Structural and functional arterial properties in patients with obstructive sleep apnoea syndrome and cardiovascular comorbidities

Abstract

The increased severity of obstructive sleep apnoea syndrome (OSAS) is associated with a parallel increase in the incidence of cardiovascular events. Whether the increased severity of OSAS is in fact associated with impaired arterial properties has never been thoroughly studied. In patients with OSAS who carry a high burden of cardiovascular risk factors, we investigated whether the severity of OSAS is associated with deterioration in the arterial properties, independent of classical cardiovascular risk factors. In 74 consecutive patients with OSAS, we non-invasively assessed, by means of tonometry and high-resolution ultrasound: carotid intima-media thickness (IMT), carotid diameter and plaques, carotid-femoral pulse wave velocity (PWV), central augmentation index (AI) and central blood pressures. The respiratory disturbance index was an independent predictor of IMT and PWV but not of carotid plaques, carotid diameter, AI or central blood pressures. Several parameters of nocturnal hypoxaemia were independently correlated with carotid IMT and PWV. In conclusion, arterial stiffening and thickening are modulated by the severity of OSAS, independently from age and cardiovascular risk factors.

Increased arterial stiffness in obstructive sleep apnea: a systematic review

“…48 More specifically, the study by Protogerou et al 48 did not find a direct association between OSA severity categories (moderate, severe and very severe) and arterial stiffness. However, they did find RDI to predict cfPWV significantly, the gold standard of arterial stiffness measurements.…”

“…They found cfPWV to be significantly higher in patients with severe OSA as compared to both mild to moderate OSA and normal controls. Protogerou et al 48 determined cfPWV, augmentation index (AIx) and central blood pressure in mild, moderate and severe OSA patients. They found that these arterial stiffness parameters did not increase with the severity of OSA after adjustment for age, gender, body mass index, heart rate, mean blood pressure, smoking and diabetes mellitus.…”

“…Out of the seven studies investigating the association between severity of OSA and arterial stiffness, 45,47,48,51,52,60,62 six provided full support for the association 45,47,51,52,60,62 and one provided mixed results. 48 More specifically, the study by Protogerou et al 48 did not find a direct association between OSA severity categories (moderate, severe and very severe) and arterial stiffness.…”

“…The methods of assessing arterial stiffness also differed between studies; however, it is encouraging that eight studies used cfPWV, AIx or both as parameters of arterial stiffness. [42][43][44][45]47,48,53,54 Furthermore, limiting our search to English language publications may have led to an omission of potentially relevant studies. Owing to methodological constraints, a meta-analysis of studies aiming to also quantify the overall magnitude of the effect of OSA on arterial stiffness could not be conducted.…”

Arterial stiffness: beyond pulse wave velocity and its measurement

“…7 The epidemiology, 8 genetic associations 9 and prognostic implications 10 of PWV (and arterial stiffness) have also been reported as has the relationship to haemodynamics, 11 cardiac structure and function. 12,13 Thus, it is increasingly important to have accurate and reproducible methods to assess PWV.…”