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Original Research: SLEEP MEDICINE |

Establishment of the Cardio-Ankle Vascular Index in Patients With Obstructive Sleep Apnea

Takiko Kumagai, BSc; Takatoshi Kasai, MD, PhD; Mitsue Kato, PSGT; Ryo Naito, MD; Ken-ichi Maeno, MD; Satoshi Kasagi, MD, PhD; Fusae Kawana, BSc; Sugao Ishiwata, MD, PhD; Koji Narui, MD
Author and Funding Information

Affiliations: From the Department of Clinical Physiology (Dr. Ishiwata, Ms. Kumagai, Ms. Kato, and Ms. Kawana) and Sleep Center (Drs. Kasai, Naito, Maeno, Kasagi, and Narui), Toranomon Hospital, Tokyo, Japan.

Correspondence to: Takatoshi Kasai, MD, PhD, Sleep Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan; e-mail: kasai-t@mx6.nisiq.net


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):779-786. doi:10.1378/chest.09-0178
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Background:  An arterial stiffness parameter, the cardio-ankle vascular index (CAVI), has been developed. CAVI is adjusted for BP and can be used to measure arterial stiffness with little influence of BP. The purpose of this study was to evaluate the reproducibility, validity, and clinical usefulness of CAVI among patients with obstructive sleep apnea (OSA), who often have elevated BP during measurement.

Methods:  Overall, 543 consecutive patients with OSA were studied. CAVI was automatically calculated from the pulse volume record, BP, and the vascular length from the heart to the ankle. First, CAVI was measured three times on different days in 25 patients to evaluate its reproducibility. Second, the correlation between CAVI and BP was assessed. Third, patients were classified into two groups (mild OSA or moderate-to-severe OSA), and the CAVIs of these groups were compared. Fourth, the correlation between CAVI and carotid intima-media thickness (IMT) was also assessed in 74 patients.

Results:  The mean coefficient of variation was 2.8. CAVI demonstrated weak or no correlations with BP (with systolic BP, r = 0.184; with diastolic BP, r = 0.223). Patients with moderate-to-severe OSA (n = 469) had a significantly greater CAVI than patients with mild OSA (p = 0.034). CAVI was positively correlated with IMT (r = 0.487).

Conclusions:  The measurement of CAVI demonstrated good reproducibility and was not affected by the BP during measurement. Additionally, CAVI was positively correlated with another arteriosclerosis indicator. CAVI was higher in patients with more severe OSA and is regarded as a clinically useful index for the progression of vascular damage.

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