Obstructive sleep apnoea and the progression of thoracic aortic aneurysm: a prospective cohort study

Author:

Gaisl ThomasORCID,Rejmer Protazy,Roeder Maurice,Baumgartner Patrick,Sievi Noriane A.,Siegfried Sandra,Stämpfli Simon F.,Thurnheer Robert,Stradling John R.,Tanner Felix C.,Kohler Malcolm

Abstract

BackgroundObstructive sleep apnoea (OSA) is associated with an increased prevalence of aortic aneurysms and it has also been suggested that severe OSA furthers aneurysm expansion in the abdomen. We evaluated whether OSA is a risk factor for the progression of ascending thoracic aortic aneurysm (TAA).MethodsPatients with TAA underwent yearly standardised echocardiographic measurements of the ascending aorta over 3 years and two level III sleep studies. The primary outcome was the expansion rate of TAA in relation to the apnoea–hypopnoea index (AHI). Secondary outcomes included surveillance for aortic events (composite end-points of rupture/dissection, elective surgery or death).ResultsBetween July 2014 and March 2020, 230 patients (median age 70 years, 83.5% male) participated in the cohort. At baseline, 34.8% of patients had AHI ≥15 events·h−1. There was no association between TAA diameter and AHI at baseline. After 3 years, mean±sd expansion rates were 0.55±1.25 mm at the aortic sinus and 0.60±1.12 mm at the ascending aorta. In the regression analysis, after controlling for baseline diameter and cardiovascular risk factors, there was strong evidence for a positive association of TAA expansion with AHI (aortic sinus estimate 0.025 mm, 95% CI 0.009–0.040 mm; p<0.001 and ascending aorta estimate 0.026 mm, 95% CI 0.011–0.041 mm; p=0.001). 20 participants (8%) experienced an aortic event; however, there was no association with OSA severity.ConclusionOSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.

Funder

Universität Zürich

Publisher

European Respiratory Society (ERS)

Subject

Pulmonary and Respiratory Medicine

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