0882 Vascular Function Indices in Sleep Apnea in Paroxysmal Atrial Fibrillation. (27th April 2018)

• Record Type: Journal Article
• Authors: Leelapakpien, T; Wang, L; Waila, H; Mehra, R
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A328
• Page End: A328
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.881
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Vascular stiffness is a risk factor for cardiovascular disease (CVD), atrial fibrillation (AF) and associated with sleep disordered breathing (SDB). We hypothesize that vascular dysfunction is more evident in paroxysmal (PAF) compared to controls and that SDB modifies this association. Methods: The Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study was designed to elucidate the pathophysiologic underpinnings of SDB and AF. Cases >18 years of age with PAF were matched 1:1 to controls without AF by age (±5 years), sex, race and body mass index (BMI±5kg/m 2 ), n=150 in each group. A subset underwent vascular function testing with peripheral arterial tonometry (PAT): augmentation index (AIx) and pulse wave velocity (PWV). Full-night attended polysomnography was performed to assess SDB (apnea hypopnea index, AHI). Conditional logistic regression and Spearman correlation coefficients were used to assess the association of PAF and SDB indices with AIx and PWV on matched cases and control pairs. The interactions of PWV and AIx with AHI and percent sleep time with SaO2<90% were tested. Results: The analytic sample was comprised of 106 participants (n=53 cases and n=53 controls) with overall age of 60 ± 12.8 years, 71.7% male, 88.7% Caucasian and BMI of 30.4 ± 6.7 kg/m 2 . AIx and PWV were not significantly associated with PAF: OR=1.02, 95%CI:0.87, 1.19, and OR=0.97, (95%CI:0.92, 1.01) respectively which persisted after adjustment and stratification for cardiovascular medications (i.e. beta-blocker, ACE inhibitor, alpha-2 blocker, calcium channel blocker, diuretic or nitrates). Although AHI was not correlated with the vascular measures, central apnea was negatively correlated with AIx, -0.22, (-0.43, -0.01), p=0.042. No significant interaction was observed between SDB and vascular indices relative to PAF. Conclusion: Unlike existing data, no significant associations were observed of measures of vascular stiffness and PAF nor with SDB indices, albeit an inverse association was observed with central apnea AIx. Unanticipated findings may be attributable to over-riding confounding by highly prevalent cardiovascular medication usage particularly in PAF and possibility that vascular dysfunction poses less of a driving risk in the early stages of AF evolution. Support (If Any): NIHRO1R01HL109493, UL1TR000439