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Huang Z, Zheng Z, Pang L, Fu K, Cheng J, Zhong M, Song L, Guo D, Chen Q, Li Y, Lv Y, Chen R, Sun X. The Association between Obstructive Sleep Apnea and Venous Thromboembolism: A Bidirectional Two-Sample Mendelian Randomization Study. Thromb Haemost 2024. [PMID: 38631385 DOI: 10.1055/a-2308-2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Despite previous observational studies linking obstructive sleep apnea (OSA) to venous thromboembolism (VTE), these findings remain controversial. This study aimed to explore the association between OSA and VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), at a genetic level using a bidirectional two-sample Mendelian randomization (MR) analysis. METHODS Utilizing summary-level data from large-scale genome-wide association studies in European individuals, we designed a bidirectional two-sample MR analysis to comprehensively assess the genetic association between OSA and VTE. The inverse variance weighted was used as the primary method for MR analysis. In addition, MR-Egger, weighted median, and MR pleiotropy residual sum and outlier (MR-PRESSO) were used for complementary analyses. Furthermore, a series of sensitivity analyses were performed to ensure the validity and robustness of the results. RESULTS The initial and validation MR analyses indicated that genetically predicted OSA had no effects on the risk of VTE (including PE and DVT). Likewise, the reverse MR analysis did not find substantial support for a significant association between VTE (including PE and DVT) and OSA. Supplementary MR methods and sensitivity analyses provided additional confirmation of the reliability of the MR results. CONCLUSION Our bidirectional two-sample MR analysis did not find genetic evidence supporting a significant association between OSA and VTE in either direction.
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Affiliation(s)
- Zhihai Huang
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhenzhen Zheng
- Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Lingpin Pang
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Kaili Fu
- Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Junfen Cheng
- Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ming Zhong
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Lingyue Song
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dingyu Guo
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qiaoyun Chen
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yanxi Li
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yongting Lv
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Riken Chen
- Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xishi Sun
- Emergency Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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2
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Li C, Lin J, Chen Q, Zhu Y. Identification and characterization of circular RNAs expression profiles in obstructive sleep apnea-induced liver injury. Aging (Albany NY) 2024; 16:6262-6272. [PMID: 38513259 PMCID: PMC11042926 DOI: 10.18632/aging.205701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024]
Abstract
Circular RNAs (circRNAs) have exhibited microRNA sponge activity, related to many important biological processes. Our study attempted to explore the comprehensive changes of circRNAs expression pattern in Obstructive sleep apnea (OSA)-induced liver injury and provide a global perspective of differentially expressed circRNAs (DECs). Then, RT-qPCR was used to confirm the microarray data. Further, gene ontology (GO) and KEGG pathway analysis were performed to annotate the DECs. Finally, the circRNA-miRNA-mRNA interaction network was established to predicted the target genes and target miRNAs of DECs for a stepwise bioinformatics analysis. We revealed a total of eighty DECs. In the meantime, six circRNAs were randomly validated by RT-qPCR. Among these circRNAs, mmu_circRNA_000469, 37851, 38959, 38983, 31665 were up-regulated in both microarray and qRT-PCR tissues, while mmu_circRNA_27565 was down-regulated. GO analysis revealed that circRNAs-target genes were largely related to liver function process such as carboxylic acid metabolic process and negative regulation of mitochondrial membrane potential. Meanwhile, KEGG analysis found that there were 13 pathways related to these circRNAs- target genes. And the most enriched pathway was Natural killer cell mediated cytotoxicity, which strongly suggests that immune responses may be important for the process of OSA-induced liver injury. In addition, four significant DECs (mmu_circRNA_000469, 38959, 38983, 27565) and their target mRNA and target miRNAs were further selected to establish the regulation network. Our study revealed that circRNAs may play a crucial role in OSA-induced liver injury and thus mmu_circRNA_000469, 38959, 38983, 27565 may serve as biomarkers of biological process of OSA-induced liver injury.
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Affiliation(s)
- Chaowei Li
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350001, China
- Department of Gastroenterology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jinhuang Lin
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Qingshi Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yueyong Zhu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350001, China
- Department of Hepatology, Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou 350001, China
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Ercolano E, Bencivenga L, Palaia ME, Carbone G, Scognamiglio F, Rengo G, Femminella GD. Intricate relationship between obstructive sleep apnea and dementia in older adults. GeroScience 2024; 46:99-111. [PMID: 37814196 PMCID: PMC10828345 DOI: 10.1007/s11357-023-00958-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Numerous evidence reports direct correlation between cognitive impairment, Alzheimer's disease and sleep disorders, in particular obstructive sleep apnea. Both obstructive sleep apnea and Alzheimer's disease are highly prevalent conditions whose incidence increases with age. Several studies demonstrate how sleep-disordered breathing may lead to poor cognition, even though the underlying mechanisms of this association remain partially unclear. According to the most recent studies, obstructive sleep apnea may be considered a modifiable risk factor for cognitive dysfunction. In the present review, the authors aim to integrate recent research examining obstructive sleep apnea and Alzheimer's disease biomarkers, also focusing on the mechanisms that support this correlation, including but not limited to the role of hypoxia and cardiovascular risk. Moreover, the potential favourable effect of obstructive sleep apnea therapy on cognitive function is discussed, to evaluate the benefits deriving from appropriate treatment of sleep-disordered breathing on cognition.
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Affiliation(s)
- Erica Ercolano
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giovanni Carbone
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Francesco Scognamiglio
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri - S.P.A. - Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Scientifico Di Telese Terme, Telese, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Department of Brain Sciences, Imperial College London, London, UK.
