Atherosclerosis of various localizations in patients with obstructive sleep apnea syndrome: development features and clinical prognosis

Objective. To evaluate the dynamics of atherosclerotic changes in the main, coronary and peripheral arteries and biochemical parameters of the lipid profile in patients with obstructive sleep apnea syndrome (OSAS) depending on the severity of respiratory disorders and to study their possible impact on the clinical prognosis. Material and methods . The study included 60 male railway workers with obesity and arterial hypertension. Based on the results of the polysomnographic study, the participants were divided into 2 groups: the first consisted of workers with an apnea/hypopnea index (AHI) ≤ 15 per hour, the second – with AHI> 15 per hour. All participants initially underwent biochemical lipid profile determination, ultrasound Dopplerography of the brachiocephalic arteries (BCA) and arteries of the lower extremities, functional load tests and, if indicated, coronary angiography. Then, the patients were monitored for 3 years and the clinical outcomes were retrospectively assessed: cardiovascular mortality, nonfatal myocardial infarctions, strokes, rehospitalizations due to cardiovascular diseases, the need for surgical revascularization and registration of cases of newly diagnosed diabetes mellitus were also taken into account. Results . Statistically significant differences were found between the study groups in the main parameters of the lipid profile with a predominance of its atherogenic fractions in the second group: LDL-С (p = 0.01 [95 % CI: –0.86; –0.11]), TG (p = 0.04 [95 % CI: –0.89; 0.09]) and non-HDL-С (p = 0.03 [95 % CI: –0.67; –0.04]). The frequency of diabetes mellitus, manifestations of coronary atherosclerosis, atherosclerosis of the brachiocephalic arteries, multifocal atherosclerosis, and repeated hospitalizations was also significantly higher in the second group. The highest prognostic value for the risk of developing systemic atherosclerosis was demonstrated by the AHI, LDL-С level, and METS-IR insulin resistance index. Conclusions . The severity of sleep breathing disorders is associated with laboratory and clinical signs of atherosclerosis progression, which indicates a pathogenetic relationship between OSA and atherosclerosis.