期刊
SLEEP
卷 33, 期 9, 页码 1193-1199出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/sleep/33.9.1193
关键词
Cardiovascular risk; sleep apnea; metabolic syndrome; sympathetic activation; baroreflex control
资金
- Conselho Nacional de Pesquisa (CNPq) [476385/2006-7, 304304/2004-2, 305159/2005-4, 306931/2006-0]
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2005/59740-7, 2008/03714-6]
- Fundacao Zerbini
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)
- National Institutes of Health [HL65176]
- National Center for Research Resources (NCRR) [1 UL1 RR024150]
- NIH Roadmap for Medical Research
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [08/03714-6] Funding Source: FAPESP
Study Objectives: Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined how the presence of USA in patients with MetSyn affected hemodynamic and autonomic variables associated with poor cardiovascular outcome. Design: Prospective clinical study. Participants: We studied 36 patients with MetSyn (ATP-III) divided into 2 groups matched for age and sex: (1) MetSyn+OSA (n = 18) and (2) MetSyn-OSA (n = 18). Measurements: USA was defined by an apnea-hypopnea index (AHI) > 15 events/hour by polysomnography. We recorded muscle sympathetic nerve activity (MSNA - microneurography), heart rate (HR), and blood pressure (BP - Finapres). Baroreflex sensitivity (BRS) was analyzed by spontaneous BP and HR fluctuations. Results: MSNA (34 +/- 2 vs 28 +/- 1 bursts/min, P = 0.02) and mean BP (111 +/- 3 vs. 99 +/- 2 mm Hg, P = 0.003) were higher in patients with MetSyn+OSA versus patients with MetSyn-USA. Patients with MetSyn+OSA had lower spontaneous BRS for increases (7.6 +/- 0.6 vs 12.2 +/- 1.2 msec/mm Hg, P = 0.003) and decreases (7.2 +/- 0.6 vs 11.9 +/- 1.6 msec/mm Hg, P = 0.01) in BP. MSNA was correlated with AHI (r = 0.48; P = 0.009) and minimum nocturnal oxygen saturation (r = -0.38, P = 0.04). Conclusion: Patients with MetSyn and comorbid USA have higher BP, higher sympathetic drive, and diminished BRS, compared with patients with MetSyn without USA. These adverse cardiovascular and autonomic consequences of USA may be associated with poorer outcomes in these patients. Moreover, increased BP and sympathetic drive in patients with MetSyn+OSA may be linked, in part, to impairment of baroreflex gain.
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