Impact of obstructive sleep apnea-hypopnea syndrome on coronary microcirculation in hypertensive patients.

Abstract

Objective: To investigate the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on coronary microcirculatory function in hypertensive patients and explore potential mechanisms.

Methods: A total of 87 patients underwent cardiac stress echocardiography, and 376 patients underwent angiography-derived microvascular resistance (AMR) assessment based on quantitative flow ratio (QFR) technology. All patients completed portable sleep monitoring. Based on the monitoring results and hypertension history, patients were categorized into five groups: control, hypertension alone, OSAHS alone, hypertension with mild OSAHS, and hypertension with moderate-to-severe OSAHS. Parameters including sleep monitoring data, coronary flow velocity reserve (CFVR), AMR, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were compared among groups. Multivariable logistic regression analysis was performed to assess the influence of different groupings on coronary microvascular dysfunction.

Results: The Hypertension with moderate-to-severe OSAHS group demonstrated significantly lower CFVR ( P  < 0.05) and significantly higher left anterior descending artery AMR (LAD-AMR), hs-CRP, and IL-6 levels compared to all other groups ( P  < 0.05). Multivariable logistic regression analysis revealed that, compared to the control group, hypertension with moderate-to-severe OSAHS was an independent correlate of both reduced CFVR [odds ratio (OR) = 6.06, 95% confidence interval (CI): 2.87-12.78] and elevated LAD-AMR (OR = 5.60, 95% CI: 4.10-7.10).

Conclusion: In hypertensive patients, co-existing moderate-to-severe OSAHS is associated with more severe coronary microvascular dysfunction and elevated levels of inflammatory markers.