Central Sleep Apnea Indicates Autonomic Dysfunction in Asymptomatic Carotid Stenosis: A Potential Marker of Cerebrovascular and Cardiovascular Risk

Study Objectives:

Arteriosclerosis related stenosis in the carotid bulb causes autonomic imbalance, likely due to carotid chemoreceptor and baroreceptor dysfunction. The latter are associated with increased cerebrovascular and cardiovascular mortality. Chemoreceptor and baroreceptor dysfunction is also involved in the origin of central sleep apnea syndrome (CSA) in different clinical entities. We hypothesized that CSA is associated with stenosis of the internal carotid artery (ICA). The mechanism of this association is an autonomic imbalance induced by stenosis-mediated chemoreceptor and baroreceptor dysfunction.

Design:

Cross-sectional prospective study.

Setting:

University-based tertiary referral sleep clinic and research center.

Patients:

Fifty-nine patients with various degrees of asymptomatic extracranial ICA (eICA) (n = 49) and intracranial ICA (iICA) stenosis (n = 10) were investigated.

Interventions:

Polysomnography to detect CSA and analysis of spontaneous heart rate variability (HRV) to detect autonomic imbalance.

Measurements and Results:

CSA occurred in 39% of the patients with eICA stenosis but was absent in patients with iICA stenosis. CSA was present in patients with severe eICA stenosis of ≥ 70% on one side. Independent predictors for CSA were severity of stenosis, asymmetric distribution of stenosis between both eICA and autonomic imbalance, namely a decrease of parasympathetic tone. The specific constellation of HRV-parameters indicated increased chemoreceptor sensitivity and impaired baroreflex sensitivity.

Conclusions:

CSA indicates autonomic dysfunction in patients with asymptomatic eICA stenosis. Detection of CSA may help to identify asymptomatic patients with an increased risk of cerebrovascular or cardiovascular events who particularly benefit from carotid revascularization.

Citation:

Rupprecht S; Hoyer D; Hagemann G; Witte OW; Schwab M. Central sleep apnea indicates autonomic dysfunction in asymptomatic carotid stenosis: a potential marker of cerebrovascular and cardiovascular risk. SLEEP 2010;33(3):327-333.