Skip to main content
SpringerLink
Log in

Arterial stiffness alteration and obstructive sleep apnea in an elderly cohort free of cardiovascular event history: the PROOF cohort study

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Introduction

Several studies suggest in middle-aged subjects a relationship between arterial stiffness, a cardiovascular risk marker, and moderate to severe obstructive sleep apnea (OSA). No extensive data are present in older subjects. This study explores this association in a sample of healthy older subjects suffering OSA.

Methods

A total of 101 volunteers aged 75.3 ± 0.7 years were examined at the hospital sleep center. Each subject was assessed for medical history, body mass index and 24-h blood pressure measures, biological blood samples, and home polygraphy in 2002–2003 (P2) as well as in 2009–2010 (P4). Arterial stiffness was also assessed using carotid-femoral and carotid-radial pulse wave velocity (cfPWV and crPWV) during P4 examination.

Results

The total group consisted of 59 women and 42 men with a mean apnea-hypopnea index (AHI) of 17.8 ± 12.1 and a mean oxygen desaturation index (ODI) of 9.8 ± 8.9. No-OSA (AHI < 15) represented 50% of the sample, and severe cases (AHI > 30) 17%. No significant differences had been founded between men and women for blood pressure, cfPWV, and crPWV. Considering the severity of the AHI, no significant differences between groups were present for PWV and blood pressure values. No difference for PWV was present for subjects with and without hypertension. No correlation was found between PWV value and AHI and ODI values at P2 or between P2 and P4 visits. cfPWV was higher in patients demonstrating incident hypertension during the follow-up.

Conclusions

In this sample of older subjects, PWV is not affected by AHI and ODI but was associated with incident hypertension. These results may suggest potential protective and adaptive mechanisms in older sleep apnea patients.

Clinical trial registrations

NCT 00759304 and NCT 00766584.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AHI:

apnea-hypopnea index

BMI:

body mass index

CPAP:

continuous positive airway pressure

HT:

hypertension

HDL:

high-density lipoprotein cholesterol

LDL:

low-density lipoprotein cholesterol

ODI:

oxygen desaturation index

OSA:

obstructive sleep apnea

P2:

clinical visits of the cohort between 2002 and 2003

P4:

clinical visits of the cohort between 2009 and 2010

PWV:

pulse wave velocity

cfPWV:

carotid-femoral pulse wave velocity

crPWV:

carotid-radial pulse wave velocity

SaO2 :

oxygen saturation

TRG:

plasma triglycerides

References

  1. Young T, Palta M, DempseyJ SJ, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  Google Scholar 

  2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathings in adults. Am J Epidemiol 177:1006–1014

    Article  PubMed  PubMed Central  Google Scholar 

  3. Senaratna CV, Perret JL, Lodge CJ, Lowe JA, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  PubMed  Google Scholar 

  4. Hongyo K, Ito N, Yamamoto K, Yamamoto K, Takeda M, Oguro R, Takami Y, Takeya Y, Sugimoto K, Rakugi H (2017) Factors associated with the severity of obstructive sleep apnea in older adults. Geriatr Gerontol Int 17:614–621

    Article  PubMed  Google Scholar 

  5. Tkacova R, McNicholas WT, Javorsky M, Fietze I, Sliwinski P, Parati G, Grote L, Hedner J. European Sleep Apnoea Database study collaborators (2014) Nocturnal intermittent hypoxia predicts prevalent hypertension in the European sleep Apnoea database cohort study. Eur Respir J 44:931–941

    Article  Google Scholar 

  6. Greco C, Spallone V (2015) Obstructive sleep apnoea syndrome and diabetes. Fortuitous association or interaction? Curr Diabetes Rev 12:129–155

    Article  PubMed  Google Scholar 

  7. Destors M, Tamisier R, Baguet JP, Ley P, Pepin JL (2014) Cardiovascular morbidity associated with obstructive sleep apnea syndrome. Rev Mal Resp 31:375–385

    Article  CAS  Google Scholar 

  8. Mc Nicholas WT, Bonsignore M et al (2007) Management committee of EU COST ACTION B26. Sleep apnea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 29:156–178

    Article  CAS  Google Scholar 

  9. Chung S, Yoon IY, Lee CH, Kim JW (2010) The association of nocturnal hypoxemia with arterial stiffness and endothelial dysfunction in male patients with obstructive sleep apnea. Respiration 79:363–369