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4
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Di Lorenzo B, Scala C, Mangoni AA, Zoroddu S, Paliogiannis P, Pirina P, Fois AG, Carru C, Zinellu A. A Systematic Review and Meta-Analysis of Mean Platelet Volume and Platelet Distribution Width in Patients with Obstructive Sleep Apnoea Syndrome. Biomedicines 2024; 12:270. [PMID: 38397872 PMCID: PMC10887137 DOI: 10.3390/biomedicines12020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent yet underestimated disorder caused by the complete or partial obstruction of the upper airways. Although polysomnography is the gold standard for OSAS diagnosis, there is an active search for easily accessible biomarkers of disease presence and severity, particularly those reflecting morphological changes in specific blood cells. We investigated the associations between the presence and severity of OSAS, continuous positive airway pressure (CPAP) treatment, mean platelet volume (MPV), and platelet distribution width (PDW), routinely assessed as part of the complete blood count. From 262 retrieved records from PubMed, the Web of Science, Scopus, and Google Scholar, 31 manuscripts were selected for a final analysis, 30 investigating MPV and 15 investigating PDW. MPV was not statistically different between OSAS patients and healthy controls; however, it progressively increased with disease severity. By contrast, OSAS patients had significantly higher PDW values than controls (SMD = 0.40, 95% CI: 0.25 to 0.56; p ˂ 0.001), and the difference increased with disease severity. In a univariate meta-regression, there were significant associations between the MPV and publication year, the apnoea-hypopnea index, and diabetes mellitus, while no associations were observed with the PDW. No significant between-group differences were observed in the subgroup analyses. These data suggest that PDW, and to a lesser extent, MPV, are potential biomarkers of OSAS and require further research to ascertain their pathophysiological significance (PROSPERO, CRD42023459413).
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Affiliation(s)
- Biagio Di Lorenzo
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy (C.C.); (A.Z.)
| | - Chiara Scala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (P.P.)
- Clinical and Interventional Pulmonology, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
| | - Stefano Zoroddu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy (C.C.); (A.Z.)
| | - Panagiotis Paliogiannis
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (P.P.)
| | - Pietro Pirina
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (P.P.)
- Clinical and Interventional Pulmonology, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Alessandro G. Fois
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy (P.P.)
- Clinical and Interventional Pulmonology, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy (C.C.); (A.Z.)
- Quality Control Unit, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy (C.C.); (A.Z.)
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Valentino N, Moattari K, Gordon AM, Ashraf AM, Sadeghpour R, Razi AE. The impact of sleep apnea on primary reverse shoulder arthroplasty for the treatment of glenohumeral osteoarthritis. Shoulder Elbow 2023; 15:54-59. [PMID: 37974649 PMCID: PMC10649509 DOI: 10.1177/17585732221089262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2023]
Abstract
Introduction As the prevalence of sleep apnea (SA) increases nationwide, large sample sized studies following primary reverse shoulder arthroplasty (RSA) in SA patients are scarce. Therefore, this study evaluated whether SA is associated with 1) longer in-hospital lengths of stay (LOS) 2) readmissions 3) medical complications and 4) costs. Methods A retrospective nationwide Medicare analysis from 2005 to 2014 was performed. Inclusion criteria were patients with SA undergoing RSA for the treatment of glenohumeral osteoarthritis. Study group patients were 1:5 ratio matched to controls yielding 6241 patients in the study and 31,179 in the comparison cohort. Logistic regression was used to calculate odds-ratios (OR) for readmissions and complications. A p-value less than 0.004 was significant. Results SA patients had significantly longer in-hospital LOS compared to their counterparts (3-days versus 2-days, p < 0.0001), but similar rates of 90-day readmissions (7.98% vs. 6.54%; OR: 1.00, p = 0.907). Patients with SA had significantly greater incidence and odds of 90-day medical complications (13.36% vs. 7.29%; OR: 1.42, p < 0.0001) and significantly higher 90-day costs ($16,529.16 vs. $14,789.15, p < 0.0001). Conclusion Patients with SA undergoing primary RSA for the treatment of glenohumeral OA have longer in-hospital LOS, increased medical complications, and costs of care. Readmissions were not more common. Level of Evidence III.
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Affiliation(s)
- Nicolás Valentino
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York, USA
| | - Kevin Moattari
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Asad M Ashraf
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ramin Sadeghpour
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
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Huang Z, Duan A, Zhao Z, Zhao Q, Zhang Y, Li X, Zhang S, Gao L, An C, Luo Q, Liu Z. Impact of Obstructive Sleep Apnea on Disease Severity and Adverse Outcomes in Patients with Acute Pulmonary Embolism. Nat Sci Sleep 2023; 15:705-717. [PMID: 37743933 PMCID: PMC10516206 DOI: 10.2147/nss.s423221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose Acute pulmonary embolism (PE) poses a life-threatening risk with high mortality rates. While the coexistence of PE and obstructive sleep apnea (OSA) is gaining recognition, its influence on PE severity and prognosis remains uncertain. This study aims to investigate the associations between OSA and disease severity, as well as outcomes, in patients with acute PE. Patients and Methods We conducted a retrospective cohort study on patients diagnosed with acute PE who had undergone previous cardiorespiratory polygraphy. OSA severity was assessed using the apnea-hypopnea index (AHI) derived from cardiorespiratory polygraphy. The severity of acute PE was evaluated using the simplified Pulmonary Embolism Severity Index (sPESI) score. Logistic regression analysis was performed to investigate the associations between AHI and the risk of belonging to the sPESI≥1 group. Cox regression analysis was used to examine the relationship between AHI and long-term adverse events, defined as a composite of all-cause mortality and non-fatal cardiovascular events. Results Among 145 acute PE patients (mean age 62.2 years, 49.7% male), 94 (64.8%) had OSA. Patients with OSA had a significantly higher proportion of sPESI≥1 (89.4% vs 68.6%, p=0.002) than non-OSA patients. Each unit increase in AHI was associated with a 15% increased risk of severe PE (sPESI≥1) (odds ratio: 1.15, 95% CI 1.05-1.26, p=0.002) after adjusting for confounders. During a median follow-up of 15.2 months, 27 (18.6%) patients experienced adverse events. Increased AHI independently predicted a higher risk of adverse events (hazard ratio: 1.03, 95% CI: 1.00-1.05, p=0.026), even after adjusting for potential confounders. AHI ≥8 events/h was associated with a significantly higher adjusted hazard ratio of 2.56 (95% CI: 1.15-5.72, p=0.022) for adverse events compared to AHI <8 events. Conclusion OSA is common in acute PE patients and is linked to increased disease severity and adverse outcomes. Implementing routine OSA screening and management may aid risk stratification and improve outcomes in acute PE patients.
