Advertisement

Different effects of apnea during rapid eye movement period on peripheral arterial stiffness in obstructive sleep apnea

  • Cheng-Yu Lin
    Affiliations
    Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Search for articles by this author
  • Chin-Shan Ho
    Affiliations
    Department of Adapted Physical Education, National Taiwan Sport University, Taoyuan, Taiwan
    Search for articles by this author
  • Wei-Chuan Tsai
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Search for articles by this author
  • Ju-Yi Chen
    Correspondence
    Corresponding author. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Search for articles by this author

      Highlights

      • Obstructive sleep apnea (OSA) is associated with arterial stiffness but is rarely studied. Among 275 patients recruited, 40.7% had rapid eye movement (REM)-predominant OSA.
      • We used polysomnography to assess patients' apnea–hypopnea index (AHI) during rapid eye movement (REM) periods (AHI-REM) of sleep.
      • AHI-REM was independently correlated with a clinically useful peripheral arterial stiffness index, compliance index (CI).
      • An increase in the interquartile range of AHI-REM was associated with a 9.6% decrease in CI.
      • AHI-REM may be a suitable surrogate marker for predicting peripheral arterial stiffness in OSA patients.

      Abstract

      Bakground and aims

      Obstructive sleep apnea (OSA) contributes to cardiovascular diseases, including arterial stiffness. The association between OSA and peripheral arterial stiffness indices remains controversial.

      Methods

      This study recruited 275 patients who were referred for sleep apnea study. Arterial stiffness was assessed by peripheral compliance index (CI) and central pulse wave velocity derived from digital volume pulse (PWVDVP) by photoplethysmography. Overnight polysomnography and autonomic nerve system function tests were also conducted.

      Results

      A total of 275 patients (170 men) were recruited. Most were middle-aged and overweight. Most patients (112/275, 40.7%) had rapid eye movement (REM)-predominant OSA. The CI was significantly correlated with the apnea–hypopnea index (AHI) (R = −0.132, p = 0.029) and AHI-REM (R = −0.170, p = 0.005) and AHI non-REM (R = −0.122, p = 0.043). Among models and variable used to predict CI, only male sex (B = −0.708, p = 0.007) and AHI-REM (B = −0.010, p = 0.033) were independent predictors of CI. An increase in the interquartile range of AHI-REM was associated with a 9.6% decrease in CI.

      Conclusions

      AHI-REM was independently correlated with a peripheral arterial stiffness index, CI. AHI-REM may be a suitable surrogate marker for predicting peripheral arterial stiffness in OSA patients.

      Keywords

      Abbreviations:

