Retinal Microvascular Abnormalities and Systemic Arterial Stiffness Are the First Manifestation of Cardiovascular Abnormalities in Patients with Untreated Moderate to Severe Obstructive Sleep Apnoea and with Low to Intermediate Cardiovascular Risk—A Pilot Study

Abstract

This study aimed to investigate macro- and microvascular function parameters and their relationship with known markers of cardiovascular risk in patients with untreated moderate to severe obstructive sleep apnoea (OSA). Fourteen patients with moderate to severe OSA and fourteen controls were included in the present study. General assessments included BMI, systemic blood pressure (BP) and circulating markers for oxidative stress and endothelial function. Additional assessments included 24 h BP and heart rate monitoring, as well as the assessment of heart rate variability. Macro- and microvascular assessments included augmentation index, carotid intima-media thickness, brachial artery flow-mediated dilation, as well as various retinal microvascular function assessments, using the Dynamic Retinal Vessel Analyzer. All participants completed the Short Form Health Survey, Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale. The results show that, in comparison to controls, BMI (p = 0.003) and AIx (p = 0.025) were significantly higher in the OSA group. There was, however, no significant difference between groups with regard to other measured systemic general, vascular and circulatory parameters (all p > 0.05). Nevertheless, the retinal microvascular function showed various alterations in the OSA patients, including a delayed reaction time in response to flicker (p = 0.047), as well as a decreased dilation amplitude (p = 0.004), dilation slope (p = 0.004), and post-flicker constriction (p = 0.015). In addition, the observed SlopeAD alterations correlated negatively with BMI values only in the OSA group (r = −0.46, p = 0.045). In conclusion, individuals with untreated moderate to severe OSA but without overt CVD, exhibit signs of increased arterial stiffness and retinal microvascular dysfunction, which can be early indicators for future vascular complications.

Macro- and Microvascular Function in Middle-Aged Individuals with Low Cardiovascular Disease Risk

“…Exclusion criteria were family history of DM, a positive diagnosis of cardio- or cerebro-vascular disease, (coronary artery disease, heart failure, arrhythmia, stroke, transient ischaemic attacks), peripheral vascular disease, severe dyslipidaemia (defined as plasma TG > 6.00 mmol/L or cholesterol levels > 7.00 mmol/L), diabetes, as well as other metabolic disorders or chronic diseases that required treatment [ 9 , 19 , 20 ]…”

Automated Retinal Vessel Analysis Based on Fundus Photographs as a Predictor for Non-Ophthalmic Diseases—Evolution and Perspectives

“…When undergoing DVA analysis, individuals with untreated moderate-to-severe obstructive sleep apnea but without overt cardiovascular disease exhibited delayed reaction time in response to flicker, as well as decreased dilation amplitude, dilation slope, and postflicker constriction, which can be early indicators for future vascular complications [79]. However, continuous positive airway pressure (CPAP) withdrawal did not affect retinal vascular responses to flickering light, suggesting that there are different effects on macrovascular and microvascular endothelial function [80].…”

Deciphering the Dilemma: Anticoagulation for Heart Failure With Preserved Ejection Fraction (HFpEF)

“…The analysis indicated that anticoagulation therapy was linked to a reduced risk of stroke, but it also carried a higher risk of major bleeding. This underscores the importance of adopting a personalized approach that takes into account individual risk factors [ 51 ]. In a similar vein, a comprehensive review was conducted to examine the effectiveness and safety of antithrombotic treatments, such as anticoagulants and antiplatelet agents, in patients with heart failure, both with and without atrial fibrillation.…”