Association of sleep apnoea risk and aortic enlargement in Marfan syndrome

BackgroundMarfan syndrome (MFS) is a connective tissue disorder characterised by complex aortic pathology and a high prevalence of obstructive sleep apnoea (OSA). OSA produces intrathoracic transmural stresses that may accelerate aortic injury. The current study was designed to examine the associations between OSA risk and markers of aortic enlargement in MFS.MethodConsecutive patients with MFS were recruited at Johns Hopkins if they completed a STOP-BANG survey. Composite survey scores were categorised into those with low OSA risk (STOP-BANG <3) and high OSA risk (STOP-BANG ≥3). Participants’ aortic data were collated to ascertain aortic root diameter, dilatation and prior aortic root replacement. Regression analyses were used to examine associations between OSA risk strata and these aortic parameters.ResultsOf the 89 participants studied, 28% had a high OSA risk and 32% had aortic grafts. Persons with high OSA risk had greater aortic root diameter (mm) (ß=4.13, SE=1.81, p=0.027) and aortic root dilatation (ß=2.80, SE=1.34, p=0.046) compared with those with low OSA risk . In addition, the odds of prior aortic root replacement was three times greater in those with high OSA risk compared with those with low OSA risk.ConclusionIn MFS, high OSA risk is associated with aortic enlargement and a threefold increased risk of having had prior aortic root replacement. These findings invite further exploration of the relationship between OSA and aortic disease in MFS, and studies to clarify whether targeted interventions for OSA might mitigate aortic disease progression in MFS.Registration numberIRB00157483.

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Redo Aortic Root Operations in Patients with Marfan Syndrome

International Journal of Angiology ◽

10.1055/s-0038-1649485 ◽

2018 ◽

Vol 27 (02) ◽

pp. 092-097

Author(s):

Vicente Orozco-Sevilla ◽

Richard Whitlock ◽

Ourania Preventza ◽

Kim de la Cruz ◽

Joseph Coselli

Keyword(s):

Marfan Syndrome ◽

Aortic Root ◽

Late Complication ◽

Disease Process ◽

Aortic Disease ◽

Late Complications ◽

Aortic Root Replacement ◽

Thoracic Aortic Disease ◽

Replacement Surgery ◽

Small Series

AbstractAortic root aneurysm is the most common cardiovascular manifestation requiring surgical intervention in patients with Marfan syndrome (MFS), a heritable thoracic aortic disease. Elective replacement of the aortic root is the treatment of choice for patients with aneurysmal complications of the aortic root and ascending aorta. There are two basic approaches to aortic root replacement: valve-sparing (VS) and valve-replacing (VR) techniques. After successful aortic root replacement surgery, several patients with MFS may develop a late complication related to their aortic disease process, such as developing a pseudoaneurysm of the coronary artery reattachment buttons, aneurysmal expansion, or aortic dissection in the remaining native aorta. These patients may also develop other late complications that are not specifically related to the heritable thoracic aortic disease, such as infections that can lead to dehiscence of some or all of the distal or proximal anastomosis. Because these complications are rare, the clinical volume of reoperations of the aortic root in patients with MFS is low, making it difficult to assess contemporary experiences with these procedures. Only a few published reports have examined reoperative aortic root surgery in patients with MFS, each of which had only a small series of patients. Herein, we describe our contemporary experience with reoperative aortic root replacement in patients with MFS and provide our operative approach for these uncommon procedures.

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Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in marfan syndrome?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.01.009 ◽

2004 ◽

Vol 127 (5) ◽

pp. 1373-1380 ◽

Cited By ~ 24

Author(s):

Osamu Tagusari ◽

Hitoshi Ogino ◽

Junjiro Kobayashi ◽

Ko Bando ◽

Kenji Minatoya ◽

...

Keyword(s):

Aortic Arch ◽

Marfan Syndrome ◽

Aortic Root ◽

Aortic Root Replacement ◽

Annuloaortic Ectasia

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Aortic Root Diameter and Arterial Stiffness: Conjoint Relations to the Incidence of Cardiovascular Disease in the Framingham Heart Study

Hypertension ◽

10.1161/hypertensionaha.121.17702 ◽

2021 ◽

Author(s):

Ramachandran S. Vasan ◽

Rebecca J. Song ◽

Vanessa Xanthakis ◽

Gary F. Mitchell

Keyword(s):

