Influence of therapy continuous positive airway pressure on arterial stiffness in patients with arterial hypertension and obstructive sleep apnea
Article Sidebar
Main Article Content
Abstract
The aim – to assess the arterial stiffness changes in patients with arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy.
Materials and methods. 185 patients with mild and moderate AH (49.8±0.8 years old) were enrolled in the study and divided into groups: 1st group – patients who had OSA (n=148), 2nd group – patients without OSA (control group, n=37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, estimation of daily sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. In 10 months follow-up study were included 105 patients, who were divided into 4 subgroups: A – patients with moderate to severe OSA on CPAP (n=23); B – patients with moderate to severe OSA without CPAP (n=29); C – patients with mild OSA (n=29); D – patients without OSA (controls, n=24). All patients received similar antihypertensive therapy according to 2013 ESH/ESC Guidelines.
Results and discussion. Patients with AH and OSA (mean apnea-hypopnea index (AHI) 38.10±2.51 event/h) in comparison with patients without OSA (mean AHI 3.02±0.25 event/h) had significantly higher body mass index (35.20±0.57 vs 30.60±0.79 kg/m, p<0.001), blood glucose level (107.2±2.2 vs 98.0±2.5 mg/dl, p=0.045), uric acid level (6.17±0.10 vs 5.5±0.3 mg/dl, p=0.048) and left ventricular mass index (LVMI) (115.80±2.39 vs 104.60±4.56 g/m, p=0.035). Also the patients with AH and OSA in comparison with patients without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (11.19±0.20 vs 10.10 m/s, p=0.014) and central systolic blood pressure (CSBP) (133.43±1.67 vs 125.22±3.41 mm Hg, p=0.027). During 10 month follow-up in patients with AH and OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.20±0.63 to 10.05±0.43 m/s, p=0.009) with achievement of normal level (<10 m/s) in 60.9 % patients, office systolic blood pressure (from 143.8±132.7 to 132.70±2.33 mm Hg, p=0.021) and diastolic blood pressure (from 93.80±3.31 to 86.00±3.19 mm Hg, p=0.012) with achievement of target levels. In patients central systolic BP decreased (from 130.30±3.97 to 119.70±2.97 mm Hg, p=0.012) and diastolic BP decreased (from 94.70±3.31 to 87.10±2.36 mm Hg, p=0.013).
Conclusions. Combination of continuous positive airway pressure (CPAP)-therapy and antihypertensive treatment had decrease of arterial stiffness and helps to achieve target blood pressure in patients with AH and moderate to severe OSA.
Article Details
Keywords:
References
Somers VK, White DP, Amin R, Abraham WT, Costa F et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. 2008 Sep 2;118(10):1080-111. doi: https://doi.org/10.1161/CirculationAHA.107.189375. Epub 2008 Aug 25.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. doi: https://doi.org/10.1093/aje/kws342. Epub 2013 Apr 14.
Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.111.179788
Floras JS. Sleep apnea and cardiovascular risk. J Cardiol. 2014;63(1):3-8. doi: https://doi.org/10.1016/j.jjcc.2013.08.009. Epub 2013 Sep 29.
Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H et al. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag. 2009;5:1063-73. Epub 2009 Dec 29. doi: https://doi.org/10.2147/vhrm.s8300.
Kaynak D, Göksan B, Kaynak H, Degirmenci N, Daglioglu S. Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol. 2003 Sep;10(5):487-93. DOI: https://doi.org/10.1046/j.1468-1331.2003.00658.x
Baguet JP, Hammer L, Lévy P, Pierre H, Launois S et al. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest. 2005 Nov;128(5):3407-12. DOI: https://doi.org/10.1378/chest.128.5.3407
Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM et al. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005 Sep 1;172(5):613-8. Epub 2005 May 18. DOI: https://doi.org/10.1164/rccm.200503-340OC
Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D et al. The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens. 2007 Jan;25(1):141-6. DOI: https://doi.org/10.1097/HJH.0b013e32801092c1
Protogerou AD, Laaban JP, Czernichow S, Kostopoulos C, Lekakis J, Safar M E, Blacher J. Structural and functional arterial properties in patients with obstructive sleep apnoea syndrome and cardiovascular comorbidities. J Hum Hypertens. 2008 Jun;22(6):415-22. Epub 2007 Dec 13. DOI: https://doi.org/10.1038/sj.jhh.1002318
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76. PMCID: PMC2699173
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737-47 PMCID: PMC2556918
Mancia G., Fagard R., Narkiewicz K., Redo´n J., Zanchetti A. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. TheTask Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertension. 2013, 31:1281–1357 doi: https://doi.org/10.1097/01.hjh.0000431740.32696.cc.
Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep1991;14:540–545. DOI: https://doi.org/10.1093/sleep/14.6.540
Iber C, Ancoli-Israel S, Chesson AL, QuranSF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med. 2017 Mar 15;13(3):479-504. doi: https://doi.org/10.5664/jcsm.6506.
SphygmoCor; AtCor Medical, Sydney, Australia (www.atcormedical.com) Chen CH, Nevo E, Fetics B, P H Pak, F C Yin, W L Maughan, D A Kass et al: Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure validation of generalized transfer function. Circulation1997; 95: 1827–1836 DOI: https://doi.org/10.1161/01.cir.95.7.1827
Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachskampf, Elyse Foster Patricia A Pellikka, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108. DOI: https://doi.org/10.1016/j.euje.2005.12.014
Dustan HP. 50th anniversary historical article: hypertension. J Am Coll Cardiol 1999; 33: 595–597. DOI: https://doi.org/10.1016/s0735-1097(99)00069-8
Cruickshank JK, Rezailashkajani M, Goudot G. Arterial stiffness, fatness, and physical fitness: ready for intervention in childhood and across the life course? Hypertension. 2009 Apr; 53(4): 602-4. doi: https://doi.org/10.1161/ HYPERTENSIONAHA. 108.128033. Epub 2009 Mar 9.
Ikonomidis I1, Lekakis J, Papadopoulos C, Triantafyllidi H, Paraskevaidis I et al. Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension. Am J Hypertens. 2008 Jul; 21(7):806-13. doi: https://doi.org/10.1038/ajh.2008.172. Epub 2008 May 22.
Triantafyllidi H, Arvaniti C, Lekakis J, Ikonomidis I, Siafakas N et al. Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. Am J Hypertens. 2009 May;22(5):525-30. doi: https://doi.org/10.1038/ajh.2009.35. Epub 2009 Mar 5.
G. Mule`, S. Cottone, A. Vadala`, V. Volpe, G. Mezzatesta, Mongiovì R, Piazza G, Nardi E, Andronico G, Cerasola G. Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. J Internal Med. 2004; 256: 22–29 doi: https://doi.org/10.1111/j.1365-2796.2004.01338.x.
Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM Tauqeer Ali, Jason G Umans, Barbara V Howard. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007 Jul; 50(1): 197-203. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.107.089078
Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation. 2010 Feb 2;121(4):505-11. doi: https://doi.org/10.1161/CIRCULATIONAHA.109.886655. Epub 2010 Jan 18.
Tine Willum Hansen, Jan A. Staessen, Christian Torp-Pedersen, Susanne Rasmussen, Lutgarde Thijs Hans Ibsen, Jørgen Jeppesen. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in general population. Circulation. 2006; 113:664-670. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.579342
Inoue N, Maeda R, Kawakami H, Tomoki Shokawa, Hideya Yamamoto, Chikako Ito, Hideo Sasaki. Aortic pulse wave velocity predicts cardiovascular mortality in middle-aged and elderly Japanese men Circ J. 2009. Vol. 73. No. 3. P. 549–553. DOI: https://doi.org/10.1253/circj.cj-08-0492
Laurent S, Alivon M, Beaussier H, Boutouyrie P. Aortic stiffness as a tissue biomarker for predicting future cardiovascular events in asymptomatic hypertensive subjects. Ann Med. 2012 Jun;44 Suppl 1:S93-7. doi: https://doi.org/10.3109/07853890.2011.653398.
