Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis

Drager, Luciano F.; Bortolotto, Luiz Aparecido; Krieger, E M; Lorenzi-Filho, Geraldo

doi:10.1161/hypertensionaha.108.119420

Cited by 141 publications

(92 citation statements)

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“…24 In adults, carotid markers of subclinical atherosclerosis are significantly higher in OSAS. 25 In our study, SDB was not associated with carotid IMT, a proxy of subclinical atherosclerosis. It is feasible that, in the pediatric age group, OSA, especially when associated with obesity, is able to elicit a low-grade inflammatory response, but, differently from adults, 26,27 it does not cause clear signs of carotid atherosclerosis.…”

Section: Association Between Sdb and Subclinical Atherosclerosis Markerscontrasting

confidence: 41%

C-Reactive Protein and Carotid Intima-Media Thickness in Children with Sleep Disordered Breathing

Licenziati

Michele

Verga

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: Obesity is a risk factor for sleep disordered breathing (SDB) in children. Plasma levels of high-sensitivity C-reactive protein (Hs-CRP) are predictive of cardiovascular morbidity in adults, and CRP levels are associated with overweight. Increased carotid intima-media thickness (IMT) is associated with several cardiovascular risk factors. We evaluated the effect of SDB on CRP levels and IMT in lean and obese children not selected for snoring. Methods: 101 children (age 5-15 years) attending a weight clinic or scheduled for routine visit. IMT was measured with quantitative B-mode ultrasound scans. The apnea-hypopnea index (AHI) was measured overnight: AHI < 1 defi ned controls, AHI ≥ 1 to < 5 = mild SDB, and AHI ≥ 5 = obstructive sleep apnea (OSA). Results: AHI was signifi cantly associated with Hs-CRP concentration (r = 0.32, p = 0.002) in all 101 children irrespective of age and sex. Body mass index (BMI) was higher in OSA children than controls (25.5 ± 7.0 vs 22.1 ± 6.9, p = 0.05). Obese children had 3.3 times more probability of having OSA (HR 3.3, 95% CI 1.2-9.3, p = 0.02) than lean children. Hs-CRP values were signifi cantly higher in children with OSA than in children without (p = 0.011), but not when BMI z-score was added as covariate. IMT was not associated with AHI or SDB. Conclusions:The results of this study suggest an association between OSA and Hs-CRP concentrations (mainly mediated by overweight and obesity), but not between OSA and subclinical atherosclerosis. There is scope for prevention in childhood before OSA syndrome causes the irreversible damage to arteries observed in adult patients.

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Section: Association Between Sdb and Subclinical Atherosclerosis Markerscontrasting

confidence: 41%

C-Reactive Protein and Carotid Intima-Media Thickness in Children with Sleep Disordered Breathing

Licenziati

Michele

Verga

et al. 2013

Journal of Clinical Sleep Medicine

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“…14) Furthermore, other cardiovascular disease risk factors such as diabetes, 15) inflammatory diseases, 16,17) and sleep apnea have been associated with thicker carotid IMT. 18) However, cardiovascular events are not determined only by increased carotid IMT, as 75% of thrombi in the carotid are caused by rupture, and 30% to 35% of coronary thrombi are caused by erosion. 19) The correlation between carotid IMT and future cardiac events remains modest at best, 20) but carotid atherosclerosis estimated by B-mode ultrasound is still a valuable predictor of myocardial infarction as a simple, noninvasive approach.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Takahashi¹,

Taguchi²,

Suzuki³

et al. 2012

Int. Heart J.

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SummarySince distinct cholesterol and triglyceride concentrations in major lipoproteins and their subclasses may be related to atherosclerosis, we investigated the relationship of cholesterol and triglyceride concentrations in lipoprotein subclasses and the severity of carotid intima-media thickness (IMT), a surrogate marker of subclinical atherosclerosis. We studied 116 apparently healthy Japanese men (53 ± 9 years) without a history of cardiovascular diseases who were not taking any medication. Carotid IMT was measured by means of high-resolution vascular ultrasound. Plasma cholesterol and triglyceride concentrations in major lipoproteins and their subclasses were determined by HPLC with gel permeation columns. By univariate analyses, carotid IMT was the most closely related to age (r = 0.528, P < 0.001), followed by smoking habit expressed as pack-year cigarette consumption (r = 0.409, P < 0.001). In addition to total cholesterol and LDL cholesterol, carotid IMT was significantly associated with cholesterol and triglyceride concentrations in several LDL and VLDL subclasses. Stepwise multiple linear regression analysis revealed that age (β = 0.436, P < 0.001), smoking (pack-years) (β = 0.225, P = 0.007), and large LDL cholesterol (β = 0.175, P = 0.023) were independent predictors of determining carotid IMT (adjusted R 2 = 0.347, P < 0.001). These results indicate that large LDL cholesterol is an important, independent determinant of carotid IMT in healthy men. (Int Heart J 2012; 53: 29-34) Key words: Intima-media thickness, Lipoprotein, Large low-density lipoprotein cholesterol, High-performance liquid chromatography, Carotid artery T he plasma lipid profile is the most important indicator of risk for cardiovascular disease and stroke. Several components have been proposed as atherogenic lipids and lipoproteins, including low-density lipoprotein (LDL) cholesterol, apolipoprotein B, non-high-density lipoprotein (HDL) cholesterol, triglycerides, and small dense LDL.1,2) Low HDL cholesterol concentrations have gained notice for potentially increasing risk and promoting the development of atherosclerosis. Among plasma lipids, LDL still accounts for the bulk of clinical attention for the prevention of cardiovascular diseases. 3)However, lipoproteins are a heterogeneous group of particles that differ in terms of their physicochemical properties and biological behaviors. Increasingly, attempts have been made to improve evaluation by considering particular subfractions of plasma lipids, in particular LDL and HDL subclasses of atherogenic lipids and lipoproteins. 4) Recently, high-performance liquid chromatography (HPLC) with a gel permeation column has been established as an alternative method for classifying and quantifying lipoproteins on the basis of differences in particle size. 5,6) Intima-media thickness (IMT) in the carotid arteries, measured with high-resolution ultrasonography, is currently the standard clinical marker and a quantitative measure of atherosclerosis; a graded, predictive relationship to over...

