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Zhai T, Liu B, Zhang J, Wu Y. Impact of obstructive sleep apnea on aortic disease occurrence: a meta-analysis. Heliyon 2022; 8:e10049. [PMID: 35992006 PMCID: PMC9389181 DOI: 10.1016/j.heliyon.2022.e10049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Aortic diseases, mainly including aortic dilatation, aortic aneurysm (AA) and aortic dissection (AD), have high morbidity and mortality. Many studies have suggested that obstructive sleep apnea (OSA) acts as a candidate risk factor for aortic diseases. Thus, we performed a meta-analysis to explore comprehensively the effect of OSA on the risk of aortic disease occurrence. Methods We searched PubMed, Embase and Cochrane Library databases from inception to February 2022 to identify studies investigating the association between OSA and aortic diameter dilatation, the prevalence of OSA in individuals with or without AA/AD and the incidence of AA/AD in individuals with or without OSA. The Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) were respectively used to evaluate the quality of the included cohort and cross-sectional studies. A random or fixed effect model was used to generate pooled effects according to interstudy heterogeneity. Sensitivity analyses were performed to test the robustness of the results. Results We identified 10 observational publications with 214,127 participants in this meta-analysis. OSA was significantly associated with increased aortic diameter (WMD = 1.46, 95% CI, 1.10–1.83, p < 0.001). OSA prevalence was higher in patients with AA/AD compared to their counterparts without AA/AD (OR = 1.90, 95% CI, 1.30–2.76, p = 0.001). No significant difference in the incidence of AA/AD was observed in individuals with or without OSA (RR = 0.85, 95% CI, 0.62–1.16, p = 0.307). Sensitivity analyses did not modify these results. Conclusions This meta-analysis suggests that OSA is associated with aortic diameter dilatation but does not affect AA/AD occurrence.
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Gessler N, Wohlmuth P, Anwar O, Debus ES, Eickholt C, Gunawardene MA, Hakmi S, Heitmann K, Rybczynski M, Schueler H, Sheikhzadeh S, Tigges E, Wiest GH, Willems S, Adam E, von Kodolitsch Y. Sleep apnea predicts cardiovascular death in patients with Marfan syndrome: a cohort study. EPMA J 2022; 13:451-460. [PMID: 36061830 PMCID: PMC9437159 DOI: 10.1007/s13167-022-00291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Background Surgical replacement of the aortic root is the only intervention that can prevent aortic dissection and cardiovascular death in Marfan syndrome (MFS). However, in some individuals, MFS also causes sleep apnea. If sleep apnea predicts cardiovascular death, a new target for predictive, preventive, and personalized medicine (PPPM) may emerge for those individuals with MFS who have sleep apnea. Methods This is an investigator-initiated study with long-term follow-up data of 105 individuals with MFS. All individuals were screened for sleep apnea regardless of symptoms. Cardiovascular death served as a primary endpoint, and aortic events as a secondary outcome. Results Sleep apnea with an apnea–hypopnea index (AHI) > 5/h was observed in 21.0% (22/105) with mild sleep apnea in 13% (14/105) and moderate to severe sleep apnea in 7.6% (8/105). After a median follow-up of 7.76 years (interquartile range: 6.84, 8.41), 10% (10/105) had died, with cardiovascular cause of death in 80% (8/10). After adjusting for age and body mass index (BMI), the AHI score emerged as an independent risk factor for cardiovascular death (hazard ratio 1.712, 95% confidence interval [1.061–2.761], p = 0.0276). The secondary outcome of aortic events occurred in 33% (35/105). There was no effect of the AHI score on aortic events after adjusting for age and BMI (hazard ratio 0.965, 95% confidence interval [0.617–1.509]), possibly due to a high number of patients with prior aortic surgery. Interpretation Sleep apnea is emerging as an independent predictor of cardiovascular death in MFS. It seems mandatory to screen all individuals with MFS for sleep apnea and to include these individuals, with both MFS and sleep apnea, in further studies to evaluate the impact of preventive measures with regard to cardiovascular death. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-022-00291-4.
