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Chew S, Colville D, Hutchinson A, Canty P, Hodgson L, Savige J. Obstructive sleep apnea, chronic obstructive pulmonary disease and hypertensive microvascular disease: a cross-sectional observational cohort study. Sci Rep 2022; 12:13350. [PMID: 35922660 PMCID: PMC9349200 DOI: 10.1038/s41598-022-17481-9] [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: 03/23/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Hypertensive microvascular disease is associated with an increased risk of diastolic heart failure, vascular dementia and progressive renal impairment. This study examined whether individuals with obstructive sleep apnoea (OSA) had more retinal hypertensive microvascular disease than those with chronic obstructive pulmonary disease (COPD) and hospital controls. This was a single-centre, cross-sectional, observational study of participants recruited consecutively from a general respiratory clinic and a general medical clinic. OSA was diagnosed on overnight polysomnography study (apnoea:hypopnoea index ≥ 5), and controls with COPD had a forced expiratory volume/forced vital capacity (forced expiratory ratio) < 70%. Individuals with both OSA and COPD were excluded. Hospital controls had no COPD on respiratory function testing and no OSA on specialist physician questioning. Study participants completed a medical questionnaire, and underwent resting BP measurement, and retinal photography with a non-mydriatic camera. Images were deidentified and graded for microvascular retinopathy (Wong and Mitchell classification), and arteriole and venular calibre using a semiautomated method at a grading centre. Individuals with OSA (n = 79) demonstrated a trend to a higher mean arterial pressure than other hospital patients (n = 143) (89.2 ± 8.9 mmHg, p = 0.02), and more microvascular retinopathy (p < 0.001), and narrower retinal arterioles (134.2 ± 15.9 μm and 148.0 ± 16.2 μm respectively, p < 0.01). Microvascular retinopathy and arteriolar narrowing were still more common in OSA than hospital controls, after adjusting for age, BMI, mean arterial pressure, smoking history and dyslipidaemia (p < 0.01, p < 0.01, respectively). Individuals with OSA demonstrated a trend to a higher mean arterial pressure than those with COPD (n = 132, 93.2 ± 12.2 mmHg and 89.7 ± 12.8 mmHg respectively, p = 0.07), and more microvascular retinopathy (p = 0.0001) and narrower arterioles (134.2 ± 15.9 and 152.3 ± 16.8, p < 0.01). Individuals with OSA alone had more systemic microvascular disease than those with COPD alone or other hospital patients without OSA and COPD, despite being younger in age.
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Affiliation(s)
- Sky Chew
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Deb Colville
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | | | | | - Lauren Hodgson
- The University of Melbourne Department of Ophthalmology Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Judy Savige
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
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Association between obstructive sleep apnoea syndrome and the risk of cardiovascular diseases: an updated systematic review and dose–response meta-analysis. Sleep Med 2020; 71:39-46. [DOI: 10.1016/j.sleep.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 01/11/2023]
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Kwon Y, Picel K, Adabag S, Vo T, Taylor BC, Redline S, Stone K, Mehra R, Ancoli-Israel S, Ensrud KE. Sleep-disordered breathing and daytime cardiac conduction abnormalities on 12-lead electrocardiogram in community-dwelling older men. Sleep Breath 2016; 20:1161-1168. [PMID: 26971326 PMCID: PMC5018906 DOI: 10.1007/s11325-016-1326-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Nocturnal cardiac conduction abnormalities are commonly observed in patients with sleep-disordered breathing (SDB). However, few population-based studies have examined the association between SDB and daytime cardiac conduction abnormalities. METHODS We examined a random sample of 471 community-dwelling men, aged ≥67 years, enrolled in the multi-center Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study. SDB severity was categorized using percent of total sleep time with oxygen saturation <90 % (%TST < 90) and apnea hypopnea index (AHI). Cardiac conduction parameters were assessed by resting 12-lead electrocardiography (ECG). All analyses were adjusted for age, site, β-blocker use, coronary heart disease, calcium channel blocker use, and use of antiarrhythmic medications. RESULTS Mean age was 77 ± 6 years, median %TST < 90 was 0.7 (IQR 0.00-3.40), and median AHI was 7.06 (IQR 2.55-15.32). Men with greater nocturnal hypoxemia (%TST < 90 ≥ 3.5 %) compared with those without hypoxemia (%TST < 90 < 1.0 %) had a lower odds of bradycardia (OR 0.55 [0.32-0.94]) and right bundle branch block (RBBB) (OR 0.24 [0.08-0.75]) but a higher odds of ventricular paced rhythm (OR 4.42 [1.29-15.19]). Heart rate (HR) increased in a graded manner with increasing %TST < 90 (p-trend 0.01) and increasing AHI (p-trend 0.006), but these gradients were small in absolute magnitude. There were no associations of SDB measures with other ECG conduction parameters. CONCLUSIONS Greater nocturnal hypoxemia in older men was associated with a lower prevalence of daytime sinus bradycardia and RBBB, a higher prevalence of ventricular paced rhythm, and higher resting HR.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Katherine Picel
