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Jenner R, Fatureto‐Borges F, Costa‐Hong V, Lopes HF, Teixeira SH, Marum E, Giorgi DAM, Consolim‐Colombo FM, Bortolotto LA, Lorenzi‐Filho G, Krieger EM, Drager LF. Association of obstructive sleep apnea with arterial stiffness and nondipping blood pressure in patients with hypertension. J Clin Hypertens (Greenwich) 2017; 19:910-918. [PMID: 28429850 PMCID: PMC8030757 DOI: 10.1111/jch.13008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid-femoral pulse wave velocity, 24-hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30-day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non-OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1±2.2 vs 12.7±2.4 m/s, P=.04; women: 11.8±2.4 vs 13.2±2.2 m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non-OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (β=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08-8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.
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Affiliation(s)
- Raimundo Jenner
- Faculty of MedicineUniversity of São PauloSão PauloBrazil
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
- Universidade UNINOVESão PauloBrazil
| | | | - Valéria Costa‐Hong
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
| | - Heno F. Lopes
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
- Universidade UNINOVESão PauloBrazil
| | - Sandra H. Teixeira
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
| | - Elias Marum
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
| | - Dante A. M. Giorgi
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
| | - Fernanda M. Consolim‐Colombo
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
- Universidade UNINOVESão PauloBrazil
| | - Luiz A. Bortolotto
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
| | - Geraldo Lorenzi‐Filho
- Sleep LaboratoryPulmonary DivisionUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Eduardo M. Krieger
- Translational Research ProgramUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Luciano F. Drager
- Hypertension UnitHeart Institute (InCor)University of São Paulo Medical SchoolSão PauloBrazil
- Hypertension UnitRenal DivisionUniversity of São Paulo Medical SchoolSão PauloBrazil
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102
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Jennum P, Tønnesen P, Ibsen R, Kjellberg J. Obstructive sleep apnea: effect of comorbidities and positive airway pressure on all-cause mortality. Sleep Med 2017; 36:62-66. [DOI: 10.1016/j.sleep.2017.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/13/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
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103
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Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, Malhotra A, Martinez-Garcia MA, Mehra R, Pack AI, Polotsky VY, Redline S, Somers VK. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol 2017; 69:841-858. [PMID: 28209226 DOI: 10.1016/j.jacc.2016.11.069] [Citation(s) in RCA: 806] [Impact Index Per Article: 115.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/01/2023]
Abstract
Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.
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Affiliation(s)
- Shahrokh Javaheri
- Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, Ohio.
| | - Ferran Barbe
- Respiratory Department, Institut Ricerca Biomèdica de Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Jerome A Dempsey
- Department of Population Health Sciences and John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rami Khayat
- Sleep Heart Program, the Ohio State University, Columbus, Ohio
| | - Sogol Javaheri
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Atul Malhotra
- Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California
| | | | - Reena Mehra
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Redline
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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104
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Abstract
PURPOSE OF REVIEW Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) and may confer significant stress to the cardiovascular system and increases the risk for future cardiovascular events. The present review will provide updates on the current understanding of the relationship of SDB and common HF biomarkers and the effect of positive airway pressure therapy on these biomarkers, with particular emphasis in patients with coexisting SDB and HF. RECENT FINDINGS Prior studies have examined the relationship between HF biomarkers and SDB, and the effect of SDB treatment on these biomarkers, with less data available in the context of coexisting SDB and HF. Overall, however, the association of SDB and circulating biomarkers has been inconsistent. Further research is needed to elucidate the relationship between biomarkers and SDB in HF, to evaluate the clinical utility of biomarkers over standard methods in large, prospective studies and also to assess the impact of treatment of SDB on these biomarkers in HF via interventional studies.
