Long-term variations of arterial stiffness in patients with obesity and obstructive sleep apnea treated with continuous positive airway pressure.

Louis-Marie Galerneau,Marisa R Bonsignore,Jean-Christian Borel,Marie Joyeux-Faure,Ingrid Jullian-Desayes,Jean-Louis Pépin,Meriem Benmerad,Sébastien Bailly,Renaud Tamisier

doi:10.1371/journal.pone.0236667

Abstract

Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.

Highlights

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete obstruction of the upper airway during sleep, resulting in chronic intermittent hypoxia and sleep fragmentation
pulse wave velocity (PWV) progression in Continuous positive airway pressure (CPAP)-treated OSA patients is mainly related to pre-existing cardiometabolic comorbidities and not influenced by CPAP adherence
In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment

Summary

Introduction

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete obstruction of the upper airway during sleep, resulting in chronic intermittent hypoxia and sleep fragmentation. [1] The association between OSA and cardiovascular diseases has been clearly demonstrated, OSA being considered as an independent risk factor for cardiovascular and metabolic co-morbidities and mortality. [2,3,4] Continuous positive airway pressure (CPAP), the first line therapy for OSA, was reported to reduce the incidence of late cardiovascular events in patients with severe OSA in cohort observational studies. [5] in the largest recent randomized controlled trials, CPAP treatment did not reduce mortality or the occurrence of late cardiovascular events in intention to treat analyses. [11,14] To date, no study has reported long term variations of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration.

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