Arousal index as a marker of carotid artery atherosclerosis in patients with obstructive sleep apnea syndrome
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It was shown in a previous cohort study that men with internal carotid artery (ICA) plaque, defined as focal wall thickness of ≥ 1.5 mm, had a threefold higher risk of stroke than those without plaque. We examined the relationship between arousal indices and sleep stages in patients with obstructive sleep apnea syndrome (OSAS) and carotid atherosclerosis.
Carotid atherosclerosis severity was evaluated using the maximal carotid wall intima-media thickness of the ICA (ICA-maxIMT) and plaque in 83 patients with OSAS.
The ICA-maxIMT values were positively correlated with the apnea hypopnea index (AHI) (ρ = 0.294, P = 0.007), arousal index (ρ = 0.289, P = 0.008), oxygen desaturation index (ρ = 0.298, P = 0.006), percentage of visually scored total sleep time spent in nocturnal oxygen saturation < 90% (SpO2 < 90%) (ρ = 0.246, P = 0.025), and the percentage of visually scored total sleep time spent in non-REM sleep stage 1 (ρ = 0.326, P = 0.003) and were negatively correlated with the percentage of visually scored total sleep time spent in non-REM sleep stages 2 and 3. Arousal index, diabetes mellitus, and age were found to be independent predictors of ICA plaque presence (OR 1.052, P = 0.003; OR 8.705, P = 0.026; OR 1.064, P = 0.023, respectively).
Several PSG variables that are indicative of sleep fragmentation, sleep disordered breathing, and poor sleep quality correlated with the occurrence of atherosclerosis, but total arousal index was the only independent predictive factor.
KeywordsArousal index Sleep stage IMT Carotid atherosclerosis Obstructive sleep apnea syndrome
We would like to thank Ms. Akiko Sato, the polysomnographer, for recording and analyzing the PSG data.
Compliance with ethical standards
The study was approved by the ethical committee of Tokyo Women’s Medical University, and written informed consent was obtained from all participants. 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.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Kitamura A, Iso H, Imano H, Ohira T, Okada T (2004) Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke 35:2788–2794. https://doi.org/10.1161/01.str.0000147723.52033.9e CrossRefGoogle Scholar
- 3.Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, Okada S, Ohta S, Naito H, Adachi M (2005) Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 172:625–630. https://doi.org/10.1164/rccm.200412-1652oc CrossRefGoogle Scholar
- 10.Saletu M, Sauter C, Lalouschek W, Saletu B, Kapfhammer G, Benesch T (2008) Is excessive daytime sleepiness a predictor of carotid atherosclerosis in sleep apnea? Atherosclerosis 196:810–816. https://doi.org/10.1016/j.atherosclerosis.2007.01.016 CrossRefGoogle Scholar
- 11.Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, Imai Y, Imaizumi T, Ishimitsu T, Ito M, Ito S, Itoh H, Iwao H, Kai H, Kario K, Kashihara N, Kawano Y, Kim-Mitsuyama S, Kimura G, Kohara K, Komuro I, Kumagai H, Matsuura H, Miura K, Morishita R, Naruse M, Node K, Ohya Y, Rakugi H, Saito I, Saitoh S, Shimada K, Shimosawa T, Suzuki H, Tamura K, Tanahashi N, Tsuchihashi T, Uchiyama M, Ueda S, Umemura S, Japanese Society of Hypertension Committee for Guidelines for the Management of Hypertension (2014) The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res 37:253–390. https://doi.org/10.1038/hr.2014.20 CrossRefGoogle Scholar
- 12.Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV, American Academy of Sleep Medicine (2012) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 2nd edn. American Academy of Sleep Medicine, DarienGoogle Scholar
- 14.Covassin N, Calvin AD, Adachi T, Macedo PG, Albuquerque FN, Bukartyk J et al (2013) Moderate sleep deprivation leads to impairment in endothelial function independent of weight gain. Circulation 128:A12965Google Scholar
- 20.Saini J, Krieger J, Brandenberger G, Wittersheim G, Simon C, Follenius M (1993) Continuous positive airway pressure treatment. Effects on growth hormone, insulin and glucose profiles in obstructive sleep apnea patients. Horm Metab Res 25:375–381. https://doi.org/10.1055/s-2007-1002123 CrossRefGoogle Scholar
- 24.Spriggs DA, French JM, Murdy JM, Curless RH, Bates D, James OF (1992) Snoring increases the risk of stroke and adversely affects prognosis. QJM 83:555–562. https://doi.org/10.1093/oxfordjournals.qjmed.a068693 Google Scholar
- 28.Salepci B, Fidan A, Ketenci SC, Parmaksiz ET, Comert SS, Kiral N, Akturk UA, Caglayan B, Salepci E (2015) The effect of obstructive sleep apnea syndrome and snoring severity to intima-media thickening of carotid artery. Sleep Breath 19:239–246. https://doi.org/10.1007/s11325-014-1002-0 CrossRefGoogle Scholar