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Affiliation(s)
- Ying Y Zhao
- Sleep Care Solutions, 1835 Yonge Street, Suite 303, Toronto, Ontario, M4S 1X8, Canada.
| | - Reena Mehra
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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105
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Schoen T, Aeschbacher S, Leuppi JD, Miedinger D, Werthmüller U, Estis J, Todd J, Risch M, Risch L, Conen D. Subclinical sleep apnoea and plasma levels of endothelin-1 among young and healthy adults. Open Heart 2017; 4:e000523. [PMID: 28409007 PMCID: PMC5384465 DOI: 10.1136/openhrt-2016-000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/27/2016] [Accepted: 12/04/2016] [Indexed: 01/04/2023] Open
Abstract
Objective Obstructive sleep apnoea (OSA) is a risk factor for vascular disease and other adverse outcomes. These associations may be at least partly due to early endothelin-1 (ET-1)-mediated endothelial dysfunction (ED). Therefore, we assessed the relationships between subclinical sleep apnoea and plasma levels of ET-1. Methods We performed a population-based study among 1255 young and healthy adults aged 25–41 years. Cardiovascular disease, diabetes or a body mass index >35 kg/m2 were exclusion criteria. Plasma levels of ET-1 were measured using a high-sensitivity, single-molecule counting technology. The relationships between subclinical sleep apnoea (OSA indices: respiratory event index (REI), oxygen desaturation index (ODI), mean night-time blood oxygen saturation (SpO2)) and ET-1 levels were assessed by multivariable linear regression analysis. Results Median age of the cohort was 35 years. Median ET-1 levels were 2.9 (IQR 2.4–3.6) and 2.5 pg/mL (IQR 2.1–3.0) among patients with (n=105; 8%) and without subclinical sleep apnoea (REI 5–14), respectively. After multivariable adjustment, subclinical sleep apnoea remained significantly associated with plasma levels of ET-1 (β=0.13 (95% CI 0.06 to 0.20) p=0.0002 for a REI 5–14; β=0.10 (95% CI 0.03 to 0.16) p=0.003 for an ODI≥5). Every 1% decrease in mean night-time SpO2 increased ET-1 levels by 0.1 pg/mL, an association that remained significant after multivariable adjustment (β=0.02 (95% CI 0.003 to 0.033) p=0.02). Conclusions In this study of young and healthy adults, we found that participants with subclinical sleep apnoea had elevated plasma ET-1 levels, an association that was due to night-time hypoxaemia. Our results suggest that ED may already be an important consequence of subclinical sleep apnoea.
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Affiliation(s)
- Tobias Schoen
- Division of Cardiology, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Joerg D Leuppi
- Medical University Clinic of Baselland and Medical Faculty of Basel, Liestal/Basel, Switzerland
| | - David Miedinger
- Medical University Clinic of Baselland and Medical Faculty of Basel, Liestal/Basel, Switzerland
| | | | | | - John Todd
- Singulex, Inc, Alameda, California, USA
| | - Martin Risch
- Labormedizinisches Zentrum Dr. Risch, Schaan, Liechtenstein.,Division of Laboratory Medicine, Kantonspital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Schaan, Liechtenstein.,Division of Clinical Biochemistry, Medical University Innsbruck, Austria.,Private University, Triesen, Liechtenstein
| | - David Conen
- Cardiovascular Research Institute Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Cardiology Division, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Population Health Research Institute, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
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106
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Xia Y, Fu Y, Wang Y, Qian Y, Li X, Xu H, Zou J, Guan J, Yi H, Meng L, Tang X, Zhu H, Yu D, Zhou H, Su K, Yin S. Prevalence and Predictors of Atherogenic Serum Lipoprotein Dyslipidemia in Women with Obstructive Sleep Apnea. Sci Rep 2017; 7:41687. [PMID: 28134311 PMCID: PMC5278373 DOI: 10.1038/srep41687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with dyslipidemia. However, no study has focused on dyslipidemia in women with OSA. The aim of this study was to determine the prevalence and risk factors for dyslipidemia in women with OSA. Between 2007 and 2013, 570 eligible female patients with suspected OSA were consecutively recruited. The analyzed data consisted of polysomnography parameters, biochemical indicators, and anthropometric measurements. Serum lipid levels and dyslipidemia were compared. Binary logistic regression and multivariate linear regression models were used to determine the independent risk factors influencing serum lipids. After multivariate adjustment, there were essentially no major differences in serum lipid levels among patients with no to mild, moderate, and severe OSA nor did serum lipid levels change with OSA severity. Dyslipidemia in total cholesterol, triglycerides, low-density lipoprotein cholesterol, apolipoproteins(apo) B and apoE increased with OSA severity, but only in non-obese subjects and those <55 years of age. Age, body mass index, waist to hip ratio, glucose and insulin were major risk factors for most serum lipids after multivariate adjustments. Our results indicate that, in women with OSA, age, obesity/central obesity, and insulin resistance are major determinants of dyslipidemia.
