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ASSOCIATIONS BETWEEN INDICES OF CARDIOVASCULAR HEALTH, BODY MASS INDEX, AND OBSTRUCTIVE SLEEP APNEA

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) is associated with poor cardiovascular (CV) health and an increased risk for CV disease and premature mortality. Noninvasive measures of CV health have been linked to sleep-disordered breathing, although the relationship between OSA severity, body mass index (BMI), and hemodynamic measures are less clear. METHODS: This study is part of a larger investigation with on-going data collection. Preliminary analysis includes a subsample of 49 adults (53% women, 67% white) who were assessed following an overnight fast, including anthropometrics (height and body mass) and noninvasive measures of CV health derived from pulse wave analysis (e.g., carotid-femoral pulse wave velocity [cfPWV], augmentation index [AIx], subendocardial viability ratio [SEVR], ejection duration [ED], and central systolic, diastolic, and pulse pressures). Participants also completed a home sleep study to evaluate the presence and severity of OSA. OSA was quantified using the apnea hypopnea index (AHI; the number of apneas plus hypopneas per hour of sleep) and categorized as <5, 5-14.9, 15-29.9, and ≥30 events/h of sleep. Multiple regression analysis was used to explore associations between CV health indices, BMI, and AHI. RESULTS: Participants (M±SD: age=34±12 y, BMI=27.7±6.8 kg/m2, resting systolic/diastolic blood pressure=121.7±12.2/77.2±8.7 mmHg) had AHI severity scores of 8.7±10.0 (range: 0.8-53.8); 47% reported <5 events/h of sleep (the lowest clinical rating) compared to 39% that reported mild and 14% that reported moderate-to-severe sleep apnea (>15 events/h of sleep). Pearson correlations revealed no associations between AHI and CV indices (p>0.05 for all). AHI was moderately correlated with BMI (r=0.40, p=0.004). Multiple regression analysis revealed that age (β=0.627, p<0.001) and the interaction between BMI× AHI (β=-0.373, p=0.003) were associated with cfPWV (the gold standard measure of aortic stiffness), accounting for ~51% of the observed variability. We observed a similar model for AIx (an indirect measure of arterial stiffness). CONCLUSIONS: We observed associations between noninvasive measures of arterial stiffness and AHI that were mediated by BMI. Participants with obesity and more severe OSA had stiffer arteries, and thus poorer CV health. The lack of association between AHI and other CV indices was surprising and warrants further exploration in a larger and more diverse sample.

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