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Affiliation(s)
- Nele Gessler
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
- Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Peter Wohlmuth
- Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Eike Sebastian Debus
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
- University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Melanie A Gunawardene
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Samer Hakmi
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Kathrin Heitmann
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Meike Rybczynski
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
- University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Helke Schueler
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
- University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Sara Sheikhzadeh
- Emergency Department, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Hamburg, Germany
- Emergency Department, Asklepios Clinic Harburg, Semmelweis University, Campus Hamburg, Hamburg, Germany
| | - Eike Tigges
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Gunther H Wiest
- Department of Pneumology and Sleep Medicine, Asklepios Clinic Harburg, Semmelweis University, Campus Hamburg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Clinic St. Georg, Semmelweis University, Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Ekaterina Adam
- University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Yskert von Kodolitsch
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
- University Heart Center Hamburg Eppendorf, Hamburg, Germany
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Hibino M, Otaki Y, Kobeissi E, Pan H, Hibino H, Taddese H, Majeed A, Verma S, Konta T, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Asahi K, Watanabe T, Watanabe T, Watanabe M, Aune D. Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality: Results From the J-SCH Study, the UK Biobank Study, and a Meta-Analysis of Cohort Studies. Circulation 2022; 145:633-644. [PMID: 34743557 DOI: 10.1161/circulationaha.121.056546] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies on this topic have been published. We investigated the association between hypertension/elevated BP and AD in 2 cohorts and conducted a meta-analysis of published prospective studies, including these 2 studies. METHODS We analyzed data from the J-SHC study (Japan-Specific Health Checkups) and UK Biobank, which prospectively followed up 534 378 and 502 424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks were calculated with random-effects models. A potential nonlinear dose-response relationship between BP and AD was tested with fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. RESULTS In the J-SHC study and UK Biobank, there were 84 and 182 ADs during the 4- and 9-year follow-up, and the adjusted hazard ratios of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI, 1.78-4.04) in hypertensive individuals, 1.33 (95% CI, 1.05-1.68) and 1.27 (95% CI, 1.11-1.48) per 20-mm Hg increase in systolic BP (SBP), and 1.67 (95% CI, 1.40-2.00) and 1.66 (95% CI, 1.46-1.89) per 10-mm Hg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary relative risks were 3.07 (95% CI, 2.15-4.38, I2=76.7%, n=7 studies, 2818 ADs, 4 563 501 participants) for hypertension and 1.39 (95% CI, 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2 = 57.0%, n=3) per 20-mm Hg increase in SBP and per 10-mm Hg increase in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mm Hg and DBP >75 mm Hg. CONCLUSIONS Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, St. Michael's Hospital (M.H., S.V.), University of Toronto, ON, Canada
- Department of Surgery (M.H., S.V.), University of Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, London, UK (M.H.., E.K., H.P., D.A.)
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, UK (M.H., H.H.., H.T., A.M.)
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan (Y.O., Tetsu Watanabe, M.W.)
| | - Elsa Kobeissi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, London, UK (M.H.., E.K., H.P., D.A.)
| | - Han Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, London, UK (M.H.., E.K., H.P., D.A.)
| | - Hiromi Hibino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, UK (M.H., H.H.., H.T., A.M.)
| | - Henock Taddese
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, UK (M.H., H.H.., H.T., A.M.)
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, UK (M.H., H.H.., H.T., A.M.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital (M.H., S.V.), University of Toronto, ON, Canada
- Department of Surgery (M.H., S.V.), University of Toronto, ON, Canada
| | - Tsuneo Konta
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Kunihiro Yamagata
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Shouichi Fujimoto
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Kazuhiko Tsuruya
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Ichiei Narita
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Masato Kasahara
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Yugo Shibagaki
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Kunitoshi Iseki
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Toshiki Moriyama
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Masahide Kondo
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Koichi Asahi
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Tsuyoshi Watanabe
- Japan Specific Health Checkups (J-SHC) Study Group (T.K., K.Y., S.F., K.T., I.N., M.K., Y.S., K.I., T.M., M.K., K.A., Tsuyoshi Watanabe)
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan (Y.O., Tetsu Watanabe, M.W.)