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Affiliation(s)
- Yunyan Xia
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Yiqun Fu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Yuyu Wang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Yingjun Qian
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Lili Meng
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Xulan Tang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Huaming Zhu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Dongzhen Yu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Huiqun Zhou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Kaiming Su
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, South Chongqing Road 225, Shanghai, 200020, China
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107
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The relationship between sleep apnea, metabolic dysfunction and inflammation: The gender influence. Brain Behav Immun 2017; 59:211-218. [PMID: 27621224 DOI: 10.1016/j.bbi.2016.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) has been associated with increased risk of cardiovascular morbidity and mortality. Although inflammatory markers may mediate this association, it is unknown the influence of gender in this mechanism. Thus, we aimed to evaluate the interaction effects between OSA and gender on metabolic and inflammatory profile in a population sample. This study is part of EPISONO cohort, in which 1042 participants underwent polysomnography, answered questionnaires, and had their blood collected for analysis of fasting glucose, total cholesterol and fractions, leptin, ghrelin, liver transaminases, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein. The results showed that men with OSA had higher leptin levels, shorter sleep latency and lower N3 sleep stage compared to men control (CTRL). They also presented higher apnea index and number of central apneas compared to both CTRL men and OSA women. In women, OSA was related to longer REM sleep latency, higher apnea-hypopnea index (AHI) during REM sleep and increased TNF-α levels compared to CTRL women. A multivariate model showed that male gender, ghrelin and total cholesterol were negatively associated with TNF-α, while IL-6, triglycerides and hypopnea index were positively associated (R2=0.21). Additionally, gender (men), body mass index, ghrelin, apnea index and smoking were positive predictors of leptin levels (R2=0.55). Of note, postmenopause was associated with changes observed in both TNF-α and AHI during REM sleep in women with OSA. Taken together, our study suggests that OSA consequences may differ between genders and this could indicate a need for different OSA management in women according to their reproductive life's stage.
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108
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Abstract
Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of breathing (central sleep apnoea). In this Clinical Year in Review, we summarise high-impact research from the past year pertaining to management, diagnosis and cardio-metabolic consequences of sleep apnoea.
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Affiliation(s)
- Jonathan C Jun
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Swati Chopra
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Alan R Schwartz
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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109
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Cardiovascular Protection From Severe OSA. Chest 2016; 150:1410-1411. [DOI: 10.1016/j.chest.2016.08.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022] Open
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110
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Caravita S, Vachiéry JL. Obstructive Ventilatory Disorder in Heart Failure-Caused by the Heart or the Lung? Curr Heart Fail Rep 2016; 13:310-318. [PMID: 27817003 DOI: 10.1007/s11897-016-0309-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) is a clinical syndrome frequently associated with airway obstruction, either as a respiratory comorbidity or as a direct consequence of HF pathophysiology. Recognizing the relative contribution of an underlying airway disease as opposed to airway obstruction due to volume overload and left atrial pressure elevation is of importance for the appropriate management of patients affected by HF. This review focuses on "les liaisons dangereuses" between the heart and the lungs, outlying recent advances linking in a vicious circle of chronic obstructive lung disease (COPD) and obstructive sleep apnea (OSA) on one side and HF on the other side. It also discusses the role of pivotal diagnostic tools such as pulmonary function tests and cardiopulmonary exercise test to determine the contribution of HF and COPD to symptoms and clinical status. Treatment implications are discussed as well.
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Affiliation(s)
- Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Pulmonary Hypertension and Heart Failure Clinic, Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
| | - Jean-Luc Vachiéry
- Pulmonary Hypertension and Heart Failure Clinic, Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium. .,Department of Cardiology, CUB Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium.