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Selcuk Adabag
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tien Vo
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Reena Mehra
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.
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Left ventricular subclinical dysfunction associated with myocardial deformation changes in obstructive sleep apnea patients estimated by real-time 3D speckle-tracking echocardiography. Sleep Breath 2015; 20:135-44. [PMID: 26003787 DOI: 10.1007/s11325-015-1197-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/20/2015] [Accepted: 05/13/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE). METHODS Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea-hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender-age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE. RESULTS LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E' was 9.6 ± 2.8 and 10.4 ± 2.5, respectively, p < 0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9 ± 1.4 % and 14.8 ± 1.5 % vs 18.2 ± 1.7 % and 17.8 ± 1.5 %; AS 27.4 ± 1.8 % and 24.9 ± 2.3 % vs 33.4 ± 2.2 % and 32.7 ± 2.9 %, respectively, p < 0.0001), but the global CS and RS were significantly reduced only in group III (17.3 ± 1.4 % and 43.1 ± 6.5 % vs 19.6 ± 1.6 % and 55.4 ± 4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r = -0.80, p < 0.0001), LS (r = -0.64, p < 0.0001), CS (r = -0.51, p < 0.0001), and RS (r = -0.62, p < 0.0001). CONCLUSIONS Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.
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Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 2013; 169:207-14. [PMID: 24161531 DOI: 10.1016/j.ijcard.2013.08.088] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 08/13/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies. METHODS We used generalized least squares regression models to estimate the dose-response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed. RESULTS Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of <5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose-response relationship indicated that per 10-unit increase in the apnea-hypopnea index was associated with a 17% greater risk of CVD in the general population. CONCLUSIONS This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.
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Affiliation(s)
- Xia Wang
- Department of Maternal and Child Health Care, School of Public Health, Shandong University, Jinan, China; Department of Nutrition and Food Hygiene and Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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High cardiovascular risk profile in patients with sleep apnea. Laryngoscope 2013; 124:306-10. [DOI: 10.1002/lary.24304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 11/07/2022]
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Nikodemova M, Finn L, Mignot E, Salzieder N, Peppard PE. Association of sleep disordered breathing and cognitive deficit in APOE ε4 carriers. Sleep 2013; 36:873-80. [PMID: 23729930 DOI: 10.5665/sleep.2714] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The aim of the study was to determine whether apolipoprotein E epsilon 4 genotype (APOE4) modifies the association of sleep disordered breathing (SDB) with cognitive function in a middle-aged population. DESIGN Cross-sectional analysis of a community-dwelling cohort. SETTINGS Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospitals and Clinics. PARTICIPANTS There were 755 adults from the Wisconsin Sleep Cohort who provided a total of 1,843 polysomnography and cognitive evaluations (most participants were assessed multiple times at approximately 4-y intervals); 56% males, average age 53.9 years (range 30-81 years). INTERVENTIONS None. MEASUREMENT AND RESULTS In-laboratory overnight polysomnography was used to assess SDB. Cognition was evaluated by a battery of six neurocognitive tests assessing memory and learning, attention, executive function, and psychomotor efficiency. The APOE4 genotype (ε3/ε4 or ε4/ ε4) was identified in 200 participants. Data were analyzed using linear mixed-effects models, accounting for multiple observations per participant. Cognitive test scores were regressed on SDB categories (AHI < 5, 5 ≤ AHI < 15, AHI ≥ 15); APOE4 and their interaction; and age, education, sex, and body mass index. There was no statistically significant association between SDB and cognitive performance among APOE4-negative individuals. However, in APOE4-positive individuals, those with AHI ≥ 15 had significantly worse performance on the Auditory Verbal Learning Test and the Controlled Oral Word Association Test. CONCLUSIONS In APOE4-positive individuals, moderate to severe sleep disordered breathing (AHI ≥ 15) was associated with poorer performance on cognitive tests that require both memory and executive function engagement.
