Can obstructive sleep apnea during REM-sleep explain long-term health consequences of sleep disordered breathing?

Title [en]

Abstract [sv]

Bakgrund:Results from observational studies have shown that patients with untreated severe obstructive sleep apnea (OSA) have an increased risk of cardiovascular morbidity and mortality. However, although treatment with continuous positive airway pressure (CPAP) is effective in reducing AHI and improving subjective daytime sleepiness randomized controlled trials have failed to show any cardio protective effect of CPAP treatment. These disappointing results could be due to the fact that selection of patients for treatment is still based solely on overall apnea-hypopnea index (AHI) while the AHI give little information about which patients are at greatest risk of OSA related consequences. There is hence an urgent need for redefining OSA and identify phenotypes with high cardiometabolic risk who should be selected for the often lifelong treatment. There are possible mechanistic pathways that sleep fragmentation by OSA during Rapid eye movement (REM) sleep have a high cardiometabolic impact and our previous results from a female population support this theory.Målsättning:The primary aim of this study is to analyze the association between obstructive sleep apnea during REM sleep and early signs of atherosclerosis in a community-based sample of men.We hypothesize that apneas and hypopneas during sleep phase REM are the most important when it comes to impact on the atherosclerotic process and other cardiometabolic processes. Arbetsplan:A community-based sample of men are investigated by whole-night polysomnography, questionnaires, spirometry, anthropometrics and high-frequency ultrasound of the common carotid artery to assess the intima-media thickness (IMT). Fasting blood samples are analyzed for cardiometabolic and inflammatory biomarkers. Betydelse:If we can be verified that OSA during REM sleep is most important for long term consequences of OSA that will have huge consequences for clinical routines as well as possibilities to prevent cardiometabolic morbidity and mortality.

Abstract [en]

Bakgrund:Results from observational studies have shown that patients with untreated severe obstructive sleep apnea (OSA) have an increased risk of cardiovascular morbidity and mortality. However, although treatment with continuous positive airway pressure (CPAP) is effective in reducing AHI and improving subjective daytime sleepiness randomized controlled trials have failed to show any cardio protective effect of CPAP treatment. These disappointing results could be due to the fact that selection of patients for treatment is still based solely on overall apnea-hypopnea index (AHI) while the AHI give little information about which patients are at greatest risk of OSA related consequences. There is hence an urgent need for redefining OSA and identify phenotypes with high cardiometabolic risk who should be selected for the often lifelong treatment. There are possible mechanistic pathways that sleep fragmentation by OSA during Rapid eye movement (REM) sleep have a high cardiometabolic impact and our previous results from a female population support this theory.Målsättning:The primary aim of this study is to analyze the association between obstructive sleep apnea during REM sleep and early signs of atherosclerosis in a community-based sample of men.We hypothesize that apneas and hypopneas during sleep phase REM are the most important when it comes to impact on the atherosclerotic process and other cardiometabolic processes. Arbetsplan:A community-based sample of men are investigated by whole-night polysomnography, questionnaires, spirometry, anthropometrics and high-frequency ultrasound of the common carotid artery to assess the intima-media thickness (IMT). Fasting blood samples are analyzed for cardiometabolic and inflammatory biomarkers. Betydelse:If we can be verified that OSA during REM sleep is most important for long term consequences of OSA that will have huge consequences for clinical routines as well as possibilities to prevent cardiometabolic morbidity and mortality.

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Uppsala University

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Hjärt-Lungfonden

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