24-hour blood pressure profile and systemic inflammation in patients with stable coronary artery disease with obstructive sleep apnea

Aim. To evaluate 24-hour blood pressure (BP) profile and systemic inflammation in patients with coronary artery disease (CAD) depending on the presence of obstructive sleep apnea (OSA).

Material and methods. This cross-sectional cohort study included 132 patients with CAD aged 62,3±6,9 years. Depending on OSA, all patients were divided into 2 groups: group 1 (n=60) — without OSA, group 2 (n=72) — with OSA. Systemic inflammation was assessed using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), Systemic immune-inflammation index (SII) — platelets´neutrophils/lymphocytes. Blood pressure was monitored with assessment of average daily values, circadian rhythm, and variability.

Results. Patients with OSA had higher nighttime blood pressure values (p<0,05) and 24-hour variability (p<0,05). In group 2 patients, a pathological blood pressure profile was detected in 66,7% of cases, while in group 1 — in 36,7%. The systemic inflammation indices were significantly higher in patients with OSA than in the group without OSA — NLR by 18,8% (p<0,01), PLR by 22,5% (p<0,01), MLR by 19,0% (p<0,01), SII by 41,0% (p<0,001).

Conclusion. We established that patients with coronary artery disease and OSA have more pronounced systemic inflammation, more often have a pathological 24-hour BP profile ("non-dipper", "night-peaker"), BP variability, higher values of average 24-hour, daytime and nighttime BP compared with patients without OSA.

1. Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) doi:10.15829/1560-4071-2020-4076.2020.

2. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Am Rev Med. 1976;27:465-84. doi:10.1146/annurev.me.27.020176.002341.

3. Mahajan SK, Mahajan K, Sharma S. Obstructive sleep apnea and coronary artery disease: An unholy nexus or a holy alliance? Lung India. 2022;39(5):460-5. doi:10.4103/lungindia.lungindia_597_21.

4. Hamsheva DS. Sindrom obstruktivnogo apnoe sna: sovremennoe sostoyanie problemy. Lechebnoe delo. 2014;1:4-15. (In Russ.) Ш

5. Sarkar P, Mukherjee S, Chai-Coetzer CL, et al. The epidemiology of obstructive sleep apnoea and cardiovascular disease. J Thorac Dis. 2018;10(Suppl 34):4189-200. doi:10.21037/jtd.2018.12.56.

6. Gorbunova MV, Babak SL, Maliavin AG. Cardiovascular and metabolic impairment in patients with obstructive sleep apnea. The Russian Archives of Internal Medicine. 2018;8(1):12-21. (In Russ.) doi:10.20514/2226-6704-2018-8-1-12-21.

7. Osipova OA, Gosteva EV, Belousova ON, et al. Metabolic risk factors in elderly patients depending on the presence of obstructive sleep apnea syndrome. Adv Geront. 2022;35(6):927-32. (In Russ.) doi:10.34922/AE.2022.35.6.015.

8. Fan J, Wang X, Ma X, et al. Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc. 2019;8(2):e010826. doi:10.1161/JAHA.118.010826.

9. Cowie MR, Linz D, Redline S, et al. Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(6):608-24. doi:10.1016/j.jacc.2021.05.048.

10. Bouzerda A. Risque cardiovasculaire et syndrome d’apnées obstructives du sommeil. Cardiovascular risk and obstructive sleep apnea. Pan Afr Med J. 2018;29:47. doi:10.11604/pamj.2018.29.47.11267.

11. Gorbunova MV, Babak SL, Malyavin AG. Rational antihypertensive therapy in patients with obstructive sleep apnea. The Russian Archives of Internal Medicine. 2019;9(2):85-92. (In Russ.)

12. Bouloukaki I, Grote L, McNicholas WT, et al. Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification. J Clin Sleep Med. 2020;16(6):889-98. doi:10.5664/jcsm.8354.

13. Hou H, Zhao Y, Yu W, et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health. 2018;8(1):010405. doi:10.7189/jogh.08.010405.

14. Mikhailova OO, Gogiberidze KO, Elfimova EM, et al. Uncontrolled hypertension and obstructive sleep apnea: integrated treatment approach. Systemic Hypertension. 2022;19(3):41-7. (In Russ.) doi:10.38109/2075-082X-2022-3-41-47.

15. Bikmetova AV. Obstructive sleep apnea-hypopnea syndrome: clinical relevance, interrelation with arterial hypertension, diagnostic and treatment principles. Vyatskij medicinskij vestnik. 2011;(1):3-8. (In Russ.)

16. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.) Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786. doi:10.15829/1560-4071-2020-3-3786.

17. Buzunov RV, Palman AD, Melnikov AYu, et al. Diagnostics and Treatment of Obstructive Sleep Apnea Syndrome in Adults. Recommendations of the Russian Society of Sleep Medicine. Effektivnaya farmakoterapiya. 2018;(35):34-45. (In Russ.)

18. Alekseeva OV, Schneider NA, Demko IV, et al. Obstructive apnea/ hypopea syndrome of sleep: criteria of severity, pathogenesis, clinical manifestations and methods of diagnosis. Sibirskij medicinskij zhurnal. 2016;140(1):91-7. (In Russ.)

19. Functional diagnostics: National guidelines/edited by N. F. Beresten, V. A. Sandrikova, S. I. Fedorova. Moscow: GEOTAR-Media, 2019. 784 p. (National Guidelines Series). (In Russ.) ISBN: 978-5-9704-4242-5.

20. Liu J, Su X, Nie Y, et al. NARRAS investigators. Nocturnal blood pressure rather than night-to-day blood pressure ratio is related to arterial stiffening in untreated young and middle-aged adults with non-dipper hypertension. J Clin Hypertens (Greenwich). 2022;24(8):1044-50. doi:10.1111/jch.14546.

21. Hoshide S, Kario K, Chia YC, et al. Characteristics of hypertension in obstructive sleep apnea: An Asian experience. J Clin Hypertens (Greenwich). 2021;23(3):489-95. doi:10.1111/jch.14184.

22. Hla KM, Young T, Finn L, et al. Longitudinal association of sleepdisordered breathing and non-dipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep. 2008;31(6): 795-800. doi:10.1093/sleep/31.6.795.

23. Marrone O, Bonsignore MR. Blood-pressure variability in patients with obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018;10:229-42. doi:10.2147/NSS.S148543.

24. Polonskiy EL, Zybina NN, Tikhomirova OV, Lomova IP. Biomarkers of non-specific inflammation and atherosclerosis of carotid arteries in obstructive sleep apnea syndrome. Medical alphabet. 2022;1(6):47-52. (In Russ.) doi:10.33667/2078-5631-2022-6-47-52.

25. Fan Z, Lu X, Long H, et al. The association of hemocyte profile and obstructive sleep apnea. Journal of clinical laboratory analysis. 2019;33(2):22680. doi:10.1002/jcla.22680.

26. Ye G, Chen Q, Chen X, et al. The Prognostic Role of Platelet-toLymphocyte Ratio in Patients with Acute Heart Failure: A Cohort Study. Sci Rep. 2019;9:10639. doi:10.1038/s41598-019-47143-2.

27. Altintas N, Çetinoğlu E, Yuceege M, et al. Neutrophil-to-lymphocyte ratio in obstructive sleep apnea; a multi center, retrospective study. Eur Rev Med Pharmacol Sci. 2015;19(17):3234-40.