Association of Obstructive Sleep Apnea with Peripheral Endothelial Function Assessed by Reactive Hyperemia Index

Jaewon Oh; Jong-Chan Youn; Geu-Ru Hong; Sang-Hak Lee; Seok-Min Kang; Donghoon Choi

doi:10.5646/jksh.2014.20.2.42

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Oh, Park, Youn, Hong, Lee, Kang, and Choi: Association of Obstructive Sleep Apnea with Peripheral Endothelial Function Assessed by Reactive Hyperemia Index

Original Article

J Korean Soc Hypertens 2014;20(2):42-50.

Published online: 13 June 2014

DOI: https://doi.org/10.5646/jksh.2014.20.2.42

Association of Obstructive Sleep Apnea with Peripheral Endothelial Function Assessed by Reactive Hyperemia Index

Jaewon Oh, MD, Jong-Chan Youn, MD, Geu-Ru Hong, MD, Sang-Hak Lee, MD, Seok-Min Kang, MD, Donghoon Choi, MD

Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Sungha Park, MD Address: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea Tel: +82-2-2228-8460, Fax: +82-2-393-2041 E-mail: shpark0530@yuhs.ac

Received 20 February 201411 June 2014 Accepted 13 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Obstructive sleep apnea (OSA) has been shown to be an important risk factor for metabolic syndrome and cardiovascular disease. Endothelial dysfunction plays a pivotal role in the pathophysiology of these diseases. However, little is known about the relationship between sleep apnea and microvascular endothelial dysfunction, as assessed by digital reactive hyperemia.

Methods:

The study population consisted of 80 patients (mean age, 48 ± 12 years-old; 65 men; 59 hypertensive). We measured–apnea hypopnea index (AHI) and mild OSA was defined as 5 < AHI <15 and moderate to severe OSA as AHI ≥ 15. Reactive hyperemia index (RHI) derived from peripheral arterial tonometry (PAT) as measurement of endothelium-mediated vasodilatation.

Results:

There were 61 OSA patients in the study population (AHI, 21.5 ± 16.7 vs. 2.7 ± 1.6 in non-OSA; p < 0.001). There were no significant difference in RHI and peripheral augmentation index (pAIx) between OSA and non-OSA group (RHI, 2.04 ± 0.48 vs. 2.06 ± 0.42; p = 0.894; pAIx, 21.7% ± 24.0% vs. 21.7% ± 30.0%; p = 1.000, respectively). Also, there was no significant difference in RHI and pAIx between mild (n = 31) and moderate to severe (n = 30) OSA group (RHI, 2.10 ± 0.47 vs. 1.98 ± 0.49; p = 0.333; pAIx, 24.2% ± 20.7% vs. 19.0% ± 27.2%; p = 0.407, respectively), either. Overall, no significant correlation between AHI and RHI was observed (r = -0.023, p = 0.837). The other OSA severity indices such as oxygen desaturation index, mean and minimum oxygen saturation were not correlated with RHI or pAIx. In the subgroup analysis for the OSA group, we could not find any significant relationships between AHI and PAT parameters, either.

Conclusions:

OSA was not observed to be associated with reactive hyperemia measured by PAT.

Keywords: Obstructive sleep apnea, Vasodilation

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Fig. 1.

Box diagrams showing (A) RHI and (B) pAIx in patients with no (AHI < 5), mild (5 ≤ AHI < 15) and moderate to severe (AHI ≥ 15) obstructive sleep apnea. In these plots, the upper and lower bars outside the boxes represent the 90% confidence interval. RHI, reactive hyperemia index; pAIx, peripheral augmentation index; AHI, apnea-hyponea index.

Fig. 2.

Scatter diagrams showing the correlations between AHI and (A) RHI and (B) pAIx. AHI, apnea-hyponea index; RHI, reactive hyperemia index; pAIx, peripheral augmentation index.

Table 1.