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111
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Senaratna CV, English DR, Currier D, Perret JL, Lowe A, Lodge C, Russell M, Sahabandu S, Matheson MC, Hamilton GS, Dharmage SC. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health. BMC Public Health 2016; 16:1029. [PMID: 28185594 PMCID: PMC5103243 DOI: 10.1186/s12889-016-3703-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors. Methods We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI). Results Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all). Sleep apnoea was significantly associated with older age (p < 0.001), unemployment (p < 0.001), asthma (p = 0.011), chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002), diabetes (p < 0.001), hypercholesterolemia (p < 0.001), hypertension (p < 0.001), heart attack (p < 0.001), heart failure (p < 0.001), angina (p < 0.001), depression (p < 0.001), post-traumatic stress disorder (p < 0.001), other anxiety disorders (p < 0.001), schizophrenia (p = 0.002), overweight/obesity (p < 0.001), insufficient physical activity (p = 0.006), smoking (p = 0.005), and high alcohol consumption (p < 0.001). Conclusion Health professional-diagnosed sleep apnoea is relatively common, particularly in older males. Associations between sleep apnoea and cardiovascular, metabolic, respiratory, and psychiatric disorders have important clinical and public health implications. As men are especially vulnerable to sleep apnoea as well as some of its chronic co-morbidities, they are potentially a priority group for health interventions. Modifiable lifestyle related factors such as smoking, alcohol consumption, level of physical activity and BMI are possible key foci for interventions.
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Affiliation(s)
- Chamara Visanka Senaratna
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dallas R English
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Dianne Currier
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Jennifer L Perret
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,Institute for Breathing & Sleep, Heidelberg, 3084, Australia
| | - Adrian Lowe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Caroline Lodge
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Melissa Russell
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Sashane Sahabandu
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Melanie C Matheson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Clayton, 3168, Australia.,School of Clinical Sciences, Monash University, Clayton, 3168, Australia
| | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.
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Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2016; 116:663-740. [PMID: 28236412 DOI: 10.1016/j.prosdent.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023]
Abstract
STATEMENT OF PROBLEM It is clear the contemporary dentist is confronted with a blizzard of information regarding materials and techniques from journal articles, advertisements, newsletters, the internet, and continuing education events. While some of that information is sound and helpful, much of it is misleading at best. PURPOSE This review identifies and discusses the most important scientific findings regarding outcomes of dental treatment to assist the practitioner in making evidence-based choices. This review was conducted to assist the busy dentist in keeping abreast of the latest scientific information regarding the clinical practice of dentistry. MATERIAL AND METHODS Each of the authors, who are considered experts in their disciplines, was asked to peruse the scientific literature published in 2015 in their discipline and review the articles for important information that may have an impact on treatment decisions. Comments on experimental methodology, statistical evaluation, and overall validity of the conclusions are included in many of the reviews. RESULTS The reviews are not meant to stand alone but are intended to inform the interested reader about what has been discovered in the past year. The readers are then invited to go to the source if they wish more detail. CONCLUSIONS Analysis of the scientific literature published in 2015 is divided into 7 sections, dental materials, periodontics, prosthodontics, occlusion and temporomandibular disorders, sleep-disordered breathing, cariology, and implant dentistry.
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Affiliation(s)
- Terence E Donovan
- Professor, Biomaterials, University of North Carolina School of Dentistry, Chapel Hill, N.C.