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Affiliation(s)
- Zhihua Huang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Anqi Duan
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhihui Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qing Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yi Zhang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xin Li
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Sicheng Zhang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Luyang Gao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Chenhong An
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qin Luo
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhihong Liu
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Zhang W, Ding Y. Impact of obstructive sleep apnea on outcomes of pulmonary embolism: A systematic review and meta‑analysis. Exp Ther Med 2023; 25:120. [PMID: 36815968 PMCID: PMC9932632 DOI: 10.3892/etm.2023.11819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
The current review aimed to assess the effect of obstructive sleep apnea (OSA) on the severity and outcomes of pulmonary embolism (PE). PubMed, Embase, ScienceDirect, CENTRAL and Google Scholar were searched for studies assessing the impact of OSA on severity and outcomes of PE. A total of 12 studies were included. Meta-analysis revealed that simplified PE severity index of >1 and pulmonary artery obstruction index score was significantly higher in patients with OSA as compared with controls, but there was no difference in right ventricle to left ventricle short-axis diameter. The need for non-invasive ventilation was significantly higher in patients with OSA but there was no difference in the need for mechanical ventilation. Patients with OSA had a significantly higher incidence of recurrence of PE. Meta-analysis also showed a statistically significantly lower risk of in-hospital mortality in patients with OSA as compared with controls, but without any difference in the risk of late mortality. Adjusted data on mortality indicated a significantly lower risk of mortality in PE patients with comorbid OSA. Limited data shows that comorbid OSA increases the severity of PE but has no effect on right ventricular function. OSA may increase the risk of recurrent PE. Paradoxically, the presence of OSA may also reduce the risk of in-hospital mortality. Results must be interpreted with caution owing to high inter-study heterogeneity and lack of matching of baseline characteristics. Current evidence needs to be confirmed by high-quality prospective studies.
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Affiliation(s)
- Wen Zhang
- Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang 312400, P.R. China
| | - Yongmin Ding
- Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang 312400, P.R. China,Correspondence to: Dr Yongmin Ding, Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), 666 Dangui Road, Shengzhou, Zhejiang 312400, P.R. China
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Yang J, Xue W, Wei Z, Hou C, Zhu H, Xu H, Wu X, Feng Y, Li X. The Associations of Platelet Activation and Coagulation Parameters with Obstructive Sleep Apnoea: A Large-Scale Observational Study. Int J Clin Pract 2023; 2023:5817644. [PMID: 36890969 PMCID: PMC9988364 DOI: 10.1155/2023/5817644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA) is associated with an increased risk of cardiovascular disease, with alterations in coagulability suspected as the mediating factor. This study explored blood coagulability and breathing-related parameters during sleep in patients with OSA. DESIGN Cross-sectional observational study. Setting. Shanghai Sixth People's Hospital. Participants. 903 patients diagnosed by standard polysomnography. Main Outcome and Measures. The relationships between coagulation markers and OSA were evaluated using Pearson's correlation, binary logistic regression, and restricted cubic spline (RCS) analyses. RESULTS The platelet distribution width (PDW) and activated partial thromboplastin time (APTT) decreased significantly with increasing OSA severity (both p < 0.001). PDW was positively associated with the apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), and microarousal index (MAI) (ß = 0.136, p < 0.001; ß = 0.155, p < 0.001; and ß = 0.091, p = 0.008, respectively). APTT was negatively correlated with AHI (ß = -0.128, p < 0.001) and ODI (ß = -0.123, p = 0.001). PDW was negatively correlated with percentage of sleep time with oxygen saturation below 90%(CT90) (ß = -0.092, p = 0.009). The minimum arterial oxygen saturation (SaO2) correlated with PDW (ß = -0.098, p = 0.004), APTT (ß = 0.088, p = 0.013), and prothrombin time (PT) (ß = 0.106, p = 0.0003). ODI was risk factors for PDW abnormalities (odds ratio (OR) = 1.009, p = 0.009) after model adjustment. In the RCS, a nonlinear dose-effect relationship was demonstrated between OSA and the risk of PDW and APTT abnormalities. CONCLUSION Our study revealed nonlinear relationships between PDW and APTT, and AHI and ODI, in OSA, with AHI and ODI increasing the risk of an abnormal PDW and thus also the cardiovascular risk. This trial is registered with ChiCTR1900025714.
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Affiliation(s)
- Jundong Yang
- Central Laboratory of Shanghai Eighth People's Hospital Affiliated to Jiangsu University, Shanghai, China
| | - Wenjun Xue
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Eighth People's Hospital Affiliated to Jiangsu University, Shanghai, China
| | - Zhicheng Wei
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Caiqiong Hou
- Basic Medical College, Jiamusi University, Jiamusi 154007, Heilongjiang, China
| | - Huaming Zhu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xiaolin Wu
- Central Laboratory of Shanghai Eighth People's Hospital Affiliated to Jiangsu University, Shanghai, China
| | - Yunhai Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Eighth People's Hospital Affiliated to Jiangsu University, Shanghai, China
| | - Xinyi Li
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Nistal DA, Martini ML, Neifert SN, Price G, Carrasquilla A, Gal JS, Caridi JM. The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Decompression and Fusion: A Single-Center Retrospective Analysis From 2008 to 2016. Int J Spine Surg 2022; 16:1075-1083. [PMID: 36153042 PMCID: PMC9807052 DOI: 10.14444/8324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a pervasive problem that can result in diminished neurocognitive performance, increased risk of all-cause mortality, and significant cardiovascular disease. While previous studies have examined risk factors that influence outcomes following cervical fusion procedures, to our knowledge, no study has examined the cost or outcome profiles for posterior cervical decompression and fusion (PCDF) procedures in patients with OSA. METHODS All cases at a single institution between 2008 and 2016 involving a PCDF were included. The primary outcome was prolonged extubation, defined as an extubation that took place outside of the operating room. Secondary outcomes included admission to the intensive care unit (ICU), complications, extended hospitalization, nonhome discharge, readmission within 30 and 90 days, emergency room visit within 30 and 90 days, and higher total costs. RESULTS We reviewed 1191 PCDF cases, of which 93 patients (7.81%) had a history of OSA. At the univariate level, patients with OSA had higher rates of ICU admissions (33.3% vs 16.8%, P < 0.0001), total complications (29.0% vs 19.0%, P = 0.0202), and respiratory complications (12.9% vs 6.6%, P = 0.0217). Multivariate regression analyses revealed no difference in the odds of a prolonged extubation (P = 0.4773) and showed that history of OSA was not predictive of higher costs. However, a significant difference was observed in the odds of having an ICU admission (P = 0.0046). CONCLUSION While patients with sleep apnea may be more likely to be admitted to the ICU postoperatively, OSA status a lone is not a risk factor for poor primary and secondary clinical outcomes following posterior cervical fusion procedures. CLINICAL RELEVANCE Various deformities of the cervical spine can exert extraluminal forces that partially collapse or obstruct the airway, thereby predisposing patients to OSA; however, no study has examined the cost or outcome profiles for PCDF procedures in patients with OSA. Therefore, this investigation highlights the ways in which OSA influences the risks, outcomes, and costs following PCDF using medical data from an institutional registry. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Dominic A. Nistal
