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Sleep apnoea and endothelial dysfunction: An individual patient data meta-analysis.
Vanessa Bironneau1, Renaud Tamisier2, Wojciech Trzepizur3
1INSERM U1063, SOPAM, Angers University, F-49045, Angers, France.
Sleep Medicine Reviews
|April 3, 2020
Summary
Severe obstructive sleep apnoea (OSA) is linked to endothelial dysfunction, a precursor to cardiovascular events, in adults without existing heart disease. This finding highlights the importance of diagnosing and managing OSA to prevent future cardiovascular complications.
Area of Science:
- Cardiology
- Sleep Medicine
- Vascular Biology
Background:
- Obstructive sleep apnoea (OSA) is a prevalent condition associated with cardiovascular disease.
- Endothelial dysfunction, a key predictor of cardiovascular events, can be assessed using the reactive hyperaemia index (RHI).
- The relationship between OSA severity and endothelial dysfunction requires further investigation using robust data.
Purpose of the Study:
- To investigate the association between obstructive sleep apnoea (OSA) severity and endothelial dysfunction, measured by RHI.
- To determine if OSA is an independent risk factor for endothelial dysfunction in patients without overt cardiovascular disease.
- To explore this association across different patient subgroups.
Main Methods:
- An individual patient data meta-analysis was conducted using data from 12 studies.
- Peripheral arterial tonometry (PAT) was used to measure RHI, and overnight polysomnography or respiratory polygraphy assessed OSA severity.
- Endothelial dysfunction was defined as a log-transformed RHI < 0.51. Statistical adjustments were made for relevant covariates.
Main Results:
- Among 730 patients without overt cardiovascular disease, severe OSA (apnoea-hypopnea index ≥30) was present in 53.0%, and 22.5% had endothelial dysfunction.
- After adjusting for confounders, severe OSA (OR: 2.27 [1.12-4.60]; p=0.02) and nocturnal hypoxemia were significantly associated with endothelial dysfunction.
- The association between severe OSA and endothelial dysfunction was not significant in patients with hypertension, obesity, and/or diabetes.
Conclusions:
- Severe obstructive sleep apnoea is independently associated with an increased risk of endothelial dysfunction in adults without overt cardiovascular disease.
- Endothelial dysfunction may be a mechanism linking OSA to late cardiovascular events.
- Targeting OSA management could be crucial for preventing cardiovascular complications.
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