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J Oral Maxillofac Surg. 2019 Feb 13. pii: S0278-2391(19)30141-7. doi: 10.1016/j.joms.2019.02.005. [Epub ahead of print]

Severe Obstructive Sleep Apnea With Imaged Carotid Plaque Is Significantly Associated With Systemic Inflammation.

Author information

1
Senior Oral and Maxillofacial Surgery VA Special Fellow, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
2
Assistant Professor of Otolaryngology/Head and Neck Surgery (Sleep Surgery), Stanford University School of Medicine, Stanford, CA.
3
Director, VA Greater Los Angeles Healthcare System Sleep Disorders Center; Clinical Professor, Medicine-Pulmonary Critical Care; Program Director, David Geffen School of Medicine at UCLA Sleep Fellowship, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Los Angeles, CA.
4
Junior Oral and Maxillofacial Surgery VA Special Fellow, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
5
Director, Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Great Los Angeles Healthcare System; Instructor, Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA.
6
Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director, Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA. Electronic address: urieleedds@gmail.com.

Abstract

PURPOSE:

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 and vascular inflammation, resulting in endothelial dysfunction and development of atherosclerotic plaque. This study compared levels of systemic inflammation between groups of patients with severe OSA with and without carotid artery calcified plaque (CACP+ and CACP-, respectively) on their panoramic image (PI) as indexed by the neutrophil-to-lymphocyte ratio (NLR).

MATERIALS AND METHODS:

This study had a retrospective cross-sectional study design. Medical records and PIs of men with severe OSA treated by the dental service (January 1, 2017 to December 31, 2017) were reviewed. The predictor variable was the presence or absence of CACP on PIs and the outcome variable was NLR. The t test was used to analyze differences in mean NLRs between groups. Atherogenic risk factors (age, body mass index, hypertension, and diabetes) were assessed for independence by descriptive and logistic regression analyses. Significance set at .05 for all tests.

RESULTS:

The study group (n = 39) of patients with CACP+ (mean age, 63 ± 7.4 yr) showed a mean NLR of 3.09 ± 1.42. The control group (n = 46) of patients with CACP- (mean age, 62 ± 6.8 yr) showed a mean NLR of 2.10 ± 0.58. The difference between groups was significant (P < .001). Logistic regression for NLR and CACP failed to show meaningful correlations with covariates.

CONCLUSION:

Older men with severe OSA and carotid atheromas on PIs show substantially greater systemic inflammation measured by NLRs. The combination of severe OSA, atheroma formation, and markedly increased NLR suggests a higher risk of MI and stroke and greater need for cardiovascular and cerebrovascular evaluation.

PMID:
30851255
DOI:
10.1016/j.joms.2019.02.005

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