| | | | | | - David R Cagna
- Professor, Advanced Prosthodontics University of Tennessee Health Sciences Center, Memphis, Tenn
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Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev 2016; 35:113-123. [PMID: 27815038 DOI: 10.1016/j.smrv.2016.10.002] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/23/2016] [Accepted: 10/05/2016] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a complex and heterogeneous disorder and the apnea hypopnea index alone can not capture the diverse spectrum of the condition. Enhanced phenotyping can improve prognostication, patient selection for clinical trials, understanding of mechanisms, and personalized treatments. In OSA, multiple condition characteristics have been termed "phenotypes." To help classify patients into relevant prognostic and therapeutic categories, an OSA phenotype can be operationally defined as: "A category of patients with OSA distinguished from others by a single or combination of disease features, in relation to clinically meaningful attributes (symptoms, response to therapy, health outcomes, quality of life)." We review approaches to clinical phenotyping in OSA, citing examples of increasing analytic complexity. Although clinical feature based OSA phenotypes with significant prognostic and treatment implications have been identified (e.g., excessive daytime sleepiness OSA), many current categorizations lack association with meaningful outcomes. Recent work focused on pathophysiologic risk factors for OSA (e.g., arousal threshold, craniofacial morphology, chemoreflex sensitivity) appears to capture heterogeneity in OSA, but requires clinical validation. Lastly, we discuss the use of machine learning as a promising phenotyping strategy that can integrate multiple types of data (genomic, molecular, cellular, clinical) to identify unique, meaningful OSA phenotypes.
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114
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Oktay AA, Lavie CJ, Milani RV, Ventura HO, Gilliland YE, Shah S, Cash ME. Current Perspectives on Left Ventricular Geometry in Systemic Hypertension. Prog Cardiovasc Dis 2016; 59:235-246. [PMID: 27614172 DOI: 10.1016/j.pcad.2016.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 12/11/2022]
Abstract
Hypertension (HTN) is a global health problem and a leading risk factor for cardiovascular disease (CVD) morbidity and mortality. The hemodynamic overload from HTN causes left ventricular (LV) remodeling, which usually manifests as distinct alterations in LV geometry, such as concentric remodeling or concentric and eccentric LV hypertrophy (LVH). In addition to being a common target organ response to HTN, LV geometric abnormalities are well-known independent risk factors for CVD. Because of their prognostic implications and quantifiable nature, changes in LV geometric parameters have commonly been included as an outcome in anti-HTN drug trials. The purpose of this paper is to review the relationship between HTN and LV geometric changes with a focus on (1) diagnostic approach, (2) epidemiology, (3) pathophysiology, (4) prognostic effect and (5) LV response to anti-HTN therapy and its impact on CVD risk reduction.
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Affiliation(s)
- Ahmet Afşin Oktay
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Yvonne E Gilliland
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Sangeeta Shah
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Michael E Cash
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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Maeder MT, Mueller C, Schoch OD, Ammann P, Rickli H. Biomarkers of cardiovascular stress in obstructive sleep apnea. Clin Chim Acta 2016; 460:152-63. [DOI: 10.1016/j.cca.2016.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
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Jehan S, Auguste E, Zizi F, Pandi-Perumal SR, Gupta R, Attarian H, Jean-Louis G, McFarlane SI. Obstructive Sleep Apnea: Women's Perspective. JOURNAL OF SLEEP MEDICINE AND DISORDERS 2016; 3:1064. [PMID: 28239685 PMCID: PMC5323064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The main characteristics of sleep-disordered breathing (SDB) are airflow limitation, chronic intermittent hypoxia, or apnea; which may lead to tissue hypoperfusion and recurrent arousal from sleep. These episodes of hypoxia or apnea can lead to tissue inflammation, and are causal factors of disturbed sleep in both men and women. Several lines of evidence suggest that sleep patterns differ along the lifespan in both male and female subjects, and this may result from the influence of female gonadotropic hormones on sleep. Compared to men, women have more sleep complaints, as women's sleep is not only influenced by gonadotropins, but also by conditions related to these hormones, such as pregnancy. It is therefore not surprising that sleep disturbances are seen during menopause, too. Factors that may play a role in this type of SDB in women include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle factors.
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Affiliation(s)
- Shazia Jehan
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Evan Auguste
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Ferdinand Zizi
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | | | - Ravi Gupta
- Department of Psychiatry, Sleep Clinic, Himalayan Institute of Medical Sciences, India
| | - Hrayr Attarian
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Giradin Jean-Louis
- Departments of Population Health, Center for Healthful Behavior Change, Health and Behavior, New York University School of Medicine, USA
| | - Samy I. McFarlane
- Division of Endocrinology and Medicine, SUNY Downstate Medical Center, USA
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Sánchez-de-la-Torre A, Abad J, Durán-Cantolla J, Mediano O, Cabriada V, Masdeu MJ, Terán J, Masa JF, de la Peña M, Aldomá A, Worner F, Valls J, Barbé F, Sánchez-de-la-Torre M. Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome. PLoS One 2016; 11:e0159207. [PMID: 27416494 PMCID: PMC4944942 DOI: 10.1371/journal.pone.0159207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea-hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level. METHODS We included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA. RESULTS The men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002). CONCLUSIONS This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted.
