Cardiovascular Function in Obstructive Sleep Apnea Patients with Controlled Hypertension
- 49 Downloads
This study investigated hemodynamic characteristics of obstructive sleep apnea (OSA) accompanied by hypertensive disease in obese men, in whom blood pressure was pharmacologically controlled within the normal range, not exceeding 140/90 mmHg. There were 21 severe OSA patients (mean age 54.1 ± 9.3 years, apnea-hypopnea index of 47.1 ± 18.8 episodes per hour) included in the study, in whom OSA was diagnosed with polysomnography. The control group consisted of healthy normotensive age-matched subjects. Hemodynamic profile was recorded nonivasively with impedance cardiography. Brachial blood pressure and radial artery tonometry were performed to capture and reconstruct peripheral radial and central aortic pressure waveforms in both groups of subjects. Compared to healthy men, OSA patients had a significantly higher body mass index (BMI); the mean increase in BMI amounted to 6.4 ± 1.2 kg/m2. The patients also presented significant differences in the hemodynamic profile. The difference consisted of a faster heart rate, higher peripheral pulse pressure, and reduced blood flow acceleration and velocity indices, describing myocardial contractility. Notably, the significance of hemodynamic differences in OSA patients disappeared in the analysis adjusted for the outstanding increase in BMI. In conclusion, the findings strongly suggest that obesity rather than the hypertensive disease per se is a source of hemodynamic consequences in OSA patients.
KeywordsArterial blood pressure Body mass Cardiovascular function Hemodynamics Hypertension Obesity Obstructive sleep apnea
The authors would like to thank all the participants involved in this study. MK and MG have equal contributions to this article.
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Poznan University of Medical Sciences (approval no. 278/14).
Written informed consent was obtained from all individual participants included in the study.
- Beck FW, Prasad AS, Kaplan J, Fitzgerald JT, Brewer GJ (1997) Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. Am J Phys 272:E1002–E1007Google Scholar
- Iber C, Ancoli-Israel S, Chesson AL, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
- Khan A, Harrison SL, Kezirian EJ, Ancoli-Israel S, O’Hearn D, Orwoll E, Redline S, Ensrud K (2013) Obstructive sleep apnea during rapid eye movement sleep, daytime sleepiness, and quality of life in older men in Osteoporotic Fractures in Men (MrOS) Sleep Study. J Clin Sleep Med 15:191–198Google Scholar
- Koren D, Chirinos JA, Katz LEL, Mohler ER, Gallagher PR, Mitchell GF, Marcus CL (2015) Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents. Int J Obes 39:1086–1093Google Scholar
- Rodgers A, MacMahon S, Gamble G, Slattery J, Sandercock P, Warlow C (1996) Blood pressure and risk of stroke in patients with cerebrovascular disease: The United Kingdom Transient Ischaemic Attack Collaborative Group. Br Med J 313:147Google Scholar
- Schneider A, Krauze T, Mińczykowski A, Dziarmaga M, Piskorski J, Szczepanik A, Banaszak A, Guzik P, Wykrętowicz A (2018) Arterial excess-reservoir pressure integral as a predictor of cardiovascular complications in patients with acute coronary syndrome. Pol Arch Intern Med 128:228–234PubMedGoogle Scholar
- Shivalkar B, Van De Heyning C, Kerremans M, Rinkevich D, Verbraecken J, De Backer W, Vrints C (2006) Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol 47:1433–1439PubMedGoogle Scholar
- Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 21:93–111PubMedGoogle Scholar
- Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM (2015) Recommendations for improving and standardizing vascular research on arterial stiffness. Hypertension 66:698–722PubMedPubMedCentralGoogle Scholar
- Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 71:2199–2269PubMedGoogle Scholar
- Young T, Plata M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing in middle-aged adults. N Engl J Med 328:1230–1235Google Scholar