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Shiina K. Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy. Hypertens Res 2024:10.1038/s41440-024-01852-y. [PMID: 39210083 DOI: 10.1038/s41440-024-01852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Obstructive Sleep Apnea (OSA) and hypertension have a high rate of co-occurrence, with OSA being a causative factor for hypertension. Sympathetic activity due to intermittent hypoxia and/or fragmented sleep is the most important mechanisms triggering the elevation in blood pressure in OSA. OSA-related hypertension is characterized by resistant hypertension, nocturnal hypertension, abnormal blood pressure variability, and vascular remodeling. In particular, the prevalence of OSA is high in patients with resistant hypertension, and the mechanism proposed includes vascular remodeling due to the exacerbation of arterial stiffness by OSA. Continuous positive airway pressure therapy is effective at lowering blood pressure, however, the magnitude of the decrease in blood pressure is relatively modest, therefore, patients often need to also take antihypertensive medications to achieve optimal blood pressure control. Antihypertensive medications targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in OSA-related hypertension, Therefore, beta-blockers and renin-angiotensin system inhibitors may be effective in the management of OSA-related hypertension, but current evidence is limited. The characteristics of OSA-related hypertension, such as nocturnal hypertension and obesity-related hypertension, suggests potential for angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucose-dependent insulinotropic polypeptide receptor/ glucagon-like peptide-1 receptor agonist (GIP/GLP-1 RA). Recently, OSA has been considered to be caused not only by upper airway anatomy but also by several non-anatomic mechanisms, such as responsiveness of the upper airway response, ventilatory control instability, and reduced sleep arousal threshold. Elucidating the phenotypic mechanisms of OSA may potentially advance more personalized hypertension treatment strategies in the future. Clinical characteristics and management strategy of OSA-related hypertension. OSA obstructive sleep apnea, BP blood pressure, ABPM ambulatory blood pressure monitoring, CPAP continuous positive airway pressure, LVH left ventricular hypertrophy, ARB: angiotensin II receptor blocker, SGLT2i Sodium-glucose cotransporter 2 inhibitors, ARNI angiotensin receptor-neprilysin inhibitor, CCB calcium channel blocker, GIP/GLP-1 RA glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide-1 receptor agonist.
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Affiliation(s)
- Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
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Wang Y, Wang X, Luo J, Qiu B, Huang R, Xiao Y. Urinary Epinephrine Sulfate Can Predict Cardiovascular Risk in Moderate-to-Severe OSA: A Metabolomics-Based Study. Nat Sci Sleep 2024; 16:1153-1168. [PMID: 39131167 PMCID: PMC11314438 DOI: 10.2147/nss.s470154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose There are currently no ideal indicators for predicting the cardiovascular risk of obstructive sleep apnea (OSA). This study aimed to employ urinary metabolomics to detect early cardiovascular risk in patients with moderate-to-severe OSA. Patients and Methods Male participants who underwent polysomnography from November 2020 to May 2021 were screened. Clinical data, polysomnography data and urine samples were collected. Untargeted metabolomics analyses of urine were performed. Multivariate analyses and receiver operating characteristic (ROC) curve analyses were subsequently performed to identify potential biomarkers. Associations between metabolites and clinical indicators and cardiovascular risk were examined through linear regression analyses with interaction and mediation analyses. Results Thirty-six male participants were included in the study, comprising 22 males with moderate-to-severe OSA and 14 age-matched controls, with an average age of 39.6 ± 9.2 years. We identified 65 metabolites in the study, involving pathways including pyrimidine, androgen, estrogen, vitamin B6 and sulfate/sulfite metabolism. Among them, epinephrine sulfate was the most significantly altered metabolite. ROC analyses highlighted that epinephrine sulfate had the highest area under the curve (AUC=0.883) for detecting moderate-to-severe OSA. Epinephrine sulfate was statistically correlated with OSA severity, hypoxia-related indicators (apnea-hypopnea index: r=0.685; oxygen desaturation index: r=0.743, p<0.0001), arterial stiffness (arterial augmentation index: r=0.361, p=0.031) and long-term cardiovascular risk (Framingham cardiovascular risk: r=0.375, p=0.024). Linear regression analysis revealed that epinephrine sulfate was significantly associated with an increased in the Framingham risk (β = 0.004, 95% CI = 0.000-0.009, p = 0.049), with the effect partly mediated by systolic blood pressure (27.6%) and not moderated by other factors. Additionally, it also significantly associated with the increased in the arterial augmentation index (β = 0.019, 95% CI = 0.000-0.037, p = 0.046), with the effect fully mediated by blood pressure and not moderated by other indices statistically. Conclusion There are significant metabolic pathway alterations in moderate-to-severe OSA patients. Urinary epinephrine sulfate markedly predicts early cardiovascular risk in OSA patients.
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Affiliation(s)
- Yuxin Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaona Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jinmei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Bintao Qiu
- Department of Central Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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García-Ortega A, Oscullo G, Mañas-Baena E, Cano-Pumarega I, Gómez-Olivas JD, Bekki A, Beauperthuy T, Barbero E, García-Sánchez A, Inglés M, Mompeán S, Calvillo P, Jiménez-Aguilella JJ, Navarrete J, Cerveró A, Jiménez D, Martínez-García MÁ. Changes in sleep-disordered breathing from the acute to the stable phase of pulmonary embolism: The ESAET study. Sleep Med 2023; 112:88-95. [PMID: 37837824 DOI: 10.1016/j.sleep.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND /Objective: Sleep-disordered breathing (SDB) may change from the acute to stable phase of some cardiovascular disorders, but little is known whether these dynamic changes also exist in pulmonary embolism (PE). This study aimed to analyze the changes in the apnea-hypopnea index (AHI) from the acute to stable phase of PE as well as the factors associated. PATIENTS/METHODS We conducted a prospective, longitudinal and multicenter study of consecutive adults requiring hospitalization for non-hypotensive acute PE, with a protocol including clinical, imaging (transthoracic echocardiography [TTE] and computed tomography), blood tests and a sleep study within 48 h of diagnosis of PE. After 3 months of follow-up, the sleep study was repeated. Right ventricular (RV) dysfunction was defined according to TTE criteria. RESULTS One hundred and eleven patients (mean age [SD]: 63 [15] years; body mass index: 28.4 [4.7] kg/m2) were included. The initial AHI was 24.4 (21.8) events/h (AHI≥5: 82.8 %; AHI≥30: 33.3 %). Seventy-seven patients (69.4 %) had RV dysfunction. In the overall cohort, the AHI decreased by 8.7 events/h from the acute to stable phase (24.4/h vs. 15.7/h; p=0.013). Patients with RV dysfunction showed a greater decrease in AHI (mean decrease 12.3/h vs. 0.43/h). In the multivariable analysis a drop of an AHI≥5 events/hour was independently associated with the presence of initial RV dysfunction (hazard ratio 3.9; 95%CI 1.3 to 12.1). CONCLUSIONS In hemodynamically stable patients with acute PE, there is a transient but clinically significant decrease in the AHI from the acute to stable phase, particularly when initially presenting with RV dysfunction.
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Affiliation(s)
- Alberto García-Ortega
- Respiratory Department, Hospital La Fe, Valencia, Spain; Respiratory Department, Hospital Doctor Peset, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain.
| | - Grace Oscullo
- Respiratory Department, Hospital La Fe, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain
| | - Eva Mañas-Baena
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
| | - Irene Cano-Pumarega
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Amina Bekki
- Respiratory Department, Hospital La Fe, Valencia, Spain
| | | | - Esther Barbero
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
| | - Aldara García-Sánchez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
| | - Marina Inglés
- Respiratory Department, Hospital La Fe, Valencia, Spain
| | | | - Pilar Calvillo
- Radiodiagnostic Department, Hospital La Fe, Valencia, Spain
| | | | | | - Alba Cerveró
- Cardiology Department, Hospital La Fe, Valencia, Spain
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Medicine Department, Universidad de Alcalá, Madrid, Spain
| | - Miguel Ángel Martínez-García
- Respiratory Department, Hospital La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Fadaei R, Fallah S, Moradi MT, Rostampour M, Khazaie H. Circulating levels of miR125a, miR126, and miR146a-5p in patients with obstructive sleep apnea and their relation with markers of endothelial dysfunction. PLoS One 2023; 18:e0287594. [PMID: 37917636 PMCID: PMC10621836 DOI: 10.1371/journal.pone.0287594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/08/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND obstructive sleep apnea (OSA) is a prevalent sleep disorder that is associated with increased risk factors for cardiovascular diseases (CVDs). Oxidative stress, insulin resistance, inflammation, and endothelial dysfunction are increased in OSA patients and microRNAs (miRs) are regulatory elements that influence these pathological mechanisms. miR125a, miR126, and miR146a-5p play a role in these pathological mechanisms and have not been evaluated in patients with OSA. METHOD This case-control study was performed on 90 OSA patients and 34 controls. Circulating levels of miR125a, miR126, and miR146a-5 were determined using real-time PCR, and serum levels of hsCRP, ICAM-1, and VCAM-1 were evaluated using ELISA kits. RESULTS miR125a and miR146a were elevated in patients with OSA compared to controls while miR126 decreased significantly. All three miRs indicated a remarkable difference between the mild-OSA group compared to the severe-OSA group. Furthermore, patients with OSA showed elevated levels of hsCRP, ICAM-1, and VCAM-1. Multiple linear regression indicated an independent association of miR125a with ICAM-1 and hsCRP, miR126 associated with VCAM-1 and total cholesterol, and miR146a-5p represented an association with apnea-hypopnea index and ICAM-1. Furthermore, miR146a-5p illustrated a good diagnostic ability to differentiate between OSA and controls. CONCLUSIONS Circulating miR125a, miR126, and miR146a-5p fluctuations in patients with OSA and their relations with markers of endothelial dysfunction provide in vivo evidence and suggest a potential role for these miRs with endothelial dysfunction in patients with OSA.
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Affiliation(s)
- Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soudabeh Fallah
- Department of Clinical Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taher Moradi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Rajkov B, Zdravković M, Ninić A, Brajković M, Klašnja S, Gardijan V, Memon L, Munjas J, Mihajlović M, Spasojević-Kalimanovska V, Radosavljević V, Sopić M. Upregulation of peripheral blood mononuclear cells resistin gene expression in severe obstructive sleep apnea and obstructive sleep apnea with coexisting type 2 diabetes mellitus. Sleep Breath 2023; 27:2031-2039. [PMID: 36917442 DOI: 10.1007/s11325-023-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is characterised by increased systemic inflammation, and is often accompanied with type 2 diabetes mellitus (T2DM) and cardiovascular disease. The aim of this investigation was to evaluate gene expression of resistin, its receptor CAP1 and CD36 as the indicators of the inflammatory changes in PBMCs in relation to the severity of OSA, and the presence of type 2 diabetes mellitus (T2DM) in OSA. METHODS Severity of OSA was defined by the apnea/hypopnea index (AHI): AHI < 30: mild to moderate OSA (MM-OSA), AHI ≥ 30: severe OSA (S-OSA). Presence of T2DM was captured: OSA with T2DM (OSA + T2DM), OSA without T2DM (OSA-T2DM). PBMC resistin, CAP1, and CD36 mRNA were determined by real-time PCR. RESULTS Resistin mRNA was significantly upregulated in S-OSA (N = 54) compared to the MM-OSA (N = 52, P = 0.043); CAP1 and CD36 mRNA levels did not differ between the groups (P = 0.302; P = 0.166, respectively). Resistin mRNA was significantly upregulated in OSA + T2DM (N = 29) compared to the OSA-T2DM (N = 77, P = 0.029); CAP1 and CD36 mRNA levels did not differ between the groups (P = 0.662; P = 0.108, respectively). AHI and T2DM were independent predictors of resistin mRNA above the 75th percentile (OR = 3.717 [1.152-11.991]; OR = 3.261 [1.000-10.630], P = 0.042 respectively). CONCLUSION Resistin gene upregulation in S-OSA indicates its possible contribution to increased inflammation in S-OSA and makes it a possible marker of the disease severity. Resistin gene upregulation in OSA + T2DM suggests that a joint effect of these two comorbidities may have a major contribution to increased inflammation and complications that arise from this state.
