151
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Ebrahimi H, Mahmoudi P, Zamani F, Moradi S. Neck circumference and metabolic syndrome: A cross-sectional population-based study. Prim Care Diabetes 2021; 15:582-587. [PMID: 33602607 DOI: 10.1016/j.pcd.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to investigate the possible association of neck circumference with cardiometabolic risk factors, and to find out the possible cutoff points of neck circumference for the diagnosis of metabolic syndrome among the Iranian population. METHOD This is a cross-sectional study in 1619 participants who were selected through clustered random sampling, as a part of a health cohort in Amol, Iran. Diagnosis of metabolic syndrome (MetS) was based on the modified criteria of the National Cholesterol Educational Program Adult Treatment Panel (NCEP ATP III). Associations of neck circumference with Mets and its components were studied using logistic regression. The optimal cutoff point of neck circumference for MetS diagnosis was calculated based on the Youden index. RESULTS Metabolic syndrome was diagnosed in 433 (26.7%) of patients. Neck circumference was shown to be significantly associated with central obesity, hypertension, hypertriglyceridemia, impaired fasting glucose, and low serum high-density lipoprotein (HDL) level, as well as MetS. The optimal cutoff points of neck circumference in the diagnosis of MetS are 36 cm and 42 cm for women and men, respectively. Sensitivity of the optimal cut-off point of NC for diagnosing patients with MetS was higher in women compared to men (70.6% compared to 55.9%). CONCLUSION A significant association was observed between neck circumference and the presence of MetS among the Iranian population and neck circumference can be offered as a new index in screening and diagnosis for MetS and assessing cardiometabolic risk factors.
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Affiliation(s)
- Hooman Ebrahimi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Mahmoudi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedighe Moradi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
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152
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Sanz-Rubio D, Khalyfa A, Qiao Z, Ullate J, Marin JM, Kheirandish-Gozal L, Gozal D. Cell-Selective Altered Cargo Properties of Extracellular Vesicles Following In Vitro Exposures to Intermittent Hypoxia. Int J Mol Sci 2021; 22:ijms22115604. [PMID: 34070558 PMCID: PMC8198838 DOI: 10.3390/ijms22115604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 01/09/2023] Open
Abstract
Intermittent hypoxia (IH), a hallmark of obstructive sleep apnea (OSA), is associated with cardiovascular and metabolic dysfunction. However, the mechanisms underlying these morbidities remain poorly delineated. Extracellular vesicles (EVs) mediate intercellular communications, play pivotal roles in a multitude of physiological and pathological processes, and could mediate IH-induced cellular effects. Here, the effects of IH on human primary cells and the release of EVs were examined. Microvascular endothelial cells (HMVEC-d), THP1 monocytes, THP1 macrophages M0, THP1 macrophages M1, THP1 macrophages M2, pre-adipocytes, and differentiated adipocytes (HAd) were exposed to either room air (RA) or IH for 24 h. Secreted EVs were isolated and characterized using transmission electron microscopy, nanoparticle tracking analysis, and Western blotting. The effects of each of the cell-derived EVs on endothelial cell (EC) monolayer barrier integrity, on naïve THP1 macrophage polarity, and on adipocyte insulin sensitivity were also evaluated. IH did not alter EVs cell quantal release, but IH-EVs derived from HMVEC-d (p < 0.01), THP1 M0 (p < 0.01) and HAd (p < 0.05) significantly disrupted HMVEC-d monolayer integrity, particularly after H2O2 pre-conditioning. IH-EVs from HMVEC-d and THP1 M0 elicited M2-polarity changes did not alter insulin sensitivity responses. IH induces cell-selective changes in EVs cargo, which primarily seem to target the emergence of endothelial dysfunction. Thus, changes in EVs cargo from selected cell sources in vivo may play causal roles in some of the adverse outcomes associated with OSA.
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Affiliation(s)
- David Sanz-Rubio
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
| | - Abdelnaby Khalyfa
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Correspondence: ; Tel.: +1-573-884-7685
| | - Zhuanhong Qiao
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - Jorge Ullate
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - José M. Marin
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), 28029 Madrid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
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153
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Stevens D, Appleton S, Melaku Y, Martin S, Adams R, Wittert G. Participation in physical activity is associated with reduced nocturnal hypoxaemia in males. ERJ Open Res 2021; 7:00852-2020. [PMID: 34046492 PMCID: PMC8141832 DOI: 10.1183/23120541.00852-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/19/2021] [Indexed: 11/07/2022] Open
Abstract
Moderate to vigorous physical activity (MVPA) interventions reduce the severity of obstructive sleep apnoea (OSA); however, little epidemiological research exists to confirm these findings. 789 participants from the population-based Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent polysomnography. MVPA was assessed using the Active Australia questionnaire, which was completed when participants were first recruited to the MAILES study (2002–2006), and again in 2010. Multinomial logistic regressions established odds ratio between OSA severity categories with MVPA, whilst adjusted linear models determined associations between OSA metrics with MVPA. Cross-sectionally, each hour of MVPA was associated with reduced severity of mean oxygen desaturation (unstandardised β (B)=−0.002, p=0.043) and reduced time below 90% oxygen saturation (B=−0.03, p=0.034). Longitudinally, each hour increase in MVPA was associated with a 4% reduction in the odds of severe OSA and less severe mean oxygen desaturation (B=−0.003, p=0.014), time below 90% oxygen saturation (B=−0.02, p=0.02), and mean duration of apnoeas (B=−0.004, p=0.016). MVPA is associated with reduced hypoxaemia in a cohort of community dwelling males, approximately half of whom had untreated OSA. As nocturnal intermittent hypoxaemia is associated with cardiometabolic disorders, MVPA may offer protection for patients with OSA. This study provides epidemiological evidence that moderate to vigorous physical activity is associated with less severe OSA-induced hypoxaemia. This result suggests that MVPA should be actively implemented in treatment regimens for people with OSA.https://bit.ly/3a9asiZ
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Affiliation(s)
- David Stevens
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Centre for Nutritional and Gastrointestinal Diseases, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Sarah Appleton
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Yohannes Melaku
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Sean Martin
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Robert Adams
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Adelaide, Australia
| | - Gary Wittert
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Centre for Male Health and Health and Wellbeing, The University of Adelaide, and the South Australian Health and Medical Research Institute, SA, Australia
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154
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Hanif U, Leary E, Schneider L, Paulsen R, Morse AM, Blackman A, Schweitzer P, Kushida CA, Liu S, Jennum P, Sorensen H, Mignot E. Estimation of Apnea-Hypopnea Index using Deep Learning on 3D Craniofacial Scans. IEEE J Biomed Health Inform 2021; 25:4185-4194. [PMID: 33961569 DOI: 10.1109/jbhi.2021.3078127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by decreased breathing events that occur through the night, with severity reported as the apnea-hypopnea index (AHI), which is associated with certain craniofacial features. In this study, we used data from 1366 patients collected as part of Stanford Technology Analytics and Genomics in Sleep (STAGES) across 11 US and Canadian sleep clinics and analyzed 3D craniofacial scans with the goal of predicting AHI, as measured using gold standard nocturnal polysomnography (PSG). First, the algorithm detects pre-specified landmarks on mesh objects and aligns scans in 3D space. Subsequently, 2D images and depth maps are generated by rendering and rotating scans by 45-degree increments. Resulting images were stacked as channels and used as input to multi-view convolutional neural networks, which were trained and validated in a supervised manner to predict AHI values derived from PSGs. The proposed model achieved a mean absolute error of 11.38 events/hour, a Pearson correlation coefficient of 0.4, and accuracy for predicting OSA of 67% using 10-fold cross-validation. The model improved further by adding patient demographics and variables from questionnaires. We also show that the model performed at the level of three sleep medicine specialists, who used clinical experience to predict AHI based on 3D scan displays. Finally, we created topographic displays of the most important facial features used by the model to predict AHI, showing importance of the neck and chin area. The proposed algorithm has potential to serve as an inexpensive and efficient screening tool for individuals with suspected OSA.
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155
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Huang L, Gao X. The interaction of obesity and craniofacial deformity in obstructive sleep apnea. Dentomaxillofac Radiol 2021; 50:20200425. [PMID: 33119994 DOI: 10.1259/dmfr.20200425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Both obesity and craniofacial deformity are important etiologies of obstructive sleep apnea (OSA). The present research aimed to explore their interaction and different impacts on OSA severity. METHODS A total of 207 consecutive OSA patients (169 males, 38 females) were included in the research. Based on the body mass index (BMI) value, patients were divided into 77 normal-weight patients (BMI <24 kg m-2), 105 overweight patients (24 ≤ BMI<28 kg m-2) and 26 obese patients (BMI ≥28 kg m-2). All accepted overnight polysomnography and standard lateral cephalogram. Cephalometric measurements involved 25 cephalometric variables. The correlations between these cephalometric variables, BMI and the apnea-hypopnea index (AHI) were evaluated. RESULTS For the whole sample after controlling for gender and age, stepwise regression analysis showed that the factors affecting AHI were increased BMI, narrowing posterior airway space, inferior displacement of hyoid and elongation of the tongue. When grouped by BMI, normal-weight group exhibited with more reduced maxillary length and mandible length, and steeper mandible plane than overweight and obese patients (p < 0.0167). Obese group showed least skeletal restriction and most prominent soft tissues enlargement (p < 0.0167). However, these skeletal indexes were not statistically correlated with AHI. CONCLUSIONS Obesity and skeletal malformations were both etiological factors of OSA, but obesity seemed to have a greater influence on AHI severity in all kinds of obese and thin OSA patients. Only in normal-weight group, it was affected by both cephalometric variables and BMI.
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Affiliation(s)
- Liping Huang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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156
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Wang J, Xu H, Yuan J, Guo C, Hu F, Yang W, Song L, Luo X, Liu R, Cui J, Liu S, Chun Y, Qiao S. Association Between Obstructive Sleep Apnea and Metabolic Abnormalities in Patients With Hypertrophic Cardiomyopathy. J Clin Endocrinol Metab 2021; 106:e2309-e2321. [PMID: 33420791 DOI: 10.1210/clinem/dgab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Metabolic abnormalities have been associated with long-term cardiac mortality in patients with hypertrophic cardiomyopathy (HCM). Obstructive sleep apnea (OSA) is a risk factor for metabolic abnormalities in general populations, but association between OSA and metabolic abnormalities in HCM is still undefined. This study aimed to investigate the relationship between OSA and metabolic dysfunction in a large series of patients with HCM. METHODS A total of 587 patients with HCM who underwent sleep evaluations at Fuwai Hospital were included. Data from clinical characteristics, polysomnography studies, and metabolic measurements were collected. RESULTS OSA was present in 344 patients (58.6%). Patients with OSA were older, more often male, and had more clinical comorbidities. Body mass index, blood pressure, fasting glucose, and triglycerides all increased (all P < 0.001) and high-density lipoprotein cholesterol decreased (P = 0.046) with the severity of OSA. In multivariate analysis, moderate to severe OSA and Log (apnea-hypopnea index + 1) were independently associated with obesity (odds ratio [OR], 2.42; 95% CI, 1.48-3.95 and OR, 1.60; 95% CI, 1.31-1.95), elevated blood pressure (OR, 1.99; 95% CI, 1.42-3.26 and OR, 1.31; 95% CI, 1.08-1.60), and elevated triglycerides (OR, 1.71; 95% CI, 1.05-2.78 and OR, 1.24; 95% CI, 1.02-1.51 but not elevated fasting glucose (OR, 0.88; 95% CI, 0.50-1.52 and OR, 1.02; 95% CI, 0.82-1.28) or reduced high-density lipoprotein cholesterol (OR, 1.30; 95% CI, 0.83-2.04 and OR, 1.06; 95% CI, 0.89-1.27). CONCLUSIONS Severity of OSA is independently associated with some profiles of metabolic abnormalities. Clinical trials are required to determine whether OSA treatment improves metabolic abnormalities and long-term outcomes in patients with HCM.
