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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200306-756OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 354-360, (2004)
© 2004 American Thoracic Society

Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults

F. Javier Nieto, David M. Herrington, Susan Redline, Emelia J. Benjamin and John A. Robbins

Department of Population Health Sciences, University of Wisconsin Medical School, Madison, Wisconsin; Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Division of Clinical Epidemiology, Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, University of California at Davis, Sacramento, California

Correspondence and requests for reprints should be addressed to F. Javier Nieto, M.D., Ph.D., Department of Population Health Sciences, University of Wisconsin Medical School, 610 Walnut Street, 707C WARF, Madison, WI 53705–2397. E-mail: fjnieto{at}wisc.edu

Clinical studies have suggested that sleep apnea is associated with impaired brachial artery flow-mediated dilation, a surrogate of endothelial dysfunction. We examined this question among older participants in the baseline examination of the Sleep Heart Health/Cardiovascular Health Study cohort (n = 1,037, age 68 years or older, 56% female). Indices of sleep apnea, derived from 12-channel home polysomnography, were the apnea–hypopnea index (average number of apneas/hypopneas per hour) and the hypoxemia index (percentage of time below 90% O2 saturation). Baseline arterial diameter and percentage of flow-mediated dilation were measured by ultrasound. Sleep apnea measures were associated with baseline diameter and the percentage of flow-mediated dilation, although these associations were weakened after adjustment for other cardiovascular risk factors, particularly body mass index. However, a statistically significant linear association between the hypoxemia index and baseline diameter was observed even after adjustment for body mass index and other confounders (p < 0.01). The associations were stronger among participants who were younger than 80 years and among those who with hypertension. This study adds to the growing body of evidence linking sleep apnea with vascular dysfunction in older subjects. Whether these relationships are entirely independent of obesity is unclear. This association might be one of the mechanisms explaining the relationship between sleep apnea, hypertension, and cardiovascular disease.

Key Words: brachial artery ultrasonography • endothelium • hypertension • sleep apnea




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