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael L. Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean N. Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabrielle Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jonathan S. Gal
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M. Caridi
- Department of Neurosurgery, UTHealth Neurosciences Spine Center, Houston, TX, USA, John M. Caridi, Department of Neurosurgery, UTHealth Neurosciences Spine Center, 6400 Fannin St, Suite 2150, Houston, TX, 77030, USA;
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10
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Zolotoff C, Puech C, Roche F, Perek N. Effects of intermittent hypoxia with thrombin in an in vitro model of human brain endothelial cells and their impact on PAR-1/PAR-3 cleavage. Sci Rep 2022; 12:12305. [PMID: 35853902 PMCID: PMC9296553 DOI: 10.1038/s41598-022-15592-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with obstructive sleep apnea/hypopnea (OSA) are at high risk of cerebrovascular diseases leading to cognitive impairment. The oxidative stress generated by intermittent hypoxia (IH) could lead to an increase in blood-brain barrier (BBB) permeability, an essential interface for the protection of the brain. Moreover, in patients with OSA, blood coagulation could be increased leading to cardiovascular complications. Thrombin is a factor found increased in these populations that exerts various cellular effects through activation of protease activated receptors (PARs). Thus, we have evaluated in an in vitro BBB model the association of IH with thrombin at two concentrations. We measured the apparent BBB permeability, expression of tight junctions, ROS production, HIF-1α expression, and cleavage of PAR-1/PAR-3. Pre-treatment with dabigatran was performed. IH and higher thrombin concentrations altered BBB permeability: high levels of HIF-1α expression, ROS and PAR-1 activation compared to PAR-3 in such conditions. Conversely, lower concentration of thrombin associated with IH appear to have a protective effect on BBB with a significant cleavage of PAR-3. Dabigatran reversed the deleterious effect of thrombin at high concentrations but also suppressed the beneficial effect of low dose thrombin. Therefore, thrombin and PARs represent novel attractive targets to prevent BBB opening in OSA.
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Affiliation(s)
- Cindy Zolotoff
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université Jean Monnet Saint-Etienne, Saint-Priest-en-Jarez, France. .,Faculté de Médecine - Campus Santé Innovations, 10 Rue de la Marandière, 42270, Saint-Priest-en-Jarez, France.
| | - Clémentine Puech
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université Jean Monnet Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Frédéric Roche
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université Jean Monnet Saint-Etienne, Saint-Priest-en-Jarez, France.,Service de Physiologie Clinique Et de L'Exercice, Centre VISAS, CHU Saint Etienne, Saint-Priest-en-Jarez, France
| | - Nathalie Perek
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université Jean Monnet Saint-Etienne, Saint-Priest-en-Jarez, France
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11
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Lee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: A review. Clin Exp Ophthalmol 2022; 50:334-344. [PMID: 35263016 PMCID: PMC9544516 DOI: 10.1111/ceo.14071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022]
Abstract
There is a growing body of literature on the effects of sleep disorders, in particular obstructive sleep apnoea (OSA), on ocular health, with consistent evidence of an increased risk of floppy eyelid syndrome, non-arteritic anterior ischaemic optic neuropathy, diabetic macular oedema, and other retinal vasculature changes in individuals with OSA. However, reports on OSA's associations with glaucoma, papilloedema, diabetic retinopathy, central serous chorioretinopathy, and keratoconus have been conflicting, while links between OSA and age-related macular degeneration have only been described fairly recently. Despite numerous suggestions that OSA treatment may reduce risk of these eye diseases, well-designed studies to support these claims are lacking. In particular, the ocular hypertensive effects of continuous positive airway pressure (CPAP) therapy for OSA requires further investigation into its potential impact on glaucoma risk and management. Reports of ocular surface complications secondary to leaking CPAP masks highlights the importance of ensuring good mask fit. Poor sleep habits have also been linked with increased myopia risk; however, the evidence on this association remains weak.
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Affiliation(s)
- Samantha S Y Lee
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Vinay K Nilagiri
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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12
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Raj R, Paturi A, Ahmed MA, Thomas SE, Gorantla VR. Obstructive Sleep Apnea as a Risk Factor for Venous Thromboembolism: A Systematic Review. Cureus 2022; 14:e22729. [PMID: 35371730 PMCID: PMC8971089 DOI: 10.7759/cureus.22729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnea (OSA), is a prevalent condition characterized by repeated episodes of pharyngeal airway obstruction resulting in hypopnea and apnea episodes during sleep leading to nightly awakenings. OSA is a major contributor to the healthcare burden worldwide due to its high cardiovascular morbidity and mortality. There is growing evidence to support a pathophysiological link between OSA and venous thromboembolism (VTE). The pro-inflammatory state along with intermittent hypoxia that is invoked in OSA is associated with blood hypercoagulability, venous stasis, and endothelial dysfunction leading to deep vein thrombosis (DVT) and pulmonary embolism (PE). In this systematic review, we aim to analyze and assess the available literature on OSA and VTE (or DVT/PE) to determine whether OSA is an independent risk factor for VTE.
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13
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Marsee MK, Shariff FS, Wiarda G, Watson PJ, Sualeh AH, Brenner TJ, McCoy ML, Al-Fadhl HD, Jones AJ, Davis PK, Zimmer D, Folsom C. Use of Thromboelastography and Rotational Thromboelastometry in Otolaryngology: A Narrative Review. J Clin Med 2022; 11:jcm11041119. [PMID: 35207392 PMCID: PMC8876674 DOI: 10.3390/jcm11041119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
In the field of otolaryngology—head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient’s real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis.
