Apnea-Specific Pulse-Rate Response is Associated With Early Subclinical Atherosclerosis in Obstructive Sleep Apnea

Introduction: In patients with obstructive sleep apnea (OSA), novel metrics such as hypoxic burden (HB) and sleep apnea-specific pulse-rate response (OHR) may better correlate with cardiovascular diseases (CVD) than the apnea-hypopnea index (AHI). This manuscript aims to assess the correlation between OHR and HB with subclinical atherosclerosis in patients with OSA, testing the hypothesis that elevated OHR and HB are associated with subclinical atherosclerosis development. Methods: In a prospective study, individuals aged 20-65 years with suspected OSA without known comorbidities were consecutively recruited and defined as OSA (AHI >= 5 events/h) or healthy controls. Using bilateral carotid ultrasonography, common carotid intima-media thickness (CIMT) was assessed and the identification of at least one atheromatous plaque defined the presence of subclinical atherosclerosis. OHR, and HB were derived from pulse-oximetry. Results: We studied 296 patients of age 45 +/- 10 years old, of whom 28% were women, and with a BMI of 30.3 +/- 5.3 kg/m2. Overall, 245 had OSA and 51 were healthy controls. After controlling for confounding variables higher OHR but not HB, was associated with higher CIMT (p = 0.006) and higher time spent with oxygen saturation below 90% (T90) was associated with an increase in carotid atheroma plaques (p = 0.032). When stratifying OSA based on HB tertiles, we observed that within tertile 2 of HB, an increase in OHR was associated with larger CIMT (p = 0.017). Conclusion: A higher OHR is associated with an increase in CIMT among adult patients with OSA. This study suggests that OHR could be a biomarker of risk for CVD in patients with OSA. (c) 2024 SEPAR. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.