Muiesan ML, Salvetti M, Paini A, Monteduro C, Rosei CA. Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J Hypertens. 2010 Sep;28(9):1935-43. doi: https://doi.org/10.1097/HJH.0b013e32833b4a55.
Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML Maarten A D H Schalekamp, Roland Asmar, Robert S Reneman, Arnold P G Hoeks, Monique M B Breteler, Jacqueline C M Witteman. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006 Feb 7;113(5):657-63. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.555235
Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005 Oct 11;112(15):2254-62. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.541078
Ikonomidis I, Lekakis J, Stamatelopoulos K, Markomihelakis N, Kaklamanis PG, Mavrikakis M. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s disease. J Am Coll Cardiol. 2004 Mar 17;43(6):1075-81. DOI: https://doi.org/10.1016/j.jacc.2003.10.042
M Eren, S Gorgulu, N Uslu, S Celik, B Dagdeviren Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart. 2004 Jan; 90(1): 37–43. DOI: https://doi.org/10.1136/heart.90.1.37
Noda A, Nakata S, Fukatsu H, Yasuda Y, Miyao E, Miyata S, Yasuma F, Murohara T, Yokota M, Koike Y. Aortic pressure augmentation as a marker of cardiovascular risk in obstructive sleep apnea syndrome. Hypertens Res. 2008 Jun;31(6):1109-14. doi: https://doi.org/10.1291/hypres.31.1109.
Korcarz CE, Gepner AD, Peppard PE, Young TB, Stein JH. The Effects of Sleep-Disordered Breathing on Arterial Stiffness are Modulated by Age. Sleep. 2010 Aug;33(8):1081-5. DOI: https://doi.org/10.1164/rccm.200703-500OC
Drager LF, Bortolotto LA, Figueiredo AC, Krieger E M, Lorenzi G F. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007;176:706-12. DOI: https://doi.org/10.1164/rccm.200703-500OC
Kohler M, Pepperell JC, Casadei B, Craig S, Crosthwaite N, Stradling J R, Davies R J O. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J 2008;32:1488-96. DOI: https://doi.org/10.1183/09031936.00026608
Jones A, Vennelle M, Connell M, Graham McKillop, David E Newby, Neil J Douglas, Renata L Riha. The effect of continuous positive airway pressure therapy on arterial stiffness and endothelial function in obstructive sleep apnea: a randomized controlled trial in patients without cardiovascular disease. Sleep Med 2013;14:1260-5 DOI: https://doi.org/10.1016/j.sleep.2013.08.786
Kirsch DB. Obstructive 17Sleep Apnea. Continuum (Minneap Minn). 2020 Aug;26(4):908-928. doi: https://doi.org/10.1212/CON.0000000000000885. PMID: 32756228.
Wang G, Goebel JR, Li C, Hallman HG, Gilford TM, Li W. Therapeutic effects of CPAP on cognitive impairments associated with OSA. J Neurol. 2020 Oct;267(10):2823-2828. doi: https://doi.org/10.1007/s00415-019-09381-2. Epub 2019 May 20. PMID: 31111204.
Laczay B, Faulx MD. Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review. J Clin Med. 2021 Aug 24;10(17):3785. doi: https://doi.org/10.3390/jcm10173785. PMID: 34501232; PMCID: PMC8432034.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. doi: https://doi.org/10.1093/aje/kws342. Epub 2013 Apr 14.
Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.111.179788
Floras JS. Sleep apnea and cardiovascular risk. J Cardiol. 2014;63(1):3-8. doi: https://doi.org/10.1016/j.jjcc.2013.08.009. Epub 2013 Sep 29.
Baguet JP, Nadra M, Barone-Rochette G, Ormezzano O, Pierre H et al. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag. 2009;5:1063-73. Epub 2009 Dec 29. doi: https://doi.org/10.2147/vhrm.s8300.