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Affiliation(s)
- Mathew K. Marsee
- Department of Graduate Medical Education, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA
- Correspondence:
| | - Faisal S. Shariff
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (F.S.S.); (P.J.W.)
| | - Grant Wiarda
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA;
| | - Patrick J. Watson
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (F.S.S.); (P.J.W.)
| | - Ali H. Sualeh
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Toby J. Brenner
- Department of Biochemistry, Indiana Wesleyan University, Marion, IN 46953, USA;
| | - Max L. McCoy
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Hamid D. Al-Fadhl
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Alexander J. Jones
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.J.J.); (P.K.D.)
| | - Patrick K. Davis
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.J.J.); (P.K.D.)
| | - David Zimmer
- Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Craig Folsom
- Department of Otolaryngology, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA;
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14
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Genuardi MV, Rathore A, Ogilvie RP, DeSensi RS, Borker PV, Magnani JW, Patel SR. Incidence of venous thromboembolism in patients with obstructive sleep apnea: a cohort study. Chest 2021; 161:1073-1082. [PMID: 34914977 DOI: 10.1016/j.chest.2021.12.630] [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: 05/29/2021] [Revised: 10/15/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Previous studies suggesting that obstructive sleep apnea (OSA) may be an independent risk factor for venous thromboembolism (VTE) have been limited by reliance on administrative data and lack of adjustment for clinical variables, including obesity. RESEARCH QUESTION Does OSA confer an independent risk of incident VTE among a large clinical cohort referred for sleep disordered breathing evaluation? STUDY DESIGN AND METHODS We analyzed the clinical outcomes of 31,309 patients undergoing overnight polysomnography within a large hospital system. We evaluated the association of OSA severity with incident VTE using Cox proportional hazards modeling accounting for age, sex, body mass index (BMI), and common comorbid conditions. RESULTS Patients were of mean age 50.4 years and 50.1% female. There were 1,791 VTE events identified over a mean follow-up of 5.3 years. In age and sex-adjusted analyses, each 10 event/hr increase in the apnea hypopnea index (AHI) was associated with a 4% increase in incident VTE risk (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.02-1.05). After adjusting for BMI, this association disappeared (HR 1.01, 95% CI 0.99-1.03). In contrast, nocturnal hypoxemia had an independent association with incident VTE. Patients with >50% sleep time spent with oxyhemoglobin saturation <90% are at 48% increased VTE risk compared to those without nocturnal hypoxemia (HR 1.48, 95% CI 1.16-1.69). INTERPRETATION In this large cohort, we found that patients with more severe OSA as measured by the AHI are more likely to have incident VTE. Adjusted analyses suggest that this association is explained due to confounding by obesity. However, severe nocturnal hypoxemia may be a mechanism by which OSA heightens VTE risk.
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Affiliation(s)
- Michael V Genuardi
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of Cardiology, University of Perelman School of Medicine, Philadelphia, PA.
| | - Aman Rathore
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rachel P Ogilvie
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA; Optum, Boston, MA
| | - Rebecca S DeSensi
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Priya V Borker
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jared W Magnani
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
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15
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Liu PK, Chiu TY, Wang NK, Levi SR, Tsai MJ. Ocular Complications of Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10153422. [PMID: 34362205 PMCID: PMC8348497 DOI: 10.3390/jcm10153422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Tzu-Yu Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Sarah R. Levi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5601)
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16
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Changes in platelet count and coagulation parameters in children with obstructive sleep apnea. Sleep Breath 2021; 26:871-878. [PMID: 34291360 DOI: 10.1007/s11325-021-02443-8] [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: 02/03/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the correlation between obstructive sleep apnea (OSA) and coagulation status and to speculate on the underlying mechanism in children with OSA. METHODS We divided 345 children with OSA (age 2-14 years) into four groups according to the apnea-hypopnea index (AHI). We compared platelet (PLT) and coagulation parameters among groups. Correlations between the polysomnography parameters and coagulation parameters were investigated. RESULTS Children with OSA had higher PLT counts than those without OSA (P < 0.001), while no significant difference was observed in prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombin time, or fibrinogen among children with/without OSA. In linear regression analysis, the AHI and oxygen desaturation index (ODI) presented positive correlation with the PLT count (R2 = 0.155, beta = 0.307, P < 0.001 and R2 = 0.113, beta = 0.262, P < 0.001), and there was no correlation among the AHI, ODI, and other coagulation parameters. The minimum and mean oxygen saturation of arterial blood manifested negative correlation with the PLT count (R2 = 0.076, beta = - 0.116, P = 0.034 and R2 = 0.083, beta = - 0.140, P = 0.008, respectively). CONCLUSIONS Children with OSA have a higher PLT count, positively correlated with OSA severity, and no evidence of coagulation disorder.
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Mochol J, Gawrys J, Gajecki D, Szahidewicz-Krupska E, Martynowicz H, Doroszko A. Cardiovascular Disorders Triggered by Obstructive Sleep Apnea-A Focus on Endothelium and Blood Components. Int J Mol Sci 2021; 22:5139. [PMID: 34066288 PMCID: PMC8152030 DOI: 10.3390/ijms22105139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. Among arousal from sleep, increased thoracic pressure and enhanced sympathetic activation, intermittent hypoxia is now considered as one of the most important pathophysiological mechanisms contributing to the development of endothelial dysfunction. Nevertheless, not much is known about blood components, which justifies the current review. This review focuses on molecular mechanisms triggered by sleep apnea. The recurrent periods of hypoxemia followed by reoxygenation promote reactive oxygen species (ROS) overproduction and increase inflammatory response. In this review paper we also intend to summarize the effect of treatment with continuous positive airway pressure (CPAP) on changes in the profile of the endothelial function and its subsequent potential clinical advantage in lowering cardiovascular risk in other comorbidities such as diabetes, atherosclerosis, hypertension, atrial fibrillation. Moreover, this paper is aimed at explaining how the presence of OSA may affect platelet function and exert effects on rheological activity of erythrocytes, which could also be the key to explaining an increased risk of stroke.
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Affiliation(s)
| | | | | | | | | | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.); (J.G.); (D.G.); (E.S.-K.); (H.M.)
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Nikolic M, Simovic S, Novkovic L, Jokovic V, Djokovic D, Muric N, Bazic Sretenovic D, Jovanovic J, Pantic K, Cekerevac I. Obesity and sleep apnea as a significant comorbidities in COVID-19 - A case report. Obes Res Clin Pract 2021; 15:281-284. [PMID: 33933379 PMCID: PMC8078914 DOI: 10.1016/j.orcp.2021.04.008] [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: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
In our paper we aimed to increase the awareness among physicians, concerning coronavirus disease 2019 (COVID-19) severity, especially in patients with specific underlying comorbidities. Obesity is the second most common condition in hospitalized COVID-19 patients. Furthermore it has a major role in the development of obstructive sleep apnoea (OSA), which is highly involved in a severe COVID-19 development and its serious outcomes. Even though obese OSA patients had an increased pulmonary embolism (PE) risk, there is no enough evidence to support the interaction between obesity and OSA regarding PE development in the setting of COVID-19. Our patient is a 45-year-old obese male with COVID-19, who was admitted to the intensive care unit (ICU) with acute respiratory failure requiring high-flow nasal oxygenation. Clinical, laboratory and diagnostic findings pointed on severe COVID-19 form, complicated with PE. After recovery, the diagnosis of OSA was established. With this case, we wanted to alert the physicians on comorbidities, such as obesity and OSA, while those conditions, to some extent, may contribute to worse COVID-19 clinical presentation.
