1251
|
Oldenburg O, Fox H, Wellmann B, Thiem U, Horstkotte D, Bitter T. Automatic positive airway pressure for treatment of obstructive sleep apnea in heart failure. SOMNOLOGIE 2017. [DOI: 10.1007/s11818-017-0124-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
1252
|
Ayas NT, Drager LF, Morrell MJ, Polotsky VY. Update in Sleep-disordered Breathing 2016. Am J Respir Crit Care Med 2017; 195:1561-1566. [PMID: 28530119 PMCID: PMC5955019 DOI: 10.1164/rccm.201701-0048up] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Najib T. Ayas
- Sleep Disorders Program and
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luciano F. Drager
- Hypertension Unit, Heart Institute (InCor) and
- Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mary J. Morrell
- Sleep and Ventilation Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- National Institute for Health Research Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College London, London, United Kingdom; and
| | - Vsevolod Y. Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
1253
|
Kwon Y, Koene RJ, Kwon O, Kealhofer JV, Adabag S, Duval S. Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2017; 10:e004609. [PMID: 28213507 DOI: 10.1161/circep.116.004609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. METHODS AND RESULTS Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea. CONCLUSIONS SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
Collapse
Affiliation(s)
- Younghoon Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Osung Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Jessica V Kealhofer
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Sue Duval
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| |
Collapse
|
1254
|
Abstract
Oral appliances (OAs) are becoming increasingly recognized not only as an alternative to but also possibly as an adjunct treatment modality for OSA. Compared with CPAP, the gold standard therapy, OAs are less efficacious but are more accepted and tolerated by patients, which, in turn, may lead to a comparable level of therapeutic effectiveness. Different OA designs currently exist, and more are constantly emerging. Additionally, state-of-the-art technologies are being used in the fabrication of many; however, all the currently available OAs employ the same mechanism of action by targeting the anatomical component involved in the pathogenesis of the disease. Furthermore, the scope of use of OAs is expanding to include patients who are edentulous. For patients with OAs, the dentist is a member of an interdisciplinary team managing OSA, and constant communication and follow-up with the sleep physician and other team members is necessary for disease management.
Collapse
|
1255
|
Tapia IE, Marcus CL. CPAP adherence: intensive strategies may be necessary. Sleep Med 2017; 34:240-241. [DOI: 10.1016/j.sleep.2017.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022]
|
1256
|
|
1257
|
Randerath W. Central sleep apnea: the problem of diagnosis. Sleep Med 2017; 34:224-225. [DOI: 10.1016/j.sleep.2016.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
|
1258
|
Khayat RN. Sleep and the Heart: What's Next? Sleep Med Clin 2017; 12:xiii-xiv. [PMID: 28477780 DOI: 10.1016/j.jsmc.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rami N Khayat
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Suite 201, Columbus, OH 43210-1267, USA.
| |
Collapse
|
1259
|
Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home. Home Healthc Now 2017; 35:314-320. [PMID: 28562401 DOI: 10.1097/nhh.0000000000000556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A review of literature revealed a lack of research pertaining to nurses' or student nurses' knowledge of continuous positive airway pressure (CPAP) and the ability to troubleshoot CPAP malfunction. This study sought to answer the following questions: What are associate degree nursing (ADN) students' knowledge, interdisciplinary communication, and problem-solving skills regarding patients' home use of CPAP? Is there a change after participation in a simulation with a patient on CPAP in home setting? Twenty-one ADN students enrolled in small Midwest college participated. A preexperimental design of one group pretest posttest was used. Each student completed a demographic questionnaire, Mayo High Performance Teamwork Scale, Interprofessional collaborative simulation experience survey, and a CPAP knowledge base survey before and upon completion of the simulation. There were no changes in students' comfort, baseline knowledge, and basic understanding regarding CPAP. However, after the simulation, students described more detailed problem-solving skills, which included using respiratory therapists, durable medical equipment providers, and community resources. On the Mayo High Performance Teamwork Scale, all 16 items demonstrated improved scores (baseline mean = 21.65 and postsimulation mean = 25.6).
Collapse
|
1260
|
Device Therapy for Sleep-Disordered Breathing in Patients with Cardiovascular Diseases and Heart Failure. Sleep Med Clin 2017; 12:243-254. [DOI: 10.1016/j.jsmc.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
1261
|
Steffen A, Sommer JU, Hofauer B, Maurer JT, Hasselbacher K, Heiser C. Outcome after one year of upper airway stimulation for obstructive sleep apnea in a multicenter German post-market study. Laryngoscope 2017; 128:509-515. [PMID: 28561345 DOI: 10.1002/lary.26688] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/31/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/HYPOTHESIS Upper airway stimulation (UAS) of the hypoglossal nerve has been implemented in the routine clinical practice for patients with moderate-to-severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure. This study reports objective and patient-reported outcome after 12 months of implantation. STUDY DESIGN Multicenter prospective single-arm study. METHODS Consecutive patients who received the UAS system (Inspire Medical Systems, Inc., Minneapolis, Minnesota, Maple Grove, MN, U.S.A.) were enrolled in three German centers. Key study exclusion criteria included body mass index > 35 kg/m2 , apnea-hypopnea index (AHI) < 15 or > 65, or complete concentric collapse at the soft palate during sedated endoscopy. Data collection at 6- and 12-month visit include home sleep test and patient-reported outcome measures. RESULTS Among the total of 60 participants, the median AHI reduced from 28.6 to 9.5 from baseline to 12 months. Patient-reported outcome measured in Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire both improved significantly from baseline to 12 months. The average usage time was 39.1 ± 14.9 hours per week among all participants based on recordings by the implanted device. One patient requested a removal of the device for cosmetic and other personal reasons and was completed without sequelae. CONCLUSION This study supported that UAS is a safe and effective treatment option for patients with OSA in routine clinical practice. LEVEL OF EVIDENCE 4. Laryngoscope, 128:509-515, 2018.
