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Mohammadi I, Adibparsa M, Yashooa RK, Sehat MS, Sadeghi M. Effect of continuous positive airway pressure therapy on blood levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in obstructive sleep apnoea adults: A systematic review, meta-analysis and trial sequential analysis. Int Orthod 2024; 22:100917. [PMID: 39213713 DOI: 10.1016/j.ortho.2024.100917] [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: 06/25/2024] [Revised: 08/11/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is a long-term disorder characterized by frequent blockages in the upper respiratory tract during sleep, often leading to abrupt awakenings, with or without a decrease in oxygen levels. The systematic review and meta-analysis aimed to assess the effect of continuous positive airway pressure therapy (CPAP) on blood interleukin (IL) levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in OSA adults. MATERIALS AND METHODS The published databases from PubMed, Scopus, Web of Science, and Cochrane Library were searched from 2003 to 2024, without any restrictions. The Review Manager software 5.3 was employed to compute effect sizes, which were presented as the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS In total, 320 records were identified through database searching; ultimately, 42 articles were included in the qualitative synthesis and then the meta-analysis. The CPAP therapy significantly reduces IL-6 levels, as indicated SMD=0.64 [95% CI: 0.35, 0.93] and P<0.0001. CPAP therapy significantly reduced IL-18 and IL-1β levels in adults with OSA, but there is no significant difference in IL-10, IL-4, or IL-17 levels. Age, blood sample, body mass index, ethnicity, and treatment duration for IL-6 and apnoea-hypopnea index with IL-10 levels were effective factors in the pooled results. Experimentally, there was an interaction between IL-18 and IL-1β. CONCLUSIONS CPAP therapy has a positive impact on inflammatory markers in OSA adults; remarkably, it reduces IL-6 and IL-1β levels. Nevertheless, more evidence (such as the role of ethnicity) and understanding of interactions are needed.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Raya Kh Yashooa
- Department of Medical Microbiology, College of Science, Knowledge University, Kirkuk Road, 44001 Erbil, Kurdistan Region, Iraq
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Olejnik AE, Kuźnar-Kamińska B. Association of Obesity and Severe Asthma in Adults. J Clin Med 2024; 13:3474. [PMID: 38930006 PMCID: PMC11204497 DOI: 10.3390/jcm13123474] [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: 04/25/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The incidence of obesity and asthma continues to enhance, significantly impacting global public health. Adipose tissue is an organ that secretes hormones and cytokines, causes meta-inflammation, and contributes to the intensification of bronchial hyperreactivity, oxidative stress, and consequently affects the different phenotypes of asthma in obese people. As body weight increases, the risk of severe asthma increases, as well as more frequent exacerbations requiring the use of glucocorticoids and hospitalization, which consequently leads to a deterioration of the quality of life. This review discusses the relationship between obesity and severe asthma, the underlying molecular mechanisms, changes in respiratory function tests in obese people, its impact on the occurrence of comorbidities, and consequently, a different response to conventional asthma treatment. The article also reviews research on possible future therapies for severe asthma. The manuscript is a narrative review of clinical trials in severe asthma and comorbid obesity. The articles were found in the PubMed database using the keywords asthma and obesity. Studies on severe asthma were then selected for inclusion in the article. The sections: 'The classification connected with asthma and obesity', 'Obesity-related changes in pulmonary functional tests', and 'Obesity and inflammation', include studies on subjects without asthma or non-severe asthma, which, according to the authors, familiarize the reader with the pathophysiology of obesity-related asthma.
