Abstract
Background Obstructive 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).
Methods Patients 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).
Results Between 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.
Conclusion OSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.
Abstract
Obstructive sleep apnoea may be an independent risk factor for faster thoracic aortic aneurysm expansion and thus potentially contributes to life-threatening complications in aortic disease https://bit.ly/35Qp4kO
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.04440-2020
This article has supplementary material available from erj.ersjournals.com
This study is registered at ClinicalTrials.gov with identifier number NCT02204774. Data availability: The dataset for this study is available from the corresponding author upon reasonable request.
Author contributions: T. Gaisl, P. Rejmer, S. Siegfried and M. Kohler had full access to all of the data. Study concept and design: J.R. Stradling and M. Kohler. Acquisition, analysis or interpretation of data: T. Gaisl, P. Rejmer, M. Roeder, P. Baumgartner, N.A. Sievi and S.F. Stämpfli. Drafting of the manuscript: T. Gaisl. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: T. Gaisl and S. Siegfried. Administrative, technical or material support: T. Gaisl, S.F. Stämpfli, R. Thurnheer, F.C. Tanner and M. Kohler. Study supervision and funding: M. Kohler.
Conflict of interest: T. Gaisl reports personal fees from Bayer AG (consulting), outside the submitted work.
Conflict of interest: P. Rejmer has nothing to disclose.
Conflict of interest: M. Roeder has nothing to disclose.
Conflict of interest: P. Baumgartner has nothing to disclose.
Conflict of interest: N.A. Sievi has nothing to disclose.
Conflict of interest: S. Siegfried has nothing to disclose.
Conflict of interest: S.F. Stämpfli reports personal fees for consultancy from Amgen, AstraZeneca, Bayer, Novartis and Pfizer, outside the submitted work.
Conflict of interest: R. Thurnheer has nothing to disclose.
Conflict of interest: J.R. Stradling reports personal fees for consultancy from Bayer AG and ResMed, outside the submitted work.
Conflict of interest: F.C. Tanner has nothing to disclose.
Conflict of interest: M. Kohler reports personal fees for consultancy from Bayer AG, AstraZeneca, Novartis, GSK, Boehringer Ingelheim and Mundipharma, outside the submitted work, and is founder and owner of the “Deep Breath Initiative” a company that provides services in the field of exhaled breath analysis.
Support statement: This work was supported by the Universität Zürich. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 30, 2020.
- Accepted October 26, 2020.
- Copyright ©ERS 2021
LIBRARY USERS
Log in through your institution
Purchase access