    Article  PubMed  Google Scholar 

  10. Kraiczi H, Caidahl K, Samuelsson A, Peker J, Hedner J (2001) Impairment of vascular endothelial function and left ventricular filling: association with the severity of apnea-induced hypoxemia during sleep. Chest 119:1085–1091

    Article  CAS  PubMed  Google Scholar 

  11. Levy P, Pepin JL, Arnaud C, Buguet JP, Dematteis M, Mach F (2009) Obstructive sleep apnea and atherosclerosis. Prog Cardiovasc Dis 51:400–410

    Article  CAS  PubMed  Google Scholar 

  12. Butt M, Khair OA, Dwivedi G, Shantsila A, Shantsila E, Lip GY (2011) Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea. Hypertension 58:417–424

    Article  CAS  PubMed  Google Scholar 

  13. Wada T, Kodaira K, Fuijshiro K, Maie K, Tsukiyama E, Fukumoto T, Uchida T, Yamasaki S (1994) Correlation of ultrasound-measured common carotid artery stiffness with pathological findings. Arterioscler Thromb 14:479–482

    Article  CAS  PubMed  Google Scholar 

  14. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker Bourdier H (2006) European network for non-invasive investigation of large arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 21:2588–2605

    Article  Google Scholar 

  15. Vachopoulos C, Aznaouridis K, Stephanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 121:505–511

    Google Scholar 

  16. Doonan RJ, Scheffer P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME, Daskalopoulou SS, Daskalopoulos ME, Daskapoulou SS (2011) Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertension Res 34:23–32

    Article  Google Scholar 

  17. Jelic S, Bartels MN, Mateika JH, Ngai P, DrMeersman RE, Basner RC (2002) Arterial stiffness increases during obstructive sleep apneas. Sleep 25:850–855

    PubMed  Google Scholar 

  18. Sarinc Ulasli S, Sariaydin M, Ozkececi G, Gunay E, Halici B, Unlu M (2016) Arterial stiffness in obstructive sleep apnoea: is there difference between daytime and nighttime? Respirology 21:1480–1485

    Article  PubMed  Google Scholar 

  19. Chung S, Yoon I, Lee CH, Kim JW (2010) The association of nocturnal hypoxemia with arterial stiffness and endothelial dysfunction in male patients with obstructive sleep apnea syndrome. Respiration 79:363–369

    Article  PubMed  Google Scholar 

  20. Phillips CL, Butlin M, Wong KK, Avolio AP (2013) Is obstructive sleep apnoea causally related to arterial stiffness? A critical review of the experimental evidence. Sleep Med Rev 17:7–18

    Article  PubMed  Google Scholar 

  21. Charalambos V, Konstatinos A, Christodoulos S (2010) Prediction of cardiovascular event and all-cause mortality with arterial stiffness. J Am Coll Cardiol 55:1318–1327

    Article  Google Scholar 

  22. Laurent S, Boutourie P, Asmar R (2002) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hpertensive patients. Hypertension 39:10–15

    Article  PubMed  Google Scholar 

  23. Vlachopoulos C, Xaplanteris P, Aboyans V, Brodman M, Cifkova R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksass A, Van Bortel L, Weber T, Yamashina A, Zimlichmann R, Boutourie P, Cockcroft J, O’Rourke M, Park JB, Schillacci G, Sillesen H, Townsend RR (2015) The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation : Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 241:507–532

    Article  CAS  PubMed  Google Scholar 

  24. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RH (2002) Aortic pulse wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 106:2085–2090

    Article  Google Scholar 

  25. Meaume S, Benetos A, Henri OF, Rudnichi A, Safar ME (2001) Aortic pulse wave velocity predicts cardiovascular mortality in subjets >70 years of age. Artherioscler Thromb Vasc Biol 21:2046–2050

    Article  CAS  Google Scholar 

  26. Barthélémy JC, Pichot V, Dauphinot V, Celle S, Laurent B, Garcin A, Maudoux D, Kerleroux J, Lacour JR, Kossovsky M, Gasoz JM, Roche F (2007) Autonomic nervous system activity and decline as prognostic indicators of cardiovascular and cerebrovascular events. The PROOF study. Neuroepidemiology 29:18–28

    Article  PubMed  Google Scholar 

  27. Sforza E, Sabri M, DaCosta A, Isaaz K, Barthélémy JC, Roche F (2015) Echocardiographic findings in healthy elderly people with sleep-disordered breathing. J Clin Sleep Med 11:975–980