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan (Y.O., Tetsu Watanabe, M.W.)
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, London, UK (M.H.., E.K., H.P., D.A.)
- Department of Nutrition, Bjørknes University College, Oslo, Norway (D.A.)
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway (D.A.)
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (D.A.)
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Kwon Y, Logan J, Redline S, Duprez D, Jacobs DR, Ouyang P, Hundley WG, Lima J, Bluemke DA, Lutsey PL. Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA). Cardiology 2019; 142:180-188. [PMID: 31189162 DOI: 10.1159/000499500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/10/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Structural and functional properties of the proximal thoracic aorta have important implications in clinical and subclinical cardiovascular disease (CVD). We examined whether obstructive sleep apnea (OSA) is associated with proximal aortic size and aortic stiffness in a multi-ethnic community-based cohort. METHODS The sample included the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary study participants without known CVD who underwent cardiac magnetic resonance imaging. The main exposure variable was OSA severity based on the polysomnography-derived apnea hypopnea index (AHI; normal, AHI <5/h; mild, 5≤ AHI <15/h; moderate to severe, AHI ≥15/h). The study outcomes were ascending aortic diameter (AoD, cm), aortic pulse wave velocity (AoPWV, m/s), and ascending aortic distensibility (AAD, %/mm Hg). Analyses were performed in the overall sample and in sex-specific strata, adjusted for multiple potential confounders. RESULTS The 708 participants were 55.9% female and on average 68 years old (54-93 years). There was a significant trend (p < 0.0001) of greater mean (SD) AoD across the three OSA groups: normal (n = 87), 3.13 cm (0.35); mild (n = 215), 3.25 (0.34); moderate to severe (n = 406), 3.37 (0.36). In adjusted analysis, participants with moderate to severe OSA had a greater mean AoD compared with the normal group: adjusted mean difference (95% CI), 0.12 cm (0.05, 0.20), p = 0.002. This AoD gradient was observed in women but not in men (p for interaction = 0.02). No differences were found in AoPWV or AAD among the OSA groups. CONCLUSION In a diverse community-based cohort, moderate to severe OSA (vs. no OSA) was associated with a larger ascending AoD in women.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA,
| | - Jeongok Logan
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Duprez
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W Greg Hundley
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Pamela L Lutsey
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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5
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Akutsu K. Etiology of aortic dissection. Gen Thorac Cardiovasc Surg 2019; 67:271-276. [PMID: 30689200 DOI: 10.1007/s11748-019-01066-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/11/2019] [Indexed: 12/28/2022]
Abstract
We discuss the etiology of aortic dissection (AD) from various points of view. The development of AD requires two pathological conditions: medial degeneration and mechanical wall stress. First, histopathological findings of medial degeneration are hypothesized to be due to a loss of elastic fibers and interconnecting elastic fibers. Damage to the vasa vasorum plays a key role in creating an entry site. The clinical causes of medial degeneration include hypertension, aortic aneurysms, obstructive sleep apnea, and connective tissue disorders. Second, mechanical wall stress is supposedly induced by shear stress caused by blood flow, together with hypertension and aortic root movement. Further investigation is necessary in the search for mechanisms responsible for medial degeneration prior to AD development.
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Affiliation(s)
- Koichi Akutsu
- Division of Vascular Medicine, Department of Cardiovascular Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, 31-21, Ohmiya-cho, Saiwaiku, Kawasaki, Kanagawa, 212-0014, Japan.
