Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing

Hiroyuki Sawatari, Akiko Chishaki, Mari Nishizaka, Tomotake Tokunou, Sonomi Adachi, Chikara Yoshimura, Tomoko Ohkusa, Shin Ichi Ando

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB. METHODS: We conducted polysomnography (PSG) and measured flow-mediated vasodilation response (%FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90% (<SpO2 90%), and averaged time desaturation summation index (TDS: [100%-averaged SpO2] × total sleep time). RESULTS: Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by %FMD. The %FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3%ODI, averaged SpO2, lowest SpO2, and <SpO2 90% showed no significant relationships. CONCLUSIONS: This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.

Original languageEnglish
Pages (from-to)458-463
Number of pages6
JournalAmerican Journal of Hypertension
Volume29
Issue number4
DOIs
Publication statusPublished - Jan 1 2016

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Sleep Apnea Syndromes
Blood Vessels
Sleep
Oxygen
Apnea
Cardiovascular Diseases
Polysomnography
Vasodilation
Hypoxia
Outpatients
tyramine-deoxysorbitol

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing. / Sawatari, Hiroyuki; Chishaki, Akiko; Nishizaka, Mari; Tokunou, Tomotake; Adachi, Sonomi; Yoshimura, Chikara; Ohkusa, Tomoko; Ando, Shin Ichi.

In: American Journal of Hypertension, Vol. 29, No. 4, 01.01.2016, p. 458-463.

Research output: Contribution to journalArticle

Sawatari, Hiroyuki ; Chishaki, Akiko ; Nishizaka, Mari ; Tokunou, Tomotake ; Adachi, Sonomi ; Yoshimura, Chikara ; Ohkusa, Tomoko ; Ando, Shin Ichi. / Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing. In: American Journal of Hypertension. 2016 ; Vol. 29, No. 4. pp. 458-463.
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title = "Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing",
abstract = "BACKGROUND: Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB. METHODS: We conducted polysomnography (PSG) and measured flow-mediated vasodilation response ({\%}FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3{\%} oxygen desaturation index (3{\%}ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90{\%} (<SpO2 90{\%}), and averaged time desaturation summation index (TDS: [100{\%}-averaged SpO2] × total sleep time). RESULTS: Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by {\%}FMD. The {\%}FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3{\%}ODI, averaged SpO2, lowest SpO2, and <SpO2 90{\%} showed no significant relationships. CONCLUSIONS: This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.",
author = "Hiroyuki Sawatari and Akiko Chishaki and Mari Nishizaka and Tomotake Tokunou and Sonomi Adachi and Chikara Yoshimura and Tomoko Ohkusa and Ando, {Shin Ichi}",
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T1 - Cumulative hypoxemia during sleep predicts vascular endothelial dysfunction in patients with sleep-disordered breathing

AU - Sawatari, Hiroyuki

AU - Chishaki, Akiko

AU - Nishizaka, Mari

AU - Tokunou, Tomotake

AU - Adachi, Sonomi

AU - Yoshimura, Chikara

AU - Ohkusa, Tomoko

AU - Ando, Shin Ichi

PY - 2016/1/1

Y1 - 2016/1/1

N2 - BACKGROUND: Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB. METHODS: We conducted polysomnography (PSG) and measured flow-mediated vasodilation response (%FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90% (<SpO2 90%), and averaged time desaturation summation index (TDS: [100%-averaged SpO2] × total sleep time). RESULTS: Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by %FMD. The %FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3%ODI, averaged SpO2, lowest SpO2, and <SpO2 90% showed no significant relationships. CONCLUSIONS: This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.

AB - BACKGROUND: Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB. METHODS: We conducted polysomnography (PSG) and measured flow-mediated vasodilation response (%FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90% (<SpO2 90%), and averaged time desaturation summation index (TDS: [100%-averaged SpO2] × total sleep time). RESULTS: Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by %FMD. The %FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3%ODI, averaged SpO2, lowest SpO2, and <SpO2 90% showed no significant relationships. CONCLUSIONS: This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.

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