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Affiliation(s)
- Alicia Sánchez-de-la-Torre
- Respiratory Department. Group of Translational Research in Respiratory Medicine. Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida. Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Respiratory Department, Hosp Universitari Germans Trias I Pujol, Badalona, Barcelona, Catalonia, Spain
| | - Joaquín Durán-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Bio-Araba Research Institute, Araba University Hospital. Department of Medicine of Basque Country University, Vitoria-Gasteiz Spain
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Respiratory Department, Hospital Universitario de Guadalajara. Guadalajara, Spain
| | - Valentín Cabriada
- Respiratory Department, Hospital Universitario Cruces. Bilbao, Spain
| | - María José Masdeu
- Respiratory Department, Hospital Parc Tauli. Sabadell, Barcelona, Catalonia. Spain
| | - Joaquín Terán
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Respiratory Department, Hospital General Yagüe. Burgos, Spain
| | - Juan Fernando Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Respiratory Department, Hospital San Pedro Alcántara, Cáceres, Spain
| | - Mónica de la Peña
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
- Clinic Analysis and Respiratory Services, Hospital Universitari Son Espases, Institut de investigació sanitaria de Palma (IdisPa), Palma de Mallorca, Spain
| | - Albina Aldomá
- Cardiology Department, Hospital Universitari Arnau de Vilanova. IRBLleida, Lleida, Catalonia, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova. IRBLleida, Lleida, Catalonia, Spain
| | - Joan Valls
- Department of Statistics. IRB Lleida, Lleida, Catalonia, Spain
| | - Ferran Barbé
- Respiratory Department. Group of Translational Research in Respiratory Medicine. Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida. Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
| | - Manuel Sánchez-de-la-Torre
- Respiratory Department. Group of Translational Research in Respiratory Medicine. Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida. Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Madrid, Spain
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Medeiros AKL, Coutinho RQ, Barros IML, Costa LOBF, Leite APDL, Bittencourt MS, Lustosa TC, Carvalho MMB, Lira MPF, Ferreira MNL, Lorenzi-Filho G, Drager LF, Pedrosa RP. Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women. Sleep Breath 2016; 21:77-83. [PMID: 27384043 DOI: 10.1007/s11325-016-1374-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with coronary disease among men. However, this association is not clear for women. In this study, we evaluate the association between OSA and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in middle-aged women. METHODS We evaluated consecutive women aged between 45 and 65 years in perimenopause or postmenopause period (with menstrual irregularity-amenorrhea > 60 days), without manifest cardiovascular disease (heart failure, coronary disease, and stroke), from two gynecologic clinics. All patients underwent clinical evaluation, computed tomographic examination for coronary artery calcium (CAC > 100 Agatston units), and portable sleep study. Multiple logistic regression models were used to evaluate the association between OSA and CAC, controlling for traditional risk factors including Framingham Risk Score (FRS), body mass index (BMI), and diabetes. RESULTS We studied 214 women (age 56 years (52-61); BMI 28 kg/m2 (25-31), 25 % diabetes, 62 % hypertension). OSA (apnea-hypopnea index (AHI) ≥5 events/h) was diagnosed in 82 women (38.3 %). CAC was more prevalent in patients with moderate/severe OSA (AHI ≥15 events/h) than in patients without or with mild OSA, 19 % vs 4.5 and 1.6 %, respectively (p < 0.01). Moderate to severe OSA was associated with CAC in unadjusted (odds ratio = 6.25, 95 % CI 1.66-23.52; p < 0.01) and adjusted (odds ratio = 8.19, 95 % CI 1.66-40.32; p = 0.01) logistic regression analysis. CONCLUSION Moderate to severe OSA is independently associated with the presence of CAC in middle-aged women. These results reinforce the concept that women are also susceptible to the cardiovascular consequences of OSA.
