Background Arterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness?
Methods Individual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid–femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis.
Results 893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m2 (30±7 kg/m2). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all p<0.01) as well as to dyslipidaemia (p=0.03) and an Epworth Sleepiness Scale score ≥9 (p=0.04), whereas it was not related to obesity (p=0.54), a severe Apnoea–Hypopnoea Index (p=0.14), mean nocturnal saturation (p=0.33) or sleep time with oxygen saturation below 90% (p=0.47). In multivariable analysis, PWV was independently associated with age, systolic blood pressure and diabetes (all p<0.01), whereas severe OSA was not significantly associated with PWV.
Conclusion Our individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters.
- sleep apnoea
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SB and JLP contributed equally.
Contributors MJ-F, SB, RT, J-CB, SM, JLP: researched data, contributed to discussion, wrote the manuscript, reviewed/edited the manuscript. L-MG, MD: researched data, contributed to discussion, reviewed/edited the manuscript. JLP takes responsibility for the integrity of the work as a whole, including the data and analysis, from inception to revised article.
Funding This study received unrestricted grants from the endowment fund ‘Agir pour les maladies chroniques’. This work was also supported by the French National Research Agency in the framework of the ‘Investissements d’avenir’ programme (ANR-15-IDEX-02).
Competing interests None of the authors has a competing interest with respect to this study except SM. SM works as a freelance specialist on pulse wave analysis and receives revenues from several medical device companies including Alam Medical whose device was used in this study.
Patient consent Not required.
Ethics approval Comité de Protection des Personnes, Sud Est V IRB0006705 France.
Provenance and peer review Not commissioned; externally peer reviewed.
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