Carotid intima-media thickness is not associated with homocysteine and vitamin D levels in obstructive sleep apnea

Abstract

Obstructive sleep apnea syndrome (OSA) is associated with increased vascular morbidity. Accelerated atherosclerosis might be one of the most important mechanisms linking OSA with the development of vascular disorders. Homocysteine (HCY) and vitamin D has been associated with atherogenesis. The aim of this study was to assess a possible association between the levels of HCY and vitamin D and the carotid intima-media thickness (cIMT), which is a known marker for subclinical atherosclerosis in patients with OSA. We prospectively enrolled 110 patients with the history of snoring, who underwent standard overnight polysomnography. Clinical characteristics of the population were recorded on admission and blood samples were obtained in the fasting condition following morning. Extracranial cIMT measurements were performed according to the standardized scanning protocol. A significant correlation was found between cIMT and apnea-hypopnea index (r = .276, p = .006), age (r = .486, p < .001), diabetes mellitus (r = .377, p < .001), coronary artery disease (r = .274, p = .006) and history of stroke (r = .251, p = .012). We failed to find any significant correlation between cIMT and the levels of HCY (r = .036, p = .724) or vitamin D (r = .027, p = .800). In conclusion, our data suggest that the association of cIMT with the severity of OSA can be influenced by multiple metabolic consequences of OSA including traditional and non-traditional risk factors. HCY and vitamin D do not seem to play a superior role in this process.

The impact of sleep apnea syndrome on the altered lipid metabolism and the redox balance

“…Measurement of subclinical atherosclerosis (e.g. thickness of carotid intima-media, endothelial dysfuntion) could be also beneficial to exclude subjects with the pre-existing atherosclerotic process [ 47 , 48 ]. It could also elucidate links between the redox imbalance, lipoprotein abnormalities and subclinical atherosclerosis in OSA subjects.…”

Serum Vitamin D Level and Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis of Observational Studies and Randomized Control Trials

“…Main summary of the characteristics of the included studies are described in ▶ Tables 1-3. A total of 22 studies published from 2006 to 2017 covering a total of 7332 human participants, from studies in different countries (Korea [15], Italy [16][17][18][19][20], Sweden [21], China [22][23][24][25][26][27], USA [28,29], Egypt [30], Scandinavian [31], Turkey [1], Iran [7,32], Bulgaria [33], and UK [34]) with age ranging from 18 to 75 years, were identified in this meta-analysis. Most of the participants were women.…”

“…Most of the participants were women. Of the 22 publications, 19 were population-based observational studies including 4 prospective studies [18,31,33,34], 8 cross-sectional studies [15-17, 19, 23, 24, 26, 27] and 7 case control studies [20-22, 25, 28-30] and 3 studies were randomized placebo-controlled trials (RCTs) [1,7,32]. Overall, three randomized clinical trials comprising 99 patients including premenopausal women [1], overweight type 2 diabetic patients with CHD [7], and metabolic syndrome [32] Also, all of the trials studies were considered to be of higher quality.…”

“…There were 17 studies reported the mean serum level of vitamin D and correlation coefficients between association serum vitamin D level and CIMT. Participants were outpatients who underwent eco-Doppler examination of the extra cranial carotid tract [17], pa-tients with mild primary hyperparathyroidism (PHPT) without any known cardiovascular risk factors [21], patients with type 2 diabetes [16,23,27,30], adults with hypertension [29], high-risk cardiac patients [25], patients with obstructive sleep apnea syndrome (OSA) [31], subjects with high cardiovascular risk [34], middle-aged and elderly men [24], postmenopausal women [22,26], post-menopausal women with Sjogren's syndrome [20], adults with growth hormone deficiency [33], subjects with pre-diabetes [19], patients with Behcet's disease [18] and patients with subclinical carotid atherosclerosis [34]. Forest plot displaying the effect of vitamin D supplementation on CIMT is shown in ▶ Fig.…”

The role of vitamin D in obstructive sleep apnoea syndrome

“…The main results of the studies examining the relationship between serum levels of vitamin D and OSAS are presented in table 1. Several works failed to demonstrate a relationship between serum vitamin D levels and OSAS severity [28, 29]. In a cross-sectional study of 181 patients, who underwent polysomnography and were stratified according to OSAS severity [30], mean vitamin D levels were 15.5±11.6 ng⋅mL −1 (95% CI: 13–17).…”