Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients. 1. Introduction Coronary artery disease (CAD) is a major health issue in developed countries and constitutes a significant cause of death and disability. The clinical spectrum of CAD ranges from stable angina pectoris to acute coronary syndromes (ACSs), a term which includes unstable angina (UA), non-ST elevation (non-Q wave) myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI) [1]. The primary pathologic process causing CAD is coronary atherosclerosis, which causes progressive coronary stenosis, provoking myocardial ischemia when myocardial oxygen demand exceeds oxygen supply, leading to angina pectoris. On the contrary, acute coronary syndromes are caused by the loss of integrity of the protective covering of some atherosclerotic plaques, leading to thrombus formation and subsequent vessel obstruction [2]. Despite the reduction in mortality rates that occurred in the past decades, it still affects 6.4% of adults in any of its forms and constitutes the cause of death of nearly 17% of adult population in the United States [3]. According to data from the Framingham Heart Study, a population-based longitudinal study, nearly one-half of males and one-third of females over 40 years of age will develop some manifestation of CAD [4]. OSA is a common disorder which has become an important public health problem, as it affects 2 to 7% of adults in the general population [5]. OSA is characterized by repetitive interruption of ventilation during sleep due to total collapse or narrowing of the pharyngeal airway despite breathing effort, resulting in a fall in oxygen saturation and arousal from sleep [6]. Repeated hypoxemia and arousals can lead to deleterious effects, ranging from daytime symptoms
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