Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain.
Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Catalonia, Spain.
PLoS One. 2019 Feb 5;14(2):e0211742. doi: 10.1371/journal.pone.0211742. eCollection 2019.
Subjects with sleep apnea-hypopnea syndrome (SAHS) show an increased carotid intima-media thickness. However, no data exist about earlier markers of atheromatous disease, such as the proliferation and expansion of the adventitial vasa vasorum (VV) to the avascular intima in this setting. Our aim was to assess carotid VV density and its relationship with sleep parameters in a cohort of obese patients without prior vascular events. A total of 55 subjects evaluated for bariatric surgery were prospectively recruited. A non-attended respiratory polygraphy was performed. The apnea-hypopnea index (AHI) and the cumulative percentage of time spent with oxygen saturation below 90% (CT90) were assessed. Serum concentrations of soluble intercellular adhesion molecule 1, P-selectin, lipocalin-2 and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. Contrast-enhanced carotid ultrasound was used to assess the VV density. Patients with SAHS (80%) showed a higher adventitial VV density (0.801±0.125 vs. 0.697±0.082, p = 0.005) and higher levels of sVCAM-1 (745.2±137.8 vs. 643.3±122.7 ng/ml, p = 0.035) than subjects with an AHI lower than 10 events/hour. In addition, a positive association exist between mean VV density and AHI (r = 0.445, p = 0.001) and CT90 (r = 0.399, p = 0.005). Finally, in the multiple linear regression analysis, female sex, fasting plasma glucose and AHI (but not CT90) were the only variables independently associated with the mean adventitial VV density (R2 = 0.327). In conclusion, a high VV density is present in obese subjects with SAHS, and chronic intermittent hypoxia is pointed as an independent risk factor for the development of this early step of atheromatous disease.
患有睡眠呼吸暂停低通气综合征（SAHS）的患者颈动脉内膜中层厚度增加。然而，在这种情况下，尚无关于动脉粥样硬化疾病早期标志物的相关数据，例如血管外膜血管（VV）向无血管内膜的增殖和扩张。我们的目的是评估肥胖患者中尚未发生血管事件的颈动脉 VV 密度及其与睡眠参数的关系。共前瞻性招募了 55 名接受减重手术评估的患者。进行了非监测性呼吸多导睡眠图。评估了呼吸暂停低通气指数（AHI）和血氧饱和度低于 90%的累计时间百分比（CT90）。测量了可溶性细胞间黏附分子 1、P 选择素、脂联素-2 和可溶性血管细胞黏附分子 1（sVCAM-1）的血清浓度。使用对比增强颈动脉超声评估 VV 密度。患有 SAHS（80%）的患者的外膜 VV 密度较高（0.801±0.125 比 0.697±0.082，p=0.005），sVCAM-1 水平较高（745.2±137.8 比 643.3±122.7ng/ml，p=0.035）。此外，平均 VV 密度与 AHI（r=0.445，p=0.001）和 CT90（r=0.399，p=0.005）之间存在正相关。最后，在多元线性回归分析中，女性、空腹血糖和 AHI（而非 CT90）是与平均外膜 VV 密度唯一相关的独立变量（R2=0.327）。总之，SAHS 肥胖患者存在高 VV 密度，慢性间歇性低氧被认为是动脉粥样硬化疾病早期发生的独立危险因素。
