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Fu Y, Lin J, Chen L, Chen X, Chen Q. Meta-analysis of the effects of CPAP therapy on estimated glomerular filtration rate in patients with obstructive sleep apnea. Sleep Breath 2023; 27:2155-2163. [PMID: 36940015 DOI: 10.1007/s11325-023-02811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease and may lead to a loss of kidney function. However, it remains unclear whether or not continuous positive airway pressure (CPAP) treatment improves the estimated glomerular filtration rate (eGFR) in patients with OSA. This meta-analysis was designed to investigate the effect of CPAP therapy on eGFR in patients with OSA. METHODS We searched the electronic databases Web of Science, Cochrane Library, PubMed, and Embase through June 1, 2022. Information about patients, CPAP duration, gender distribution, pre- and post-CPAP treatment eGFR, and age of patients were collected for further analysis. We applied the standardized mean difference (SMD) with a 95%confidence interval (CI) to analyze the pooled effects. Both Stata 12.0 software and Review Manager 5.2 software were employed for all statistical analyses. RESULTS A sample of 13 studies with 519 patients was included in the meta-analysis. There was no significant change of eGFR levels before and after CPAP usage for patients with OSA (SMD = - 0.05, 95%CI: - 0.30 to 0.19, Z = 0.43, p = 0.67). However, subgroup analysis revealed that the level of eGFR was obviously decreased after CPAP therapy in patients with OSA and CPAP use duration > 6 months (SMD = - 0.30, 95% CI = - 0.49 to - 0.12, z = 3.20, p = 0.001), and elderly patients (> 60 years) (SMD = - 0.32, 95% CI = - 0.52 to - 0.11, z = 3.02, p = 0.002). CONCLUSIONS Meta-analysis confirmed that OSA treatment with CPAP has no clinically significant effect on eGFR.
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Affiliation(s)
- Yuyu Fu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 Donghai Street, Quanzhou, 362000, Fengze District, China
| | - Jiayu Lin
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fengze District, China
| | - Lijun Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fengze District, China
| | - Xiaoyu Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fengze District, China.
| | - Qingshi Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fengze District, China.
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Li JH, Gao YH, Xue X, Su XF, Wang HH, Lin JL, Zhao LB, Zou X, Gao Y, Guo JJ, Shi M, Xu WH, Wang YB, Qian XS, Chen KB, Fan L, Liu L. Association between Serum Cystatin C levels and long‐term cardiovascular outcomes and all-cause mortality in older patients with obstructive sleep apnea. Front Physiol 2022; 13:934413. [PMID: 36117703 PMCID: PMC9471320 DOI: 10.3389/fphys.2022.934413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: To investigate the association between obstructive sleep apnea (OSA) severity and baseline serum cystatin C (Cys-C) concentration and to explore the association between baseline serum Cys-C and long-term cardiovascular outcomes and mortality in older patients with OSA.Methods: Between January 2015 and October 2017, a total of 1107 consecutive eligible older patients (≥60 years) with OSA were included in this multicenter, prospective cohort study, and baseline demographics, clinical characteristics, sleep parameters, and follow-up outcomes were collected. Participants were divided into different groups based on baseline serum Cys-C levels. The primary end point was major adverse cardiovascular events (MACE) and the secondary end point was all-cause mortality. The correlation between OSA severity and baseline serum Cys-C was evaluated by Spearman correlation analysis. Multivariate Cox regression was used to analyze the association between Cys-C and the incidence of MACE and mortality.Results: Participants included 672 men and 435 women, with a median age of 66 (range, 60–96) years. At baseline, apnea–hypopnea index (AHI) (r = 0.128, p < 0.05), oxygen desaturation index (ODI) (r = 0.116, p < 0.05), and the lowest pulse oxygen saturation (LSpO2) (r = −0.097, p < 0.05) were correlated with serum Cys-C concentration. During the median follow-up period of 42 months, 97 patients (8.8%) experienced MACE and 40 patients (3.6%) experienced death. The association between serum Cys-C levels and the risk of MACE and all-cause mortality was slow rising shaped. The multivariable Cox regression analysis showed patients with a serum Cys-C concentration of ≥1.14 mg/L had higher risks of MACE (HR = 5.30, 95% CI: 2.28–12.30, p < 0.05) and all-cause mortality (HR = 9.66, 95% CI: 2.09–44.72, p < 0.05) compared with patients with serum Cys-C of ≤0.81 mg/L in older patients with OSA. The receiver-operating characteristic curve showed baseline serum Cys-C levels exhibited moderately capable of identifying patients with a long-term risk of clinical adverse events (MACE and mortality).Conclusion: OSA severity was positively correlated with serum Cys-C concentration. High levels of Cys-C were independently associated with increased risks of MACE and all-cause mortality in older patients with OSA, suggesting that lowering Cys-C levels should be considered as a therapeutic target, and monitoring serum Cys-C may be beneficial to the favorable prognosis of older patients with OSA.
