Prevalence of Obstructive Sleep Apnea in Patients with Thoracic Aortic Aneurysm: A Prospective, Parallel Cohort Study

Abstract

Background: The pathogenesis and etiology of thoracic aortic aneurysms (TAA) are largely unknown. Preliminary data from patients with aortic dissection and abdominal aneurysms suggest a causal link of obstructive sleep apnea (OSA) on aortic disease. Objectives: The aim of the study was to assess the prevalence of OSA in patients with TAA compared to a matched control group. Method: In this prospective parallel-cohort study, we 2-to-1 matched 208 patients with verified TAA (at the aortic sinus and/or ascending aorta) to 104 controls without TAA according to sex, age, height, weight, and left ventricular ejection fraction. All participants underwent an ultrasound of the thoracic aorta and a level III respiratory polygraphy. OSA was defined as apnea-hypopnea index 5/h. The prevalence of OSA was compared with conditional logistic regression and controlling for the matching variables. Results: A total of 312 patients (mean age 65 ± 11 years, 82% male, mean body mass index 27 ± 4 kg/m2) were successfully 2-to-1 matched in the final model. Prevalence of OSA was significantly higher in the TAAgroup when compared to the matched control group (63 vs. 47%; odds ratio 1.87 [95% CI 1.05-3.34]; p = 0.03). When applying a higher apnea-hypopnea index threshold (15/h), the odds ratio increased to 3.25 (95% CI 1.65-6.42; p < 0.001). The median apnea-hypopnea index was higher in patients with TAA (9.2/h [3.3-20.0] vs. 4.5/h [2.2-11.1], p < 0.001). Conclusions: Patients with TAA have a higher prevalence of OSA when compared to the general population. Since OSA is effectively treatable and might contribute to the pathogenesis of TAA, further longitudinal trials are needed to assess the association between OSA and TAA.

Effects of obstructive sleep apnea on the thoracic aorta and the main pulmonary artery: assessment by CT

“…31 A meta-analysis and a prospective study recently evidenced, respectively, a higher risk of aortic dissection in patients with OSA and a higher prevalence of OSA in patients with thoracic aortic aneurysms, compared to the general population. 32,33 However, a recent nationwide retrospective analysis by Shih et al 34 did not find an association between OSA and aortic aneurysm, in the Taiwan population.…”

Sleep apnea predicts cardiovascular death in patients with Marfan syndrome A cohort study

“…Regarding the general population beside Marfan syndrome, several studies indicate that sleep apnea alone elevates the risk for aortic dissection, aortic dilatation and aortic rupture (25)(26)(27), whereas others did not con rm these ndings (28). It was also observed that the duration of an oxygen saturation < 90% in uenced the sizes of the ascending aorta and the main pulmonary artery, showing greater dimensions in patients with sleep apnea (29).…”

Sleep apnea predicts cardiovascular death in patients with Marfan syndrome: a cohort study

“…However, this association was no longer significant after adjusting for further covariates like age, gender, baseline aortic diameter, systolic blood pressure, and antihypertensive medication [13]. Regarding the general population beside Marfan syndrome, several studies indicate that sleep apnea alone elevates the risk for aortic dissection, aortic dilatation, and aortic rupture [28][29][30], whereas others did not confirm these findings [31]. It was also observed that the duration of an oxygen saturation < 90% influenced the sizes of the ascending aorta and the main pulmonary artery, showing greater dimensions in patients with sleep apnea [32].…”