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Affiliation(s)
- Branislava Rajkov
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Marija Zdravković
- Department of Cardiology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Ninić
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
| | - Milica Brajković
- Department of Pulmology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Slobodan Klašnja
- Department of Cardiology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Vera Gardijan
- Department of Pulmology, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Lidija Memon
- Department of Laboratory Diagnostics, University Medical Center "Bežanijska Kosa", Belgrade, Serbia
| | - Jelena Munjas
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
| | - Marija Mihajlović
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | | | | | - Miron Sopić
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
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Cunha LF, Santos RB, Giatti S, Parise BK, Aielo AN, Silva WA, Souza SP, Bortolotto LA, Lotufo PA, Bensenor IM, Drager LF. Gender Modulated the Association of Sleep Apnea and Sleep Duration with Arterial Stiffness: The ELSA-Brasil Study. Angiology 2023:33197231193618. [PMID: 37688484 DOI: 10.1177/00033197231193618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
Increased arterial stiffness is independently associated with cardiovascular risk. Obstructive sleep apnea (OSA) and sleep duration (SDUR) may contribute to increased arterial stiffness, but it is unclear whether this association is modulated by gender. We aimed to evaluate the potential impact of gender in modulating the association of OSA and SDUR with arterial stiffness. Participants from the ELSA-Brasil study performed sleep assessments with portable polygraph to define OSA severity and SDUR by 1-week wrist actigraphy. Pulse wave velocity (PWV) was measured using a standard technique without access to the sleep data. We studied 1863 participants (42.2% male, age: 49±8 years, respiratory disturbance index (RDI): 9.9 (4.5-19.4) events/h, SDUR: 6.5 (5.9-7.1) hours, mean PWV: 7.3 ± 1.2 m/s). We found that men had higher PWV, higher frequency of diabetes, and higher blood pressure when compared to women. The regression analysis showed an independent association between increased RDI and PWV in men (ß: 0.007; 95% CI: 0.001-0.012), but not in women. In contrast, an independent association between SDUR and increased arterial stiffness was observed only in women (ß: 0.068; 95% CI: 0.002-0.134). In conclusion, the association of sleep disorders with arterial stiffness showed a distinct gender pattern depending on the sleep variable studied.
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Affiliation(s)
- Lorenna F Cunha
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ronaldo B Santos
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Soraya Giatti
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Barbara K Parise
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wagner A Silva
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Silvana P Souza
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
| | - Luciano F Drager
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Sao Paulo, Brazil
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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8
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Covassin N, Lu D, St. Louis EK, Chahal AA, Schulte PJ, Mansukhani MP, Xie J, Lipford MC, Li N, Ramar K, Caples SM, Gay PC, Olson EJ, Silber MH, Li J, Somers VK. Sex-specific associations between daytime sleepiness, chronic diseases and mortality in obstructive sleep apnea. Front Neurosci 2023; 17:1210206. [PMID: 37425007 PMCID: PMC10326268 DOI: 10.3389/fnins.2023.1210206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA. Methods Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness (N = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality. Results In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality. Conclusion The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.
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Affiliation(s)
- Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Dongmei Lu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Erik K. St. Louis
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Anwar A. Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Phillip J. Schulte
- Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Meghna P. Mansukhani
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jiang Xie
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Melissa C. Lipford
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nanfang Li
- Center of Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang Hypertension Institute of Xinjiang, Urumqi, China
| | - Kannan Ramar
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sean M. Caples
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Peter C. Gay
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eric J. Olson
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Michael H. Silber
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jingen Li
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Condoleo V, Bonfrate L, Armentaro G, Pelaia C, Cassano V, De Marco M, Severini G, Pastura CA, Miceli S, Maio R, Perticone M, Arturi F, Sesti G, Sciacqua A. Effects of continuous positive airway pressure on comprehensive geriatric assessment and cognitive function in elderly patients with obstructive sleep apnea syndrome. Intern Emerg Med 2023; 18:769-779. [PMID: 36808594 DOI: 10.1007/s11739-023-03220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) can lead to cognitive impairment and depression affecting memory, attention, and executive functions. Continuous positive airway pressure (CPAP) treatment seems to be able to revert changes in brain networks and neuropsychological tests correlated to OSAS. The aim of the present study was to evaluate the effects of a 6-month treatment with CPAP on functional, humoral and cognitive parameters in a cohort of elderly OSAS patients with several comorbidities. We enrolled 360 elderly patients suffering from moderate to severe OSAS and indication for nocturnal CPAP. At baseline the Comprehensive Geriatric Assessment (CGA) revealed a borderline Mini-Mental State Examination (MMSE) score that improved after 6-month treatment with CPAP (25.3 ± 1.6 vs 26 ± 1.5; p < 0.0001), as well as the Montreal Cognitive Assessment (MoCA) showed a mild improvement (24.4 ± 2.3 vs 26.2 ± 1.7; p < 0.0001). Moreover, functionality activities increased after treatment, as documented by a short physical performance battery (SPPB) (6.3 ± 1.5 vs 6.9 ± 1.4; p < 0.0001). Reduction of the Geriatric Depression Scale (GDS) from 6.0 ± 2.5 to 4.6 ± 2.2 (p < 0.0001) was also detected. Changes of homeostasis model assessment (HOMA) index, oxygen desaturation index (ODI), sleep-time spent with saturation below 90% (TC90), peripheral arterial oxyhaemoglobin saturation (SpO2), apnea-hypopnea index (AHI) and estimation of glomerular filtration rate (eGFR), contributed, respectively, to 27.9%, 9.0%, 2.8%, 2.3%, 1.7% and 0.9% of MMSE variability for a total of 44.6% of MMSE variations. GDS score changes were due to the improvement of AHI, ODI and TC90, respectively, for 19.2%, 4.9%, 4.2% of the GDS variability, cumulative responsible for 28.3% of GDS modifications. The present real-world study shows that CPAP treatment is able to improve cognition and depressive symptoms in OSAS elderly patients.
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Affiliation(s)
- Valentino Condoleo
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy.
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Mario De Marco
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Giandomenico Severini
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Carlo Alberto Pastura
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa - Località Germaneto, 88100, Catanzaro, Italy
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He H, Lachlan T, Chandan N, Lim VG, Kimani P, Ng GA, Ali A, Randeva H, Osman F. Obstructive Sleep Apnoea and Cardiac Arrhythmias (OSCA) trial: a nested cohort study using injectable loop recorders and Holter monitoring in patients with obstructive sleep apnoea. BMJ Open 2023; 13:e070884. [PMID: 36792325 PMCID: PMC9950886 DOI: 10.1136/bmjopen-2022-070884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is associated with increased cardiovascular mortality despite continuous positive airways pressure (CPAP) therapy. This excess risk may be related to increased arrhythmia risk, especially atrial fibrillation (AF). The true incidence of arrhythmia in patients with OSA is unknown. Implantable loop recorders (ILR) are powerful tools for detecting arrhythmias long-term. Cardiac autonomic function may be important in arrhythmogenesis in these patients but needs further study. We aim to identify the true incidence of arrhythmias (especially AF) using ILRs, assess cardiac autonomic function using Holter monitors in patients with OSA and explore cardiovascular outcomes. METHODS AND ANALYSIS A two-centre (University Hospital Coventry and St. Cross Hospital, Rugby) nested cohort study using Reveal LINQ (Medtronic, UK) ILR to identify precise arrhythmia (atrial/ventricular) incidence in patients with moderate-severe OSA. 200 patients will be randomised 1:1 to standard care alone or standard care+ILR (+Holter monitor at baseline and 12 months). The primary objective is to compare arrhythmia detection over 3 years between the two groups. Cardiac autonomic function will be assessed in the ILR-arm at baseline and 12 months post CPAP. Secondary objectives will explore the mechanisms linking OSA and arrhythmia using cardiac autonomic function parameters based on Holter recordings and circulating biomarkers (high sensitivity Troponin-T, N-terminal pro B-type natriuretic peptide, matrix metalloproteinase-9, fibroblast growth factor 23, high sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-α) before and after CPAP initiation in the ILR-arm. ETHICS AND DISSEMINATION This study has been approved by the Health Research Authority after examination by the Solihull Research and Ethics Committee. The main ethical considerations was the minimally invasive nature of ILR insertion outside of usual care. Patient advisory groups were consulted with a positive outcome for this type of research. We plan on publishing papers in peer-reviewed journals based on the primary objective and any interesting findings from secondary objectives. We will endeavour to publish all relevant data. TRIAL REGISTRATION NUMBER NCT03866148.
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Affiliation(s)
- Hejie He
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Thomas Lachlan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick Warwick Medical School, Coventry, UK
| | - Nakul Chandan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ven Gee Lim
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick Faculty of Medicine, Coventry, UK
| | - G Andre Ng
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Asad Ali
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Faizel Osman
- University of Warwick Warwick Medical School, Coventry, UK
- R&D Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Fiedorczuk P, Olszewska E, Rogalska J, Brzóska MM. Osteoprotegerin, Chitinase 3-like Protein 1, and Cardiotrophin-1 as Potential Biomarkers of Obstructive Sleep Apnea in Adults-A Case-Control Study. Int J Mol Sci 2023; 24:ijms24032607. [PMID: 36768925 PMCID: PMC9916736 DOI: 10.3390/ijms24032607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered a risk factor for cardiovascular diseases, depression, accidents, and stroke. Recent clinical practice guidelines for OSA expressed the need for a new clinical tool that establishes the Apnea-Hypopnea Index (AHI) to determine the disease burden. The serum and plasma concentrations of Osteoprotegerin (OPG), Chitinase 3-like protein 1 (YKL-40), and Cardiotrophin-1 (CT-1) in 80 subjects-52 OSA patients, 27 moderate (15 ≤ AHI ˂ 30) and 25 severe (AHI ≥ 30), and 28 non-OSA controls (AHI 0-5)-were determined. Moreover, the Total Oxidative Status (TOS), Total Antioxidative Status (TAS), and Oxidative Stress Index (OSI) were assessed in the serum and plasma to evaluate whether the severity of OSA and the concentrations of OPG, YKL-40, and CT-1 correlate with the oxidative/reductive status. The serum and plasma concentrations of YKL-40 and CT-1 were higher in the OSA group, whereas the serum and plasma concentrations of OPG were lower compared to the control group. The concentrations of OPG, YKL-40, and CT-1 in the serum and plasma correlated with AHI; however, a better correlation of the concentrations was obtained for the above-mentioned proteins in the plasma. The concentrations of YKL-40 and CT-1 in the serum and OPG in the plasma show better diagnostic capabilities for moderate and severe OSA than the concentrations of YKL-40 and CT-1 in the plasma and the concentrations of OPG in the serum.
