title: Association between obstructive sleep apnea severity and endothelial dysfunction in an increased background of cardiovascular burden.
abstract: 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.
authors: Department of Medicine, Case School of Medicine, Cleveland, OH, USA.
authors: Fadi
authors: F
authors: Seif
authors: Sanjay R
authors: SR
authors: Patel
authors: Harneet
authors: H
authors: Walia
authors: Michael
authors: M
authors: Rueschman
authors: Deepak L
authors: DL
authors: Bhatt
authors: Daniel J
authors: DJ
authors: Gottlieb
authors: Eldrin F
authors: EF
authors: Lewis
authors: Susheel P
authors: SP
authors: Patil
authors: Naresh M
authors: NM
authors: Punjabi
authors: Denise C
authors: DC
authors: Babineau
authors: Susan
authors: S
authors: Redline
authors: Reena
authors: R
authors: Mehra
mesh_terms: D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications* / Q000473:pathology / Q000503:physiopathology*; D045422:Continuous Positive Airway Pressure; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D014664:Vasodilation
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: cardiovascular disease; endothelial dysfunction; sleep apnea