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Affiliation(s)
- Ana Kelley L Medeiros
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil
| | - Ricardo Q Coutinho
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil
| | - Isly M L Barros
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil
| | - Laura O B F Costa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil
| | - Ana Paula D L Leite
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil
| | - Marcio S Bittencourt
- University Hospital, University of São Paulo, São Paulo, Brazil.,Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Thais C Lustosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil
| | - Martinha M B Carvalho
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil
| | - Maria Priscila Figueiredo Lira
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil
| | - Moacir N L Ferreira
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Recife, Pernambuclo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo P Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Rua dos Palmares, Recife, Pernambuclo, Brazil. .,Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,Hospital Metropolitano Sul Dom Helder Câmara-IMIP Hospitalar, Cabo de Santo Agostinho, Brazil.
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Korcarz CE, Peppard PE, Young TB, Chapman CB, Hla KM, Barnet JH, Hagen E, Stein JH. Effects of Obstructive Sleep Apnea and Obesity on Cardiac Remodeling: The Wisconsin Sleep Cohort Study. Sleep 2016; 39:1187-95. [PMID: 27091525 PMCID: PMC4863205 DOI: 10.5665/sleep.5828] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/11/2016] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVES To characterize the prospective associations of obstructive sleep apnea (OSA) with future echocardiographic measures of adverse cardiac remodeling. METHODS This was a prospective long-term observational study. Participants had overnight polysomnography followed by transthoracic echocardiography a mean (standard deviation) of 18.0 (3.7) y later. OSA was characterized by the apnea-hypopnea index (AHI, events/hour). Echocardiography was used to assess left ventricular (LV) systolic and diastolic function and mass, left atrial volume and pressure, cardiac output, systemic vascular resistance, and right ventricular (RV) systolic function, size, and hemodynamics. Multivariate regression models estimated associations between log10(AHI+1) and future echocardiographic findings. A secondary analysis looked at oxygen desaturation indices and future echocardiographic findings. RESULTS At entry, the 601 participants were mean (standard deviation) 47 (8) y old (47% female). After adjustment for age, sex, and body mass index, baseline log10(AHI+1) was associated significantly with future reduced LV ejection fraction and tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm. After further adjustment for cardiovascular risk factors, participants with higher baseline log10(AHI+1) had lower future LV ejection fraction (β = -1.35 [standard error = 0.6]/log10(AHI+1), P = 0.03) and higher odds of TAPSE ≤ 15 mm (odds ratio = 6.3/log10(AHI+1), 95% confidence interval = 1.3-30.5, P = 0.02). SaO2 desaturation indices were associated independently with LV mass, LV wall thickness, and RV area (all P < 0.03). CONCLUSIONS OSA is associated independently with decreasing LV systolic function and with reduced RV function. Echocardiographic measures of adverse cardiac remodeling are strongly associated with OSA but are confounded by obesity. Hypoxia may be a stimulus for hypertrophy in individuals with OSA.
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Affiliation(s)
- Claudia E. Korcarz
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul E. Peppard
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Terry B. Young
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carrie B. Chapman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - K. Mae Hla
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jodi H. Barnet
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Erika Hagen
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James H. Stein
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Silvani A, Calandra-Buonaura G, Dampney RAL, Cortelli P. Brain-heart interactions: physiology and clinical implications. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0181. [PMID: 27044998 DOI: 10.1098/rsta.2015.0181] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 05/03/2023]
Abstract
The brain controls the heart directly through the sympathetic and parasympathetic branches of the autonomic nervous system, which consists of multi-synaptic pathways from myocardial cells back to peripheral ganglionic neurons and further to central preganglionic and premotor neurons. Cardiac function can be profoundly altered by the reflex activation of cardiac autonomic nerves in response to inputs from baro-, chemo-, nasopharyngeal and other receptors as well as by central autonomic commands, including those associated with stress, physical activity, arousal and sleep. In the clinical setting, slowly progressive autonomic failure frequently results from neurodegenerative disorders, whereas autonomic hyperactivity may result from vascular, inflammatory or traumatic lesions of the autonomic nervous system, adverse effects of drugs and chronic neurological disorders. Both acute and chronic manifestations of an imbalanced brain-heart interaction have a negative impact on health. Simple, widely available and reliable cardiovascular markers of the sympathetic tone and of the sympathetic-parasympathetic balance are lacking. A deeper understanding of the connections between autonomic cardiac control and brain dynamics through advanced signal and neuroimage processing may lead to invaluable tools for the early detection and treatment of pathological changes in the brain-heart interaction.
