Carotid Artery Wall Thickness in Patients With Obstructive Sleep Apnea Syndrome

Abstract

Background and Purpose-Epidemiological studies have suggested a pathophysiological link between sleep apnea syndrome and cerebrovascular diseases. The mechanism by which sleep disturbance can affect the predisposition to developing stroke is not clear. The aim of this study was to investigate whether patients with obstructive sleep apnea syndrome have an increase in atherosclerosis indicators at the carotid artery level. Methods-We included 23 male patients with severe obstructive sleep apnea syndrome (respiratory disturbance index Ͼ30). Intima-media thickness and the presence of steno-occlusive lesions in the common carotid arteries were investigated with B-mode high-resolution ultrasonography. Results of the ultrasonographic examination were compared with those of a group of 23 subjects without obstructive sleep apnea syndrome who were matched for age and comorbid factors. Results-The intima-media thickness of the common carotid arteries of patients with obstructive sleep apnea syndrome was significantly higher (PϽ0.0001) than that of control subjects (1.429Ϯ0.34 versus 0.976Ϯ0.17 mm). Conclusions-Results of the present study show that carotid wall thickness is increased in patients with severe sleep apnea syndrome. There is strong evidence that an increase in the thickness of the carotid artery wall is a valid marker of the risk of stroke. For this reason, our finding seems to further strengthen the hypothesis that patients with obstructive sleep apnea syndrome are at risk of developing cerebrovascular diseases regardless of the association with other vascular risk factors.

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

“…Recent studies have evaluated the effect of OSAS on most of the aforementioned arterial characteristics. [14][15][16][17][18][19][20] These studies demonstrated an increase in carotid IMT and arterial stiffness in patients with OSAS, suggesting that OSAS may promote vascular disease. However, some of these studies excluded patients with cardiovascular or cerebrovascular disease, hypertension, diabetes mellitus, hyperlipidaemia or severe obesity 17,20 and therefore were not representative of the usual population of patients with OSAS encountered in clinical practice who exhibit a high burden of cardiovascular risk factors.…”

“…Carotid IMT, which is considered by many investigators as a surrogate marker for the development of atherosclerosis, as well as an independent predictor of cardiovascular death, 12,22 was shown to be increased in patients with OSAS compared to the control group. 14,15,17,18 Most of these studies, apart from one, 15 have shown that IMT is independently related to the severity of OSAS, as expressed by apnoea-hypopnoea index or nocturnal hypoxaemia. [16][17][18][19] Our data confirm these previous results in a population of patients with numerous cardiovascular comorbidities and further support recent data in humans regarding the independent effect of OSAS in the development of atherosclerosis.…”

Evaluation of association between obstructive sleep apnea and coronary risk scores predicted by tomographic coronary calcium scoring in asymptomatic patients

“…Nocturnal desaturation and reoxygenation episodes observed in these patients have been suggested to result in oxidative stress which facilitates the metabolic cascade associated with increased inflammatory response and development of atherosclerosis (14). Many of the studies investigating the influence of OSA on presence and severity of atherosclerosis have studied the association of OSA and carotid intima-media thickness as a marker of systemic atherosclerosis in various populations (15)(16)(17)(18)(19). Although there are variations regarding the designs and populations of these studies, general finding is that OSA patients have higher carotid intima-media thickness values in association with disease severity.…”

Impaired Functional Capacity Predicts Mortality in Patients with Obstructive Sleep Apnea

“…It has been theorized that nocturnal hypoxia may cause increased catecholamine release possibly leading to autonomic dysfunction (38)(39)(40), which is known to be associated with mortality (41)(42)(43). HRR after stress testing has been well recognized as a measure of autonomic function (44) and a risk factor for adverse clinical outcomes in several disease states (48,49).…”