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Affiliation(s)
- Jian-Hua Li
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ying-Hui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Xin Xue
- Department of Respiratory, Yanan University Affiliated Hospital, Yan’an, China
| | - Xiao-Feng Su
- Medical College, Yan’an University, Yan’an, China
| | | | - Jun-Ling Lin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Li-Bo Zhao
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiao Zou
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Gao
- Department of General Practice, 960th Hospital of PLA, Jinan, China
| | - Jing-Jing Guo
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
| | - Min Shi
- Department of Respiratory and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wei-Hao Xu
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ya-Bin Wang
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Shun Qian
- Department of Respiratory and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Kai-Bing Chen
- Sleep Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
- *Correspondence: Kai-Bing Chen, ; Li Fan, ; Lin Liu,
| | - Li Fan
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Kai-Bing Chen, ; Li Fan, ; Lin Liu,
| | - Lin Liu
- Department of Respiratory and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Kai-Bing Chen, ; Li Fan, ; Lin Liu,
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Zhang XB, Chen GP, Huang MH, Chen XX, Zhan FF, He XZ, Cai L, Zeng HQ. Bcl-2 19-kDa Interacting Protein 3 (BNIP3)-Mediated Mitophagy Attenuates Intermittent Hypoxia-Induced Human Renal Tubular Epithelial Cell Injury. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e936760. [PMID: 35836356 PMCID: PMC9295414 DOI: 10.12659/msm.936760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background As a novel pathophysiological characteristic of obstructive sleep apnea, intermittent hypoxia (IH) contributes to human renal tubular epithelial cells impairment. The underlying pathological mechanisms remain unrevealed. The present study aimed to evaluate the influence of Bcl-2 19-kDa interacting protein 3 (BNIP3)-mediated mitophagy on IH-induced renal tubular epithelial cell impairment. Material/Methods Human kidney proximal tubular (HK-2) cells were exposed to IH condition. IH cycles were as follows: 21% oxygen for 25 min, 21% descended to 1% for 35 min, 1% oxygen sustaining for 35 min, and 1% ascended to 21% for 25 min. The IH exposure lasted 24 h with 12 cycles of hypoxia and re-oxygenation. Both the siBNIP3 and BNIP3 vector were transfected to cells. Cell viability and apoptosis, mitochondrial morphology and function, and mitophagy were detected by cell counting kit-8, flow cytometry and TUNEL staining, transmission electron microscopy, western blotting, and immunofluorescence, respectively. Results In the IH-induced HK-2 cells, inhibition of BNIP3 further aggravated mitochondrial structure damage, and decreased mitophagy level, leading to increased cell apoptosis and decreased cell viability. While overexpression of BNIP3 enhanced mitophagy, which protected mitochondrial structure, it can decrease cell death in HK-2 cells exposed to IH. Conclusions The present study showed that BNIP3-mediated mitophagy plays a protective role against IH-induced renal tubular epithelial cell impairment.
