The objective of this study was to evaluate endothelial function and carotid intima media thickness (CIMT) in moderate to severe obstructive sleep apnea (OSA) without comorbidities.
It is an observational case control study in which endothelial function was assessed using flow-mediated dilatation (FMD) and peripheral arterial tonometry (PAT), and carotid artery ultrasound was used to measure CIMT in study group subjects that included 20 normotensive, non-diabetic, treatment naïve, and moderate to severe OSA patients, and 20 normotensive, non-diabetic, and non-OSA subjects served as a control group. Study was conducted in Polysomnography Laboratory, Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS) Hospital, New Delhi.
FMD was significantly lower in the moderate to severe OSA group compared to non-OSA group (mean ± SD, 8.3 ± 2.8 vs. 13.4 ± 4.1 %; p = 0.0001). Reactive hyperemia index (RHI) was also significantly lower in the OSA group (1.55 ± 0.27 vs. 2.01 ± 0.48, p = 0.0007). CIMT was observed to be significantly higher in the OSA group compared to the non-OSA group (0.54 ± 0.09 vs. 0.48 ± 0.08 mm; p = 0.049). In the OSA group, FMD, RHI, and CIMT did not show a significant correlation with OSA disease severity indices [apnea hypopnea index (AHI), oxygen desaturation index (ODI), and minimum O2 saturation].
Endothelial function in macrovascular and microvascular circulation is significantly impaired in moderate to severe OSA patients without comorbidities. These patients also show evidence of subclinical atherosclerosis, in the form of increased CIMT.
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The authors acknowledge the study subjects, highly trained staff nurses (Mr. Sreejith, Mr. Shashikant, Mr. Mohan Babu, Ms. Tsering, and Ms. Dhanya), medical social worker, Mr Ajeet, laboratory technician, Mr. Rohit Rai, and laboratory attendant, Mr. Dharmender Sharma, for their immense help in the recruitment, conduct, and completion of this study. The authors are thankful to AIIMS administration for the provision of EndoPAT™ probes.
Professor Surendra Kumar Sharma was supported by a J.C. Bose National Fellowship (SB/S2/JCB-04/2013), from the Ministry of Science and Technology, Government of India.
No funding was received for this research.
Conflict of interest
The authors declare that they have no conflicts of interest.
This study was approved by the ethics committee of All India Institute of Medical Sciences (AIIMS). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Farooqui, F.A., Sharma, S.K., Kumar, A. et al. Endothelial function and carotid intima media thickness in obstructive sleep apnea without comorbidity. Sleep Breath 21, 69–76 (2017). https://doi.org/10.1007/s11325-016-1371-7
- Obstructive sleep apnea
- Endothelial function
- Flow-mediated dilatation
- Peripheral arterial tonometry
- Reactive hyperemia index
- Carotid intima media thickness