Severe Obstructive Sleep Apnea with Imaged Carotid Plaque Significantly Associated with Systemic Inflammation

Publication date: Available online 13 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Urie K. Lee, Stanley Yung Liu, Michelle R. Zeidler, Hoang-Anh Tran, Tina I. Chang, Arthur H. Friedlander

Abstract

Objective

Persons with obstructive sleep apnea (OSA) are at heightened risk of myocardial infarction (MI) and stroke caused by adiposity and intermittent hypoxia which provoke proinflammatory cytokines to induce systemic/vascular inflammation resulting in endothelial dysfunction and development of atherosclerotic plaque. We aim to compare the levels of systemic inflammation between groups of patients having severe OSA with and without carotid artery calcified plaque (CACP+/CACP–) on their panoramic image (PI) as indexed by the neutrophil-lymphocyte ratio (NLR).

Study Design

Retrospective, cross-sectional study design. Medical records and PIs of adult male patients with severe OSA treated by the Dental Service (January 1, 2017 – December 31, 2017) were reviewed. The predictor variable was the presence or absence of CACP on PIs and the outcome variable was NLR level. T-test analyzed differences in mean NLRs between groups. Atherogenic risk factors (age, BMI, hypertension, diabetes) were assessed for independence by descriptive and logistic regression analysis. Significance set at 0.05 for all tests.

Results

Study group (N = 39) of CACP+ subjects (mean age 63 ± 7.4) showed mean NLR of 3.09 ± 1.42. Control group (N = 46) of CACP– subjects (mean age 62 ± 6.8) showed mean NLR of 2.10 ± 0.58. The difference between groups was significant (P<0.001). Logistic regression for both NLR and CACP failed to show significant correlations with covariates.

Conclusion

Older males with severe OSA having carotid atheromas on panoramic radiograph show significantly greater systemic inflammation measured by NLRs. The combination of severe OSA, atheroma formation, and markedly elevated NLR suggest higher risk of MI and stroke and need to refer for cardiovascular/cerebrovascular evaluation.

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