Nonrestorative Sleep, Sleep Apnea, and Major Adverse Cardiac and Cerebrovascular Events

Nonrestorative sleep — the experience of waking unrefreshed despite apparently adequate sleep duration — is one of the more reliably under-investigated complaints in primary care. It is also one of the more reliably present.

The cardiovascular evidence has shifted in the last decade. Where the conversation used to centre on apnea-hypopnea index as the primary risk signal, more recent work has implicated sleep fragmentation, sympathetic activation, and oxygen desaturation independently of formal OSA thresholds.

The practical implication for the dental-sleep clinician is that a normal home sleep test does not rule out sleep-driven cardiovascular risk. Patients who report habitual unrefreshing sleep, daytime somnolence, or witnessed snoring with normal AHI deserve more than reassurance — they deserve a second look.