Introduction and objective:
Obstructive sleep apnea (OSA) is associated with cardiovascular risk and higher mortality. Assessment of subclinical organ lesions is significant for prevention of clinically manifested complications which might result in death. The aim of the study was to assess the prevalence of subclinical target organ damage in hypertensive patients with OSA, and to establish whether these lesions are dependent on the intensity of sleep-disordered breathing.

Material and methods:
The study covered 67 patients with OSA diagnosed on the basis of polygraphy. Depending on the apnea/hypopnea index (AHI), the patients were divided into two groups: G1 (n=32; AHI=5–30) and G2 (n=35; AHI>30). The control group C consisted of 31 hypertensive subjects with OSA risk estimated as low based on the Berlin Questionnaire (BQ). Each patient had the following parameters measured: intima-media thickness (IMT), ankle-brachial index (ABI), left ventricular mass index (LVMI), and estimated glomerular filtration rate (eGFR).

The patients with severe OSA had significantly higher LVMI compared to the control group (130.99±44.6 g/m2 versus 106.61±27.86 g/m2; p=0.0332). The G2 group had higher eGFR than C (104.7±17.96 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0058). Similar results of eGFR were observed between G1 and C (104.35±21.06 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0081). G1 and G2 did not differ significantly in terms of eGFR. The other measured parameters, such as IMT and ABI, did not differ significantly between OSA and controls.

Patients with severe OSA demonstrate signs of left ventricular hypertrophy, while early atherosclerotic lesions (ABI and IMT) were not more intense than in the control group. High eGFR levels may indicate hyperfiltration, which does not correlate with OSA intensity level.

Gottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA. 2020;323(14):1389–1400.
Semelka M, Wilson J, Floyd R. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Am Fam Physician. 2016;94(5):355–60.
Dredla BK, Castillo PR. Cardiovascular Consequences of Obstructive Sleep Apnea. Curr Cardiol Rep. 2019;21(11):137.
Lin C-H, Lurie RC, Lyons OD. Sleep apnea and chronic kidney disease. A state of the art review. Chest 2020;157(3):673–685.
Williams B, Mancia G, Spiering W, et al. 2018 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33):3021–3104.
Ito E, Inoue Y. International Classification of Sleep Disorders, Third Edition. American Academy of Sleep Medicine. Nihon Rinsho. 2015; 73(6):916–923.
Corona-Villalobos CP, Sorensen L, Pozios I, et al. Left ventricular wall thickness in patients with hypertrophic cardiomyopathy: a comparison between cardiac magnetic resonance imaging and echocardiography. Int J Cardiovasc Imaging 2016;32(6):945–954.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.
Levey AS, Inker LA, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis. 2014;63(5):820–34.
Dursunoglu D, Dursunoglu N, Evrengul H, et al. Impact of obstructive sleep apnoea on left ventricular mass and global function. Eur Respir J. 2005;26:283–288;.
Cicco S, Castellana G, Marra L, Di Lecce V, Carratu P, Prete M, Ranieri G, Resta O, Carpagnano GE, Racanelli V, Dragonieri S, Vacca A. Galectin-3 and neutrophil-to-lymphocyte ratio are indicative of heart remodelling and disease severity in patients with obstructive sleep apnoea. Sleep Med. 2021;82:117–124.
Aslan K, Deniz A, Cayli M, Bozdemir H, Sarica Y, Seydaoglu G. Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome. Cardiol J. 2013;20(5):519–25.
Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnea. J Hypertens. 1990;8(10):941–946.
Kostrzewska M, Piorunek T, Hoffmann K, et al. Carotid artery intima-media thickness in hypertensive patients with obstructive sleep apnea. Adv Exp Med Biol. 2015;839:61–66.
Ali SS, Oni ET, Warraich HJ, et al. Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block! Sleep Med Rev. 2014;18(5): 379–391.
Minoguchi K, Yokoe T, Tazaki T, et al. Increased Carotid Intima-Media Thickness and Serum Inflammatory Markers in Obstructive Sleep Apnea, Am J Respir Crit Care Med. 2005;172:625–30.
Tan TY, Liou CW, Friedman M, et al. Factors associated with increased carotid intima-media thickness in obstructive sleep apnea/hypopnea syndrome. Neurologist 2012;18(5):277–281.
Kong D, Qin Z, Wang W, Kang J. Effect of obstructive sleep apnea on carotid artery intima media thickness related to inflammation. Clin Invest Med. 2017;40(1):E25-E33.
Theodoropoulos K, Lykouras D, Karkoulias K, et al. Association between the severity of newly diagnosed obstructive sleep apnea and subclinical carotid atherosclerosis in patients without overt cardiovascular disease. Eur Rev Med Pharmacol Sci. 2017;21(7):1568–1575.
Steiropoulos P, Bogiatzi C, Archontogeorgis K, et al. Is there evidence of early vascular disease in patients with obstructive sleep apnoea without known comorbidities? Preliminary findings. Open Cardiovasc Med J. 2013;7:61–68.
Nagayoshi M, Lutsey PL, Benkeser D, et al. Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2016;251:467–475.
Schaefer CA, Adam L, Weisser-Thomas J, et al. High prevalence of peripheral arterial disease in patients with obstructive sleep apnoea. Clin Res Cardiol. 2015;104(9):719–26.
Lin C-H, Perger E, Lyons OD. Obstructive sleep apnea and chronic kidney disease. Curr Opin Pulm Med. 2018;24(6):549–554.
Kanbay M, Ertuglu LA, Afsar B, et al. Renal hyperfiltration defined by high estimated glomerular filtration rate: A risk factor for cardiovascular disease and mortality. Diabetes Obes Metab. 2019;21(11):2368–2383.
Canales MT, Hagen EW, Barnet et al. Sleep Apnea and Kidney Function Trajectory: Results From a 20-Year Longitudinal Study of Healthy Middle-Aged Adults. Sleep. 2018;41(1):181.
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