Relationship between obstructive sleep apnea-hypopnea syndrome and aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FAN Kangjun , LI Zhaoshui , SUN Zhanfa , QIAO Youjin , LIN Mingshan , LIU Tingxing , SUN Long , CHI Yifan ,  HUANG Qiang

Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, 266071, Shandong, P.R.China;

Corresponding?author：

HUANG Qiang, Email: qdhuangq@outlook.com

Keywords：

Obstructive sleep apnea-hypopnea syndrome; aortic dissection; hypertension

DOI：

10.7507/1007-4848.201808006

Video：

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Objective To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and aortic dissection (AD).Methods Fifty three patients with AD diagnosed by CTA in our hospital from January 2016 to January 2018 were selected. All the patients with AD were scored by the STOP-BANG questionnaire. The patients who scored more than or equal to 3 received polysomnography (PSG) after surgical or conservative treatment, and according to whether the sleep apnea-hypopnea index was higher than or equal to 5. Fifty-three patients were divided into an OSAHS group and a non OSAHS group.Results There were 18 patients with 17 males and 1 female at average age of 43.3±8.4 years in the OSAHS group, and 35 patients with 23 males and 12 females at average age of 56.6±12.9 years in the non OSAHS group. There was no statistical difference between the two groups in the Stanford classification of aortic dissection, the time of onset, personal history, the history of diabetes, coronary heart disease and hyperlipidemia, or post-treatment systolic/diastolic blood pressure before sleep (P>0.05). The age of patients in the OSAHS group was significantly less than that in the non OSAHS group (P<0.01), the proportion of men/women (P=0.021), weight (P<0.01), height (P=0.028), body mass index (P<0.01), and post-treatment systolic/diastolic blood pressure after waking up (P=0.028,P=0.044) in the OSAHS group were significantly higher than those in the non OSAHS group. In the OSAHS group, the proportion of previous hypertension was significantly higher than that in the non OSAHS group (P=0.042).Conclusion AD patients combined with OSAHS are mostly male patients. The number of young and high-fat people is significantly more than that in the non OSAHS group. OSAHS may be one of the risk factors for young, high-fat men with AD.

Citation： FAN Kangjun, LI Zhaoshui, SUN Zhanfa, QIAO Youjin, LIN Mingshan, LIU Tingxing, SUN Long, CHI Yifan, HUANG Qiang. Relationship between obstructive sleep apnea-hypopnea syndrome and aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(5): 457-460. doi: 10.7507/1007-4848.201808006 Copy

1.	中華醫學會呼吸病學分會睡眠呼吸障礙學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南 (2011 年修訂版). 中華結核和呼吸雜志, 2012, 35(1): 9-12.
2.	Madaeva I, Berdina O, Polyakov V, et al. Obstructive sleep apnea and hypertension in adolescents: effect on neurobehavioral and cognitive functioning. Can Respir J, 2016, 4: 1-6.
3.	Drager LF, McEvoy RD, Barbe F, et al. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation, 2017, 136(19): 1840-1850.
4.	崔聰, 張力, 高夏, 等. Stanford A 型主動脈夾層累及冠狀動脈的外科治療. 中國胸心血管外科臨床雜志, 2017, 24(12): 932-936.
5.	范康鈞, 何謙, 古君, 等. ADAMTS-9 對急性主動脈夾層的診斷價值研究. 中國胸心血管外科臨床雜志, 2017, 24(5): 355-358.
6.	Erbel R, Aboyans V, Boileau C, et al. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J, 2014, 35(41): 2873-2926.
7.	Gaisl T, Bratton DJ, Kohler M. The impact of obstructive sleep apnoea on the aorta. Eur Respir J, 2015, 46(2): 532-544.
8.	Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth, 2012, 108: 768-775.
9.	Sampol G, Romero O, Salas A, et al. Obstructive sleep apnea and thoracic aorta dissection. Am J Respir Crit Care Med, 2003, 168(12): 1528-1531.
10.	Zhang X, Zhang T, Zhang X, et al. Obstructive sleep apnea syndrome: a risk factor for Stanford’s type B aortic dissection. Ann Vasc Surg, 2014, 28(8): 1901-1908.
11.	Naito R, Sakakura K, Kasai T, et al. Aortic dissection is associated with intermittent hypoxia and re-oxygenation. Heart Vessels, 2012, 27(3): 265-270.
12.	Saruhara H, Takata Y, Usui Y, et al. Obstructive sleep apnea as a potential risk factor for aortic disease. Heart Vessels, 2012, 27(2): 166-173.
13.	Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc, 2004, 79(8): 1036-1046.
14.	Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens, 2012, 26(5): 281-287.
15.	Faulk K, Shell B, Nedungadi TP, et al. Role of angiotensin-converting enzyme 1 within the median preoptic nucleus following chronic intermittent hypoxia. Am J Physiol Regul Integr Comp Physiol, 2017, 312(2): R245-R252.
16.	李慧, 孫麗, 李悅. 阻塞性睡眠呼吸暫停綜合征與主動脈疾病關系的研究進展. 中華實用診斷與治療雜志, 2017, 31(1): 92-94.
17.	Lavie L. Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea. Front Biosci(Elite Ed), 2012, 4: 1391-1403.
18.	Kraiczi H, Hedner J, Peker Y, et al. Comparison of atenolol, amlodipine, enalapril, hydrochlorothiazide and losartan for antihypertensive treatment in patients with obstructive sleep apnea. Am J Respir Crit Care Med, 2000, 161(5): 1423-1428.
19.	Basyuni S, Barabas M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis, 2018, 10(Suppl 1): 48-56.
20.	Keles T, Durmaz T, Bayram NA, et al. Effect of continuous positive airway pressure therapy on aortic stiffness in patients with obstructive sleep apnea syndrome. Echocardiography, 2009, 26(10): 1217-1224.