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Affiliation(s)
- Juan Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Haobo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Chao Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Fenghuan Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiaoliang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Rong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jingang Cui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Shengwen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yushi Chun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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157
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Kim DH, Kim B, Han K, Kim SW. The relationship between metabolic syndrome and obstructive sleep apnea syndrome: a nationwide population-based study. Sci Rep 2021; 11:8751. [PMID: 33888816 PMCID: PMC8062463 DOI: 10.1038/s41598-021-88233-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022] Open
Abstract
There has been a need for research on the association between metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) using large data such as nationwide population-based data that adjusts important confounding factors. Therefore, we investigated the relationship between MetS and OSAS. The data source we used was the National Health Insurance Service claims database managed by the Republic of Korea government, in which 10,113,560 individuals were enrolled in 2009 and followed up until 2018. The independent association of MetS with the risk of OSAS was determined using a Cox proportional hazards model with adjustment for age, sex, smoking status, alcohol consumption, regular physical exercise, and body mass index. Our results showed that MetS were strongly associated to OSAS which was adjusted for several confounding factors. Also, we found men, increased waist circumference and increased triglyceride are important risk factors for OSAS.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, Republic of Korea.
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea.
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158
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Kargar B, Zamanian Z, Hosseinabadi MB, Gharibi V, Moradi MS, Cousins R. Understanding the role of oxidative stress in the incidence of metabolic syndrome and obstructive sleep apnea. BMC Endocr Disord 2021; 21:77. [PMID: 33882916 PMCID: PMC8059172 DOI: 10.1186/s12902-021-00735-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Understanding the causes and risk factors of metabolic syndrome is important for promoting population health. Oxidative stress has been associated with metabolic syndrome, and also obstructive sleep apnea. These are two diseases which have common prognostic characteristics for heart disease. The aim of this study was to examine the role of oxidative stress in the concurrent presence of metabolic syndrome and obstructive sleep apnea in a working population. METHODS Participants were 163 artisan bakers in Shahroud, Iran, routinely exposed to significant heat stress and other oxidative stress indicators on a daily basis as part of their work. Using a cross-sectional design, data relevant to determining metabolic syndrome status according to International Diabetes Federation criteria, and the presence of obstructive sleep apnea according to the STOP-Bang score, was collected. Analyses included hierarchical binary logistic regression to yield predictors of the two diseases. RESULTS Hierarchical binary logistic regression showed that oxidative stress - alongside obesity, no regular exercise, and smoking - was an independent predictor of metabolic syndrome, but not obstructive sleep apnea. Participants who were obese were 28 times more likely to have metabolic syndrome (OR 28.59, 95% CI 4.91-63.02) and 44 times more likely to have obstructive sleep apnea (OR 44.48, 95% CI 4.91-403.28). Participants meeting metabolic syndrome criteria had significantly higher levels of malondialdehyde (p < 0.05) than those who did not. No difference in oxidative stress index levels were found according to obstructive sleep apnea status. CONCLUSIONS Our findings suggest that oxidative stress contributes to the onset of metabolic syndrome, and that obstructive sleep apnea is involved in oxidative stress. Whilst obesity, exercise, and smoking remain important targets for reducing the incidence of metabolic syndrome and obstructive sleep apnea, policies to control risks of prolonged exposure to oxidative stress are also relevant in occupations where such environmental conditions exist.
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Affiliation(s)
- Behnam Kargar
- Department of Pharmacology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Vahid Gharibi
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Sanyar Moradi
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
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159
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Pio-Abreu A, Moreno H, Drager LF. Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps. J Hum Hypertens 2021; 35:315-324. [PMID: 33414503 DOI: 10.1038/s41371-020-00470-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/06/2020] [Accepted: 12/07/2020] [Indexed: 01/29/2023]
Abstract
Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent collapse of the upper airway during sleep, resulting in partial (hypopnoeas) and total obstructions (apneas). These respiratory events observed in OSA may trigger multiple pathways involved in the blood pressure (BP) instability during the night and potentially influencing daytime BP as well (carry-over effects). This review provides an update about the impact of OSA and its treatments on 24-h BP control. Overall, there is growing evidence suggest that OSA is associated with higher frequency of nondipping BP pattern and nocturnal hypertension in a dose-dependent manner. The presence of nondiping BP (especially the reverse pattern) is independently associated with OSA regardless of sleep-related symptoms suggesting a potential tool for screening OSA in patients with clinical indication for performing ABPM. Beyond dipping BP, preliminary evidence associated OSA with white-coat effect and higher frequency of masked hypertension and BP variability than the control group (no OSA). Unfortunately, most of the evidence on the evidence addressing the impact of OSA treatment on BP was limited to office measurements. In the last years, data from observational and randomized studies pointed that CPAP is able to promote 24-h BP decrease especially in patients with resistant and refractory hypertension. A randomized trial suggests that CPAP is able to decrease the rate of masked hypertension as compared to no treatment in patients with severe OSA. Interestingly, nondipping BP is a good predictor of BP response to CPAP making ABPM an interesting tool for better OSA management.
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Affiliation(s)
- Andrea Pio-Abreu
- Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Heitor Moreno
- Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Luciano F Drager
- Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil. .,Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
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160
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Bai J, He B, Wang N, Chen Y, Liu J, Wang H, Liu D. Snoring Is Associated With Increased Risk of Stroke: A Cumulative Meta-Analysis. Front Neurol 2021; 12:574649. [PMID: 33868139 PMCID: PMC8047148 DOI: 10.3389/fneur.2021.574649] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/08/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Several studies have suggested that snoring is associated with an increased risk of stroke; however, the results are inconsistent. We aim to conduct a systematic review and meta-analysis of observational studies assessing the association between snoring and the risk of stroke in adults. Methods: We searched PubMed for relevant studies. A random-effect model was adopted to summary relative risks (RRs), and forest plots from a cumulative meta-analysis method were used for a better presentation of how the pooled RRs changed as updated evidence accumulated. Results: The literature search yielded 16 articles that met our inclusion criteria, and a total of 3,598 stroke patients and 145,901 participants were finally included in our analysis. A consistent trend toward association was found after the initial discovery, and the summary analysis indicated that snoring is associated with a 46% (RR, 1.46; 95%CI, 1.29–1.63; p < 0.001) increased risk of stroke. Conclusions: Snoring is associated with a significantly increased risk for stroke, up to 46%. The importance of the current study lies in that we provide an imputes to take a more active approach against the increased risk of stroke in snorers.
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Affiliation(s)
- Jing Bai
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Bing He
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Nan Wang
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Yifei Chen
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China.,Department of Clinical Medicine, Henan University of Science and Technology, Luohe, China
| | - Junxiang Liu
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Haoran Wang
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
| | - Dongliang Liu
- Cardiovascular Institute of Luohe, Luohe Central Hospital, Luohe Medical College, Luohe, China
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161
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AYYILDIZ F, YILDIRAN H, KÖKTÜRK O. Hafif dereceli obstrüktif uyku apne sendromlu olgularda D vitamini suplemantasyonunun antropometrik ölçümler ve vücut bileşimine etkisi. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.782576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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162
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Bostan OC, Akcan B, Saydam CD, Tekin M, Dascı O, Balcan B. Impact of Gender on Symptoms and Comorbidities in Obstructive Sleep Apnea. Eurasian J Med 2021; 53:34-39. [PMID: 33716528 DOI: 10.5152/eurasianjmed.2021.19233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective Obstructive sleep apnea (OSA) is more common in men than in women. In this study, we aimed to address the impact of gender on symptoms and comorbidities in patients with OSA. Materials and Methods This cross-sectional study was conducted among 1,317 consecutive patients, who were admitted to the Sleep Apnea Clinic of the Marmara University Hospital between November 2015 and October 2018, and who completed questionnaires and a sleep study with cardiorespiratory polygraphy. OSA was defined as Apnea Hypopnea Index (AHI) ≥15/hour. Results In all, 1,042 patients (334 women) fulfilled the inclusion criteria. OSA was observed in 589 patients (56.5%). Women were older than men (50.2±12.5 versus 45.6±15.1 years) and had lower AHI (22.1±20.1 versus 26.8±21.9 events/h). In the OSA group, women were older (53.7±11.5 versus 47.8±12.8 years) and more obese (BMI 34.6 versus 31.8 kg/m2). Symptoms were categorized as frequent/very frequent, and women with OSA complained more about daytime fatigue (74.6% versus 63.7%), nocturia (69.7% versus 51.8%), headache in the morning (50.0% versus 28.4%), depressive mood (49.0% versus 19.5%), and restless legs symptoms (43.1% versus 17.2%), than did men (all p values <0.05). Comorbidities were observed more in women than in men (lung disease [25.4% versus 13.7%], hypertension [29.6% versus 15.0%], diabetes [20.3% versus 11.3%], and hypothyroidism [14.0 % versus 4.1%]). In regression analysis, age (OR 1.03, p<0.001), BMI (OR 1.13, p<0.001), and male sex (OR 2.08, p<0.001) were significantly predictive for OSA while history of tonsillectomy was protective (OR 0.48, p=0.033). Conclusion Fatigue, nocturia, headache, depressive mood, restless leg, and comorbidities were observed more in women. OSA-related symptoms develop late and/or the referral of women for diagnostic evaluation of OSA is delayed. Symptoms and comorbidities in women should be evaluated more attentively for earlier referral and diagnosis of OSA.
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Affiliation(s)
- Ozge Can Bostan
- Department of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey.,Department of Pulmonary Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Beyza Akcan
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihan Durmus Saydam
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Muhammet Tekin
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Omur Dascı
- Department of Sleep Clinic, Marmara University School of Medicine, Istanbul, Turkey
| | - Baran Balcan
- Department of Pulmonary Medicine, Marmara University School of Medicine, Istanbul, Turkey
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163
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The influence of obstructive sleep apnea syndrome on anthropometric parameters at 12 months after laparoscopic sleeve gastrectomy. Sci Rep 2021; 11:5781. [PMID: 33707630 PMCID: PMC7952692 DOI: 10.1038/s41598-021-85192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess the influence of obstructive sleep apnea syndrome (OSAS) on the change in anthropometric parameters and body composition, in patients undergoing laparoscopic sleeve gastrectomy (LSG). This prospective study included patients undergoing LSG who had pre-operative polysomnography data and were also evaluated at six and 12 months after surgery. All patients included also had whole body composition analysis data before surgery and at six and 12 months after surgery. The results are presented in comparison between patients with and without OSAS. We included 73 patients in the analysis with a mean ± SD age and body mass index (BMI) of 40.3 ± 10.9 years and 45.4 ± 6.3 kg/m2, respectively. As compared to the baseline levels, at 6 months there was a significant decrease in BMI, weight, waist circumference, serum glucose and HbA1c. At 12 months there was no further decrease as compared to the 6 months levels, irrespective of OSAS status. We observed a significant decrease at 6 months in percentage of fat, in both types of patients. However, as compared to the 6 months levels, at 12 months the percent fat had a significant decrease only in patients without OSAS (− 4.6%, 95% CI − 7.6 to − 1.7%) and not in those with OSAS (− 2.2%, 95% CI − 4.5 to 0.2%). In our study, patients with OSAS showed a similar decrease in different anthropometric parameters as those without OSAS after LSG. However, at 12 months of follow-up there was a significant decrease in the percent fat only in patients without OSAS.