Collapse
Affiliation(s)
- Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - J Ulrich Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, University-Hospital Mannheim, Mannheim, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Joachim T Maurer
- Department of Otorhinolaryngology, Head and Neck Surgery, University-Hospital Mannheim, Mannheim, Germany
| | | | - Clemens Heiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Munich, Germany
| |
Collapse
|
1262
|
Schipper MH, Jellema K, Thomassen BJW, Alvarez-Estevez D, Verbraecken J, Rijsman RM. Stroke and other cardiovascular events in patients with obstructive sleep apnea and the effect of continuous positive airway pressure. J Neurol 2017; 264:1247-1253. [PMID: 28550476 DOI: 10.1007/s00415-017-8522-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/29/2017] [Accepted: 05/16/2017] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a known-risk factor for cardiovascular diseases. There are indications that treatment with continuous positive airway pressure (CPAP) reduces the risk of new cardiovascular events. In this study, we analyzed the incidence of cardiovascular events in patients with OSA and compared for the impact of CPAP therapy. All polysomnographies performed in 2009 and 2010 were selected with an AHI ≥5 and patients older than 18 years. These 1110 patients were approached with a questionnaire about cardiovascular events and CPAP treatment. Finally, 554 patients were included in analyses. CPAP treatment was based on compliance (level 1 treatment) and extended with residual respiratory events (level 2 treatment). OSA was set as AHI ≥5 and classified in mild (AHI 5-15), moderate (AHI 15-30) and severe (AHI ≥30) OSA. 50 cardiovascular events occurred in 44 patients during follow-up (mean follow-up time 5.9 years) in 554 patients. The events were significantly higher in patients with increasing classification of OSA-severity (p = 0.016). A first-ever cardiovascular event did not differ significantly between mild, moderate and severe OSA. Untreated CPAP patients had significantly more cardiovascular events as compared to treated patients with a hazard ratio of 2.66 partially adjusted for age, AHI and smoking. There was no significant contribution of other cardiovascular risk factors. Patients with OSA with an indication for CPAP treatment have more cardiovascular events when untreated compared to treated patients. This indicates that treatment of OSA by CPAP can reduce the risk for cardiovascular events.
Collapse
Affiliation(s)
- Mirjam H Schipper
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands. .,Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands.
| | - Korne Jellema
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands
| | | | - Diego Alvarez-Estevez
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan Verbraecken
- Department of Pulmonary Medicine, Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Roselyne M Rijsman
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.,Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| |
Collapse
|
1263
|
Farrell PC, Richards G. Recognition and treatment of sleep-disordered breathing: an important component of chronic disease management. J Transl Med 2017; 15:114. [PMID: 28545542 PMCID: PMC5445298 DOI: 10.1186/s12967-017-1211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/13/2017] [Indexed: 12/14/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a highly prevalent condition, and is associated with many debilitating chronic diseases. The role of untreated obstructive sleep apnea (OSA) in arterial hypertension has been recognized in international guidelines. Treatment with continuous positive airway pressure (CPAP) is associated with clinically-relevant reductions in blood pressure. In heart failure (HF), SDB is associated with worse prognosis and increased mortality. Major HF guidelines recommend that patients should be treated for sleep apnea to improve their HF status. Severe OSA increases the risk of arrhythmias, including atrial fibrillation, influences risk management in stroke, and is highly prevalent in patients with type 2 diabetes. Effective treatment with CPAP improves the success of antiarrhythmic interventions, improves outcomes in stroke and reduces hyperglycemia in diabetes. Patients with coronary artery disease also have a high prevalence of SDB, which is independently associated with worse outcomes. The role of CPAP for secondary cardiovascular prevention remains to be determined. Data from large, well-conducted clinical trials have shown that noninvasive ventilation, targeted to markedly reduce hypercapnia, significantly improves survival and reduces readmission in stable hypercapnic chronic obstructive pulmonary disease. The association of SDB with chronic diseases contributes to the high healthcare costs incurred by SDB patients. SDB also has an important negative impact on quality of life, which is reversed by CPAP treatment. The high prevalence of SDB, and its association with diseases that cause significant morbidity and mortality, suggest that the diagnosis and management of SDB is an important therapeutic goal. First, adherent CPAP treatment significantly improves the quality of life of all patients with SDB; second, it eliminates the negative impact of untreated SDB on any associated chronic diseases; and third, it significantly reduces the increased costs of all hospital and medical services directly associated with untreated SDB. In short, the recognition and treatment of SDB is vital for the continued health and wellbeing of individual patients with SDB.
Collapse
Affiliation(s)
- Peter C. Farrell
- ResMed Science Center, c/o ResMed, 9001 Spectrum Center Blvd., San Diego, CA 92123 USA
| | | |
Collapse
|
1264
|
Jee AS, Corte TJ, Wort SJ, Eves ND, Wainwright CE, Piper A. Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep. Respirology 2017; 22:1022-1034. [PMID: 28544189 DOI: 10.1111/resp.13080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Adelle S Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen J Wort
- Pulmonary Hypertension Department, Royal Brompton Hospital and Imperial College, London, UK
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Claire E Wainwright
- School of Medicine, Lady Cilento Children's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
1265
|
Abstract
Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute or long-term consequences of such stimuli, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. Whether effective treatment of either OSA or CSA improves the HF trajectory by reducing cardiovascular morbidity or mortality has yet to be definitively established. ADVENT-HF, designed to determine the effect of treating both CSA and non-sleepy OSA HF patients with a peak-airflow triggered ASV algorithm, could resolve this present clinical equipoise concerning the treatment of SDB.