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Affiliation(s)
- Aneta Elżbieta Olejnik
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, Szamarzewskiego 84 Street, 60-569 Poznan, Poland;
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Khalaji A, Amirkhani N, Sharifkashani S, Behnoush AH. Role of galectin-3 as a biomarker in obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2023; 27:2273-2282. [PMID: 37129844 DOI: 10.1007/s11325-023-02842-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Because obstructive sleep apnea (OSA) is a prevalent condition, biomarkers for OSA would be very useful. Galectin-3 has gained attention as a marker for several diseases. The aim of this study was to investigate the association between circulating galectin-3 levels and OSA. METHODS PubMed, Scopus, Embase, and Web of Science were explored to find the studies evaluating galectin-3 in OSA and controls, within different severities of OSA, or before and after continuous positive airway pressure (CPAP) treatment in cases with OSA. We used random-effect meta-analysis to calculate standardized mean differences (SMD) along with 95% confidence intervals (CI). Newcastle-Ottawa Scale was used assessment of the risk of bias in studies. RESULTS An initial search resulted in 289 results. After exclusion of duplicate studies, screening of titles/abstracts and assessments of full texts, six studies were included comprised of 987 cases with a mean age of 54.4 years. Meta-analysis showed that there were significantly higher galectin-3 circulating levels in patients with OSA than in healthy controls (SMD 0.80, 95% CI 0.30 to 1.31, p value < 0.01). Severe OSA was related to higher levels of galectin-3, in comparison to non-severe OSA (SMD 0.76, 95% CI 0.29 to 1.22, p value < 0.01). CPAP therapy also significantly reduced galectin-3 peripheral levels in patients with OSA (SMD - 3.55, 95% CI - 6.90 to - 0.20, p value = 0.04). CONCLUSION The findings suggest that Galectin-3 may have potential utility as a biomarker in patients with OSA. Further research is needed to demonstrate its role in pathophysiology, as well as its possible use in diagnosis and prognosis.
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Affiliation(s)
- Amirmohammad Khalaji
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikan Amirkhani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir Hossein Behnoush
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Saxena D, Imayama I, Adrish M. Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs. J Clin Med 2023; 12:6552. [PMID: 37892689 PMCID: PMC10607310 DOI: 10.3390/jcm12206552] [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: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of sleep fragmentation, nocturnal asthma symptoms, daytime sleepiness, and snoring. The prevalence of OSA increases with asthma severity, as evidenced by multiple large studies. Asthma may lower the threshold for arousal in OSA, resulting in the hypopnea with arousal phenotype. Epidemiologic studies in adults have shown that OSA is associated with worse asthma severity, increased frequency of exacerbation, and poor quality of life. The current literature assessing the relationship among OSA, asthma, and CPAP therapy is heavily dependent on observational studies. There is a need for randomized controlled trials to minimize the interference of confounding shared risk factors.
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Affiliation(s)
- Damini Saxena
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ikuyo Imayama
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, IL 60607, USA
| | - Muhammad Adrish
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Tosun F, Babayiğit C, Dikmen N, Doğan S, Dirican E. The effect of continuous positive airway pressure treatment on inflammatory parameters and periostin levels in patients with obstructive sleep apnea syndrome. Sleep Breath 2023; 27:275-282. [PMID: 35478293 DOI: 10.1007/s11325-022-02616-z] [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: 09/24/2021] [Revised: 03/24/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of the study was to examine the effects of continuous positive airway pressure (CPAP) treatment on inflammation parameters in patients with obstructive sleep apnea syndrome (OSAS). METHODS Patients aged 18 to 65 years who underwent polysomnography (PSG) in the sleep clinic between January 1, 2019, and December 31, 2019, were included in the study. Patients with severe OSAS initiated treatment with CPAP. Patients and control subjects were assessed for levels of periostin, TNF-alpha, TGF-beta, and IL-6. Patients were re-evaluated 3 months later. Comparisons for the serum markers were made between controls and patients of different severity of OSAS. Comparisons of serum markers were also made between baseline and 3 month follow-up. RESULTS: A total of 92 patients were enrolled in the study, including 25 controls (apnea-hypopnea index or AHI < 5/h), 39 patents with mild to moderate OSAS who did not receive CPAP, and 28 patients with severe OSAS receiving CPAP treatment. When all three groups were compared, levels of periostin, TNF-alpha, TGF-beta, and IL-6, as inflammatory markers, were higher in the OSAS group, though not at a statistically significant level. In patients with severe OSAS, there were statistically significant decreases in the TGF-beta 1, TNF-alpha, and IL-6 values between baseline values and the same measures taken after 3 months of CPAP treatment. Periostin values also decreased after treatment, but this decrease was not at a significant level. CONCLUSION Inflammatory parameters of patients with OSAS were significantly higher compared with healthy participants. Regression of inflammation was detected after CPAP treatment.
