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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome.Atherosclerosis. 2010; 208: 490-495
- Obstructive sleep apnea: an emerging risk factor for atherosclerosis.Chest. 2011; 140: 534-542
- 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
- 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
- Coronary calcium as a predictor of coronary events in four racial or ethnic groups.N. Engl. J. Med. 2008; 358: 1336-1345
- Calcification of the abdominal aorta as an independent predictor of cardiovascular events: a meta-analysis.Heart. 2012; 98: 988-994
- Independent association between obstructive sleep apnea and subclinical coronary artery disease.Chest. 2008; 133: 927-933
- Association of coronary artery calcification with obstructive sleep apnea and obesity in middle-aged men.Nutr. Metab. Cardiovasc. Dis. 2010; 20: 575-582
- Association of obstructive sleep apnoea with subclinical coronary atherosclerosis.Atherosclerosis. 2013; 231: 191-197
- Obstructive sleep apnea and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis study.J. Am. Heart Assoc. 2014; 3: e001241
- Quantification of coronary artery calcium using ultrafast computed tomography.J. Am. Coll. Cardiol. 1990; 15: 827-832
- Association between plasma neutrophil gelatinase associated lipocalin level and obstructive sleep apnea or nocturnal intermittent hypoxia.PLoS One. 2013; 8: e54184
- The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications.American Academy of Sleep Medicine, Westchester, IL, USA2007
- Differences in associations between visceral fat accumulation and obstructive sleep apnea by sex.Ann. Am. Thorac. Soc. 2014; 11: 383-391
- 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
- Aortic calcification.Eur. J. Vasc. Endovasc. Surg. 2005; 30: 476-488
- Cardiovascular calcification: an inflammatory disease.Circ. J. 2011; 75: 1305-1313
- Findings from the PDAY study. Pathobiological determinants of atherosclerosis in youth (PDAY) research group.Arterioscler. Thromb. 1993; 13: 1291-1298
- Blood pressure and vascular calcification.Hypertension. 2010; 55: 990-997
- Abdominal aortic calcium and multi-site atherosclerosis: the multiethnic study of atherosclerosis.Atherosclerosis. 2011; 214: 436-441
- 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
- Wall shear stress and early atherosclerosis: a review.AJR Am. J. Roentgenol. 2000; 174: 1657-1665
- 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
Article info
Publication history
Published online: April 26, 2015
Accepted:
April 22,
2015
Received in revised form:
March 23,
2015
Received:
January 7,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
