Arterial stiffness and obstructive sleep apnea in patients with arterial hypertension and continuous positive airway pressure therapy
Keywords:arterial hypertension, obstructive sleep apnea, continuous positive airway pressure, blood pressure, arterial stiffness, pulse wave velocity
Background. Obstructive sleep apnea (OSA), especially severe, is related to fatal and non-fatal cardiovascular events. OSA and arterial hypertension (AH) have significant correlations, and this comorbidity is very common and is associated with an increased risk of cardiovascular diseases. One of the causes is an increased arterial stiffness. Aortic pulse wave velocity is a highly reproducible noninvasive indicator of arterial stiffness recommended in current guidelines for evaluation of cardiovascular risk. The purpose of the study was to assess the arterial stiffness changes in patients with AH and OSA and possibilities of its correction by continuous positive airway pressure (CPAP) therapy. Materials and methods. One hundred and eighty-five patients with mild and moderate AH (49.80 ± ± 0.80 years old) were enrolled in the study and divided into groups: group 1 — those who had OSA (n = 148), group 2 — individuals without OSA (controls, n = 37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, evaluation of daytime sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and assessment of pulse wave velocity. The 10-month follow-up study included 105 patients, who were divided into 4 subgroups: A — those with moderate to severe OSA on CPAP (n = 23); B — individuals with moderate to severe OSA without CPAP (n = 29); C — patients with mild OSA (n = 29); D — people without OSA (controls, n = 24). All examinees received similar antihypertensive therapy according to 2013 European Society of Hypertension/European Society of Cardiology Guidelines. Results. Patients with AH and OSA (mean apnea-hypopnea index of 38.10 ± 2.51 events/h) compared to those without OSA (mean apnea-hypopnea index of 3.02 ± 0.25 events/h) had significantly higher body mass index (35.20 ± 0.57 kg/m2 vs 30.60 ± 0.79 kg/m2, P < 0.001), as well as blood glucose level (107.2 ± 2.2 mg/dl vs 98.0 ± 2.5 mg/dl, P = 0.045), uric acid level (6.17 ± 0.10 mg/dl vs 5.5 ± 0.3 mg/dl, P = 0.048) and left ventricular mass index (115.80 ± 2.39 g/m2 vs 104.60 ±
± 4.56 g/m2, P = 0.035). During 10 months of follow-up, patients with AH and OSA on CPAP therapy reported a significant decrease in pulse wave velocity in elastic arteries (from 12.20 ± 0.63 m/s to 10.05 ± 0.43 m/s, P = 0.009), office systolic blood pressure (from 143.8 ± 132.7 mm Hg to 132.70 ± ± 2.33 mm Hg; P = 0.021) and diastolic blood pressure (from 93.80 ± 3.31 mm Hg to 86.00 ± 3.19 mm Hg; P = 0.012). Central systolic blood pressure also decreased (from 130.30 ±
± 3.97 mm Hg to 119.70 ± 2.97 mm Hg; P = 0.012). Conclusions. Combination of continuous positive airway pressure therapy and antihypertensive treatment improves arterial elasticity and helps achieve target blood pressure in hypertensive patients with moderate to severe obstructive sleep apnea.
Somers V.K., White D.P., Amin R., Abraham W.T., Costa F. et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College оf Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. 2008, Sep 2. 118(10). 1080-1111. doi: 10.1161/Circulation AHA.107.189375. Epub 2008, Aug 25.
Peppard P.E., Young T., Barnet J.H., Palta M., Hagen E.W. et al. Increased prevalence of sleep-disordered brea-thing in adults. Am. J. Epidemiol. 2013, May 1. 177(9). 1006-1014. doi: 10.1093/aje/kws342. Epub 2013, Apr 14.
Pedrosa R.P., Drager L.F., Gonzaga C.C., Sousa M.G., de Paula L.K. et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011. 58. 811-817. doi: 10.1161/HYPERTENSIONAHA.111.179788.
Floras J.S. Sleep apnea and cardiovascular risk. J. Cardiol. 2014 Jan. 63(1). 3-8. doi: 10.1016/j.jjcc.2013.08.009. Epub 2013, Sep 29.
Baguet J.P., Nadra M., Barone-Rochette G., Ormezzano O., Pierre H. et al. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc. Health Risk Ma-nag. 2009. 5. 1063-1073. Epub 2009, Dec 29. doi: 10.2147/vhrm.s8300.