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Affiliation(s)
- Fatma Tosun
- Department of Chest Diseases, Faculty of Medicine, Hatay Mustafa Kemal University, Tayfur Sökmen (31060) Campus, Alahan-Antakya, 31060, Hatay, Turkey
| | - Cenk Babayiğit
- Department of Chest Diseases, Faculty of Medicine, Hatay Mustafa Kemal University, Tayfur Sökmen (31060) Campus, Alahan-Antakya, 31060, Hatay, Turkey
| | - Nursel Dikmen
- Department of Chest Diseases, Faculty of Medicine, Hatay Mustafa Kemal University, Tayfur Sökmen (31060) Campus, Alahan-Antakya, 31060, Hatay, Turkey.
| | - Serdar Doğan
- Department of Biochemistry, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Emre Dirican
- Department of Biostatistics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
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Luo Y, Zhang FR, Wu JL, Jiang XJ. Efficacy of continuous positive airway pressure on TNF-α in obstructive sleep apnea patients: A meta-analysis. PLoS One 2023; 18:e0282172. [PMID: 36952521 PMCID: PMC10035913 DOI: 10.1371/journal.pone.0282172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Tumor necrosis factor-α (TNF-α) is an important mediator of the immune response. At present, the improvement of TNF-α after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is still controversial. METHODS We conducted a systematic review of the present evidence based on a meta-analysis to elucidate the effects of TNF-α on OSAHS after CPAP treatment. RESULTS To measure TNF-α, ten studies used enzyme-linked immunosorbent assay (ELISA), and one used radioimmunoassay. The forest plot outcome indicated that CPAP therapy would lower the TNF-α levels in OSAHS patients, with a weighted mean difference (WMD) of 1.08 (95% CI: 0.62-1.55; P < 0.001) based on the REM since there is highly significant heterogeneity (I2 = 90%) among the studies. Therefore, we used the subgroup and sensitivity analyses to investigate the source of heterogeneity. The findings of the sensitivity analysis revealed that the pooled WMD ranged from 0.91 (95% CI: 0.52-1.31; P < 0.001) to 1.18 (95% CI: 0.74-1.63; P < 0.001). The findings were not influenced by any single study. Notably, there was homogeneity in the Asia subgroup and publication year: 2019, implying that these subgroups could be the source of heterogeneity. CONCLUSION Our meta-analysis recommends that CPAP therapy will decrease the TNF-α level in OSAHS patients, but more related research should be conducted.
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Affiliation(s)
- Yong Luo
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fa-Rong Zhang
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun-Lin Wu
- Department of Endocrinology, Fifth Hospital in Wuhan, Wuhan, Hubei, China
| | - Xi-Jiao Jiang
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wang Y, Hu C. Leptin and Asthma: What Are the Interactive Correlations? Biomolecules 2022; 12:biom12121780. [PMID: 36551211 PMCID: PMC9775505 DOI: 10.3390/biom12121780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Leptin is an adipokine directly correlated with the proinflammatory obese-associated phenotype. Leptin has been demonstrated to inhibit adipogenesis, promote fat demarcation, promote a chronic inflammatory state, increase insulin sensitivity, and promote angiogenesis. Leptin, a regulator of the immune response, is implicated in the pathology of asthma. Studies involved in the key cell reaction and animal models of asthma have provided vital insights into the proinflammatory role of leptin in asthma. Many studies described the immune cell and related cellular pathways activated by leptin, which are beneficial in asthma development and increasing exacerbations. Subsequent studies relating to animal models support the role of leptin in increasing inflammatory cell infiltration, airway hyperresponsiveness, and inflammatory responses. However, the conclusive effects of leptin in asthma are not well elaborated. In the present study, we explored the general functions and the clinical cohort study supporting the association between leptin and asthma. The main objective of our review is to address the knowns and unknowns of leptin on asthma. In this perspective, the arguments about the different faces of leptin in asthma are provided to picture the potential directions, thus yielding a better understanding of asthma development.