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Affiliation(s)
- Piotr Fiedorczuk
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
- Correspondence: ; Tel.: +48-663-751-516
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Joanna Rogalska
- Department of Toxicology, Medical University of Bialystok, 15-089 Bialystok, Poland
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12
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Xu Y, Yang N, Wei M, Wang F, Zhang K, Shi L, Chou H, Li Y. Association of obstructive sleep apnea with endothelial function and heart remodeling in hypertension: A cross-sectional study. Am J Med Sci 2023; 365:42-47. [PMID: 36007623 DOI: 10.1016/j.amjms.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study aims to analyze the association of obstructive sleep apnea (OSA) with endothelial function and heart structure in patients with hypertension and lay a clinical foundation for preventing and treating endothelial dysfunction and heart remodeling in patients with hypertension. METHODS A cross-sectional study design was adopted in this study. From April 2020 to April 2021, 143 patients with hypertension were included and classified into two groups according to the severity of OSA: 81 patients with hypertension without OSA [apnea-hypopnea index (AHI) < 5 events/hour] serving as the control group; 62 patients with hypertension with moderate-severe OSA (AHI ≥ 15 events/hour) serving as the OSA group. The endothelial function and heart structure were assessed by flow-mediated vasodilation (FMD) and transthoracic echocardiography. Logistic regression analyses were conducted to identify factors associated with endothelial dysfunction and heart remodeling. RESULTS Compared with the control group, patients with OSA had significantly greater interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) (P < 0.05), and FMD exhibited a significant decrease (P < 0.05). Logistic regression analyses demonstrated that gender and AHI were associated with FMD (P < 0.05), and FMD was associated with LVMI (P < 0.05). CONCLUSIONS OSA was associated with endothelial dysfunction and heart remodeling in patients with hypertension. Endothelial dysfunction may be crucial for the development of heart remodeling in patients with hypertension with OSA.
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Affiliation(s)
- Yuanyuan Xu
- Tianjin Medical University, Tianjin 300211, People's Republic of China; TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Ning Yang
- TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China; TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Maoti Wei
- Center of Clinical Epidemiology, TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Fenghua Wang
- Center of Clinical Epidemiology, TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Kun Zhang
- TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Leilei Shi
- Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Hongda Chou
- Tianjin Medical University, Tianjin 300211, People's Republic of China; TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China
| | - Yuming Li
- TEDA International Cardiovascular Hospital, Tianjin 300457, People's Republic of China.
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13
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Rubina SS, Makarova II, Yusufov AA. [The relationship of vascular complications with cerebrovascular reactivity and endothelial dysfunction in patients with obstructive sleep apnea]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:82-88. [PMID: 37276003 DOI: 10.17116/jnevro202312305282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the relationship of vascular complications with cerebrovascular reactivity (CVR) and endothelial dysfunction in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS One hundred and twelve patients were examined. The patients were stratified into the main group with moderate and severe OSA and the control group without apnea. All patients underwent anthropometry, polysomnography, transcranial dopplerography and duplex scanning of the brachial artery. RESULTS Patients with OSA showed a more frequent decrease in post-occlusive vascular dilatation. The CVR indices in the hypercapnic test in the main group were in the range of 0.91-0.97 and significantly lower after 1 minute on the left, after 5 minutes on both sides and after 10 minutes on the left. A positive correlation during a hypercapnic test between the CVR on the left after 10 minutes and the desaturation index (r=0.287, p=0.021), between the CVR on the left after 5 and 10 minutes and acute cerebrovascular accident (r=0.248, p=0.048 and r=0.285, p=0.022, respectively), as well as a negative correlation between the indicators of the middle cerebral artery and chronic cerebral ischemia were established in patients with apnea. CONCLUSION Timely assessment of pathological changes in central and peripheral hemodynamics in patients with OSA will allow diagnosing early signs of vascular complications, which will further improve the personalized strategy for the prevention of stroke and chronic cerebral ischemia.
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Affiliation(s)
- S S Rubina
- Tver State Medical University, Tver, Russia
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14
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Potential Diagnostic and Monitoring Biomarkers of Obstructive Sleep Apnea-Umbrella Review of Meta-Analyses. J Clin Med 2022; 12:jcm12010060. [PMID: 36614858 PMCID: PMC9821668 DOI: 10.3390/jcm12010060] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease that imposes a significant impact on the health and wellbeing of patients and a financial burden on individuals, their families, and society. Development of new methods of testing other than an overnight sleep study, such as measurement of serum or plasma biomarkers, may provide an easier diagnostic process to identify patients with OSA and allow earlier initiation of treatment, which might prevent serious comorbidities. We conducted a systematic review and quality assessment of available meta-analyses regarding potential diagnostic and monitoring biomarkers of obstructive sleep apnea. A total of 14 sets of candidate biomarkers displayed differences in levels or concentrations in OSA patients compared to non-OSA controls, and decreased after OSA treatment: CRP, IL-6, TNF-α, Il-8, HCY, ICAM-1, VCAM-1, VEGF, TC, LDLc, HDLc, TG, leptin, MDA, ALT, AST, IGF-1, adiponectin, and cortisol. This review summarizes the evidence for OSA-associated potential biomarkers and demonstrates that the quality of available studies, as measured by AMSTAR2, is often low and associated with a high risk of bias.
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15
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Pengo MF, Gozal D, Martinez-Garcia MA. Should we treat with continuous positive airway pressure severe non-sleepy obstructive sleep apnea individuals without underlying cardiovascular disease? Sleep 2022; 45:6677982. [PMID: 36029295 DOI: 10.1093/sleep/zsac208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Indexed: 12/14/2022] Open
Abstract
The majority of the current international obstructive sleep apnea (OSA) guidelines base the recommendation to treat OSA with continuous positive airway pressure (CPAP) on the presence of symptoms (principally, albeit not exclusively on daytime hypersomnolence). In nonsleepy patients, even with severe OSA, controversies remain, as clear evidence supporting CPAP treatment of this subgroup of OSA patients is lacking. However, given the nonnegligible proportion of non-sleepy OSA patients, clinicians often face a serious dilemma since CPAP treatment in these patients may prove to be not cost-effective. Here, we propose a simple three-step-based algorithm that attempts to better phenotype non-sleepy OSA patients prior to reaching a CPAP treatment decision while also considering a series of clinically relevant elements in the process that may improve with CPAP therapy. Such algorithm focuses on the presence of several OSA symptoms that are susceptible to benefit from treatment and also relies on OSA phenotypes that need to be considered in an effort to achieve optimal cardiovascular prevention. Here, we attempt to establish a framework for clinicians who are evaluating severe nonsleepy OSA patients in their practices. However, the algorithm proposal needs to be extensively validated before being systematically implemented in clinical settings.
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Affiliation(s)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Miguel Angel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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16
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Association between arterial stiffness and sleep apnoea in patients with resistant hypertension. J Hum Hypertens 2022; 36:1078-1084. [PMID: 34992213 DOI: 10.1038/s41371-021-00642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Resistant Hypertension (RHT) is associated with a higher risk of Obstructive Sleep Apnoea (OSA). OSA and aortic stiffness (AS) measured by Pulse Wave Velocity (PWV) are independent risk factors for cardiovascular events. We assessed, in a cross-sectional study, the association between AS measured by PWV and OSA severity in patients with RHT. All patients were submitted to polysomnography, PWV measure and 24 h ABPM. Bivariate analysis compared patients with and without moderate/severe OSA. Multivariate analysis was performed to assess the independent correlates of moderate/severe OSA. A total of 376 patients were included, 31% were men with a mean age of 63 ± 10 years. Moderate/severe OSA was diagnosed in 214 patients (57%), 63 patients (17%) presented AS. Uncontrolled ABPM (true RHT) was found in 215 patients (57.2%) and among them 113 were diagnosed with moderate/severe OSA. Evaluating AS in patients with mild, moderate and severe apnoea, we observed a progressive increase in PWV (8.19 ± 1.55, 8.51 ± 1.84, 8.67 ± 1.68, respectively). Classifying them in 2 groups: (1) without apnoea/mild apnoea and (2) moderate/severe apnoea, we found higher values in group 2 (8.21 ± 1.52 m/s vs. 8.60 ± 1.75 m/s, p = 0.02), especially among true RHT patients (8.28 ± 1.62 vs. 8.81 ± 1.86, p = 0.029), women (8.13 ± 1.49 vs. 8.55 ± 1.73, p = 0.036), and uncontrolled nocturnal systolic BP (8.49 ± 1.63 vs. 8.58 ± 1.78, p = 0.04). In conclusion, in this RHT cohort, although with borderline results, the more severe the apnoea, the greater the arterial stiffness, mainly among women, true RHT and patients with an adverse nocturnal BP profile.
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17
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Saz-Lara A, Lucerón-Lucas-Torres M, Mesas AE, Notario-Pacheco B, López-Gil JF, Cavero-Redondo I. Association between sleep duration and sleep quality with arterial stiffness: A systematic review and meta-analysis. Sleep Health 2022; 8:663-670. [PMID: 36055936 DOI: 10.1016/j.sleh.2022.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Altered sleep parameters, such as duration and quality, play an important role in the pathogenesis and progression of cardiovascular diseases, as well as in all-cause morbidity and mortality. It has been suggested that the specific mechanisms underlying this association could be through the influence of sleep parameters on vascular markers, such as arterial stiffness (AS), although this remains unclear. Thus, in this meta-analysis, we aimed to assess the association between sleep duration and sleep quality with AS in adults. METHODS PubMed, Scopus, Web of Science and Cochrane Library databases were searched from inception to July 30, 2021. The DerSimonian and Laird method was used to compute pooled effect size estimates and their respective 95% confidence intervals (95% CIs) of the association of sleep duration and sleep quality with AS. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the United States National Institute of Health National Heart, Lung, and Blood Institute was used to assess the risk of bias. RESULTS Finally, 14 studies (8 cross-sectional studies and baseline data from 6 prospective longitudinal studies) involving 97,837 individuals between 18 and 92 years of age were included. Our results showed that increased sleep duration, as continuous values, does not influence AS (effect size [ES]: 0.00; 95% CIs: -0.15, 0.15) in the general population. However, when sleep duration was longer than 8 hours (ES: 0.21; 95% CIs: 0.06, 0.36), according to sleep categories, a significant increase in pulse wave velocity was shown. Poor sleep quality was associated with increased AS (ES: 0.13; 95% CIs: 0.04, 0.21) in the general population. The overall risk of bias for studies examining sleep duration was fair in 77.8% of the included studies and the overall risk of bias for studies examining sleep quality was fair in 55.6%. CONCLUSIONS Our findings showed that both long sleep duration and poor sleep quality were associated with AS in adults. These findings underscore the influence of sleep on vascular health markers, specifically AS, as a possible pathway to explain the increased cardiovascular morbidity and mortality associated with sleep disorders.
