High prevalence of peripheral arterial occlusive disease (PAOD) in patients with obstructive sleep apnea

Objective: To evaluate the percentage of patients with obstructive sleep apnea (OSA) having peripheral arterial occlusive disease (PAOD) as co-morbidity.

Background: OSA has been found to be a risk factor for arteriosclerosis in addition to classical cardiovascular risk factors. Whereas OSA is known to be associated with coronary artery disease and stroke, the clinical impact of OSA on PAOD is unclear.

Methods and results: In this prospective study, 51 consecutive patients with suspected OSA and without known arteriosclerotic diseases (22% female, age 62±11 years) were included and underwent standardized angiologic screening before polysomnography. Patients presented with significant AHI (39±25 events/h) and daytime sleepiness (Epworth sleepiness scale [ESS] 10.3±5.4) and were divided into three groups according to apnea hypopnea index (AHI; AHI 5–14, n=15; AHI 15–29, n=16; AHI ≥30, n=20). Patients with AHI <5 were defined as control group. Prevalence of PAOD, defined as documentation of ≥1 arteriosclerotic plaque by duplex sonography was 94%. In addition, central pulse wave velocity was different between these groups (P<0.05): 5.6±2.0m/s in AHI 5–14, 6.9±2.7m/s in AHI 15–29 and 7.7±1.5m/s in AHI ≥30. There were no significant differences in other functional markers for PAOD such as ancle-brachial index, pulse wave index, digital-segmental pulsoszillography or walking distance.

Conclusion: The extraordinarily high prevalence of PAOD in patients with OSA and the association between severity of OSA and pulse wave velocity supports a presumable role of OSA in the pathogenesis of peripheral arteriosclerosis and demands further trials with positive airway pressure-treatment in PAOD patients.