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

Abstract

Background: Both obstructive sleep apnea syndrome (OSAS) and coronary artery calcification (CAC) are considered to be related with the presence of coronary artery disease (CAD). In this study we evaluate the association between OSAS and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in patients who had OSAS but no history of known CAD. Methods: Seventy-three patients who were asymptomatic for CAD and had suspected OSAS were referred to overnight attended polysomnography. Patients were classified into 4 groups according to the Apnea-Hypopnea Index (AHI). All patients underwent computed tomographic examination for tomographic coronary calcification scoring. Physical examination, sleep study recordings, complete blood count and serum biochemistry were obtained from all patients. Results: In the whole group, AHI levels were weakly correlated with coronary calcium score (r = 0.342, p = 0.003) and body mass index (r = 0.337, p = 0.004), moderately correlated with basal oxygen saturation (r = −0.734, p < 0.001), and strongly correlated with oxygen desaturation index (r = 0.844, p < 0.001). In an univariate analysis, age, AHI, basal oxygen saturation, and oxygen desaturation index were associated with CAC in patients with OSAS. In a multiple logistic regression model, age (OR 1.108,%95 CI 1.031-1.191, p = 0.005) and AHI (OR 1.036,% 95 CI 1.003-1.070, p = 0.033) were only independent predictors of CAC in patients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of 54.3% and 56.5% respectively. Conclusions: Our findings suggest that in patients with moderate or severe OSAS and advanced age, physicians should be alert for the presence of subclinical atherosclerosis.

Síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) y su relación con complicaciones perioperatorias: revisión de la literatura

“…La inflamación e hipoxia intermitente desempeña un rol importante en el desarrollo de ateroesclerosis [14]. Al ser expuesto el endotelio a hipoxia intermitente, este activa selectivamente vías inflamatorias vasculares que promueven la formación de radicales libres de oxígeno y causan un efecto deletéreo sobre células endoteliales, macrófagos y plaquetas que posteriormente expresarán moléculas de adhesión y liberarán citocinas proinflamatorias y factores de crecimiento causando disfunción endotelial [15][16][17][18][19].…”

Comprehensive coronary plaque assessment in patients with obstructive sleep apnea

“…Several studies have investigated CAD in OSA using computed tomography (Arik et al., ; Kent et al., ; Kim et al., ; Kwon et al., ; Lutsey et al., ; Luyster, Kip, Aiyer, Reis, & Strollo, ; Matthews et al., ; Medeiros et al., ; Murphy et al., ; Nakanishi‐Minami et al., ; Pusuroglu et al., ; Seo et al., ; Sharma et al., ; Sorajja et al., ; Weinreich et al., ). However, there were considerable differences in the studied populations and diagnostic tests.…”

“…However, there were considerable differences in the studied populations and diagnostic tests. Particularly, most studies used only coronary artery calcium score (CAC) to evaluate the severity of CAD (Arik et al., ; Kim et al., ; Kwon et al., ; Lutsey et al., ; Luyster et al., ; Matthews et al., ; Medeiros et al., ; Seo et al., ; Sorajja et al., ; Weinreich et al., ). However, recent studies demonstrated that coronary plaques are typically non‐calcified or partially calcified in OSA (Murphy et al., ; Sharma et al., ).…”

Response to Impact of Obstructive Sleep Apnea on Cardiovascular Outcomes in Patients Treated With Percutaneous Coronary Intervention: Rationale and Design of the Sleep and Stent Study

“…In our recent study, 3 our findings suggest that in patients with moderate or severe OSA syndrome, physicians should be alert for the presence of subclinical atherosclerosis. In this study, we investigated 73 patients who were asymptomatic for coronary artery disease and suspected OSA syndrome.…”