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Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | - Arthur E Mesas
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | | | | | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autonoma de Chile, Talca, Chile
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18
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Olszewska E, Pietrewicz TM, Świderska M, Jamiołkowski J, Chabowski A. A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS. Int J Mol Sci 2022; 23:ijms232214116. [PMID: 36430593 PMCID: PMC9699588 DOI: 10.3390/ijms232214116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
- Correspondence:
| | | | - Magdalena Świderska
- Department of Physiology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, 15-089 Bialystok, Poland
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Hernández-Bustabad A, Morales-Arraez D, González-Paredes FJ, Abrante B, Díaz-Flores F, Abreu-González P, de la Barreda R, Quintero E, Hernández-Guerra M. Chronic intermittent hypoxia promotes early intrahepatic endothelial impairment in rats with nonalcoholic fatty liver disease. Am J Physiol Gastrointest Liver Physiol 2022; 323:G362-G374. [PMID: 35916415 DOI: 10.1152/ajpgi.00300.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a progressive disease that ranges from simple steatosis to cirrhosis. Obstructive sleep apnea syndrome (OSAS) and chronic intermittent hypoxia (CIH) are implicated in the pathogenesis of NAFLD. However, the overlapping consequences of CIH on liver sinusoidal endothelial function over time in NAFLD are largely unknown. We explored endothelial dysfunction in a rat model of NAFLD with a high-fat diet exposed to CIH [12 h/day, every 30 s to fractional concentration of oxygen ([Formula: see text] 8%-10%]. The livers were isolated and perfused, and the endothelial function was determined by testing the vasodilation of the liver circulation to increased concentrations of acetylcholine and von Willebrand factor (vWF) and intercellular adhesion molecule 1 (ICAM-1) expression. Phosphorylated endothelial nitric oxide synthase (p-eNOS), cGMP, and oxidative stress were assessed to determine nitric oxide bioavailability. Inflammation and fibrosis were evaluated by transaminases, myeloperoxidase activity, hydroxyproline, and histological evaluation. Hypoxia-inducible factors (HIFs) were studied as a marker of hypoxia and after a second insult with acetaminophen. CIH exposure provoked typical systemic features of OSAS and provoked a decreased response in vasodilation to acetylcholine. This was associated with increased oxidative stress and reduced p-eNOS and cGMP. The microcirculation impairment due to CIH preceded significant hepatic inflammation and fibrotic changes, despite the presence of HIF expression. In conclusion, CIH exacerbates endothelial dysfunction in NAFLD rats associated with increased oxidative stress and reduced nitric oxide bioavailability. This occurs before inflammation and fibrosis establish. Our results suggest that with CIH endothelial dysfunction should be considered an early target.NEW & NOTEWORTHY We believe the findings are of relevance because we demonstrate that chronic intermittent hypoxia further augments impaired hepatic endothelial dysfunction in nonalcoholic fatty liver disease rats. Because obstructive sleep apnea syndrome is associated with systemic endothelial dysfunction in cardiovascular disorders, and chronic intermittent hypoxia is an independent and reversible risk factor for hypertension and coronary artery disease, we hypothesized that this entity may be of potential relevance in the pathophysiology of nonalcoholic fatty liver disease.
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Affiliation(s)
| | - Dalia Morales-Arraez
- Liver Unit, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Francisco Javier González-Paredes
- Department of Internal Medicine, Institute of Biomedical Technologies and Canarian Biomedical Research Centre, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - Beatriz Abrante
- Department of Internal Medicine, Institute of Biomedical Technologies and Canarian Biomedical Research Centre, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - Felicitas Díaz-Flores
- Central Laboratory Department, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Pedro Abreu-González
- Physiology Department, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Raquel de la Barreda
- Liver Unit, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Enrique Quintero
- Liver Unit, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain
| | - Manuel Hernández-Guerra
- Liver Unit, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain.,Department of Internal Medicine, Institute of Biomedical Technologies and Canarian Biomedical Research Centre, University of La Laguna, San Cristóbal de La Laguna, Spain
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20
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Mecenas P, Miranda GHN, Fagundes NCF, Normando D, Ribeiro KCF. Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review. Sleep Breath 2022; 26:1447-1458. [PMID: 34482502 DOI: 10.1007/s11325-021-02485-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This review aimed to evaluate the effects of oral appliance (OA) therapy on serum inflammatory cytokines in adults diagnosed with obstructive sleep apnea (OSA). METHODS Seven electronic databases and partial gray literature were searched without restrictions through March 2021. Articles evaluating the levels of serum inflammatory cytokines in patients with OSA after OA treatment were included. The risk of bias (RoB) was assessed using the before-and-after tool or RoB 2.0. The level of certainty was assessed using the GRADE tool. RESULTS Five studies met the eligibility criteria. One was a randomized clinical trial (RCT), while four were non-randomized clinical trials (NRCTs). Among the studies, C-reactive protein (CRP), IL-6, IL-10, IL-1β, and tumor necrosis factor α (TNF-α) were investigated. The RCT reported no significant differences in marker levels after 2 months of OA therapy, while the NRCTs showed improvement on CRP, TNF-α, and IL-1β levels after longer follow-up periods. The RoB was evaluated as showing some concern in the RCT. Three NRCTs presented good RoB, and one showed a fair RoB. The level of certainty was graded as moderate quality for inflammatory marker levels assessed in the RCT The levels of certainty evaluated in NRCTs were classified as very low. CONCLUSIONS Although limited, existing scientific evidence showed that OA therapy may improve serum cytokine levels in adults with OSA. However, short treatment periods are not effective in reducing markers of systemic inflammation which may require extended time and a decrease of in apneic events to improve.
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Affiliation(s)
- Paulo Mecenas
- Department of Orthodontics, Faculdade Integrada Brasil Amazônia (FIBRA), Belém, Pará, Brazil.
| | | | | | - David Normando
- Faculty of Dentistry, Federal University of Pará (UFPA), Belém, Pará, Brazil
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21
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Zietzer A, Breitrück N, Düsing P, Böhle S, Klussmann JP, Al-Kassou B, Goody PR, Hosen MR, Nickenig G, Nachtsheim L, Shabli S, Jansen F, Jansen S. The lncRNA MRPL20-AS1 is associated with severe OSAS and downregulated upon hypoxic injury of endothelial cells. Int J Cardiol 2022; 369:65-68. [PMID: 35988669 DOI: 10.1016/j.ijcard.2022.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder in humans. Although OSAS is clearly related to arterial hypertension, coronary artery disease, and heart failure, it remains unknown through which pathomechanisms OSAS influences cardiovascular health. Recent research has pinpointed long non-coding RNAs (lncRNA) as important molecular mediators of various cardiovascular pathologies. In this study, we have identified the lncRNA MRPL20-AS1 to be affected by OSAS in patients as well as by hypoxia in vitro. METHODS AND RESULTS A transcriptomic analysis was performed on peripheral blood from four patients with severe OSAS taken after one night of polygraphic assessment. We found that three lncRNAs were significantly dysregulated, of which MRPL20-AS1 was the most significant. In a larger cohort of 22 OSAS patients, MRPL20-AS1 was inversely correlated with the apnea-hypopnea index (AHI). This indicates that OSAS patients with higher AHI levels and therefore more severe OSAS had lower levels of MRPL20-AS1 in the blood. The results were recapitulated in vitro by subjecting endothelial cells to hypoxia. In these experiments, hypoxia led to a significant downregulation of MRPL20-AS1 in endothelial cells. CONCLUSION MRPL20-AS1 may serve as a useful tool to identify patients suffering from severe OSAS and further research should be done to evaluate the therapeutic potential of MRPL20-AS1 as a target to counteract the cardiovascular effects of OSAS.
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Affiliation(s)
- Andreas Zietzer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Nils Breitrück
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Philip Düsing
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sabrina Böhle
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Jens Peter Klussmann
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Philip Roger Goody
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Mohammed Rabiul Hosen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lisa Nachtsheim
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Sami Shabli
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Felix Jansen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Stefanie Jansen
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
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22
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Kajikawa M, Higashi Y. Obesity and Endothelial Function. Biomedicines 2022; 10:biomedicines10071745. [PMID: 35885049 PMCID: PMC9313026 DOI: 10.3390/biomedicines10071745] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 02/08/2023] Open
Abstract
Obesity is a major public health problem and is related to increasing rates of cardiovascular morbidity and mortality. Over 1.9 billion adults are overweight or obese worldwide and the prevalence of obesity is increasing. Obesity influences endothelial function through obesity-related complications such as hypertension, dyslipidemia, diabetes, metabolic syndrome, and obstructive sleep apnea syndrome. The excess fat accumulation in obesity causes adipocyte dysfunction and induces oxidative stress, insulin resistance, and inflammation leading to endothelial dysfunction. Several anthropometric indices and imaging modalities that are used to evaluate obesity have demonstrated an association between obesity and endothelial function. In the past few decades, there has been great focus on the mechanisms underlying endothelial dysfunction caused by obesity for the prevention and treatment of cardiovascular events. This review focuses on pathophysiological mechanisms of obesity-induced endothelial dysfunction and therapeutic targets of obesity.
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Affiliation(s)
- Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Correspondence: ; Tel.: +81-82-257-5831
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23
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Autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. Pediatr Res 2022; 91:1834-1840. [PMID: 34404927 DOI: 10.1038/s41390-021-01691-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of the study was to assess the relationship between autonomic nervous function and low-grade inflammation in children with sleep-disordered breathing. METHODS We enrolled habitually snoring children aged 3-14 years for overnight polysomnography (PSG) and high-sensitivity C-reactive protein (hsCRP) measurement. Low-grade inflammation was defined as hsCRP >1.0 mg/L to <10.0 mg/L. An electrocardiogram recording was extracted from PSG. Heart rate variability was analyzed using time and frequency domain methods. RESULTS In total, 190 children were included, with 61 having primary snoring (PS), 39 mild obstructive sleep apnea (OSA), and 90 moderate-to-severe OSA. The average RR interval displayed a significant decline, whereas the low frequency/high frequency (LF/HF) ratio showed an increasing tendency in children with PS, mild OSA, and moderate-to-severe OSA. Mean RR was mainly influenced by age and the apnea hypopnea index (AHI) (all P < 0.01). AHI was an independent risk factor for the altered LF/HF ratio at all sleep stages except N3 stage (all P < 0.05). In the wake stage, low-grade inflammation was an independent risk factor of altered LF/HF ratio (P = 0.014). CONCLUSIONS Autonomic nervous function was impaired in children with OSA. The sympathetic-vagal balance was influenced by low-grade inflammation in the wake stage, whereas it was only affected by AHI when falling asleep. IMPACT We found that autonomic nervous function was impaired in children with OSA. We found that there was a negative correlation between systemic inflammation and autonomic nervous function in children with SDB only at wake stage. A negative association between systemic inflammation and autonomic nervous function was demonstrated in children in this study. Furthermore, altered LF/HF ratio maybe a good indicator of autonomic nervous dysfunction in children as it only correlated with the SDB severity, not with age.