Baseline characteristics of study patients

Characteristic	Non-OSA (n = 19)	OSA (n = 61)	p-value
Age (yr)	45 ± 15	49 ± 11	0.321
Male	13 (68.4)	52 (85.2)	0.174
Body mass index (kg/m²)	26.6 ± 3.2	27.6 ± 3.4	0.274
Waist hip ratio	0.91 ± 0.05	0.93 ± 0.05	0.085
Hypertension	15 (78.9)	44 (72.1)	0.767
Diabetes mellitus	1 (5.3)	6 (9.8)	>0.999
Dyslipidemia	0	8 (13.1)	0.188
Angiotensin converting enzyme inhibitor	3 (15.8)	3 (4.9)	0.142
Angiotensin receptor blocker	11 (57.9)	28 (45.9)	0.435
Calcium channel blocker	1 (5.3)	4 (6.6)	>0.999
Beta-blocker	5 (26.3)	12 (19.7)	0.534
Diuretics	7 (36.8)	17 (27.9)	0.568
Vasodilator	3 (15.8)	5 (8.2)	0.386
Aspirin	5 (26.3)	20 (32.8)	0.778
Statin	5 (26.3)	22 (36.1)	0.581
Systolic blood pressure (mm Hg)	135 ± 25	135 ± 15	0.960
Diastolic blood pressure (mm Hg)	80 ± 9	86 ± 9	0.174
Heart rate (/min)	60 ± 7	63 ± 9	0.201
Total cholesterol (mg/dL)	173.8 ± 21.7	194.3 ± 37.7	0.043
Low density lipoprotein cholesterol (mg/dL)	99.9 ± 21.8	123.4 ± 46.8	0.011
High density lipoprotein cholesterol (mg/dL)	45.5 ± 12.4	46.0 ± 11.2	0.877
Triglycerides (mg/dL)	183.9 ± 130.7	164.4 ± 95.3	0.537
Fasting blood glucose (mg/dL)	101.6 ± 16.5	104.1 ± 17.2	0.868
Blood urea nitrogen (mg/dL)	13.5 ± 3.2	14.6 ± 5.2	0.372
Creatinine (mg/dL)	0.89 ± 0.18	0.99 ± 0.40	0.303
Apnea-hyponea index	2.9 ± 2.0	21.5 ± 16.7	<0.001
Oxygen desaturation index	3.5 ± 2.5	20.0 ± 15.7	<0.001
Mean oxygen saturation (%)	95.9 ± 1.3	94.9 ± 1.7	0.013
Minimum oxygen saturation (%)	88.6 ± 3.7	84.4 ± 5.6	0.001
Reactive hyperemia index	2.08 ± 0.44	2.04 ± 0.47	0.708
Peripheral augmentation index (%)	17.5 ± 23.6	23.0 ± 25.9	0.416

Values are presented as mean ± standard deviation or number (%). p-value by Student t-test and chi-square test.

OSA, obstructive sleep apnea.

Table 2.

Correlation analysis with RHI and peripheral AIx in overall groups

Variable	RHI		Peripheral AIx
Variable	R	p-value	R	p-value
Age (yr)	-0.137	0.227	0.583	<0.001
Body mass index (kg/m²)	0.017	0.880	-0.290	0.010
Waist hip ratio	0.046	0.689	0.156	0.175
Systolic blood pressure (mm Hg)	0.078	0.729	0.307	0.165
Diastolic blood pressure (mm Hg)	-0.090	0.691	-0.152	0.501
Heart rate (/min)	0.116	0.324	-0.329	0.004
Total cholesterol (mg/dL)	-0.053	0.668	-0.125	0.310
Low density lipoprotein cholesterol (mg/dL)	-0.104	0.417	-0.118	0.356
High density lipoprotein cholesterol (mg/dL)	0.016	0.904	0.212	0.095
Triglycerides (mg/dL)	0.072	0.575	-0.267	0.035
Fasting blood glucose (mg/dL)	-0.070	0.554	0.004	0.973
Blood urea nitrogen (mg/dL)	-0.106	0.368	-0.025	0.832
Creatinine (mg/dL)	-0.044	0.707	-0.131	0.265
Apnea-hyponea index	-0.023	0.837	-0.094	0.408
Oxygen desaturation index	-0.017	0.879	-0.107	0.356
Mean oxygen saturation (%)	0.010	0.931	0.062	0.593
Minimum oxygen saturation (%)	-0.034	0.770	0.188	0.101
Reactive hyperemia index			0.160	0.158
Peripheral AIx (%)	0.160	0.158