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Affiliation(s)
- Yang Wang
- Department of Respiratory Medicine (Department of Respiratory and Critical Care Medicine), Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine (Department of Respiratory and Critical Care Medicine), Xiangya Hospital, Central South University, Changsha 410008, China
- Correspondence:
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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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Oxidative Stress Markers among Obstructive Sleep Apnea Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9681595. [PMID: 34336121 PMCID: PMC8321764 DOI: 10.1155/2021/9681595] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Obstructive sleep apnea (OSA) is a chronic respiratory disorder, which can be present in up to 50% of the population, depending on the country. OSA is characterized by recurrent episodes of partial or complete obstruction of the upper airways with consistent movement of the respiratory musculature during sleep. Apneas and hypopneas can lead to a decrease in oxygen saturation, an increase in carbon dioxide in the blood, and subsequent arousals and sleep fragmentation caused by repetitive activation of the central nervous system. As a consequence, intermittent hypoxemia and consequent reoxygenation result in the production of reactive oxygen species, leading to systematic oxidative stress, which is postulated to be a key mechanism of endothelial dysfunction and increased risk for cardiovascular disorders in patients with OSA. In this review, various biomarkers of oxidative stress, including high-sensitivity C-reactive protein, pregnancy-associated plasma protein-A, superoxide dismutase, cell-free DNA, 8-hydroxy-2-deoxyguanosine, advanced oxidation protein products, lipid peroxidation products, receptor for advanced glycation end-products, and thioredoxin are discussed. Biomarkers of oxidative stress have the potential to be used to assess disease severity and treatment response. Continuous positive airway pressure (CPAP) is one of the most common noninvasive treatments for OSA; it keeps the upper airways open during sleep. This reduces episodes of intermittent hypoxia, reoxygenation, and arousal at night. CPAP has been shown to have anti-inflammatory properties and decrease oxidative stress. The administration of certain compounds, like vitamins A, C, and E as well as N-acetylcysteine and allopurinol, can decrease oxidative stress markers. However, their role in the treatment of OSA remains unclear.
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Chung F, Waseem R, Pham C, Penzel T, Han F, Bjorvatn B, Morin CM, Holzinger B, Espie CA, Benedict C, Cedernaes J, Saaresranta T, Wing YK, Nadorff MR, Dauvilliers Y, De Gennaro L, Plazzi G, Merikanto I, Matsui K, Leger D, Sieminski M, Mota-Rolim S, Inoue Y, Partinen M. The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study. Sleep Breath 2021; 25:849-860. [PMID: 33907966 PMCID: PMC8079162 DOI: 10.1007/s11325-021-02373-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) may increase the risk of severe COVID-19; however, the level of potential modulation has not yet been established. The objective of the study was to determine the association between high risk of OSA, comorbidities, and increased risk for COVID-19, hospitalization, and intensive care unit (ICU) treatment. METHODS We conducted a cross-sectional population-based web survey in adults in 14 countries/regions. The survey included sociodemographic variables and comorbidities. Participants were asked questions about COVID-19, hospitalization, and ICU treatment. Standardized questionnaire (STOP questionnaire for high risk of OSA) was included. Multivariable logistic regression was conducted adjusting for various factors. RESULTS Out of 26,539 respondents, 20,598 (35.4% male) completed the survey. Mean age and BMI of participants were 41.5 ± 16.0 years and 24.0 ± 5.0 kg/m2, respectively. The prevalence of physician-diagnosed OSA was 4.1% and high risk of OSA was 9.5%. We found that high risk of OSA (adjusted odds ratio (aOR) 1.72, 95% confidence interval (CI): 1.20, 2.47) and diabetes (aOR 2.07, 95% CI: 1.23, 3.48) were associated with reporting of a COVID-19 diagnosis. High risk for OSA (aOR 2.11, 95% CI: 1.10-4.01), being male (aOR: 2.82, 95% CI: 1.55-5.12), having diabetes (aOR: 3.93, 95% CI: 1.70-9.12), and having depression (aOR: 2.33, 95% CI: 1.15-4.77) were associated with increased risk of hospitalization or ICU treatment. CONCLUSIONS Participants at high risk of OSA had increased odds of having COVID-19 and were two times more likely to be hospitalized or treated in ICU.
