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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200306-756OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 3, February 2004, 354-360

A more recent version of this article appeared on February 1, 2004
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Submitted on June 10, 2003
Accepted on October 7, 2003

Sleep apnea and markers of vascular endothelial function in a large community sample of older adults

F. Javier Nieto1*, David M Harrington2, Susan Redline3, Emelia J Benjamin4, and John A Robbins5

1 Population Health Sciences, University of Wisconsin Medical School, Madison, WI, USA, 2 Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA, 3 Division of Clinical Epidemiology, Case Western Reserve University, Cleveland, OH, USA, 4 Medicine, Boston University School of Medicine, Boston, MA, USA, 5 Medicine, University of California at Davis, Sacramento, CA, USA

* To whom correspondence should be addressed. 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 elderly participants in the baseline examination of the Sleep Heart Health/Cardiovascular Health Study cohort (n=1,037, age>68 yrs, 56% female). Indices of sleep apnea, derived from 12-channel home polysomnography were: apnea-hypopnea index (average number of apneas/hypopneas per hour) and hypoxemia index (%time below 90% O2 saturation). Baseline arterial diameter and flow-mediated dilatation (%FMD) were measured by ultrasound. Sleep apnea measures were associated with baseline diameter and %FMD, although these associations were weakened after adjustment for other cardiovascular risk factors, particularly body mass index (BMI). However, a statistically significant linear association between the hypoxemia index and baseline diameter was observed even after adjustment for BMI and other confounders (p<0.01). The associations were stronger among participants <80 years and among hypertensives. 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 relation between sleep apnea, hypertension, and cardiovascular disease.
Key words: brachial artery ultrasonography, endothelium, hypertension, sleep apnea




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