Sleep and Endothelial Dysfunction

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Authors: Smith, A.H. · Schnyders, J. ·Birckbichler, M. · Huttenlock, T. · Hunt, B. · Bubu, O.M.  Wheaton College, Wheaton, IL. 

Abstract: 

Introduction: Mounting evidence implicates sleep deprivation and obstructive sleep apnea as possible risk factors for vascular endothelial dysfunction. Mechanisms that effect this relationship remain unclear. Studies examining this association have contradicting findings; therefore, we conducted a systematic review to evaluate the evidence of an association between sleep deprivation, obstructive sleep apnea and endothelial dysfunction. 

Methods: Original published literature assessing any association of sleep deprivation, obstructive sleep apnea and vascular endothelial dysfunction were identified separately by searching PubMed, Medline, Web of Science Core Collection, OpenGrey and ProQuest from onset to June 2017. The terms sleep deprivation, obstructive sleep apnea and endothelial dysfunction were identified as MeSH terms. Various study types were also identified and included in this study. This study utilized the PRISMA guidelines. Articles identified from the search were first screened using titles and abstracts of the publications and eligible articles for this review had to meet certain inclusion criteria. 

Results: One hundred and five (105) articles were identified in the systematic literature search, 74 articles examining associations between OSA and endothelial function, and 31 articles examining associations between sleep deprivation and endothelial function. Results indicate that both Sleep deprivation and OSA severity affected Flow-Mediated Dilation (FMD), Carotid-femoral Pulse Wave Velocity (PWV) and other measures of endothelial dysfunction with higher hypoxia measures resulting in significantly adverse effects. OSA severity also adversely affected levels of inflammatory markers such as C-reactive protein. Sleep deprivation and OSA measures were also associated with reduced vascular reactivity, and impaired endothelial repair capability. Furthermore, in OSA patients, CPAP therapy significantly improved endothelial function. 

Conclusion: Sleep Deprivation and obstructive sleep apnea are strongly associated with vascular endothelial dysfunction. Mechanisms underlying this relationship are associated with hypoxia, reduced vascular reactivity, and impaired endothelial repair capability. Future studies are needed to determine if sleep deprivation and OSA actually precede the onset of endothelial dysfunction. We will continue this research by performing meta-analyses for both of these sleep exposures.

SLEEP 2018 Abstract Supplement Vol. 41

Abstract No. 0871, Pg. A342