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Affiliation(s)
- Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, M5T2S8, Canada. .,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.
| | - Rida Waseem
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, M5T2S8, Canada
| | - Chi Pham
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, M5T2S8, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Thomas Penzel
- Sleep Medicine Center, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Charles M Morin
- École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, Canada
| | - Brigitte Holzinger
- Institute for Dream and Consciousness Research, Medical University of Vienna, Vienna, Austria
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christian Benedict
- Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden
| | - Jonathan Cedernaes
- Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden.,Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Starkville, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Guiseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilona Merikanto
- Department of Psychology and Logopedics and SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kentaro Matsui
- Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan.,Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Damien Leger
- Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France.,Universite de Paris, VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Paris, France
| | - Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Sergio Mota-Rolim
- Brain Institute, Onofre Lopes University Hospital, Natal, Brazil.,Physiology and Behavior Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, and Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
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11
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Zhang C, Cheng Y, Liu F, Ma J, Wang G. A community study of the risk for obstructive sleep apnea and respiratory inflammation in an adult Chinese population. Postgrad Med 2021; 133:531-540. [PMID: 33851902 DOI: 10.1080/00325481.2021.1914466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: We aimed to investigate the relationship between obstructive sleep apnea (OSA) risk and respiratory inflammation evaluated by the exhaled breath condensate (EBC) interleukin-6 (IL-6) and plasma surfactant protein-D (SP-D), based on the Berlin questionnaire (BQ) screening values in an adult, urban community in Beijing, China.Methods: Volunteers aged >40 years were recruited from the Shichahai community of central Beijing (Registration number: NCT04832711). Their general information and disease history were recorded. OSA risk was assessed using the BQ. IL-6 in EBC and plasma SP-D were d etected by enzyme-linked immunoassay through specimens collected while fasting. The differences in IL-6 and SP-D values between high-risk and low-risk groups for OSA were compared, and the factors affecting their values were analyzed.Results: Among 1,239 participants, 18.8% of participants were in the high-risk group. There were more participants with higher body mass index, chronic hypertension, coronary heart disease, and diabetes in the high-risk group than in the low-risk group (P < 0.05). There were no significant differences in EBC IL-6 and plasma SP-D between the high- and low-OSA risk groups (p > 0.05). After adjustment for age, sex and chronic comorbidities, multivariate logistic regression showed that there was no correlation between risk of OSA and IL-6 in EBC. However, the risk of OSA (odds ratio [OR] [95% CI]: 1.69 [1.15,2.48]; β = 0.522) and BMI (OR [95%CI]: 0.94 [0.91,0.98]; β = -0.061) were independently associated with plasma SP-D level (p < 0.05 for both). Stratification analysis showed that OSA risk were independently associated with plasma SP-D levels in participants <65 years, or men, or participants with BMI<25.Conclusion: This study showed that plasma SP-D, an inflammation biomarker, was associated with risk of OSA and BMI in a Chinese central urban community.The relationship between the risk of OSA and respiratory inflammation in community populations needs to be further evaluated.
