ABSTRACT
I. Introduction There is now evidence that obstructive sleep apnea (OSA) is associated with increased risk of myocardial infarction and stroke, independent of confounding factors (1-3). Atherosclerosis is a common pathological factor underlying all types of cardiovascular diseases and is the leading cause of coronary heart disease, stroke, and peripheral vascular disease (4). Therefore, atherosclerosis is an attractive intermediate mechanism to explain the link between OSA and cardiovascular morbidity and mortality (5). The mechanisms whereby OSA may contribute to atherosclerosis, however, are under investigation and not completely understood. Patients with OSA frequently present with one or several features of metabolic syndrome, including hypertension, central obesity, insulin resistance, and dyslipidemia. These are well-known risk factors for atherosclerosis (5). This observation raises the question of whether OSA is simply a marker that clusters with previously recognized and well-established risk factors for atherosclerosis. In this chapter, we shall explore the evidence that OSA is not simply an innocent bystander but may directly contribute to atherosclerosis.
