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Obstructive sleep apnoea in patients with abdominal aortic aneurysms: highly prevalent and associated with aneurysm expansion


Mason, R H; Ruegg, G; Perkins, J; Hardinge, M; Amann-Vesti, B; Senn, O; Stradling, J R; Kohler, M (2011). Obstructive sleep apnoea in patients with abdominal aortic aneurysms: highly prevalent and associated with aneurysm expansion. American Journal of Respiratory and Critical Care Medicine, 183(5):668-674.

Abstract

RATIONALE: Abdominal aortic aneurysms (AAA) are associated with life-threatening complications. The likelihood that an AAA will rupture is influenced by the aneurysm diameter and its expansion rate; reasons for rapid expansion are largely unknown. OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in patients with AAA, and investigate a possible association between OSA and rate of AAA expansion. METHODS: 127 patients (11 females), included in an AAA surveillance program, agreed to participate and underwent a sleep study. Annual AAA expansion was determined retrospectively from available ultrasound measurements. OSA was characterised using both oxygen desaturation index (ODI) and apnea-hypopnea index (AHI). Univariate and multivariate analysis was performed to assess the effect of OSA severity on AAA expansion. MEASUREMENTS AND MAIN RESULTS: Mean age, 67.9 (SD 6.0) years. Median interval between the first and last AAA measurements, 18.0 (range 2-113) months. An ODI or AHI of >10 was found in 40.5% and 41.5% of the patients respectively. Patients with an ODI>30 (n=12) had a significantly faster median yearly AAA expansion rate (2.9, quartiles 2.0/5.7 mm/y) than patients with an ODI 0-5 (n=47, 1.2, quartiles 0/3.1 mm/y) or 6-15 (n=43, 1.3, quartiles 0/2.7 mm/y) (p<0.05). In multivariate regression analysis, controlling for cardiovascular risk factors and medications, ODI >30 remained an independent risk factor for AAA expansion. CONCLUSIONS: In patients with AAA, OSA is highly prevalent. Severe OSA may be a causal factor for faster AAA expansion, but this needs to be proven in a randomized controlled intervention trial.

Abstract

RATIONALE: Abdominal aortic aneurysms (AAA) are associated with life-threatening complications. The likelihood that an AAA will rupture is influenced by the aneurysm diameter and its expansion rate; reasons for rapid expansion are largely unknown. OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in patients with AAA, and investigate a possible association between OSA and rate of AAA expansion. METHODS: 127 patients (11 females), included in an AAA surveillance program, agreed to participate and underwent a sleep study. Annual AAA expansion was determined retrospectively from available ultrasound measurements. OSA was characterised using both oxygen desaturation index (ODI) and apnea-hypopnea index (AHI). Univariate and multivariate analysis was performed to assess the effect of OSA severity on AAA expansion. MEASUREMENTS AND MAIN RESULTS: Mean age, 67.9 (SD 6.0) years. Median interval between the first and last AAA measurements, 18.0 (range 2-113) months. An ODI or AHI of >10 was found in 40.5% and 41.5% of the patients respectively. Patients with an ODI>30 (n=12) had a significantly faster median yearly AAA expansion rate (2.9, quartiles 2.0/5.7 mm/y) than patients with an ODI 0-5 (n=47, 1.2, quartiles 0/3.1 mm/y) or 6-15 (n=43, 1.3, quartiles 0/2.7 mm/y) (p<0.05). In multivariate regression analysis, controlling for cardiovascular risk factors and medications, ODI >30 remained an independent risk factor for AAA expansion. CONCLUSIONS: In patients with AAA, OSA is highly prevalent. Severe OSA may be a causal factor for faster AAA expansion, but this needs to be proven in a randomized controlled intervention trial.

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24 citations in Web of Science®
35 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Angiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2011
Deposited On:04 Feb 2011 17:47
Last Modified:05 Apr 2016 14:43
Publisher:American Thoracic Society
ISSN:1073-449X
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1164/rccm.201001-0051OC
PubMed ID:20622036

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