Relationship Between Framingham 10-Year Cardiovascular Disease Risk Score and Pulse Wave Amplitude Drop Characteristics in a Sleep Clinic Cohort

Glenn M Stewart; Benjamin K Tong; Philip de Chazal; Joanne Flood; Yu Sun Bin; Kristina Kairaitis; John R Wheatley; Andrew S L Chan; Amanda J Piper; Brendon J Yee; Peter A Cistulli; Sydney Sleep Biobank Investigators

doi:10.1016/j.chest.2025.09.136

Relationship Between Framingham 10-Year Cardiovascular Disease Risk Score and Pulse Wave Amplitude Drop Characteristics in a Sleep Clinic Cohort

Chest. 2025 Oct 15:S0012-3692(25)05534-5. doi: 10.1016/j.chest.2025.09.136. Online ahead of print.

Collaborators

Sydney Sleep Biobank Investigators:
Peter Cistulli, Philip de Chazal, Kate Sutherland, Nina Sarkissian, Yu Sun Bin, Chin Moi Chow, Andrew Chan, Anna Mohammadieh, Aimee Lowth, Jacob Graham, William Wood, Gary Cohen, Callum Bennett, Mohammad Ahmadi, John Wheatley, Kristina Kairaitis, Stephen Lambert, Rita Ginn, Tracey Burns, Brendon Yee, Amanda Piper, Keith Wong, Kerri Melehan, Margaret Chan, David Wang, Gislaine Gauthier

Affiliations

¹ Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Camperdown, NSW, Australia. Electronic address: glenn.stewart@sydney.edu.au.
² Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St. Leonards, Camperdown, NSW, Australia.
³ Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Camperdown, NSW, Australia.
⁴ Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
⁵ Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Respiratory and Sleep Medicine, Westmead, NSW, Australia; Westmead Clinical School, Faculty of Medicine and Health, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
⁶ Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Respiratory and Sleep Medicine, Westmead, NSW, Australia; Westmead Clinical School, Faculty of Medicine and Health, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
⁷ Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁸ Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia.

PMID: 41106590
DOI: 10.1016/j.chest.2025.09.136

Abstract

Background: Pulse oximetry-derived measures of autonomic vascular re-activity during sleep, quantified by pulse wave amplitude drop (PWAD) characteristics such as the PWAD index, have recently been proposed as a biomarker of cardiovascular disease (CVD) outcomes in patients with OSA.

Research question: Are PWAD characteristics associated with Framingham 10-year CVD risk score in a sleep clinic population?

Study design and methods: This study examined PWAD characteristics in 725 individuals (38% female; median [interquartile range] age, 52 [39-63] years; BMI, 28.6 [24.9-33.2] kg/m²) who underwent diagnostic polysomnography and had sufficient clinical data to determine CVD status and calculate a Framingham 10-year CVD risk score. Individuals were categorized as either having established CVD (CVD_ESTABLISHED, n = 110) or a Framingham 10-year CVD risk score that was elevated (CVD_ELEVATED, n = 407) or low (CVD_LOW, n = 208). Standard polysomnography variables and PWAD characteristics, including PWAD_INDEX (number of PWAD events that occurred during all sleep stages divided by total sleep time [events/h]) and PWAD_DURATION (average duration of PWAD events [seconds]), were compared between groups.

Results: The PWAD_INDEX was lower (P < .01) in the CVD_ESTABLISHED (28.5 [13.2-45.2] events/h) and CVD_ELEVATED (38.7 [20.8-53.0] events/h) groups than in the CVD_LOW group (47.7 [35.7-62.6] events/h). The PWAD_DURATION was longer (P < .01) in CVD_ESTABLISHED (10.4 [8.2-14.5] seconds) and CVD_ELEVATED (8.7 [7.6-10.1] seconds) groups than in CVD_LOW group (8.0 [7.2-8.8] seconds). Similar group differences were observed during rapid-eye movement and non-rapid-eye movement sleep, and in patients with and without OSA. The magnitude difference in PWAD_INDEX and PWAD_DURATION remained similar after adjusting for age, sex, BMI, BP, total sleep time, apnea-hypopnea index, and oxygen desaturation index (adjusted PWAD_INDEX [95% CI] was 34.2 [29.9-38.7] in CVD_ESTABLISHED, 39.4 [37.1-41.6] in CVD_ELEVATED, and 46.6 [42.5-50.7] in CVD_LOW; P < .01).

Interpretation: These data indicate that PWAD characteristics may provide a complementary marker of CVD risk in sleep clinic populations with and without OSA. The pathophysiologic mechanisms linking nocturnal PWAD characteristics and CVD risk require further study.

Keywords: OSA; polysomnography; pulse oximetry; sleep disorders; vascular autonomic function.