Impairment of Vascular Endothelial Function and Left Ventricular Filling: Association With the Severity of Apnea-Induced Hypoxemia During Sleep

doi:10.1378/chest.119.4.1085

Chest

Volume 119, Issue 4, April 2001, Pages 1085-1091

https://doi.org/10.1378/chest.119.4.1085 Get rights and content

Study objective

To investigate whether a dose-effect relationship exists between the severity of obstructive sleep apnea (OSA) and subclinical indicators of myocardial or vascular dysfunction.

Design

Cross-sectional study using correlation analysis.

Participants

Twenty subjects referred to our sleep laboratory for screening or therapy of OSA but without regular medication and without known cardiovascular disease.

Measurements

Severity of OSA was quantified by polysomnography. Moreover, nocturnal excretion of norepinephrine was determined. Left ventricular (LV) myocardial function was assessed with Doppler echocardiography. Using ultrasonographic measurements, endothelium-dependent and endothelium-independent conduit artery dilation were measured as flow-mediated and glyceryltrinitrate-induced changes in brachial artery diameter.

Results

Worsening nocturnal hypoxemia, measured as nocturnal oxygen saturation nadir or percentage of sleep time spent in hypoxemia (< 90% hemoglobin oxygen saturation), predicted increased interventricular septum thickness (corrected for age and body mass index), prolonged isovolumetric relaxation time, decreased ratio between peak early and late mitral flow velocities, as well as reduced endothelium-dependent dilatory capacity of the brachial artery (all relationships corrected for cofactor age and with p < 0.05) were observed. Associations between these cardiovascular function markers and nocturnal excretion of norepinephrine followed the same trend, but relations with interventricular septum thickness and flow-mediated artery dilation missed significance (p = 0.064 and p = 0.061, respectively). LV posterior wall thickness, measures of LV systolic function, early mitral flow deceleration time, and endothelium-independent artery dilation were not significantly related to the degree of nocturnal hypoxemia or norepinephrine excretion. None of the correlations with apnea-hypopnea index were statistically significant.

Conclusions

The severity of apnea-related hypoxemia is associated with a gradual deterioration of LV diastolic function as well as large-artery endothelial function.

Section snippets

Patients

All male nonsmokers without regular medication and without history of diseases known to affect the cardiovascular system were selected from a total of 81 subjects consecutively referred to the Sleep Laboratory of the Pulmonary Department of Sahlgrenska University Hospital, Gothenburg, Sweden, for either implementation of nasal continuous positive airway pressure therapy or diagnostic sleep apnea screening. None of the participants received continuous positive airway pressure therapy before or

Sample Characteristics

Characteristics of the study sample are outlined in Table 1. Correlations between measures of OSA severity as well as NE excretion are described in Table 2. While the two measures of hypoxemia were found to be highly redundant (R² = 93.7%), their variance explained only between 48.8% and 67.7% of the variance in AHI and nocturnal NE excretion. AHI was significantly related to BMI (r = 0.509, p = 0.022) whereas all remaining correlations between AHI, SATMIN, HYPOX%, or NE excretion on the one

Discussion

The results of the current study suggest that the severity of apnea-induced HbO₂ desaturations in OSA is associated with a gradual but significant tendency toward reduced LV diastolic function and toward an impaired endothelium-dependent dilatory capacity of conduit arteries.

Considering the relatively small sample size of the present study, narrow sampling criteria providing a relatively homogeneous study group as well as statistical control of the remaining influence of confounding variables

ACKNOWLEDGMENT

We gratefully acknowledge the assistance of Anita Morath-Riha.

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Classic cardiovascular risk factors do not explain all the cardiovascular events. Obstructive sleep apnoea (OSA) has been proposed as a potential and prevalent cardiovascular risk factor. Our study aimed to describe the prevalence of OSA in a middle-aged cohort with mild–moderate cardiovascular risk and evaluate its association with atherosclerotic disease.
This is an observational cross-sectional ancillary study of the ILERVAS project which was aimed to study subclinical arterial disease in a cohort with mild–moderate cardiovascular risk. In a sample of consecutive subjects, we performed a sleep study and evaluate OSA prevalence and its association with carotid and femoral atheroma plaques and atherosclerotic burden.
Overall, 966 subjects with a median age of 57 years (25–75th percentile; 52–62) and a body mass index (BMI) of 28.5 kg/m² (25.6–31.6) were included. Of these, 72.6% (69.7%–75.3%) had OSA (apnoea–hypopnoea index (AHI) ≥ 5/h); 35.7% (32.8%–38.8%) had mild OSA (AHI 5–14.9/h) and 36.9% (33.9%–39.9%) had moderate/severe OSA (AHI ≥ 15/h). Mean oxygen saturation and the percentage of time with oxygen saturation < 90% (CT90) were associated with atherosclerotic burden (e^β (95%CI) 0.932 (0.892, 0.974); 1.005 (1.002, 1.009), respectively) and total plaque (OR (95%CI) 0.88 (0.797,0.971); 1.013 (1.004,1.021), respectively). No association with the AHI or oxygen desaturation index was found.
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: This work was supported by grants from the Swedish Medical Research Council (grant No. 9892), the Medical Faculty of Gothenburg University, and the Swedish Heart and Lung Foundation.

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Chest

Clinical Investigations: SleepImpairment of Vascular Endothelial Function and Left Ventricular Filling: Association With the Severity of Apnea-Induced Hypoxemia During Sleep

Study objective

Design

Participants

Measurements

Results

Conclusions

Section snippets

Patients

Sample Characteristics

Discussion

ACKNOWLEDGMENT

Chest

Clin Chest Med

Lancet

Chest

Lancet

Mayo Clin Proc

J Chromatogr

J Am Coll Cardiol

Chest

Chest

Chest

Am J Med Sci

Am J Cardiol

Chest

Chest

Am Heart J

Am J Cardiol

Chest

Is high and fluctuating muscle nerve sympathetic activity in the sleep apnoea syndrome of pathogenetic importance for the development of hypertension?

J Hypertens Suppl

Hemodynamic studies in sleep apnea

A community study of snoring and sleep-disordered breathing: health outcomes

Am J Respir Crit Care Med

The impact of obesity on left ventricular mass and geometry: the Framingham Heart Study

JAMA

Ventricular mass in hypertensive and normotensive obese subjects

Int J Obes Relat Metab Disord

Clinical Investigations: Sleep
Impairment of Vascular Endothelial Function and Left Ventricular Filling: Association With the Severity of Apnea-Induced Hypoxemia During Sleep