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Original research
Pulse arrival time, a novel sleep cardiovascular marker: the multi-ethnic study of atherosclerosis
  1. Younghoon Kwon1,
  2. Christopher Wiles2,
  3. B Eugene Parker2,
  4. Brian R Clark2,
  5. Min-Woong Sohn3,
  6. Sara Mariani4,
  7. Jin-Oh Hahn5,
  8. David R Jacobs6,
  9. James H Stein7,
  10. Joao Lima8,
  11. Vishesh Kapur9,
  12. Andrew Wellman4,
  13. Susan Redline10,
  14. Ali Azarbarzin4
  1. 1 Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2 Barron Associates, Inc, Charlottesville, Virginia, USA
  3. 3 Department of Health Management & Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
  4. 4 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5 Department of Mechanical Engineering, University of Maryland at College Park, College Park, Maryland, USA
  6. 6 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  7. 7 University of Wisconsin-Madison, Madison, Wisconsin, USA
  8. 8 Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  9. 9 Department of Medicine, University of Washington, Seattle, Washington, USA
  10. 10 Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Younghoon Kwon, Department of Medicine, University of Minnesota, Minneapolis, MI 55455, USA; yhkwon{at}uw.edu

Abstract

Background Pulse arrival time (PAT) is commonly used to estimate blood pressure response. We hypothesised that PAT response to obstructive respiratory events would be associated with increased cardiovascular risk in people with obstructive sleep apnoea.

Methods PAT, defined as the time interval between electrocardiography R wave and pulse arrival by photoplethysmography, was measured in the Multi-Ethnic Study of Atherosclerosis Sleep study participants. The PAT response to apnoeas/hypopnoeas was defined as the area under the PAT waveform following respiratory events. Cardiovascular outcomes included markers of subclinical cardiovascular disease (CVD): left ventricular mass, carotid plaque burden score and coronary artery calcification (CAC) (cross-sectional) and incident composite CVD events (prospective). Multivariable logistic and Cox proportional hazard regressions were performed.

Results A total of 1407 participants (mean age 68.4 years, female 47.5%) were included. Higher PAT response (per 1 SD increase) was associated with higher left ventricular mass (5.7 g/m2 higher in fourth vs first quartile, p<0.007), higher carotid plaque burden score (0.37 higher in fourth vs first quartile, p=0.02) and trended to greater odds of CAC (1.44, 95% CI 0.98 to 2.15, p=0.06). A total of 65 incident CVD events were observed over the mean of 4.1 (2.6) years follow-up period. Higher PAT response was associated with increased future CVD events (HR: 1.20, 95% CI 1.02 to 1.42, p=0.03).

Conclusion PAT is independently associated with markers of subclinical CVD and incident CVD events. Respiratory-related PAT response is a novel and promising polysomnography metric with cardiovascular implications.

  • sleep apnoea
  • clinical epidemiology

Data availability statement

Data are available on reasonable request. Data available for request include data from exam 1 through exam 5 and events data updated through follow-up year 10. Also included are data from eleven ancillary studies: #079 (NT-ProBNP and Troponin), #042 (Epidemiology of Vascular Inflammation and Atherosclerosis), #081 (Apolipoproteins B and A-1), #067 (MRI RV-Function), #057 (Cystatin-C), #244 (NT Pro-BNP and HS Cardiac Troponin-T), #205 (Brachial IMT), #113 (Exam 5 Sleep), #047/075 (vitamin D), #195 (Fatty Acid) and #200 (Total FFA). https://biolincc.nhlbi.nih.gov/studies/mesa/.

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Data availability statement

Data are available on reasonable request. Data available for request include data from exam 1 through exam 5 and events data updated through follow-up year 10. Also included are data from eleven ancillary studies: #079 (NT-ProBNP and Troponin), #042 (Epidemiology of Vascular Inflammation and Atherosclerosis), #081 (Apolipoproteins B and A-1), #067 (MRI RV-Function), #057 (Cystatin-C), #244 (NT Pro-BNP and HS Cardiac Troponin-T), #205 (Brachial IMT), #113 (Exam 5 Sleep), #047/075 (vitamin D), #195 (Fatty Acid) and #200 (Total FFA). https://biolincc.nhlbi.nih.gov/studies/mesa/.

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Footnotes

  • Contributors Conception: YK, BEP, SM and SR; Data acquisition: YK, CW, BEP, BRC, SM, SR and AA; Data analysis: YK, CW, BEP, BRC and AA; Drafting and Critical Review: YK, CW, BEP, BBC, M-WS, SM, J-OH, DRJ, JHS, JL, VK, AW, SR and AA.

  • Funding This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Centre for Advancing Translational Sciences (NCATS). A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. This publication was developed under the Science to Achieve Results (STAR) research assistance agreements, No. RD831697 (MESA Air) and RD-83830001 (MESA Air Next Stage), awarded by the US Environmental Protection Agency. It has not been formally reviewed by the EPA. YK, AA and SM were supported by NIH R21HL140432. AA was supported by the NIH R01HL153874 American Heart Association (19CDA34660137) and the American Academy of Sleep Medicine Foundation (188-SR-17 SR-17). SR, AW and AA were partially supported by NHLBI R35HL135818.

  • Disclaimer The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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