Obstructive Sleep Apnea, Masked Hypertension, and Arterial Stiffness in Men

Drager, Luciano F.; Diegues-Silva, Luzia; Diniz, Patricia Martini; Bortolotto, Luiz Aparecido; Pedrosa, Rodrigo Pinto; Couto, Roberta B.; Marcondes, Bianca; Giorgi, Dante Marcelo Artigas; Lorenzi-Filho, Geraldo; Krieger, E M

doi:10.1038/ajh.2009.246

Cited by 88 publications

(73 citation statements)

References 28 publications

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“…45 A subsequent study by the same group examined arterial stiffness in OSA patients with and without masked hypertension. 46 It was found that, whereas both types of OSA patients showed significantly higher arterial stiffness as compared to healthy controls, OSA patients with masked hypertension had the highest arterial stiffness. Chung et al 47 compared cfPWV in patients with mild to moderate OSA, severe OSA and control subjects.…”

Section: Resultsmentioning

confidence: 96%

Increased arterial stiffness in obstructive sleep apnea: a systematic review

et al. 2010

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Obstructive sleep apnea is a prevalent disease that is associated with significant morbidity and mortality, particularly due to cardiovascular disease. An emerging cardiovascular risk factor, arterial stiffness, may also be involved in the cardiovascular complications of obstructive sleep apnea. The purpose of this review was to summarize the current literature regarding the effect of obstructive sleep apnea on arterial stiffness. We conducted a systematic literature review using PubMed, Embase and the Cochrane Library. We identified 24 studies that met search criteria investigating the effect of obstructive sleep apnea on arterial stiffness. Arterial stiffness was found to be increased in obstructive sleep apnea patients compared with controls or increased in severe compared with mild sleep apnea. In some studies, a positive correlation was identified between the degree of arterial stiffness and sleep apnea severity. In the two randomized, controlled trials and the two nonrandomized trials identified, treatment of obstructive sleep apnea with continuous positive airway pressure led to significant decreases in arterial stiffness. Obstructive sleep apnea appears to have an independent effect on arterial stiffness, which may be one of the mechanisms accounting for sleep apnea-associated cardiovascular risk.

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Section: Resultsmentioning

confidence: 96%

Increased arterial stiffness in obstructive sleep apnea: a systematic review

et al. 2010

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“…Because obesity and insulin resistance tend to accompany OSA as comorbidities, it has been difficult to isolate the independent effect of OSA and its treatments on the development and consequences of hypertension. Several studies have postulated that increased sympathetic tone and endothelial dysfunction cause hypertension in OSA 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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BackgroundThe cardiovascular effects of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients are not clear because of confounding by comorbid conditions.Methods and ResultsProspective interventional study of PAP therapy and withdrawal. Apnea Hypopnea Index (AHI; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (BPs), Aortic Augmentation Index (AAIx), and central (PWV c‐f) and peripheral pulse wave (PWV c‐r) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of PAP therapy, and 1 week after PAP withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5) AHI events/hour. After 4 weeks post‐PAP initiation and sustained after 12 weeks, subjects experienced decreases in central systolic BP (P=0.008), diastolic BP, mean BP, AAIx, and PWV c‐r, and brachial artery dilation (all P<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models, PAP use (hours/night) predicted reductions in diastolic BP (β=−0.65 [SE, 0.32] mm Hg/hour; P=0.045), AAIx (β=−0.53 [0.27] %/hour; P=0.049) and PWV c‐r (β=−0.13 [0.05] m·s−1/hour; P=0.007), and improved brachial artery flow‐mediated dilation (β=0.31 [0.14] %/hour use; P=0.015). After 1 week of PAP withdrawal, brachial diameter, diastolic BP, mean BP, AAIx, and heart rate increased (P≤0.05).Conclusions PAP therapy reduces arterial tone and improves endothelial and diastolic function in young to middle‐aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with PAP withdrawal.Clinical Trial RegistrationURL: https://clinicaltrials.gov/. Unique identifier: NCT01317329.

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“…Several studies have revealed higher PWV in obstructive sleep apnoea (OSA) patients than in controls and reported nocturnal oxygen desaturation to be associated with high PWV 19, 20…”

Section: Introductionmentioning

confidence: 99%

Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

et al. 2018

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AimsSleep‐disordered breathing (SDB) is associated with arterial stiffness, which may be one of the factors that lead to heart failure (HF). We examined the relationship between pulse wave velocity (PWV) and SDB in patients who have HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).Methods and resultsWe measured the apnoea–hypopnoea index (AHI) by polysomnography, echocardiographic parameters, and PWV in 221 HF patients. Age, blood pressure, and PWV were higher in HFpEF (ejection fraction > 50%, n = 70) patients than in HFrEF (ejection fraction < 50%, n = 151) patients. All HF patients were divided into three groups according to AHI: none‐to‐mild SDB group (AHI < 15 times/h, n = 77), moderate SDB group (15 < AHI < 30 times/h, n = 59), and severe SDB group (AHI > 30 times/h, n = 85). Although blood pressure and echocardiographic parameters did not differ among the three groups, PWV was significantly higher in the severe SDB group than in the none‐to‐mild and moderate SDB groups (P = 0.002). When the HFrEF and HFpEF patients were analysed separately, PWV was significantly higher in the severe SDB group than in the none‐to‐mild and moderate SDB groups in patients with HFpEF (P = 0.002), but not in those with HFrEF (P = 0.068). In the multiple regression analysis to determine PWV, the presence of severe SDB was found to be an independent predictor of high PWV in HFpEF (β = 0.234, P = 0.005), but not in HFrEF patients.ConclusionsSevere SDB is associated with elevated arterial stiffness and may be related to the pathophysiology of HF, especially in HFpEF patients.

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Obstructive Sleep Apnea, Masked Hypertension, and Arterial Stiffness in Men

Abstract: Patients with OSA presented a higher unadjusted rate of masked hypertension than matched controls. Lowest oxygen saturation has an independent association with arterial stiffness.

Cited by 88 publications

References 28 publications

Increased arterial stiffness in obstructive sleep apnea: a systematic review

Increased arterial stiffness in obstructive sleep apnea: a systematic review

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

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