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AlSheikh S. Relationship Between Peripheral Arterial Diseases and Obstructive Sleep Apnea: A Systematic Review. Cureus 2023; 15:e35550. [PMID: 37007316 PMCID: PMC10058385 DOI: 10.7759/cureus.35550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
Although the effects of obstructive sleep apnea (OSA) on the cardiovascular outcomes of coronary artery disease (CAD) have been well-established, its significance on the occurrence of peripheral arterial disease (PAD) remains debatable. Prompt diagnosis and treatment of OSA would help reduce cardiovascular comorbidities. Our study aimed to assess the relationship between OSA and PAD and report any statistical association between the two conditions. Here, we investigated the prevalence and association of OSA in PAD based on related articles from PubMed, Embase, and the Cochrane Library. All databases were systematically searched from January 2000 to December 2020. A total of 238 articles deemed relevant were assessed for eligibility, of which seven articles were selected for the systematic review. Seven prospective cohorts were qualified for inclusion, which included 26,881 male and 34,403 female patients (N = 61,284). The retrieved articles described OSA severity based on the apnea-hypopnea index and reported increased OSA prevalence in PAD patients. The Epworth sleepiness scale showed no association between OSA severity, poor ankle-brachial index values, and increased daytime sleepiness. The prevalence of OSA increased in patients with PAD. Further research and prospective clinical trials are required to establish strong associations between OSA and PAD to make appropriate changes in patient management algorithms and improve their outcomes.
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Roncoroni J, Okun M, Hudson A. Systematic review: sleep health in the US Latinx population. Sleep 2022; 45:zsac092. [PMID: 35460556 DOI: 10.1093/sleep/zsac092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/10/2022] [Indexed: 09/19/2023] Open
Abstract
Sleep disturbances are a common and unmet health problem in Latinx. While Latinx report similar sleep disturbances as non-Hispanic Whites [NHW], Latinx suffer from these disturbances to a greater degree than their NHW counterparts. Sleep disturbances are associated with increased risk of chronic health conditions, which Latinx experience at high rates. Research also points to significant sleep differences within Latinx. Given that Latinx are a rapidly growing population in the United States, sleep disparities between Latinx and NHWs and sleep differences within Latinx warrant further investigation. While research on Latinx sleep is growing, the last narrative review on US Latinx sleep health was published by Loredo and colleagues in 2010. Our narrative review expands on Loredo et al.'s work, adding the literature on Latinx sleep published since 2010 (N = 70). A total of 78 peer-reviewed articles related to young to middle-aged (i.e., 18-65 years) healthy Latinx adult sleep were identified in three databases-PsycInfo, PubMed/Medline, and Web of Science. With the socioecological model as framework, this review (1) summarizes current evidence pertaining to sleep health in healthy, community dwelling, urban Latinx adults; (2) discusses measurement challenges related to investigating Latinx sleep disparities and differences; and (3) discusses potential contributors to Latinx sleep. The prevalence of short sleep duration, long sleep duration, and poor sleep quality is high among Latinx; there are differences by Latinx subgroup. Our review identifies several multi-level influences associated with poor sleep: SES, sexual minority status, racial discrimination, access to care, neighborhood environment, and shift work. N = 250/250.
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Affiliation(s)
- Julia Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Michele Okun
- Psychology Department University of Colorado, Colorado Springs, CO, USA
| | - Amy Hudson
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
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Shiina K, Takata Y, Nakano H, Fujii M, Iwasaki Y, Kumai K, Matsumoto C, Chikamori T, Tomiyama H. Moderate to severe obstructive sleep apnea is independently associated with inter-arm systolic blood pressure difference: Tokyo Sleep Heart Study. J Hypertens 2022; 40:318-326. [PMID: 34478413 DOI: 10.1097/hjh.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is recognized as an independent risk factor for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD), inter-ankle systolic blood pressure difference (IAND), and ankle-brachial index (ABI) are all known predictors of cardiovascular events. The aim of the present study was to investigate the association between OSA and four-limb blood pressure differences. METHODS We conducted this cross-sectional study in a large sleep cohort from Tokyo Sleep Heart Study. In 2643 consecutive patients who visited our sleep clinic for polysomnography between 2005 and 2017, all the patients underwent blood pressure measurement simultaneously in all the four limbs by oscillometric methods. RESULTS The prevalence rate of IAD ≥10 mmHg was significantly higher in the moderate OSA (15 ≤ apnea-hypopnea index [AHI] < 30) group (4.2%) and severe OSA (AHI ≥ 30) group (4.6%) than that in the no/mild (AHI < 15) OSA group (1.4%). Multivariate logistic regression analysis also identified moderate to severe OSA as being significantly associated with IAD ≥10 mmHg, even after adjustments for confounding variables (moderate OSA: odds ratio [OR], 4.869; 95% confidence interval [CI], 1.080-21.956; P = 0.039; severe OSA: OR, 5.301; 95% CI, 1.226-22.924; P = 0.026). However, there were no significant associations of the OSA severity with IAND ≥15 mmHg or ABI <0.9. CONCLUSIONS Moderate to severe OSA was independently associated with the IAD, not but with the IAND or ABI.