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Affiliation(s)
- Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Gong-Ping Chen
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Mao-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Xiang-Xing Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen UniversityZhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Feng-Fu Zhan
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen UniversityZhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Xiu-Zhen He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Ling Cai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
| | - Hui-Qing Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical Medical College of Fujian Medical University, Xiamen, Fujian, China (mainland)
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Wang Y, Lin YN, Zhang LY, Li CX, Li SQ, Li HP, Zhang L, Li N, Yan YR, Li QY. Changes of circulating biomarkers of inflammation and glycolipid metabolism by CPAP in OSA patients: a meta-analysis of time-dependent profiles. Ther Adv Chronic Dis 2022; 13:20406223211070919. [PMID: 35519435 PMCID: PMC9066626 DOI: 10.1177/20406223211070919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Continuous positive airway pressure (CPAP) is the first-line therapy for moderate-to-severe obstructive sleep apnea (OSA). Specifying timing of CPAP benefits on OSA-related biomarkers will help to assess the effectiveness of CPAP and to optimize the treatment strategies. Purpose: To explore the time-dependent changes of circulating biomarkers to CPAP treatment in patients with OSA, including inflammatory biomarkers [C-reactive protein (CRP) and tumor necrosis factor–α (TNF-α)] and glycolipid metabolic biomarkers [fasting blood glucose (FBG), fasting insulin (FINS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG)]. Methods: Searches of PubMed and Embase database were completed. Two independent reviewers extracted data from 68 included studies. A meta-analysis was conducted using a random-effect (or fixed-effect) model and standardized mean difference (SMD) model. The timing profiles of circulating biomarkers changes of inflammation and glycolipid metabolism were analyzed based on different CPAP duration, that is, short-term (<3 months), mid-term (3–6 months), and long-term (⩾6 months). Results: Those first improved by short-term treatment include CRP [SMD: 0.73, 95% confidence interval (CI): 0.15–1.31; p = 0.014], TNF-α [SMD: 0.48 (95% CI: 0.10–0.86; p = 0.014)], FBG [SMD: 0.32 (95% CI: 0.07–0.57; p = 0.011)], and LDL [SMD: 0.40 (95% CI: 0.18–0.62; p = 0.000)]. Those first improved by the mid-term or long-term treatment include HDL [SMD: –0.20 (95% CI: –0.36 to –0.03; p = 0.018)] and TC [SMD: 0.20 (95% CI: 0.05–0.34; p = 0.007)]. There were insignificant changes for TG and FINS after short or long CPAP. Conclusion: Our results imply that changes of circulating biomarkers for patients with OSA under CPAP treatment have a time-dependent profile.
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Affiliation(s)
- Yi Wang
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Li Yue Zhang
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Chuan Xiang Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
- Department of Respiratory and Critical Care Medicine, Tongren Hospital Affiliated to Wuhan University, The Third Hospital of Wuhan, Wuhan, P.R. China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ning Li
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, No. 197 Rui Jin 2nd Road, Shanghai 200025, P.R. China Institute of Respiratory Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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5
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Rimke AN, Ahmed SB, Turin TC, Pendharkar SR, Raneri JK, Lynch EJ, Hanly PJ. Effect of CPAP Therapy on Kidney Function in Patients With Chronic Kidney Disease: A Pilot Randomized Controlled Trial. Chest 2020; 159:2008-2019. [PMID: 33316238 DOI: 10.1016/j.chest.2020.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND OSA is common in chronic kidney disease (CKD) and may accelerate a decline in kidney function. It is not clear whether treatment of OSA with CPAP improves kidney function. RESEARCH QUESTION Does treatment with CPAP improve kidney function in patients with CKD and coexisting OSA? STUDY DESIGN AND METHODS A randomized, controlled, nonblinded, parallel clinical trial was performed of patients with stages 3 and 4 CKD and coexisting OSA comparing the effect of CPAP vs usual care on the estimated glomerular filtration rate (eGFR) and the urine albumin to creatinine ratio (ACR) over 12 months. RESULTS Fifty-seven patients were enrolled and 30 were randomized to CPAP. They had moderately severe CKD (eGFR, 38.4 ± 1.5 mL/min/1.73 m2) and significant OSA and nocturnal hypoxemia (oxygen desaturation index: 23.9 events/h; interquartile range [IQR], 20.3 events/h; mean peripheral capillary oxygen saturation: 89.5%; IQR, 1.7%); 60% had baseline albuminuria (ACR, > 3 mg/mmol). No significant difference was found between CPAP and usual care in the change in eGFR and ACR over 12 months. Although some improvement in eGFR occurred with CPAP therapy in patients with a lower risk of CKD progression, this did not reach statistical significance. INTERPRETATION Although CPAP did not provide additional renal benefits over usual care in all CKD patients, some evidence suggested that CPAP slowed the decline in eGFR in CKD patients with a lower risk of CKD progression. These preliminary data support the need for larger clinical trials exploring the effects of CPAP on kidney function. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02420184; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Alex N Rimke