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Affiliation(s)
- Maria Nikodemova
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53726, USA
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Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury. Sleep Breath 2013; 17:85-91. [PMID: 22294346 DOI: 10.1007/s11325-012-0653-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/10/2012] [Accepted: 01/13/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We hypothesized that obstructive sleep apnea(OSA) has a dose-dependent impact on mortality in those with ischemic heart disease or previous myocardial injury. METHODS We performed a retrospective cohort study of 281 consecutive OSA patients with a history of myocardial injury as determined by elevated troponin levels or with known existing ischemic heart disease. We compared survival between those with severe OSA [apnea–hypopneaindex (AHI) ≥30] and those with mild to moderate OSA(AHI >5 and <30). RESULTS Of the 281 patients (mean age 65 years, mean BMI34, 98% male, 58% with diabetes), 151 patients had mild moderate OSA and 130 had severe OSA. During a mean follow-up of 4.1 years, there were significantly greater deaths in the severe OSA group compared to the mild moderate OSA group [53 deaths (41%) vs. 44 deaths(29%), respectively, p00.04]. The adjusted hazard ratio for mortality with severe OSA was 1.72 (95% confidence interval1.01–2.91, p00.04). CONCLUSIONS The severity of obstructive sleep apnea is associated with increased risk of death, and risk stratification based on OSA severity is relevant even in the diseased cardiac patient.
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Shankar A, Peppard PE, Young T, Klein BEK, Klein R, Nieto FJ. Sleep-disordered breathing and retinal microvascular diameter. Atherosclerosis 2013; 226:124-8. [PMID: 23137824 PMCID: PMC3529805 DOI: 10.1016/j.atherosclerosis.2012.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is an emerging risk factor for cardiovascular disease (CVD). Microvascular dysfunction has been proposed as a potential mechanism in the pathogenesis of CVD in SDB. The retinal vasculature offers a unique opportunity to investigate the systemic effects of microvascular dysfunction as it can be viewed non-invasively and is also structurally and functionally similar to microvasculature elsewhere in the body. We therefore examined the association between SDB and retinal microvascular diameter after adjusting for major confounders. METHODS We examined n = 476 participants from the Wisconsin Sleep Cohort Study. SDB was characterized using the apnea-hypopnea index (AHI) as <5 events/h, 5-14.9 events/h, and ≥15 events/h. Outcomes of interest included the presence of retinal arteriolar narrowing (mean retinal arteriolar diameter <141.0 um) and retinal venular widening (mean venular diameter >223.0 um). RESULTS Higher AHI was found to be positively associated with retinal venular dilatation, independent of body mass index, hypertension, diabetes, and lipid levels. Compared to an AHI of <5 events/h (referent), the multivariable-adjusted odds ratio of retinal venular widening for an AHI of 5-14.9 events/h was 1.31 (0.75-2.28) and for an AHI of >15 events/h was 2.08 (1.03-2.16); p-trend = 0.045. In contrast, there was no association between AHI and retinal arteriolar narrowing (p-trend = 0.72). CONCLUSION Higher AHI, a marker of SDB, was positively associated with wider retinal venules, independent of age, gender, BMI, hypertension, diabetes, and lipid levels. These data suggest that the association of SDB with cardiovascular disease may be mediated, in part, by microvasculature.
