Abstract P416: Objectively Measured Snoring is Not Associated With Maladaptive Arterial Remodeling in Overweight and Obese Adults

Abstract

Introduction: We previously reported that snoring severity was related to carotid arterial remodeling as characterized by wider inter-adventitial diameter (IAD) and greater intima-media thickness (IMT) in overweight and obese adults without obstructive sleep apnea (OSA). Considered to be an adaptive mechanism to maintain circumferential wall and shear stress homeostasis and a natural process in the setting of aging, early arterial remodeling is associated with cardiovascular morbidity and mortality. Elevations in arterial circumferential wall tension (CWT) and stress (CWS) in the setting of this compensatory arterial remodeling is considered maladaptive. We aimed to examine the association between snoring severity and CWT and CWS in adults with or without OSA. Methods: Cross-sectional analyses were conducted using 24-month follow up data from the Slow Adverse Vascular Effects lifestyle intervention study. The original population consisted of 349 overweight/obese (BMI 25-40 kg/m 2 ) adults aged 20-45 years old without hypertension or diabetes. The snoring index (SI) and oxygen desaturation index (ODI) were measured by the ResMed ApneaLink device among 122 participants. Snoring/OSA was categorized into three groups: OSA (ODI≥5; n=41), heavy snoring (ODI<5, ≥median SI; n=40), and low snoring (ODI<5, below-median SI; n=41). B-mode carotid ultrasound was used to measure end-diastole mean common carotid artery (CCA) IMT and lumen diameter (LD). Mean CWT (kPa*mm) and CWS (kPa) were calculated using Laplace’s law: CWT=MAP*(LD/2) and CWS= CWT/IMT; CCA wall to lumen ratio (WLR) = IMT/ LD. We used multiple linear regression to assess the association between snoring/OSA categories and CWT, CWS, and WLR adjusting for intervention group, age, sex, race, pulse pressure, BMI, non-HDL cholesterol, and fasting glucose, . Results: Participants were, on average, 40.1 ± 5.9 years old with a BMI of 31.6 ± 4.4 kg/m 2 ; 76.2% were women and 82% were white. Most CVD risk factors differed across snoring/OSA categories, including age, BMI, lipids, and fasting glucose, with risk factors worse in the OSA and heavy snoring groups compared to the low snoring group (all p <0.05). In unadjusted analyses, CWT was higher in both heavy snoring (32.71 ± 4.74) and OSA (33.74 ± 5.09) groups compared to the low snoring group (29.94 ± 4.51; all p<0.01). Differences were also noted in WLR between the low snoring and OSA groups (0.11 ± 0.01 vs. 0.12 ± 0.02; p<0.05). Between-group differences in CWT were attenuated (p=0.09) and eliminated in WLR after multivariable adjustment. Differences in CWS across snoring/OSA categories were not observed. Conclusion: Our findings suggest that, in overweight and obese young to middle-aged adults without hypertension or diabetes, objectively measured snoring may not be associated with maladaptive arterial remodeling after accounting for traditional CVD risk factors.