TY - JOUR T1 - Obstructive sleep apnea and the progression of thoracic aortic aneurysm: a prospective cohort study JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.03322-2020 SP - 2003322 AU - Thomas Gaisl AU - Protazy Rejmer AU - Maurice Roeder AU - Patrick Baumgartner AU - Noriane A. Sievi AU - Sandra Siegfried AU - Simon F. Stämpfli AU - Robert Thurnheer AU - John R. Stradling AU - Felix C. Tanner AU - Malcolm Kohler Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/10/29/13993003.03322-2020.abstract N2 - Background Obstructive sleep apnea (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 aneurysms (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 apnea-hypopnea-index (AHI). Secondary outcomes included surveillance for aortic events (composite endpoints of rupture, dissection, elective surgery, and death).Results Between July 2014 and March 2020, 230 patients (median age 70 years, 78% male) participated in the cohort. At baseline, 34.8% of patients had an AHI of ≥15 events·h−1. There was no association between TAA diameters and the AHI at baseline. After 3 years mean 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 to 0.040], p<0.001; ascending aorta estimate 0.026 mm [95%CI 0.011 to 0.041], p=0.001). Twenty 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Gaisl reports personal fees from Bayer AG (consulting), outside the submitted work.Conflict of interest: Dr. Rejmer has nothing to disclose.Conflict of interest: Dr. Roeder has nothing to disclose.Conflict of interest: Dr. Baumgartner has nothing to disclose.Conflict of interest: Dr. Sievi has nothing to disclose.Conflict of interest: Dr. Siegfried has nothing to disclose.Conflict of interest: Dr. Stämpfli reports personal fees from Amgen, AstraZeneca, Bayer, Novartis, and Pfizer, outside the submitted work.Conflict of interest: Dr. Thurnheer has nothing to disclose.Conflict of interest: Dr. Stradling reports personal fees from Bayer AG, personal fees from ResMed, outside the submitted work.Conflict of interest: Dr. Tanner has nothing to disclose.Conflict of interest: Dr. Kohler reports personal fees from Bayer AG, outside the submitted work. ER -