1. 中華醫學會呼吸病學分會睡眠呼吸障礙學組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南 (2011 年修訂版). 中華結核和呼吸雜志, 2012, 35(1): 9-12.
2. Madaeva I, Berdina O, Polyakov V, et al. Obstructive sleep apnea and hypertension in adolescents: effect on neurobehavioral and cognitive functioning. Can Respir J, 2016, 4: 1-6.
3. Drager LF, McEvoy RD, Barbe F, et al. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation, 2017, 136(19): 1840-1850.
4. 崔聰, 張力, 高夏, 等. Stanford A 型主動脈夾層累及冠狀動脈的外科治療. 中國胸心血管外科臨床雜志, 2017, 24(12): 932-936.
5. 范康鈞, 何謙, 古君, 等. ADAMTS-9 對急性主動脈夾層的診斷價值研究. 中國胸心血管外科臨床雜志, 2017, 24(5): 355-358.
6. Erbel R, Aboyans V, Boileau C, et al. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J, 2014, 35(41): 2873-2926.
7. Gaisl T, Bratton DJ, Kohler M. The impact of obstructive sleep apnoea on the aorta. Eur Respir J, 2015, 46(2): 532-544.
8. Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth, 2012, 108: 768-775.
9. Sampol G, Romero O, Salas A, et al. Obstructive sleep apnea and thoracic aorta dissection. Am J Respir Crit Care Med, 2003, 168(12): 1528-1531.
10. Zhang X, Zhang T, Zhang X, et al. Obstructive sleep apnea syndrome: a risk factor for Stanford’s type B aortic dissection. Ann Vasc Surg, 2014, 28(8): 1901-1908.
11. Naito R, Sakakura K, Kasai T, et al. Aortic dissection is associated with intermittent hypoxia and re-oxygenation. Heart Vessels, 2012, 27(3): 265-270.
12. Saruhara H, Takata Y, Usui Y, et al. Obstructive sleep apnea as a potential risk factor for aortic disease. Heart Vessels, 2012, 27(2): 166-173.
13. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc, 2004, 79(8): 1036-1046.
14. Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens, 2012, 26(5): 281-287.
15. Faulk K, Shell B, Nedungadi TP, et al. Role of angiotensin-converting enzyme 1 within the median preoptic nucleus following chronic intermittent hypoxia. Am J Physiol Regul Integr Comp Physiol, 2017, 312(2): R245-R252.
16. 李慧, 孫麗, 李悅. 阻塞性睡眠呼吸暫停綜合征與主動脈疾病關系的研究進展. 中華實用診斷與治療雜志, 2017, 31(1): 92-94.
17. Lavie L. Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea. Front Biosci(Elite Ed), 2012, 4: 1391-1403.
18. Kraiczi H, Hedner J, Peker Y, et al. Comparison of atenolol, amlodipine, enalapril, hydrochlorothiazide and losartan for antihypertensive treatment in patients with obstructive sleep apnea. Am J Respir Crit Care Med, 2000, 161(5): 1423-1428.
19. Basyuni S, Barabas M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis, 2018, 10(Suppl 1): 48-56.
20. Keles T, Durmaz T, Bayram NA, et al. Effect of continuous positive airway pressure therapy on aortic stiffness in patients with obstructive sleep apnea syndrome. Echocardiography, 2009, 26(10): 1217-1224.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between obstructive sleep apnea-hypopnea syndrome and aortic dissection

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