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Affiliation(s)
- Maja Nikolic
- University of Kragujevac, Faculty of Medical Sciences, Department of Physiology, Serbia
| | - Stefan Simovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Serbia.
| | - Ljiljana Novkovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
| | - Vuk Jokovic
- Center for Vascular Surgery, University Clinical Center Kragujevac, Serbia
| | - Danijela Djokovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Serbia; Clinic for Psychiatry, University Clinical Center Kragujevac, Serbia
| | - Nemanja Muric
- University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Serbia; Clinic for Psychiatry, University Clinical Center Kragujevac, Serbia
| | - Danijela Bazic Sretenovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Internal Medicine, University Clinical Center Kragujevac, Serbia
| | - Jovan Jovanovic
- Clinic for Cardiology, University Clinical Center Kragujevac, Serbia
| | - Katarina Pantic
- Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
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Ambati A, Ju YE, Lin L, Olesen AN, Koch H, Hedou JJ, Leary EB, Sempere VP, Mignot E, Taheri S. Proteomic biomarkers of sleep apnea. Sleep 2021; 43:5830732. [PMID: 32369590 DOI: 10.1093/sleep/zsaa086] [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] [Received: 10/26/2019] [Revised: 04/09/2020] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is characterized by recurrent partial to complete upper airway obstructions during sleep, leading to repetitive arousals and oxygen desaturations. Although many OSA biomarkers have been reported individually, only a small subset have been validated through both cross-sectional and intervention studies. We sought to profile serum protein biomarkers in OSA in unbiased high throughput assay. METHODS A highly multiplexed aptamer array (SomaScan) was used to profile 1300 proteins in serum samples from 713 individuals in the Stanford Sleep Cohort, a patient-based registry. Outcome measures derived from overnight polysomnography included Obstructive Apnea Hypopnea Index (OAHI), Central Apnea Index (CAI), 2% Oxygen Desaturation index, mean and minimum oxygen saturation indices during sleep. Additionally, a separate intervention-based cohort of 16 individuals was used to assess proteomic profiles pre- and post-intervention with positive airway pressure. RESULTS OAHI was associated with 65 proteins, predominantly pathways of complement, coagulation, cytokine signaling, and hemostasis which were upregulated. CAI was associated with two proteins including Roundabout homolog 3 (ROBO3), a protein involved in bilateral synchronization of the pre-Bötzinger complex and cystatin F. Analysis of pre- and post intervention samples revealed IGFBP-3 protein to be increased while LEAP1 (Hepicidin) to be decreased with intervention. An OAHI machine learning classifier (OAHI >=15 vs OAHI<15) trained on SomaScan protein measures alone performed robustly, achieving 76% accuracy in a validation dataset. CONCLUSIONS Multiplex protein assays offer diagnostic potential and provide new insights into the biological basis of sleep disordered breathing.
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Affiliation(s)
- Aditya Ambati
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Yo-El Ju
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Ling Lin
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Alexander N Olesen
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Henriette Koch
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Julien Jacques Hedou
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Eileen B Leary
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Vicente Peris Sempere
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
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20
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Shen T, Wang J, Yang W, Li L, Qiao Y, Yan X, Chen M, Tang X, Zou J, Zhao Y. Hematological Parameters Characteristics in Children with Obstructive Sleep Apnea with Obesity. Risk Manag Healthc Policy 2021; 14:1015-1023. [PMID: 33737842 PMCID: PMC7961133 DOI: 10.2147/rmhp.s297341] [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: 12/14/2020] [Accepted: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate the possible correlation between obesity and hematological parameters in children with obstructive sleep apnea (OSA). Methods A total of 460 children was initially included in our study, which were divided into children with OSA and children without OSA. Multiple analysis was performed for obesity by adjusting confounding factors such as age and gender in 460 children. Further, to minimize the influence of confounding factors and selective bias, propensity score matching (PSM) was performed in children with OSA. Hematological parameters such as inflammatory and coagulable parameters were compared between the normal weight children with OSA and the obese children with OSA following PSM. Results OSA (OR = 3.061; P<0.001; 95% CI, 1.772–5.288) represented an independent risk factor for obesity. Besides, the obese children with OSA had higher levels of white blood cell (WBC) (P<0.001), neutrophil (NEUT) (P<0.001), neutrophil-lymphocyte ratio (NLR) (P=0.006), fibrinogen (FIB) (P=0.033), while had a lower level of activated partial thromboplastin time (APTT) (P=0.048). No significant differences were observed in other hematological parameters. In linear regression, the results indicated that the levels of WBC (R2 = 0.123, Beta = 0.289, P<0.001), NEUT (R2 = 0.124, Beta = 0.282, P<0.001), NLR (R2 = 0.105, Beta = 0.184, P=0.026) and FIB (R2 = 0.086, Beta = 0.246, P=0.003) were positively correlated with BMI, while the level of APTT (R2 = 0.057, Beta = −0.171, P=0.044) was significantly negatively correlated with BMI. Conclusion OSA was an independent risk factor contributing to obesity. WBC, NEUT, NLR, FIB and APTT are correlated with obesity in children with OSA (aged from 2 to 14 years). These indicators could be used to estimate the status of inflammation and hypercoagulation in the obese children with OSA.
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Affiliation(s)
- Tian Shen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen Yang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Linke Li
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yixin Qiao
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaohong Yan
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Min Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Chengdu Shangjin Nanfu Hospital, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian Zou
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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21
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Bikov A, Meszaros M, Schwarz EI. Coagulation and Fibrinolysis in Obstructive Sleep Apnoea. Int J Mol Sci 2021; 22:ijms22062834. [PMID: 33799528 PMCID: PMC8000922 DOI: 10.3390/ijms22062834] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.