Cardiovascular Disease ◽

Pulse Pressure ◽

Aortic Root ◽

Cox Regression ◽

Prognostic Significance ◽

Root Diameter ◽

Cvd Risk ◽

Heart Study ◽

Increased Risk ◽

Central Pulse Pressure

Higher central pulse pressure is associated with higher carotid-femoral pulse wave velocity (CFPWV) and an increased risk of cardiovascular disease (CVD). A smaller aortic root diameter (AoR) is associated with higher central pulse pressure. We hypothesized that the combination of a smaller AoR and higher CFPWV is associated with increased CVD risk (relative to a larger AoR and lower CFPWV). We tested this hypothesis in the community-based Framingham Study (N=1970, mean age 60 years, 57% women). We created sex-specific longitudinal echocardiographic AoR trajectories over 2 decades, categorizing participants into smaller versus larger AoR groups. We cross-classified participants based on their AoR trajectory and CFPWV (dichotomized at the sex-specific median). We used Cox regression to relate the cross-classified groups to CVD incidence on follow-up (median 17 years): lower CFPWV, larger AoR (referent group; 6.4/1000 person-years); lower CFPWV, smaller AoR (6.9/1000 person-years); higher CFPWV, larger AoR (23.1/1000 person-years); and higher CFPWV, smaller AoR (21.9/1000 person-years). In sex-pooled analyses, groups with higher CFPWV were associated with a multivariable-adjusted 1.8-fold risk of CVD ( P <0.01) regardless of AoR size. We observed effect modification by sex ( P for sex×AoR-CFPWV group interaction 0.04). In men, the group with smaller AoR and higher CFPWV was associated with a 2.5- to 2.8-fold risk of CVD ( P <0.001). In women, the group with larger AoR and higher CFPWV experienced a statistically nonsignificant 70% to 80% higher CVD risk. Our observations indicate that the prognostic significance of a smaller versus larger AoR varies in men versus women. Additional studies are warranted to confirm our findings.

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Reimplantation Valve-Sparing Aortic Root Replacement in Marfan Syndrome Using the Valsalva Conduit: An Intercontinental Multicenter Study

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.10.084 ◽

2007 ◽

Vol 83 (2) ◽

pp. S769-S773 ◽

Cited By ~ 36

Author(s):

Fabrizio Settepani ◽

Wilson Y. Szeto ◽

Davide Pacini ◽

Ruggero De Paulis ◽

Luigi Chiariello ◽

...

Keyword(s):

Marfan Syndrome ◽

Multicenter Study ◽

Aortic Root ◽

Aortic Root Replacement ◽

Valve Sparing

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Obstructive Sleep Apnoea and Type 2 Diabetes

US Endocrinology ◽

10.17925/use.2014.10.01.35 ◽

2014 ◽

Vol 10 (01) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Abd A Tahrani ◽

Asad Ali ◽

◽

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Medical Condition ◽

Diabetes Type 2 ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

Osa Treatment ◽

The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnea (OSA) is a very common medical condition that is associated with increased risk for cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

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Increased liver stiffness in patients with severe sleep apnoea and metabolic comorbidities

European Respiratory Journal ◽

10.1183/13993003.00601-2018 ◽

2018 ◽

Vol 51 (6) ◽

pp. 1800601 ◽

Cited By ~ 9

Author(s):

Wojciech Trzepizur ◽

Jérôme Boursier ◽

Marc Le Vaillant ◽

Pierre-Henri Ducluzeau ◽

Séverine Dubois ◽

...

Keyword(s):

Metabolic Syndrome ◽

Liver Disease ◽

Liver Fibrosis ◽

Liver Stiffness ◽

Sleep Apnoea ◽

Screening Tools ◽

The Metabolic Syndrome ◽

Obstructive Sleep ◽

Increased Risk ◽

Metabolic Comorbidities

The goal of this study was to assess the relationship between the severity of obstructive sleep apnoea (OSA) and liver stiffness measurement (LSM), one of the most accurate noninvasive screening tools for liver fibrosis in nonalcoholic fatty liver disease.The study included 147 patients with at least one criterion for the metabolic syndrome, assessed by polysomnography for suspected OSA. LSM was performed using transient elastography (FibroScan). Significant liver disease and advanced liver fibrosis were defined as LSM ≥7.3 and ≥9.6 kPa, respectively.23 patients were excluded because of unreliable LSM. Among 124 patients, 34 (27.4%) had mild OSA, 38 (30.6%) had moderate OSA and 52 (42.0%) had severe OSA. LSM values were 7.3– <9.6 kPa in 18 (14.5%) patients and ≥9.6 kPa in 15 (12.1%) patients. A dose–response relationship was observed between OSA severity and LSM values (p=0.004). After adjustment for age, sex, metabolic syndrome and insulin resistance, severe OSA was associated with an increased risk of LSM ≥7.3 kPa (OR 7.17, 95% CI 2.51–20.50) and LSM ≥9.6 kPa (OR 4.73, 95% CI 1.25–17.88).In patients with metabolic comorbidities, severe OSA is independently associated with increased liver stiffness, which may predispose to a higher risk of significant liver disease and poorer prognosis.