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Affiliation(s)
- Cheng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yuan Cheng
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Feng Liu
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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12
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Shrestha J, Ryan ST, Mills O, Zhand S, Razavi Bazaz S, Hansbro PM, Ghadiri M, Ebrahimi Warkiani M. A 3D-printed microfluidic platform for simulating the effects of CPAP on the nasal epithelium. Biofabrication 2021; 13. [PMID: 33561837 DOI: 10.1088/1758-5090/abe4c1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/09/2021] [Indexed: 02/01/2023]
Abstract
Obstructive sleep apnoea (OSA) is a chronic disorder that involves a decrease or complete cessation of airflow during sleep. It occurs when the muscles supporting the soft tissues in the throat relax during sleep, causing narrowing or closure of the upper airway. Sleep apnoea is a serious medical condition with an increased risk of cardiovascular complications and impaired quality of life. Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe cases of OSA and is effective in mild sleep apnoea. However, CPAP therapy is associated with the development of several nasal side effects and is inconvenient for the user, leading to low compliance rates. The effects of CPAP treatment on the upper respiratory system, as well as the pathogenesis of side effects, are incompletely understood and not adequately researched. To better understand the effects of CPAP treatment on the upper respiratory system, we developed an in vitro 3D-printed microfluidic platform. A nasal epithelial cell line, RPMI 2650, was then exposed to certain conditions to mimic the in-vivo environment. To create these conditions, the microfluidic device was utilized to expose nasal epithelial cells grown and differentiated at the air-liquid interface. The airflow was similar to what is experienced with CPAP, with pressure ranging between 0-20 cm of H20. Cells exposed to pressure showed decreased barrier integrity, change in cellular shape, and increased cell death (lactate dehydrogenase release into media) compared to unstressed cells. Stressed cells also showed increased secretions of inflammatory markers IL-6 and IL-8 and had increased production of ATP. Our results suggest that stress induced by airflow leads to structural, metabolic, and inflammatory changes in the nasal epithelium, which may be responsible for developing nasal side-effects following CPAP treatment.
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Affiliation(s)
- Jesus Shrestha
- University of Technology Sydney, 15 Broadway, Sydney, New South Wales, 2007, AUSTRALIA
| | - Sean Thomas Ryan
- The University of Sydney, 15 Broadway, Sydney, New South Wales, 2006, AUSTRALIA
| | - Oliver Mills
- The University of Sydney, Camperdown, Sydney, New South Wales, 2006, AUSTRALIA
| | - Sareh Zhand
- University of Technology Sydney, 15 Broadway, Sydney, New South Wales, 2007, AUSTRALIA
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering, University of Technology Sydney, 15 Broadway, Sydney, New South Wales, 2007, AUSTRALIA
| | | | - Maliheh Ghadiri
- The University of Sydney, Camperdown, Sydney, New South Wales, 2006, AUSTRALIA
| | - Majid Ebrahimi Warkiani
- School of Biomedical Engineering, University of Technology Sydney Faculty of Engineering and Information Technology, 15 Broadway, Sydney, New South Wales, 2007, AUSTRALIA
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13
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Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients. J Clin Med 2021; 10:jcm10020277. [PMID: 33451164 PMCID: PMC7828672 DOI: 10.3390/jcm10020277] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO2). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade’s activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease’s severity and treatment.
