Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery disease. 1. Introduction Obstructive sleep apnea (OSA) is a common medical condition characterized by abnormal collapse of the pharyngeal airway during sleep, causing repetitive arousals, and drops in the oxygen saturation. It is highly prevalent in the general population [1] and it acts as an independent risk factor for hypertension (HT) [2, 3]. In addition, several studies have suggested that OSA is associated with other cardiovascular diseases such as heart failure [4], arrhythmias [5], pulmonary hypertension [6], and coronary artery disease (CAD). Although mortality from CAD has fallen since 1975, it is still a major cause of death and disability in developed countries. The high prevalence of cardiovascular risk factors in the general population (diabetes mellitus, cigarette smoking, obesity, hypertension, and lack of regular physical activity) facilitates the development of atherosclerosis in coronary arteries and, subsequently, the presence of CAD. Although clinical guidelines for the management of CAD still do not consider OSA as a specific risk factor, results from the Sleep Heart Health Study have shown that OSA may increase the risk of CAD in middle-aged men with an apnea-hypopnea index (AHI) ≥ 30？h？1 [7]. 2. Association between Obstructive Sleep Apnea and Coronary Artery Disease Several cross-sectional and epidemiological studies have evaluated the
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