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada; Alberta Kidney Disease Network, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Sachin R Pendharkar
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jill K Raneri
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Emma J Lynch
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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6
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Huang MH, Zhang XB, Wang HL, Li LX, Zeng YM, Wang M, Zeng HQ. Intermittent hypoxia enhances the tumor programmed death ligand 1 expression in a mouse model of sleep apnea. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:97. [PMID: 31019947 DOI: 10.21037/atm.2019.01.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background As a hallmark of obstructive sleep apnea (OSA), intermittent hypoxia (IH) promotes tumor progress. The high expression of programmed death 1 and programmed death ligand 1 (PD-L1) in tumor leads to immune evasion and subsequently aggravates tumor progress. This study aims to determine the tumor PD-L1 expression under the IH condition. Methods A total of 24 C57BL/6J mice were randomly assigned to the normoxia (control, CTL) group and the IH group. Mice in the IH group were subjected to the IH condition for 5 weeks. Lung cancer cells were injected into the flank of each mouse after 1 week of IH exposure. Tumor PD-L1 expression was detected by immunohistochemistry (IHC). Correlation between tumor weight, tumor volume, and expression of PD-L1 was analyzed. Results Compared to the CTL group, mice in the IH group had a high PD-L1 expression. The IH can enhance the tumor PD-L1 expression. Tumor weight, volume, and HIF-1α levels were closely associated with the PD-L1 expression in the IH group, while dissimilar findings were observed in the CTL group. Conclusions The IH enhances tumor PD-L1 expression in OSA mimicking mice. Additional studies are required to clarify the underlying mechanism.
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Affiliation(s)
- Mao-Hong Huang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Xiao-Bin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China.,Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.,The Second Clinical Medical College, Fujian Medical University, Quanzhou 362000, China.,Respiratory Medicine Center of Fujian Province, Quanzhou 362000, China
| | - Hui-Ling Wang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Liu-Xia Li
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.,The Second Clinical Medical College, Fujian Medical University, Quanzhou 362000, China.,Respiratory Medicine Center of Fujian Province, Quanzhou 362000, China
| | - Miao Wang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
| | - Hui-Qing Zeng
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
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Chuang LP, Lin SW, Lee LA, Chang CH, Huang HY, Hu HC, Kao KC, Hsieh MJ, Yang CT, Li HY, Chen NH. Elevated Serum Markers of Acute Kidney Injury in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:207-213. [PMID: 30736871 PMCID: PMC6374082 DOI: 10.5664/jcsm.7618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES Previous research revealed a positive correlation between endothelial cell injury (indicated by albuminuria) and obstructive sleep apnea (OSA). However, little else has been revealed about acute kidney injury (AKI) in patients with OSA. METHODS This prospective study recruited consecutive patients undergoing overnight polysomnography for evaluation of sleep apnea. Patients in whom any major disease or recent infection had been previously diagnosed were excluded. Ultimately, data from 75 patients with apnea-hypopnea indices of 5 or more were analyzed. Baseline values for the urinary albumin-creatinine ratio (UACR), serum levels for three markers of AKI (cystatin C, neutrophil gelatinase-associated lipocalin [NGAL], interleukin-18 [IL-18]), and polysomnography data were recorded and analyzed. Patients then were followed for 6 months of continuous positive airway pressure (CPAP) treatment. RESULTS At baseline, UACRs were greater in patients with more severe OSA (P = .005, r = .329). All three serum markers of AKI (cystatin C, NGAL, and IL-18) studied were positively correlated with OSA severity, and two (cystatin C and IL-18) were positively correlated with the frequency of oxygen desaturation during sleep. However, none of the AKI markers had positive correlations with UACR. After 6 months of CPAP treatment, UACR and IL-18 were decreased significantly in patients with good adherence. CONCLUSIONS Albuminuria and levels of three serum markers of AKI (cystatin C, NGAL, IL-18) were positively correlated with OSA severity, and good adherence with CPAP treatment decreased albuminuria and interleukin-18 levels. These results may provide additional tools for assessing early renal injury in patients with OSA.