Collapse
Affiliation(s)
- Nobuhiko Haruki
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine.,The University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto
| | - John S Floras
- The University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto
| |
Collapse
|
1266
|
Aslan G, Afsar B, Siriopol D, Kanbay A, Sal O, Benli C, Okcuoglu J, Covic A, Kanbay M. Cardiovascular Effects of Continuous Positive Airway Pressure Treatment in Patients With Obstructive Sleep Apnea: A Meta-Analysis. Angiology 2017; 69:195-204. [DOI: 10.1177/0003319717709175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gamze Aslan
- Department of Cardiology, Koc University Hospital, Istanbul, Turkey
| | - Baris Afsar
- Department of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, “C.I. PARHON” University Hospital, “Grigore T. Popa” University of Medicine, Iaşi, Romania
| | - Asiye Kanbay
- Department of Pulmonary Medicine, Sleep Disorders Unit, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | - Oguzhan Sal
- Koc University School of Medicine, Istanbul, Turkey
| | - Caghan Benli
- Koc University School of Medicine, Istanbul, Turkey
| | | | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, “C.I. PARHON” University Hospital, “Grigore T. Popa” University of Medicine, Iaşi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
1267
|
Wickwire EM. Making Dollars and Sense of SAVE. J Clin Sleep Med 2017; 13:765-766. [PMID: 28260592 DOI: 10.5664/jcsm.6606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Emerson M Wickwire
- Department of Psychiatry and Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
1268
|
Thomas RJ, Bianchi MT. Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details. J Clin Sleep Med 2017; 13:657-664. [PMID: 28095974 DOI: 10.5664/jcsm.6574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/09/2016] [Indexed: 11/13/2022]
|
1269
|
Affiliation(s)
- D A Calhoun
- Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
1270
|
Hernigou J, Dakhil B, Belmont L, Couffinhal JC, Bagan P. [Sleep apnea syndrome and abdominal aortic aneurysm: Study of the prevalence of sleep apnea syndrome in patients with aneurysm and research of association. Clinical study on 52 patients]. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:162-169. [PMID: 28705405 DOI: 10.1016/j.jdmv.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Prevalence of abdominal aortic aneurysms (AAA) in Europe is between 4.1 % and 8.9 %. The risk of rupture of AAA is related to the evolution of its diameter. The role of sleep apnea (SA) remains still discussed. The objective of this study was to study the prevalence of SA in patients presenting with AAA in comparison with the general population as well as the relation between the AAA diameter and the severity of SA. MATERIALS AND METHODS Between June 2012 and December 2014, we included all patients referred for surgical treatment of an AAA. All the patients had a preoperative polysomnography and angio-scanner. An apnea/hypopnea index (AHI)>10/h was chosen for the diagnosis of SA. SA prevalence was compared with the prevalence in general population. The patients were also divided into two groups according to the severity of SA: group 1 (no SA and light SAS); group 2 (moderate and severe SA). RESULTS Fifty-two patients were included. Fifty-six percent of the patients presented SA - prevalence was significantly higher than in the general population (56 vs. 8 %, P<0.001). The distribution of the two groups was: group 1, n=27 patients, group 2, n=25 patients. AAA diameter and BMI were higher in group 2 than in group 1, respectively 61mm vs. 55mm, P=0.03 and 28 vs. 23, P=0.02. CONCLUSION Prevalence of SA in patients with an AAA seems to be significantly higher than in general population. The growth of the aneurysm seems to be linked to the severity of SA.
Collapse
Affiliation(s)
- J Hernigou
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
| | - B Dakhil
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - L Belmont
- Service de pneumologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - J C Couffinhal
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| | - P Bagan
- Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France
| |
Collapse
|
1271
|
Relation of Obstructive Sleep Apnea and a Common Variant at Chromosome 4q25 to Atrial Fibrillation. Am J Cardiol 2017; 119:1387-1391. [PMID: 28258728 DOI: 10.1016/j.amjcard.2017.01.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
Abstract
Obstructive sleep apnea (OSA) and single nucleotide polymorphisms (SNPs) at the 4q25 locus are associated with increased risk of atrial fibrillation (AF). Whether these associations are independent of traditional risk factors for AF remains unknown. Using billing code queries and manual chart review, we assembled a cohort of adults that underwent overnight polysomnography and at least 1 12-lead electrocardiogram. Case status was defined by electrocardiographic data in support of AF or documentation of AF by a staff cardiologist. Controls were defined by a lack of primary evidence of AF and absence of a diagnosis of AF in the medical record. OSA severity was categorized based on Apnea-Hypopnea Index. Genotyping for a key 4q25 SNP (rs2200733) was performed using the Sequenom platform. Logistic regression was used to test for associations of AF with OSA category and 4q25 SNP genotype while adjusting for age, gender, body mass index, ancestry, hypertension status, and heart failure status. The cohort consisted of 674 subjects (62 ± 13 years; 44% women), including 132 patients with AF. After adjustment for established risk factors, the association between AF and OSA severity was borderline significant (odds ratio 1.2, 95% CI 1.0 to 1.5). The association between AF and 4q25 SNP status remained significant in a fully adjusted model that included OSA severity (odds ratio 1.5, 95% CI 1.3 to 5.7). In conclusion, OSA severity and the chromosome 4q25 SNP genotype were associated with AF status independent of clinical risk factors. Knowledge of AF-related SNPs may enhance AF risk stratification for those undergoing polysomnography.
