Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
Hypertens Res. 2019 Feb;42(2):195-203. doi: 10.1038/s41440-018-0143-0. Epub 2018 Nov 30.
The additive effect of hypertension on carotid atherosclerosis in patients with obstructive sleep apnea (OSA) is well-established; however, the effect of the nondipping pattern has not yet been evaluated. In this study, we aim to assess the effect of the nondipping pattern on carotid atherosclerosis, which is quantified as carotid intima-media thickness (CIMT), and on the high-risk carotid profile in normotensive patients with OSA. We included 189 patients with OSA in this cross-sectional study. We followed a 2 × 2 factorial design to create groups according to the presence of OSA and nondipping pattern. All patients underwent carotid ultrasonography to quantify their CIMT and presence of plaques. Patients who had CIMT ≥ 0.9 mm and/or carotid plaques were classified as having a high-risk carotid profile. Patients in the OSA/nondipper group had a 26% higher CIMT and five times the prevalence of a high-risk carotid profile compared to patients in the non-OSA/dipper group. CIMT was correlated with age, the apnea-hypopnea index (AHI), minimum oxygen saturation, and nighttime systolic blood pressure (SBP). Independent of age, diabetes, and AHI, a one mmHg increase in nighttime SBP was associated with a 0.22 mm increase in CIMT and a 4% increase in odds for the high-risk carotid profile. Similarly, independent of age and diabetes, being in the OSA/nondipper group was associated with 6.7 times increased odds for a high-risk carotid profile than being in the non-OSA/dipper group. Modeling with both the nondipping status and presence of OSA produced an 8% higher discriminative value than modeling with neither of these parameters. We found an additive effect of the nondipping pattern on carotid atherosclerosis in normotensive patients with OSA. Our findings suggested that in addition to having established hypertension, a nondipping pattern in normotensive patients with OSA may aggravate atherosclerosis.
高血压对阻塞性睡眠呼吸暂停（OSA）患者颈动脉粥样硬化的附加作用已得到充分证实；然而，非杓型模式的影响尚未得到评估。在这项研究中，我们旨在评估非杓型模式对颈动脉粥样硬化的影响，这通过颈动脉内膜中层厚度（CIMT）来量化，并评估 OSA 患者中血压正常的高危颈动脉特征。我们纳入了 189 例 OSA 患者进行这项横断面研究。我们采用 2×2 析因设计，根据 OSA 和非杓型模式的存在创建组。所有患者均接受颈动脉超声检查以量化 CIMT 和斑块的存在。CIMT≥0.9mm 和/或颈动脉斑块的患者被归类为具有高危颈动脉特征。与非 OSA/杓型组相比，OSA/非杓型组的 CIMT 增加了 26%，且具有高危颈动脉特征的患者患病率增加了五倍。CIMT 与年龄、呼吸暂停低通气指数（AHI）、最低血氧饱和度和夜间收缩压（SBP）相关。独立于年龄、糖尿病和 AHI，夜间 SBP 每增加 1mmHg，CIMT 增加 0.22mm，高危颈动脉特征的发生几率增加 4%。同样，独立于年龄和糖尿病，OSA/非杓型组发生高危颈动脉特征的几率比非 OSA/杓型组高 6.7 倍。与既不考虑非杓型状态也不考虑 OSA 相比，同时考虑这两个因素进行建模可使预测能力提高 8%。我们发现非杓型模式对血压正常的 OSA 患者的颈动脉粥样硬化有附加作用。我们的研究结果表明，除了患有已确立的高血压外，血压正常的 OSA 患者的非杓型模式可能会加重动脉粥样硬化。