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Affiliation(s)
- Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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Voulgaris A, Archontogeorgis K, Steiropoulos P, Papanas N. Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Obstructive Sleep Apnoea Syndrome and Overlap Syndrome. Curr Vasc Pharmacol 2021; 19:285-300. [PMID: 32188387 DOI: 10.2174/1570161118666200318103553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea syndrome (OSAS) are among the most prevalent chronic respiratory disorders. Accumulating data suggest that there is a significant burden of cardiovascular disease (CVD) in patients with COPD and OSAS, affecting negatively patients' quality of life and survival. Overlap syndrome (OS), i.e. the co-existence of both COPD and OSAS in the same patient, has an additional impact on the cardiovascular system multiplying the risk of morbidity and mortality. The underlying mechanisms for the development of CVD in patients with either OSAS or COPD and OS are not entirely elucidated. Several mechanisms, in addition to smoking and obesity, may be implicated, including systemic inflammation, increased sympathetic activity, oxidative stress and endothelial dysfunction. Early diagnosis and proper management of these patients might reduce cardiovascular risk and improve patients' survival. In this review, we summarize the current knowledge regarding epidemiological aspects, pathophysiological mechanisms and present point-to-point specific associations between COPD, OSAS, OS and components of CVD, namely, pulmonary hypertension, coronary artery disease, peripheral arterial disease and stroke.
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Affiliation(s)
- A Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - K Archontogeorgis
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - P Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Papanas
- Diabetes Centre, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Sapiña-Beltrán E, Gracia-Lavedan E, Torres G, Gaeta AM, Paredes J, Mayoral A, Fernández E, Bermúdez-López M, Valdivielso JM, Farràs-Salles C, Pamplona R, Lecube A, de Batlle J, Barbé F, Dalmases M. Prevalence of Obstructive Sleep Apnoea and Its Association With Atherosclerotic Plaques in a Cohort of Subjects With Mild-Moderate Cardiovascular Risk. Arch Bronconeumol 2021; 58:490-497. [PMID: 33741145 DOI: 10.1016/j.arbres.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Classic cardiovascular risk factors do not explain all the cardiovascular events. Obstructive sleep apnoea (OSA) has been proposed as a potential and prevalent cardiovascular risk factor. Our study aimed to describe the prevalence of OSA in a middle-aged cohort with mild-moderate cardiovascular risk and evaluate its association with atherosclerotic disease. METHODS This is an observational cross-sectional ancillary study of the ILERVAS project which was aimed to study subclinical arterial disease in a cohort with mild-moderate cardiovascular risk. In a sample of consecutive subjects, we performed a sleep study and evaluate OSA prevalence and its association with carotid and femoral atheroma plaques and atherosclerotic burden. RESULTS Overall, 966 subjects with a median age of 57 years (25-75th percentile; 52-62) and a body mass index (BMI) of 28.5kg/m2 (25.6-31.6) were included. Of these, 72.6% (69.7%-75.3%) had OSA (apnoea-hypopnoea index (AHI)≥5/h); 35.7% (32.8%-38.8%) had mild OSA (AHI 5-14.9/h) and 36.9% (33.9%-39.9%) had moderate/severe OSA (AHI≥15/h). Mean oxygen saturation and the percentage of time with oxygen saturation<90% (CT90) were associated with atherosclerotic burden (eβ (95%CI) 0.932 (0.892, 0.974); 1.005 (1.002, 1.009), respectively) and total plaque (OR (95%CI) 0.88 (0.797,0.971); 1.013 (1.004,1.021), respectively). No association with the AHI or oxygen desaturation index was found. CONCLUSIONS This study confirms a high prevalence of OSA in patients with mild-moderate cardiovascular risk and shows an association between atherosclerotic burden, total and femoral plaque with CT90 and mean oxygen saturation, suggesting the importance of OSA-related hypoxaemia in the induction of atherosclerotic disease.
