Published ahead of print on October 9, 2003, doi:10.1164/rccm.200306-767OC
American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 348-353, (2004)
© 2004 American Thoracic Society
Endothelial Function in Obstructive Sleep Apnea and Response to Treatment
Mary S. M. Ip,
Hung-Fat Tse,
Bing Lam,
Kenneth W. T. Tsang and
Wah-Kit Lam
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Correspondence and requests for reprints should be addressed to Mary S. M. Ip, M.D., Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China. E-mail: msmip{at}hkucc.hku.hk
Impaired endothelium-dependent vascular relaxation is a prognostic marker of atherosclerosis and cardiovascular disease. We evaluated endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin (NTG)–induced dilation of the brachial artery with Doppler ultrasound in 28 men with obstructive sleep apnea (OSA) and 12 men without OSA. Subjects with OSA (apnea–hypopnea index; mean ± SD, 46.0 ± 14.5) had lower FMD compared with subjects without OSA (5.3 ± 1.7% vs. 8.3 ± 1.0%, p < 0.001), and major determinants of FMD were the apnea–hypopnea index and age. There was no significant difference in NTG-induced dilation. Subjects with OSA were randomized to nasal continuous positive airway pressure (nCPAP) or observation for 4 weeks. Subjects on nCPAP had significant increase in FMD, whereas those on observation had no change (4.4% vs. -0.8%, difference of 5.2%, p < 0.001). Neither group showed significant change in NTG-induced vasodilation. Eight subjects who used nCPAP for over 3 months were reassessed on withdrawing treatment for 1 week. On nCPAP withdrawal, FMD became lower than during treatment (p = 0.02) and were similar to baseline values. Our findings demonstrated that men with moderate/severe OSA have endothelial dysfunction and treatment with nCPAP could reverse the dysfunction; the effect, however, was dependent on ongoing use.
Key Words: vascular reactivity • flow-mediated dilation • obstructive sleep apnea • endothelial function • nasal continuous positive airway pressure
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