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24
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Effects of obstructive sleep apnea hypopnea syndrome on postoperative complications in patients who undergo off-pump coronary artery bypass grafting. Sleep Breath 2022; 26:1897-1905. [DOI: 10.1007/s11325-022-02649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
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25
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Lee CH, Hsu WC, Yeh TH, Ko JY, Lin MT, Kang KT. Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Laryngoscope 2022; 132:2275-2284. [PMID: 35567416 DOI: 10.1002/lary.30176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). STUDY DESIGN Systematic review and meta-analysis. METHODS The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea-hypopnea index (AHI) and inflammatory cytokines were evaluated using a random-effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. RESULTS Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by -11.3 events/h (95% confidence interval [CI], -15.8 to -6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels, respectively. Sleep surgery significantly reduced TNF-α levels, with an MD of -2.8 pg/ml (95% CI, -5.1 to -0.6) and an SMD of -0.56 (95% CI, -0.85 to -0.27). Furthermore, sleep surgery reduced IL-6 levels, with an MD of -0.6 pg/ml (95% CI, -1.0 to -0.2) and an SMD of -0.66 (95% CI, -0.89 to -0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta-regression analyses. Funnel plots showed possible publication bias in current data. CONCLUSIONS In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 2022.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,College of Public Health, Institute of Health Policy and Management, National Taiwan University, New Taipei City, Taiwan
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26
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Influence of Apnea Hypopnea Index and the Degree of Airflow Limitation on Endothelial Function in Patients Undergoing Diagnostic Coronary Angiography. BIOLOGY 2022; 11:biology11030457. [PMID: 35336830 PMCID: PMC8945418 DOI: 10.3390/biology11030457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
Abstract
Background: Obstructive sleep apnea is associated with an increased prevalence of cardiovascular disease. The mechanism of these associations is not completely understood. We aimed to investigate the association of the apnea hypopnea index and the degree of airflow limitation with endothelial dysfunction. Methods: This was a single-center prospective study of patients admitted for diagnostic coronary angiography (CAG). Endothelial function was assessed by the non-invasive EndoPAT system by reactive hyperemia index (RHI) and divided into two groups: endothelial dysfunction and normal endothelial function. Sleep apnea signs were detected by WatchPAT measuring the respiratory disturbance index (pRDI), the apnea and hypopnea index (pAHI), and the oxygen desaturation index (ODI). Patients underwent spirometry and body plethysmography. Based on CAG, the severity of coronary artery disease was assessed as follows: no significant coronary artery disease, single-, two- and three-vessel disease. Results: A total of 113 patients were included in the study. Breathing disorders measured by WatchPAT and spirometry were more severe in patients with endothelial dysfunction: pRDI (27.3 vs. 14.8, p = 0.001), pAHI (24.6 vs. 10.3, p < 0.001), ODI (13.7 vs. 5.2, p = 0.002), forced expiratory volume in one second (FEV1) (81.2 vs. 89, p = 0.05). In a multivariate regression analysis, pAHI and FEV1 were independent predictors of endothelial dysfunction assessed by RHI. There was no correlation between the severity of coronary artery disease and endothelial dysfunction. Conclusions: Obstructive sleep apnea signs and greater airflow limitation were associated with endothelial dysfunction regardless of the severity of the coronary artery disease.
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27
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Brown J, Yazdi F, Jodari-Karimi M, Owen JG, Reisin E. Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship. Curr Hypertens Rep 2022; 24:173-184. [PMID: 35246797 PMCID: PMC8897114 DOI: 10.1007/s11906-022-01181-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 01/04/2023]
Abstract
Purpose of Review Obstructive sleep apnea (OSA) is an underdiagnosed illness linked to essential hypertension (HTN), resistant hypertension (r-HTN), and cardiovascular disease (CVD). This review provides updates on the epidemiology, pathophysiology, and treatments of OSA-associated HTN. Recent Findings Mild sleep apnea increases the risk for HTN. Eighty-nine percent of young patients aged 18–35 with HTN not attributed to secondary causes have underlying OSA. Home sleep studies are noninferior to formal polysomnography for OSA diagnosis. Nocturnal oxygen desaturation rate is positively correlated with HTN severity. Gut microbiome neo-colonization in response to high-fat diet cravings in patients with OSA alters immune function and worsens HTN. Carbonic anhydrase inhibitors and probiotics show newfound potential for OSA-associated HTN treatment. OSA recognition improves hospital outcomes after a STEMI. Hypoxia-inducible factor (HIF) transcription increases in a dose-dependent manner to hypoxia, and HIFs are strongly linked to cancer growth. Summary OSA and HTN are comorbid conditions with adversely connected pathophysiology including sympathetic hyperactivity, gut dysbiosis, proinflammation, endothelial damage, rostral fluid shifts, pharyngeal collapse, intravascular fluid retention, nocturnal energy expenditure, and metabolic derangements. The dose–response effect of OSA on HTN severity challenges blood pressure (BP) control, so those with refractory HTN should be screened for OSA.
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Affiliation(s)
- John Brown
- School of Medicine, Louisiana State University Health Sciences Center, Gravier Street, New Orleans, LA, 70112, USA
| | - Farshid Yazdi
- Section of Nephrology, Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Mona Jodari-Karimi
- School of Medicine, Louisiana State University Health Sciences Center, Gravier Street, New Orleans, LA, 70112, USA
| | - Jonathan G Owen
- Section of Nephrology, Department of Medicine, University of New Mexico School of Medicine, 2211 Lomas Blvd NE, Albuquerque, NM, 87131, USA
| | - Efrain Reisin
- Section of Nephrology, Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
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28
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Hao W, Wang X, Fan J, Zeng Y, Ai H, Nie S, Wei Y. Association between apnea-hypopnea index and coronary artery calcification: a systematic review and meta-analysis. Ann Med 2021; 53:302-317. [PMID: 33522282 PMCID: PMC7877988 DOI: 10.1080/07853890.2021.1875137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/06/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the association between presence and severity of obstructive sleep apnoea (OSA) and the presence of subclinical coronary artery disease (CAD) as assessed by coronary calcium score. METHODS Medline, Cochrane, and Google Scholar databases were searched. The presence of coronary artery calcification (CAC) and CAC score were assessed. RESULTS Irrespective of the cut-off value of apnoea-hypopnea index (AHI) (5 or 15 events/h), patients in the OSA group had higher rate of CAC presence and mean CAC score than those in the control group. Subgroup analyses of patients monitored with home sleep apnoea testing (HSAT) or in-hospital/laboratory polysomnography showed that the OSA group had higher rate of CAC presence and mean CAC score than the control group, except in the comparison of mean CAC score between AHI ≥5 vs. <5 events/h for patients using HSAT, which was not significant. Pair-wise comparison showed that CAC score may increase with increased OSA severity. CONCLUSIONS In participants without symptomatic coronary disease, the presence of OSA was associated with the presence and extent of CAC. However, potential confounders such as age, gender, and BMI and the diversity of CAC scores may affect the association.
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Affiliation(s)
- Wen Hao
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yaping Zeng
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shaoping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yongxiang Wei
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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29
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Luo J, Wang X, Guo Z, Xiao Y, Cao W, Zhang L, Su L, Guo J, Huang R. Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice. Front Cardiovasc Med 2021; 8:716916. [PMID: 34676249 PMCID: PMC8523814 DOI: 10.3389/fcvm.2021.716916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications. Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups. Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P > 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052). Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.
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Affiliation(s)
- Jinmei Luo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaona Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zijian Guo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenhao Cao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Linfan Su
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Junwei Guo
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Abu Jawdeh EG, Huang H, Westgate PM, Patwardhan A, Bada H, Bauer JA, Giannone P. Intermittent Hypoxemia in Preterm Infants: A Potential Proinflammatory Process. Am J Perinatol 2021; 38:1313-1319. [PMID: 32512605 DOI: 10.1055/s-0040-1712951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A major consequence of prematurity is intermittent hypoxemia (IH). Data from both adult studies and neonatal animal models suggest that IH is proinflammatory; however, there is limited data in preterm infants. Here, we assess the relationship between IH and systemic inflammation, namely, serum C-reactive protein (CRP) in preterm infants. STUDY DESIGN Serum CRP was measured at 30 days of life, at the time of peak IH frequency. IH measures (e.g., per cent time in hypoxemia, frequency, duration) were calculated the week prior to CRP collection. Statistical analyses were based on Spearman's correlation. RESULTS A total of 26 infants were included. Median gestational age and birth weight were 274/7 weeks and 980 g, respectively. There were positive correlations between primary IH measures and CRP levels, especially for events longer than 1-minute duration (r range: 0.56-0.74, all p < 0.01). CONCLUSION We demonstrate that IH is associated with increased CRP for the first time in preterm infants. Our findings are consistent with studies from adults and neonatal animal models suggesting that IH is a proinflammatory process. KEY POINTS · IH events are common.. · IH is associated with elevated C-reactive protein.. · Longer IH events (>1 min) are of most significance..
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Affiliation(s)
- Elie G Abu Jawdeh
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Hong Huang
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Abhijit Patwardhan
- Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, Kentucky
| | - Henrietta Bada
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - John A Bauer
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Peter Giannone
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
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Tedesco Silva LM, Cortes A, Rossi B, Boll L, Waclawovsky G, Eibel B, Cadaval Gonçalves S, Irigoyen MC, Martinez D. Effects of Hydroxychloroquine on endOthelial function in eLDerly with sleep apnea (HOLD): study protocol for a randomized clinical trial. Trials 2021; 22:638. [PMID: 34535165 PMCID: PMC8447592 DOI: 10.1186/s13063-021-05610-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Sleep apnea and coronary artery disease are prevalent and relevant diseases. The mechanism by which sleep apnea leads to coronary artery disease remains unclear. Intermittent hypoxia, caused by sleep apnea, leads to inflammation and consequent endothelial dysfunction. Endothelial dysfunction precedes the development of atherosclerotic disease and the occurrence of cardiovascular events. Agents that potentially act to improve endothelial function can help prevent cardiovascular events. Patients using immunomodulators due to rheumatic diseases have a lower prevalence of cardiovascular diseases. However, the potential cardioprotective effect of these drugs in patients without autoimmune diseases is not clear. Hydroxychloroquine (HCQ) is an immunomodulator used to treat rheumatoid arthritis and systemic lupus erythematosus. In addition to its anti-inflammatory properties, HCQ reduces cholesterol and blood glucose levels and has antithrombotic effects. The drug is inexpensive and widely available. Adverse effects of HCQ are rare and occur more frequently with high doses. OBJECTIVE In this randomized clinical trial, the effect of HCQ treatment on endothelial function will be tested in seniors with sleep apnea. METHODS We will recruit participants over the age of 65 and with moderate-severe sleep apnea from an ongoing cohort. We chose to use this sample already evaluated for sleep apnea for reasons of convenience, but also because the elderly with sleep apnea are vulnerable to heart disease. Endothelial function will be assessed by examining flow-mediated dilation of the brachial artery, the gold standard method, considered an independent predictor of cardiovascular events in the general population and by peripheral arterial tonometry, the most recent and most easily obtained method. Hydroxychloroquine will be used at a dose of 400 mg/daily for 8 weeks. DISCUSSION Our study aims to obtain evidence, albeit preliminary, of the efficacy of hydroxychloroquine in improving endothelial function and reducing cardiovascular risk markers. If the improvement occurs, we plan to design a randomized multicenter clinical trial to confirm the findings. TRIAL REGISTRATION ClinicalTrials.gov NCT04161339 . Registered on November 2019.
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Affiliation(s)
| | - Antonio Cortes
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz Rossi
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Brazil
| | - Liliana Boll
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Brazil
| | - Gustavo Waclawovsky
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Brazil
| | - Bruna Eibel
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Brazil
| | | | - Maria Claudia Irigoyen
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Denis Martinez
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Li MM, Zheng YL, Wang WD, Lin S, Lin HL. Neuropeptide Y: An Update on the Mechanism Underlying Chronic Intermittent Hypoxia-Induced Endothelial Dysfunction. Front Physiol 2021; 12:712281. [PMID: 34512386 PMCID: PMC8430344 DOI: 10.3389/fphys.2021.712281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
Endothelial dysfunction (ED) is a core pathophysiological process. The abnormal response of vascular endothelial (VE) cells to risk factors can lead to systemic consequences. ED caused by intermittent hypoxia (IH) has also been recognized. Neuropeptide Y (NPY) is an important peripheral neurotransmitter that binds to different receptors on endothelial cells, thereby causing ED. Additionally, hypoxia can induce the release of peripheral NPY; however, the involvement of NPY and its receptor in IH-induced ED has not been determined. This review explains the definition of chronic IH and VE function, including the relationship between ED and chronic IH-related vascular diseases. The results showed that that the effect of IH on VE injury is mediated by the VE-barrier structure and endothelial cell dysfunction. These findings offer new ideas for the prevention and treatment of obstructive sleep apnea syndrome and its complications.