Kaynak D., Göksan B., Kaynak H., Degirmenci N., Daglioglu S. Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries? Eur. J. Neurol. 2003 Sep. 10(5). 487-493. doi: 10.1046/j.1468-1331.2003.00658.x.
Baguet J.P., Hammer L., Lévy P., Pierre H., Launois S. et al. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest. 2005 Nov. 128(5). 3407-3412. doi: 10.1378/chest.128.5.3407.
Drager L.F., Bortolotto L.A., Lorenzi M.C., Figueiredo A.C., Krieger E.M. et al. Early signs of atherosclerosis in obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 2005, Sep 1. 172(5). 613-618. Epub 2005, May 18. doi: 10.1164/rccm.200503-340OC.
Tsioufis C., Thomopoulos K., Dimitriadis K., Amfilochiou A., Tousoulis D. et al. The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J. Hypertens. 2007 Jan. 25(1). 141-146. doi: 10.1097/HJH.0b013e32801092c1.
Protogerou A.D., Laaban J.P., Czernichow S., Kostopoulos C., Lekakis J., Safar M.E., Blacher J. Structural and functional arterial properties in patients with obstructive sleep apnoea syndrome and cardiovascular comorbidities. J. Hum. Hypertens. 2008 Jun. 22(6). 415-422. Epub 2007, Dec 13. doi: 10.1038/sj.jhh.1002318.
Epstein L.J., Kristo D., Strollo P.J. Jr, Friedman N., Malhotra A. et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med. 2009, Jun 15. 5(3). 263-276. PMCID: PMC2699173.
Collop N.A., Anderson W.M., Boehlecke B., Claman D., Goldberg R. et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Aca-demy of Sleep Medicine. J. Clin. Sleep Med. 2007. 3. 737-747. PMCID: PMC2556918.
Mancia G., Fagard R., Narkiewicz K., Redo’n J., Zanchetti A. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. TheTask Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension. 2013. 31. 1281-1357 doi: 10.1097/01.hjh.0000431740.32696.cc.
Johns M.W. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991. 14. 540-545. doi: 10.1093/sleep/14.6.540.
Iber C., Ancoli-Israel S., Chesson A.L., Quran S.F. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine, 2007.
Kapur V.K., Auckley D.H., Chowdhuri S., Kuhlmann D.C., Mehra R., Ramar K., Harrod C.G. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline J. Clin. Sleep Med. 2017, Mar 15. 13(3). 479-504. doi: 10.5664/jcsm.6506.
SphygmoCor; AtCor Medical, Sydney, Australia (www.atcormedical.com).
Chen C.H., Nevo E., Fetics B., Pak P.H., Yin F.C., Maughan W.L., Kass D.A. et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure validation of generalized transfer function. Circulation. 1997. 95. 1827-1836. doi: 10.1161/01.cir.95.7.1827.
Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachskampf, Elyse Foster Patricia A Pellikka et al. Re-commendations for chamber quantification. Eur. J. Echocardiogr. 2006. 7. 79-108. doi: 10.1016/j.euje.2005.12.014.
Dustan H.P. 50th anniversary historical article: hypertension. J. Am. Coll. Cardiol. 1999. 33. 595-597. doi: 10.1016/s0735-1097(99)00069-8.
Cruickshank J.K., Rezailashkajani M., Goudot G. Arterial stiffness, fatness, and physical fitness: ready for intervention in childhood and across the life course? Hypertension. 2009 Apr. 53(4). 602-4. doi: 10.1161/HYPERTENSIONAHA.108.128033. Epub 2009, Mar 9.
Ikonomidis I., Lekakis J., Papadopoulos C., Triantafyllidi H., Paraskevaidis I. et al. Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension. Am. J. Hypertens. 2008 Jul. 21(7). 806-813. doi: 10.1038/ajh.2008.172. Epub 2008, May 22.
Triantafyllidi H., Arvaniti C., Lekakis J., Ikonomidis I., Siafakas N. et al. Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. Am. J. Hypertens. 2009 May. 22(5). 525-530. doi: 10.1038/ajh.2009.35. Epub 2009, Mar 5.
Mule G., Cottone S., Vadala A., Volpe V., Mezzatesta G., Mongiovì R., Piazza G., Nardi E., Andronico G., Cerasola G. Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. Journal of Internal Medicine. 2004. 256. 22-29. doi: 10.1111/j.1365-2796.2004.01338.x.
