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Original research
Pulse arrival time, a novel sleep cardiovascular marker: the multi-ethnic study of atherosclerosis


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).

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