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Obstructive sleep apnea during rapid eye movement sleep is associated with early signs of atherosclerosis in women
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
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2018 (English)In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, no 7, article id zsy099Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Although obstructive sleep apnea (OSA) is associated with overall cardiovascular disease and mortality, the association with atherosclerotic cardiovascular disease is less clear, especially in women. Recently, it has been suggested that OSA during rapid eye movement (REM) sleep, associated with long apneas and deep desaturations, could have severe cardiometabolic consequences. The aim of this study was to investigate whether OSA during REM sleep is associated with early signs of atherosclerosis in a population-based sample of women. Methods: In the community-based "Sleep and Health in Women" (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements, blood sampling, blood pressure measurement, and answered questionnaires. Ten years later, 201 of the original participants, free of known atherosclerotic disease at baseline and without continuous positive airway pressure treatment for OSA, underwent a high-frequency ultrasound of the common carotid artery to assess the individual thickness of the layers of the artery wall. Results: Severe OSA during REM sleep (REM apnea-hypopnea index [AHI] >= 30) was associated with a thicker intima. This association was still significant after adjustment for age, body mass index, alcohol, and smoking, as well as for further adjustment for systolic blood pressure, low-density lipoprotein, C-reactive protein, and diabetes (ss-coefficient, 0.008; p-value, 0.022). The association between a REM AHI of >= 30 and intima thickness was also seen in women with no or mild OSA and normal non-REM AHI. Conclusions: In this study of a community-based sample of women, severe OSA during REM sleep was independently associated with early signs of atherosclerosis. Statement of Significance Individuals with obstructive sleep apnea run an increased risk of cardiovascular disease, but the relationship between obstructive sleep apnea and atherosclerotic diseases is still unclear, especially in women. Sleep apnea and respiration deteriorate during rapid eye movement (REM)-sleep and sleep apnea during REM sleep might have severe adverse effects. In this study of a community-based sample of women, severe sleep apnea during REM sleep was associated with early signs of atherosclerosis, defined as increased intima thickness, at 10 years of follow-up. The association was also seen in women with low overall apnea-hypopnea index, normally not considered for treatment of sleep apnea. This suggests that occurrence of frequent obstructive apneas during REM sleep has to be taken into consideration when diagnosing and treating sleep apnea.

Place, publisher, year, edition, pages
Oxford University Press, 2018. Vol. 41, no 7, article id zsy099
Keywords [en]
obstructive sleep apnea, cardiovascular morbidity, rapid eye movement-related sleep apnea, carotid tery intima thickness, atherosclerosis
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-150478DOI: 10.1093/sleep/zsy099ISI: 000439187200018PubMedID: 29762755OAI: oai:DiVA.org:umu-150478DiVA, id: diva2:1238474
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-13Bibliographically approved

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Franklin, Karl A

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