Evaluation of association between obstructive sleep apnea and coronary risk scores predicted by tomographic coronary calcium scoring in asymptomatic patients

Abstract

ÖZETAmaç: Obstrüktif uyku apnesi sendromu (OSA) solunumla ilgili uyku bozuklukları içinde incelenen ve vücuttaki birçok sistemi ilgilendiren önemli bir sağlık sorunudur. Koroner arter hastalığı için asemptomatik olup, OSA varlığından şüphe edilen hastalar kullanılarak yapılan bu kesitsel gözlem çalışması, obstrüktif uyku apnesi sendromu ile koroner ateroskleroz varlığı ve yaygınlığı arasındaki ilişkiyi doğrudan araştırmak için planlanmıştır. Yöntemler: Çeşitli nedenler ile uyku laboratuvarında uyku testi yapılan 97 hastaya (yaş: 49.17±0.86) tomografik koroner kalsiyum skorlaması tetkiki yapıldı. Tüm hastaların kardiyovasküler risk faktörleri, kullanmakta oldukları ilaçlar ile uyku testi sonuçları kaydedildi. Hastalar uyku testinde saptanan apne-hipopne indeksleri (AHİ) kullanılarak obstrüktif uyku apnesi şiddetine göre 4 gruba ayrıldı. Değişkenler arasında ilişkile-rin değerlendirilmesinde lineer ve lojistik regresyon analizleri kullanıldı. Bulgular: Gruplar arasında basit horlama grubundan ağır OUAS grubuna gidildikçe tomografik koroner kalsiyum skorlaması ile öngörülen kardiyovasküler risk skorlarının doğrusal olarak anlamlı derecede arttığı görüldü (p=0.046). Hastalar cinsiyete göre ayrıldıklarında, AHİ ve uyku ABSTRACT Objective: This cross-sectional observational study is designed to evaluate direct effects of obstructive sleep apnea syndrome (OSA) on presence and extent of coronary atherosclerosis by using tomographic coronary calcification scoring on a population asymptomatic for coronary artery disease. Methods: Ninety-seven consecutive patients (49.17±0.86 years) who were evaluated with sleep study for the suspicion of obstructive sleep apnea syndrome underwent tomographic coronary calcium scoring test. Cardiovascular risk factors, current medications and sleep study recordings of all patients were recorded. Patients were classified into 4 groups according to the apnea-hypopnea index (AHI). Linear and logistic regression analyses were used for assessment of association between variables. Results: Coronary risk scores of patients, assessed by tomographic coronary calcium scoring, were observed to increase linearly from simple snoring group to severe OSA groups (p=0.046). When patients were classified according to their gender, AHI and parameters reflecting severity of OSA-related hypoxia were found to correlate significantly with coronary risk scores of women but not with scores of men. Linear regression analysis revealed age as the only independent associated variable with cardiovascular risk scores assessed by tomographic coronary calcification scoring (Beta coefficient: 0.27, 95% CI 0.007-0.087, p=0.018). Binary logistic regression analysis also revealed age as the only variable which independently predicted the presence of coronary calcification (OR:1.11, 95% CI 1.039-1.188, p=0.002). Conclusion: These results suggest that presence of OSA may contribute to coronary artery disease risk of patients in association with its severity; however, association between OSA and subclinical atherosclerosis seems ...

Galectin-3 is associated with coronary plaque burden and obstructive sleep apnoea syndrome severity

“…Galectin-3 and age were independent predictors of coronary atherosclerosis in OSAS patients. Furthermore, the presence and total number of coronary plaques and AHI score were found to be higher in the OSAS group than in the controls and in the severe OSAS group compared to the moderate and mild OSAS groups, which is consistent with previous studies [16][17][18][19][20]. Galectin-3 plays a pivotal role in the development of fibrosis and tissue remodelling in kidney and heart [6].…”

“…In addition, age was found to be a significant predictor of the presence of coronary calcification in this setting. These analyses suggest that the presence of OSAS may contribute to CAD risk of patients in association with its severity; however, association between OSAS and subclinical atherosclerosis seemed to be primarily dependent on age [20]. In our study, we investigated the relation between galectin-3 concentration and coronary atherosclerosis indicated by the presence and burden of coronary plaque detected by CCTA in patients (3) galectin-3 concentrations correlated with the total number of coronary plaques; and (4) galectin-3 and age were independent significant predictors of coronary atherosclerosis in with OSAS.…”

“…The association between OSAS and atherosclerosis has been investigated in many recent studies [16][17][18][19][20]. Kwon et al [16] reported a relation between OSAS and coronary calcium score (CCS) progression after adjustment for demographics, behaviours, and body mass index.…”

“…Age and AHI were also found to be independent predictors of CCS in OSAS [19]. Kepez et al [20] investigated the direct effects of OSAS on the presence and extent of coronary atherosclerosis by using tomographic CCS on a population asymptomatic for CAD, and it was found to be higher in the severe OSAS group compared to the other OSAS groups. In addition, age was found to be a significant predictor of the presence of coronary calcification in this setting.…”

Advanced age and apnea-hypopnea index predict subclinical atherosclerosis in patients with obstructive sleep apnea syndrome

“…To confirm this study, our results showed that the risk of subclinical atherosclerosis was increasing with a sensitivity of 77.8% when AHI > 16 which is an indicator of moderate-to-severe OSAS. Besides, Kepez et al observed that the relationship between the severity of OSAS and the increase in cardiovascular risk was dependent only on the age of patients [23]. On the contrary, our results demonstrate that the level of AHI and advanced age are independently associated with the development of CAC.…”