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Affiliation(s)
- Mei-Mei Li
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yan-Li Zheng
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Wan-da Wang
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shu Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Hui-Li Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Raptis DG, Sinani O, Rapti GG, Papanikolaou A, Dadouli K, Ntellas P, Kapsalaki EZ, Malli F, Gourgoulianis KI, Xiromerisiou G. Clinically Silent Small Vessel Disease of the Brain in Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091673. [PMID: 34574014 PMCID: PMC8469951 DOI: 10.3390/diagnostics11091673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with increased risk of cerebrovascular disease. The aim of the present study was to investigate the association between the presence of the small vessel disease (SVD) of the brain in patients with OSAHS. The study included 24 patients with moderate to severe OSAHS and 34 healthy volunteers. All the subjects underwent magnetic resonance imaging (MRI) of the brain, in order to sought periventricular white matter (PVWM), deep white matter (DWM) and brainstem SVD. Among patients with OSAHS, 79.1% had SVD (grade 1-3, Fazekas score) in DWM and 91.7% in PVWM while 22.4% had brainstem-white matter hyperintensities (B-WMH). Patients with OSAHS had a much higher degree of SVD in the DWM and PVWM compared to the control group (p < 0.001). The multivariate analysis showed an independent significant association of OSAHS with SVD (DWM and PVWM) (p = 0.033, OR 95% CI: 8.66 (1.19-63.08) and: p = 0.002, OR 95% CI: 104.98 (5.15-2141)). The same analysis showed a moderate association of OSAHS with B-WMH (p = 0.050, OR 15.07 (0.97-234.65)). Our study demonstrated an independent significant association of OSAHS with SVD and a moderate association of OSAHS with B-WMH.
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Affiliation(s)
- Dimitrios G. Raptis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Olga Sinani
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41222 Larissa, Greece; (O.S.); (A.P.)
| | - Georgia G. Rapti
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Aikaterini Papanikolaou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41222 Larissa, Greece; (O.S.); (A.P.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece;
| | - Panagiotis Ntellas
- Department of Medical Oncology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Eftychia Z. Kapsalaki
- Department of Diagnostic Radiology, Faculty of Medicine, General University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
| | - Foteini Malli
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece
- Correspondence: ; Tel.: +30-241-068-4612; Fax: +30-241-350-1563
| | - Konstantinos I. Gourgoulianis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, University of Thessaly, 41110 Larissa, Greece;
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Lisan Q, van Sloten T, Boutouyrie P, Laurent S, Danchin N, Thomas F, Guibout C, Perier MC, Dagnelie P, Henry RM, Schram MT, Heinzer R, Marques-Vidal P, van der Kallen CJ, Crijns HJ, van Greevenbroek M, Reesink K, Köhler S, Sastry M, Jouven X, Stehouwer CDA, Empana JP. Sleep Apnea is Associated With Accelerated Vascular Aging: Results From 2 European Community-Based Cohort Studies. J Am Heart Assoc 2021; 10:e021318. [PMID: 34308679 PMCID: PMC8475690 DOI: 10.1161/jaha.120.021318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The mechanisms underlying the association between obstructive sleep apnea (OSA) and cardiovascular disease may include accelerated vascular aging. The aim was to compare the magnitude of vascular aging in patients with high versus low risk of OSA. Methods and Results In 2 community-based studies, the PPS3 (Paris Prospective Study 3) and the Maastricht Study, high risk of OSA was determined with the Berlin questionnaire (a screening questionnaire for OSA). We assessed carotid artery properties (carotid intima-media thickness, Young's elastic modulus, carotid-femoral pulse wave velocity, carotid pulse wave velocity, carotid diameter using high precision ultrasound echography), and carotid-femoral pulse wave velocity (in the Maastricht Study only). Regression coefficients were estimated on pooled data using multivariate linear regression. A total of 8615 participants without prior cardiovascular disease were included (6840 from PPS3, 62% men, mean age 59.5±6.2 years, and 1775 from the Maastricht Study, 51% men, 58.9±8.1 years). Overall, high risk of OSA prevalence was 16.8% (n=1150) in PPS3 and 23.8% (n=423) in the Maastricht Study. A high risk of OSA was associated with greater carotid intima-media thickness (β=0.21; 0.17-0.26), Young's elastic modulus (β=0.21; 0.17-0.25), carotid-femoral pulse wave velocity (β=0.24; 0.14-0.34), carotid pulse wave velocity (β=0.31; 0.26-0.35), and carotid diameter (β=0.43; 0.38-0.48), after adjustment for age, sex, total cholesterol, smoking, education level, diabetes mellitus, heart rate, and study site. Consistent associations were observed after additional adjustments for mean blood pressure, body mass index, or antihypertensive medications. Conclusions These data lend support for accelerated vascular aging in individuals with high risk of OSA. This may, at least in part, underlie the association between OSA and cardiovascular disease.
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Affiliation(s)
- Quentin Lisan
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France.,Department of Otolaryngology-Head and Neck Surgery Foch HospitalSchool of MedicineUniversity Paris Saclay Paris France
| | - Thomas van Sloten
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Pierre Boutouyrie
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France.,Department of Medicine Service of Internal Medicine Lausanne University Hospital and University of Lausanne Switzerland
| | - Stéphane Laurent
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France.,Department of Medicine Service of Internal Medicine Lausanne University Hospital and University of Lausanne Switzerland
| | - Nicolas Danchin
- Department of Cardiology and Cardiovascular Research Institute MaastrichtMaastricht University Medical Center Maastricht Netherlands.,Department of Biomedical EngineeringMaastricht University Medical Centre Maastricht the Netherlands
| | - Frédérique Thomas
- Department of Biomedical EngineeringMaastricht University Medical Centre Maastricht the Netherlands
| | - Catherine Guibout
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France
| | - Marie-Cécile Perier
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France
| | - Pieter Dagnelie
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands.,AP-HP Department of PharmacologyGeorges Pompidou European Hospital Paris France
| | - Ronald M Henry
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Miranda T Schram
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Raphaël Heinzer
- MHeNs School for Mental Health and Neuroscience Maastricht University Maastricht the Netherlands.,Department of Respiratory Medicine Maastricht University Medical Centre Maastricht The Netherlands
| | - Pedro Marques-Vidal
- MHeNs School for Mental Health and Neuroscience Maastricht University Maastricht the Netherlands
| | - Carla J van der Kallen
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Harry J Crijns
- Preventive and Clinical Investigation Center Paris France
| | - Marleen van Greevenbroek
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Koen Reesink
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,AP-HP Department of Cardiology Georges Pompidou European Hospital Paris France
| | - Sebastian Köhler
- Department of EpidemiologyMaastricht University Medical Centre Maastricht the Netherlands
| | - Manuel Sastry
- Center for Investigation and Research in SleepLausanne University Hospital and University of Lausanne Switzerland
| | - Xavier Jouven
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France.,Department of Cardiology and Cardiovascular Research Institute MaastrichtMaastricht University Medical Center Maastricht Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular DiseasesMaastricht University Maastricht the Netherlands.,Department of Internal MedicineMaastricht University Medical Centre Maastricht the Netherlands
| | - Jean-Philippe Empana
- INSERM UMR 970 Integrative Epidemiology of Cardiovascular Diseases University of Paris Paris France
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The role of sleep disorders in cardiovascular diseases: Culprit or accomplice? Life Sci 2021; 283:119851. [PMID: 34324916 DOI: 10.1016/j.lfs.2021.119851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
Sleep disorders frequently comorbid with several cardiovascular diseases (CVDs), attracting increasing scientific attention and interest. Sleep disorders include insomnia, sleep-disordered breathing, restless legs syndrome, etc. It is well known that inflammation, sympathetic activation, and endothelial dysfunction play critical roles in sleep disorders, all of which are predisposing factors for CVDs. The comorbidity of sleep disorders and CVDs may have a bidirectional relationship. Patients with CVDs may have a high incidence of sleep disorders and vice versa. This review focused on the comorbidity of sleep disorders and CVDs and discussed the potential pathophysiological mechanisms and therapeutic strategies. In addition to the existing mechanisms, this review summarized novel potential mechanisms underlying comorbidities, such as gut microbiota, orexin, and extracellular vesicles, which may provide a theoretical basis for further basic research and clinical investigations on improving therapeutic outcomes.
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C-reactive protein in children with obstructive sleep apnea and effects of adenotonsillectomy. Auris Nasus Larynx 2021; 49:92-99. [PMID: 34272056 DOI: 10.1016/j.anl.2021.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is an important serum marker of inflammation associated with cardiovascular outcomes. This study aims to evaluate the association between CRP and childhood obstructive sleep apnea (OSA) and clarify the effects of adenotonsillectomy on serum CRP levels in children with OSA. METHODS Children with symptoms suggestive of OSA who underwent an overnight polysomnography were recruited from a tertiary medical center. Their serum CRP levels were measured. For children who underwent adenotonsillectomy for OSA treatment, polysomnography and serum high-sensitivity CRP (hs-CRP) level measurement were conducted after surgery. RESULTS This study included 326 children (mean age: 7.2 ± 3.0 years; boys: 67%). Children with apnea-hypopnea index (AHI) > 5 events/h had significantly higher hs-CRP levels than children with AHI of 1-5 events/h and AHI < 1 event/h [median (interquartile range): 0.08 (0.03-0.25) vs 0.03 (0.02-0.14) vs 0.04 (0.01-0.10), P < 0.001]. Log-transformed hs-CRP levels were positively associated with log AHI values (r = 0.2, P < 0.001). In multiple linear regression analysis, hs-CRP levels were independently associated with AHI; 101 children with OSA (ie, AHI > 1) underwent adenotonsillectomy. In children with OSA in the study cohort, a significant reduction of hs-CRP levels did not occur after surgery [from 0.07 (0.02-0.22) to 0.08 (0.03-0.17), P = 0.716]. In children with OSA having abnormal hs-CRP levels (ie, CRP > 1 mg/dL), hs-CRP levels significantly decreased after surgery [from 1.87 (1.11-2.78) to 0.20 (0.07-1.04), P = 0.043]. CONCLUSION Children with OSA had increased hs-CRP levels. Children with OSA and abnormal hs-CRP levels exhibited significantly reduced hs-CRP levels following adenotonsillectomy.
