RT Journal Article
SR Electronic
T1 Pulse arrival time, a novel sleep cardiovascular marker: the multi-ethnic study of atherosclerosis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1124
OP 1130
DO 10.1136/thoraxjnl-2020-216399
VO 76
IS 11
A1 Younghoon Kwon
A1 Christopher Wiles
A1 B Eugene Parker
A1 Brian R Clark
A1 Min-Woong Sohn
A1 Sara Mariani
A1 Jin-Oh Hahn
A1 David R Jacobs
A1 James H Stein
A1 Joao Lima
A1 Vishesh Kapur
A1 Andrew Wellman
A1 Susan Redline
A1 Ali Azarbarzin
YR 2021
UL http://thorax.bmj.com/content/76/11/1124.abstract
AB 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.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/.