Cumulative Hypoxemia During Sleep Predicts Vascular Endothelial Dysfunction in Patients With Sleep-Disordered Breathing

Am J Hypertens. 2016 Apr;29(4):458-63. doi: 10.1093/ajh/hpv135. Epub 2015 Aug 18.


Background: Sleep-disordered breathing (SDB) is associated with repeated intermittent hypoxemia, and it is known as one of the risk factors for cardiovascular diseases. Previous studies assessing the effects of frequency and depth of hypoxemia on cardiovascular diseases have shown conflicting results. The aim of the current study was to clarify what SDB-related parameters most predict endothelial dysfunction to better understand the pathogenesis of endothelial dysfunction in patients with SDB.

Methods: We conducted polysomnography (PSG) and measured flow-mediated vasodilation response (%FMD) in 50 outpatients suspected of SDB. Evaluated indices included: apnea-hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), averaged arterial oxygen saturation (averaged SpO2), lowest arterial oxygen saturation (lowest SpO2), ratio of arterial oxygen saturation <90% (<SpO2 90%), and averaged time desaturation summation index (TDS: [100%-averaged SpO2] × total sleep time).

Results: Significant differences were observed only in the TDS between the first and third (P = 0.03) and between the first and forth (P = 0.04) quartile groups, stratified by %FMD. The %FMD showed a significant relationship with TDS (β = -0.47, P = 0.001), even after adjusting for confounding factors (β = -0.33, P = 0.02). In contrast, AHI, 3%ODI, averaged SpO2, lowest SpO2, and <SpO2 90% showed no significant relationships.

Conclusions: This study shows the validity of TDS in predicting endothelial damage in patients with SDB. Cumulative hypoxemia, rather than the frequency of hypoxemic events presented as AHI, may be a greater contributing factor in causing endothelial dysfunction. A simple index like TDS may be a useful and novel indicator of the influence of SDB on the vasculature.

Keywords: blood pressure; cardiovascular diseases; endothelial function; hypertension; hypoxemia; sleep-disordered breathing..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Endothelium, Vascular / physiopathology*
  • Female
  • Humans
  • Hyperemia / physiopathology
  • Hypoxia / blood
  • Hypoxia / diagnosis
  • Hypoxia / etiology*
  • Hypoxia / physiopathology
  • Male
  • Middle Aged
  • Oximetry
  • Oxygen / blood*
  • Polysomnography
  • Predictive Value of Tests
  • Respiration*
  • Risk Factors
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / physiopathology
  • Sleep*
  • Vascular Diseases / diagnosis
  • Vascular Diseases / etiology*
  • Vascular Diseases / physiopathology
  • Vasodilation*


  • Biomarkers
  • Oxygen