Severity of Obstructive Sleep Apnea Is Positively Associated With the Presence of Carotid Artery Atheromas

Are Panoramic Images a Good Tool to Detect Calcified Carotid Atheroma? A Systematic Review

Simple Summary

The goal of the present review is to investigate the reliability of panoramic dental images to detect calcified carotid atheroma. The findings of this systematic review exhibit that panoramic radiographs can be used for dental diagnosis and treatment planning, as well as to detect calcified carotid artery atheroma, so it can be a tool to prevent cardiovascular diseases.

Abstract

To investigate the reliability of panoramic dental images to detect calcified carotid atheroma, electronic databases (PubMed, IEEE/Xplore and Embase) were searched. Outcomes included cerebrovascular disease events, cardiovascular disease events, patient previous diseases, and combined endpoints. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Hence, 15 studies were selected from 507 potential manuscripts. Five studies had a low risk of bias, while the remaining nine studies were found to have a moderate risk. Heterogeneous results were obtained but showed that patients with risk factors, such as obesity, diabetes mellitus, hypertension, and smoking, and with calcified carotid atheroma on panoramic images, have a higher prevalence than healthy patients. The evidence in the literature was found to be equivocal. However, the findings of this systematic review exhibit that panoramic radiographs can be used for dental diagnosis and treatment planning, as well as to detect calcified carotid artery atheroma.

Clinical study of atherosclerotic plaque in the carotid artery and lower extremities in patients with obstructive sleep apnea-hypopnea syndrome

OBJECTIVE

The present study aimed to explore the relationship between young and middle-aged patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and atherosclerotic plaque of the carotid artery and lower extremities.

METHODS

A total of 110 patients diagnosed with OSAHS by polysomnography in the researchers' hospital from September 2018 to September 2019 were selected as the research objects. The enrolled patients were divided into a mild group (36 cases), a moderate group (38 cases), and a severe group (36 cases). Another 36 healthy subjects were set up as the non-OSAHS group. All the selected subjects were examined by color Doppler ultrasound of the carotid artery and lower extremity arteries.

RESULTS

The detection rate of atherosclerotic plaque of the carotid artery and/or lower extremities in patients with OSAHS was significantly higher than that in the non-OSAHS group (P < 0.05), and the incidence of plaque tended to increase along with an increase in the degree of OSAHS.

CONCLUSION

The findings indicate that OSAHS might be an independent influencing factor for atherosclerosis.

Targeting subclinical organ damage in obstructive sleep apnea: a narrative review

Subclinical abnormalities in cardiac and vascular structure reflect the adverse effects triggered by a variety of risk factors on the cardiovascular (CV) system thereby representing an intermediate step in the cardiovascular continuum; such alterations are recognized as reliable markers of increased cardiovascular risk in different clinical settings including obstructive sleep apnea (OSA). The mechanisms underlying subclinical organ damage (OD) in the OSA setting are multifactorial. Hypoxemia and hypercapnia, induced by repeated collapses of upper airways, have been suggested to trigger a cascade of events such as activation of the sympathetic tone, renin-angiotensin-aldosterone system leading to endothelial dysfunction, vasoconstriction, myocardial and vascular remodeling, and hypertension. Furthermore, coexisting non-haemodynamic alterations such as increased oxidative stress, release of inflammatory substances, enhanced lipolysis and insulin resistance have been reported to play a role in the pathogenesis of both cardiac and extra-cardiac OD. In this article we reviewed available evidence on the association between OSA and subclinical cardiac (i.e., left and right ventricular hypertrophy, left atrial dilatation) and extra-cardiac organ damage (i.e., carotid atherosclerosis, arterial stiffness, microvascular retinal changes, and microalbuminuria). This association is apparently stronger for cardiac and carotid subclinical damage than for other markers (i.e., arterial stiffness and retinal changes) and mostly evident in the setting of severe OSA.