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Affiliation(s)
- Anoop Shankar
- Department of Community Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9190, Morgantown, WV 26506, USA.
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Massierer D, Martinez D, Fuchs SC, Pellin PP, Garcia MS, Zacharias AL, Antunes IF, Wainstein MV, Moreira LB, Ribeiro JP, Fuchs FD. Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease. CAD SAUDE PUBLICA 2012; 28:1530-8. [DOI: 10.1590/s0102-311x2012000800011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 03/02/2012] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA), a risk factor for coronary artery disease, remains under diagnosed. We investigated if OSA identified by the Berlin Questionnaire (BQ) is associated with the risk of coronary artery disease. Cases were patients referred for elective coronariography. The cases were classified with significant coronary lesions (stenosis > 50% in an epicardial coronary) or without significant coronary lesions. Controls were selected from a population-based sample. Positive BQ results were identified in 135 (41.2%) of 328 cases, in contrast with 151 (34.4%) of 439 control subjects (p = 0.03). In a multinomial logistic analysis, the risk for OSA identified by the BQ was independently associated with coronary artery disease in cases with lesions of at least 50% (OR = 1.53; 95%CI: 1.02-2.30; p = 0.04). The risk from OSA identified by the BQ was higher in younger subjects (40-59 years) (OR = 1.76; 95%CI: 1.05-2.97; p = 0.03) and in women (OR = 3.56; 95%CI: 1.64-7.72; p = 0.001). In conclusion, OSA identified by the BQ greatly increases the risks of coronary artery disease in patients having significant coronary artery lesions indicated by anangiogram, particularly in younger individuals and in women.
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Abstract
Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anatomically compromised, collapsible airway, the sleep-induced loss of compensatory tonic input to the upper airway dilator muscle motor neurons leads to collapse of the pharyngeal airway. In turn, the ability of the sleeping subject to compensate for this airway obstruction will determine the degree of cycling of these events. Several of the classic neurotransmitters and a growing list of neuromodulators have now been identified that contribute to neurochemical regulation of pharyngeal motor neuron activity and airway patency. Limited progress has been made in developing pharmacotherapies with acceptable specificity for the treatment of sleep-induced airway obstruction. We review three types of major long-term sequelae to severe OSA that have been assessed in humans through use of continuous positive airway pressure (CPAP) treatment and in animal models via long-term intermittent hypoxemia (IH): 1) cardiovascular. The evidence is strongest to support daytime systemic hypertension as a consequence of severe OSA, with less conclusive effects on pulmonary hypertension, stroke, coronary artery disease, and cardiac arrhythmias. The underlying mechanisms mediating hypertension include enhanced chemoreceptor sensitivity causing excessive daytime sympathetic vasoconstrictor activity, combined with overproduction of superoxide ion and inflammatory effects on resistance vessels. 2) Insulin sensitivity and homeostasis of glucose regulation are negatively impacted by both intermittent hypoxemia and sleep disruption, but whether these influences of OSA are sufficient, independent of obesity, to contribute significantly to the "metabolic syndrome" remains unsettled. 3) Neurocognitive effects include daytime sleepiness and impaired memory and concentration. These effects reflect hypoxic-induced "neural injury." We discuss future research into understanding the pathophysiology of sleep apnea as a basis for uncovering newer forms of treatment of both the ventilatory disorder and its multiple sequelae.
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Affiliation(s)
- Jerome A Dempsey
- The John Rankin Laboratory of Pulmonary Medicine, Departments of Population Health Sciences and of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53706, USA.
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