Consequences of Comorbid Sleep Apnea in the Metabolic Syndrome— Implications for Cardiovascular Risk

Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined h...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) N.Y.), 2010-09, Vol.33 (9), p.1193-1199
Main Authors: TROMBETTA, Ivani C, SOMERS, Virend K, NEGRAO, Carlos E, MAKI-NUNES, Cristiane, DRAGER, Luciano F, TOSCHI-DIAS, Edgar, ALVES, Maria Janieire N. N, FRAGA, Raffael F, RONDON, Maria Urbana P. B, BECHARA, Maita G, LORENZI-FILHO, Geraldo
Format: Article
Language:English
Subjects:
Adult
Baroreflex
Behavioral psychophysiology
Biological and medical sciences
Blood Pressure
Cardiovascular Diseases - etiology
Case-Control Studies
Cohort Studies
Female
Fundamental and applied biological sciences. Psychology
Heart Rate
Humans
Male
Medical sciences
Metabolic diseases
Metabolic Syndrome - complications
Metabolic Syndrome - metabolism
Metabolic Syndrome - physiopathology
Middle Aged
Miscellaneous
Other metabolic disorders
Oxygen Consumption
Pneumology
Psychology. Psychoanalysis. Psychiatry
Psychology. Psychophysiology
Respiratory system : syndromes and miscellaneous diseases
Risk Factors
Sleep Apnea and Metabolic Syndrome in Cardiovascular Risk
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - metabolism
Sleep Apnea, Obstructive - physiopathology
Vasodilation
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Summary:Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined how the presence of OSA in patients with MetSyn affected hemodynamic and autonomic variables associated with poor cardiovascular outcome. Prospective clinical study. We studied 36 patients with MetSyn (ATP-III) divided into 2 groups matched for age and sex: (1) MetSyn+OSA (n = 18) and (2) MetSyn-OSA (n = 18). OSA was defined by an apnea-hypopnea index (AHI) > 15 events/hour by polysomnography. We recorded muscle sympathetic nerve activity (MSNA - microneurography), heart rate (HR), and blood pressure (BP - Finapres). Baroreflex sensitivity (BRS) was analyzed by spontaneous BP and HR fluctuations. MSNA (34 +/- 2 vs 28 +/- 1 bursts/min, P = 0.02) and mean BP (111 +/- 3 vs. 99 +/- 2 mm Hg, P = 0.003) were higher in patients with MetSyn+OSA versus patients with MetSyn-OSA. Patients with MetSyn+OSA had lower spontaneous BRS for increases (7.6 +/- 0.6 vs 12.2 +/- 1.2 msec/mm Hg, P = 0.003) and decreases (7.2 +/- 0.6 vs 11.9 +/- 1.6 msec/mm Hg, P = 0.01) in BP. MSNAwas correlated with AHI (r = 0.48; P = 0.009) and minimum nocturnal oxygen saturation (r = -0.38, P = 0.04). Patients with MetSyn and comorbid OSA have higher BP, higher sympathetic drive, and diminished BRS, compared with patients with MetSyn without OSA. These adverse cardiovascular and autonomic consequences of OSA may be associated with poorer outcomes in these patients. Moreover, increased BP and sympathetic drive in patients with MetSyn+OSA may be linked, in part, to impairment of baroreflex gain.
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/33.9.1193