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164
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Détrait M, Pesse M, Calissi C, Bouyon S, Brocard J, Vial G, Pépin JL, Belaidi E, Arnaud C. Short-term intermittent hypoxia induces simultaneous systemic insulin resistance and higher cardiac contractility in lean mice. Physiol Rep 2021; 9:e14738. [PMID: 33682327 PMCID: PMC7937943 DOI: 10.14814/phy2.14738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intermittent hypoxia (IH) is the major feature of obstructive sleep apnea syndrome, well-known to induce cardiometabolic complications. We previously demonstrated that IH induces hyperinsulinemia and associated altered insulin signaling in adipose tissue, liver, and skeletal muscle, but impact of IH on cardiac insulin signaling and functional/structural consequences remains unknown. Therefore, the aims of this study were to investigate in both lean and obese mice the effects of chronic IH on the following: (1) cardiac insulin signaling and (2) cardiac remodeling and function. METHODS C57BL/6 J male mice were fed low-fat (LFD) or high-fat (HFD) diet for 20 weeks, and exposed to IH (21-5% FiO2, 60 s cycle, 8 h/day) or normoxia (N) for the last 6 weeks. Systemic insulin sensitivity was evaluated by an insulin tolerance test. Cardiac remodeling and contractile function were assessed by cardiac ultrasonography. Ultimately, hearts were withdrawn for biochemical and histological analysis. RESULTS In LFD mice, IH-induced hyperinsulinemia and systemic insulin resistance that were associated with increased phosphorylations of cardiac insulin receptor and Akt on Tyr1150 and Ser473 residues, respectively. In addition, IH significantly increased cardiac interstitial fibrosis and cardiac contractility. In the HFD group, IH did not exert any additional effect, nor on insulin/Akt signaling, nor on cardiac remodeling and function. CONCLUSION Our study suggests that, despite systemic insulin resistance, IH exposure mediates an adaptive cardiac response in lean but not in obese mice. Further studies are needed to investigate which specific mechanisms are involved and to determine the long-term evolution of cardiac responses to IH.
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Affiliation(s)
- Maximin Détrait
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Mélanie Pesse
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Clément Calissi
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Bouyon
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Jacques Brocard
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France.,University Lyon, ENS de Lyon, Inserm, CNRS SFR Biosciences, UCBL, Lyon, France
| | - Guillaume Vial
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Elise Belaidi
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Claire Arnaud
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
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165
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Knowlden AP, Higginbotham JC, Grandner MA, Allegrante JP. Modeling Risk Factors for Sleep- and Adiposity-Related Cardiometabolic Disease: Protocol for the Short Sleep Undermines Cardiometabolic Health (SLUMBRx) Observational Study. JMIR Res Protoc 2021; 10:e27139. [PMID: 33687340 PMCID: PMC7988396 DOI: 10.2196/27139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/24/2023] Open
Abstract
Background Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors. Objective This SLUMBRx study aims to address 4 topics pertinent to the adiposity-sleep hypothesis: the relationship between adiposity and sleep duration; sex-based differences in the relationship between adiposity and sleep duration; the influence of adiposity indices and sleep duration on cardiometabolic outcomes; and the role of socioecological factors as effect modifiers in the relationship between adiposity indices, sleep, and cardiometabolic outcomes. Methods SLUMBRx will employ a large-scale survey (n=1000), recruiting 159 participants (53 normal weight, 53 overweight, and 53 obese) to be assessed in 2 phases. Results SLUMBRx was funded by the National Institutes of Health, Heart, Lung, and Blood Institute through a K01 grant award mechanism (1K01HL145128-01A1) on July 23, 2019. Institutional Review Board (IRB) approval for the research project was sought and obtained on July 10, 2019. Phase 1 of SLUMBRx, the laboratory-based component of the study, will gather objective adiposity indices (air displacement plethysmography and anthropometrics) and cardiometabolic data (blood pressure, pulse wave velocity and pulse wave analysis, and a blood-based biomarker). Phase 2 of SLUMBRx, a 1-week, home-based component of the study, will gather sleep-related data (home sleep testing or sleep apnea, actigraphy, and sleep diaries). During phase 2, detailed demographic and socioecological data will be collected to contextualize hypothesized adiposity and sleep-associated cardiometabolic disease risk factors. Collection and analyses of these data will yield information necessary to customize future observational and intervention research. Conclusions Precise implementation of the SLUMBRx protocol promises to provide objective and empirical data on the interaction between body composition and sleep duration. The hypotheses that will be tested by SLUMBRx are important for understanding the pathogenesis of cardiometabolic disease and for developing future public health interventions to prevent its conception and treat its consequences. International Registered Report Identifier (IRRID) PRR1-10.2196/27139
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Affiliation(s)
- Adam P Knowlden
- Department of Health Science, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, United States
| | - John C Higginbotham
- Department of Community Medicine and Population Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL, United States
| | - Michael A Grandner
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, United States.,Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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166
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Zhang Z, Wang Y, Li H, Ni L, Liu X. Age-specific markers of adiposity in patients with obstructive sleep apnea. Sleep Med 2021; 83:196-203. [PMID: 34044357 DOI: 10.1016/j.sleep.2021.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Adiposity can have varying effects on the individual depending upon its distribution pattern. We assessed age-related distribution of adipose tissue by anthropometric measures and bioelectrical impedance analysis, as well as their association with obstructive sleep apnea (OSA) severity. METHODS Participants were 169 elderly (aged ≥ 65 years) and 142 non-elderly (aged < 65 years) referred for overnight polysomnography. The associations between obesity parameters and apnea-hypopnea index (AHI) were determine by univariate and multivariate linear regression analyses. Area under receiver operating characteristic curve (AUC) was used to access the predicting performance of some parameters. RESULTS Compared with non-elderly, elderly showed higher conicity index and visceral adiposity (VA)/subcutaneous adiposity (SA), lower body mass index (BMI), neck circumference, waist circumference, hip circumference and SA. Multiple regression analyses revealed that VA and VA/SA were independently associated with AHI in elderly (explained 17.2% of the AHI 0.5 variability), while BMI and VA/SA were independently associated with AHI in non-elderly (explained 25.9% of the AHI 0.5 variability), after adjusting for age, sex, cigarette smoking, alcohol drinking and main comorbidities. In elderly, VA over 128 cm2 and VA/SA less than 0.41 resulted in sensitivity, specificity and AUC of 0.382, 0.790, 0.580 and 0.176, 0.947, 0.553 in predicting moderate-to-severe OSA, respectively. In non-elderly, BMI over 24.7 kg/m2 and VA/SA over 0.54 resulted in sensitivity, specificity and AUC of 0.883, 0.484, 0.704 and 0.550, 0.710, 0.667 in predicting moderate-to-severe OSA, respectively. CONCLUSIONS VA is strongly associated with OSA severity in elderly, independently of general obesity as per BMI standards, while general adiposity appears to be more strongly associated with OSA severity in non-elderly. Our study supports age-specific approaches should be developed with respect to prediction and treatment of OSA.
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Affiliation(s)
- Zhigang Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China.
| | - Yanjun Wang
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hong Li
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Lianfang Ni
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
| | - Xinmin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China
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167
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Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADDM, Machado CA, Poli-de-Figueiredo CE, Amodeo C, Mion Júnior D, Barbosa ECD, Nobre F, Guimarães ICB, Vilela-Martin JF, Yugar-Toledo JC, Magalhães MEC, Neves MFT, Jardim PCBV, Miranda RD, Póvoa RMDS, Fuchs SC, Alessi A, Lucena AJGD, Avezum A, Sousa ALL, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Nogueira ADR, Dinamarco N, Eibel B, Forjaz CLDM, Zanini CRDO, Souza CBD, Souza DDSMD, Nilson EAF, Costa EFDA, Freitas EVD, Duarte EDR, Muxfeldt ES, Lima Júnior E, Campana EMG, Cesarino EJ, Marques F, Argenta F, Consolim-Colombo FM, Baptista FS, Almeida FAD, Borelli FADO, Fuchs FD, Plavnik FL, Salles GF, Feitosa GS, Silva GVD, Guerra GM, Moreno Júnior H, Finimundi HC, Back IDC, Oliveira Filho JBD, Gemelli JR, Mill JG, Ribeiro JM, Lotaif LAD, Costa LSD, Magalhães LBNC, Drager LF, Martin LC, Scala LCN, Almeida MQ, Gowdak MMG, Klein MRST, Malachias MVB, Kuschnir MCC, Pinheiro ME, Borba MHED, Moreira Filho O, Passarelli Júnior O, Coelho OR, Vitorino PVDO, Ribeiro Junior RM, Esporcatte R, Franco R, Pedrosa R, Mulinari RA, Paula RBD, Okawa RTP, Rosa RF, Amaral SLD, Ferreira-Filho SR, Kaiser SE, Jardim TDSV, Guimarães V, Koch VH, Oigman W, Nadruz W. Brazilian Guidelines of Hypertension - 2020. Arq Bras Cardiol 2021; 116:516-658. [PMID: 33909761 PMCID: PMC9949730 DOI: 10.36660/abc.20201238] [Citation(s) in RCA: 268] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Weimar Kunz Sebba Barroso
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Andréa Araujo Brandão
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo , SP - Brasil
| | - Décio Mion Júnior
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Hospital São Francisco , Ribeirão Preto , SP - Brasil
| | | | | | | | - Maria Eliane Campos Magalhães
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro , RJ - Brasil
| | - Mário Fritsch Toros Neves
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | | | - Sandra C Fuchs
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
| | | | | | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de Goiás , Goiânia , GO - Brasil
- Liga de Hipertensão Arterial , Goiânia , GO - Brasil
| | | | | | | | | | | | | | | | - Bruna Eibel
- Instituto de Cardiologia , Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre , RS - Brasil
- Centro Universitário da Serra Gaúcha (FSG), Caxias do Sul , RS - Brasil
| | | | | | | | | | | | | | - Elizabete Viana de Freitas
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Departamento de Cardiogeriatria da Sociedade Brazileira de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Emilton Lima Júnior
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba , PR - Brasil
| | - Erika Maria Gonçalves Campana
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Universidade Iguaçu (UNIG), Rio de Janeiro , RJ - Brasil
| | - Evandro José Cesarino
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
- Associação Ribeirãopretana de Ensino, Pesquisa e Assistência ao Hipertenso (AREPAH), Ribeirão Preto , SP - Brasil
| | - Fabiana Marques
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - Fernando Antonio de Almeida
- Pontifícia Universidade Católica de São Paulo , Faculdade de Ciências Médicas e da Saúde , Sorocaba , SP - Brasil
| | | | | | - Frida Liane Plavnik
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Hospital Alemão Oswaldo Cruz , São Paulo , SP - Brasil
| | | | | | | | - Grazia Maria Guerra
- Instituto do Coração (InCor), São Paulo , SP - Brasil
- Universidade Santo Amaro (UNISA), São Paulo , SP - Brasil
| | | | | | | | | | | | - José Geraldo Mill
- Centro de Ciências da Saúde , Universidade Federal do Espírito Santo , Vitória , ES - Brasil
| | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais , Belo Horizonte , MG - Brasil
- Hospital Felício Rocho , Belo Horizonte , MG - Brasil
| | - Leda A Daud Lotaif
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital do Coração (HCor), São Paulo , SP - Brasil
| | | | | | | | | | | | - Madson Q Almeida
- Hospital das Clínicas da Faculdade de Medicina da USP , São Paulo , SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | - Roberto Esporcatte
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
- Hospital Pró-Cradíaco , Rio de Janeiro , RJ - Brasil
| | - Roberto Franco
- Universidade Estadual Paulista (UNESP), Bauru , SP - Brasil
| | - Rodrigo Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife , PE - Brasil
| | | | | | | | | | | | | | - Sergio Emanuel Kaiser
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | | | | | - Vera H Koch
- Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | - Wille Oigman
- Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro , RJ - Brasil
| | - Wilson Nadruz
- Universidade Estadual de Campinas (UNICAMP), Campinas , SP - Brasil
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Bock JM, Vungarala S, Karim S, Somers VK. Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP. Can J Cardiol 2021; 37:756-765. [PMID: 33610689 DOI: 10.1016/j.cjca.2021.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience repetitive partial or complete airway collapse during sleep resulting in nocturnal hypoxia-normoxia cycling, and are at increased cardiovascular risk. The number of apneas and hypopneas indexed per hour of sleep (apnea-hypopnea index) along with the associated intermittent hypoxia predict the increased cardiovascular risk; thus, their attenuation or prevention are objectives of OSA therapy. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA and, when effective, mitigates the apnea-hypopnea index and hypoxemia. As such, it is reasonable to expect CPAP would decrease cardiovascular risk. However, 3 recent randomized clinical trials of CPAP vs usual care did not show any significant effects of CPAP in attenuating incident cardiovascular events in patients with OSA. In this review, we discuss these studies in addition to potential complementary therapeutic options to CPAP (eg, neurostimulation) and conclude with suggested therapeutic targets for future interventional studies (eg, the autonomic nervous system). Although these areas of research are exciting, they have yet to be tested to any similar degree of rigour as CPAP.