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Affiliation(s)
- Li-Pang Chuang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Ang Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-yu Huang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Chung Hu
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ning-Hung Chen
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
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8
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Zhang XB, Cai JH, Yang YY, Zeng YM, Zeng HQ, Wang M, Cheng X, Luo X, Ewurum HC. Telmisartan attenuates kidney apoptosis and autophagy-related protein expression levels in an intermittent hypoxia mouse model. Sleep Breath 2018; 23:341-348. [PMID: 30219962 PMCID: PMC6418059 DOI: 10.1007/s11325-018-1720-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/21/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) is associated with renal impairs. As a novel pathophysiological hallmark of OSA, chronic intermittent hypoxia (CIH) enhances apoptosis and autophagy. The present study aims to evaluate the effect of telmisartan on CIH-induced kidney apoptosis and autophagy in a mouse model of OSA. Materials and methods Mice were randomly allocated to normoxia, CIH, and CIH+telmisartan groups (n = 12 in each group). The CIH exposure duration was 12 weeks. Mice in the CIH+telmisartan group received telmisartan administration. The terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay and western blotting of Bax and cleaved caspase-3 were conducted for evaluating apoptosis in kidney tissue. While the autophagy-related proteins, beclin-1 and LC3, were also observed via western blotting. Results The percentage of apoptotic cell in the CIH group was significantly higher than that of normoxia group; meanwhile, Bax and cleaved caspase-3 protein levels were increased in the CIH group than those of normoxia group (all p < 0.05). Compared with the normoxia group, mice in the CIH group had greater autophagy-related proteins (beclin-1 and LC3) expression. When compared to the CIH group, both the renal apoptosis and autophagy in the CIH+telmisartan group were decreased. Conclusion The CIH accelerates renal apoptosis and autophagy levels. Telmisartan ameliorating those levels suggests that it might prevent renal impairs from the CIH in OSA patients.
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Affiliation(s)
- Xiao-Bin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China.,Teaching Hospital of Fujian Medical University, Xiamen, China.,Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, No. 34, Zhongshanbei Road, Licheng District, Quanzhou, 362000, Fujian Province, China.,The Second Clinical Medical College of Fujian Medical University, Quanzhou, China.,Center of Respiratory Medicine of Fujian Province, Quanzhou, China
| | - Jing-Huang Cai
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China.,Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Yu-Yun Yang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China.,Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, No. 34, Zhongshanbei Road, Licheng District, Quanzhou, 362000, Fujian Province, China. .,The Second Clinical Medical College of Fujian Medical University, Quanzhou, China. .,Center of Respiratory Medicine of Fujian Province, Quanzhou, China.
| | - Hui-Qing Zeng
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China. .,Teaching Hospital of Fujian Medical University, Xiamen, China.