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14
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Nocturnal Continuous Positive Airway Pressure (nCPAP) Decreases High-Sensitivity C-Reactive Protein (hs-CRP) in Obstructive Sleep Apnea-Hypopnea Syndrome. SLEEP DISORDERS 2020; 2020:8913247. [PMID: 33204538 PMCID: PMC7652622 DOI: 10.1155/2020/8913247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 01/24/2023]
Abstract
Background Systemic and airway inflammation has recently been linked to obstructive sleep apnea-hypopnea syndrome (OSAHS) and is considered to be a probable risk factor for OSAHS-induced cardiovascular damage. High-sensitivity C-reactive protein (hs-CRP), as an inflammatory mediator, may be useful for the prediction of the risk of cardiovascular disease (CVD) and assessment of nocturnal continuous positive airway pressure (nCPAP) therapy effect in OSAHS patients. Methods A prospective, controlled, cross-sectional study was conducted on 64 consecutive adult subjects with suspected sleep-disordered breathing (SDB). Results OSAHS was confirmed in 43 patients (24 normotensive and 19 hypertensive patients) and ruled out in 21 normotensive subjects (controls). The median plasma level of hs-CRP did not differ significantly between OSAHS patients and controls. It showed an unmarked rise with the severity of OSAHS (p = 0.20) and was not correlated with AHI (p = 0.067; r = 0.28). After adjusting for cervical perimeter (CP), waist-to-hip ratio (WHR), and blood sugar level, hs-CRP level of 1 mg/dL or greater was significantly more often observed in OSAHS patients compared with controls (p = 0.032; OR = 5.60) and was also significantly associated with AHI (p = 0.021). A significant decrease in the median plasma hs-CRP level was observed in CPAP compliant patients (p = 0.006). Of those, only normotensive patients showed a significant decrease in plasma hs-CRP level. In hypertensive ones, however, the hs-CRP level dropped but not significantly. Using a linear regression model, the change in hs-CRP level (Δhs-CRP) following a 6-month-nCPAP therapy was found to positively correlate with the baseline hs-CRP level for both hypertensive (p = 0.02; r = 0.68), and even more normotensive OSAHS patients (p < 0.0001; r = 0.89). Conclusion nCPAP therapy may have a cardiovascular protective effect in OSAHS patients. hs-CRP level would be useful as a valuable predictor of success in OSAHS treatment monitoring.
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15
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Wang Y, Meagher RB, Ambati S, Ma P, Phillips BG. Patients with obstructive sleep apnea have suppressed levels of soluble cytokine receptors involved in neurodegenerative disease, but normal levels with airways therapy. Sleep Breath 2020; 25:1641-1653. [PMID: 33037528 PMCID: PMC8376707 DOI: 10.1007/s11325-020-02205-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/13/2020] [Accepted: 09/26/2020] [Indexed: 12/14/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) results in systemic intermittent hypoxia. By one model, hypoxic stress signaling in OSA patients alters the levels of inflammatory soluble cytokines TNF and IL6, damages the blood brain barrier, and activates microglial targeting of neuronal cell death to increase the risk of neurodegenerative disorders and other diseases. However, it is not yet clear if OSA significantly alters the levels of the soluble isoforms of TNF receptors TNFR1 and TNFR2 and IL6 receptor (IL6R) and co-receptor gp130, which have the potential to modulate TNF and IL6 signaling. Methods Picogram per milliliter levels of the soluble isoforms of these four cytokine receptors were estimated in OSA patients, in OSA patients receiving airways therapy, and in healthy control subjects. Triplicate samples were examined using Bio-Plex fluorescent bead microfluidic technology. The statistical significance of cytokine data was estimated using the nonparametric Wilcoxon rank-sum test. The clustering of these high-dimensional data was visualized using t-distributed stochastic neighbor embedding (t-SNE). Results OSA patients had significant twofold to sevenfold reductions in the soluble serum isoforms of all four cytokine receptors, gp130, IL6R, TNFR1, and TNFR2, as compared with control individuals (p = 1.8 × 10−13 to 4 × 10−8). Relative to untreated OSA patients, airways therapy of OSA patients had significantly higher levels of gp130 (p = 2.8 × 10−13), IL6R (p = 1.1 × 10−9), TNFR1 (p = 2.5 × 10−10), and TNFR2 (p = 5.7 × 10−9), levels indistinguishable from controls (p = 0.29 to 0.95). The data for most airway-treated patients clustered with healthy controls, but the data for a few airway-treated patients clustered with apneic patients. Conclusions Patients with OSA have aberrantly low levels of four soluble cytokine receptors associated with neurodegenerative disease, gp130, IL6R, TNFR1, and TNFR2. Most OSA patients receiving airways therapy have receptor levels indistinguishable from healthy controls, suggesting a chronic intermittent hypoxia may be one of the factors contributing to low receptor levels in untreated OSA patients. Electronic supplementary material The online version of this article (10.1007/s11325-020-02205-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ye Wang
- Department of Statistics, University of Georgia, Athens, GA, 30602, USA
| | - Richard B Meagher
- Department of Genetics, University of Georgia, Athens, GA, 30602, USA.