RHI, reactive hyperemia index; AIx, augmentation index.

Table 3.

Correlation analysis with RHI and peripheral AIx in OSA groups

Variable	RHI		Peripheral AIx
Variable	R	p-value	R	p-value
Age (yr)	-0.036	0.782	0.609	<0.001
Body mass index (kg/m²)	-0.108	0.407	-0.317	0.014
Waist hip ratio	0.079	0.549	0.064	0.631
Systolic blood pressure (mm Hg)	0.160	0.553	0.378	0.149
Diastolic blood pressure (mm Hg)	-0.039	0.885	-0.041	0.881
Heart rate (/min)	0.108	0.414	-0.315	0.016
Total cholesterol (mg/dL)	-0.037	0.797	-0.172	0.224
Low density lipoprotein cholesterol (mg/dL)	-0.140	0.338	-0.174	0.232
High density lipoprotein cholesterol (mg/dL)	0.083	0.569	0.212	0.143
Triglycerides (mg/dL)	0.063	0.669	-0.283	0.049
Fasting blood glucose (mg/dL)	-0.120	0.383	0.011	0.936
Blood urea nitrogen (mg/dL)	-0.096	0.480	-0.038	0.782
Creatinine (mg/dL)	0.006	0.965	-0.130	0.340
Apnea-hyponea index	-0.004	0.973	-0.175	0.181
Oxygen desaturation index	-0.011	0.935	-0.150	0.257
Mean oxygen saturation (%)	0.002	0.987	0.074	0.579
Minimum oxygen saturation (%)	-0.061	0.646	0.235	0.073
Reactive hyperemia index			0.154	0.240
Peripheral AIx (%)	0.154	0.240

RHI, reactive hyperemia index; AIx, augmentation index.

Table 4.

Multiple regression analysis for the association between reactive hyperemia index and AHI

Variable	Overall group (r² = 0.371)		Obstructive sleep apnea group (r² = 0.475)
Variable	ß	p-value	ß	p-value
Age	-0.280	0.348	-0.117	0.779
Female gender	0.220	0.512	0.447	0.289
Body mass index	0.010	0.973	-0.043	0.907
Waist hip ratio	-0.524	0.136	-0.511	0.218
Systolic blood pressure	0.258	0.479	0.251	0.594
Heart rate	-0.460	0.096	-0.281	0.372
Oxygen desaturation index	1.906	0.176	1.996	0.236
AHI	-1.770	0.224	-1.782	0.311

AHI, apnea-hyponea index; ß, unstandardized coefficient.

Table 5.

Multiple regression analysis for the association between peripheral augmentation index and AHI

Variable	Overall group (r² = 0.624)		OSA group (r² = 0.800)
Variable	ß	p-value	ß	p-value
Age	0.440	0.070	0.518	0.076
Female gender	0.184	0.480	0.327	0.216
Body mass index	-0.288	0.335	-0.153	0.509
Waist hip ratio	-0.221	0.402	-0.310	0.224
Systolic blood pressure	0.165	0.556	0.259	0.383
Heart rate	-0.309	0.142	-0.404	0.062
Oxygen desaturation index	1.916	0.086	1.808	0.099
AHI	-1.938	0.094	-2.000	0.088

AHI, apnea-hyponea index; ß, unstandardized coefficient.

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