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Arslan NG, Pancar GS. Nailfold capillaroscopic changes of sleep apnea patients. Microvasc Res 2021; 137:104177. [PMID: 33984340 DOI: 10.1016/j.mvr.2021.104177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) have frequent association with comorbidities and this makes it an independent risk factor for cardiovascular disease. Not only endothelial dysfunction, but also arterial stiffening, increased inflammatory mediators, oxidative stress after hypoxemia that develops due to OSAS, cause vascular pathologies in all diameters of vessels. Nail bed capillaroscopy is a simple, noninvasive, useful method to examine microcirculation and evaluate nail bed capillary abnormalities in diseases that cause vascular damage. The aim of this study is to examine microvascular changes in the nail bed of OSAS patients by capillaroscopy. METHODS 59 OSAS patients and 60 healthy cases (totally 119) were included. One single attended polysomnography was applied with Embla N7000 series (RemLogic Eastmed, Natus); and apnea-hypopnea index (AHI), oxygen de-saturation index >4% (ODI4%), minimum oxygen saturation (SaO2 Min.), total duration of oxygen desaturation, comorbidities, body mass index (BMI), smoking habit, sleep questionnaire applications were analyzed. Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30) and all images were evaluated for capillary density, capillary loop enlargement, capillary tortuosity, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages. RESULTS The prevalence rates of all capillaroscopy findings were significantly higher in the patient group (p < 0.05). There was an inverse and moderate relationship between AHI and mean saturation (p < 0.05). A statistically significant correlation was detected between the presence of hypertension (HT) and the severity of capillary tortuosity (CT) (p = 0.002), avascular area (AA) (p = 0.004), and periungual cyanosis (PUC) (p = 0.042); also between smoking habit and intensity of capillary dilatation, enlargement dilatation-enlarged giant capillaries (CELON) (p = 0.004), CT (p = 0.018) findings. Capillary distribution (CD), CELON, CT and AA findings were significantly higher in the group with low mean saturation (p < 0.05). DM was found to be significantly higher in individuals with high Epworth Sleep Scale (ESS) (p = 0.035). CONCLUSION In this study; 1) the nail bed capillaroscopy was used to examine vascular damage in OSAS, and 2) irregularities detected in the distal nail bed specific to a disease have been mentioned for the first time. It has been shown that endothelial damage is particularly related to the severity of hypoxia. HT and smoking history causes endothelial damage independent of the severity of the disease and hypoxia. Also, ESS may be more determinant in the screening of sleep disorders in diabetic patients.
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Affiliation(s)
- Nevra Gullu Arslan
- Samsun Educational and Research Hospital, Department of Pulmonology, TR-55000 Samsun, Turkey.
| | - Gunseli Sefika Pancar
- Samsun Education and Research Hospital, Department of Dermatology, TR-55000 İlkadim, Samsun, Turkey
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Imani MM, Sadeghi M, Farokhzadeh F, Khazaie H, Brand S, Dürsteler KM, Brühl A, Sadeghi-Bahmani D. Evaluation of Blood Levels of C-Reactive Protein Marker in Obstructive Sleep Apnea: A Systematic Review, Meta-Analysis and Meta-Regression. Life (Basel) 2021; 11:life11040362. [PMID: 33921787 PMCID: PMC8073992 DOI: 10.3390/life11040362] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Introduction: High sensitivity C-reactive protein (hs-CRP) and CRP are inflammatory biomarkers associated with several inflammatory diseases. In both pediatric and adult individuals with Obstructive Sleep Apnea (OSA) higher hs-CRP and CRP were observed, compared to controls. With the present systematic review, meta-analysis and meta-regression we expand upon previous meta-analyses in four ways: (1) We included 109 studies (96 in adults and 13 in children); (2) we reported subgroup and meta-regression analyses in adults with OSA compared to controls on the serum and plasma levels of hs-CRP; (3) we reported subgroup and meta-regression analyses in adults with OSA compared to controls on the serum and plasma levels of CRP; (4) we reported serum and plasma levels of both hs-CRP and CRP in children with OSA, always compared to controls. (2) Materials and Methods: The PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases were searched to retrieve articles published until 31 May 2020, with no restrictions. The data included basic information involving the first author, publication year, country of study, ethnicity of participants in each study, age, BMI, and AHI of both groups, and mean and standard deviation (SD) of plasma and serum levels of CRP and hs-CRP. (3) Results: A total of 1046 records were retrieved from the databases, and 109 studies were selected for the analysis (96 studies reporting the blood levels of hs-CRP/CRP in adults and 13 studies in children). For adults, 11 studies reported plasma hs-CRP, 44 serum hs-CRP, 9 plasma CRP, and 32 serum CRP levels. For children, 6 studies reported plasma hs-CRP, 4 serum hs-CRP, 1 plasma CRP, and 2 serum CRP levels. Compared to controls, the pooled MD of plasma hs-CRP levels in adults with OSA was 0.11 mg/dL (p < 0.00001). Compared to controls, the pooled MD of serum hs-CRP levels in adults with OSA was 0.09 mg/dL (p < 0.00001). Compared to controls, the pooled MD of plasma CRP levels in adults with OSA was 0.06 mg/dL (p = 0.72). Compared to controls, the pooled MD of serum CRP levels in adults with OSA was 0.36 mg/dL (p < 0.00001). Compared to controls, the pooled MD of plasma hs-CRP, serum hs-CRP, plasma hs-CRP, and serum hs-CRP in children with OSA was 1.17 mg/dL (p = 0.005), 0.18 mg/dL (p = 0.05), 0.08 mg/dL (p = 0.10), and 0.04 mg/dL (p = 0.33), respectively. The meta-regression showed that with a greater apnea-hypapnea index (AHI), serum hs-CRP levels were significantly higher. (4) Conclusions: The results of the present systematic review, meta-analysis and meta-regression showed that compared to healthy controls plasma and serum levels of hs-CRP and serum CRP level were higher in adults with OSA; for children, and compared to controls, just plasma hs-CRP levels in children with OSA were higher.
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Affiliation(s)
- Mohammad Moslem Imani
- Department of Orthodontics, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran;
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran;
| | - Farid Farokhzadeh
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran;
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran; (H.K.); (D.S.-B.)
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran; (H.K.); (D.S.-B.)
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland;
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, 4052 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran 25529, Iran
- Correspondence:
| | - Kenneth M. Dürsteler
- Psychiatric Clinics, Division of Substance Use Disorders, University of Basel, 4002 Basel, Switzerland;
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001 Zurich, Switzerland
| | - Annette Brühl
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland;
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Dena Sadeghi-Bahmani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran; (H.K.); (D.S.-B.)
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland;
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
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39
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Öztop N, Özer PK, Demir S, Beyaz Ş, Tiryaki TO, Özkan G, Aydogan M, Bugra MZ, Çolakoglu B, Büyüköztürk S, Nalçacı M, Yavuz AS, Gelincik A. Impaired endothelial function irrespective of systemic inflammation or atherosclerosis in mastocytosis. Ann Allergy Asthma Immunol 2021; 127:76-82. [PMID: 33775901 DOI: 10.1016/j.anai.2021.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge on endothelial dysfunction and its relation to atherosclerosis in mastocytosis is limited. OBJECTIVE To investigate the endothelial function in mastocytosis by flow-mediated dilatation (FMD) and biomarkers related to vascular endothelia and to evaluate its relationship with the presence of subclinical atherosclerosis by carotid intima media thickness (CIMT). METHODS A total of 49 patients with mastocytosis and 25 healthy controls (HCs) were included. The FMD and CIMT during transthoracic echocardiography biomarkers including endocan, endothelin-1, and vascular endothelial growth factor (VEGF) were measured in the sera of participants. Tumor necrosis factor-alpha, interleukin 6, and high-sensitive C-reactive protein were determined as inflammatory biomarkers. RESULTS The mean FMD % was lower in the patients than HCs (11.26% ± 5.85% vs 17.84% ± 5.27% P < .001) and was the lowest in the advanced systemic mastocytosis and smoldering systemic mastocytosis group among the patients (P = .03). The median value of VEGF was considerably higher in patients than HCs (73.30 pg/mL; minimum-maximum 32.46-295.29 pg/mL vs 46.64 pg/mL; minimum-maximum, 11.09-99.86 pg/mL; P = .001) and it was the highest in the advanced systemic mastocytosis and smoldering systemic mastocytosis group (P = .01). The FMD was inversely correlated with endocan (r = -0.390; P = .006), endothelin-1 (r = -0.363; P = .01) and VEGF (r = -0.402; P = .004) but there were no correlations between FMD and tumor necrosis factor-alpha, interleukin 6, and high-sensitive C-reactive protein. No differences in CIMT values between patients and HCs and no correlation between CIMT and the biomarkers were observed. CONCLUSION Endothelial dysfunction in mastocytosis becomes evident with decreased FMD and elevated serum VEGF in the absence of atherosclerosis or systemic inflammation and is related to disease severity.
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Affiliation(s)
- Nida Öztop
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Pelin Karaca Özer
- Department of Cardiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Şengül Beyaz
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Tarık Onur Tiryaki
- Division of Hematology, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Gülkan Özkan
- Division of Hematology, Department of Internal Medicine, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Aydogan
- Department of Cardiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Melike Zehra Bugra
- Department of Cardiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Bahauddin Çolakoglu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Suna Büyüköztürk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Meliha Nalçacı
- Division of Hematology, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Akif Selim Yavuz
- Division of Hematology, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.
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40
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Sex-Specific Differential Responses of Circulating Biomarkers in Obstructive Sleep Apnea Treatment. A Post Hoc Analysis of a Randomized Controlled Trial. Ann Am Thorac Soc 2021; 17:605-613. [PMID: 31860326 DOI: 10.1513/annalsats.201908-593oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Knowledge of sex-specific changes of cardiovascular biomarkers in response to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) is limited.Objectives: We hypothesized a differential sex-specific cardiovascular biomarker response with CPAP therapy for OSA.Methods: Participants with moderate-severe OSA (apnea-hypopnea index, 15 events/h) were randomized to CPAP versus sham and completed polysomnography and collection of biomarkers of inflammation (myeloperoxidase, fibrinogen, paraoxonase, interleukin [IL]-6, IL-6 soluble receptor, aryl esterase, oxidized low-density lipoprotein, lipoprotein A, plasminogen activator inhibitor 1, and F2-isoprostane urine/creatinine ratio) and vascular measures at baseline and 8 weeks of therapy with either CPAP (n = 72) or sham treatment (n = 70). Post hoc secondary analyses of sex-study arm interaction relative to change in inflammatory biomarkers were evaluated via linear regression with adjustment for baseline biomarker value, age, race, body mass, index, waist circumference, and CPAP adherence. Interactions were further evaluated via sex-stratified analyses.Results: The study sample comprised a total of 149 participants aged 50.8 ± 11.7 years; 55% were male, and 55% were white. Participants had a median apnea-hypopnea index of 26.3 events per hour (interquartile range, 13-37). There were substantial interactions between study arm and sex for myeloperoxidase, paraoxonase, and fibrinogen (P = 0.03, P = 0.03, and P = 0.08, respectively). No significant interactions were found for the vascular measures. Estimates were similar but with decreased power in sex-stratified analyses, with decreased biomarkers in women and increased biomarkers in men.Conclusions: Differential sex-specific responses to CPAP therapy for OSA were observed for circulating inflammatory biomarkers, which persisted after adjustment for confounders. These findings set the stage for validation studies and, if confirmed, biochemical pathway elucidation to inform sex-specific personalized treatment approaches.Clinical trial registered with www.clinicaltrials.gov (NCT00607893).
