Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea

Solelhac, Geoffroy; Sánchez‐de‐la‐Torre, Manuel; Blanchard, Margaux; Berger, Mathieu; Hirotsu, Camila; Imler, Théo; Sánchez-de-la-Torre, Alicia; Haba‐Rubio, José; Marchi, Nicola Andrea; Bayon, Virginie; Bailly, Sébastien; Goupil, F.; Waeber, Adrien; Heiniger, Grégory; Pigeanne, Thierry; Gràcia-Lavedán, Esther; Zapater, Andrea; Abad, Jorge; Ordax, Estrella; Masdeu, María José; Cabriada-Nuño, Valentin; Egea, Carlos; Broecke, Sandra Van Den; Vollenweider, Péter; Marques‐Vidal, Pedro; Vaucher, Julien; Bernardi, Giulio; Betta, Monica; Siclari, Francesca; Barbé, Ferrán; Gagnadoux, Frédéric; Heinzer, Raphaël

doi:10.1164/rccm.202206-1223oc

Cited by 39 publications

(16 citation statements)

References 37 publications

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“…In addition, our findings are in agreement with previous research showing that CPAP 42 -but also NSO 43 can reduce measures of increased sympathetic traffic. In contrast, this study shows that individuals with OSA and a low ΔHR, which has also been linked to increased cardiovascular risk in population studies, 32,44 did not exhibit a reduction in BP with treatment. This result is in agreement with our prior hypothesis that people with a low ΔHR do not seem to benefit from therapy, 32,35 potentially due to pathogenic modifications related to cardiovascular morbidity that go beyond OSA pathogenesis and, thus, are unlikely to be ameliorated by OSA treatment.…”

Section: Baseline δHr As a Predictor Of A Favorable Treatment Effect ...contrasting

confidence: 89%

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden

Messineo,

Sands,

Schmickl

et al. 2024

Hypertension

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BACKGROUND: Obstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea’s physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in posttreatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB). METHODS: ΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB. RESULTS: A high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0–10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9–7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5–10.4) mm Hg drop in SBP. CONCLUSIONS: A high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.

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Section: Baseline δHr As a Predictor Of A Favorable Treatment Effect ...contrasting

confidence: 89%

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden

Messineo,

Sands,

Schmickl

et al. 2024

Hypertension

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“…It is also worth considering in future whether emerging technologies could be used to better quantify OSA severity in train drivers, rather than relying on self-report, screeners and/or single night polysomnography (PSG). New metrics of OSA severity, including measures of hypoxia 36 , 37 , sleep fragmentation 38 , 39 and autonomic responses 40 , 41 have been shown to better predict cardio-metabolic risk associated with OSA. The implementation of these approaches in this worker population may also be helpful in future for identifying workers at risk of significant incidents, and should be considered where possible in future analyses.…”

Section: Discussionmentioning

confidence: 99%

Reconsidering screening thresholds in health assessments for obstructive sleep apnea using operational and safety incident data

Naweed,

Lechat,

Chapman

et al. 2024

Sci Rep

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The rail industry in Australia screens workers for probable obstructive sleep apnea (OSA) due to known safety risks. However, existing criteria to trigger screening only identify a small proportion of workers with OSA. The current study sought to examine the relationship between OSA risk and rail incidents in real-world data from Australian train drivers, and conducted a proof of concept analysis to determine whether more conservative screening criteria are justified. Health assessment (2016–2018) and subsequent rail incident data (2016–2020) were collected from two passenger rail service providers. Predictors included OSA status (confirmed no OSA with a sleep study, controlled OSA, unknown OSA [no recorded sleep assessment data] and confirmed OSA with no indication of treatment); OSA risk according to the current Standard, and OSA risk according to more conservative clinical markers (BMI threshold and cardiometabolic burden). Coded rail safety incidents involving the train driver were included. Data were analysed using zero-inflated negative binomial models to account for over-dispersion with high 0 counts, and rail safety incidents are reported using Incidence Risk Ratios (IRRs). A total of 751 train drivers, typically middle-aged, overweight to obese and mostly men, were included in analyses. There were 43 (5.7%) drivers with confirmed OSA, 62 (8.2%) with controlled OSA, 13 (1.7%) with confirmed no OSA and 633 (84.4%) drivers with unknown OSA. Of the 633 train drivers with unknown OSA status, 21 (3.3%) met ‘at risk’ criteria for OSA according to the Standard, and incidents were 61% greater (IRR: 1.61, 95% Confidence Interval (CI) 1.02–2.56) in the years following their health assessment compared to drivers who did not meet ‘at risk’ criteria. A more conservative OSA risk status using lower BMI threshold and cardiometabolic burden identified an additional 30 ‘at risk’ train drivers who had 46% greater incidents compared to drivers who did not meet risk criteria (IRR (95% CI) 1.46 (1.00–2.13)). Our more conservative OSA risk criteria identified more workers, with greater prospective incidents. These findings suggest that existing validated tools could be considered in future iterations of the Standard in order to more sensitively screen for OSA.

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“…S olelhac et al [ 8 ] evaluated the association between pulse wave amplitude drops (PWAD) index and incident or recurrent cardiovascular events in three prospective cohorts: HypnoLaus (general population), ISAACC (acute coronary syndrome with OSA), and the Pays de la Loire Sleep Cohort (OSA cohort). The study aimed to investigate the value of PWAD as a biomarker of cardiovascular risk in OSA, related to sympathetic activation and vasoreactivity.…”

Section: Year In Review: Advances In Sleep Breathing Disordersmentioning

confidence: 99%

“…He also pointed out that randomised control trials (RCTs) on the effect of OSA therapy on cardiovascular outcomes would be important in these vulnerable phenotypes [ 13 ]. Another useful tool from the perspective of phenotyping is the PWAD index, which would allow the recognition of individuals most at risk for cardiovascular disease [ 8 ].…”

Section: State Of the Art Session: Sdb And The Heart – What Is Next?mentioning

confidence: 99%

“…Arousal burden, which has been defined as total duration of all arousals divided by the total sleep time (%), associated with long-term all-cause and cardiovascular mortality [ 46 ]. Sleep apnoea-specific pulse rate response, which is the difference between the maximum pulse rate after the airway reopening and the minimum pulse rate during respiratory events, associated with cardiovascular morbidity and mortality [ 8 , 47 ]. PWAD, as another marker, is related to variations of the tissue blood volume and reflects peripheral vasoconstriction resulting from sympathetic activation after arousal.…”

Section: Hot Topics: Precision Medicine In Osamentioning

confidence: 99%

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ERS International Congress 2023: highlights from the Sleep Disordered Breathing Assembly

Siciliano,

Bradicich,

Tondo

et al. 2023

ERJ Open Res

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The topic of sleep-related breathing disorders is always evolving, and during the European Respiratory Society (ERS) International Congress 2023 in Milano (Italy), the latest research and clinical topics in respiratory medicine have been presented. The most interesting issues ranged from new diagnostic tools, including cardiovascular parameters and artificial intelligence, pathophysiological traits of SDB from routine polysomnography or polygraphy signals, up to new biomarkers and the diagnostic approach in patients with excessive daytime sleepiness. This article summarises the most relevant studies and topics to this extent presented at the ERS International Congress 2023. Each section has been written by Early Career Members of the ERS Assembly 4.

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Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea

Cited by 39 publications

References 37 publications

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden

Reconsidering screening thresholds in health assessments for obstructive sleep apnea using operational and safety incident data

ERS International Congress 2023: highlights from the Sleep Disordered Breathing Assembly

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