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Association between obstructive sleep apnea severity and endothelial dysfunction in an increased background of cardiovascular burden
Author(s) -
Seif Fadi,
Patel Sanjay R.,
Walia Harneet,
Rueschman Michael,
Bhatt Deepak L.,
Gottlieb Daniel J.,
Lewis Eldrin F.,
Patil Susheel P.,
Punjabi Naresh M.,
Babineau Denise C.,
Redline Susan,
Mehra Reena
Publication year - 2013
Publication title -
journal of sleep research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 117
eISSN - 1365-2869
pISSN - 0962-1105
DOI - 10.1111/jsr.12026
Subject(s) - obstructive sleep apnea , medicine , endothelial dysfunction , cardiology , association (psychology) , sleep apnea , sleep apnea syndromes , polysomnography , apnea , psychology , psychotherapist
Summary The objective of this study is to examine whether increasing obstructive sleep apnea ( OSA ) severity is associated with worsening endothelial function. The design is a cross‐sectional examination of the baseline assessment of a multi‐centre randomized controlled clinical trial examining the effects of oxygen, continuous positive airway pressure ( CPAP ) therapy or lifestyle modifications on cardiovascular biomarkers. Participants were recruited from cardiology clinics at four sites. Participants with an apnea–hypopnea index ( AHI ) of 15–50 and known cardio/cerebrovascular disease ( CVD ) or CVD risk factors were included. OSA severity indices [oxygen desaturation index ( ODI ), AHI and percentage of sleep time below 90% oxygen saturation (total sleep time <90)] and a measure of endothelium‐mediated vasodilatation [Framingham reactive hyperaemia index (F‐ RHI ) derived from peripheral arterial tonometry ( PAT )] were assessed. The sample included 267 individuals with a mean AHI of 25.0 ± 8.5 SD and mean F‐ RHI 0.44 ± 0.38. In adjusted models, the slope of the relationship between ODI and F‐ RHI differed above and below an ODI of 24.6 ( P = 0.04), such that above an ODI of 24.6 there was a marginally significant decline in the geometric mean of the PAT ratio by 3% [95% confidence interval ( CI ): 0%, 5%; P = 0.05], while below this point, there was a marginally significant incline in the geometric mean of the PAT ratio by 13% (95% CI : 0%, 27%; P = 0.05) per 5‐unit increase in ODI . A similar pattern was observed between AHI and F‐ RHI . No relation was noted with total sleep time <90 and F‐ RHI . There was evidence of a graded decline in endothelial function in association with higher levels of intermittent hypoxaemia.