Source: Annual Congress 2001 - Cardiovascular pathophysiology in OSA
Disease area: Sleep and breathing disorders

Abstract

Obstructive sleep apnoea (OSA) is associated with increases in arterial blood pressure (BP) and cardiovascular death but interpreting these findings is complicated by co-existing therapy and other important risk factors such as obesity. We have studied baroreceptor sensitivity (BRS-mmHg), a marker of autonomic nervous system responsiveness via a spectral approach, and the HOMA index, a measure of insulin resistance calculated from fasting glucose and insulin values in patients with OSA and matched controls. We recruited 21 obese OSA patients (mean body mass index (BMI) 36.4, mean Epworth sleepiness score (ESS) 14.1 ±] 1.2), 9 obese non-apnoeic controls (mean BMI 37.4, mean ESS 9.4±]1.6), 6 lean OSA patients (mean BMI 27.6, ESS 13.5±] 3.7) and 21 lean controls (mean BMI 26.2, mean ESS 8±]1.2). Groups did not differ in age and were not receiving therapy for hypertension or OSA. Statistical comparisons used a Mann Whitney U Test. Obese controls were more insulin resistant than lean subjects (3.3±] 1 vs 1.2±] 0.1, p<0.02), but did not differ in BRS. Obese OSA patients were also insulin resistant (3.3±]0.3 vs 1.2±]0.1, p<0.01), but had significantly lower BRS than lean controls (6.3±]0.7 vs 12.7±]2.0, p<0.01). Lean OSA patients had both significantly reduced BRS (4.9±]1.1 vs 12.7±]2.0, p<0.01) and increased insulin resistance (1.9±]0.2 vs 1.2±]0.1, p<0.01) compared to lean controls. These data suggest cardiovascular and metabolic changes occur in stable OSA patients in addition to those attributable to obesity alone. Whether these can be reversed with treatment remains to be determined.

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S. R. Coughlin, L. Mawdsley, J. A. Mugarza, J. P. H. Wilding, P. M. A. Calverley (Liverpool, United Kingdom). Cardiovascular and metabolic consequences of obstructive sleep apnoea. Eur Respir J 2001; 16: Suppl. 31, 3498

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