Kaynak D, Göksan B, Kaynak H, Degirmenci N, Daglioglu S. Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol. 2003 Sep;10(5):487-93. DOI: https://doi.org/10.1046/j.1468-1331.2003.00658.x
Baguet JP, Hammer L, Lévy P, Pierre H, Launois S et al. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest. 2005 Nov;128(5):3407-12. DOI: https://doi.org/10.1378/chest.128.5.3407
Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM et al. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005 Sep 1;172(5):613-8. Epub 2005 May 18. DOI: https://doi.org/10.1164/rccm.200503-340OC
Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D et al. The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens. 2007 Jan;25(1):141-6. DOI: https://doi.org/10.1097/HJH.0b013e32801092c1
Protogerou AD, Laaban JP, Czernichow S, Kostopoulos C, Lekakis J, Safar M E, Blacher J. Structural and functional arterial properties in patients with obstructive sleep apnoea syndrome and cardiovascular comorbidities. J Hum Hypertens. 2008 Jun;22(6):415-22. Epub 2007 Dec 13. DOI: https://doi.org/10.1038/sj.jhh.1002318
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76. PMCID: PMC2699173
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737-47 PMCID: PMC2556918
Mancia G., Fagard R., Narkiewicz K., Redo´n J., Zanchetti A. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. TheTask Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension 2013, 31:1281–1357 doi: https://doi.org/10.1097/01.hjh.0000431740.32696.cc.
Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep1991;14:540–545. DOI: https://doi.org/10.1093/sleep/14.6.540
Iber C, Ancoli-Israel S, Chesson AL, QuranSF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med. 2017 Mar 15;13(3):479-504. doi: https://doi.org/10.5664/jcsm.6506.
SphygmoCor; AtCor Medical, Sydney, Australia (www.atcormedical.com)
Chen CH, Nevo E, Fetics B, P H Pak, F C Yin, W L Maughan, D A Kass et al: Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure validation of generalized transfer function. Circulation1997; 95: 1827–1836 DOI: https://doi.org/10.1161/01.cir.95.7.1827
Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachskampf, Elyse Foster Patricia A Pellikka, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108. DOI: 10.1016/j.euje.2005.12.014
Dustan HP. 50th anniversary historical article: hypertension. J Am Coll Cardiol 1999; 33: 595–597. DOI: https://doi.org/10.1016/s0735-1097(99)00069-8
Cruickshank JK, Rezailashkajani M, Goudot G. Arterial stiffness, fatness, and physical fitness: ready for intervention in childhood and across the life course? Hypertension. 2009 Apr; 53(4): 602-4. doi: https://doi.org/10.1161/HYPERTENSIONAHA.108.128033. Epub 2009 Mar 9.
Ikonomidis I1, Lekakis J, Papadopoulos C, Triantafyllidi H, Paraskevaidis I et al. Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension. Am J Hypertens. 2008 Jul; 21(7):806-13. doi: https://doi.org/10.1038/ajh.2008.172. Epub 2008 May 22.
Triantafyllidi H, Arvaniti C, Lekakis J, Ikonomidis I, Siafakas N et al. Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. Am J Hypertens. 2009 May;22(5):525-30. doi: https://doi.org/10.1038/ajh.2009.35. Epub 2009 Mar 5.
G. Mule`, S. Cottone, A. Vadala`, V. Volpe, G. Mezzatesta, Mongiovì R, Piazza G, Nardi E, Andronico G, Cerasola G. Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. Journal of Internal Medicine 2004; 256: 22–29 doi: https://doi.org/10.1111/j.1365-2796.2004.01338.x.
Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM Tauqeer Ali, Jason G Umans, Barbara V Howard. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007 Jul; 50(1): 197-203. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.107.089078
Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation. 2010 Feb 2;121(4):505-11. doi: https://doi.org/10.1161/CIRCULATIONAHA.109.886655. Epub 2010 Jan 18.