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Affiliation(s)
- Andras Bikov
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9MT, UK
- Correspondence: ; Tel.: +44-161-291-2493; Fax: +44-161-291-5730
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary;
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
- Centre of Competence Sleep & Health Zurich, University of Zurich, 8091 Zurich, Switzerland
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22
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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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23
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Chokesuwattanaskul A, Lertjitbanjong P, Thongprayoon C, Bathini T, Sharma K, Mao MA, Cheungpasitporn W, Chokesuwattanaskul R. Impact of obstructive sleep apnea on silent cerebral small vessel disease: a systematic review and meta-analysis. Sleep Med 2019; 68:80-88. [PMID: 32028230 DOI: 10.1016/j.sleep.2019.11.1262] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD. METHODS Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS A total of 14 observational studies comprising of 4335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD magnetic resonance imaging (MRI) findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% confidence interval [CI], 1.46-3.66, I2 = 79%) and 1.78 (95% CI, 1.06-3.01, I2 = 41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled odds ratio (OR) of 2.15 (95% CI, 0.64-7.29, I2 = 55%). CONCLUSIONS Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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24
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Obstructive sleep apnea and venous thromboembolism: Overview of an emerging relationship. Sleep Med Rev 2019; 50:101233. [PMID: 31838272 DOI: 10.1016/j.smrv.2019.101233] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnea (OSA) is a risk factor for cardiovascular syndromes. Venous thromboembolism (VTE) is a chronic disease, and pulmonary embolism (PE) is the major expression of VTE and the third most frequent cardiovascular disease. An increasing and emerging number of cross-sectional and longitudinal studies have linked OSA to VTE, and have postulated different putative pathways to explain how OSA might increase the risk of PE. We aim to provide a critical overview of the existing evidence about the complex relationship between these two conditions, with some factors and confounding variables still to be clarified. A global interpretation of the studies shows OSA is highly prevalent in VTE patients. This association represents a major public health burden, given the high prevalence and the mortality rates of both disorders. Although still not proven, OSA may induce a persistent hypercoagulable state that may contribute to increase VTE rate and its recurrence. Coagulant activity, platelet function and fibrinolytic system may improve after continuous positive airway pressure (CPAP) in OSA. However, there is a still a lack of randomized controlled trials to evaluate the potential of CPAP and/or extend oral anticoagulation to reduce PE incidence, recurrence and mortality by PE in patients with OSA.
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25
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Keller K, Hobohm L, Münzel T, Ostad MA, Espinola-Klein C, Lavie CJ, Konstantinides S, Lankeit M. Survival Benefit of Obese Patients With Pulmonary Embolism. Mayo Clin Proc 2019; 94:1960-1973. [PMID: 31585580 DOI: 10.1016/j.mayocp.2019.04.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE). PATIENTS AND METHODS Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes. RESULTS From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were more frequently female (60.2% vs 52.7%), had a lower cancer rate (13.6% vs 20.5%), and were more often treated with systemic thrombolysis (6.4% vs 4.3%) and surgical embolectomy (0.3% vs 0.1%) vs the reference group (P<.001 for all). Overall, 51,226 patients (14.8%) died during in-hospital stay. Obese patients had lower mortality (10.9% vs 15.2%; P<.001) vs the reference group and a reduced odds ratio (OR) for in-hospital mortality (OR, 0.74; 95% CI, 0.71-0.77; P<.001) independent of age, sex, comorbidities, and reperfusion therapies. This survival benefit of obese patients was more pronounced in obesity classes I (OR, 0.56; 95% CI, 0.52-0.60; P<.001) and II (OR, 0.63; 95% CI 0.58-0.69; P<.001). Underweight patients had higher prevalence of cancer and higher mortality rates (OR, 1.15; 95% CI, 1.00-1.31; P=.04). CONCLUSION Obesity is associated with decreased in-hospital mortality rates in patients with PE. Although obese patients were more often treated with reperfusion therapies, the survival benefit of obese patients occurred independently of age, sex, comorbidities, and reperfusion treatment.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Rhine Main, Germany
| | - Mir A Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-University Medicine, Berlin, Germany; Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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26
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Abstract
With the growing obesity epidemic, the global burden of AF and obstructive sleep apnoea (OSA) is increasing at an alarming rate. Obesity, age, male gender, alcohol consumption, smoking and heart failure are common risk factors for both AF and OSA and they are independently associated with adverse cardiovascular outcomes. Weak evidence from observational studies link OSA to the development of AF. Hypoxia/hypercapnia, systemic inflammation and autonomic nervous system modulation are biological mechanisms that link OSA to AF. Patients with OSA have a poor response to catheter ablation of AF and often suffer recurrences. Observational data shows that continuous positive airway pressure is associated with a reduction in AF burden and a better response to catheter ablation of AF. However, prospective randomised studies are needed to confirm the usefulness of continuous positive airway pressure in the treatment of AF in patients with OSA.
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Affiliation(s)
- Ghanshyam Shantha
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
| | - Frank Pelosi
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
| | - Fred Morady
- Clinical Cardiac Electrophysiology, University of Michigan Ann Arbor, MI, US
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27
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García-Ortega A, Mañas E, López-Reyes R, Selma MJ, García-Sánchez A, Oscullo G, Jiménez D, Martínez-García M. Obstructive sleep apnoea and venous thromboembolism: pathophysiological links and clinical implications. Eur Respir J 2019; 53:13993003.00893-2018. [PMID: 30385528 DOI: 10.1183/13993003.00893-2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnoea (OSA) and pulmonary embolism (PE) remain major health issues worldwide. Data from pathophysiological studies suggest that both intermittent hypoxia and sleep fragmentation are associated with increased blood coagulability, endothelial dysfunction and venous stasis. There is growing evidence that OSA is potentially prevalent in and a risk factor for PE. Conversely, patients with acute PE have two to four times greater risk of moderate-to-severe OSA. The role of continuous positive airway pressure (CPAP) treatment in improving clinically meaningful outcomes in PE patients remains unclear, although some authors have suggested that CPAP could improve the hypercoagulability state and normalise circadian alterations in some of the coagulation molecules, as observed in patients with OSA. Emerging research highlights the complex interdependent relationships between OSA and PE, emphasising the need for rigorous, well-powered trials that address the impact of OSA and its treatment on the prevention and management of PE. Undoubtedly, these will require closer collaboration between the sleep medicine and clinical/venous thromboembolism communities.
