Metabolic OSA

A prevalent condition associated with poor health outcomes

Metabolic Obstructive sleep apnea (MOSA) is a condition associated with adverse cardiovascular events and poor health outcomes (1-3). The disease is characterized by repeated partial (“hypopnea”) or complete (“apnea”) obstruction of the upper airway during sleep which can result in varying effects that include oxygen desaturation, arousal from sleep, and excitation of the sympathetic nervous system as evidenced by surges in heart rate. Observational studies report a strong association between untreated OSA and incident cardiovascular disease and mortality (2-5). 

Most patients who seek treatment, do so for symptomatic relief of excessive sleepiness. However, approximately half of those with Obstructive sleep apnea in the general population do not report excessive sleepiness (6). In these asymptomatic patients, treatment has the potential to reduce the risk of cardiovascular disease.

Some MOSA patients without excessive sleepiness who experience a greater change in their pulse rate in response to respiratory events seem to be at an increased risk of poor cardiovascular outcomes (3).

Obstructive sleep apnea (OSA) is a prevalent condition (7). Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disturbances are common and underdiagnosed among middle-aged and older adults, and the prevalence varies by race/ethnicity, sex, and obesity status. OSA prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse cardiovascular outcomes, OSA is often underrecognized and undertreated in cardiovascular practice.


  1. Veasey SC et al., N Engl J Med. 2019; 380(15): 1442-9.
  2. Azarbarzin A et al., Eur Heart J. 2019; 40(14): 1149-57.
  3. Azarbarzin A et al., Am J Respir Crit Care Med. 2021.
  4. Campos-Rodriguez F et al., Ann Intern Med. 2012; 156(2): 115-22.
  5. Marin JM et al., Lancet. 2005; 365(9464): 1046-53.
  6. Kapur VK et al., Sleep. 2005; 28(4): 472-7.
  7. Benjafield AV et al., Lancet Respir Med. 2019; 7(8): 687-98.