Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice.

Jinmei Luo,Xiaona Wang,Yi Xiao,Wenhao Cao,Zijian Guo,Junwei Guo,Linfan Su,Li Zhang,Rong Huang

doi:10.3389/fcvm.2021.716916

Abstract

Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications.Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups.Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P > 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052).Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.

Highlights

Obstructive sleep apnea (OSA) is the most common sleep breathing disorder
After controlling for age, body mass index (BMI), rhinitis, hypertension, smoking, glucose level, HbA1C, hemoglobin (Hb), creatinine (Cr), total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDLC), and high-density lipoprotein (HDL), we found that TNF-α was negatively associated with the mean SpO2 (r = −0.258, P = 0.043; Figure 3)
Our study comprehensively assessed systemic inflammatory biomarkers and vascular endothelial function in Chinese middleaged men with moderate and severe OSA without severe complications. We found that these patients had only low levels of systemic inflammatory biomarkers and vascular endothelial biomarkers, which were mainly manifested by elevated high-sensitivity C-reactive protein (hsCRP), TNF-α, and vascular endothelial growth factor (VEGF) levels

Summary

Introduction

Obstructive sleep apnea (OSA) is the most common sleep breathing disorder. A literature-based analysis in 2019 indicated that ∼936 million patients had OSA in China, which was the country with the largest affected population [1]. Even mild OSA without comorbidities may lead to vascular endothelial dysfunction and elevated arterial stiffness [6,7,8], which characterizes the early stage of arterial atherosclerosis and can predict cardiovascular events in the future [9,10,11,12,13]. These subclinical abnormalities may provide additional evidence for the primary prevention of coronary heart disease and treatment response assessment

Results

Discussion

Conclusion