Cardiometabolic comorbidities in obstructive sleep apnea patients are related to disease severity, nocturnal hypoxemia, and decreased sleep quality

Abstract

Background: Obstructive sleep apnea syndrome (OSA) is currently recognized as an independent risk factor for hypertension, arrhythmia, coronary heart disease, stroke, and metabolic disorders (e.g. diabetes, dyslipidemia). In clinical practice, apnea-hypopnea index (AHI) is the marker used to classify disease severity and guide treatment. However, AHI alone does not sufficiently identify OSA patients at risk for cardiometabolic comorbidities. With this in mind, the aim of this retrospective study was to determine whether some polysomnographic parameters (e.g. apnea-hypopnea duration, sleep structure, nocturnal hypoxemia) are specifically associated with cardiometabolic comorbidities in OSA. Methods: In this retrospective study, 1717 patients suffering from moderate/severe OSA were included between 2013 and 2017. Data on demographics, comorbidities, and polysomnographic characteristics were collected and analyzed to identify factors associated with cardiometabolic complications. Results: The medical files of 1717 patients (68% male) were reviewed. The mean AHI was 43.1 +/− 27.7 with 57.3% of patients suffering from severe OSA, and 52% from at least one cardiovascular comorbidity (CVCo). Diabetes affected 22% of the patients and 27% exhibited dyslipidemia. Patients affected by CVCos were older, and more often women and non-smokers. These patients also had worse sleep quality, and a more marked intermittent/ global nocturnal hypoxemia. With regard to diabetes, diabetics were older, more often non-smoker, non-drinker women, and were more obese. These patients also exhibited more severe OSA, especially in non-REM (NREM) sleep, worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. Dyslipidemia was more frequent in the absence of alcohol consumption, and was associated with OSA severity, decreased sleep quality, and longer AH in REM sleep. Conclusions: This study identifies demographic and polysomnographic factors associated with cardiometabolic comorbidities. Patients (especially women) suffering from more severe OSA, longer sleep apneas and hypopneas, worse sleep quality, and marked intermittent/global nocturnal hypoxemia are more likely to develop cardiometabolic comorbidities. This should stimulate clinicians to obtain adequate treatment in this population.

miR-3574 ameliorates intermittent hypoxia-induced cardiomyocyte injury through inhibiting Axin1

“…There is increased recognition that OSA, characterized by intermittent hypoxia (IH), is deemed as a risk factor for the development of many cardiovascular diseases such as hypertension [ 4 ], myocardial ischemia [ 6 ], heart failure [ 7 ], atherosclerosis [ 17 ], and coronary artery disease [ 18 ]. The IH leads to a number of potential adverse consequences, including activation of inflammation [ 19 ], insulin resistance [ 20 ], oxidative stress [ 21 ], sympathetic activation [ 22 ], and endothelial dysfunction [ 23 ].…”

“…Intermittent hypoxia (IH) is the hallmark feature of OSA, which is likely to be the underlying cause for OSA-related comorbidities [ 2 , 3 ]. Meanwhile, it is noteworthy that OSA is an independent risk for cardiovascular diseases, such as systemic arterial hypertension [ 4 ], atrial fibrillation [ 5 ], ischemic heart disease [ 6 ], metabolic disorders [ 4 ], and congestive heart failure [ 7 ]. Therefore, the understanding of the molecular mechanisms of OSA-related cardiovascular diseases and development of novel therapeutic strategies for such patients are urgently required.…”

Participation in physical activity is associated with reduced nocturnal hypoxaemia in males

“…A novel finding of this study was the significant association between increasing the amount of time undertaking MVPA between baseline and 2010 and shorter mean duration of apnoeas, along with the nonsignificant association with shorter mean duration of hypopnoeas. This is clinically important, as longer duration of apnoeas and hypopnoeas are associated with increased prevalence and severity of hypertension [ 25 – 27 ], and increased prevalence of cardiovascular disease [ 28 ]. The reductions in apnoea duration, but not hypopnoea duration, may provide a mechanism as to why increased MVPA over time may improve hypoxaemia.…”

Ultrasound techniques in the diagnosis of vascular structural changes and blood flow velocity in patients with obstructive sleep apnea

“…Современными исследованиями установлена связь ОАС с такими заболеваниями как артериальная гипертензия, атеросклероз, нарушения сердечного ритма и проводимости, метаболические расстройства, инсульт, инфаркт миокарда и др. [9][10][11][12][13]. Вместе с тем, механизмы, лежащие в основе формирования патологических изменений со стороны сердечно-сосудистой системы у пациентов с ОАС, остаются до конца неясными, что обусловливает необходимость дальнейшего изучения этой проблемы.…”

“…Кроме того, основным фактором, влияющим на КИМ СА, была продолжительность гипоксии во время общего сна. Эти результаты позволили предположить, что связанная с ОАС гипоксия и системное ремоделирование сосудов могут быть обусловлены прогрессированием атеросклероза и, следовательно, могут увеличивать кардиометаболический риск у пациентов с нарушениями дыхания во время сна [12,34].…”