Collapse
|
1272
|
Ayas NT, Bhattacharjee R, Pack AI. AJRCCM: 100-Y ear A nniversary.Sleep-Disordered Breathing: Still the New Kid on the Block. Am J Respir Crit Care Med 2017; 195:1107-1111. [DOI: 10.1164/rccm.201701-0199ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Najib T. Ayas
- Department of MedicineUniversity of British ColumbiaVancouver, British Columbia, Canada
| | - Rakesh Bhattacharjee
- Department of PediatricsUniversity of California, San DiegoSan Diego, Californiaand
| | - Allan I. Pack
- Department of MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania
| |
Collapse
|
1273
|
Cistulli PA, Celermajer DS. Endothelial Dysfunction and Obstructive Sleep Apnea: The Jury Is Still Out! Am J Respir Crit Care Med 2017; 195:1135-1137. [DOI: 10.1164/rccm.201701-0237ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter A. Cistulli
- Charles Perkins CentreUniversity of SydneySydney, New South Wales, Australia
- Department of Respiratory and Sleep MedicineRoyal North Shore HospitalSydney, New South Wales, Australiaand
| | - David S. Celermajer
- Department of CardiologyRoyal Prince Alfred Hospital and University of SydneySydney, New South Wales, Australia
| |
Collapse
|
1274
|
Johnson KG, Johnson DC. Cognitive dysfunction: another reason to treat obstructive sleep apnea in stroke patients. Sleep Med 2017; 33:191-192. [DOI: 10.1016/j.sleep.2016.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022]
|
1275
|
Pépin JL. Syndrome d’apnées obstructives du sommeil : redéfinir les parcours de soins et accéder à la médecine personnalisée. Presse Med 2017; 46:465-467. [DOI: 10.1016/j.lpm.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
1276
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 2017; 136:e137-e161. [PMID: 28455343 DOI: 10.1161/cir.0000000000000509] [Citation(s) in RCA: 1891] [Impact Index Per Article: 270.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Biykem Bozkurt
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Javed Butler
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Donald E Casey
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Monica M Colvin
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Mark H Drazner
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Gerasimos S Filippatos
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Gregg C Fonarow
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Michael M Givertz
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Steven M Hollenberg
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - JoAnn Lindenfeld
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Frederick A Masoudi
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Patrick E McBride
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Pamela N Peterson
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Lynne Warner Stevenson
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| | - Cheryl Westlake
- Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. ACP Representative. ISHLT Representative. HFSA Representative. CHEST Representative. ACC/AHA Task Force on Performance Measures Representative. AAFP Representative
| |
Collapse
|
1277
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail 2017; 23:628-651. [PMID: 28461259 DOI: 10.1016/j.cardfail.2017.04.014] [Citation(s) in RCA: 429] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
1278
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2017; 70:776-803. [PMID: 28461007 DOI: 10.1016/j.jacc.2017.04.025] [Citation(s) in RCA: 1334] [Impact Index Per Article: 190.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
1279
|
Samson R, Qi A, Jaiswal A, Le Jemtel TH, Oparil S. Obesity-Associated Hypertension: the Upcoming Phenotype in African-American Women. Curr Hypertens Rep 2017; 19:41. [DOI: 10.1007/s11906-017-0738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
1280
|
Meurice JC, Antone E, Gilbert M, Watrin A, Bironneau V. [Continuous positive airway pressure in obstructive sleep apnea]. Presse Med 2017; 46:423-431. [PMID: 28434626 DOI: 10.1016/j.lpm.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022] Open
Abstract
Continuous positive airway pressure (CPAP) is currently the most used and efficient therapy in OSAS. Efficiency of CPAP on sleep respiratory disorders is the same whether in fixed or automatic mode. Larger studies are required to evaluate their respective beneficial impact on cardiovascular or metabolic complications of OSAS. Close medical monitoring is necessary during the first weeks of CPAP therapy. Compliance to CPAP therapy is crucial for efficacy in preventing cardiovascular or metabolic complications of OSAS. As beneficial effects of CPAP in obese patients are modest, on blood pressure levels and metabolic disorders, its use has to be part of a comprehensive care of OSAS and related comorbidities.
Collapse
Affiliation(s)
- Jean Claude Meurice
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France.