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Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Soumya Vungarala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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169
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Silva WA, Almeida-Pititto B, Santos RB, Aielo AN, Giatti S, Parise BK, Souza SP, Vivolo SF, Lotufo PA, Bensenor IM, Drager LF. Obstructive sleep apnea is associated with lower adiponectin and higher cholesterol levels independently of traditional factors and other sleep disorders in middle-aged adults: the ELSA-Brasil cohort. Sleep Breath 2021; 25:1935-1944. [PMID: 33590375 DOI: 10.1007/s11325-021-02290-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) may contribute to metabolic and inflammatory deregulation but previous studies failed to consider sleep duration, sleep fragmentation, insomnia, and daytime sleepiness as potential confounders. METHODS Consecutive non-diabetic middle-aged participants from the ELSA-Brasil cohort were invited to perform a clinical evaluation, home sleep study for 1 night, and wrist actigraphy for 7 days. OSA was defined by an apnea-hypopnea index ≥ 15 events/h. Participants were stratified according to the presence of OSA measuring the following markers: fasting glucose, glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) index, fasting insulin, insulin after 2 h of glucose load, glycated hemoglobin, total cholesterol and their fractions, triglycerides, C-reactive protein, TNF-alpha, interleukin-6, interleukin-10, leptin, adiponectin, E-selectin, ADMA, MCP-1, TGF, apolipoprotein B, fibrinogen, and lipoprotein(a). Differences between groups were identified by chi-square test and ANOVA. RESULTS We studied 708 participants (mean age: 46 ± 5 years, men: 44%, BMI 26.1 ± 4.1 kg/m2). Compared to no OSA, participants with OSA presented higher levels while fasting and after 2 h glucose load of insulin, HOMA-IR, cholesterol, triglycerides, and C-reactive protein (all p < 0.001). After linear regression analysis adjusting for traditional risk factors plus sleep duration, fragmentation, insomnia, and daytime sleepiness, OSA was negatively associated with adiponectin (β = - 0.271 CI 95% - 0.456 - 0.085) and positively associated with cholesterol (β = 9.707 CI 95% 2.737 16.678). Sex-stratification revealed that these associations were significant for men but not women. CONCLUSIONS In non-diabetic middle-age adults, men with OSA presented with lower adiponectin and higher cholesterol levels independently of sleep duration, sleep fragmentation, insomnia, and daytime sleepiness.
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Affiliation(s)
- Wagner A Silva
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Bianca Almeida-Pititto
- Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
- Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ronaldo B Santos
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Renal Division, University of São Paulo, São Paulo, Brazil
| | - Soraya Giatti
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Renal Division, University of São Paulo, São Paulo, Brazil
| | - Barbara K Parise
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Renal Division, University of São Paulo, São Paulo, Brazil
| | - Silvana P Souza
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Sandra F Vivolo
- Department of Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Isabela M Bensenor
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil
| | - Luciano F Drager
- Center of Clinical and Epidemiologic Research (CPCE), University of Sao Paulo, Av. Prof. Lineu Prestes, 2565-4 andar, Cidade Universitária, São Paulo, SP, 05508-000, Brazil.
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
- Hypertension Unit, Renal Division, University of São Paulo, São Paulo, Brazil.
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170
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Souza SP, Santos RB, Santos IS, Parise BK, Giatti S, Aielo AN, Cunha LF, Silva WA, Bortolotto LA, Lorenzi-Filho G, Lotufo PA, Bensenor IM, Drager LF. Obstructive Sleep Apnea, Sleep Duration, and Associated Mediators With Carotid Intima-Media Thickness: The ELSA-Brasil Study. Arterioscler Thromb Vasc Biol 2021; 41:1549-1557. [PMID: 33567870 DOI: 10.1161/atvbaha.120.315644] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Silvana P Souza
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Heart Institute (InCor) (S.P.S., R.B.S., W.A.S., L.A.B., L.F.D.), University of Sao Paulo, Brazil
| | - Ronaldo B Santos
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Heart Institute (InCor) (S.P.S., R.B.S., W.A.S., L.A.B., L.F.D.), University of Sao Paulo, Brazil
| | - Itamar S Santos
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil
| | - Barbara K Parise
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Renal Division (B.K.P., S.G., A.N.A., L.F.C., L.F.D.), University of Sao Paulo, Brazil
| | - Soraya Giatti
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Renal Division (B.K.P., S.G., A.N.A., L.F.C., L.F.D.), University of Sao Paulo, Brazil
| | - Aline N Aielo
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Renal Division (B.K.P., S.G., A.N.A., L.F.C., L.F.D.), University of Sao Paulo, Brazil
| | - Lorenna F Cunha
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Renal Division (B.K.P., S.G., A.N.A., L.F.C., L.F.D.), University of Sao Paulo, Brazil
| | - Wagner A Silva
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Heart Institute (InCor) (S.P.S., R.B.S., W.A.S., L.A.B., L.F.D.), University of Sao Paulo, Brazil
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute (InCor) (S.P.S., R.B.S., W.A.S., L.A.B., L.F.D.), University of Sao Paulo, Brazil
| | | | - Paulo A Lotufo
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil
| | - Luciano F Drager
- Center of Clinical and Epidemiologic Research (CPCE) (S.P.S., R.B.S., I.S.S., B.K.P., S.G., A.N.A., L.F.C., W.A.S., P.A.L., I.M.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Heart Institute (InCor) (S.P.S., R.B.S., W.A.S., L.A.B., L.F.D.), University of Sao Paulo, Brazil.,Hypertension Unit, Renal Division (B.K.P., S.G., A.N.A., L.F.C., L.F.D.), University of Sao Paulo, Brazil
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171
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Younossi ZM, Corey KE, Lim JK. AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology 2021; 160:912-918. [PMID: 33307021 DOI: 10.1053/j.gastro.2020.11.051] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease, with global public health impact affecting more than 25% of the global population. NAFLD is associated with significant morbidity and mortality from cirrhosis, hepatocellular carcinoma, solid organ malignancies, diabetes mellitus, cardiovascular disease, and obstructive sleep apnea, resulting in significant health care resource use and decreased health-related quality of life. NAFLD cirrhosis is a leading indication for liver transplantation in the United States. Lifestyle modification to achieve weight loss remains a first-line intervention in patients with NAFLD. We summarize evidence-based interventions for lifestyle modification in the treatment of NAFLD and provided best practice advice statements to address key issues in clinical management.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases and Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
| | - Kathleen E Corey
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
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172
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Minami T, Matsumoto T, Tabara Y, Gozal D, Smith D, Murase K, Tanizawa K, Takahashi N, Nakatsuka Y, Hamada S, Handa T, Takeyama H, Oga T, Nakamoto I, Wakamura T, Komenami N, Setoh K, Tsutsumi T, Kawaguchi T, Kamatani Y, Takahashi Y, Morita S, Nakayama T, Hirai T, Matsuda F, Chin K. Impact of sleep-disordered breathing on glucose metabolism among individuals with a family history of diabetes: the Nagahama study. J Clin Sleep Med 2021; 17:129-140. [PMID: 32955012 DOI: 10.5664/jcsm.8796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVES It is well known that a family history of diabetes (FHD) is a definitive risk factor for type 2 diabetes. It has not been known whether sleep-disordered breathing (SDB) increases the prevalence of diabetes in those with an FHD. METHODS We assessed SDB severity in 7,477 study participants by oximetry corrected by objective sleep duration determined by wrist actigraphy. Glycated hemoglobin ≥6.5% and/or current medication for diabetes indicated the presence of diabetes. In addition to the overall prevalence, the prevalence of recent-onset diabetes during the nearly 5 years before the SDB measurements were made was investigated. RESULTS Of the 7,477 participants (mean age: 57.9; range: 34.2-80.7; SD: 12.1 years; 67.7% females), 1,569 had an FHD. The prevalence of diabetes in FHD participants with moderate-to-severe SDB (MS-SDB) was higher than in those without SDB (MS-SDB vs without SDB: all, 29.3% vs 3.3% [P < .001]; females, 32.6% vs 1.9% [P < .001]; males, 26.2% vs 11.7% [P = .037]). However, multivariate analysis showed that MS-SDB was significantly associated with a higher prevalence of diabetes only in FHD-positive females (odds ratio [95% confidence interval]: females, 7.43 [3.16-17.45]; males, 0.92 [0.37-2.31]). Among the FHD-positive participants, the prevalence of recent-onset diabetes was higher in those with MS-SDB than those without SDB, but only in females (MS-SDB vs without SDB: 21.4% vs 1.1%; P < 0.001). CONCLUSIONS MS-SDB was associated with diabetes risk in females with an FHD, and future studies are needed on whether treatment of SDB in females with an FHD would prevent the onset of diabetes.
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Affiliation(s)
- Takuma Minami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, Missouri
| | - Dale Smith
- Department of Behavioral Sciences, Olivet Nazarene University, Bourbonnais, Illinois
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naomi Takahashi
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advance Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Advance Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Isuzu Nakamoto
- Nursing Science, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Wakamura
- Nursing Science, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Komenami
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanobu Tsutsumi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoichiro Kamatani
- Kyoto-McGill International Collaborative School in Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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173
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Cao W, Wang X, Luo J, Huang R, Xiao Y. Impact of obstructive sleep apnea on cardiovascular risk in patients with acromegaly. Sleep Med 2021; 80:193-198. [PMID: 33601232 DOI: 10.1016/j.sleep.2021.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Respiratory complications represented by obstructive sleep apnea (OSA), cardiovascular disease (CVD), and metabolic disorders including insulin resistance (IR) are common in patients with acromegaly. OSA is further associated with a higher risk of IR and CVD in the general population. However, significant information on the effect of OSA on IR and CVD risk for patients with acromegaly remains to be scarce. PATIENTS AND METHODS This retrospective study included 125 patients with active acromegaly. Medical history, anthropometric parameters, polysomnographic and fasting biochemical measurements were collected. Ten-year Framingham CVD risk scores were calculated and categorized as low, moderate, and high. IR was assessed using the homeostasis model assessment (HOMA-IR). RESULTS OSA was confirmed in two thirds of the enrolled patients. Compared with patients without OSA, patients with both OSA and acromegaly were found to have higher proportion of HOMA-IR and moderate-to-high 10-year CVD risk. Logistic regression analysis showed that OSA, HOMA-IR, and low-density lipoprotein cholesterol were all risk factors for moderate-to-high CVD risk. Meanwhile, no mediating effect of HOMA-IR in the association between OSA and Framingham CVD risk was observed in patients with acromegaly. CONCLUSIONS The coexistence of OSA might increase the CVD risk for patients with acromegaly, and IR might independently contribute to CVD risk in acromegalic patients with OSA.
