Kim Jinyoung, Mohler Emile R, Keenan Brendan T, Maislin David, Arnardottir Erna Sif, Gislason Thorarinn, Benediktsdottir Bryndis, Gudmundsdottir Sigrun, Sifferman Andrea, Staley Bethany, Pack Frances M, Maislin Greg, Chirinos Julio A, Townsend Raymond R, Pack Allan I, Kuna Samuel T
School of Nursing, University of Pennsylvania, Philadelphia, PA.
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
Sleep. 2017 Sep 1;40(9). doi: 10.1093/sleep/zsx126.
Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. The purpose of this study was to compare carotid intima-media thickness (IMT), an early sign of atherosclerosis, in obese and nonobese adults with OSA before and following positive airway pressure (PAP) treatment.
A total of 206 adults newly diagnosed with OSA with an apnea-hypopnea index (AHI) of 15-75 events/hour and 53 controls with AHI <10 were studied. Waist circumference was used to classify participants as obese and nonobese. Bilateral common carotid artery B-mode ultrasound was performed at baseline to assess IMT, arterial diameter, arterial-wall mass, and circumferential wall stress. Measurements were repeated in 118 participants with OSA who completed a 4-month PAP treatment and had an average daily use over that period of ≥4 hours/day.
No significant differences in carotid IMT, diameter, or arterial-wall mass were present at baseline between participants with OSA and controls stratified by waist circumference, after adjusting for other cardiovascular risk factors. In participants with OSA, who had adequate PAP adherence over the 4-month treatment, carotid artery diameter significantly increased (mean change [95% confidence interval] = 0.13 [0.06, 0.20] mm; p = .0004), but no significant changes in carotid IMT, arterial-wall mass, and circumferential stress were observed in obese and nonobese participants.
Regardless of obesity status, carotid IMT is not increased in adults with moderate to severe OSA versus controls and does not change following 4 months of PAP treatment.
关于阻塞性睡眠呼吸暂停（OSA）是否为动脉粥样硬化的独立危险因素，目前仍存在争议。本研究旨在比较经气道正压通气（PAP）治疗前后，肥胖和非肥胖成年OSA患者的颈动脉内膜中层厚度（IMT），这是动脉粥样硬化的早期迹象。
共研究了206名新诊断为OSA且呼吸暂停低通气指数（AHI）为15 - 75次/小时的成年人，以及53名AHI < 10的对照组。通过腰围将参与者分为肥胖和非肥胖组。在基线时进行双侧颈总动脉B超检查，以评估IMT、动脉直径、动脉壁质量和圆周壁应力。对118名完成4个月PAP治疗且该期间平均每日使用时间≥4小时/天的OSA参与者重复进行测量。
在调整其他心血管危险因素后，按腰围分层的OSA参与者和对照组在基线时的颈动脉IMT、直径或动脉壁质量无显著差异。在4个月治疗期间PAP依从性良好的OSA参与者中，颈动脉直径显著增加（平均变化[95%置信区间] = 0.13 [0.06, 0.20] mm；p = .0004），但肥胖和非肥胖参与者的颈动脉IMT、动脉壁质量和圆周应力均无显著变化。
无论肥胖状况如何，中度至重度OSA成年患者的颈动脉IMT与对照组相比未增加，且在PAP治疗4个月后也未改变。