| | - Elise Antone
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Mylene Gilbert
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Audrey Watrin
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Vanessa Bironneau
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France
| |
Collapse
|
1281
|
Liu A, Abbasi F, Kim SH, Ariel D, Lamendola C, Cardell J, Xu S, Patel S, Tomasso V, Mojaddidi H, Grove K, Tsao PS, Kushida CA, Reaven GM. Effect of Pioglitazone on Cardiometabolic Risk in Patients With Obstructive Sleep Apnea. Am J Cardiol 2017; 119:1205-1210. [PMID: 28219664 DOI: 10.1016/j.amjcard.2016.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 11/25/2022]
Abstract
Prevalence of insulin resistance is increased in patients with obstructive sleep apnea (OSA). Because insulin resistance is an independent predictor of cardiovascular disease (CVD), this study was initiated to see if pioglitazone administration would improve insulin sensitivity and thereby decrease risk of CVD in overweight/obese, nondiabetic, insulin-resistant patients with untreated OSA. Patients (n = 30) were administered pioglitazone (45 mg/day) for 8 weeks, and measurements were made before and after intervention of insulin action (insulin-mediated glucose uptake by the insulin suppression test), C-reactive protein, lipid/lipoprotein profile, and gene expression profile of periumbilical subcutaneous fat tissue. Insulin sensitivity increased 31% (p <0.001) among pioglitazone-treated subjects, associated with a decrease in C-reactive protein concentration (p ≤0.001), a decrease in plasma triglyceride, and increase in high-density lipoprotein cholesterol concentrations (p ≤0.001), accompanied by significant changes in apolipoprotein A1 and B concentrations and lipoprotein subclasses known to decrease CVD risk. In addition, subcutaneous adipose tissue gene expression profile showed a 1.6-fold (p <0.01) increase in GLUT4 expression and decreased expression in 5 of 9 inflammatory genes (p <0.05). In conclusion, enhanced insulin sensitivity can significantly decrease multiple cardiometabolic risk factors in patients with untreated OSA, consistent with the view that coexisting insulin resistance plays an important role in the association between OSA and increased risk of CVD.
Collapse
|
1282
|
Ng Y, Joosten SA, Edwards BA, Turton A, Romios H, Samarasinghe T, Landry S, Mansfield DR, Hamilton GS. Oxygen Desaturation Index Differs Significantly Between Types of Sleep Software. J Clin Sleep Med 2017; 13:599-605. [PMID: 28212692 DOI: 10.5664/jcsm.6552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/19/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to compare the oxygen desaturation index (ODI) generated by two different sleep software systems. METHODS Participants undergoing diagnostic polysomnography for suspected obstructive sleep apnea underwent simultaneous oximetry recording using the ResMed ApneaLink Plus device (AL) and Compumedics Profusion PSG3 system (Comp). The ODI was calculated by the algorithms in the respective software of each system. To determine if differences were due to algorithm or recording devices, the Comp software was also used to generate ODI values using oximetry data from the AL. RESULTS In 106 participants, there was good correlation but poor agreement in the ODI generated by the two systems. AL ODI values tended to be higher than Comp ODI values, but with significant variability. For ODI4%, bias was 4.4 events/h (95% limits of agreement -5.8 to 14.6 events/h). There was excellent correlation and agreement when the same oximetry raw data was analyzed by both systems. For ODI4%, bias was 0.03 events/h (95% limits of agreement -2.7 to 2.8 events/h). Similar results were evident when the ODI3% was used. CONCLUSIONS There is a clinically significant difference in ODI values generated by the two systems, likely due to device signal processing, rather than difference in ODI calculation algorithms.
Collapse
Affiliation(s)
- Yvonne Ng
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Simon A Joosten
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Anthony Turton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Helen Romios
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Thilini Samarasinghe
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,Hudson Institute of Medical Research, Victoria, Australia
| | - Shane Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Darren R Mansfield
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia
| |
Collapse
|
1283
|
Türoff A, Thiem U, Fox H, Spießhöfer J, Bitter T, Tamisier R, Punjabi NM, Horstkotte D, Oldenburg O. Sleep duration and quality in heart failure patients. Sleep Breath 2017; 21:919-927. [PMID: 28389910 DOI: 10.1007/s11325-017-1501-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/19/2017] [Accepted: 04/04/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients. METHODS Two hundred fifty consecutive patients with HF-REF (NYHA class ≥II, ejection fraction ≤45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory. RESULTS Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults. CONCLUSIONS HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB.
Collapse
Affiliation(s)
- Anke Türoff
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
- Emergency Department, Asklepios Klinik Wansbek, Hamburg, Germany
| | - Ulrich Thiem
- Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany
| | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Jens Spießhöfer
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
- Department of Pulmonology, Hanover Medical School, Hanover, Germany
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1042, Grenoble Alps University and Sleep, Exercise and Physiology Laboratory, EFCR, Grenoble University Hospital, Grenoble, France
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| |
Collapse
|
1284
|
Wolley MJ, Pimenta E, Calhoun D, Gordon RD, Cowley D, Stowasser M. Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoea. J Hum Hypertens 2017; 31:561-567. [PMID: 28382959 DOI: 10.1038/jhh.2017.28] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/17/2017] [Accepted: 02/22/2017] [Indexed: 01/22/2023]
Abstract
Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment of PA improves sleep apnoea parameters in these patients. We therefore aimed to determine whether specific medical or surgical treatment of PA improves OSA, as measured by the apnoea-hypopnoea index (AHI). We recruited patients undergoing diagnostic workup for PA if they had symptoms suggestive of OSA. Patients with confirmed PA underwent polysomnography (PSG) at baseline and again at least 3 months after specific treatment for PA. Of 34 patients with PA, 7 (21%) had no evidence of OSA (AHI <5), 9 (26%) had mild (AHI ⩾5 and <15), 8 (24%) moderate (AHI ⩾15 and <30) and 10 (29%) severe OSA (AHI ⩾30). Body mass index tertile, neck circumference and 24 h urinary sodium correlated with the AHI. Twenty patients had repeat PSG performed after treatment for PA (mineralocorticoid receptor antagonists in 13 with bilateral PA and adrenalectomy in 7 with unilateral PA). In this group the median (s.d.) AHI reduced from 22.5 (14.7) to 12.3 (12.1) (P=0.02). Neck circumference reduced with PA treatment (41.6 vs 41.2 cm, P=0.012). OSA is common in patients with primary aldosteronism and may improve with specific therapy for this disease. Aldosterone and sodium-mediated fluid retention in the upper airways and neck region may be a potential mechanism for this relationship.
