Association of CCL5 with Arterial Stiffness in Obstructive Sleep Apnea: The Modifying Role of Excessive Daytime Sleepiness Open Access

Abstract

Background: Obstructive sleep apnea (OSA) is a common condition linked to elevated cardiovascular risk, partly through inflammation-induced vascular dysfunction. While arterial stiffness, measured by pulse wave velocity (PWV), is a known consequence of OSA, the specific inflammatory mediators involved remain incompletely understood. CCL5, a chemokine implicated in endothelial injury and atherosclerosis, may be a key contributor to vascular remodeling in this population. This study investigates whether CCL5 is associated with arterial stiffness in OSA patients and whether this association varies by levels of daytime sleepiness.

 

Methods: Data were drawn from the EMOSS study, including 63 adults with confirmed OSA. Plasma CCL5 concentrations were measured using a multiplex ELISA platform. Arterial stiffness was assessed via carotid-femoral PWV. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS), with participants stratified into Sleepy (ESS ≥10) and Non-Sleepy (ESS <10) groups. Linear regression and generalized additive models (GAMs) were used to evaluate associations between CCL5 and PWV, adjusting for age, sex, body mass index (BMI), race/ethnicity, and apnea-hypopnea index (AHI). Exploratory analyses used the Pittsburgh Sleep Quality Index (PSQI) to assess broader sleep disturbance.

 

Results: In linear models, CCL5 was not significantly associated with PWV in the full sample (β = 0.2513, p = 0.224), nor within ESS or PSQI subgroups. However, GAMs revealed a significant non-linear association between CCL5 and PWV in the Sleepy group (pseudo R² = 0.087, AIC = 210.3), with no association observed in Non-Sleepy participants (pseudo R² < 0). Similar patterns were found when stratified by PSQI-defined sleep quality, indicating that subjective symptom burden may enhance detection of inflammation-related vascular risk.

 

Conclusions: CCL5 is associated with increased arterial stiffness in individuals with OSA who experience excessive daytime sleepiness, suggesting inflammation may contribute disproportionately to vascular dysfunction in this subgroup. These findings highlight the potential utility of CCL5 as a biomarker for targeted cardiovascular risk stratification and inform future efforts toward symptom-informed intervention in sleep-disordered populations.

Table of Contents

Introduction 1

Methods 3

Results 6

Discussion 9

Conclusion 11

Reference List 14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	CCL5 Biomarkers Epworth Sleepiness Scale Arterial stiffness Pulse wave velocity Obstructive sleep apnea Daytime sleepiness
Committee Chair / Thesis Advisor	Pak, Victoria, Emory University

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