Author(s): SURGET, S., THOMAS-ZANETTI, A., Institution: UNIVERSITÉ CLAUDE BERNARD LYON 1, Country: FRANCE, Abstract-ID: 1062

INTRODUCTION:
Atherosclerosis is a systemic and slowly progressing disease that affect several arterial beds and considered the leading cause of cardiovascular disease worldwide. Carotid plaque rupture is a major cause of ischemic stroke and can be predicted by atherosclerotic plaque instability. Intraplaque hemorrhage (IPH) is the main factor of carotid plaque instability and is promoted by a hypoxic and pro-inflammatory environment. Obstructive sleep apnea (OSA) is strongly associated with cardiovascular disease and stroke and is known to promote atherosclerosis. On the contrary, Physical Activity (PA) has shown beneficial effects on both of these and to reduce IPH in patients with asymptomatic carotid stenosis. The objective of the present study is to evaluate whether we find the beneficial effects of PA on IPH and plaque instability in patients with OSA.
METHODS:
96 patients who had carotid endarterectomy answered the STOP BANG (SB) questionnaire. Patients with a SB score > 2 underwent a polysomnography (PSG). Patient with SB score < 3 were considered as non-apneic. OSA was defined as an AHI > 15/h. Patients also answered the GPAQ questionnaire for PA assessment. Carotid plaques were embedded in paraffin and sections stained with Perl’s Blue to evaluate IPH. A quantification of total surface IPH surface was performed on the QuPath software with a ratio between hemorrhagic surface area and the total tissue surface area.
RESULTS:
32 patients were considered had no OSA (SB score < 3 or AHI < 15/h) and 64 had OSA requiring treatment. Interestingly, the IPH quantification measured by Perl’s Blue is higher in patients with OSA than in patients without OSA (0.08 vs 0.008 ; p = 0.022). Furthermore, there is a positive correlation between the AHI and the IPH quantification (r = 0.3 ; p = 0.04). However, we did not see any significant difference of PA and sedentary levels between patients with or without OSA (p > 0.05). Moreover, IPH did not appear to be influenced by the level of physical activity of patients suffering from OSA either for a threshold of 600 MET.min.week-1 or a threshold of 1600 MET.min.week-1.
CONCLUSION:
Our findings suggest that obstructive sleep apnea is associated with increased intraplaque hemorrhage and plaque instability after carotid endarterectomy, with a relationship linked to OSA severity. In contrast to previous observations in asymptomatic stenosis, physical activity was not associated with reduced IPH in this population. These results suggest that OSA may represent a specific therapeutic target in post-endarterectomy patients.