Tine Willum Hansen, Jan A. Staessen, Christian Torp-Pedersen, Susanne Rasmussen, Lutgarde Thijs Hans Ibsen, Jørgen Jeppesen. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in general population. Circulation. 2006; 113:664-670. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.579342
Inoue N, Maeda R, Kawakami H, Tomoki Shokawa, Hideya Yamamoto, Chikako Ito, Hideo Sasaki. Aortic pulse wave velocity predicts cardiovascular mortality in middle-aged and elderly Japanese men Circ J. 2009. Vol. 73. No. 3. P. 549–553. DOI: https://doi.org/10.1253/circj.cj-08-0492
Laurent S, Alivon M, Beaussier H, Boutouyrie P. Aortic stiffness as a tissue biomarker for predicting future cardiovascular events in asymptomatic hypertensive subjects. Ann Med. 2012 Jun;44 Suppl 1:S93-7. doi: https://doi.org/10.3109/07853890.2011.653398.
Muiesan ML, Salvetti M, Paini A, Monteduro C, Rosei CA. Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J Hypertens. 2010 Sep;28(9):1935-43. doi: https://doi.org/10.1097/HJH.0b013e32833b4a55.
Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML Maarten A D H Schalekamp, Roland Asmar, Robert S Reneman, Arnold P G Hoeks, Monique M B Breteler, Jacqueline C M Witteman. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006 Feb 7;113(5):657-63. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.555235
Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005 Oct 11;112(15):2254-62. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.541078
Ikonomidis I, Lekakis J, Stamatelopoulos K, Markomihelakis N, Kaklamanis PG, Mavrikakis M. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s disease. J Am Coll Cardiol. 2004 Mar 17;43(6):1075-81. DOI: https://doi.org/10.1016/j.jacc.2003.10.042
M Eren, S Gorgulu, N Uslu, S Celik, B Dagdeviren Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart. 2004 Jan; 90(1): 37–43. DOI:https://doi.org/10.1136/heart.90.1.37
Noda A, Nakata S, Fukatsu H, Yasuda Y, Miyao E, Miyata S, Yasuma F, Murohara T, Yokota M, Koike Y. Aortic pressure augmentation as a marker of cardiovascular risk in obstructive sleep apnea syndrome. Hypertens Res. 2008 Jun;31(6):1109-14. doi: https://doi.org/10.1291/hypres.31.1109.
Korcarz CE, Gepner AD, Peppard PE, Young TB, Stein JH. The Effects of Sleep-Disordered Breathing on Arterial Stiffness are Modulated by Age. Sleep. 2010 Aug;33(8):1081-5. DOI:https://doi.org/10.1164/rccm.200703-500OC
Drager LF, Bortolotto LA, Figueiredo AC, Krieger E M, Lorenzi G F. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007;176:706-12. DOI:https://doi.org/10.1164/rccm.200703-500OC
Kohler M, Pepperell JC, Casadei B, Craig S, Crosthwaite N, Stradling J R, Davies R J O. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J 2008;32:1488-96. DOI: https://doi.org/10.1183/09031936.00026608
Jones A, Vennelle M, Connell M, Graham McKillop, David E Newby, Neil J Douglas, Renata L Riha. The effect of continuous positive airway pressure therapy on arterial stiffness and endothelial function in obstructive sleep apnea: a randomized controlled trial in patients without cardiovascular disease. Sleep Med 2013;14:1260-5 DOI: https://doi.org/10.1016/j.sleep.2013.08.786
Kirsch DB. Obstructive Sleep Apnea. Continuum (Minneap Minn). 2020 Aug;26(4):908-928. doi: https://doi.org/10.1212/CON.0000000000000885. PMID: 32756228.
Wang G, Goebel JR, Li C, Hallman HG, Gilford TM, Li W. Therapeutic effects of CPAP on cognitive impairments associated with OSA. J Neurol. 2020 Oct;267(10):2823-2828. doi: https://doi.org/10.1007/s00415-019-09381-2. Epub 2019 May 20. PMID: 31111204.
Laczay B, Faulx MD. Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review. J Clin Med. 2021 Aug 24;10(17):3785. doi: https://doi.org/10.3390/jcm10173785. PMID: 34501232; PMCID: PMC8432034.