Emerging concepts in anesthetic management for intestinal transplantation: a 2020-2025 narrative review.

Obstructive sleep apnea (OSA) describes a sleep disorder, characterized by recurrent upper airway obstruction during sleep, leading to respiratory interruptions and intermittent hypoxemia []. OSA remains largely undiagnosed in the general adult population []. Known risk factors to develop OSA are male sex, higher age and obesity []. OSA is a potentially life-threatening sleep disorder, due to discussed associations with cardiovascular diseases [] with increased all-cause mortality [], as well as with increased rates of psychiatric disorders []. The exact mechanism of the association between OSA and cardiovascular diseases is still not completely understood, while one hypothesis is the acceleration of vascular ageing. A marker for vascular ageing and atherosclerosis seems to be an increasing aortic stiffness (AS) [], which can be quantified by pulse pressure (PP), using non-invasive blood pressure measurements, as well as by pulse wave velocity (PWV) and aortic distensibility (AD) using cardiovascular magnetic resonance (CMR) imaging. PP describes a non-invasive straightforward method using brachial blood pressure values and can be used as a surrogate marker for AS []. Moreover, PWV and AD describe stable parameter evaluating the individual aging of vessels [, ]. PWV increased with increasing blood pressure, age and male gender [], which was confirmed in an analysis of aortic stiffness parameters in our Hamburg City Health Study (HCHS) CMR cohort []. Increasing aortic stiffness was described as a strong predictor of future cardiovascular events and all-cause mortality []. However, in the context of AS and OSA, the current literature reported contradicting results with [, ] and without associations between AS and OSA [, ]. In these studies, AS was quantified by different methods: by PP as a AS surrogate marker [], by non-CMR-based carotid-femoral PWV (cfPWV) [, ] and by CMR-based PWV []. Data about aortic stiffness, especially including PP and CMR-based PWV and AD, as well as OSA data in high-volume population-based studies remains sparse []. Therefore, based on our data in the HCHS cohort [] and the current knowledge about OSA and CVD, our objective was to examine possible associations between aortic stiffness parameters and OSA in this Hamburg City Health Study CMR cohort. The Hamburg City Health Study (HCHS) is a single-center, prospective, long-term, population-based, epidemiologic study with the aim to include over 30,000 citizens of the city of Hamburg, Germany, with an age between 45 and 74 years []. This analysis is based on the first available 10,000 participants of the HCHS, who were included between February 8th, 2016 and November 7th, 2018, of whom 1,498 participants underwent CMR-based AS quantification as previously described in [, ] and non-invasive blood pressure measurements for pulse pressure quantification, as well as exhibited available OSA data (Fig. , Supplemental Fig. ). A symptomatic high risk OSA cohort was defined as self-reported OSA while HCHS study interview and/or as a combination of snoring with respiratory arrests and an Epworth Sleepiness Scale (ESS) > 10. The ESS conducted eight questions about the likelihood of falling asleep while sitting or reading, in front of the television, in the cinema or theatre, as a co-driver, while mid-day nap, sitting while talking, sitting while eating, in the car while a short stop [] (Fig. ).