Sex influences endothelial function in sleep-disordered breathing

The bases for the association between sleep-disordered breathing (SDB) and cardiovascular disease are poorly understood. Endothelial dysfunction, assessed with brachial artery ultrasonography, may predict cardiovascular risk and represent preclinical vascular disease. We determined whether flow-medi...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) N.Y.), 2004-09, Vol.27 (6), p.1113-1120
Main Authors: FAULX, Michael D, LARKIN, Emma K, HOIT, Brian D, AYLOR, Joan E, WRIGHT, Andrew T, REDLINE, Susan
Format: Article
Language:English
Subjects:
Activity levels. Psychomotricity
Adult
Anthropometry
Biological and medical sciences
Body Mass Index
Cohort Studies
Electrocardiography
Electroencephalography
Electromyography
Endothelium, Vascular - physiology
Female
Fundamental and applied biological sciences. Psychology
Humans
Male
Polysomnography
Psychology. Psychoanalysis. Psychiatry
Psychology. Psychophysiology
Severity of Illness Index
Sex Distribution
Sleep Apnea Syndromes - diagnosis
Sleep Apnea Syndromes - epidemiology
Sleep Apnea Syndromes - physiopathology
Vigilance. Attention. Sleep
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Summary:The bases for the association between sleep-disordered breathing (SDB) and cardiovascular disease are poorly understood. Endothelial dysfunction, assessed with brachial artery ultrasonography, may predict cardiovascular risk and represent preclinical vascular disease. We determined whether flow-mediated dilation (FMD) and peak blood flow (PBF) increase after cuff occlusion is altered with SDB. 193 participants (58% women) in a cohort study were studied with overnight polysomnography and subsequent brachial artery ultrasonography. SDB was quantified using the apnea-hypopnea index (AHI) and indexes of overnight desaturation and arousal frequency. Two-dimensional and Doppler-velocity measurements of the brachial artery were obtained at baseline and after 5 minutes of upper-arm cuff occlusion. FMD and PBF were defined as the percentage changes from baseline in brachial artery diameter and flow, respectively. In the entire sample, the AHI was inversely associated with both FMD (r = -0.30, P < .001) and PBF (r = -0.20, P < .001). However, sex-stratified univariate analyses showed that these relationships were exclusive to women. Specifically, FMD was significantly lower in women with an AHI > or = 15 than in women with lower AHI scores (P < .005), with no relationship between AHI and FMD in men. Additionally, PBF decreased significantly with increasing AHI (r = -0.29, P = .010) in women alone. Statistical modeling, adjusting for body mass index, age, and other covariates, similarly showed that SDB severity significantly influenced FMD and PBF, with significant interactions between sex and AHI, reinforcing that the associations between SDB severity and endothelial function were stronger in women than in men. Moderate levels of SBD are associated with impaired conduit and resistance endothelial function in women. Women with SDB may be more vulnerable to early SDB-related cardiovascular disease than are men.
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/27.6.1113