Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies

Zhou, Xiaoxu; Liu, Fei; Zhang, Wei; Wang, Guili; Guo, Daqiao; Fu, Weiguo; Wang, Lixin

doi:10.1177/1708538118766102

Cited by 20 publications

(16 citation statements)

References 34 publications

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“…Obstructive sleep apnea syndrome (OSAS) is a common but underestimated potentially dangerous disease, the prevalence is estimated to range from 3% to 7% in the general population but may be much higher1-4. Pathophysiologically, the disease is characterized by repetitive complete or partial upper airway collapse, resulting in interruption of airflow and persistence of inspiratory effort during sleep.…”

Section: Introductionmentioning

confidence: 99%

“…Pathophysiologically, the disease is characterized by repetitive complete or partial upper airway collapse, resulting in interruption of airflow and persistence of inspiratory effort during sleep. Despite increasing breathing efforts, the upper airway collapse results in episodes of obstructive hypopneas or apneas affecting the sleep architecture and the whole body via instant and long-term mechanisms1,4.…”

Section: Introductionmentioning

confidence: 99%

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Obstructive sleep apnea syndrome promotes the progression of aortic dissection via a ROS- HIF-1α-MMPs associated pathway

et al. 2019

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Aims: Obstructive sleep apnea syndrome (OSAS) has been increasingly recognized as an independent risk factor for aortic dissection (AD) and it is strongly associated with the extent of intermittent hypoxia and re-oxygenation (IH). This study aimed to clarify role of ROS- HIF-1α-MMPs pathway in the pathogenesis of AD and whether the HIF-1α inhibitor attenuates AD formation.Methods and results: 8-week-old male ApoE-/- mice were given β-aminopropionitrile at a concentration of 0.1 % for 3 weeks and infused via osmotic mini pumps with either saline or 2,500 ng/min/kg angiotensin II (Ang II) for 2 weeks. To mimic the OSAS, one group was exposed to IH, which consisted of alternating cycles of 20.9% O2/8% O2 FiO2 (30 episodes per hour) with 20 s at the nadir FiO2 during the 12-h light phase, 2 weeks before Ang II infusion. After Ang II infusion, we assessed remodeling in the aorta by echocardiography, histological and immunohistochemical analysis. IH treatment resulted in significant enlargement of the luminal area, destruction of the media, marked thickening of the adventitia, higher incidence of AD formation and lower survival rate in compared with the Ang II only group. Moreover, IH exposure markedly increased the aortic ROS production and subsequent HIF-1α expression, which in turn promoted the expressions of VEGF, MMP2 and MMP9 and finally leading to the progression of AD. Besides, in vitro study confirmed that IH induced HIF-1α expression plays an important role in the induction of MMPs and that is regulated by the PI3K/AKT/FRAP pathway. Intriguingly, a selective HIF-1α inhibitor KC7F2 could significantly ameliorate IH exposure induced aforementioned deleterious effects in vitro and in vivo.Conclusion: OSAS induced IH can promote the occurrence and progression of AD via a ROS- HIF-1α-MMPs associated pathway. The selective HIF-1α inhibitor KC7F2 could be a novel therapeutic agent for AD patient with OSAS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea syndrome promotes the progression of aortic dissection via a ROS- HIF-1α-MMPs associated pathway

et al. 2019

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“…This case-control study included 143 TBAD patients, and the prevalence of OSA was as high as 64.3%. In 2003, Sampol et al (46) first found a correlation between OSA and aortic dissection, and an increasing number of studies have shown that OSA is an independent risk factor for AD, especially for TBAD patients with moderate to severe OSA (47)(48)(49). Previous studies have indicated that OSA may lead to dilatation of the aorta, including the aortic root (52)(53)(54)(55), thoracic aorta (56) and abdominal aorta (57); other studies have come to the opposite conclusion (58), and most of the OSA patients in these studies had no history of cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…The potential correlation between OSA and TBAD was first reported by Sampol et al ( 46 ). An increasing number of studies have shown that OSA is an important cause of AD ( 42 , 47 – 49 ).…”

Section: Introductionmentioning

confidence: 99%

Obstructive Sleep Apnoea in Stanford Type B Aortic Dissection Is Associated With Multiple Imaging Signs Related to Late Aortic Events

Zhang

et al. 2021

Front. Cardiovasc. Med.