      AHI (apnea–hypopnea index), ANS (autonomic nervous system), CI (compliance index), EEG (electroencephalography), HRV (heart rate variability), LF/HF (ratio of low-frequency to high-frequency heart rate), NREM (non–rapid eye movement), OSA (obstructive sleep apnea), PSG (polysomnography), PWVba (brachial–ankle pulse wave velocity), PWVCF (carotid–femoral pulse wave velocity), PWVcr (carotid–radial pulse wave velocity), PWVDVP (pulse wave velocity from digital volume pulse), REM (rapid eye movement)
      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 access
      One-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 Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Korcarz C.
        • Stein J.
        • Peppard P.
        • et al.
        Combined effects of sleep disordered breathing and metabolic syndrome on endothelial function: the Wisconsin Sleep Cohort study.
        Sleep. 2014; 37: 1707-1713
        • Korcarz C.
        • Benca R.
        • Barnet J.
        • et al.
        Treatment of obstructive sleep apnea in young and middle-aged adults: effects of positive airway pressure and compliance on arterial stiffness, endothelial function, and cardiac hemodynamics.
        J. Am. Heart Assoc. 2016; 5 (e002930–e002930)
        • Ancoli Israel S.
        • Kripke D.F.
        • Klauber M.R.
        • et al.
        Morbidity, mortality and sleep-disordered breathing in community dwelling elderly.
        Sleep. 1996; 19: 277-282
        • Peppard P.
        • Young T.
        • Barnet J.
        • et al.
        Increased prevalence of sleep-disordered breathing in adults.
        Am. J. Epidemiol. 2013; 177: 1006-1014
        • Somers V.
        • White D.
        • Amin R.
        • et al.
        Sleep apnea and cardiovascular disease: an american heart association/american college of cardiology foundation scientific statement from the american heart association council for high blood pressure research professional education committee, council on clinical cardiology, stroke council, and council on cardiovascular nursing.
        J. Am. Coll. Cardiol. 2008; 52: 686-717
        • Jelic S.
        • Padeletti M.
        • Kawut S.
        • et al.
        Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea.
        Circulation. 2008; 117: 2270-2278
        • Shiina K.
        • Tomiyama H.
        • Takata Y.
        • et al.
        Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study.
        Hypertens. Res. 2006; 29: 433-441
        • Kohler M.
        • Craig S.
        • Nicoll D.
        • et al.
        Endothelial function and arterial stiffness in minimally symptomatic obstructive sleep apnea.
        Am. J. Respir. Crit. Care Med. 2008; 178: 984-988
        • Alberto E.
        • Tanigawa T.
        • Maruyama K.
        • et al.
        Relationships between nocturnal intermittent hypoxia, arterial stiffness and cardiovascular risk factors in a community-based population: the Toon health study.
        J. Atherosclerosis Thromb. 2014; 21: 1290-1297
        • Kuo T.-H.
        • Yang D.-C.
        • Lin W.-H.
        • et al.
        Compliance index, a marker of peripheral arterial stiffness, may predict renal function decline in patients with chronic kidney disease.
        Int. J. Med. Sci. 2015; 12: 530-537
        • Vlachopoulos C.
        • Aznaouridis K.
        • Stefanadis C.
        Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.
        J. Am. Coll. Cardiol. 2010; 55: 1318-1327
        • Mitchell G.
        • Hwang S.-J.
        • Vasan R.
        • et al.
        Arterial stiffness and cardiovascular events: the framingham heart study.
        Circulation. 2010; 121: 505-511
        • Tsai W.-C.
        • Chen J.-Y.
        • Wang M.-C.
        • Wu H.-T.
        • et al.
        Association of risk factors with increased pulse wave velocity detected by a novel method using dual-channel photoplethysmography.
        Am. J. Hypertens. 2005; 18: 1118-1122
        • Townsend R.
        • Wilkinson I.
        • Schiffrin E.
        • et al.
        Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the american heart association.
        Hypertension. 2015; 66: 698-722
        • Chen J.-Y.
        • Tsai W.-C.
        • Wu M.-S.
        • Hsu C.-H.
        • et al.
        Novel Compliance Index derived from digital volume pulse associated with risk factors and exercise capacity in patients undergoing treadmill exercise tests.
        J. Hypertens. 2007; 25: 1894-1899
        • Chou C.-H.
        • Ho C.-S.
        • Tsai W.-C.
        • et al.
        Effects of chronic hepatitis C infection on arterial stiffness.
        J. Am. Soc. Hypertens. 2017 Nov; 11: 716-723
        • Wang M.C.
        • Wu A.B.
        • Cheng M.F.
        • et al.
        Association of arterial stiffness indexes, determined from digital volume pulse measurement and cardiovascular risk factors in chronic kidney disease.
        Am. J. Hypertens. 2011; 24: 544-549
        • Chen J.Y.
        • Chou C.H.
        • Tsai W.C.
        • et al.
        Effects of increased systemic inflammation and central obesity on arterial stiffness in patients with nonalcoholic fatty liver disease.
        J. Am. Soc. Hypertens. 2012; 6: 253-260
        • Chen J.Y.
        • Tsai P.J.
        • Tai H.C.
        • et al.
        Increased aortic stiffness and attenuated lysyl oxidase activity in obesity.
        Arterioscler. Thromb. Vasc. Biol. 2013; 33: 839-846
        • Chou C.H.
        • Tsai W.C.