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28
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Maresky HS, Klar MM, Tepper J, Gavriel H, Ziv Baran T, Shapiro CM, Tal S. Mandibular width as a novel anthropometric measure for assessing obstructive sleep apnea risk. Medicine (Baltimore) 2019; 98:e14040. [PMID: 30681560 PMCID: PMC6358386 DOI: 10.1097/md.0000000000014040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Craniofacial abnormalities are a known obstructive sleep apnea (OSA) risk factor, but still need to be better characterized. This study investigates the relationship between mandibular width and the risk of developing OSA.We retrospectively analyzed 3D reconstructions of head and neck computed tomography (CT) scans at our institution for mandibular width, neck circumference, neck fat volume (NFV), airway volume (AWV), and NFV:AWV ratio. Age, gender, and BMI were also documented. Patients were contacted to complete a STOP-BANG survey to assess OSA risk. Only patients with reconstructable scans and completed STOP-BANG questionnaires were included in the study. Survey results were analyzed to assess the correlation between mandible width and STOP-BANG. Mandible association was also compared to the associations of the other known risk factors.The final analysis included 427 patients with a mean age of 58.98 years (standard deviation = 16.77), 56% of whom were male. Mandibular width was found to positively correlate with STOP-BANG score (r = .416, P < .001). Statistically significant differences between mandible size for each risk group was seen (P < .001). After controlling for age and sex, mandible size was significantly different only for the low risk vs. high risk groups (odds ratio = 1.11; 95% confidence interval = 1.03-1.20; P = .007). Furthermore, when stratified according to mandible size, the small mandible group (<77.50 mm) predominantly consisted of low risk patients; the medium size mandible group (77.50-84.40 mm) was predominated by intermediate risk patients, and large mandible (>84.40 mm) was predominantly seen in high risk patients. Mandible width expressed a stronger association than NFV:AWV ratio, but neck circumference and NFV had stronger associations than did mandible width.In addition to previously documented OSA risk factors, mandibular width is positively correlated with OSA as an independent risk factor. Observation of a wide mandible (jaw) should raise awareness of OSA risk and increase screening methods when appropriate.
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Affiliation(s)
- Hillel S. Maresky
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontaria, Canada
| | - Miriam M. Klar
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jaron Tepper
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine
| | - Tomer Ziv Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Colin M. Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sigal Tal
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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29
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Downing F, Gibson S. Anaesthesia of brachycephalic dogs. J Small Anim Pract 2018; 59:725-733. [PMID: 30374971 DOI: 10.1111/jsap.12948] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 06/07/2018] [Accepted: 09/22/2018] [Indexed: 12/27/2022]
Abstract
Brachycephalic breeds of dog have grown in popularity in the UK and so form an increasing proportion of cases requiring anaesthesia. These breeds are predisposed to several conditions, notably brachycephalic obstructive airway syndrome and gastro-oesophageal reflux, that have important implications for anaesthetic management and carry high risk for complications. This review incorporates peer-reviewed veterinary literature with clinical experience in a discussion on perioperative management of brachycephalic dogs. We focus on preoperative identification of common concurrent conditions, practical strategies for reducing anaesthetic risk and improving postoperative management. Comparisons of brachycephalic obstructive airway syndrome with the human condition of obstructive sleep apnoea are included where appropriate.
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Affiliation(s)
- F Downing
- Davies Veterinary Specialists, Herts, SG5 3HR, UK
| | - S Gibson
- Davies Veterinary Specialists, Herts, SG5 3HR, UK
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30
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Barceló A, Morell-Garcia D, Sanchís P, Peña-Zarza JA, Bauça JM, Piérola J, Peña MDL, Toledo-Pons N, Giménez P, Ribot C, Alonso-Fernández A. Prothrombotic state in children with obstructive sleep apnea. Sleep Med 2018; 53:101-105. [PMID: 30504083 DOI: 10.1016/j.sleep.2018.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Increased blood coagulation might be one important mechanism linking obstructive sleep apnea (OSA) with cardiovascular diseases. We tested the association between several hemostatic parameters and sleep breathing-related variables in a representative pediatric population with a clinical suspicion of OSA. METHODS Polysomnography was performed in 152 snoring children to diagnose OSA. Anthropometric and clinical data were registered and venous blood samples were collected for the measurement of platelet count, plateletcrit, platelet distribution width (PDW), mean platelet volume (MPV), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and C-reactive protein. RESULTS Children with OSA had significantly higher platelet count, plateletcrit and PDW compared with those without OSA. After controlling for the anthropometric characteristics (age, gender, body mass index (BMI) z-score), platelet count negatively correlated with minimum SaO2 while the plateletcrit correlated with time with SaO2 <90% and MPV correlated with apnea-hypopnea index. PT and PT international normalized ratio correlated with mean SaO2 and aPTT correlated with the oxygen desaturation index. CONCLUSION Our findings suggest that different OSA-related effects may be factors contributing to an enhanced coagulability in pediatric OSA. Measures reflecting apnea severity and disrupted sleep were associated with clotting factor changes independent of covariates affecting hemostatic function.
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Affiliation(s)
- Antonia Barceló
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Spain
| | - Daniel Morell-Garcia
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain.
| | - Pilar Sanchís
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - José Antonio Peña-Zarza
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain; Sleep Unit, Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Javier Piérola
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Mónica de la Peña
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Spain; Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain; Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Paloma Giménez
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Caterina Ribot
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Alberto Alonso-Fernández
- Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Spain; Department of Respiratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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31
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Abstract
INTRODUCTION Stroke is a major cause of disability and death in the United States and across the world, and the incidence and prevalence of stroke are expected to rise significantly due to an aging population. Obstructive sleep apnea, an established independent risk factor for stroke, is a highly prevalent disease that is estimated to double the risk of stroke. It remains uncertain whether non-apnea sleep disorders increase the risk of stroke. Areas covered: This paper reviews the literature describing the association between incident stroke and sleep apnea, rapid eye movement sleep behavior disorder, restless legs syndrome, periodic limb movements of sleep, insomnia, and shift work. Expert commentary: Trials of continuous positive airway pressure for stroke prevention in sleep apnea patients have been largely disappointing, but additional trials that target populations not yet optimally studied are needed. Self-reported short and long sleep duration may be associated with incident stroke. However, abnormal sleep duration may be a marker of chronic disease, which may itself be associated with incident stroke. The relationship between non-apnea sleep disorders and incident stroke deserves further attention. Identification of specific non-apnea sleep disorders or sleep problems that convey an increased risk for stroke may provide novel targets for stroke prevention.
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Affiliation(s)
- Mollie McDermott
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Devin L. Brown
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
- Michigan Medicine Michael S. Aldrich Sleep Disorders Laboratory, Ann Arbor, Michigan, USA
| | - Ronald D. Chervin
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
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