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Affiliation(s)
- Esther Sapiña-Beltrán
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Esther Gracia-Lavedan
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Gerard Torres
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Anna M Gaeta
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain
| | - Judith Paredes
- Oxigen Salud, Homecare Provider, C/ Pere IV, 453, 08020 Barcelona, Spain
| | - Ana Mayoral
- Oxigen Salud, Homecare Provider, C/ Pere IV, 453, 08020 Barcelona, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, Av. Rovira Roure 80, 25198 Lleida, Spain
| | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, Av. Rovira Roure 80, 25198 Lleida, Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, Av. Rovira Roure 80, 25198 Lleida, Spain
| | - Cristina Farràs-Salles
- Primary Care ABS Balàfia - Pardinyes - Secà de Sant pere, Av. Alcalde Recasens s/n, 25005 Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, University of Lleida-Lleida Biomedical Research Institute (UdL-IRBLleida), Av. Rovira Roure 80, 25198 Lleida, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Obesity, Diabetes and Metabolism Research Group (ODIM), Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Av. Rovira Roure 80, Lleida, Spain
| | - Jordi de Batlle
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Ferran Barbé
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Mireia Dalmases
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Av. Rovira Roure 80, 25198 Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Av. Monforte de Lemos, 3-5, Pabellón 11, 28029 Madrid, Spain.
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Rich K. The connection between obstructive sleep apnea and peripheral artery disease. JOURNAL OF VASCULAR NURSING 2020; 38:195-197. [PMID: 33279111 DOI: 10.1016/j.jvn.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Kathleen Rich
- Franciscan Health - Michigan City, Michigan City, Indiana.
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Ahsan MJ, Latif A, Fazeel HM, Lateef N, Zoraiz Ahsan M, Kapoor V, Batool SS, Mirza M, Ashfaq Z, Holmberg M, Anwer F. Obstructive sleep apnea and peripheral vascular disease: a systematic review based on current literature. J Community Hosp Intern Med Perspect 2020; 10:188-193. [PMID: 32850063 PMCID: PMC7426973 DOI: 10.1080/20009666.2020.1764276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is an established risk factor for poor cardiovascular outcomes and coronary artery disease, but its influence on the development of peripheral artery disease (PAD) is not well established. The aim of our study was to understand the mutual prevalence of OSA and PAD and any reported statistical association between the two conditions. Methods PubMed, Ovid Embase, Web of Science, Cochrane library and clinicaltrials.gov databases were systematically searched up to 29 November 2018. A total of 844 articles were identified and 744 articles were screened for relevance. Results and Conclusion Eleven prospective cohorts qualified for inclusion with N = 63,642 (M = 28,062, F = 35,494). All studies evaluated OSA severity primarily with apnea–hypopnea index (AHI) values. The overall prevalence of PAD was 20.5% (N = 13,068). Except for two studies, all studies reported an increased prevalence of OSA in patients with PAD. OSA severity was not found to have an association with poor ankle brachial index values or increasing daytime sleepiness as measured by Epworth sleepiness scale. Further prospective clinical trials are required to further delineate this finding.
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Affiliation(s)
| | - Azka Latif
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Hafiz Muhammad Fazeel
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Noman Lateef
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | | | - Vikas Kapoor
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | | | - Mohsin Mirza
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Zubair Ashfaq
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Mark Holmberg
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Faiz Anwer
- Department of Internal Medicine, Cleveland Medical Center, Cleveland, OH, USA
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Association between sleep-disordered breathing and lower extremity artery disease: a meta-analysis. Sleep Breath 2020; 25:227-236. [DOI: 10.1007/s11325-020-02096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
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Alshehri MM, Alqahtani AS, Alenazi AM, Aldhahi M, Alothman S, Gray C, Alqahtani B, Khunti K, Kluding P. Associations between ankle-brachial index, diabetes, and sleep apnea in the Hispanic community health study/study of Latinos (HCHS/SOL) database. BMC Cardiovasc Disord 2020; 20:118. [PMID: 32138679 PMCID: PMC7059725 DOI: 10.1186/s12872-020-01402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. METHODS A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. RESULTS There were significant differences between groups in the mean of apnea-hypopnea index (P < 0.001; no DM + normal ABI = 5.42 ± 9.66, no DM + abnormal ABI = 7.11 ± 11.63, DM + normal ABI = 10.99 ± 15.16, DM + abnormal ABI = 12.81 ± 17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (β = 3.25, P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. CONCLUSION These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.
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Affiliation(s)
- Mohammed M Alshehri
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2002, Kansas City, KS, 66160, USA.
