Sex influences endothelial function in sleep-disordered breathing
Sex influences endothelial function in sleep-disordered breathing
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DOI：
10.1093/sleep/27.6.1113
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发表时间：
2004-09-15
期刊：
影响因子：
5.6
通讯作者：
Redline, S
中科院分区：
文献类型：
--
作者：
Faux, MD;Larkin, EK;Redline, S
背景：睡眠呼吸障碍（SDB）和心血管疾病之间的联系的基础知之甚少。肱动脉超声检查评估的内皮功能障碍可预测心血管风险并代表临床前血管疾病。我们确定是否流量介导的扩张（FMD）和峰值血流量（PBF）增加后，袖带闭塞是改变与SDB。方法：193名参与者（58%的妇女）在一项队列研究进行了研究，过夜多导睡眠图和随后的肱动脉超声检查。采用呼吸暂停低通气指数（AHI）、夜间去饱和度指数和觉醒频率指数对SDB进行定量。在基线和上臂袖带闭塞5分钟后获得肱动脉的二维和多普勒速度测量值。FMD和PBF分别定义为肱动脉直径和血流相对于基线的百分比变化，结果：在整个样本中，AHI与FMD（r =-0.30，P <0.001）和PBF（r =-0.20，P <0.001）呈负相关。然而，性别分层的单变量分析表明，这些关系是专为妇女。具体来说，在AHI大于或等于15的女性中，FMD显著低于AHI评分较低的女性（P <0.005），男性中AHI和FMD之间没有关系。此外，在单独的女性中，PBF随着AHI的增加而显著降低（r =-0.29，P = .010）。统计建模，调整体重指数，年龄和其他协变量，同样表明，SDB严重程度显着影响FMD和PBF，性别和AHI之间的显着相互作用，加强SDB严重程度和内皮功能之间的关联更强的女性比男性。女性SDB患者可能比男性更容易发生早期SDB相关的心血管疾病。
Background: The bases for the association between sleep-disordered breathing (SDB) and cardiovascular disease are poorly understood. Endothelial dysfunction, assessed with brachial artery ultrasonography, may predict cardiovascular risk and represent preclinical vascular disease. We determined whether flow-mediated dilation (FMD) and peak blood flow (PBF) increase after cuff occlusion is altered with SDB.Methods: 193 participants (58% women) in a cohort study were studied with overnight polysomnography and subsequent brachial artery ultrasonography. SDB was quantified using the apnea-hypopnea index (AHI) and indexes of overnight desaturation and arousal frequency. Two-dimensional and Doppler-velocity measurements of the brachial artery were obtained at baseline and after 5 minutes of upper-arm cuff occlusion. FMD and PBF were defined as the percentage changes from baseline in brachial artery diameter and flow, respectively.Results: In the entire sample, the AHI was inversely associated with both FMD (r = -0.30, P < .001) and PBF (r = -0.20, P < .001). However, sex-stratified univariate analyses showed that these relationships were exclusive to women. Specifically, FMD was significantly lower in women with an AHI greater than or equal to 15 than in women with lower AHI scores (P < .005), with no relationship between AHI and FMD in men. Additionally, PBF decreased significantly with increasing AHI (r = -0.29, P = .010) in women alone. Statistical modeling, adjusting for body mass index, age, and other covariates, similarly showed that SDB severity significantly influenced FMD and PBF, with significant interactions between sex and AHI, reinforcing that the associations between SDB severity and endothelial function were stronger in women than in men.Conclusions: Moderate levels of SBD are associated with impaired conduit and resistance endothelial function in women. Women with SDB may be more vulnerable to early SDB-related cardiovascular disease than are men.