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Coronary Artery Complications Related to Aortic Root Replacement in Marfan Syndrome

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2021.09.007 ◽

2021 ◽

Author(s):

Santo K. Ricceri ◽

Tami J. Bang ◽

Amanda Goodwin ◽

Amber Khanna ◽

Daniel W. Groves ◽

...

Keyword(s):

Coronary Artery ◽

Marfan Syndrome ◽

Aortic Root ◽

Aortic Root Replacement

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Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

European Respiratory Journal ◽

10.1183/13993003.01849-2019 ◽

2020 ◽

Vol 55 (4) ◽

pp. 1901849 ◽

Cited By ~ 5

Author(s):

Samu Kainulainen ◽

Brett Duce ◽

Henri Korkalainen ◽

Arie Oksenberg ◽

Akseli Leino ◽

...

Keyword(s):

Reaction Time ◽

Obstructive Sleep Apnoea ◽

Significant Risk ◽

Sleep Apnoea ◽

Type I ◽

Median Reaction Time ◽

Diagnostic Parameters ◽

Obstructive Sleep ◽

Increased Risk ◽

Psychomotor Vigilance

Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance.We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea–hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression.A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20–1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26–1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21–6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05–1.07, p<0.01) and older age (ORrange 1.01–1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance.These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

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Screening for obstructive sleep apnoea in professional drivers

Breathe ◽

10.1183/20734735.0364-2019 ◽

2020 ◽

Vol 16 (1) ◽

pp. 29364 ◽

Cited By ~ 2

Author(s):

Sophia E. Schiza ◽

Izolde Bouloukaki

Keyword(s):

Obstructive Sleep Apnoea ◽

Early Identification ◽

Sleep Apnoea ◽

Screening Tools ◽

List Type ◽

Objective Data ◽

Sleep Study ◽

Professional Drivers ◽

Obstructive Sleep ◽

Increased Risk

Professional drivers show a higher prevalence of obstructive sleep apnoea (OSA) compared with the general population. Furthermore, there is concern about the association between OSA and car crash risk given that drivers with OSA show an increased risk for car accidents. Despite this risk, OSA is often underdiagnosed and undertreated in this population, mainly due to lack of appropriate screening and sleep study referrals. Polysomnography (PSG), the gold standard test, is inappropriate for systematic screening because of its high expense, complexity and relative inaccessibility in this population. Therefore, there is a strong demand for good screening tools, including both subjective and objective data that may assist in early identification of possible OSA among professional drivers and, thus, aid in PSG examination referral and OSA management in an accredited sleep centre. However, there is considerable disagreement over screening methods and criteria for triggering a sleep study referral in different countries. There is also a strong need for further research in the area of OSA screening of commercial drivers in order to improve the diagnostic accuracy of screening tools and ensure that patients with OSA are accurately identified.Key pointsObstructive sleep apnoea (OSA) is often undiagnosed and undertreated in professional drivers.Professional drivers often under-report and are reluctant to report OSA symptoms.Barriers to OSA diagnosis include appropriate screening and sleep study referrals.Screening tools including both subjective and objective data may assist in early identification of possible OSA among professional drivers.Educational aimsTo evaluate screening instruments currently used to identify OSA risk in professional drivers.To provide guidance for developing an assessment strategy for OSA by professional driver medical examiners.

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Relationship of Obstructive Sleep Apnoea with Diabetic Retinopathy: A Meta-Analysis

BioMed Research International ◽

10.1155/2017/4737064 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Zhenliu Zhu ◽

Fengying Zhang ◽

Yunxia Liu ◽

Shuqin Yang ◽

Chunting Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Sensitivity Analysis ◽

Diabetic Retinopathy ◽

Publication Bias ◽

Meta Analysis ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

Relationship Of ◽

The Relationship

Until now, the relationship of obstructive sleep apnoea (OSA) with diabetic retinopathy (DR) was controversial. This meta-analysis was performed to obtain definitive conclusion on this topic. Relevant articles were searched on databases of Pubmed, Google Scholar, and Chinese National Knowledge Infrastructure (CNKI). The articles were selected according to inclusion and exclusion criteria. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship of OSA with risk of DR.I2andPvalue were used to assess the presence of heterogeneity.I2≥ 50% orP<0.05indicated significant heterogeneity. Sensitivity analysis was performed to evaluate the robustness of pooled results. Begg’s funnel plot and Egger’s regression analysis were adopted to assess publication bias. 6 eligible studies were selected in the present meta-analysis. The pooled results indicated that OSA was significantly associated with increased risk of DR (OR = 2.01, 95% CI = 1.49–2.72). Subgroup analysis based on type of diabetes mellitus suggested that OSA was related to DR in both Type 1 and Type 2 diabetes mellitus. Sensitivity analysis demonstrated that pooled results were robust. No significant publication bias was observed (P=0.128). The results indicate that OSA is related to increased risk of DR.

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