Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population
2.2. Methods
2.2.1. Medical and Psychiatric Assessment
2.2.2. Sleep Evaluation and Study
2.3. Statistical Analyses
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- For gender, the presence of obesity and smoking status in model 1.
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- For gender, the presence of obesity, smoking status, presence of type 2 diabetes, presence of dyslipidaemia and aspirin therapy in model 2.
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- For gender, the presence of obesity, smoking status, presence of type 2 diabetes, presence of dyslipidaemia, aspirin therapy and Epworth Sleepiness Scale scores in model 3.
2.4. Data Collected
3. Results
3.1. Polysomnographic Data (Table 3)
Whole Sample (n = 1404) | Subjects without LGI (n = 929) | Subjects with LGI (n = 475) | p-Value | |
---|---|---|---|---|
Sleep latency (min) | 26.3 (14.4–50.5) | 25.0 (14.3–49.0) | 28.0 (14.7–51.0) | 0.256 |
Sleep efficiency (%) | 76.6 (66.2–83.9) | 76.8 (66.7–83.9) | 76.3 (65.2–84.0) | 0.680 |
Sleep period time (min) | 449.5 (408.5–482.8) | 451.0 (410.5–485.5) | 445.7 (406.0–478.5) | 0.173 |
Total sleep time (min) | 376.0 (326.4–416.5) | 379.0 (327.5–418.0) | 373.0 (322.0–414.5) | 0.231 |
% stage 1 | 8.1 (5.4–11.5) | 8.2 (5.6–11.2) | 7.9 (5.2–11.8) | 0.470 |
% stage 2 | 54.9 (47.2–61.4) | 55.0 (47.4–61.3) | 54.8 (46.2–61.7) | 0.755 |
% Stage 3 | 2.3 (0.1–7.9) | 2.3 (0.1–7.6) | 2.6 (0.2–8.2) | 0.325 |
% REM | 15.5 (10.9–19.3) | 15.6 (11.3–19.4) | 15.2 (10.2–19.3) | 0.115 |
REM latency (min) | 85.0 (60.0–137.5) | 84.2 (60.0–132.0) | 87.5 (60.9–153.8) | 0.036 |
% wake after sleep onset | 14.0 (8.4–22.6) | 13.9 (8.4–22.4) | 14.2 (8.1–23.2) | 0.987 |
Number of awakenings | 32 (22–47) | 32 (22–47) | 32 (21–48) | 0.487 |
Micro-arousal index | 13 (8–22) | 13 (8–21) | 14 (8–25) | 0.119 |
Apnoea–hypopnoea index | 7 (2–22) | 7 (2–21) | 8 (2–28) | 0.151 |
Oxygen desaturation index | 3 (1–11) | 3 (1–10) | 4 (1–15) | 0.001 |
Total time under 90% of SaO2 (min) | 6.3 (0.3–49.8) | 4.3 (0.0–36.5) | 13.0 (0.5–78.0) | <0.001 |
PLMS index | 2 (0–11) | 2 (0–12) | 1 (0–10) | 0.033 |
Median (P25–P75) | Median (P25–P75) | Median (P25–P75) | Wilcoxon test |
3.2. Univariate Analyses (Table 4)
Variables | Categories | % | Subjects without LGI | Subjects with LGI | p-Value Chi² | OR (CI 95%) | p-Value |
---|---|---|---|---|---|---|---|
Gender | Female (n = 435) male (n = 969) | 31.0% 69.0% | 25.2% 74.8% | 42.3% 57.7% | <0.001 | 1 0.46 (0.36 to 0.58) | <0.001 |
Age (years) | <50 (n = 574) ≥50 (n = 830) | 40.9% 59.1% | 40.8% 59.2% | 41.1% 58.9% | 0.926 | 1 0.99 (0.79 to 1.24) | 0.926 |
BMI (kg/m²) | <30 (n = 738) ≥30 (n = 666) | 52.5% 47.5% | 62.1% 37.9% | 33.9% 66.1% | <0.001 | 1 3.20 (2.54 to 4.03) | <0.001 |
Smoking | No (n = 1131) Yes (n = 273) | 80.6% 19.4% | 82.4% 17.6% | 77.1% 22.9% | 0.018 | 1 1.39 (1.06 to 1.82) | 0.018 |
Alcohol | No (n = 887) Yes (n = 517) | 63.2% 36.8% | 62.3% 37.7% | 64.8% 35.2% | 0.355 | 1 0.90 (0.71 to 1.13) | 0.355 |