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Affiliation(s)
- Wenhao Cao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaona Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinmei Luo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rong Huang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Atherogenic Index of Plasma in Obstructive Sleep Apnoea. J Clin Med 2021; 10:jcm10030417. [PMID: 33499142 PMCID: PMC7865393 DOI: 10.3390/jcm10030417] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Dyslipidaemia is well recognised in obstructive sleep apnoea (OSA) and could contribute to the development of cardiovascular disease (CVD). Atherogenic index of plasma (AIP) predicts cardiovascular morbidity and mortality better than the individual lipid levels. The aim of this study was to investigate the AIP in patients with OSA in relation with disease severity. Methods: Four hundred sixty-one patients with OSA and 99 controls participated in this study. AIP was assessed in the morning following a diagnostic sleep study. The association between lipid values and OSA were adjusted for age, gender, and body mass index. Results: Patients with OSA had higher AIP and triglyceride, and lower high-density lipoprotein cholesterol (HDL-C) levels (all p < 0.05). AIP significantly correlated with the Epworth Sleepiness Scale score (ρ = 0.19), the apnoea-hypopnoea index (ρ = 0.40) and oxygen desaturation index (ρ = 0.43, all p < 0.05). However, there was no relationship between the AIP and markers of sleep quality such as total sleep time, sleep period time, sleep efficiency, arousal index or percentage of REM sleep (all p > 0.05). AIP was not a better predictor for self-reported cardiovascular disease or diabetes than HDL-C. Conclusions: AIP is elevated in OSA and is related to disease severity. However, it does not seem to have an additional clinical value compared to HDL-C.
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175
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Guo H, Ding H, Yan Y, Chen Q, Zhang J, Chen B, Cao J. Intermittent hypoxia-induced autophagy via AMPK/mTOR signaling pathway attenuates endothelial apoptosis and dysfunction in vitro. Sleep Breath 2021; 25:1859-1865. [PMID: 33483906 DOI: 10.1007/s11325-021-02297-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/10/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to examine whether or not intermittent hypoxia (IH) upregulated autophagy and the contributions of autophagy to endothelial apoptosis and dysfunction in human umbilical vein endothelial cells (HUVECs). METHOD HUVECs were incubated under normoxia and IH conditions. After 3-, 6-, 12-, and 24-h exposure, the autophagic vacuoles and autophagosomes were observed by transmission electron microscopy and monodansylcadaverine staining. The protein levels of autophagy-related biomarkers and AMPK/mTOR pathway were measured by Western blot. The apoptosis-related proteins and the percentage of apoptotic cells were evaluated by Western blot and flow cytometry, respectively, while the levels of endothelial function biomarkers were assessed by ELISA. RESULTS IH induced autophagy, as determined by the increased numbers of the autophagic vacuoles, autophagosomes, and by the elevated levels of Beclin-1 protein, the LC3II/LC3I ratio, and p62 degradation. IH-induced autophagic flux peaked at 12-h duration and weakened at 24 h. IH increased the ratio of p-AMPK/AMPK and decreased the ratio of p-mTOR/mTOR, while compound C restored the alteration. A significant decrease in the Bcl-2 level and the Bcl-2/Bax ratio and a significant increase in the protein expression levels of Bax and cleaved caspase 3 and in the percentage of apoptosis were observed under IH exposure. Moreover, the NO level was reduced, while the ET-1 and VEGF levels were raised under IH condition. These alterations were suppressed by the pretreatment of 3-methyladenine. CONCLUSIONS IH upregulates autophagy through AMPK/mTOR pathway in HUVECs in vitro, which might be protective against endothelial apoptosis and dysfunction caused by IH.
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Affiliation(s)
- Hengjuan Guo
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Hui Ding
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yuxia Yan
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Qianqian Chen
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jing Zhang
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Baoyuan Chen
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jie Cao
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
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Michalek-Zrabkowska M, Macek P, Martynowicz H, Gac P, Mazur G, Grzeda M, Poreba R. Obstructive Sleep Apnea as a Risk Factor of Insulin Resistance in Nondiabetic Adults. Life (Basel) 2021; 11:life11010050. [PMID: 33451031 PMCID: PMC7828530 DOI: 10.3390/life11010050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this research was to assess the relationship between prevalence and severity of obstructive sleep apnea (OSA) and insulin resistance among patients with increased risk of OSA without diabetes mellitus. METHOD AND MATERIALS our study group involved 102 individuals with suspected OSA, mean age 53.02 ± 12.37 years. Data on medical history, medication usage, sleep habits, sleep quality and daytime sleepiness, were obtained using questionnaires. All patients underwent standardized full night polysomnography. Serum fasting insulin and glucose concentration were analyzed, the homeostatic model assessment-insulin resistance (HOMA-IR) index was calculated. RESULTS polysomnographic study indicated that in the group with OSA mean values of apnea-hypopnea index (AHI), oxygen desaturation index (ODI), duration of SpO2 < 90% and average desaturation drop were significantly higher compared to the group without OSA, while the minimum SpO2 was significantly lower. The carbohydrate metabolism parameters did not differ within those groups. Significantly higher fasting insulin concentration and HOMA-IR index were found in the group with AHI ≥ 15 compared to the group with AHI < 15 and in the group with AHI ≥ 30 compared to the group with AHI < 30. Higher AHI and ODI were independent risk factors for higher fasting insulin concentration and higher HOMA-IR index. Increased duration of SpO2 < 90% was an independent risk factor for higher fasting glucose concentration. CONCLUSIONS Individuals with moderate to severe OSA without diabetes mellitus had a higher prevalence of insulin resistance.
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Affiliation(s)
- Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
| | - Pawel Gac
- Department of Hygiene, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
| | - Magda Grzeda
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
- Correspondence: ; Tel.: +48-530-173-222
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (P.M.); (H.M.); (G.M.); (R.P.)
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Kelly A, Meurling J, Kirthi Jeyarajah S, Ryan C, Hughes R, Garvey J, Kirby B. Obstructive sleep apnoea in psoriasis and hidradenitis suppurativa. Br J Dermatol 2021; 184:1183-1185. [PMID: 33404093 DOI: 10.1111/bjd.19802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/03/2021] [Accepted: 01/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- A Kelly
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - J Meurling
- Department of, Respiratory, St. Vincent's University Hospital, Dublin, Ireland
| | - S Kirthi Jeyarajah
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - C Ryan
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - R Hughes
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - J Garvey
- Department of, Respiratory, St. Vincent's University Hospital, Dublin, Ireland
| | - B Kirby
- Departments of, Department of, Dermatology, St. Vincent's University Hospital, Dublin, Ireland
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178
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Polesel DN, Nozoe KT, Bittencourt L, Tufik S, Andersen ML, Fernandes MTB, Hachul H. Waist-to-height ratio and waist circumference as the main measures to evaluate obstructive sleep apnea in the woman's reproductive life stages. Women Health 2021; 61:277-288. [PMID: 33390097 DOI: 10.1080/03630242.2020.1862386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder. In women, the frequency of OSA increases substantially during and after the menopause, as does the prevalence of obesity in this reproductive life stage. This cross-sectional study uses data from the Sao Paulo Epidemiologic Sleep Study (EPISONO, 2007), and comprises a sample of 500 women aged 20-80 years. Multiple logistic regression analysis was used to assess the factors associated with OSA in premenopausal and postmenopausal women. All participants underwent polysomnography, and obesity was assessed using the waist-to-height ratio (WHtR), body mass index, neck and waist circumference, measured using standard methods. WHtR was the factor most associated with a significant increase in risk of OSA in premenopausal women. Waist circumference was the factor most associated with OSA in postmenopausal women, for all severities of the disease. Anthropometric factors presented a high rate of accuracy in the classification of women with OSA. The study found that different obesity-related anthropometric measures should be considered in the diagnosis of OSA, according to the woman's reproductive stage.
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Affiliation(s)
| | - Karen Tieme Nozoe
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Lia Bittencourt
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Monica Levy Andersen
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | | | - Helena Hachul
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
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179
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Gu M, Huang W, Li X, Liu Y, Wang F, Fang C, Chen T. Association of Hypertriglyceridemic Waist Phenotype with Obstructive Sleep Apnea: A Cross-Sectional Study. Nat Sci Sleep 2021; 13:2165-2173. [PMID: 34955662 PMCID: PMC8694710 DOI: 10.2147/nss.s335288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Hypertriglyceridemic waist (HTGW) phenotype is an independent risk factor for metabolic disorders. Although obstructive sleep apnea (OSA) is associated with metabolic disorders, it is unclear whether there is an association between HTGW phenotype and OSA. METHODS We enrolled consecutive participants presenting to a sleep center in Shanghai, China. Full-night polysomnography was performed, and serum triglyceride (TG) levels and waist circumference (WC) were calculated. HTGW phenotype was defined as increased WC (men > 90 cm, women > 80 cm) and elevated TG levels (> 1.7 mmol/L). Participants were classified into four groups: normal TG with normal WC (NTNW); normal TG with increased WC (NTGW); elevated TG with normal WC (HTNW); and elevated TG with enlarged WC, namely HTGW. The relationships between HTGW phenotypes and OSA were assessed using binary (apnea hypopnea index, [AHI]≥5/hr) and multinomial logistic regression analyses (clinical AHI severity categories). RESULTS We included 3190 participants in this cross-sectional study. Compared to the NTNW phenotype, participants with NTGW and HTGW phenotypes had the significantly higher risk of OSA (AHI ≥5/hr, odds ratio [OR] = 2.51, 95% confidence interval [CI] = 1.91-3.31; OR = 3.76, 95% CI = 2.67-5.31, respectively), after adjustment for confounders. In subgroup analyses categorised by age, sex, and BMI, the aforementioned associations remained significant. The association between the NTGW, HTGW phenotype and OSA risk remained significant across the OSA severity groups. Multinomial logistic regression also revealed that the mild (OR = 1.63, 95% CI = 1.07-2.50), moderate (OR = 1.875, 95% CI = 1.22-2.88), and severe OSA (OR = 3.18, 95% CI = 2.14-4.73) were associated with HTGW phenotype. CONCLUSION Both NTGW and HTGW phenotype were positively associated with OSA risk in all subgroups. Further longitudinal follow-up studies are needed to determine the causal link and prognostic role of these metabolic factors.
