Obstructive Sleep Apnea Linked With Accelerated Vascular Aging, CVD Risk

Individuals at high risk of obstructive sleep apnea (OSA) may be at increased risk of accelerated vascular aging, a known contributor to cardiovascular disease, according to study findings published in the Journal of the American Heart Association.

As a highly prevalent condition affecting up to 49% of men and 23% of women older than 40 years, OSA has been identified as a major risk factor for cardiovascular diseases, including coronary artery disease, heart failure, and stroke. Although the link is widely known, researchers note that the mechanisms underlying the association are “incompletely understood,” with current research suggesting that increased cardiovascular risk in individuals with OSA may be mediated by accelerated vascular aging.

“Vascular aging is characterized by accumulation of functional and structural changes of vessels throughout life….key manifestations of vascular aging include arterial stiffening, greater carotid intima-media thickness, and carotid diameter enlargement,” explained the study authors.

Seeking to further investigate the association between OSA and several manifestations indicative of vascular aging, the researchers assessed data of 2 community-based cohort studies from 2 European countries: the Paris Prospective Study 3 (PPS3) in France (n = 6840; 62% men; mean [SD] age, 59.5 [6.2] years) and the Maastricht Study in the Netherlands (n = 1775; 51% men; mean age, 58.9 [8.1] years).

All participants were free of previous cardiovascular disease, with risk of OSA determined via the Berlin questionnaire. Assessed manifestations of vascular aging included carotid artery properties (carotid intima-media thickness, Young’s elastic modulus, carotid-femoral pulse wave velocity, carotid pulse wave velocity, carotid diameter using high precision ultrasound echography), with carotid-femoral pulse wave velocity of the Maastricht Study also assessed separately.

High risk of OSA prevalence was identified in 16.8% (n = 1150) of the PPS3 cohort and in 23.8% (n = 423) of the Maastricht Study. Moreover, those at high risk of OSA were significantly associated with markedly higher levels of all vascular aging variables than low-risk counterparts, after adjustment for age, sex, smoking, education level, total cholesterol, diabetes , heart rate, and study site:

• Carotid intima-media thickness (β = 0.21; 0.17–0.26)
• Young’s elastic modulus (β = 0.21; 0.17–0.25)
• Carotid-femoral pulse wave velocity (β = 0.24; 0.14– 0.34)
• Carotid pulse wave velocity (β = 0.31; 0.26–0.35)
• Carotid diameter (β = 0.43; 0.38–0.48)

"Our findings could explain, in part, why people with sleep apnea have an increased risk of mortality and cardiovascular diseases," said study author Quentin Lisan, MD, PhD, Department of Head and Neck Surgery, Foch Hospital, in a statement.

Acknowledging limitations of the study, including the lack of polysomnography to identify sleep apnea and its primary focus on White Europeans, Lisan said that future research should assess the effectiveness of continuous positive airway pressure on slowing or reversing vascular aging, as these devices have been shown to significantly decrease the risk of heart failure.

In the meantime, Lisan recommended greater utilization of noninvasive, low-cost sleep apnea tests to proactively track vascular aging and for people with the condition to manage and improve aspects of their vascular health, such as cholesterol and blood pressure,t o optimal levels.

Reference

Lisan Q, van Sloten T, Boutouyrie P, et al. Sleep apnea is associated with accelerated vascular aging: results from 2 European community-based cohort studies. J Am Heart Assoc. Published online July 26, 2021. doi:​​10.1161/JAHA.120.021318