A Strong Clue on Chest Radiography for Metabolic Syndrome in Patients with Obstructive Sleep Apnea: Aortic Arch Calcification

Abstract

Aim: Obstructive sleep apnea (OSA) is associated with increased atherosclerosis and metabolic syndrome (MetS). Vascular calcification plays a pivotal role in the development of atherosclerosis. However, data regarding vascular calcification and MetS is insufficient. The aim of the present study was to investigate the association between MetS and aortic arch calcification in patients with OSA.

Material and Methods: Patients who underwent an overnight polysomnography and diagnosed with OSA were enrolled into the study. Patients were classified into two groups based on the presence of MetS. Two examiners who were unaware of the results of polysomnographic assessment reviewed the chest radiograms.

Results: A total of 314 patients with OSA were included in the study. 33.1% of the patients were female and mean age was 51.2±10.9. Of these, 43.6% had mild OSA, 30.9% had moderate OSA, and 25.5% had severe OSA. Aortic arch calcification was detected in 56.4% (n=177) and MetS was detected in 58.6% (n=184) of the patients. Prevalence of aortic arch calcification was higher in patients with MetS than in those without MetS (p<0.001). By multiple logistic regression analysis found that body mass index (1.148, 95% CI, 1.089-1.210), apnea hypnea index (1.039, 95% CI, 1.016-1.062), and aortic arch calcification (4.986, 95% CI, 2.887-8.610) were found to be predictors of MetS.

Conclusion: Aortic arch calcification seen in chest radiography is strongly associated with MetS in patients with OSA. Aortic arch calcification may be an alerting finding for clinicians regarding the development of MetS in patients with OSA.

Keywords

• obstructive sleep apnea,aortic arch calcification,metabolic syndrome

Obstrüktif Uyku Apneli Hastalarda Metabolik Sendrom İçin Göğüs Radyografisi Üzerinde Güçlü Bir İpucu: Aortik Ark Kalsifikasyonu

Öz

Amaç: Obstrüktif uyku apnesi (OSA), ateroskleroz ve metabolik sendrom (MetS) gelişimi için önemli bir risk faktörüdür. Vasküler kalsifikasyon ateroskleroz gelişiminde önemli bir rol oynamaktadır. Buna rağmen, literatürde MetS ile vasküler kalsifikasyon arasındaki ilişkiyi gösteren veriler yetersizdir. Bu çalışmanın amacı, OSA'lı hastalarda MetS ile aortik ark kalsifikasyonu arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntemler: Bir gece polisomnografi laboratuvarında yatan ve OSA tanısı koyulan hastalar çalışmaya dahil edildi. Hastalar MetS varlığına göre iki gruba ayrıldı. Polisomnografik değerlendirme sonuçlarından habersiz olan iki araştırmacı akciğer grafilerini inceledi.

Bulgular: Çalışmaya OSA tanısı alan toplam 314 hasta dahil edildi. Hastaların %33,1 kadın ve ortalama yaş 51,2±10,9 idi. Çalışmaya alınan hastaların %43,6'sında hafif OSA, %30,9'unda orta derecede OSA ve %25,5'inde ağır OSA varlığı saptandı. Hastaların %56,4'ünde (n=177) aortik ark kalsifikasyonu, %58,6'sında (n=184) ise MetS saptandı. Aortik ark kalsifikasyonu prevalansının MetS saptanan hastalarda MetS saptanamayan hastalara göre daha yüksek olduğu bulundu (p<0,001). Çoklu lojistik regresyon analizinde, vücut kitle indeksinin (1,148; %95 GA 1,089-1,210), apne hipopne indeksinin (1,039; %95 GA, 1,016-1,062) ve aortik ark kalsifikasyonunun (4,986; 95% GA 2,887-8,610) MetS varlığı için bağımsız prediktörler olduğu bulundu.

Sonuç: OSA'lı hastalarda akciğer grafisinde görülebilen aortik ark kalsifikasyonu ile MetS arasında güçlü bir ilişki olduğu bulundu. Aortik ark kalsifikasyonu, OSA'lı hastalarda MetS gelişimi ile ilgili klinisyenler için uyarıcı bir bulgu olabilir.

Anahtar Kelimeler

• obstruktif uyku apne,aort ark kalsifikasyonu,metabolik sendrom

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