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Affiliation(s)
- Meizhen Gu
- Department of Otolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Weijun Huang
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Otolaryngology Head & Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xinyi Li
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Otolaryngology Head & Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yupu Liu
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Otolaryngology Head & Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Fan Wang
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Otolaryngology Head & Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Chao Fang
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Otolaryngology-Head & Neck Surgery, The First Hospital of Putian, Putian, Fujian Province, People's Republic of China
| | - Ting Chen
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.,Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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180
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Flanagan EW, Most J, Broskey NT, Altazan AD, Beyl RA, Keadle SK, Drews KL, Singh P, Redman LM. Identification of changes in sleep across pregnancy and the impact on cardiometabolic health and energy intake in women with obesity. Sleep Med 2021; 77:120-127. [PMID: 33352456 PMCID: PMC7887073 DOI: 10.1016/j.sleep.2020.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
This prospective, observational study investigated changes in sleep and the effect on energy intake, gestational weight gain, and cardiometabolic health across pregnancy in 52 healthy pregnant women with obesity. Habitual sleep was assessed by wrist-worn actigraphy (time spent in bed; TIB, total sleep time; TST, and sleep efficiency) in early (130-156 weeks) and late (350-366) pregnancy. A change to habitual sleep was defined as change of one-half of the standard deviation of TIB and TST across six consecutive nights from early pregnancy. Energy intake and changes in weight, fasting glucose, insulin, and lipids across pregnancy were compared between women who changed sleep. During early pregnancy, TIB was 9:24 ± 0:08 h and varied by 1:37 ± 0:07 h across the six nights. TST and sleep efficiency significantly declined from early to late pregnancy (7:03 ± 0:08 h to 6:28 ± 0:09 h, p < 0.001) and (76 ± 0.1% to 71 ± 0.2%, p < 0.001), respectively. For women who increased TIB (n = 11), fasting glucose decreased (-11.6 ± 4.3%, p < 0.01) across pregnancy and they had a trend towards decreased insulin (-57.8 ± 33.5%; p = 0.09) and HOMA-IR (-72.4 ± 37.3%; p = 0.06) compared to women who decreased TIB (n = 13). Women who increased TIB had a significantly lower daily energy intake across pregnancy (-540 ± 163 kcal; p < 0.01) and tended to have less gestational weight gain (-147 ± 88 g/week; p = 0.10). Changes in TST did not affect plasma markers, energy intake or weight gain. The positive relationship between sleep and cardiometabolic health during pregnancy is explained in part by lower energy intake. We hypothesize lower energy intake is due to a prolonged overnight fast and a decrease in the time available for eating.
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Affiliation(s)
- Emily W Flanagan
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Jasper Most
- Zuyderland Medical Center, Sittard/Geleen, 6162, BG, the Netherlands
| | - Nicholas T Broskey
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Abby D Altazan
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Sarah K Keadle
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA
| | - Kimberly L Drews
- Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Prachi Singh
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA.
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181
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Elgart M, Redline S, Sofer T. Machine and Deep Learning in Molecular and Genetic Aspects of Sleep Research. Neurotherapeutics 2021; 18:228-243. [PMID: 33829409 PMCID: PMC8116376 DOI: 10.1007/s13311-021-01014-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
Epidemiological sleep research strives to identify the interactions and causal mechanisms by which sleep affects human health, and to design intervention strategies for improving sleep throughout the lifespan. These goals can be advanced by further focusing on the environmental and genetic etiology of sleep disorders, and by development of risk stratification algorithms, to identify people who are at risk or are affected by, sleep disorders. These studies rely on comprehensive sleep-related data which often contains complex multi-dimensional physiological and molecular measurements across multiple timepoints. Thus, sleep research is well-suited for the application of computational approaches that can handle high-dimensional data. Here, we survey recent advances in machine and deep learning together with the availability of large human cohort studies with sleep data that can jointly drive the next breakthroughs in the sleep-research field. We describe sleep-related data types and datasets, and present some of the tasks in the field that can be targets for algorithmic approaches, as well as the challenges and opportunities in pursuing them.
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Affiliation(s)
- Michael Elgart
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
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182
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Cruz FC, Drager LF, Queiróz DB, Souza GA, Pedrosa RP, Patriota TLC, Dórea EL, Vieira MLC, Righi CG, Martinez D, da Silva GA, Silva GV, Pio-Abreu A, Lotufo PA, Benseãor IM, Bortolotto LA, Fuchs FD, Lorenzi-Filho G. The effect of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea and uncontrolled hypertension - Study design and challenges during the COVID-19 pandemic. Clinics (Sao Paulo) 2021; 76:e2926. [PMID: 34495079 PMCID: PMC8382149 DOI: 10.6061/clinics/2021/e2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and ≥80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index ≥15 events/hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. ClinicalTrials.gov: NCT02270658. RESULTS The first 100 patients are predominantly males (n=69), age: 52±10 years, body mass index: 32.7±3.9 kg/m2 with frequent co-morbidities. CONCLUSIONS The MORPHEOS trial has a unique study design including a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP.
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Affiliation(s)
- Fernanda C.S.G. Cruz
- Laboratorio de Sono, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciano F. Drager
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Unidade de Hipertensao, Divisao Renal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Daniel B.C. Queiróz
- Laboratorio de Sono, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gabriela A. Souza
- Laboratorio de Sono, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo P. Pedrosa
- Laboratorio do Sono e Coracao, Pronto-Socorro Cardiologico de Pernambuco (PROCAPE), Universidade de Pernambuco, Recife, PE, BR
| | - Tarcya L.G Couto Patriota
- Laboratorio do Sono e Coracao, Pronto-Socorro Cardiologico de Pernambuco (PROCAPE), Universidade de Pernambuco, Recife, PE, BR
| | - Egidio L. Dórea
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Luiz C. Vieira
- Unidade de Ecocardiografia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Camila G. Righi
- Laboratorio Interdisciplinar de Pesquisa em Sono, Hospital de Clinicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, BR
| | - Denis Martinez
- Laboratorio Interdisciplinar de Pesquisa em Sono, Hospital de Clinicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, BR
| | - Geruza A. da Silva
- Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Giovanio V. Silva
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andrea Pio-Abreu
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo A. Lotufo
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Isabela M. Benseãor
- Hospital Universitario, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz A. Bortolotto
- Unidade de Hipertensao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Flávio D. Fuchs
- Divisao de Cardiologia, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, BR
| | - Geraldo Lorenzi-Filho
- Laboratorio de Sono, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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183
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Wang W, Zheng Y, Li M, Lin S, Lin H. Recent Advances in Studies on the Role of Neuroendocrine Disorders in Obstructive Sleep Apnea-Hypopnea Syndrome-Related Atherosclerosis. Nat Sci Sleep 2021; 13:1331-1345. [PMID: 34349578 PMCID: PMC8326525 DOI: 10.2147/nss.s315375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease is a common cause of death worldwide, and atherosclerosis (AS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) critically contribute to the initiation and progression of cardiovascular diseases. OSAHS promotes endothelial injury, vascular smooth muscle cell (VSMC) proliferation, abnormal lipid metabolism, and elevated arterial blood pressure. However, the exact OSAHS mechanism that causes AS remains unclear. The nervous system is widely distributed in the central and peripheral regions. It regulates appetite, energy metabolism, inflammation, oxidative stress, insulin resistance, and vasoconstriction by releasing regulatory factors and participates in the occurrence and development of AS. Studies showed that OSAHS can cause changes in neurophysiological plasticity and affect modulator release, suggesting that neuroendocrine dysfunction may be related to the OSAHS mechanism causing AS. In this article, we review the possible mechanisms of neuroendocrine disorders in the pathogenesis of OSAHS-induced AS and provide a new basis for further research on the development of corresponding effective intervention strategies.
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Affiliation(s)
- Wanda Wang
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Yanli Zheng
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Meimei Li
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Shu Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China.,Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
| | - Huili Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
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184
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Thosar SS, Bhide MC, Katlaps I, Bowles NP, Shea SA, McHill AW. Shorter Sleep Predicts Longer Subsequent Day Sedentary Duration in Healthy Midlife Adults, but Not in Those with Sleep Apnea. Nat Sci Sleep 2021; 13:1411-1418. [PMID: 34408517 PMCID: PMC8364911 DOI: 10.2147/nss.s322459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Sedentary behavior and suboptimal sleep increase risks for chronic diseases. We hypothesized that sedentary behavior and sleep affect each other and that an underlying sleep disorder would alter these relationships. To test these hypotheses, we studied the bidirectional relationships between sedentary behavior and sleep (duration and efficiency) in healthy controls (HC) and people with untreated obstructive sleep apnea (OSA). PATIENTS AND METHODS Fifty-two volunteers (18 HC, 19 mild OSA [apnea/hypopnea index [AHI] range 5-14.9/hour], 15 moderate OSA [AHI range 15-29.9/hour]) were studied with actigraphy and sleep diaries across ~9 consecutive nights of self-selected consistent ~8-hour sleep episodes at home (range 4-21/nights per person). We analyzed whether total time asleep and sleep efficiency affected the subsequent daytime sedentary duration while controlling for body mass index and whether the severity of OSA altered this relationship. We also tested the reverse relationship, namely whether daytime sedentary duration affected the subsequent night's sleep and if any such relationship differed with OSA severity. RESULTS Overnight sleep duration and efficiency negatively predicted the subsequent day's sedentary duration in HC (p<0.02), but not in people with mild or moderate OSA (p>0.05). There was no significant reverse relationship between daytime sedentary duration and the subsequent night's sleep duration or efficiency (p≥0.2). CONCLUSION In healthy adults, short nighttime sleep predicts a longer duration of sedentary behavior on a subsequent day, but we did not observe this relationship in people with OSA. The mechanisms underlying this association in healthy individuals and its disruption in the presence of OSA need to be studied.
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Affiliation(s)
- Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences.,School of Nursing.,Knight Cardiovascular Institute, School of Medicine.,OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, 97239, USA
| | | | | | | | - Steven A Shea
- Oregon Institute of Occupational Health Sciences.,OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Andrew W McHill
- Oregon Institute of Occupational Health Sciences.,School of Nursing
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185
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Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure? Sleep Med Clin 2020; 16:125-144. [PMID: 33485525 DOI: 10.1016/j.jsmc.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibility.
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186
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Shi H, Xiang S, Huang X, Wang L, Hua F, Jiang X. Development and validation of a nomogram for predicting the risk of obstructive sleep apnea in patients with type 2 diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1675. [PMID: 33490187 PMCID: PMC7812169 DOI: 10.21037/atm-20-6890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Obstructive sleep apnea (OSA) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) in China, but few patients with clinical symptoms of OSA are referred for diagnostic polysomnography (PSG). Thus, this study aimed to develop and validate an easy-to-use nomogram that predicts the severity of OSA in patients with T2DM. Methods This retrospective study included consecutive patients with T2DM admitted to the Endocrinology Department, Third Affiliated Hospital of Soochow University between January 1, 2016 and December 31, 2019. OSA was diagnosed with PSG. Participants were randomly assigned to a training cohort (70%) and a validation cohort (30%). Demographic, anthropometric, and biochemical data were collected. A least absolute shrinkage and selection operator (LASSO) regression model was used to reduce data dimensionality and identify factors for inclusion in the nomogram (training cohort). Nomogram validation was performed in the validation cohort. Results The study included 280 participants in the training group and 118 participants in the validation group. OSA prevalence was 58.5%. LASSO regression identified waist-to-hip ratio (WHR), smoking status, body mass index (BMI), serum uric acid (UA), the homeostasis model assessment insulin resistance index (HOMA-IR), and history of fatty liver disease as predictive factors for inclusion in the nomogram. Discrimination and calibration in the training group (C-index =0.88) and validation group (C-index =0.881) were good. The nomogram identified patients with T2DM at risk for OSA with an area under the curve of 0.851 [95% confidence interval (CI), 0.788-0.900]. Conclusions Our nomogram could be used to facilitate individualized prediction of OSA risk in patients with T2DM and help prioritize patients for diagnostic PSG.
