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Association between obstructive sleep apnea severity and endothelial dysfunction in an increased background of cardiovascular burden
被引:45
|作者:
Seif, Fadi
[1
]
Patel, Sanjay R.
[2
,3
]
Walia, Harneet
[1
]
Rueschman, Michael
[2
]
Bhatt, Deepak L.
[2
,4
]
Gottlieb, Daniel J.
[2
,4
]
Lewis, Eldrin F.
[2
]
Patil, Susheel P.
[5
]
Punjabi, Naresh M.
[5
]
Babineau, Denise C.
[6
]
Redline, Susan
[2
,3
]
Mehra, Reena
[1
,7
]
机构:
[1] Case Sch Med, Dept Med, Cleveland, OH USA
[2] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA
[3] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Boston, MA 02215 USA
[4] Harvard Univ, Sch Med, VA Boston Healthcare Syst, Boston, MA USA
[5] Johns Hopkins Univ, Baltimore, MD USA
[6] Case Western Reserve Univ, Ctr Clin Invest, Cleveland, OH 44106 USA
[7] Case Sch Med, Case Comprehens Canc Ctr, Case Ctr Transdisciplinary Res Energet & Canc, Cleveland, OH USA
关键词:
cardiovascular disease;
endothelial dysfunction;
sleep apnea;
OXIDATIVE STRESS;
BRACHIAL-ARTERY;
NITRIC-OXIDE;
RISK-FACTORS;
VASODILATION;
IMPAIRMENT;
AMPLITUDE;
HYPOPNEA;
DISEASE;
FLOW;
D O I:
10.1111/jsr.12026
中图分类号:
R74 [神经病学与精神病学];
学科分类号:
摘要:
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.
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页码:443 / 451
页数:9
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