Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Background: Structural and functional properties of the proximal thoracic aorta have important implications in clinical and subclinical cardiovascular disease (CVD). We examined whether obstructive sleep apnea (OSA) is associated with proximal aortic size and aortic stiffness in a multi-ethnic community-based cohort. Methods: The sample included the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary study participants without known CVD who underwent cardiac magnetic resonance imaging. The main exposure variable was OSA severity based on the polysomnography-derived apnea hypopnea index (AHI; normal, AHI <5/h; mild, 5≤ AHI <15/h; moderate to severe, AHI ≥15/h). The study outcomes were ascending aortic diameter (AoD, cm), aortic pulse wave velocity (AoPWV, m/s), and ascending aortic distensibility (AAD, %/mm Hg). Analyses were performed in the overall sample and in sex-specific strata, adjusted for multiple potential confounders. Results: The 708 participants were 55.9% female and on average 68 years old (54–93 years). There was a significant trend (p < 0.0001) of greater mean (SD) AoD across the three OSA groups: normal (n = 87), 3.13 cm (0.35); mild (n = 215), 3.25 (0.34); moderate to severe (n = 406), 3.37 (0.36). In adjusted analysis, participants with moderate to severe OSA had a greater mean AoD compared with the normal group: adjusted mean difference (95% CI), 0.12 cm (0.05, 0.20), p = 0.002. This AoD gradient was observed in women but not in men (p for interaction = 0.02). No differences were found in AoPWV or AAD among the OSA groups. Conclusion: In a diverse community-based cohort, moderate to severe OSA (vs. no OSA) was associated with a larger ascending AoD in women.

Characteristics of hypertension and arterial stiffness in obstructive sleep apnea: A Scandinavian experience from a prospective study of 6408 normotensive and hypertensive patients

“…In a univariate logistic regression analysis, OSA was associated with increased PP, but when the model was adjusted for age, sex, and other relevant confounders, OSA was no longer associated with increased PP neither in the overall population nor hypertensive or normotensive subgroups. Our results are in line with some previous studies which also could not document an association between OSA and arterial stiffness assessed by PWV 19–21 . In a meta‐analysis of nine studies including 893 patients referred for suspicion of OSA, Joyeux‐Faure and associates showed that increased arterial stiffness in patients with OSA was mainly driven by conventional CV risk factors rather than apnea parameters 19 .…”

“…Similarly, in the MESA (The Multi-Ethnic Study of Atherosclerosis) study of 708 participants, moderate to severe OSA (vs No-OSA controls) was not associated with aortic PWV. 20 However, in contrast to our results and those mentioned above, [19][20][21] a number of studies in the past have documented an association between OSA and increased arterial stiffness as reflected by higher PWV. [8][9][10][11]22 Most of these studies [8][9]11 had some methodological issues such as small sample sizes, inclusion of eastern populations who were non-obese by BMI [10][11] but had higher waist circumference, differences in OSA severity, as well as assessment of arterial stiffness by different methodologies.…”

“…Arterial stiffness was not measured by the gold standard method; ie, PWV, which in practical terms may not be feasible to perform in such a large study due to its limited availability, and currently its utilization in the research area. However, our results are in line with those studies of OSA patients which used PWV as a marker of increased arterial stiffness 19–21 . The information on smoking status was ascertained through self‐reported questionnaires and categorized in current smokers and non‐smokers.…”

Targeting subclinical organ damage in obstructive sleep apnea: a narrative review

“…In multivariable analysis, age, systolic BP, and diabetes turned out to be independent correlates of PWV, thus suggesting that elevated arterial stiffness in OSA patients is mostly driven by risk factors/comorbidities rather than by sleep-disordered breathing parameters. The MESA Sleep Ancillary study [71] in agreement with the results of the meta-analysis by Joyeux-Faure et al [70], failed to find differences in aortic PWV or ascending aortic distensibility among the 708 participants stratified according to AHI (normal, AHI < 5/h; mild, 5 ≤ AHI < 15/h; moderate-tosevere, AHI ≥ 15 events/h), after adjusting for major confounders. Finally, a significant higher PWV was found by Song et al in 62 young nonobese subjects with OSA compared to 33 non-OSA controls with similar clinical and demographic characteristics (6.9 ± 1.50 vs. 6.15 ± 1.41 m/s, P = 0.02) [63] (Table 3).…”

Intermittent hypoxia-related alterations in vascular structure and function: a systematic review and meta-analysis of rodent data

“…This suggests a progressive remodeling of arteries over time. Interestingly, internal vessel diameter was not modified in rodents while, in humans, it is postulated that obstructive sleep apnea could induce an increase in diameter, at least in some patients and vessels 43,44 . IH models in rodents might rapidly attain the late characteristics of the disease such as thickening the media following changes in the inner diameter of vessels.…”