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Affiliation(s)
- Huan Shi
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
| | - Shoukui Xiang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
| | - Xiaolin Huang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
| | - Long Wang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
| | - Fei Hua
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
| | - Xiaohong Jiang
- Department of Endocrinology, First People's Hospital of Changzhou, Changzhou, China
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187
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Neeland IJ, Eliasson B, Kasai T, Marx N, Zinman B, Inzucchi SE, Wanner C, Zwiener I, Wojeck BS, Yaggi HK, Johansen OE. The Impact of Empagliflozin on Obstructive Sleep Apnea and Cardiovascular and Renal Outcomes: An Exploratory Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care 2020; 43:3007-3015. [PMID: 33004464 PMCID: PMC7770278 DOI: 10.2337/dc20-1096] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the effects of empagliflozin on the incidence of obstructive sleep apnea (OSA) and its effects on metabolic, cardiovascular (CV), and renal outcomes among participants with or without OSA in the EMPA-REG OUTCOME trial. RESEARCH DESIGN AND METHODS Participants with diabetes and CV disease were randomized to empagliflozin (10 and 25 mg) or placebo daily in addition to standard of care. OSA was assessed by investigator report using Medical Dictionary for Regulatory Activities version 18.0, and CV outcomes were independently adjudicated. Analyses were performed using multivariable-adjusted Cox regression models. RESULTS OSA was reported in 391 of 7,020 (5.6%) participants at baseline. Those with OSA were more likely to be male (83% vs. 71%) and to have moderate to severe obesity (BMI ≥35 kg/m2; 55% vs. 18%). Over a median of 3.1 years, empagliflozin had similar placebo-adjusted reductions in HbA1c, waist circumference, and systolic blood pressure, regardless of OSA status, but a larger effect on weight (adjusted mean ± SE difference at week 52: OSA vs. no OSA -2.9 ± 0.5 vs. -1.9 ± 0.1 kg). Incidence of 3-point major adverse CV events, CV death, heart failure hospitalization, and incident or worsening nephropathy in the placebo group was 1.2- to 2.0-fold higher for those with baseline OSA compared with those without. Empagliflozin significantly reduced the risk for outcomes regardless of OSA status (P-interaction all >0.05). Fifty patients reported a new diagnosis of OSA through 7 days after medication discontinuation, and this occurred less often with empagliflozin treatment (hazard ratio 0.48 [95% CI 0.27, 0.83]). CONCLUSIONS In EMPA-REG OUTCOME, participants with OSA had greater comorbidity and higher frequency of CV and renal events. Empagliflozin had favorable effects on risk factors and CV and renal outcomes regardless of preexisting OSA and may also reduce the risk for new-onset OSA.
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Affiliation(s)
- Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Bjorn Eliasson
- Department of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nikolaus Marx
- Department of Internal Medicine I (Cardiology), RWTH University Hospital, Aachen, Germany
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, Yale University, New Haven, CT
| | - Christoph Wanner
- Department of Medicine, Wuerzburg University Clinic, Wuerzburg, Germany
| | - Isabella Zwiener
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Brian S Wojeck
- Section of Endocrinology, Yale School of Medicine, Yale University, New Haven, CT
| | - Henry K Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, CT
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Zhang Z, Yang D, Wang H, Liu X. Effects of age and sex on the performance of the NoSAS score as a screening tool for obstructive sleep apnea: a hospital-based retrospective study in China. Sleep Breath 2020; 25:1407-1417. [DOI: 10.1007/s11325-020-02254-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 01/24/2023]
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189
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Wang J, Wang X, Yu W, Zhang K, Wei Y. Obstructive sleep apnea-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients. J Thorac Dis 2020; 12:5603-5616. [PMID: 33209393 PMCID: PMC7656408 DOI: 10.21037/jtd-20-2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases were searched manually and automatically for relevant English articles. All of the included articles focused on a comparison of the incidence of postoperative parameters of multi-organ function in CHD patients undergoing elective CABG with and without OSA. Studies were excluded if they met any one of the following criteria: (I) duplicate publication; (II) ongoing or unpublished studies; (III) only published as abstracts or conference proceedings; and (IV) less than 30 patients in the patient cohort. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls [odds risk (OR), 1.97; 95% CI, 1.50 to 2.59, P<0.0001]. In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, P<0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased 243% (OR, 3.43; 95% CI, 1.35 to 8.71; P=0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; P=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P<0.0001). Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications.
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Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.,Center for Cardiac Intensive Care, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xinxin Wang
- Department of General Surgery, Chinese PLA general hospital, Beijing, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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190
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Bikov A, Frent S, Pleava R, Kunos L, Bokhari S, Meszaros M, Mihaicuta S. The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea-Regional Differences in Two Central-Eastern European Sleep Centers. J Clin Med 2020; 9:jcm9113583. [PMID: 33172084 PMCID: PMC7694741 DOI: 10.3390/jcm9113583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romania. Methods: Data from 588 (282 from Hungary, 306 from Romania) untreated patients with OSA were retrospectively analyzed. The prevalence rates of hypertension, diabetes, dyslipidemia, allergic rhinitis, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, cerebrovascular and cardiovascular disease, arrhythmia and depression were compared between the two populations following adjustment for demographics, body mass index, smoking history, comorbidities and sleep parameters. Results: The prevalence rates of hypertension, arrhythmia, cerebrovascular and cardiovascular disease, diabetes and COPD in the whole study population were directly related to the severity of OSA. We found an inverse correlation between the prevalence of osteoporosis and OSA severity (all p < 0.05). Following adjustment, the prevalence of dyslipidemia was higher in the Hungarian cohort, whilst the prevalence of asthma, cardiovascular and cerebrovascular diseases was higher in the Romanian cohort (all p < 0.05). Conclusions: There was no difference in the prevalence rate of most comorbidities in patients with OSA from the two cohorts, except for dyslipidemia, asthma, cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester M239LT, UK
| | - Stefan Frent
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
- Correspondence:
| | - Roxana Pleava
- Department of Cardiology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Saba Bokhari
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Stefan Mihaicuta
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
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Abstract
PURPOSE OF REVIEW The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.
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Affiliation(s)
| | - Kapil G Kapoor
- Eastern Virginia Medical School, Norfolk
- Wagner and Kapoor Research Institute, Virginia Beach, Virginia, USA
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192
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Delpachitra S, Campbell A, Wibowo E. Preference for sleep management strategies among prostate cancer patients: An Aotearoa/New Zealand perspective ✰. Cancer Treat Res Commun 2020; 25:100219. [PMID: 33120315 DOI: 10.1016/j.ctarc.2020.100219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many men with prostate cancer (PCa) experience insomnia symptoms post-treatment. We explore here PCa patients' preference for strategies to manage their sleep. PATIENTS AND METHODS A brief online survey was launched on Facebook and promoted by Prostate Cancer Foundation New Zealand. The survey contained validated questionnaires on various sleep-related parameters, as well as questions about sleep management strategies. RESULTS We recruited 82 PCa patients (67.9 ± 6.3 years old). Participants with high insomnia severity index (ISI) scores reported significantly worse daytime sleepiness, more severe fatigue, being less of a "morning person", and more frequent dreaming. Most participants (71-95%) were open to trying behavioural strategies for improving sleep hygiene, especially by improving their sleeping conditions and having a consistent sleep-wake schedule. Insomnia severity and past use of androgen deprivation therapy were significant predictors for the number of sleep treatments used. Participants with a high ISI were more likely to have used medication, CBT, and herbal remedies or supplements for treating sleep issues than those with low ISI. Furthermore, in patients who had not used these treatments options, those with a high ISI were more willing to try CBT and hypnosis compared to those with a low ISI. Reasons for not willing to try various sleep treatments were documented. CONCLUSION Most PCa patients are willing to adjust their behavior or lifestyle to improve their sleep habits/behaviours. Patients with severe insomnia are more likely to have both used and express willingness to try, interventions to improve sleep, with preferences for CBT and hypnosis.
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Affiliation(s)
- Shenyll Delpachitra
- Department of Anatomy, University of Otago, 270 Great King St, Dunedin, New Zealand - 9016.
| | - Angela Campbell
- WellSleep, Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Erik Wibowo
- Department of Anatomy, University of Otago, 270 Great King St, Dunedin, New Zealand - 9016.
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193
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What Is the Most Common Cause of Secondary Hypertension?: An Interdisciplinary Discussion. Curr Hypertens Rep 2020; 22:101. [PMID: 33119816 DOI: 10.1007/s11906-020-01106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Traditional statements in medical textbooks pointed that 90 to 95% of cases of hypertension is essential or primary. However, secondary hypertension seems to be common in those patients with resistant forms of hypertension. Appropriate investigation and treatment may have prognostic impact but frequently hypertension remission did not occur raising concerns about the real meaning of secondary hypertension. Here, we provided an interdisciplinary and critical discussion comprising an endocrinologist, a nephrologist, and a cardiologist with expertise in resistant hypertension. We reviewed the literature approaching each one of the recognizable cause of hypertension. RECENT FINDINGS Recent studies pointed that the most common causes of secondary hypertension are those who overall responses to their treatments do not promote hypertension remission including obstructive sleep apnea (OSA), chronic kidney disease, renovascular hypertension and primary aldosteronism. The authors raised concerns regarding the lack of inclusion of obesity by several societies as a formal cause of hypertension considering not only the biologic plausibility but also the huge impact of weight loss therapies such as bariatric surgery on hypertension remission. In contrast, there is no discussion that a very rare condition-namely pheochromocytoma-is the most "typical" cause of hypertension by promoting hypertension remission in the majority of patients after surgical procedure. Hypertension is a complex condition with multiple environmental and genetics interactions. In clinical practice, it is challenging to prove causality in hypertension. Common conditions largely acceptable as causes of hypertension (OSA, chronic kidney disease, renovascular hypertension, and primary aldosteronism) frequently occur in a setting of an established hypertension background and therefore do not promote hypertension remission in a significant proportion of patients. If obesity becomes largely accepted by several societies as a secondary form of hypertension, this pandemic condition will be certainly the most common cause of hypertension.
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194
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Sasaki N, Watanabe K, Kawakami N. Personal values in adolescence and their associations with metabolic biomarkers in adulthood: a Japanese population-based study. Biopsychosoc Med 2020; 14:26. [PMID: 33042217 PMCID: PMC7542755 DOI: 10.1186/s13030-020-00197-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022] Open
Abstract
Background Personal values, which are formed in early life, can have an impact on health outcome later in life. Objective The aim of this study is to investigate the relation between personal values in adolescence and bio-indicators related to metabolic syndrome (MetS) in adulthood. Participants and Methods The longitudinal data used was from the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE). Personal values in adolescence were retrospectively obtained in 2017 from a self-reporting questionnaire, composed of value priorities and commitment to the values. Venous samples were collected in 2012 for low and high-density lipoprotein (LDL, HDL) cholesterol and hemoglobin A1c (HbA1c). Body mass index (BMI), waist circumference and systolic and diastolic blood pressure (SBP, DBP) were also measured. The associations of each variable were examined by partial correlation analysis. In addition, multiple linear regression analysis was conducted to examine overall associations between personal values and the sum of standardized scores (Z-score) of the biomarkers as a proxy of MetS. Results The total population (n = 668) included 261 men and 407 women. For men, the personal value priority of “Having influence on society” was associated with high HDL cholesterol (0.133, p = 0.032) and “Cherishing familiar people” with low waist circumference (r = -0.129, p = 0.049), low SBP, and high DBP (r = -0.135, p = 0.039; r = 0.134, p = 0.041). For women, “Not bothering others” was associated with high SBP and low DBP (r = 0.125, p = 0.015; r = -0.123, p = 0.017). "Economically succeeding" was associated with a worse outcome (β = 0.162, p = 0.042) in men. Conclusions Although some significant associations were found between personal values in adolescence and MetS-related markers in adulthood, the overall associations were not strong. Culturally prevailing values were likely to be associated with a good outcome of metabolic health.