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Affiliation(s)
| | - Giovanna Calandra-Buonaura
- Autonomic Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy IRCCS, Institute of Neurological Sciences of Bologna, Bellaria University Hospital, Block G, Via Altura 3, 40139 Bologna, Italy
| | - Roger A L Dampney
- School of Medical Sciences (Physiology) and Bosch Institute for Biomedical Research, University of Sydney, Sidney, New South Wales, Australia
| | - Pietro Cortelli
- Autonomic Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy IRCCS, Institute of Neurological Sciences of Bologna, Bellaria University Hospital, Block G, Via Altura 3, 40139 Bologna, Italy
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Maeder MT, Schoch OD, Rickli H. A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vasc Health Risk Manag 2016; 12:85-103. [PMID: 27051291 PMCID: PMC4807890 DOI: 10.2147/vhrm.s74703] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.
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Affiliation(s)
- Micha T Maeder
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Otto D Schoch
- Department of Respiratory Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
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Sex Effect on Obesity Indices and Metabolic Outcomes in Patients with Obese Obstructive Sleep Apnea and Type 2 Diabetes After Laparoscopic Roux-en-Y Gastric Bypass Surgery: a Preliminary Study. Obes Surg 2016; 26:2629-2639. [DOI: 10.1007/s11695-016-2140-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Analysis of large-volume data holds promise for improving the application of precision medicine to sleep, including improving identification of patient subgroups who may benefit from alternative therapies. Big data used within the health care system also promises to facilitate end-to-end screening, diagnosis, and management of sleep disorders; improve the recognition of differences in presentation and susceptibility to sleep apnea; and lead to improved management and outcomes. To meet the vision of personalized, precision therapeutics and diagnostics and improving the efficiency and quality of sleep medicine will require ongoing efforts, investments, and change in our current medical and research cultures.
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Mokhlesi B, Ham SA, Gozal D. The effect of sex and age on the comorbidity burden of OSA: an observational analysis from a large nationwide US health claims database. Eur Respir J 2016; 47:1162-9. [DOI: 10.1183/13993003.01618-2015] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/14/2015] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent condition but studies exploring the burden of OSA-associated comorbidities have been limited by small sample sizes with underrepresentation of women.We queried the Truven Health MarketScan Research Databases 2003–2012, which is a collection of health insurance claims for working adults and retirees with employer-sponsored health insurance. Adults with a diagnostic code for OSA with at least 12 months of follow-up from the index date of OSA diagnosis were compared to a matched random sample. Comorbidities were assessed using International Classification of Diseases, Ninth Edition, codes. A logistic regression model was constructed to test the independent association between OSA and comorbidities.Our cohort included 1 704 905 patients with OSA and 1 704 417 matched controls. All comorbidities were significantly more prevalent in OSA patients. Type 2 diabetes and ischaemic heart disease were more prevalent in men but hypertension and depression were more prevalent in women with OSA. In contrast, the sex differences in the prevalence of congestive heart failure, arrhythmias and stroke were less pronounced. The prevalence of comorbidities increased with age but the effect of age varied based on the specific comorbidity. The divergence between OSA and controls was more pronounced after the sixth decade of life for most cardiovascular diseases (i.e.heart failure, ischaemic heart disease, stroke and arrhythmias), while depression exhibited an opposite trend. In a fully adjusted model, the odds of all comorbidities were significantly increased in OSA patients.In a large, nationally representative sample of working and retired people, OSA is strongly associated with significant comorbidities in both men and women with unique sex differences emerging.
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