Red Cell Distribution Width, Unlike Neutrophil Lymphocyte Ratio Is Unable to Accurately Gauge Enhanced Systemic Inflammation Associated With Panoramic Imaged Carotid Plaque

INTRODUCTION

We have previously shown that panoramic X-rays (PXs) demonstrating calcified carotid artery atheromas (CCAA) are associated with increased systemic inflammation demonstrating increased neutrophil lymphocyte ratios (NLRs), a validated risk indicator of fatal myocardial infarctions arising from coronary artery atherosclerosis. Using this same cohort of patients (with minor adjustments because of missing data), we sought to determine if a like association existed between PXs evidencing CCAA and elevated red blood cell distribution width (RDW) given conflicting data as its reliability relative to NLR as a biologic marker of system inflammation. We hypothesized that CCAAs on PXs would simultaneously be associated with both increased NLR and RDW.

MATERIALS AND METHODS

Investigators implemented a cross-sectional study design. Study sample consisted of patient medical records and PXs of white men ≥ 55 years. Two groups (N = 50 each) were constituted, one with atheromas (CCAA+) and without atheromas (CCAA-). The predictor variable was CCAA+ and outcome variables were NLR and RDW. Bootstrapping analysis was employed to analyze the differences in mean NLRs and RDWs between groups since the data was not normally distributed. Statistical significance determined to be ≤ 0.05 for all tests. The Medical Center's Institutional Review Board approved the research protocol.

RESULTS

A study group of 50 CCAA+ men (mean age 71; range 58-89 years) demonstrated a mean NLR of 2.98 ± 1.38 and an RDW of 13.21 ± 0.85. A control group of 50 CCAA- males (mean age 70 range; 55-91 years) evidenced a mean NLR of 2.38 ± 0.77 and an RDW of 13.16 ± 0.77. Bootstrapping comparison of NLR values evidenced significant (P = 0.008) difference (95% confidence interval of difference of mean: - 0.4272, 0.4384; observed effect size: 0.579) between groups; however, there was no significant difference in RDW values between the groups. Furthermore, logistic regression modeling demonstrated that for a one unit increase in NLR the odds of being CCAA+ (vs. CCAA-) increases by a factor of 1.659.

CONCLUSION

The existence of CCAA seen on PXs of elderly white men is associated with significantly (P = 0.008) elevated NLR values but is not associated with increases in RDW.

Obstructive Sleep Apnea Risk and Stroke among Blacks with Metabolic Syndrome: Results from Metabolic Syndrome Outcome (MetSO) Registry

Introduction:

The American Stroke Association estimates that stroke is the fifth leading cause of death in the United States. According to the Center for Disease Control and Prevention someone in the United States has a stoke every 40 seconds, affecting more than 795,000 people of which 140,000 result in death [1]. Emerging evidence suggests that obstructive sleep apnea (OSA) is a strong risk factor for stroke. This study using The Metabolic Syndrome Outcome (MetSO) registry explored whether blacks at risk for obstructive sleep apnea (OSA) are at greater risk for a stroke.

Method:

The present study utilized data from the MetSO study, an NIH-funded cohort study of blacks with metabolic syndrome (MetS). Patients were diagnosed with MetS using standard criteria articulated in the joint interim statement for harmonizing the MetS. The study assessed OSA risk using the Apnea Risk Evaluation System (ARES); defining high risk as a total ARES score ≥6. Data was coded and analyzed by an experienced statistician using SPSS 20.0.

Results:

A total of 1035 participants were screened for MetS in the MetSO registry. During the data collection period 875 participants were enrolled during the time of analysis. The average age of the sample was 62±14 years (range: 20–97); 71% were female, and all were of black race/ethnicity. Seventy-one percent reported finishing high school, and 43% reported annual income <10K. Descriptive analyses showed 93% of the participants were diagnosed with hypertension; 61%, diabetes; 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease and 10% had a stroke history. Using the ARES screener, we estimated that 48% were at high risk for OSA. Logistic regression analysis, adjusting for age and gender, showed that patients at high risk for OSA had a nearly three-fold increase in the odds of having a stroke (OR = 2.79, 95% CI: 1.64–4.73).

Conclusion:

In the MetSO registry, a cohort of blacks with MetS, the prevalence of stroke is greater than in the general US population. Blacks at risk for OSA are particularly vulnerable to experiencing a stroke.