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Bolshakova SE, Madaeva IM, Berdina ON, Bugun OV, Rychkova LV. Ultrasound techniques in the diagnosis of vascular structural changes and blood flow velocity in patients with obstructive sleep apnea. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- S. E. Bolshakova
- Scientific Center of Family Health Problems and Human Reproduction
| | - I. M. Madaeva
- Scientific Center of Family Health Problems and Human Reproduction
| | - O. N. Berdina
- Scientific Center of Family Health Problems and Human Reproduction
| | - O. V. Bugun
- Scientific Center of Family Health Problems and Human Reproduction
| | - L. V. Rychkova
- Scientific Center of Family Health Problems and Human Reproduction
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42
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Wang M, Sun FR, Bi YL, Ma YH, Yin JJ, Shen XN, Wang XT, Tan L, Yu JT. Sleep Characteristics and Cerebrospinal Fluid Progranulin in Older Adults: The CABLE Study. Neurotox Res 2021; 39:764-773. [PMID: 33443646 DOI: 10.1007/s12640-020-00326-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
Cerebrospinal fluid (CSF) progranulin (PGRN) is related to various neurodegeneration diseases. And sleep problems can cause abnormality in protein metabolism in vivo. We aim to explore the potential associations between the self-reported sleep characteristics and CSF PGRN in cognitively intact older adults. Our study recruited 747 participants (mean (standard deviation (SD)) age, 61.99 (10.52) years, 329 (42.89%) females) who had normal cognition from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) study with CSF PGRN and sleep characteristics measured. The multiple linear regression and nonlinear regression adjusted for age, gender, education, and apolipoprotein E-epsilon 4 gene (APOE4) status were used to assess the associations between sleep characteristics and PGRN. Interaction effects were explored between APOE4 status and sleep characteristics on CSF PGRN level. Sleep disturbances indicated lower CSF PGRN (β = - 0.0186, p = 0.0160). For detailed items in sleep disturbances, lower CSF PGRN was found in males who woke up during sleep (β = - 0.0121, p = 0.0062) and in females who had breathing difficulties (β = - 0.0258, p = 0.0271). Meanwhile, sleep efficiency was associated with CSF PGRN (β = - 0.0512, p = 0.0497). No significant interaction effects between sleep characteristics and APOE4 status were found. Meanwhile, we did not find a nonlinear relationship between nocturnal sleep duration and CSF PGRN. Sleep problems may influence the metabolism of PGRN, thus attenuating the protective effects of PGRN on neurodegeneration diseases.
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Affiliation(s)
- Meng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Fu-Rong Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan-Lin Bi
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jian-Jun Yin
- Department of Neurology, Qingdao Hiser Hospital, Qingdao University, Qingdao, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Tong Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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43
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Baylan FA, Yarar E. Relationship between the mitochondria-derived peptide MOTS-c and insulin resistance in obstructive sleep apnea. Sleep Breath 2021; 25:861-866. [PMID: 33394327 DOI: 10.1007/s11325-020-02273-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The co-occurrence of obstructive sleep apnea (OSA) and obesity are common. Mitochondrial open reading frame of the 12S rRNA-c (MOTS-C) is one of the newly identified mitochondrial derivative peptides that play a role in the regulation of metabolic homeostasis. We aimed to examine the serum levels of MOTS-C to help understand the role of the disease in the pathophysiology, thereby investigating whether it can contribute to the appropriate treatment. MATERIALS AND METHODS Seventy patients with OSAS and 20 healthy controls were included. The serum MOTS-C level was measured in all patients. For each participant, demographic features, lipid profile, serum glucose levels, and insulin levels were also evaluated. Homeostatic model assessment indicator of insulin resistance (HOMA-IR) was calculated for all participants. RESULTS Patients with OSAS (n = 70) were grouped as mild (n = 19), moderate (n = 19), and severe (n = 32). Patients with AHI ≤ 5 were considered as the healthy control group (n = 20). Mean age was 50.3 years and 74% (67/90) of the study sample was male. As expected, as the severity of OSA increased, BMI, insulin levels and HOMA-IR increased. MOTS-C levels were significantly lower in patients with OSA compared to healthy controls (p < 0.000) and we found that MOTS-C levels decreased as OSA severity increased. There was a negative correlation between serum MOTS-C levels and AHI and BMI (r = - 0.492, p < 0.001, r = - 0.382, p < 0.001, respectively). Serum MOTS-C levels were independently associated with AHI in BMI and HOMA-IR in linear regression analysis (p < 0.010, p < 0.007, p < 0.007, respectively). CONCLUSION Serum MOTS-C level is related to OSA and BMI. MOTS-C may be a useful new marker for early metabolic disorders in patients with OSA.
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Affiliation(s)
- Filiz Alkan Baylan
- Department of Biochemistry, Kahramanmaras Sütcü İmam University Hospital, Kahramanmaras, Turkey.
| | - Esra Yarar
- Department of Chest Diseases, Necip Fazıl City Hospital, Kahramanmaras, Turkey
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44
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Wang J, Wang X, Yu W, Zhang K, Wei Y. Obstructive sleep apnea-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients. J Thorac Dis 2020; 12:5603-5616. [PMID: 33209393 PMCID: PMC7656408 DOI: 10.21037/jtd-20-2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases were searched manually and automatically for relevant English articles. All of the included articles focused on a comparison of the incidence of postoperative parameters of multi-organ function in CHD patients undergoing elective CABG with and without OSA. Studies were excluded if they met any one of the following criteria: (I) duplicate publication; (II) ongoing or unpublished studies; (III) only published as abstracts or conference proceedings; and (IV) less than 30 patients in the patient cohort. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls [odds risk (OR), 1.97; 95% CI, 1.50 to 2.59, P<0.0001]. In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, P<0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased 243% (OR, 3.43; 95% CI, 1.35 to 8.71; P=0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; P=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P<0.0001). Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications.
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Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.,Center for Cardiac Intensive Care, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xinxin Wang
- Department of General Surgery, Chinese PLA general hospital, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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45
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Kang KT, Yeh TH, Hsu YS, Ko JY, Lee CH, Lin MT, Hsu WC. Effect of Sleep Surgery on C-Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta-Analysis. Laryngoscope 2020; 131:1180-1187. [PMID: 33111981 DOI: 10.1002/lary.29212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate associations between sleep surgery and CRP (C-reactive protein) levels in adults with obstructive sleep apnea (OSA). STUDY DESIGN Meta-analysis. METHODS Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C-reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random-effects model. RESULTS Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea-hypopnea index (AHI) after surgery was significantly reduced by -21.1 (95% confidence interval [CI], -28.4 to -13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = -0.39, 95% CI, -0.67 to -0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: -0.72 vs. -0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high-sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow-up period (i.e., <6 vs. >6 months). CONCLUSIONS Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180-1187, 2021.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Shuo Hsu
- Department of Otolaryngology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Ming-Tzer Lin
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
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Chalegre ST, Lins-Filho OL, Lustosa TC, França MV, Couto TLG, Drager LF, Lorenzi-Filho G, Bittencourt MS, Pedrosa RP. Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Breath 2020; 25:1195-1202. [PMID: 33094411 DOI: 10.1007/s11325-020-02226-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. METHODS The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. RESULTS Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). CONCLUSION CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.
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Affiliation(s)
- Sintya T Chalegre
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Ozeas L Lins-Filho
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil.
| | - Thais C Lustosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Marcus V França
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Tarcya L G Couto
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor) and Renal Division, University Hospital, Faculdade de Medicina, University of São Paulo, Sao Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Marcio S Bittencourt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein & Faculdade Israelita de Ciências da Saúde Albert Einstein, Sao Paulo, Brazil
| | - Rodrigo P Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
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Valenzuela PL, Carrera-Bastos P, Gálvez BG, Ruiz-Hurtado G, Ordovas JM, Ruilope LM, Lucia A. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 2020; 18:251-275. [PMID: 33037326 DOI: 10.1038/s41569-020-00437-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.
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Affiliation(s)
| | - Pedro Carrera-Bastos
- Centre for Primary Health Care Research, Lund University/Region Skane, Skane University Hospital, Malmö, Sweden
| | - Beatriz G Gálvez
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M Ordovas
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,IMDEA Alimentacion, Madrid, Spain
| | - Luis M Ruilope
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain. .,Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.
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48
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Büchner N, Woehrle H, Dellweg D, Wiater A, Young P, Hein H, Randerath W. [Management of Diagnostic Procedures and Treatment of Sleep Related Breathing Disorders in the Context of the Coronavirus Pandemic - German Respiratory Society (DGP), German Sleep Society (DGSM)]. Pneumologie 2020; 74:571-581. [PMID: 32521554 PMCID: PMC7516352 DOI: 10.1055/a-1184-8442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- N Büchner
- Medizinische Klinik I (Pneumologie, Schlaf- und Beatmungsmedizin), Helios Klinikum Duisburg GmbH, Duisburg
| | | | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - A Wiater
- Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, Schwalmstadt-Treysa
| | - P Young
- Medical Park, Neurologische Klinik Reithofpark, Bad Feilnbach
| | - H Hein
- Praxis und Schlaflabor für Innere Medizin, Pneumologie, Allergologie, Schlafmedizin, Reinbek
| | - W Randerath
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen
- Institut für Pneumologie an der Universität zu Köln, Köln
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Wali SO, Al-Mughales J, Alhejaili F, Manzar MD, Alsallum F, Almojaddidi H, Gozal D. The utility of proinflammatory markers in patients with obstructive sleep apnea. Sleep Breath 2020; 25:545-553. [DOI: 10.1007/s11325-020-02149-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
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Büchner N, Woehrle H, Dellweg D, Wiater A, Young P, Hein H, Randerath W. [Management of diagnostic procedures and treatment of sleep related breathing disorders in the context of the coronavirus pandemic]. SOMNOLOGIE 2020; 24:274-284. [PMID: 32837296 PMCID: PMC7306656 DOI: 10.1007/s11818-020-00253-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
When providing sleep medical services special aspects must be taken into account in the context of the coronavirus pandemic. Despite all prevention, due to the high number of unrecognized cases, SARS-CoV2 contacts in the sleep laboratory must be expected and appropriate precautions are necessary. Nevertheless, the continuation or resumption of sleep medical services under the appropriate hygiene measures is strongly recommended to avoid medical and psychosocial complications. There is no evidence for a deterioration of COVID-19 through CPAP therapy. In principle, the application of positive pressure therapy via various mask systems can be accompanied by the formation of infectious aerosols. In the case of confirmed infection with SARS-CoV2, a pre-existing PAP therapy should be continued in an outpatient setting in accordance with the local guidelines for home isolation, since discontinuation of PAP therapy is associated with additional cardiopulmonary complications due to the untreated sleep-related breathing disorder. According to the current state of knowledge inhalation therapy, nasal high-flow (NHF), and PAP therapy can be carried out without increased risk of infection for health care workers (HCW) as long as appropriate personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) is being used.This position paper of the German Society for Pneumology and Respiratory Medicine (DGP) and the German Society for Sleep Medicine (DGSM) offers detailed recommendations for the implementation of sleep medicine diagnostics and therapy in the context of the coronavirus pandemic.
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Affiliation(s)
- N. Büchner
- Medizinischen Klinik I (Pneumologie, Schlaf- und Beatmungsmedizin), Helios Klinikum Duisburg GmbH, An der Abtei 7–11, 47166 Duisburg, Deutschland
| | | | - D. Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus, Philipps-Universität Marburg, Schmallenberg Grafschaft, Deutschland
| | - A. Wiater
- Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, Schwalmstadt-Treysa, Deutschland
| | - P. Young
- Neurologische Klinik Reithofpark, Medical Park, Bad Feilnbach, Deutschland
| | - H. Hein
- Praxis und Schlaflabor für Innere Medizin, Pneumologie, Allergologie, Schlafmedizin, Reinbek, Deutschland
| | - W. Randerath
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen, Deutschland
- Institut für Pneumologie, Universität zu Köln, Köln, Deutschland
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