Researchers have found that patients with obstructive sleep apnea (OSA) have higher levels of a type of dead cells (apoptotic cells) from the lining (endothelium) of their blood vessels circulating in their bloodstream than people who do not have OSA.
The finding may help explain why those with OSA are at higher risk for cardiovascular disease (CVD).
According to the researchers, “levels of apoptotic endothelial cells are correlated with abnormal endothelial vasorelaxation, a precursor of atherosclerosis-related events,” and that treatment with nasal continuous positive airway pressure (nasal CPAP) can reduce levels of circulating apoptotic endothelial cells in OSA patients.
These findings appear in the June 1 issue of the American Journal of Respiratory and Critical Care Medicine , a publication of the American Thoracic Society.
Lead researcher Ali El Sohl, M.D., M.P.H., said the study was done “to explain why patients with OSA had a higher risk of cardiovascular morbidity and mortality.” He added that “the increased levels of circulating apoptotic endothelial cells would mean less production of nitric oxide that is crucial to artery vasodilatation. The less nitric oxide, the higher potentially is the risk of hypertension and acute heart attack. CPAP treatment would likely restore the physiologic function of the lining of the blood vessels.”
For the study, 14 men with OSA were recruited from the Sleep Clinic at the Erie County Medical Center, a hospital affiliated with the University of Buffalo, in New York. The patients were nonsmokers without any coexisting diseases, and they did not use medications. Ten healthy nonsmokers were recruited from a wellness clinic at the same hospital to serve as controls.
The OSA patients were given polysomnographic testing to verify the diagnosis. This involved evaluating brain waves, electrical activity of muscles, eye movements, breathing rates, blood pressure, blood oxygen saturation and heart rhythm, as well as direct observation of patients during sleep.
The men were comparable in age, blood pressure and metabolic profiles, but the OSA patients had a higher body–mass index, though the difference was not statistically significant. The OSA patients also had more apoptotic cells circulating in their bloodstreams and had vasomotor dysfunction.
The OSA patients were given nasal CPAP treatment for eight weeks. Use of CPAP ranged from four to seven hours per night. At the end of the study, the patients' vascular reactivity and circulating endothelial apoptotic cells were reevaluated and compared to the controls.