Collapse
Affiliation(s)
- M J Wolley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - E Pimenta
- Experimental Medicine CV/Hem, Clinical Sciences, Global Drug Discovery, Bayer Pharma AG, Wuppertal, Germany
| | - D Calhoun
- Sleep/Wake Disorders Center, Division of Pulmonary, Allergy and Critical Care Medicine and Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R D Gordon
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - D Cowley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - M Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| |
Collapse
|
1285
|
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is a significant risk factor for systemic hypertension and other cardiovascular diseases. While this relationship has been firmly established, a detailed understanding of how OSA leads to hypertension is lacking. This review will examine the emerging idea that the gut microbiota plays a role in the development of hypertension, including that associated with OSA. RECENT FINDINGS Disruption of the normal composition of the gut microbiota, termed dysbiosis, has been identified in a number of metabolic and cardiovascular diseases, including diabetes, obesity, and atherosclerosis. Recently, a number of studies have demonstrated gut dysbiosis in various animal models of hypertension as well as in hypertensive patients. Evidence is now emerging that gut dysbiosis plays a causal role in the development of OSA-induced hypertension. In this review, we will examine the evidence that gut dysbiosis plays a role in OSA-induced hypertension. We will discuss potential mechanisms linking OSA to gut dysbiosis, examine how gut dysbiosis may be linked to hypertension, and highlight how this understanding may be utilized for the development of future therapeutics.
Collapse
Affiliation(s)
- David J Durgan
- Department of Anesthesiology, Baylor College of Medicine, One Baylor Plaza, Room 434D, Houston, TX, 77030, USA.
| |
Collapse
|
1286
|
A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome. Sci Rep 2017; 8:45901. [PMID: 28374832 PMCID: PMC5379203 DOI: 10.1038/srep45901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (−14324, −13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.
Collapse
|
1287
|
Ferini-Strambi L, Lombardi GE, Marelli S, Galbiati A. Neurological Deficits in Obstructive Sleep Apnea. Curr Treat Options Neurol 2017; 19:16. [DOI: 10.1007/s11940-017-0451-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
1288
|
Zhao YY, Wang R, Gleason KJ, Lewis EF, Quan SF, Toth CM, Morrical M, Rueschman M, Weng J, Ware JH, Mittleman MA, Redline S. Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep 2017; 40:3737623. [PMID: 28419387 PMCID: PMC5806548 DOI: 10.1093/sleep/zsx040] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives The long-term effect of continuous positive airway pressure (CPAP) on health-related quality of life (HRQOL) in patients with high cardiovascular disease risk and obstructive sleep apnea (OSA) without severe sleepiness is uncertain. We aimed to determine the effect of CPAP treatment on HRQOL in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. Methods In this randomized, controlled, parallel group study, 169 participants were assigned to treatment with CPAP or the control group (conservative medical therapy [CMT] or CMT with sham CPAP). Analyses were based on an intention-to-treat approach. Linear mixed effect models were fitted to compare the changes in the Medical Outcomes Study Short Form-36 (SF-36) and in subjective sleepiness (Epworth Sleepiness Scale [ESS]) between groups from baseline to the average of 6- and 12-month measurements. Results CPAP improved several domains of HRQOL including bodily pain (treatment effect 9.7 [95% confidence interval, CI 3.9 to 15.4]; p = .001), vitality (5.7 [95% CI 1.5 to 9.9]; p = .008), general health (8.2 [95% CI 3.7 to 12.7]; p < .001), physical functioning (5.5 [95% CI 1.1 to 10.0]; p = .016), and the physical health summary score (3.3 [95% CI 1.4 to 5.3]; p = .001). CPAP also resulted in less daytime sleepiness (mean change in ESS -1.0 point [95% CI -2.0 to -0.0]; p = .040). Conclusions In patients with moderate-severe OSA at high risk of cardiovascular events and without severe sleepiness, CPAP improved daytime sleepiness and multiple domains of HRQOL over 6 to 12 months of follow-up, with the largest improvement observed for bodily pain.
Collapse
Affiliation(s)
- Ying Y Zhao
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J Gleason
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Eldrin F Lewis
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Stuart F Quan
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Claudia M Toth
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael Morrical
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jia Weng
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - James H Ware
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Murray A Mittleman
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
1289
|
Benoist L, de Ruiter M, de Lange J, de Vries N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med 2017; 34:109-117. [PMID: 28522078 DOI: 10.1016/j.sleep.2017.01.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effectiveness of positional therapy (PT) with the sleep position trainer (SPT) to oral appliance therapy (OAT) in patients with mild-to-moderate positional obstructive sleep apnea (POSA). METHODS Multicenter, prospective, randomized, controlled trial. Patients with mild-to-moderate POSA (apnea-hypopnea index (AHI) ≥5 ≤ 30/hour sleep) were randomized for PT or OAT. Polysomnography was repeated after 3 months. Efficacy, adherence, mean disease alleviation (MDA), quality of life, dropouts and adverse events were evaluated. RESULTS A total of 177 patients were screened for the study; 99 underwent randomization and 81 completed the study. Intention-to-treat (ITT) analysis of median [IQR] AHI showed a reduction in the PT group from 13.0 [9.7-18.5] to 7.0 [3.8-12.8], p < 0.001 and in the OAT group from 11.7 [9.0-16.2] to 9.1 [4.9-11.7], p < 0.001. Mean adherence (≥4 h/night, ≥5 days/week) was 89.3 ± 22.4% for SPT versus 81.3 ± 30.0% in OAT patients, p = 0.208. CONCLUSIONS Oral appliance therapy and positional therapy were equally effective in reducing the median AHI in patients with mild-to-moderate POSA. The results of this study have important implications for future OSA treatment guidelines and daily clinical practice. CLINICALTRIALS. GOV NUMBER NCT02045576.