Roman M.J., Devereux R.B., Kizer J.R., Lee E.T., Galloway J.M. Tauqeer Ali, Jason G. Umans, Barbara V. Howard. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007 Jul. 50(1). 197-203. doi: 10.1161/HYPERTENSIONAHA.107.089078.
Mitchell G.F., Hwang S.J., Vasan R.S., Larson M.G., Pencina M.J. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation. 2010, Feb 2. 121(4). 505-511. doi: 10.1161/CIRCULATIONAHA.109.886655. Epub 2010, Jan 18.
Tine Willum Hansen, Jan A. Staessen, Christian Torp-Pedersen, Susanne Rasmussen, Lutgarde Thijs Hans Ibsen, Jørgen Jeppesen. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in general population. Circulation. 2006. 113. 664-670. doi: 10.1161/CIRCULATIONAHA.105.579342.
Inoue N., Maeda R., Kawakami H., Tomoki Shokawa, Hideya Yamamoto, Chikako Ito, Hideo Sasaki. Aortic pulse wave velocity predicts cardiovascular mortality in middle-aged and elderly Japanese men Circ. J. 2009. Vol. 73. № 3. P. 549-553. doi: 10.1253/circj.cj-08-0492.
Laurent S., Alivon M., Beaussier H., Boutouyrie P. Aortic stiffness as a tissue biomarker for predicting future cardiovascular events in asymptomatic hypertensive subjects. Ann. Med. 2012 Jun. 44. Suppl. 1. 93-97. doi: 10.3109/07853890.2011.653398.
Muiesan M.L., Salvetti M., Paini A., Monteduro C., Rosei C.A. Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J. Hypertens. 2010 Sep. 28(9). 1935-1943. doi: 10.1097/HJH.0b013e32833b4a55.
Mattace-Raso F.U., van der Cammen T.J., Hofman A., van Popele N.M., Bos M.L., Maarten A.D.H. Schalekamp, Roland Asmar, Robert S. Reneman, Arnold P.G. Hoeks, Monique M.B. Breteler, Jacqueline C.M. Witteman. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006, Feb 7. 113(5). 657-663. doi: 10.1161/CIRCULATIONAHA.105.555235.
Redfield M.M., Jacobsen S.J., Borlaug B.A., Rodeheffer R.J., Kass D.A. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005, Oct 11. 112(15). 2254-2262. doi: 10.1161/CIRCULATIONAHA.105.541078.
Ikonomidis I., Lekakis J., Stamatelopoulos K., Markomihelakis N., Kaklamanis P.G., Mavrikakis M. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s disease. J. Am. Coll. Cardiol. 2004, Mar 17. 43(6). 1075-1081. doi: 10.1016/j.jacc.2003.10.042.
Eren M., Gorgulu S., Uslu N., Celik S., Dagdeviren B., Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart. 2004 Jan. 90(1). 37-43. doi: 10.1136/heart.90.1.37.
Noda A., Nakata S., Fukatsu H., Yasuda Y., Miyao E., Miyata S., Yasuma F., Murohara T., Yokota M., Koike Y. Aortic pressure augmentation as a marker of cardiovascular risk in obstructive sleep apnea syndrome. Hypertens Res. 2008 Jun. 31(6). 1109-1114. doi: 10.1291/hypres.31.1109.
Korcarz C.E., Gepner A.D., Peppard P.E., Young T.B., Stein J.H. The Effects of Sleep-Disordered Breathing on Arterial Stiffness are Modulated by Age. Sleep. 2010 Aug. 33(8). 1081-1085. doi: 10.1164/rccm.200703-500OC.
Drager L.F., Bortolotto L.A., Figueiredo A.C., Krieger E.M., Lorenzi G.F. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 2007. 176. 706-712. doi: 10.1164/rccm.200703-500OC.
Kohler M., Pepperell J.C., Casadei B., Craig S., Crosthwaite N., Stradling J.R., Davies R.J.O. CPAP and measures of cardiovascular risk in males with OSAS. Eur. Respir. J. 2008. 32. 1488-1496. doi: 10.1183/09031936.00026608.
Jones A., Vennelle M., Connell M., Graham McKillop, David E. Newby, Neil J. Douglas, Renata L. Riha. The effect of continuous positive airway pressure therapy on arterial stiffness and endothelial function in obstructive sleep apnea: a randomized controlled trial in patients without cardiovascular disease. Sleep Med. 2013. 14. 1260-1265. doi: 10.1016/j.sleep.2013.08.786.
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