most of these arrhythmias.25 Other arrhythmias found more frequently in patients with sleep apnea include ventricular ectopy, ventricular tachycardia, premature ventricular contraction, atrioventricular block, and sinus arrest.27

Hypertension

Approximately 50% of individuals with OSA are also hypertensive, a correlation that also may be attributable to the effects of obesity on blood pressure (BP).28 Studies indicate that severity of OSA is directly correlated with severity of both sleep apnea and daytime hypertension.29 The increase in sympathetic activity caused by the induction of the fight-or-flight response is believed to be one contributing factor to the rise in BP. Treatment of OSA with nCPAP has been shown to decrease BP during both daytime and night-time hours.30

Strokes

OSA is an independent risk factor for the development of strokes or transient ischemic attacks.31 Studies show that patients with untreated OSA experience more strokes and have higher rates of stroke morbidity and mortality than do patients who are treated with nCPAP.32

Diabetes

Sleep apnea is a risk factor for abnormal glucose metabolism, insulin resistance, and type 2 diabetes.33,34 Treatment with nCPAP in individuals with OSA and type 2 diabetes has led to an increase in insulin sensitivity and a decrease in HbAlc levels.35

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) rates are increased in individuals with OSA. Studies show that the severity of GERD also increases with an increase in the AHI.36 In patients with OSA, treatment of GERD has been shown to decrease the number of arousals during sleep.37

Psychiatric Conditions

Studies on veterans with sleep apnea showed an increase in psychiatric conditions compared to controls. A significant increase was found in mood disorders, such as depression, anxiety, dementia, psychosis, and post-traumatic stress disorder.38 Studies indicate that treatment with nCPAP can reduce symptoms of depression.39

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