Research On Association Between Inflammatory Factors And Atherosclerosis In Patients With Obstructive Sleep Apnea Syndrome

Objective To investigate the association of jugular arterialintima-medium thickness (IMT) with plasma tumor necrosis factor-α(TNF-α) and interlukin-18 (IL-18) in patients with obstructive sleepapnea syndrome (OSAS), and to observe the effects of continuouspositive airway pressure (CPAP) treatment on plasma TNF-α, IL-18and jugular arterial IMT.Methods Based on apnea hypopnea index (AHI), 52 male patientswith OSAS confirmed by polysomnography (OSAS group) weredivided into mild, moderate and severe OSAS subgroups. 18 malesubjects without OSAS were recruited as control group which wasmarched with OSAS groups in age and body mass index (BMI). Threemonths' treatment of CPAP was performed in 20 OSAS patients.Comparison of difference and association was made between OSASand control groups in terms of jugular arterial IMT, plasma TNF-α,IL-18, blood lipid and metabolic parameters. They were also comparedbefore and after CPAP treatment in OSAS group.Results Compared with control group, there were significant higherAHI, TNF-αand IL-18 but remarkably lower minimal pulse oxygen saturation (miniSpO₂) and high density lipoprotein (HDL) in OSASgroup. Jugular arterial IMT was significantly higher in OSAS groupthan that in control group. Moreover, a significant difference in jugulararterial IMT was detected between moderate and severe OSASsubgroups. Pearson correlation analysis showed that jugular arterialIMT had a positive linear correlation with AHI, plasma IL-18 levels (P=0.000) and TNF-αlevels (P=0.04), but had a closely negativelinear correlation with miniSpO₂ (P=0.005). In addition, jugulararterial IMT was associated with age. Multiple factors stepwiseregressive analysis indicated that AHI and age were predicting factorsof jugular arterial IMT. Plasma TNF-αlevels had a closely positivelinear correlation with AHI and plasma IL-18 levels, but had a closelynegative linear correlation with miniSpO₂ and HDL. Plasma IL-18levels displayed a closely positive linear correlation with AHI, but aclose negative linear correlation with miniSpO_b and HDL. After CPAPtreatment in OSAS patients, there was a significant decrease in AHI,systolic and diastolic blood pressure, plasma IL-18 and TNF-αlevels,but a significant decrease in miniSpO₂ (all P＜0.001); while nosignificant difference was found in blood cholesterol, HDL, lowerdensity lipoprotein (LDL), triglyceride (TG) and jugular arterial IMT.Conclusion This study demonstrated that jugular arterial IMT, plasmaTNF-αand IL-18 levels were higher in OSAS patients. Jugular arterial IMT was correlated with plasma TNF-αand IL-18 levels, AHI andminiSpO₂. AHI and age were independent predicting factors of jugulararterial IMT. The plasma levels of TNF-αand IL-18 had closelypositive correlation with AHI but closely negative correlation withminiSpO2 and HDL. All these suggested that atherosclerosis might bepromoted by higher plasma levels of TNF-αand IL-18 in OSASpatients. By improving AHI, miniSpO₂, plasma TNF-αand IL-18 levelswith CPAP treatment, the progress of artheroslerosis may be halted,and therefore the risks of cerebrocardiovascular events can be reduced.