Caffeine | No (n = 279) Yes (n = 1125) | 19.9% 80.1% | 21.1% 78.9% | 17.5% 82.5% | 0.107 | 1 1.26 (0.95 to 1.68) | 0.108 |
Type 2 diabetes | No (n = 1106) Yes (n = 298) | 78.8% 21.2% | 81.6% 18.4% | 73.3% 26.7% | <0.001 | 1 1.62 (1.24 to 2.10) | <0.001 |
Dyslipidaemia status | No (n = 526) Untreated (n = 488) Treated (n = 390) | 37.5% 34.8% 27.7% | 37.6% 32.0% 30.4% | 37.3% 40.2% 22.5% | 0.001 | 1 1.27 (0.98 to 1.64) 0.75 (0.56 to 0.99) | 0.001 |
Hypertension status | Untreated (n = 533) Controlled (n = 527) Uncontrolled (n = 344) | 38.0% 37.5% 24.5% | 39.3% 37.9% 22.8% | 35.4% 36.8% 27.8% | 0.104 | 1 1.08 (0.84 to 1.40) 1.35 (1.02 to 1.80) | 0.104 |
Number of antihypertensive treatments | 0 (n = 533) 1 (n = 510) 2 (n = 236) ≥3 (n = 125) | 38.0% 36.3% 16.8% 8.9% | 39.3% 36.1% 16.6% 8.0% | 35.4% 36.8% 17.3% 10.5% | 0.316 | 1 1.13 (0.88 to 1.47) 1.16 (0.84 to 1.60) 1.45 (0.97 to 2.16) | 0.318 |
Cardiovascular comorbidities | No (n = 1119) Yes (n = 285) | 79.7% 20.3% | 79.9% 20.1% | 79.4% 20.6% | 0.825 | 1 1.03 (0.78 to 1.36) | 0.825 |
Aspirin therapy | No (n = 1084) Yes (n = 320) | 77.2% 22.8% | 75.4% 34.6% | 80.8% 19.2% | 0.020 | 1 0.72 (0.55 to 0.95) | 0.021 |
OSAS status | No (n = 566) Mild (n = 362) Moderate to severe with ODI < 15/h (n = 217) Moderate to severe without ODI ≥ 15/h (n = 259) | 40.3% 25.8% 15.5% 18.4% | 40.6% 27.3% 16.3% 15.8% | 39.8% 22.7% 13.9% 23.6% | 0.003 | 1 0.85 (0.64 to 1.13) 0.87 (0.62 to 1.22) 1.52 (1.12 to 2.05) | 0.003 |
Insomnia disorder | No (n = 469) Sleep deprivation alone (n = 314) Insomnia without short sleep duration (n = 367) Insomnia with short sleep duration (n = 254) | 33.4% 22.4% 26.1% 18.1% | 34.8% 21.9% 25.7% 17.6% | 30.7% 23.4% 27.0% 18.9% | 0.508 | 1 1.21 (0.89 to 1.64) 1.18 (0.89 to 1.58) 1.21 (0.88 to 1.68) | 0.509 |
Sleep movement disorders | No (n = 1112) Moderate to severe PLMs alone (n = 110) RLS alone or combined with PLMs (n = 182) | 79.2% 7.8% 13.0% | 78.2% 8.0% 13.8% | 81.3% 7.6% 11.1% | 0.325 | 1 0.91 (0.60 to 1.39) 0.77 (0.55 to 1.09) | 0.326 |
ESS | <11 (n = 843) ≥11 and <14 (n = 245) ≥14 (n = 316) | 60.0% 17.5% 22.5% | 61.8% 17.8% 20.4% | 56.6% 16.8% 26.6% | 0.035 | 1 1.03 (0.76 to 1.40) 1.42 (1.08 to 1.85) | 0.036 |
Major depression | No (n = 783) Remitted (n = 295) Current (n = 326) | 55.8% 21.0% 23.2% | 56.8% 20.8% 22.4% | 53.7% 21.5% 24.8% | 0.485 | 1 1.09 (0.82 to 1.45) 1.17 (0.90 to 1.54) | 0.485 |
LGI | No (n = 929) Yes (n = 475) | 66.2% 33.8% | |||||
Median (P25–P75) | Wilcoxon test | ||||||
Age (years) | 52 (45–60) | 53 (45–60) | 52 (45–59) | 0.380 | |||
BMI (kg/m²) | 29.6 (26.2–33.8) | 28.4 (25.3–32.1) | 32.2 (28.4–37.1) | <0.001 | |||
CRP (mg/L) | 1.9 (1.0–3.8) | 1.2 (0.1–1.9) | 4.9 (3.8–7.0) | <0.001 | |||
ESS | 9 (6–13) | 9 (5–13) | 9 (6–14) | 0.005 | |||
ISI | 14 (9–18) | 14 (9–17) | 14 (10–18) | 0.164 | |||
BDI | 4 (2–8) | 4 (2–8) | 4 (2–8) | 0.056 |
3.3. Multivariate Analyses (Table 5)
Variables | Model 1 OR Adjusted (CI 95%) | p-Value | Model 2 OR Adjusted (CI 95%) | p-Value | Model 3 OR Adjusted (CI 95%) | p-Value |
---|---|---|---|---|---|---|