Collapse
Affiliation(s)
- Linda Benoist
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Amsterdam, The Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Maurits de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands; Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
1290
|
Haviv Y, Zini A, Almoznino G, Keshet N, Sharav Y, Aframian DJ. Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea. Oral Dis 2017; 23:629-635. [DOI: 10.1111/odi.12633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Y Haviv
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - A Zini
- Department of Community Dentistry; Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - G Almoznino
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center; Tel-Hashomer, Medical Corps; Israel Defence Forces; Jerusalem Israel
| | - N Keshet
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - DJ Aframian
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| |
Collapse
|
1291
|
Spannella F, Giulietti F, Di Pentima C, Lombardi FE, Borioni E, Sarzani R. Blood Pressure and Metabolic Changes After 3-Month CPAP Therapy in a Very Elderly Obese with Severe Obstructive Sleep Apnea: A Case Report and Review of the Literature. High Blood Press Cardiovasc Prev 2017; 24:341-346. [PMID: 28324596 DOI: 10.1007/s40292-017-0190-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/06/2017] [Indexed: 12/23/2022] Open
Abstract
Age is one of the main risk factor for the presence of obstructive sleep apnea (OSA). This syndrome is associated with hypertension, cardiovascular disease, cognitive impairment and metabolic abnormalities, such as type 2 diabetes. Continuous positive airway pressure (CPAP) represents the gold standard therapy, but its benefit is still to be determined in very elderly. We report the blood pressure and metabolic changes in a very elderly obese with severe OSA after 3-month CPAP therapy. We have evaluated a very elderly obese male affected by severe symptomatic OSA, poor controlled nocturnal hypertension and insulin resistance. After 3-month CPAP therapy, without any changes in drug therapy, we observed a normalization of circadian blood pressure (BP) pattern, an improved insulin sensitivity, together with a reduced resting energy expenditure, despite no significant change in weight. This case report shows the benefits of OSA treatment with CPAP, not only on BP profile, but also on metabolic parameters in a very elderly, a particular type of patient in which scientific evidence is still scant. Further studies are needed to better investigate the relationship between OSA, CPAP therapy and energy expenditure not only in adults but also in elderly patients.
Collapse
Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Chiara Di Pentima
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Francesca Elena Lombardi
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Elisabetta Borioni
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, Italian National Research Centre on Aging, Hospital "U. Sestilli", IRCCS-INRCA, via della Montagnola n. 81, 60127, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
| |
Collapse
|
1292
|
Bironneau V, Goupil F, Ducluzeau PH, Le Vaillant M, Abraham P, Henni S, Dubois S, Paris A, Priou P, Meslier N, Sanguin C, Trzépizur W, Andriantsitohaina R, Martinez MC, Gagnadoux F. Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes. Cardiovasc Diabetol 2017; 16:39. [PMID: 28327146 PMCID: PMC5361793 DOI: 10.1186/s12933-017-0521-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 12/11/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D. Methods 140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function. Results 21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04). Conclusions Moderate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.
Collapse
Affiliation(s)
| | | | - Pierre Henri Ducluzeau
- Unité d'Endocrinologie-Diabétologie-Nutrition, Pole de Médecine, CHRU de Tours, Tours, France
| | - Marc Le Vaillant
- Centre de Recherche Médecine, Sciences, Santé, Santé mentale, Société, CNRS UMR 8211, INSERM UMR U988-EHESS, Villejuif, France
| | - Pierre Abraham
- Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Samir Henni
- Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Séverine Dubois
- Département d'Endocrinologie, Diabétologie, Nutrition, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Audrey Paris
- Service de Pneumologie, Centre Hospitalier, Le Mans, France
| | - Pascaline Priou
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Nicole Meslier
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Claire Sanguin
- Service d'Endocrinologie, Diabétologie, Centre Hospitalier, Le Mans, France
| | - Wojciech Trzépizur
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | | | | | - Frédéric Gagnadoux
- Université Bretagne Loire, INSERM UMR 1063, Angers, France. .,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
| |
Collapse
|
1293
|
Sharma N, Lee J, Youssef I, Salifu MO, McFarlane SI. Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic. ACTA ACUST UNITED AC 2017. [PMID: 28638745 DOI: 10.4172/2167-0277.1000260] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiovascular disease (CVD) is the main cause of death among adult men and women in the USA and impacts millions around the globe. Traditional risk factors for CVD include obesity, diabetes, hypertension and dyslipidemia. The modern-day epidemic of obesity not only increased the rate of CVD but also ushered in an additional CVD risk factor to be added to the list; that is obstructive sleep apnea (OSA). In this review, we discuss the growing epidemic of obesity and OSA, highlighting the common pathogenic hypotheses linking these risk factors to CVD. We will also highlight the therapeutic rationale of OSA as a way to reduce CVD risk.
