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Published ahead of print on October 9, 2003, doi:10.1164/rccm.200306-767OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 3, February 2004, 348-353

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

Endothelial function in obstructive sleep apnea and response to treatment

Mary SM Ip*, Hung-Fat Tse, Bing Lam, Kenneth WT Tsang, and Wah-Kit Lam

* To whom correspondence should be addressed. E-mail: msmip{at}hkucc.hku.hk.

Impaired endothelium-dependent vascular relaxation is a prognostic marker of atherosclerosis and cardiovascular disease. We evaluated endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in 28 men with obstructive sleep apnea (OSA) and 12 men without OSA. Subjects with OSA (apnea-hypopnea index, AHI, mean ± SD 46.0 ± 14.5) had lower FMD compared to subjects without OSA (5.3 ± 1.7% vs. 8.3 ± 1.0 %, P<0.001), and major determinants of FMD were AHI and age. There was no significant difference in NTG-induced dilation. OSA subjects were randomized to nasal continuous positive airway pressure (nCPAP) or observation for four weeks. Subjects on nCPAP had significant increase in FMD while those on observation had no change (+4.4% versus -0.8% , difference +5.2%, P <0.001). Neither group showed significant change in NTG-induced vasodilation. Eight subjects who used nCPAP for over three months were reassessed on withdrawing treatment for one week. On nCPAP withdrawal, FMD became lower than during treatment (P= 0.02), and were similar to baseline values. Our findings demonstrated that men with moderate/severe OSA have endothelial dysfunction, and treatment with nCPAP could reverse the dysfunction, but the effect was dependent on ongoing use.
Key words: flow mediated dilation, sleep apnea




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