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Association between Obstructive Sleep Apnea and Arterial Stiffness: data from the ELSA-Brasil cohort.


Arterial stiffness is an independent marker for cardiovascular disease. Several factors may contribute to increase arterial stiffness such as age, smoking, diabetes and high blood pressure. Growing evidence suggest that Obstructive Sleep Apnea (OSA) may also contribute to increase arterial stiffness but the following issues remain unclear: 1) Is mild OSA associated with increased arterial stiffness?; 2) Does sleep duration modulate the association of OSA with arterial stiffness?


The study aimed to compare a validated marker of arterial stiffness, namely pulse wave velocity (PWV), in participants without OSA (no-OSA; apnea-hypopnea index, AHI, <5 events/h), mild OSA (AHI 5-14.9 events/h) and moderate/severe OSA (AHI ≥15 events/h), adjusting for common cardiovascular risk factors and objective sleep duration.


Participants from the ELSA-Brasil cohort (Sao Paulo center) were included in this study. The participants performed sleep assessments with portable polygraph (Embletta GoldTM) and 7-days of wrist actigraphy (Actiwatch 2TM). Common carotid artery and femoral artery pressure waveforms were recorded noninvasively by using a pressure-sensitive transducer (Complior, Arthech Medicale, France). The final PWV value was obtained by the arithmetic average of 10 consecutive cardiac cycles in regular rhythm. The analysis was adjusted for the following risk factors: age, gender, education, body mass index, hypertension, diabetes, LDL-cholesterol, HDL-cholesterol, smoking, alcoholism and objective sleep duration.


The sample consisted of 1,993 participants (mean age 49±8 years, 57% female). There was a significant linear trend for increasing PWV across no-OSA (n=603), mild (n=746), and moderate/severe OSA (n=644) (P for trend <0.001). The estimated mean PWV after adjustment for confounding factors for no-OSA, mild and moderate/severe groups were 9.63 (95% CI: 9.43, -9.84), 9.90 (95% CI: 9.71, 10.08) and 10.12 m/s (95% CI: 9.94, 10.30), respectively. In the analysis of post-hoc differences adjusted for multiple comparisons using the Sidak method, there were significant differences between all three groups (no-OSA vs mild and moderate/severe groups, and mild vs moderate/severe groups, p<0.05).


In this large cohort, all kinds of OSA severity (from mild to severe OSA) contributed to increase PWV regardless of traditional risk factors and objective sleep duration.


obstructive sleep apnea, sleep duration, pulse wave velocity and arterial stiffness.


Área Clínica


Center of Clinical and Epidemiologic Research - Sao Paulo - Brasil, Heart Institute - Sao Paulo - Brasil, Renal Division and Hypertension Unit - Sao Paulo - Brasil


Lorenna Franco Cunha, Ronaldo B Santos, Wagner A Silva, Aline N Aiello, Soraya Giatti, Barbara K Parise, Silvana P Souza, Paulo A Lotufo, Isabela M Bensenor, Luciano F Drager