Collapse
Affiliation(s)
- Navneet Sharma
- Department of Medicine, Divisions of Endocrinology and Nephrology, New York, USA
| | - Justin Lee
- Department of Medicine, Divisions of Endocrinology and Nephrology, New York, USA
| | - Irini Youssef
- Department of Medicine, Divisions of Endocrinology and Nephrology, New York, USA
| | - Moro O Salifu
- Department of Medicine, Divisions of Endocrinology and Nephrology, New York, USA
| | - Samy I McFarlane
- Department of Medicine, Divisions of Endocrinology and Nephrology, New York, USA
| |
Collapse
|
1294
|
Kahwash R, Khayat RN. A Practical Approach to the Identification and Management of Sleep-Disordered Breathing in Heart Failure Patients. Sleep Med Clin 2017; 12:205-219. [PMID: 28477775 DOI: 10.1016/j.jsmc.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sleep-disordered breathing (SDB) is a major health problem affecting much of the general population. Although SDB is responsible for rapid progression of heart failure (HF) and the worsening morbidity and mortality, advanced HF state is associated with accelerated development of SDB. In the face of recent developments in SDB treatment and availability of effective therapeutic options known to improve quality of life, exercise tolerance, and heart function, most HF patients with SDB are left unrecognized and untreated. This article provides an overview of SDB in HF with focus on practical approaches intended to facilitate screening and treatment.
Collapse
Affiliation(s)
- Rami Kahwash
- Section of Heart Failure and Transplant, Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA.
| | - Rami N Khayat
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
1295
|
Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
Collapse
Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| |
Collapse
|
1296
|
Tamisier R, Lévy P, Pépin JL. Do patients with obstructive sleep apnoea deserve new dedicated antihypertensive strategies? Thorax 2017; 72:495-497. [PMID: 28265033 DOI: 10.1136/thoraxjnl-2016-209772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Renaud Tamisier
- HP2 Laboratory, Inserm, Univ. Grenoble Alpes, Grenoble, France.,Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Laboratory, Inserm, Univ. Grenoble Alpes, Grenoble, France.,Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm, Univ. Grenoble Alpes, Grenoble, France.,Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| |
Collapse
|
1297
|
Central Sleep Apnea in Heart Failure. J Am Coll Cardiol 2017; 69:1588-1591. [DOI: 10.1016/j.jacc.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
|
1298
|
Affiliation(s)
- Dieneke Hubbeling
- Wandsworth Crisis and Home Treatment Team, South West London and St George's Mental Health NHS Trust, London, UK
| | - Manhal Zarroug
- Wandsworth Crisis and Home Treatment Team, South West London and St George's Mental Health NHS Trust, London, UK
| | - Robert Bertram
- Wandsworth Crisis and Home Treatment Team, South West London and St George's Mental Health NHS Trust, London, UK
| |
Collapse
|
1299
|
Cortese R, Gileles-Hillel A, Khalyfa A, Almendros I, Akbarpour M, Khalyfa AA, Qiao Z, Garcia T, Andrade J, Gozal D. Aorta macrophage inflammatory and epigenetic changes in a murine model of obstructive sleep apnea: Potential role of CD36. Sci Rep 2017; 7:43648. [PMID: 28240319 PMCID: PMC5327416 DOI: 10.1038/srep43648] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/25/2017] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) affects 8-10% of the population, is characterized by chronic intermittent hypoxia (CIH), and causally associates with cardiovascular morbidities. In CIH-exposed mice, closely mimicking the chronicity of human OSA, increased accumulation and proliferation of pro-inflammatory metabolic M1-like macrophages highly expressing CD36, emerged in aorta. Transcriptomic and MeDIP-seq approaches identified activation of pro-atherogenic pathways involving a complex interplay of histone modifications in functionally-relevant biological pathways, such as inflammation and oxidative stress in aorta macrophages. Discontinuation of CIH did not elicit significant improvements in aorta wall macrophage phenotype. However, CIH-induced aorta changes were absent in CD36 knockout mice, Our results provide mechanistic insights showing that CIH exposures during sleep in absence of concurrent pro-atherogenic settings (i.e., genetic propensity or dietary manipulation) lead to the recruitment of CD36(+)high macrophages to the aortic wall and trigger atherogenesis. Furthermore, long-term CIH-induced changes may not be reversible with usual OSA treatment.
Collapse
Affiliation(s)
- Rene Cortese
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Alex Gileles-Hillel
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Isaac Almendros
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Mahzad Akbarpour
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Ahamed A Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Zhuanghong Qiao
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Tzintzuni Garcia
- Center for Research Informatics, The University of Chicago, Chicago, IL, USA
| | - Jorge Andrade
- Center for Research Informatics, The University of Chicago, Chicago, IL, USA
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
1300
|
Abstract
Obstructive sleep apnea is a common condition, with multiple potential neurocognitive, cardiovascular, and metabolic consequences. Efficacious treatment is available, but patient engagement is typically required for treatment to be effective. Patients with sleep apnea are phenotypically diverse and have individual needs, preferences, and values that impact treatment decisions. There has been a shift in obstructive sleep apnea management from diagnosis to chronic care management. Making treatment decisions that incorporate an individual patient's values and preferences and are personalized for that patient's biology has the potential to improve patient outcomes. A patient-centered care approach in obstructive sleep apnea is reviewed including 1) determining patient-specific needs to guide treatment decisions, 2) understanding patient values, preferences, and other factors impacting treatment decisions and using shared decision-making, 3) enhancing patient education and support to improve treatment adherence, 4) promoting patient engagement, 5) optimizing care coordination, continuity of care, and access to care, and 6) determining and assessing patient-centered outcomes.
Collapse
Affiliation(s)
- Janet Hilbert
- Yale University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
| | - Henry K Yaggi
- Yale University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| |
Collapse
|