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“…10,11 Patients with OSA have been shown to have endothelial dysfunction 12e15 and evidence for premature atherosclerosis. 16 Current evidence suggests that inflammatory processes, oxidative stress and endothelial dysfunction may play roles in the pathogenesis of hypertension and vascular complications in OSA. 15 We have previously shown elevated concentrations of circulating soluble endoglin (sEng) and soluble fms-like tyrosine kinase-1 (sFlt-1) in hypertensive OSA compared to normotensive OSA.…”

Section: Introductionmentioning

confidence: 99%

Endothelial dysfunction and hypertension in obstructive sleep apnea – Is it due to intermittent hypoxia?

Jafari

Mohsenin

2013

Journal of Cardiovascular Disease Research

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a b s t r a c tBackground: Obstructive sleep apnea (OSA) is a prevalent disorder causing hypertension. Endothelial dysfunction appears to underlie development of hypertension. It is not known whether hypoxia during sleep is necessarily the prerequisite process for endothelial dysfunction and hypertension in OSA. We therefore examined the relationship between endothelial-dependent vasodilatory capacity, hypoxia and circulating angiogenesis inhibitors in OSA. Methods and results:We studies 95 subjects with and without OSA and hypertension. Endothelialdependent vasodilation was assessed using brachial artery flow-mediated vasodilation method (FMD). Plasma angiogenesis inhibitors, endoglin (sEng) and fms-like tyrosine kinase-1 (sFlt-1), were measured using ELISA. The apneaehypopnea indexes were 41 AE 5 and 48 AE 4 events/hr in normotensive OSA (N-OSA) and hypertensive OSA (H-OSA), respectively, indicating severe OSA. The sleep time spent with SaO 2 < 90% (T < 90%) were 34 AE 8 and 40 AE 9 min, respectively. FMD was markedly impaired in H-OSA (8.0% AE 0.5) compared to N-OSA (13.5% AE 0.5, P < 0.0001), H-non-OSA (10.5% AE 0.8, P < 0.01), and N-non-OSA (16.1% AE 1.0, P < 0.0001). There was no correlation between T < 90% and FMD. Both OSA groups had elevated levels of sFlt-1 (62.4 AE 5.9 and 63.9 AE 4.7 pg/ml) compared to N-non-OSA (32.1 AE 6.5, P ¼ 0.0008 and P ¼ 0.0004, respectively) and H-non-OSA (41.2 AE 7.0, P < 0.05 and P ¼ 0.03, respectively). In contrast, sEng was only elevated in H-OSA (4.20 AE 0.17 ng/ml) compared with N-OSA (3.64 AE 0.14, P ¼ 0.01) and N-non-OSA (3.48 AE 0.20, P ¼ 0.01). There was a modest but statistically significant inverse correlation between sEng and FMD in only H-OSA group (r ¼ À0.38, P < 0.05). Conclusion: These data show that patients with OSA and hypertension have marked impairment of FMD, independent of hypoxia exposure, which is associated with increased sEng.Copyright Ó 2013, SciBioIMed.Org, Published by Reed Elsevier India Pvt. Ltd. All rights reserved. Key MessagesObstructive sleep apnea is a highly prevalent disorder with associated high morbidity and mortality. Obstructive sleep apnea is now considered as one of the causes of systemic hypertension. No all patients with obstructive sleep apnea develop hypertension. There appears to be divergent responses to apnea-associated hypoxia. In this article a group of patients with severe obstructive sleep apnea and hypoxia exposure during sleep had normal blood pressure and relatively preserved endothelial-dependent vasodilatory capacity. A comparable group of patients with similar apnea severity and hypoxia exposure had marked impairment in endothelial-dependent vasodilatory capacity and hypertension. This group had significantly elevated circulating levels of soluble endoglin, an angiogenesis inhibitor, with known effect on endothelial function and development of hypertension. It is conceivable that inflammatory state of obstructive sleep apnea provokes release of angiogenesis inhibitors causing downstream perturbation of endothelial...

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Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis

Cited by 141 publications

References 50 publications

C-Reactive Protein and Carotid Intima-Media Thickness in Children with Sleep Disordered Breathing

C-Reactive Protein and Carotid Intima-Media Thickness in Children with Sleep Disordered Breathing

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Endothelial dysfunction and hypertension in obstructive sleep apnea – Is it due to intermittent hypoxia?

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