Apneia obstrutiva do sono e sua relação com doenças cardiovasculares: mecanismos fisiopatológicos e estratégias de tratamento

Abstract

Objective: To analyze the association between obstructive sleep apnea (OSA) and cardiovascular diseases (CVD), addressing the main pathophysiological mechanisms involved and the therapeutic possibilities described in the scientific literature. Methods: This is an integrative literature review conducted through searches in the PubMed/MEDLINE, LILACS, SciELO, Embase, and Scopus databases. The descriptors “Obstructive Sleep Apnea,” “Cardiovascular Diseases,” “Pathophysiology,” and “Treatment” were combined using the Boolean operator “AND.” Original articles published between 2018 and 2025 in Portuguese, English, and Spanish, available in full text and directly related to the proposed theme, were included. Study screening and selection were performed using the Rayyan software. Results: Thirteen studies composed the final sample. Evidence demonstrated that OSA is closely associated with mechanisms such as intermittent hypoxia, oxidative stress, systemic inflammation, endothelial dysfunction, and sympathetic hyperactivity, alterations that contribute to the development and worsening of cardiovascular diseases, especially hypertension, atrial fibrillation, and heart failure. Clinical and demographic factors, including obesity, aging, and cardiovascular comorbidities, also influenced both the pathophysiological expression of the disease and the response to treatment. Continuous positive airway pressure (CPAP) therapy showed relevant benefits mainly in intermediate and physiological outcomes, although its clinical effectiveness is often limited by poor patient adherence. Other therapeutic approaches, including mandibular advancement devices, upper airway surgeries, and dapagliflozin, demonstrated promising results but still lack robust evidence regarding their impact on major cardiovascular outcomes. Conclusion: Obstructive sleep apnea represents an important cardiovascular risk factor, making early diagnosis and individualized management essential. Despite therapeutic advances, important gaps remain regarding the impact of interventions on major cardiovascular clinical events.