    PubMed  PubMed Central  Google Scholar 

  28. Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the management of arterial hypertension: The Task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  29. O’Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plant GE (2002) Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertension 15:426–444

    Article  Google Scholar 

  30. (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of the American Academy of Sleep Medicine Task Force. Sleep 22:667–89

  31. Pavlova MK, Duffy JF, Shea SA (2008) Polysomnographic respiratory abnormalities in asymptomatic individuals. Sleep 31:241–248

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pepin JL, Tamisier R, Baguet JP, Lévy P (2013) Arterial health is related to obstructive sleep apnea severity and improves with CPAP treatment. Sleep Med Rev 17:3–5

    Article  PubMed  Google Scholar 

  33. Seetho JW, Asher R, Parke RJ, Craig S, Duffy N, Hardy KJ, Wilding JP (2015) Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnea. Sleep Breath 19:1155–1165

    Article  PubMed  Google Scholar 

  34. Toprak A, Reddy J, Chen W, Srinivasan S, Berenson G (2009) Relation of pulse pressure and arterial stiffness to concentric left ventricular hypertrophy in young me (from the Bogalusa heart study). Am J Cardiol 103:978–984

    Article  PubMed  Google Scholar 

  35. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y (1993) Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 21:1497–1506

    Article  CAS  PubMed  Google Scholar 

  36. Litvin AY, Sukmarova ZN, Elfimova EM, Aksenova AV, Galitsin PV, Rogoza AN, Chazova IE (2013) Effect of CPAP on vascular risk factors in patients with obstructive sleep apnea and arterial hypertension. Vasc Health Risk Manag 9:229–235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Vlachopoulos C, Aznaouidid K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness. J of Am Coll Cardiology 55:1318–1327

    Article  Google Scholar 

  38. Wang J, Yu W, Gao M, Zhang F, Gu C, Yu Y, Wei Y (2015) Impact of obstructive sleep apnea syndrome on endothelial function, arterial stiffening and serum inflammatory markers: an updated meta-analysis and metaregression of 18 studies. J Am Heart Assoc 4(11). https://doi.org/10.1161/JAHA.115.002454

  39. Tamisier R, Borel J, Millasseau S (2016) Arterial stiffness in patients with obstructive sleep apnea syndrome: an individual meta-analysis of contributing factors. J Hypertens Suppl 2:e100. https://doi.org/10.1097/01.hip.000001593.31023.87

    Article  Google Scholar 

  40. Bruno RM, Rossi L, Fabrini M, Durani E, Di Coscio E, Maestri M, Guidi P, Frenzilli G, Salvetti A, Taddei S, Bonanni E, Ghiadoni L (2013) Renal vasodilating capacity and endothelial function are impaired in patients with obstructive sleep apnea and no traditional cardiovascular risk factors. J Hypertens 31:1456–1464

    Article  CAS  PubMed  Google Scholar 

  41. Sforza E, Roche F (2016) Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach. Hypoxia 4:99–108

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lavie P, Lavie L (2009) Unexpected survival advantages in elderly people with moderate sleep apnoea. J Sleep Res 18:397–403

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors of this study would like to thank all the study participants and Delphine Maudoux for her help in data acquisition as well as Arnauld Garcin.

Funding

French Minister of Health provided financial support in the form of PHRC 1998 and 2001 funding (funding of salaries and clinical research devices). The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Service de Physiologie Clinique et de l’Exercice, CHU Nord, Saint-Etienne, EA SNA EPIS 4607, Faculté de Médecine Jacques Lisfranc, Université de Lyon, Université Jean Monnet, 42023, Saint-Etienne, France

    Emilia Sforza, Sandrine Millasseau, David Hupin, Jean-Claude Barthélémy & Frédéric Roche

Authors
  1. Emilia Sforza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandrine Millasseau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Hupin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Claude Barthélémy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frédéric Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frédéric Roche.

Ethics declarations

The University Hospital and the local Ethics Committee (CCPRB Rhone-Alpes Loire) approved the PROOF as well as the SYNAPSE Study. The National Committee for Information and Liberty (CNIL) gave also at this time consent for data collection. All subjects gave their written consent prior to participation in the study.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sforza, E., Millasseau, S., Hupin, D. et al. Arterial stiffness alteration and obstructive sleep apnea in an elderly cohort free of cardiovascular event history: the PROOF cohort study. Sleep Breath 23, 201–208 (2019). https://doi.org/10.1007/s11325-018-1683-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-018-1683-x

Keywords

Search

Navigation