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6
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Zhou X, Liu F, Zhang W, Wang G, Guo D, Fu W, Wang L. Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies. Vascular 2018; 26:515-523. [PMID: 29566589 DOI: 10.1177/1708538118766102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives Obstructive sleep apnea acts as a potential risk factor for the development of cardiovascular disease. We undertook collaborative meta-analyses to clarify the risk of aortic dissection among adults suffering obstructive sleep apnea. Methods A systematic search of the databases (PubMed, Embase, and Cochrane Library) was performed. Studies reporting on the association between obstructive sleep apnea and aortic dissection were included. Information on 424 cases of aortic dissection in 56,291 patients from one cohort, four case-controls, and two cross-sectional studies were included in this study. Results The summary suggested that patients with obstructive sleep apnea are associated with an overall significant 60% increase in the risk of aortic dissection, compared to unexposed patients (odds ratios 1.60; 95% confidence interval 1.01-2.53), with a significantly higher apnea-hypopnea index (mean difference 10.71; 95% confidence interval 7.46-13.96). Moreover, a greater relation was found between moderate-to-severe obstructive sleep apnea and aortic dissection (odds ratios 4.43; 95% confidence interval 2.59-7.59). Adverse outcomes obtained by sleep study such as oxygen desaturation index (mean difference 10.51; 95% confidence interval 7.54-13.48), average SaO2 (-1.36; 95% confidence interval -2.63 to -0.09), and minimum SaO2 (-3.63; 95% confidence interval -5.27 to -1.98) were correspondingly related to patients with aortic dissection. Conclusions Obstructive sleep apnea, especially moderate-to-severe obstructive sleep apnea, may impose an additional risk of suffering from aortic dissection with a potential mechanism including intermittent hypoxia.
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Affiliation(s)
- Xiushi Zhou
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Fei Liu
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Wei Zhang
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Guili Wang
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
| | - Lixin Wang
- Department of Vascular Surgery, 92323 Zhongshan Hospital Fudan University , Shanghai, China
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7
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Wang L, Chen J, Li G, Luo S, Wang R, Li W, Zhang J, Liu Y, Huang W, Cao Y, Zhou Y, Chen P, Pressman GS, Somers VK, Luo J. The Prevalence of Sleep Apnea in Type B Aortic Dissection: Implications for False Lumen Thrombosis. Sleep 2017; 40:3052719. [PMID: 28364434 DOI: 10.1093/sleep/zsw071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) has been implicated in aortic dissection. Thrombosis of the false lumen is associated with a prognosis of type B aortic dissection (AoD), and partial thrombosis has been reported to be an independent predictor of mortality. This study sought to explore whether the severity of OSA is associated with false lumen thrombosis. Aims and Methods In this observational study, 151 type B AoD patients were recruited consecutively from 2013 to 2015. The status of the false lumen was classified as patent, partially thrombosed, or completely thrombosed based on a computer tomography angiography image. Patients were divided into non-OSA group (apnea-hypopnea index [AHI] < 5), and mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), and severe OSA groups (AHI > 30) using the AHI. Results The prevalence of OSA in type B dissection was 66.2%. Among 151 cases, 51 patients (33.8%) were in the non-OSA group, 56 (37.1%) were in the mild group, 21 (13.9%) were in the moderate group, and 23 (15.2%) were in the severe group. Additionally, a partially thrombosed false lumen was observed in 88 patients (58.3%). Multivariable analysis revealed that OSA severity was positively associated with partial thrombosis (odds ratio, 1.784, 95% confidence interval: 1.182-2.691, P = .006) after adjusting for other confounding factors. Conclusions OSA was present in two-thirds of patients with type B AoD. The severity of OSA was significantly associated with an increased risk of partial false lumen thrombosis. OSA may therefore be implicated in both the etiology and prognosis of AoD.
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Affiliation(s)
- Ling Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangxi Li
- Department of Respiratory, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rui Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiawei Zhang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuan Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhui Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingshu Cao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.,Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingyan Chen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.,Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Gregg S Pressman
- Division of Cardiology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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