- Physical Therapy department, Jazan University, Jizan, Saudi Arabia.
| | - Abdulfattah S Alqahtani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Aqeel M Alenazi
- Department of Physical Therapy and Rehabilitation Science, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Monira Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Shaima Alothman
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2002, Kansas City, KS, 66160, USA
| | - Corey Gray
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2002, Kansas City, KS, 66160, USA
| | - Bader Alqahtani
- Department of Physical Therapy and Rehabilitation Science, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Patricia Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2002, Kansas City, KS, 66160, USA
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Xia Y, You K, Xiong Y, Jiang H. Sleep-Disordered Breathing and Peripheral Arterial Disease: Current Evidence. EAR, NOSE & THROAT JOURNAL 2019; 100:185-191. [PMID: 31547705 DOI: 10.1177/0145561319872168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) is associated with atherosclerosis. Peripheral arterial disease (PAD) is a manifestation of atherosclerosis in lower extremity arteries. No systematic review addressing the relationship between PAD and SDB was found. We performed this study aimed to summarize the relationship between SDB and PAD described in current clinical studies. MATERIAL AND METHODS PubMed and Embase electronic databases were searched for clinical articles (published before 3 April, 2019) describing studies that evaluated the association between SDB and PAD. We showed the results involved in the association in clinical studies. RESULTS In total, 8 clinical studies have been included, and most of them were cross-sectional studies. Six articles demonstrated the coexistence of SDB and PAD, evidenced by high prevalence of SDB in patients with PAD and vice versa. Meanwhile, the included studies exhibited independent positive associations between SDB or sleep parameters and PAD after adjusting for multiple confounders. CONCLUSION From present clinical prospective, positive association between SDB and PAD was shown. More prospective, randomized controlled studies are needed to establish the cause-effect relationships involved.
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Affiliation(s)
- Yunyan Xia
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kai You
- Department of Anesthesiology, 117970First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuanping Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongqun Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, 117970First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Nagayoshi M, Lutsey PL, Benkeser D, Wassel CL, Folsom AR, Shahar E, Iso H, Allison MA, Criqui MH, Redline S. Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016; 251:467-475. [PMID: 27423537 PMCID: PMC4983210 DOI: 10.1016/j.atherosclerosis.2016.06.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/04/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Numerous biological pathways linking sleep disturbances to atherosclerosis have been identified, such as insulin resistance, inflammation, hypertension, and endothelial dysfunction. Yet, the association of sleep apnea and sleep duration with peripheral artery disease (PAD) is not well characterized. METHODS We evaluated the cross-sectional association between objectively measured sleep and prevalent PAD in 1844 participants (mean age 68 years) who in 2010-2013 had in-home polysomnography, 7-day wrist actigraphy and ankle-brachial index (ABI) measurements. We also evaluated the relation between self-reported diagnosed sleep apnea and PAD incidence in 5365 participants followed from 2000 to 2012. PAD was defined as ABI < 0.90. RESULTS In cross-sectional analyses, severe sleep apnea [apnea-hypopnea index (AHI) ≥30 vs. AHI <5] was associated with greater prevalent PAD only among black participants [multivariate adjusted prevalence ratio (95% CI): 2.29 (1.07-4.89); p-interaction = 0.05]. Short and long sleep duration was also associated with a 2-fold higher prevalence of PAD as compared with those who slept 7 h/night, in the full sample. In longitudinal analyses, participants with self-reported diagnosed sleep apnea were at higher risk of incident PAD [multivariable adjusted hazard ratio (95% CI): 1.93 (1.05-3.53)], with no evidence of interaction by race/ethnicity. CONCLUSIONS These findings support a significant association between sleep apnea and prevalent and incident PAD, with evidence for stronger associations with objectively measured sleep apnea and cross sectional PAD in blacks. In addition, short and long sleep duration was associated with PAD. These results identify sleep disturbances as a potential risk factor for PAD.
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Affiliation(s)
- Mako Nagayoshi
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - David Benkeser
- Division of Biostatistics, University of California, Berkeley, CA, USA
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Colchester, VT, USA
| | - Aaron R Folsom
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Eyal Shahar
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
Analysis of large-volume data holds promise for improving the application of precision medicine to sleep, including improving identification of patient subgroups who may benefit from alternative therapies. Big data used within the health care system also promises to facilitate end-to-end screening, diagnosis, and management of sleep disorders; improve the recognition of differences in presentation and susceptibility to sleep apnea; and lead to improved management and outcomes. To meet the vision of personalized, precision therapeutics and diagnostics and improving the efficiency and quality of sleep medicine will require ongoing efforts, investments, and change in our current medical and research cultures.
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