Interrelationships among common predictors of cardiovascular diseases in patients of OSA: A large-scale observational study

Abstract

Background and aims: The apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) and insulin resistance has been recognized as common cardiovascular diseases (CVD) risk factors. However, whether they were biomarkers for 10-year CVD risk in obstructive sleep apnea (OSA) had been rarely studied. Besides, interrelationships between the ApoB/ApoA-I, insulin resistance and OSA remain unclear. Methods and results: A total of 4010 subjects were finally included. Anthropometric, fasting biochemical, and polysomnographic parameters were collected. 10-year Framingham CVD risk score (FRS) was calculated for each subjects. The relationships between insulin resistance, OSA risk and the ApoB/ApoA-I was evaluated through logistic regressions analysis, restricted cubic spline (RCS) analysis and mediation analysis. ApoB/ApoA-I, HOMA-IR and AHI were all risk factors for high10-year CVD risk as assessed by FRS (odds ratios (OR) Z 5.365, 1.094, 1.010, respectively, all P < 0.001)). The fully adjusted OR (95% confidence intervals) for both OSA [1 (reference), 1.308 (1.027e1.665), 1.517 (1.178e1.953), and 1.803 (1.371e2.372)] and insulin resistance [1 (reference), 1.457 (1.173e1.711), 1.701 (1.369e2.113), 2.051(1.645e2.558)] increased from the first to the fourth quartiles of the ApoB/ApoA-I. The RCS mapped a nonlinear doseeeffect relationship between the ApoB/ApoA-I and risk of insulin resistance and OSA. Mediation analyses showed HOMA-IR explain 9.7%, 4.7% and 10.8% of the association between apnea-hypopnea index, oxygen desaturation index, micro-arousal index and ApoB/ApoA-I, respectively. Conclusions: Our study revealed that ApoB/ApoA-I, insulin resistance and OSA were risk factors for CVD. Insulin resistance may serve as a potential mediator in OSA-related lipoprotein disorders and further increase CVD risk.

Risk of Cardiovascular Disease in Apnoeic Individuals: Role of Comorbid Insomnia Disorder

“…In this study, we demonstrated that 59.6% of apnoeic individuals had a moderate-to-high 10-year CVD risk, which is significantly higher than in the general population [ 41 ]. However, the rate of apnoeic individuals with moderate-to-high 10-year CVD risk highlighted in our study seems to be higher than that of the study by Li et al (2020) [ 42 ]. Indeed, in this previous study, only 34.0% of apnoeic individuals had a moderate-to-high 10-year CVD risk [ 42 ].…”

“…However, the rate of apnoeic individuals with moderate-to-high 10-year CVD risk highlighted in our study seems to be higher than that of the study by Li et al (2020) [ 42 ]. Indeed, in this previous study, only 34.0% of apnoeic individuals had a moderate-to-high 10-year CVD risk [ 42 ]. However, compared to our study, the apnoeic individuals recruited in the study by Li et al (2020) had a better demographic (younger age and lower body mass index) and cardiometabolic profile (lower prevalence of type 2 diabetes, hypertension, and dyslipidaemia) [ 42 ], which may have led to an underestimation of the 10-year CVD risk in their study given the major role played by these demographic and cardiometabolic factors in the development of CVD [ 28 ].…”

“…Indeed, in this previous study, only 34.0% of apnoeic individuals had a moderate-to-high 10-year CVD risk [ 42 ]. However, compared to our study, the apnoeic individuals recruited in the study by Li et al (2020) had a better demographic (younger age and lower body mass index) and cardiometabolic profile (lower prevalence of type 2 diabetes, hypertension, and dyslipidaemia) [ 42 ], which may have led to an underestimation of the 10-year CVD risk in their study given the major role played by these demographic and cardiometabolic factors in the development of CVD [ 28 ]. On the other hand, the rate of apnoeic individuals with moderate-to-high 10-year CVD risk demonstrated in our study seems to be smaller than that of the study by Luyster et al (2014) (66.4%) [ 18 ].…”

Associations between obstructive sleep apnea and cardiac troponin T levels: a meta-analysis

“…Moreover, OSA is strongly associated with metabolic disorders such as obesity, hypertension, dyslipidemia, and glucose metabolic diseases. Therefore, this disease can be considered as a key risk factor for CVD (Li et al, 2020).…”

Emergency Department Visits with Obstructive Sleep Apnea in the United States

“…It is worth noting that differences exist in the reasons for ED visit between patients with OSA and without OSA, especially with respect to Respiratory, Cardiovascular and Lymphatic categories. According to the research of May AM [18] and Li X [19], there are strong associations betwen OSA and cardiac arrhythmias and cardiovascular disease. On the other hand, through the research of Owens RL [20], we can learn that there is a reciprocal interaction between chronic obstructive pulmonary disease and OSA.…”