| | - Miao Wang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China.,Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Xiao Cheng
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, No.201, Hubin Nan Road, Siming District, Xiamen, 361004, Fujian Province, People's Republic of China.,Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Xiongbiao Luo
- Department of Computer Science, Xiamen University, Xiamen, Fujian, China
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Voulgaris A, Archontogeorgis K, Nena E, Tsigalou C, Xanthoudaki M, Kouratzi M, Tripsianis G, Froudarakis M, Steiropoulos P. Serum levels of NGAL and cystatin C as markers of early kidney dysfunction in patients with obstructive sleep apnea syndrome. Sleep Breath 2018; 23:161-169. [PMID: 29946947 DOI: 10.1007/s11325-018-1677-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/20/2018] [Accepted: 05/30/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome (OSAS) has been recently proposed as an independent risk factor for chronic kidney disease. Cystatin C (Cyst C) and neutrophil gelatinase-associated lipocalin (NGAL) are novel biomarkers for the earlier detection of latent kidney disease. The aim of the study was to assess serum Cyst C and NGAL levels in otherwise healthy OSAS patients and to explore possible associations with sleep parameters. METHODS Consecutive subjects (n = 96, 79.2% males), without known comorbidities, with symptoms suggestive of OSAS were included. All of them underwent polysomnography (PSG) and blood examination for the measurement of serum Cyst C and NGAL levels. RESULTS Based on apnea-hypopnea index (AHI), subjects were classified into two groups: 32 controls and 64 OSAS patients, with no significant differences in terms of age (50.1 ± 11.7 vs 51 ± 12.2 years, p = 0.747) and BMI (33.9 ± 8.8 vs 35.9 ± 13.1 kg/m2, p = 0.449). Serum Cyst C and NGAL mean levels were higher in OSAS patients compared to those in controls (1155.2 ± 319.3 vs 966.8 ± 173 ng/ml, p = 0.001, and 43.7 ± 23.2 vs 35.6 ± 13.8 ng/ml, p = 0.035, respectively). After adjustment for age and BMI in OSAS patients, serum NGAL levels were associated with AHI (β = 0.341, p = 0.015) and minimum oxyhemoglobin saturation during sleep (β = - 0.275, p = 0.032), while serum Cyst C levels were associated with percentage of time with oxyhemoglobin saturation < 90% (β = 0.270, p = 0.043), average (β = - 0.308, p = 0.018), and minimum (β = - 0.410, p = 0.001) oxyhemoglobin saturation during sleep. CONCLUSIONS Higher risk for latent kidney disease in otherwise healthy OSAS patients is indicated. Sleep hypoxia seems to be a significant contributor in the pathogenetic process of renal dysfunction in OSAS.
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Affiliation(s)
- Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace and University General Hospital, Alexandroupolis, Greece
| | - Kostas Archontogeorgis
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Xanthoudaki
- Department of Pneumonology, Medical School, Democritus University of Thrace and University General Hospital, Alexandroupolis, Greece
| | - Maria Kouratzi
- Department of Pneumonology, Medical School, Democritus University of Thrace and University General Hospital, Alexandroupolis, Greece
| | - Grigorios Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marios Froudarakis
- Department of Pneumonology, Medical School, Democritus University of Thrace and University General Hospital, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. .,Department of Pneumonology, Medical School, Democritus University of Thrace and University General Hospital, Alexandroupolis, Greece.
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Abstract
Obstructive sleep apnoea (OSA) is very common in patients with Type 2 diabetes (T2D), which is not surprising considering that obesity is a common risk factor for both conditions. In general population studies, OSA has been shown to be associated with several comorbidities including increased risk of road traffic accidents, T2D, hypertension and lack of nocturnal dipping of blood pressure, hyperlipidaemia, increased inflammation, increased risk of cardiovascular disease and mortality, increased risk of atrial fibrillation, worse quality of life, and erectile dysfunction. However, the impact of OSA on diabetes-related vascular and metabolic outcomes remains unclear. Furthermore, the impact of continuous positive airway pressure (CPAP) treatment in patients with T2D is also unclear. This unclarity regarding the impact of OSA and CPAP in patients with T2D has possibly contributed to the lack of screening for OSA in patients with T2D in the UK despite the high prevalence of OSA in patients with T2D. In this commentary, I provide an overview about OSA with a particular focus on its role and impact in patients with T2D.
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Affiliation(s)
- Abd A Tahrani
- 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- 2 Department of Diabetes & Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK
- 3 Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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11
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Cystatin C Levels in Middle-Aged Patients with Obstructive Sleep Apnea Syndrome. Pulm Med 2016; 2016:8081723. [PMID: 27843647 PMCID: PMC5098092 DOI: 10.1155/2016/8081723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Obstructive sleep apnea syndrome (OSAS) is associated with systemic inflammation and increased risk of cardiovascular and chronic kidney disease. Cystatin C (Cyst C) is a novel biomarker of both latent renal damage and cardiovascular disease. Aim of the study was to measure serum levels of Cyst C, as well as IL-8 and CRP, in otherwise healthy OSAS patients. Methods. 84 individuals examined with polysomnography for OSAS symptoms without known comorbidities were prospectively recruited. Results. According to apnea hypopnea index (AHI) subjects were divided in two groups: OSAS group (AHI > 5/hour, n = 64) and controls (AHI < 5/hour, n = 20), which were age- and BMI-matched. Cyst C levels were higher in OSAS patients versus controls (1176.13 ± 351.33 versus 938.60 ± 245.83 ng/mL, resp.; p = 0.017) while serum IL-8 and CRP levels did not differ significantly. Positive correlation was found between Cyst C levels and respiratory disturbance index (RDI) (r = 0.240, p = 0.039) and percentage of time with oxygen saturation <90% (r = 0.290, p = 0.02) and negative correlation was found between Cyst C levels and average oxygen saturation during sleep (r = -0.291, p = 0.012). After adjustment for age and BMI, RDI was the only independent predictor of Cyst C levels (β = 0.256, p = 0.039). Conclusion. Cyst C serum levels are increased in OSAS patients without comorbidities, suggesting an increased renal and cardiovascular disease risk.
