Association Between Nocturnal Hypoxemia Parameters and Coronary Microvascular Dysfunction: A Cross-Sectional Study

Overview

Journal Nat Sci Sleep

Publisher Dove Medical Press

Date 2025 Jan 3

PMID 39749250

Authors

Lanxin Feng

Xin Zhao

Jianqiao Song

Shuwen Yang

Jianping Xiang

Min Zhang

Chenchen Tu

Xiantao Song

Affiliations

Soon will be listed here.

Abstract

Objective: There is a connection between obstructive sleep apnea (OSA) and coronary microvascular dysfunction (CMD), but the underlying mechanisms remain unclear. This study aims to evaluate the correlation between OSA-related nocturnal hypoxemia parameters and CMD.

Methods: This is an observational, single-center study that included patients who underwent polysomnography and coronary angiography during hospitalization. The presence of CMD was determined by angio-based index of microcirculatory resistance (AccuIMR). Categorical variables were compared using chi-square test or Fisher exact test. The -test and Mann-Whitney -test were used to compare normally and non-normally distributed continuous variables, respectively. Univariate and multivariable logistic regression analyses were performed to evaluate the relationship between nocturnal hypoxemia parameters and CMD.

Results: A total of 133 patients were included in this study, of whom 72 (54.14%) had evidence of CMD. Patients with CMD exhibited a higher prevalence of OSA and experienced more severe nocturnal hypoxia. After adjusting for potential confounding factors, minimum oxygen saturation (minSpO) ≤90% (OR 5.89; 95% CI 1.73-19.99; =0.004) and the percentage of time spent with oxygen saturation below 90% (T90) ≥5% (OR 3.13; 95% CI 1.05-9.38; =0.041) were independently associated with CMD. However, no significant association was observed between apnea-hypopnea index (AHI) and CMD.

Conclusion: Parameters of nocturnal hypoxemia are associated with CMD. Hypoxemia parameters may more sensitively reflect the correlation between OSA and CMD than AHI.

References

Bruno R, Rossi L, Fabbrini M, Duranti E, Di Coscio E, Maestri M . Renal vasodilating capacity and endothelial function are impaired in patients with obstructive sleep apnea syndrome and no traditional cardiovascular risk factors. J Hypertens. 2013; 31(7):1456-64. DOI: 10.1097/HJH.0b013e328360f773. View

Pepine C, Anderson R, Sharaf B, Reis S, Smith K, Handberg E . Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010; 55(25):2825-32. PMC: 2898523. DOI: 10.1016/j.jacc.2010.01.054. View

Lavie L . Oxidative stress--a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis. 2008; 51(4):303-12. DOI: 10.1016/j.pcad.2008.08.003. View

Fan J, Wang X, Ma X, Somers V, Nie S, Wei Y . Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc. 2019; 8(2):e010826. PMC: 6497330. DOI: 10.1161/JAHA.118.010826. View

Wang N, Li S, Zhao L, Li H, Li Z, Shi Q . Relationship between obstructive sleep apnea and coronary microcirculatory function among patients with cardiac syndrome X. Coron Artery Dis. 2013; 25(1):35-9. DOI: 10.1097/MCA.0000000000000058. View

Ooi E, Rajendran S, Tavella R, Air T, Mahadavan G, Arstall M . Predictors of Obstructive Sleep Apnoea (OSA) Population in the Coronary Angiogram Database of South Australia (CADOSA). Curr Probl Cardiol. 2021; 47(6):100846. DOI: 10.1016/j.cpcardiol.2021.100846. View

Sanchez-de-la-Torre M, Sanchez-de-la-Torre A, Bertran S, Abad J, Duran-Cantolla J, Cabriada V . Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial. Lancet Respir Med. 2019; 8(4):359-367. DOI: 10.1016/S2213-2600(19)30271-1. View

Yeghiazarians Y, Jneid H, Tietjens J, Redline S, Brown D, El-Sherif N . Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021; 144(3):e56-e67. DOI: 10.1161/CIR.0000000000000988. View

Nguyen P, Katikireddy C, McConnell M, Kushida C, Yang P . Nasal continuous positive airway pressure improves myocardial perfusion reserve and endothelial-dependent vasodilation in patients with obstructive sleep apnea. J Cardiovasc Magn Reson. 2010; 12:50. PMC: 2945335. DOI: 10.1186/1532-429X-12-50. View

10.

Ng M, Yeung A, Fearon W . Invasive assessment of the coronary microcirculation: superior reproducibility and less hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve. Circulation. 2006; 113(17):2054-61. DOI: 10.1161/CIRCULATIONAHA.105.603522. View

11.

Ooi E, Rajendran S, Munawar D, Hnin K, Mahadavan G, Pati P . The Association of Obstructive Sleep Apnea in Ischemia with No Obstructive Coronary Artery Disease - A Pilot Study. Curr Probl Cardiol. 2022; 48(5):101111. DOI: 10.1016/j.cpcardiol.2022.101111. View

12.

Jiang J, Li C, Hu Y, Li C, He J, Leng X . A novel CFD-based computed index of microcirculatory resistance (IMR) derived from coronary angiography to assess coronary microcirculation. Comput Methods Programs Biomed. 2022; 221:106897. DOI: 10.1016/j.cmpb.2022.106897. View

13.

Lima Illescas M, Aucapina Aguilar D, Vallejo Ledesma L . A review on the influence of rapid maxillary expansion and mandibular advancement for treating obstructive sleep apnea in children. J Clin Pediatr Dent. 2023; 47(1):9-16. DOI: 10.22514/jocpd.2022.035. View

14.

Berry R, Budhiraja R, Gottlieb D, Gozal D, Iber C, Kapur V . Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012; 8(5):597-619. PMC: 3459210. DOI: 10.5664/jcsm.2172. View

15.

Mileva N, Nagumo S, Mizukami T, Sonck J, Berry C, Gallinoro E . Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022; 11(7):e023207. PMC: 9075440. DOI: 10.1161/JAHA.121.023207. View

16.

Heinzer R, Eckert D . Treatment for obstructive sleep apnoea and cardiovascular diseases: are we aiming at the wrong target?. Lancet Respir Med. 2019; 8(4):323-325. DOI: 10.1016/S2213-2600(19)30351-0. View

17.

Zhang Y, Pu J, Niu T, Fang J, Chen D, Yidilisi A . Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Non-ST-Segment Elevation Myocardial Infarction Patients. JACC Cardiovasc Interv. 2024; 17(16):1874-1886. DOI: 10.1016/j.jcin.2024.04.048. View

18.

Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey J, Khayat R, Javaheri S . Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol. 2017; 69(7):841-858. PMC: 5393905. DOI: 10.1016/j.jacc.2016.11.069. View

19.

Gdowski M, Murthy V, Doering M, Monroy-Gonzalez A, Slart R, Brown D . Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta-Analysis of Aggregate Data. J Am Heart Assoc. 2020; 9(9):e014954. PMC: 7428565. DOI: 10.1161/JAHA.119.014954. View

20.

Kapur V, Auckley D, Chowdhuri S, Kuhlmann D, Mehra R, Ramar K . Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017; 13(3):479-504. PMC: 5337595. DOI: 10.5664/jcsm.6506. View