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Background: Obstructive sleep apnoea (OSA) is highly prevalent in patients with Stanford type B aortic dissection (TBAD). Few studies have evaluated the effects of OSA on vascular changes in TBAD patients. This study aimed to explore the effect of OSA on aortic morphological changes in TBAD patients and its relation to late aortic events (LAEs).Methods: This case-control study included 143 TBAD patients. The diameters of different parts of the aorta were measured based on computed tomography angiography (CTA). According to the apnoea-hypopnoea index (AHI), OSA was classified as mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), or severe (AHI > 30). The false lumen (FL) status was evaluated and classified as partially thrombosed, patent, or completely thrombosed.Results: The OSA prevalence in TBAD patients was 64.3%, and image differences related to LAEs between TBAD patients with and without OSA included the maximum aortic diameter at onset (37.3 ± 3.9 vs. 40.3 ± 4.5 mm, p < 0.001), the FL diameter of the proximal descending thoracic aorta (16.0 ± 6.8 vs. 20.3 ± 4.7 mm, p < 0.001), and the proportion of the FL that was partially thrombosed (39.2 vs. 64.1%, p = 0.004). Additionally, in the multivariable analysis of patients with OSA, the risks of an aortic diameter ≥40 mm, a proximal descending aorta FL ≥ 22 mm and a partially thrombosed FL were 4.611 (95% CI: 1.796–11.838, p = 0.001), 2.544 (95% CI: 1.050–6.165, p = 0.039), and 2.565 (95% CI: 1.167–5.637, p = 0.019), respectively, after adjustment for confounding factors. Trend tests showed that the risks of an aortic diameter ≥40 mm and a partially thrombosed FL increased with increasing OSA severity.Conclusions: TBAD patients with moderate to severe OSA have aortic dilatation in different parts of the aorta. OSA is an independent risk factor for multiple imaging signs related to LAEs, suggesting that OSA is an important factor affecting the prognosis of TBAD patients.

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“…However, our finding of a higher prevalence of OSA in type IIIb than type IIIa is a novel finding. Recently, Zhou et al 10) performed a meta-analysis of observational studies using a systematic search of PubMed, Embase and Cochrane Library. In their meta-analysis, information on 424 cases of aortic dissection among 56,291 patients was obtained from one cohort, four case-control and two cross-sectional studies.…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea as a risk factor for the onset and progression of aortic dissection

et al. 2019

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Background: Aortic dissection is thought to develop and progress due to hypertension and atherosclerosis, but the detailed mechanisms of the onset and progression are still unknown. In this study, we investigated the relationship between type of aortic dissection and the atherosclerotic risk factors including obstructive sleep apnea (OSA) and discussed potential mechanisms. Methods: There were 52 consecutive patients with aortic dissection who were admitted to our hospital, and a sleep study was performed to look for OSA in 42 of them (27 men and 15 women, age: 67 12 years, BMI: 24 4, De-Bakey type I: n=6, type IIIa: n=7, type IIIb: n=29). Results: In the 42 patients who had a sleep study, OSA was seen in 36 patients (86%). OSA was more frequent in type IIIb (n=27) than in type IIIa (n=4) aortic dissection (93% vs 57%, p= 0.01). Univariate logistic regression analysis indicated that the presence of OSA could distinguish type IIIb from IIIa (odds ratio: 10.125, 95% confidence interval: 1.272-80.623, P=0.029). Conclusion: OSA was frequently associated with aortic dissection and its prevalence was higher in type IIIb than type IIIa, suggesting that OSA may be associated with the development and progression of aortic dissection.

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Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies

Cited by 20 publications

References 34 publications

Obstructive sleep apnea syndrome promotes the progression of aortic dissection via a ROS- HIF-1α-MMPs associated pathway

Obstructive sleep apnea syndrome promotes the progression of aortic dissection via a ROS- HIF-1α-MMPs associated pathway

Obstructive Sleep Apnoea in Stanford Type B Aortic Dissection Is Associated With Multiple Imaging Signs Related to Late Aortic Events

Obstructive sleep apnea as a risk factor for the onset and progression of aortic dissection

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