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12
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Effect of positive airway pressure on glomerular filtration rate in patients with sleep-disordered breathing: a meta-analysis. Sleep Breath 2016; 21:53-59. [DOI: 10.1007/s11325-016-1364-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/23/2016] [Indexed: 01/01/2023]
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13
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Kheirandish-Gozal L, Philby MF, Alonso-Álvarez ML, Terán-Santos J, Gozal D. Biomarkers of Alzheimer Disease in Children with Obstructive Sleep Apnea: Effect of Adenotonsillectomy. Sleep 2016; 39:1225-32. [PMID: 27070140 DOI: 10.5665/sleep.5838] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/02/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE Obese children are at increased risk for developing obstructive sleep apnea (OSA), and both of these conditions are associated with an increased risk for end-organ morbidities. Both OSA and obesity (OB) have been associated with increased risk for Alzheimer disease (AD). This study aimed to assess whether OSA and OB lead to increased plasma levels of 2 AD markers amyloid β protein 42 (Aβ42) and pre-senilin 1 (PS1). METHODS Fasting morning plasma samples from otherwise healthy children with a diagnosis of OB, OSA, or both (OSA+OB), and controls, and in a subset of children with OSA after adenotonsillectomy (T&A) were assayed for Aβ42 and PS1 levels using commercial enzyme-linked immunosorbent assay kits. RESULTS 286 children (mean age of 7.2 ± 2.7 y) were evaluated. Compared to control subjects, OB children had similar Aβ42 (108.3 ± 31.7 pg/mL versus 83.6 ± 14.6 pg/mL) and PS1 levels (0.89 ± 0.44 ng/mL versus 0.80 ± 0.29 pg/mL). However, OSA children (Aβ42: 186.2 ± 66.7 pg/mL; P < 0.001; PS1: 3.42 ± 1.46 ng/mL; P < 0.001), and particularly OSA+OB children had significant elevations in both Aβ42 (349.4 ± 112.9 pg/mL; P < 0.001) and PS1 (PS1: 4.54 ± 1.16 ng/mL; P < 0.001) circulating concentrations. In a subset of 24 children, T&A resulted in significant reductions of Aβ42 (352.0 ± 145.2 versus 151.9 ± 81.4 pg/mL; P < 0.0001) and PS1 (4.82 ± 1.09 versus 2.02 ± 1.18 ng/mL; P < 0.0001). CONCLUSIONS Thus, OSA, and particularly OSA+OB, are associated with increased plasma levels of AD biomarkers, which decline upon treatment of OSA in a representative, yet not all- encompassing subset of patients, suggesting that OSA may accelerate AD-related processes even in early childhood. However, the cognitive and overall health-related implications of these findings remain to be defined.
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Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Mona F Philby
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - María Luz Alonso-Álvarez
- Sleep Unit, CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Hospital Universitario de Burgos (HUBU), Burgos, Spain
| | - Joaquin Terán-Santos
- Sleep Unit, CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Hospital Universitario de Burgos (HUBU), Burgos, Spain
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
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A Tahrani A. Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes. EUROPEAN ENDOCRINOLOGY 2015; 11:81-89. [PMID: 29632575 PMCID: PMC5819072 DOI: 10.17925/ee.2015.11.02.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham; Birmingham, UK; Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK
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