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Brachial artery diameter, blood flow and flow-mediated dilation in sleep-disordered breathingDepartment of Medicine, Boston University School of Medicine; VA Boston Healthcare Systemhchami{at}bu.edu
Department of Mathematics and Statistics, Boston University School of Public Health; NHLBI’s Framingham Heart Study
Department of Medicine, Boston University School of Medicine; Whitaker Cardiovascular Institute, Boston University School of Medicine
Cardiovascular Engineering, Inc., Holliston
Department of Mathematics and Statistics, Boston University School of Public Health; NHLBI’s Framingham Heart Study
NHLBI’s Framingham Heart Study
Department of Medicine, Boston University School of Medicine; NHLBI’s Framingham Heart Study; Whitaker Cardiovascular Institute, Boston University School of Medicine
Department of Medicine, Boston University School of Medicine
Department of Medicine, Boston University School of Medicine; NHLBI’s Framingham Heart Study; Whitaker Cardiovascular Institute, Boston University School of Medicine; Department of Epidemiology, Boston University School of Public Health
Department of Medicine, Boston University School of Medicine; VA Boston Healthcare System Abstract
Clinic-based, case-control studies linked sleep-disordered breathing (SDB) to markers of endothelial dysfunction. We attempted to validate this association in a large community-based sample, and evaluate the relation of SDB to arterial diameter and peripheral blood flow. This community-based, cross-sectional observational study included 327 men and 355 women, aged 42–83 years, from the Framingham Heart Study site of the Sleep Heart Health Study. The polysomnographically derived apnea-hypopnea index and the hypoxemia index (percent sleep time with oxyhemoglobin saturation below 90%) were used to quantify the severity of SDB. Brachial artery ultrasound measurements included baseline diameter, percent flow-mediated dilation, and baseline and hyperemic flow velocity and volume. The baseline brachial artery diameter was significantly associated with both the apnea-hypopnea index and the hypoxemia index. The association was diminished by adjustment for body mass index, but remained significant for the apnea-hypopnea index. Age-, sex-, race- and body mass index-adjusted mean diameters were 4.32, 4.33, 4.33, 4.56, 4.53 mm for those with apnea-hypopnea index < 1.5, 1.5–4.9, 5–14.9, 15–29.9,
Key Words: epidemiology • obstructive sleep apnea • vascular endothelium • vascular remodeling
Vascular Medicine, Vol. 14, No. 4,
351-360 (2009) |
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30, respectively; p = 0.03. Baseline flow measures were associated with the apnea-hypopnea index but this association was non-significant after adjusting for body mass index. No significant association was observed between measures of SDB and percent flow-mediated dilation or hyperemic flow in any model. In conclusion, this study supports a moderate association of SDB and larger baseline brachial artery diameter, which may reflect SDB-induced vascular remodeling. This study does not support a link between SDB and endothelial dysfunction as measured by brachial artery flow-mediated dilation.