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Correspondence |

Additive Effects of OSA and Hypertension on Endothelial Damage FREE TO VIEW

Mario Francesco Damiani, MD; Cristina Scoditti, MD; Elioda Bega, MD; Alfredo Scoditti, MD; Francesco Fanfulla, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Respiratory Diseases, San Camillo Clinic, Taranto, Italy

bDepartment of Respiratory Diseases, San Paolo Hospital, Bari, Italy

cInstitute of Respiratory Diseases and Sleep Disorders, Maugeri Hospital, Pavia, Italy

COPRRESPONDENCE TO: Mario Francesco Damiani, MD, Via Masaccio 12, 74100 Taranto, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):520-521. doi:10.1016/j.chest.2016.11.046
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We read with great interest the recent article in CHEST (September 2016) entitled “Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep.” In their article, Appleton et al demonstrated that an apnea-hypopnea index during rapid eye movement sleep (REM AHI) > 30 events/h is independently related to the presence of hypertension (HTN). Interestingly, they also confirmed the relationship between REM OSA and HTN among patients without OSA (due to an AHI < 10 events/h). The authors remarked that the role of OSA in the development of HTN is due to its impact on endothelial damage. On the other hand, it is well known that HTN also is responsible for vascular dysfunction. In this regard, we would like to highlight the important impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis. Pathophysiologically, it is widely accepted that the role of both conditions in the development of endothelial damage is mediated by inflammation., Indeed, in patients with HTN, increased blood pressure stimulates inflammatory mechanisms, in which the vasoactive peptides angiotensin II and endothelin-1 have a key role. On the other hand, in patients with OSA, the hypoxia-reoxygenation cycle and sleep fragmentation trigger the generation of reactive oxygen species, and inflammation. Therefore, in patients with OSA and HTN, there is the possibility that all the aforesaid mechanisms operate simultaneously and/or synergistically. In this regard, Drager et al demonstrated additive effects of OSA and HTN on carotid intima-media thickness, diameter, and distensibility. Moreover, our group has recently evaluated the consequences of the coexistence of OSA and HTN on intima-media thickness, and on inflammatory markers of atherosclerosis (such as interleukin-6 and pentraxin-3). These early markers of atherosclerosis were significantly increased in hypertensive patients with OSA compared with normotensive patients with OSA, hypertensive patients without OSA, or control subjects.

For all these reasons, we would like to stimulate discussion about the need to measure the previously mentioned early markers of vascular damage in order to unmask REM OSA even when overnight polysomnography is negative, among patients with HTN. In this regard, further studies are needed to evaluate the impact of the simultaneous presence of REM OSA and HTN on the risk of atherosclerosis.

References

Appleton S.L. .Vakulin A. .Martin S.A. .et al Hypertension is associated with undiagnosed OSA during rapid eye movement sleep. Chest. 2016;150:495-505 [PubMed]journal. [CrossRef] [PubMed]
 
Fruchart J.C. .Nierman M.C. .Stroes E.S. .Kastelein J.J. .Duriez P. . New risk factors for atherosclerosis and patient risk assessment. Circulation. 2004;109:III15-III19 [PubMed]journal. [PubMed]
 
Atkeson A. .Jelic S. . Mechanisms of endothelial dysfunction in obstructive sleep apnea. Vasc Health Risk Manag. 2008;4:1327-1335 [PubMed]journal. [CrossRef] [PubMed]
 
Virdis A. .Schiffrin E.L. . Vascular inflammation: a role in vascular disease in hypertension? Curr Opin Nephrol Hypertens. 2003;12:181-187 [PubMed]journal. [CrossRef] [PubMed]
 
Drager L.F. .Bortolotto L.A. .Krieger E.M. .Lorenzi-Filho G. . Additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension. 2009;53:64-69 [PubMed]journal. [CrossRef] [PubMed]
 
Damiani M.F. .Zito A. .Carratù P. .et al Obstructive sleep apnea, hypertension, and their additive effects on atherosclerosis. Biochem Res Int. 2015;2015:984193- [PubMed]journal. [PubMed]
 

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References

Appleton S.L. .Vakulin A. .Martin S.A. .et al Hypertension is associated with undiagnosed OSA during rapid eye movement sleep. Chest. 2016;150:495-505 [PubMed]journal. [CrossRef] [PubMed]
 
Fruchart J.C. .Nierman M.C. .Stroes E.S. .Kastelein J.J. .Duriez P. . New risk factors for atherosclerosis and patient risk assessment. Circulation. 2004;109:III15-III19 [PubMed]journal. [PubMed]
 
Atkeson A. .Jelic S. . Mechanisms of endothelial dysfunction in obstructive sleep apnea. Vasc Health Risk Manag. 2008;4:1327-1335 [PubMed]journal. [CrossRef] [PubMed]
 
Virdis A. .Schiffrin E.L. . Vascular inflammation: a role in vascular disease in hypertension? Curr Opin Nephrol Hypertens. 2003;12:181-187 [PubMed]journal. [CrossRef] [PubMed]
 
Drager L.F. .Bortolotto L.A. .Krieger E.M. .Lorenzi-Filho G. . Additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension. 2009;53:64-69 [PubMed]journal. [CrossRef] [PubMed]
 
Damiani M.F. .Zito A. .Carratù P. .et al Obstructive sleep apnea, hypertension, and their additive effects on atherosclerosis. Biochem Res Int. 2015;2015:984193- [PubMed]journal. [PubMed]
 
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