Citation Information :
Suri JC, Sachdev SS, Jain AK, Khalid A, Isser HS, Mittal MK. Cardiovascular morbidity in subjects with Obstructive sleep apnea and Its correlation with the severity of disease. Indian Sleep Med 2009; 4 (2):49-60.
There is paucity of Indian data evaluating the relationship of hypertension, ventricular dysfunction and carotid artery intima media thickness with Obstructive sleep apnea hypopnea syndrome (OSAHS) and its severity. This observational study compared these outcomes amongst subjects with and without OSAHS. Subjects categorized as ‘High Risk’ on Berlin\'s questionnaire underwent polysomnography. The outcomes were evaluated by history, examination, electrocardiography, echocardiography and carotid artery ultrasonography. There were 48 cases (polysomnography confirmed OSAHS) and 44 controls (without OSAHS). Of the 48 cases, 28 (58%) were classified as severe and 20 (42%) non-severe (mild and moderate). A significant association independent of confounders was documented between OSAHS and: (i) blood pressure and hypertension; (ii) previous myocardial infarction, diastolic dysfunction, left ventricular hypertrophy, pulmonary hypertension and arrhythmias; and (iii) carotid artery plaques and intima-media thickness. However, there was no significant impairment of ejection fraction or systolic dysfunction. No statistically significant “dose response” relationship was evident on comparing subjects with severe and non-severe OSAHS.
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB. Sleep disordered breathing and cardiovascular disease: cross sectional results of the Sleep Heart Health Study. Am J Resp Crit Care Med 2001; 163: 19-25.
Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: Implications for cardiac and vascular disease. JAMA 2003; 290: 1906-14.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 1378-84.
Haas DC, Foster GL, Nieto FJ, Redline S, Resnick S, Resnick HE, Robbins JA, Young T, Pickering TG. Age-dependent associations between sleep-disordered breathing and hypertension. Circulation 2005; 111: 614-21.
Nieto FJ, Young TB, Lind BK, et al. Association of sleep disordered breathing, sleep apnea and hypertension in a large community based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-36.
Chan J, Sanderson J, Chan W, et al. Prevalence of sleep disorder breathing in diastolic heart failure. Chest 1997; 111: 1488-93.
Chaouat A, Weitzenblum E, Krieger J, et al. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest 1996; 109: 380- 6.
Good DC, Henkle JQ, Gelber D, et al. Sleep disorder breathing and poor functional outcome after stroke. Stroke 1996; 27: 252-9.
Wessendorf T, Dahm C, Teschler H. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology 2003; 60: 1053.
Ghaffar A, Reddy KS, Singhi M. Burden of noncommunicable diseases in South Asia. Br Med J 2004; 328: 807-10.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485- 91
Williams JS, Brown SM, Conlin PR. Blood pressure measurement. N Engl J Med 2009; 360: e6.
Rechtshaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human sleep. National Institutes of Health, US Government Printing Office, Washington DC, R8, Publication no. 204.
American Academy of Sleep Medicine. Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Report of an AASM Task Force on Sleep 1999; 22: 667-89.
Mohan V, Ravikumar R, Rani SS, Deep R. Intima media thickness of the carotid artery in South Indian diabetic and non- diabetic subjects : the Chennai Urban Population Study (CUPS). Diabetologia 2000; 43: 494-9.
Gerulakos G, Ramaswani G, Veuer MG, Fisher GM, Renton S, Nicolaides A. Arterial wall changes in type 2 diabetic subjects. Diabetes Med 1994; 11:692 – 5.
Baroncini LAV, de Oliveira A, Vidal EA, Franca GJ, Stahlke PSDB, Alessi A, et al. Appropriateness of carotid plaque and intima-media thickness assessment in routine clinical practice. Cardiovascular Ultrasound 2008; 6: 52 doi:10.1186/1476-7120-6-52.
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. http:// www.idf.org/webdata/docs/Metac_syndrome_def.pdf; accessed Jan 15th 2009.
Douglas Bradley T, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet 2009; 373: 82-93.
McNicholas WT, Bansignore MR and the management committee of EU COST. ACTION B26. Sleep apnea as an independent risk factor for cardiovascular disease. Current evidence, basic mechanisms and research priorities. Eur Respir J 2007; 29: 156-78.
Chow CK, Lock K, Teo K, Subramanian S, McKee M, Yusuf S. Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. Int J Epidemiol. 2009 Mar 4. [Epub ahead of print].
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 937-52.
Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev 2005; 9: 211-24.
Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK. Obstructive Sleep Apnea, Inflammation, and the Metabolic Syndrome. Metab Syndr Relat Disord. 2009 Apr 3. [Epub ahead of print].
Wilcox I. “Syndrome Z”: The interaction of sleep apnea, vascular risk factors and heart disease. Thorax 1998; 53; 25-8.
Sasanabe RK, Banno K, Otake R, Hasegawa K, Usui MM, Shiomi T. Metabolic syndrome in Japanese patients with obstructive sleep apnea syndrome. Hypertens Res 2006; 29:315-22.
Parker JD, Brooks D, Kozar LF et al. Acute and chronic effects of airway obstruction on canine left ventricular performance. Am J Respir Crit Care Med 1999; 160: 1888- 96.
Arias MA, Garcia-Rio F, Mediano O, et al. Obstructive sleep apnea syndrome affects left ventricular diastolic dysfunction: Effects of nasal continuous positive airway pressure in men. Circulation 2005; 112: 375-83.
Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173: 910–6.
Lanfranchi PA, Somers VK, Braghiroli A, et al. Cebtral sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk. Circulation 2003; 107: 727- 32.
Flemons WW, Remmers JE, Gillis AM. Sleep apnea and cardiac arrhythmias. Is there a relationship? Am Rev Respir Dis 1993; 148: 618–21.
Baguet JP, Hammer L, Levy P, et al. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest 2005; 128: 3407-12.
Suzuki T, Nakano H, Maekawa J, et al. Obstructive sleep apnea and carotid-artery intima-media thickness. Sleep 2004; 27:129-33.
Altin R, Ozdemir H, Mahmutyazicioðlu K, Kart L, Uzun L, Ozer T, Savranlar A, Aydin M. Evaluation of carotid artery wall thickness with high-resolution sonography in obstructive sleep apnea syndrome. J Clin Ultrasound 2005; 33: 80-6.
Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172:613-8. Epub 2005 May 18.
Silvestrini M, Rizzato B, Placidi F, Baruffaldi R, Bianconi A, Diomedi M. Carotid artery wall thickness in patients with obstructive sleep apnea syndrome. Stroke 2002; 33: 1782– 5.
Li C, Zhang XL, Liu H, Wang ZG, Yin KS. Association among plasma interleukin-18 levels, carotid intima- media thickness and severity of obstructive sleep apnea. Chin Med J (Engl) 2009; 122: 24-9.
Tanriverdi H, Evrengul H, Kara CO, Kuru O, Tanriverdi S, Ozkurt S, Kaftan A, Kilic M. Aortic stiffness, flow-mediated dilatation and carotid intima-media thickness in obstructive sleep apnea: non-invasive indicators of atherosclerosis. Respiration 2006; 73:733-4.
Drager LF, Bortolotto LA, Krieger EM, Lorenzi-Filho G. Additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension 2009; 53: 64-9. Epub 2008 Nov 17.
Saletu M, Sauter C, Lalouschek W, Saletu B, Kapfhammer G, Benesch T, Zeitlhofer J. Is excessive daytime sleepiness a predictor of carotid atherosclerosis in sleep apnea? Atherosclerosis 2008; 196: 810-6. Epub 2007 Mar 13.