        • Wang M.C.
        • et al.
        Effects of deranged glucose homeostasis on peripheral arterial stiffness index in patients with pre-diabetes mellitus.
        Int. Heart J. 2013; 54: 27-32
        • Phillips C.
        • Butlin M.
        • Wong K.
        • et al.
        Is obstructive sleep apnoea causally related to arterial stiffness? A critical review of the experimental evidence.
        Sleep Med. Rev. 2013; 17: 7-18
        • Grace K.
        • Hughes S.
        • Horner R.
        Identification of the mechanism mediating genioglossus muscle suppression in REM sleep.
        Am. J. Respir. Crit. Care Med. 2013; 187: 311-319
        • McSharry D.
        • Saboisky J.
        • Deyoung P.
        • et al.
        Physiological mechanisms of upper airway hypotonia during REM sleep.
        Sleep. 2014; 37: 561-569
        • Koo B.
        • Dostal J.
        • Ioachimescu O.
        • et al.
        The effects of gender and age on REM-related sleep-disordered breathing.
        Sleep Breath. 2008; 12: 259-264
        • Resta O.
        • Carpanano G.E.
        • Lacedonia D.
        • et al.
        Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA).
        Respir. Med. 2005; 99: 91-96
        • Somers V.K.
        • Dyken M.E.
        • Clary M.P.
        • et al.
        Sympathetic neural mechanisms in obstructive sleep apnea.
        J. Clin. Invest. 1995; 96: 1897-1904
        • Somers V.K.
        • Dyken M.E.
        • Mark A.L.
        • et al.
        Sympathetic-nerve activity during sleep in normal subjects.
        N. Engl. J. Med. 1993; 328: 303-307
        • Kirby D.A.
        • Verrier R.L.
        Differential effects of sleep stage on coronary hemodynamic function during stenosis.
        Physiol. Behav. 1989; 45: 1017-1020
        • Findley L.J.
        • Wilhoit S.C.
        • Suratt P.M.
        Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea.
        Chest. 1985; 87: 432-436
        • Gami A.
        • Howard D.
        • Olson E.
        • et al.
        Day-night pattern of sudden death in obstructive sleep apnea.
        N. Engl. J. Med. 2005; 352: 1206-1214
        • Rechtschaffen A.
        • Kales A.
        A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.
        U. S. National Institute of Neurological Diseases and Blindness, Neurological Information Network, Bethesda, Md1968
        • Mokhlesi B.
        • Finn L.
        • Hagen E.
        • et al.
        Obstructive sleep apnea during REM sleep and hypertension. results of the Wisconsin Sleep Cohort.
        Am. J. Respir. Crit. Care Med. 2014; 190: 1158-1167
        • Haba Rubio J.
        • Janssens J.-P.
        • Rochat T.
        • et al.
        Rapid eye movement-related disordered breathing: clinical and polysomnographic features.
        Chest. 2005; 128: 3350-3357
        • Ewing D.J.
        • Clarke B.F.
        Diagnosis and management of diabetic autonomic neuropathy.
        Br. Med. J. 1982; 285: 916-918
        • Malliani A.
        • Lombardi F.
        • Pagani M.
        • et al.
        Clinical exploration of the autonomic nervous system by means of electrocardiography.
        Ann. N. Y. Acad. Sci. 1990; 601: 234-246
      1. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task force of the european society of cardiology and the north american society of pacing and electrophysiology.
        Circulation. 1996; 93: 1043-1065
        • Lee H.-Y.
        • Oh B.-H.
        Aging and arterial stiffness.
        Circ. J. 2010; 74: 2257-2262
        • Wolk R.
        • Kara T.
        • Somers V.
        Sleep-disordered breathing and cardiovascular disease.
        Circulation. 2003; 108: 9-12
        • Doonan R.
        • Scheffler P.
        • Lalli M.
        • et al.
        Increased arterial stiffness in obstructive sleep apnea: a systematic review.
        Hypertens. Res. 2011; 34: 23-32
        • Wang J.
        • Yu W.
        • Gao M.
        • et al.
        Impact of obstructive sleep apnea syndrome on endothelial function, arterial stiffening, and serum inflammatory markers: an updated meta-analysis and metaregression of 18 studies.
        J. Am. Heart Assoc. 2015; 4
        • Chen C.-Y.
        • Yu C.-C.
        Obstructive sleep apnea is independently associated with arterial stiffness in ischemic stroke patients.
        J. Neurol. 2015; 262: 1247-1254
        • Pedrosa R.
        • Barros I.M.L.
        • Drager L.
        • et al.
        OSA is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women.
        Chest. 2014; 146: 66-72
        • Kim T.
        • Lee C.
        • Lee S.
        • et al.
        Impacts of comorbidities on the association between arterial stiffness and obstructive sleep apnea in the elderly.
        Respiration. 2015; 89: 304-311
        • Chowienczyk P.J.
        • Kelly R.P.
        • MacCallum H.
        • et al.
        Photoplethysmographic assessment of pulse wave reflection: blunted response to endothelium-dependent beta2-adrenergic vasodilation in type II diabetes mellitus.
        J. Am. Coll. Cardiol. 1999; 34: 2007-2014
        • Peppard P.
        • Ward N.
        • Morrell M.
        The impact of obesity on oxygen desaturation during sleep-disordered breathing.
        Am. J. Respir. Crit. Care Med. 2009; 180: 788-793
        • Koo B.
        • Patel S.
        • Strohl K.
        • et al.
        Rapid eye movement-related sleep-disordered breathing: influence of age and gender.
        Chest. 2008; 134: 1156-1161