OSAS No Mild Moderate to severe with ODI < 15/h Moderate to severe without ODI ≥ 15/h | 1 0.92 (0.68 to 1.25) 0.88 (0.61 to 1.27) 1.50 (1.06 to 2.13) | 0.023 | 1 0.95 (0.70 to 1.30) 0.93 (0.64 to 1.34) 1.51 (1.06 to 2.14) | 0.041 | 1 0.95 (0.70 to 1.30) 0.93 (0.64 to 1.35) 1.51 (1.06 to 2.14) | 0.045 |
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AHI | apnoea–hypopnoea index |
CPAP | continuous positive airway pressure |
CRP | C-reactive protein |
DSM | Diagnostic and Statistical Manual of Mental Disorders |
ODI | oxygen desaturation index |
OSAS | obstructive sleep apnoea syndrome |
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Inclusion Criteria | Exclusion Criteria |
---|---|
Hypertension according to the diagnostic criteria of the World Health Organization: mean systolic blood pressure ≥140 mmHg or mean diastolic blood pressure ≥90 mmHg or self-reported diagnosis of clinically demonstrated hypertension or taking antihypertensive medication | Acute and/or uncontrolled hepatic, pancreatic, pulmonary, cardiovascular, renal or infectious diseases |
Age ≥ 18 years old | Past or current severe psychiatric diseases (psychotic disorder, bipolar disorder and substance use disorder) |
CRP levels < 10 mg/L | Past or current cancer, autoimmune or inflammatory diseases |
Absence of pregnancy | Past or current malformation or lesion (head trauma, lesions of cerebral respiratory centres, craniofacial malformations and abnormal chest deformities) |
Central disorders of hypersomnolence, OSAS already known or course of treatment before Sleep Laboratory and sleep apnoea syndrome with predominantly central component |
Analyses | Results |
---|---|
Comparison of polysomnographic parameters | Hypertensive patients with low-grade inflammation have higher parameters related to intermittent hypoxia (oxygen desaturation index and total time under 90% of oxygen saturation) than those without low-grade inflammation. |
Prevalence of low-grade inflammation in hypertensive individuals | 33.8% |
Univariate analyses | Confounding factors identified: gender, body mass index, smoking, type 2 diabetes, dyslipidaemia status, aspirin therapy and Epworth Sleepiness Scale scores. |
Multivariate analyses | Unlike mild OSAS and moderate to severe OSAS with low intermittent hypoxia, only moderate to severe OSAS with high intermittent hypoxia was significantly associated with higher risk of low-grade inflammation in hypertensive patients after adjustment for confounding factors. |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Hein, M.; Wacquier, B.; Conenna, M.; Lanquart, J.-P.; Point, C. Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk. Life 2024, 14, 592. https://doi.org/10.3390/life14050592
Hein M, Wacquier B, Conenna M, Lanquart J-P, Point C. Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk. Life. 2024; 14(5):592. https://doi.org/10.3390/life14050592
Chicago/Turabian StyleHein, Matthieu, Benjamin Wacquier, Matteo Conenna, Jean-Pol Lanquart, and Camille Point. 2024. "Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk" Life 14, no. 5: 592. https://doi.org/10.3390/life14050592