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Obstructive sleep apnea and abdominal aortic calcification: Is there an association independent of comorbid risk factors?

      Highlights

      • We examine the association between OSA severity and abdominal aortic calcification.
      • Abdominal aortic calcification increases in severe OSA.
      • Traditional risk factors are more potent to increase aortic calcification than OSA.
      • OSA may enhance atherosclerosis mainly through comorbid cardiometabolic disorders.

      Abstract

      Background

      No studies have addressed the relationship between obstructive sleep apnea (OSA) and abdominal aortic calcification (AAC), a marker for subclinical atherosclerosis and future cardiovascular events.

      Objectives

      To investigate 1) the association between OSA severity and AAC, and 2) whether OSA can impact the extent of AAC independent of comorbid atherogenic risk factors.

      Methods

      390 participants aged 40–70 years underwent polysomnography and abdominal computed tomography. AAC was separately quantified in the upper and lower abdominal aorta using the modified Agatston scoring method, and the total AAC score was calculated as a sum of the two scores. OSA was defined as none/mild (apnea-hypopnea index [AHI] <15, n = 87), moderate (AHI 15–30, n = 129), and severe (AHI ≥30, n = 174).

      Results

      Log-transformed total AAC score adjusted for age and body mass index (BMI) was greater in participants with an elevated AHI (3.4 for none/mild OSA, 3.7 for moderate OSA, and 4.2 for severe OSA, p = 0.04). Multivariate linear regression analysis including age and BMI as covariates showed that severe OSA was associated with higher scores for the lower and total AAC (β = 0.15 and 0.14, p = 0.01 and 0.01, respectively). The association did not persist after additionally adjusting for traditional atherogenic risk factors including visceral fat, smoking, hypertension, dyslipidemia, and diabetes.

      Conclusions

      Severe OSA was associated with a greater extent of AAC, which was dependent on coexisting atherogenic risk factors. Comorbid cardiometabolic disorders may largely mediate the association of OSA with subclinical atherosclerosis.

      Keywords

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      References

        • Drager L.F.
        • Bortolotto L.A.
        • Maki-Nunes C.
        • et al.
        The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome.
        Atherosclerosis. 2010; 208: 490-495
        • Drager L.F.
        • Polotsky V.Y.
        • Lorenzi-Filho G.
        Obstructive sleep apnea: an emerging risk factor for atherosclerosis.
        Chest. 2011; 140: 534-542
        • Ali S.S.
        • Oni E.T.
        • Warraich H.J.
        • et al.
        Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block!.
        Sleep. Med. Rev. 2014; 18: 379-391
        • Sangiorgi G.
        • Rumberger J.A.
        • Severson A.
        • et al.
        Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology.
        J. Am. Coll. Cardiol. 1998; 31: 126-133
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • et al.
        Coronary calcium as a predictor of coronary events in four racial or ethnic groups.
        N. Engl. J. Med. 2008; 358: 1336-1345
        • Bastos Goncalves F.
        • Voute M.T.
        • Hoeks S.E.
        • et al.
        Calcification of the abdominal aorta as an independent predictor of cardiovascular events: a meta-analysis.
        Heart. 2012; 98: 988-994
        • Sorajja D.
        • Gami A.S.
        • Somers V.K.
        • Behrenbeck T.R.
        • Garcia-Touchard A.
        • Lopez-Jimenez F.
        Independent association between obstructive sleep apnea and subclinical coronary artery disease.
        Chest. 2008; 133: 927-933
        • Kim S.H.
        • Cho G.Y.
        • Baik I.
        • et al.
        Association of coronary artery calcification with obstructive sleep apnea and obesity in middle-aged men.
        Nutr. Metab. Cardiovasc. Dis. 2010; 20: 575-582
        • Weinreich G.
        • Wessendorf T.E.
        • Erdmann T.
        • et al.
        Association of obstructive sleep apnoea with subclinical coronary atherosclerosis.
        Atherosclerosis. 2013; 231: 191-197
        • Kwon Y.
        • Duprez D.A.
        • Jacobs D.R.
        • et al.
        Obstructive sleep apnea and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis study.
        J. Am. Heart Assoc. 2014; 3: e001241
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte Jr., M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J. Am. Coll. Cardiol. 1990; 15: 827-832
        • Murase K.
        • Mori K.
        • Yoshimura C.
        • et al.
        Association between plasma neutrophil gelatinase associated lipocalin level and obstructive sleep apnea or nocturnal intermittent hypoxia.
        PLoS One. 2013; 8: e54184
        • Iber C.
        • Ancoli-Israel S.
        • Chesson A.
        • Quan S.
        The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications.
        American Academy of Sleep Medicine, Westchester, IL, USA2007
        • Harada Y.
        • Oga T.
        • Chihara Y.
        • Azuma M.
        • Murase K.
        • Toyama Y.
        • et al.
        Differences in associations between visceral fat accumulation and obstructive sleep apnea by sex.
        Ann. Am. Thorac. Soc. 2014; 11: 383-391
        • Teramoto T.
        • Sasaki J.
        • Ueshima H.
        • et al.
        Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese.
        J. Atheroscler. Thromb. 2007; 14: 45-50
        • Jayalath R.W.
        • Mangan S.H.
        • Golledge J.
        Aortic calcification.
        Eur. J. Vasc. Endovasc. Surg. 2005; 30: 476-488
        • New S.E.
        • Aikawa E.
        Cardiovascular calcification: an inflammatory disease.
        Circ. J. 2011; 75: 1305-1313
        • Natural history of aortic and coronary atherosclerotic lesions in youth
        Findings from the PDAY study. Pathobiological determinants of atherosclerosis in youth (PDAY) research group.
        Arterioscler. Thromb. 1993; 13: 1291-1298
        • Jensky N.E.
        • Criqui M.H.
        • Wright M.C.
        • Wassel C.L.
        • Brody S.A.
        • Allison M.A.
        Blood pressure and vascular calcification.
        Hypertension. 2010; 55: 990-997
        • Wong N.D.
        • Lopez V.A.
        • Allison M.
        • et al.
        Abdominal aortic calcium and multi-site atherosclerosis: the multiethnic study of atherosclerosis.
        Atherosclerosis. 2011; 214: 436-441
        • Fox C.S.
        • Hwang S.J.
        • Massaro J.M.
        • et al.
        Relation of subcutaneous and visceral adipose tissue to coronary and abdominal aortic calcium (from the Framingham Heart Study).
        Am. J. Cardiol. 2009; 104: 543-547
        • Shaaban A.M.
        • Duerinckx A.J.
        Wall shear stress and early atherosclerosis: a review.
        AJR Am. J. Roentgenol. 2000; 174: 1657-1665
        • Kauppila L.I.
        • Polak J.F.
        • Cupples L.A.
        • Hannan M.T.
        • Kiel D.P.
        • Wilson P.W.
        New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study.
        Atherosclerosis. 1997; 132: 245-250