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Kazuhiro Watanabe
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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195
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Li X, Fu Z, Xu H, Zou J, Zhu H, Li Z, Su K, Huai D, Yi H, Guan J, Yin S. Influence of multiple apolipoprotein A-I and B genetic variations on insulin resistance and metabolic syndrome in obstructive sleep apnea. Nutr Metab (Lond) 2020; 17:83. [PMID: 33005209 PMCID: PMC7523361 DOI: 10.1186/s12986-020-00501-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The relationships between apolipoprotein A-I (APOA-I), apolipoprotein B (APOB) with insulin resistance, metabolic syndrome (MetS) are unclear in OSA. We aimed to evaluate whether the multiple single nucleotide polymorphism (SNP) variants of APOA-I and APOB exert a collaborative effect on insulin resistance and MetS in OSA. Methods Initially, 12 APOA-I SNPs and 30 APOB SNPs in 5259 subjects were examined. After strict screening, four APOA-I SNPs and five APOB SNPs in 4007 participants were included. For each participant, the genetic risk score (GRS) was calculated based on the cumulative effect of multiple genetic variants of APOA-I and APOB. Logistic regression analyses were used to evaluate the relationships between APOA-I/APOB genetic polymorphisms, insulin resistance, and MetS in OSA. Results Serum APOB levels increased the risk of insulin resistance and MetS adjusting for age, gender and BMI [odds ratio (OR = 3.168, P < 0.001; OR = 6.098, P < 0.001, respectively]. APOA-I GRS decreased the risk of insulin resistance and MetS after adjustments (OR = 0.917, P = 0.001; OR = 0.870, P < 0.001, respectively). APOB GRS had no association with insulin resistance (OR = 1.364, P = 0.610), and had weak association with MetS after adjustments (OR = 1.072, P = 0.042). In addition, individuals in the top quintile of the APOA-I genetic score distribution had a lower risk of insulin resistance and MetS after adjustments (OR = 0.761, P = 0.007; OR = 0.637, P < 0.001, respectively). Conclusions In patients with OSA, cumulative effects of APOA-I genetic variations decreased the risk of insulin resistance and MetS, whereas multiple APOB genetic variations had no associations with insulin resistance and weak association with MetS.
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Affiliation(s)
- Xinyi Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Zhihui Fu
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Huajun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Jianyin Zou
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Huaming Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Zhiqiang Li
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Huashan Road 1954, Shanghai, 200030 People's Republic of China
| | - Kaiming Su
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - De Huai
- Department of Otorhinolaryngology, Huai'an Second People's Hospital, Huai'an Hospital Affiliated to Xuzhou Medical University, 62 Huaihai South Road, Huai'an, 223002 Jiangsu People's Republic of China
| | - Hongliang Yi
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Jian Guan
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Shankai Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233 People's Republic of China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233 People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
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196
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Santos I, Rocha I, Gozal D, Meira e Cruz M. Obstructive sleep apnea, shift work and cardiometabolic risk. Sleep Med 2020; 74:132-140. [DOI: 10.1016/j.sleep.2020.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/12/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022]
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197
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Facin AC, Uscategui RAR, Maronezi MC, Pavan L, Menezes MP, Montanhim GL, Camacho AA, Feliciano MAR, Moraes PC. Liver and spleen elastography of dogs affected by brachycephalic obstructive airway syndrome and its correlation with clinical biomarkers. Sci Rep 2020; 10:16156. [PMID: 32999366 PMCID: PMC7527336 DOI: 10.1038/s41598-020-73209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study is to determine whether the brachycephalic obstructive airway syndrome (BOAS) is correlated to alterations in liver and spleen elasticity. Forty-eight brachycephalic and 22 mesocephalic dogs were submitted to a BOAS functional assessment, laboratory tests, abdominal ultrasound and liver and spleen Acoustic Radiation Force Impulse (ARFI) elastography. Dogs clinically affected by BOAS had higher values of liver stiffness (p < 0.001) than healthy dogs: medial lobes (1.57 ± 0.37 m/s), left and right lateral lobes (1.54 ± 0.50 m/s, 1.23 ± 0.28 m/s, respectively) and caudate lobe (1.28 ± 0.42 m/s). Compared to the mesocephalic group, the brachycephalic group (BOAS clinically affected and unaffected dogs) had higher spleen (2.51 ± 0.45 m/s; p < 0.001) and liver stiffness (p < 0.001): medial lobes (1.53 ± 0.37 m/s), left and right lateral lobes (1.47 ± 0.47 m/s, 1.20 ± 0.30 m/s, respectively) and caudate lobe (1.23 ± 0.40 m/s). Principal component analysis explained 70% of the variances composed by liver stiffness increase, erythrocytes and alanine aminotransferase reduction. Brachycephalic dogs had higher spleen and liver stiffness and a subacute inflammatory state, which represent another BOAS systemic effect. Consequently, these dogs can be at higher risk of hepatic disorders compared with mesocephalic dogs, similarly to humans affected by sleep apnea syndrome.
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Affiliation(s)
- Andréia Coutinho Facin
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil.
| | - Ricardo Andres Ramirez Uscategui
- Institute of Agrarian Sciences, Federal University of the Jequitinhonha and Mucuri Valleys (UFVJM), Unaí, Minas Gerais, 38610-000, Brazil
| | - Marjury Cristina Maronezi
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
| | - Letícia Pavan
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
| | - Mareliza Possa Menezes
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
| | - Gabriel Luiz Montanhim
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
| | - Aparecido Antonio Camacho
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
| | | | - Paola Castro Moraes
- Department of Clinic and Veterinary Surgery, São Paulo State University (UNESP), School of Agricultural and Veterinarian Sciences, Jaboticabal, São Paulo, 14884-900, Brazil
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Badoer E. The Carotid Body a Common Denominator for Cardiovascular and Metabolic Dysfunction? Front Physiol 2020; 11:1069. [PMID: 32982794 PMCID: PMC7478291 DOI: 10.3389/fphys.2020.01069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
The carotid body is a highly vascularized organ designed to monitor oxygen levels. Reducing oxygen levels in blood results in increased activity of the carotid body cells and reflex increases in sympathetic nerve activity. A key contributor to elevated sympathetic nerve activity in neurogenic forms of hypertension is enhanced peripheral chemoreceptor activity. Hypertension commonly occurs in metabolic disorders, like obesity. Such metabolic diseases are serious global health problems. Yet, the mechanisms contributing to increased sympathetic nerve activity and hypertension in obesity are not fully understood and a better understanding is urgently required. In this review, we examine the literature that suggests that overactivity of the carotid body may also contribute to metabolic disturbances. The purine ATP is an important chemical mediator influencing the activity of the carotid body and the role of purines in the overactivity of the carotid body is explored. We will conclude with the suggestion that tonic overactivity of the carotid body may be a common denominator that contributes to the hypertension and metabolic dysfunction seen in conditions in which metabolic disease exists such as obesity or insulin resistance induced by high caloric intake. Therapeutic treatment targeting the carotid bodies may be a viable treatment since translation to the clinic could be more easily performed than expected via repurposing antagonists of purinergic receptors currently in clinical practice, and the use of other minimally invasive techniques that reduce the overactivity of the carotid bodies which may be developed for such clinical use.
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Affiliation(s)
- Emilio Badoer
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC, Australia
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199
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Reduced regional homogeneity and neurocognitive impairment in patients with moderate-to-severe obstructive sleep apnea. Sleep Med 2020; 75:418-427. [PMID: 32980663 DOI: 10.1016/j.sleep.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/03/2020] [Accepted: 09/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurocognitive dysfunction and abnormal regional homogeneity (ReHo) have been reported in patients with obstructive sleep apnea (OSA). However, little is known about whether brain functional alteration could be used to differentiate from healthy controls (HCs) and its correlation with neurocognitive impairment. METHODS Thirty-three treatment-naive patients with moderate-to-severe OSA and 22 HCs with matched age, sex and education underwent the evaluation of Epworth sleepiness scale, neurocognitive function, full night polysomnography and resting-state functional magnetic resonance imaging scan. ReHo, support vector machine, and correlation with neurocognitive function were administrated to analyze the data. RESULTS Compared with HCs, patients with OSA showed decreased ReHo in the bilateral superior frontal gyrus (FG), bilateral superior medial prefrontal cortex (PFC)/right supplementary motor area (SMA), left middle FG, and right precentral/postcentral gyrus. Negative correlations were observed between the ReHo values in the left superior FG/middle FG and apnea hypopnea index, oxygen desaturation index in the OSA group. The scores of Stroop word test, Stroop color-word test, symbol coding test were all negatively correlated with the ReHo values in the right precentral gyrus/postcentral gyrus in patients. Scores of the animal naming fluency test were positively correlated with the ReHo values in the left superior FG/middle FG in patients. Moreover, support vector machine analysis showed the ReHo values in the left superior FG/middle FG or bilateral superior medial PFC/right SMA both could discriminate patients from HCs with good accuracies, sensitivities, and specificities (85.45%, 87.88%, 81.82% and 81.82%, 84.85%, 77.27%, respectively). CONCLUSION Dysfunction in the frontal lobe is a potentially pivotal neuro-pathophysiological mechanism of neurocognitive impairment in patients with moderate-to-severe OSA. And significantly lower ReHo values in the left superior FG/middle FG and/or superior medial PFC/SMA are promising imaging biomarkers to discriminate moderate-to-severe patients with OSA from HCs.
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Prevalence of obstructive sleep apnea risk and associated factors among patients with type 2 diabetes mellitus on follow up at Jimma Medical Center, Southwest Ethiopia. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 21:100234. [PMID: 32923370 PMCID: PMC7475117 DOI: 10.1016/j.jcte.2020.100234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnea is a periodic, partial or complete obstruction in the upper airway during sleep. It is highly prevalent among obese patients with type two diabetes mellitus. There were high numbers of participants with high risk of OSA among the study participants.
Background Obstructive sleep apnea (OSA) is a periodic, partial or complete obstruction in the upper airway during sleep that disrupts normal sleep pattern. Despite its significant morbidities and mortality, the majority of patients with OSA remain undiagnosed. The purpose of this study was to assess the prevalence and associated factors of OSA risk among type 2 diabetes patients on follow up at Jimma Medical Center from January 13 to March 2, 2020. Method A hospital based cross-sectional study was conducted and consecutive sampling technique was employed. The stop bang questionnaire was used to assess OSA risk. Data were collected using structured questionnaire and entered into EPI data 3.1 and exported to SPSS version 20 for analysis. Logistic regression was employed to identify factors associated with high risk OSA. A variable having a p-value of <0.2 in the bivariate model was subjected to multivariate analysis. Adjusted odds ratios were calculated at 95% confidence interval and considered significant with a p-value of ≤0.05. Result 253 patients seen in the outpatient clinic were involved with mean age and mean duration of diabetes was 50.27 ± 14.08 and 6.48 ± 5.20 years respectively. The study finding showed that the prevalence of high risk OSA was 45.5%. According to multivariate analysis comorbid hypertension (AOR = 2; 95% CI: 1.04, 3.89), physical inactivity (AOR = 2.11; 95% CI: 1.11,4), BMI ≥ 30 kg/m2: (AOR = 5.41; 95% CI: 1.68,17.3 and neck circumference > 40 cm: (AOR = 6.3; 95% CI: 2.8,14.2 were independently associated with an increased risk of OSA. Conclusion There is high number of participants with high risk of OSA. BMI of ≥ 30 kg/m2, physical inactivity, neck circumference of > 40 cm and comorbid hypertension were associated with high risk OSA among participants. Early detection and appropriate interventions are important among high risk groups.
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