Author:
Kwon Younghoon,Wiles Christopher,Parker B Eugene,Clark Brian R,Sohn Min-Woong,Mariani Sara,Hahn Jin-Oh,Jacobs David R,Stein James H,Lima Joao,Kapur Vishesh,Wellman Andrew,Redline Susan,Azarbarzin Ali
Abstract
BackgroundPulse arrival time (PAT) is commonly used to estimate blood pressure response. We hypothesised that PAT response to obstructive respiratory events would be associated with increased cardiovascular risk in people with obstructive sleep apnoea.MethodsPAT, defined as the time interval between electrocardiography R wave and pulse arrival by photoplethysmography, was measured in the Multi-Ethnic Study of Atherosclerosis Sleep study participants. The PAT response to apnoeas/hypopnoeas was defined as the area under the PAT waveform following respiratory events. Cardiovascular outcomes included markers of subclinical cardiovascular disease (CVD): left ventricular mass, carotid plaque burden score and coronary artery calcification (CAC) (cross-sectional) and incident composite CVD events (prospective). Multivariable logistic and Cox proportional hazard regressions were performed.ResultsA total of 1407 participants (mean age 68.4 years, female 47.5%) were included. Higher PAT response (per 1 SD increase) was associated with higher left ventricular mass (5.7 g/m2 higher in fourth vs first quartile, p<0.007), higher carotid plaque burden score (0.37 higher in fourth vs first quartile, p=0.02) and trended to greater odds of CAC (1.44, 95% CI 0.98 to 2.15, p=0.06). A total of 65 incident CVD events were observed over the mean of 4.1 (2.6) years follow-up period. Higher PAT response was associated with increased future CVD events (HR: 1.20, 95% CI 1.02 to 1.42, p=0.03).ConclusionPAT is independently associated with markers of subclinical CVD and incident CVD events. Respiratory-related PAT response is a novel and promising polysomnography metric with cardiovascular implications.
Funder
National Heart, Lung, and Blood Institute
U.S. Environmental Protection Agency
American Heart Association
National Center for Advancing Translational Sciences
American Academy of Sleep Medicine
Subject
Pulmonary and Respiratory Medicine
Cited by
19 articles.
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