| | - Suresh Ambati
- Department of Genetics, University of Georgia, Athens, GA, 30602, USA
| | - Ping Ma
- Department of Statistics, University of Georgia, Athens, GA, 30602, USA
| | - Bradley G Phillips
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, 30602, USA.,Clinical and Translational Research Unit, University of Georgia, Athens, GA, 30602, USA
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16
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Shumway C, Curtin K, Taylor S, Sundar KM, Wirostko BM, Ritch R. Association between Obstructive Sleep Apnea and Exfoliation Syndrome: The Utah Project on Exfoliation Syndrome. Ophthalmol Glaucoma 2020; 4:260-267. [PMID: 33007491 DOI: 10.1016/j.ogla.2020.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Exfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, is a systemic disorder with genetic predisposition due to variations in lysyl oxidase-like 1 (LOXL1) function, leading to altered elastin matrices in ocular and systemic tissues. Obstructive sleep apnea (OSA) is a highly prevalent disorder also involving elastic tissue dysfunction and is associated with glaucoma. Because of the similarities between the disorders, we sought to uncover any relationship in the prevalence of these diagnoses. DESIGN Case-control, retrospective cohort study. PARTICIPANTS A cohort of 81 735 patients diagnosed with OSA at ages 50 to 90 years was identified from medical records from 1996 to 2017 in the Utah Population Database. Case subjects were matched to random controls on sex and birth year in a 4:1 ratio. METHODS International Classification of Diseases, Ninth Revision (ICD-9) codes or their Tenth Revision equivalent were used to define a diagnosis of OSA (ICD-9 327.23) and a diagnosis of XFS (ICD-9 365.52 and 366.11). Conditional logistic regression odds ratios (ORs) accounting for individual matching on sex and birth year were used to estimate the risk of XFS in patients with OSA. Models included adjustment for race, obesity, tobacco use, hypertension (HTN), atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD). MAIN OUTCOME MEASURE Whether patients with OSA have an increased risk of diagnosis of XFS compared with controls without OSA. RESULTS There was an increased risk of an XFS diagnosis in patients with OSA compared with non-OSA controls (OR, 1.27; 95% confidence interval [CI], 1.02-1.59; P = 0.03). In a stratification of patients by HTN diagnosis history, patients with OSA and HTN exhibited an increased risk of XFS compared with non-OSA controls with HTN (OR, 2.67; 95% CI, 2.06-3.46; P < 0.0001). CONCLUSIONS Patients with OSA may be at an increased risk of XFS compared with patients without OSA, particularly in patients with a history of HTN.
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Affiliation(s)
- Caleb Shumway
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Karen Curtin
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sam Taylor
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Krishna M Sundar
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbara M Wirostko
- Department of Ophthalmology and Visual Sciences, John Moran Eye Center, University of Utah, Salt Lake City, Utah.
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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17
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Yang H, Engeland CG, King TS, Sawyer AM. The relationship between diurnal variation of cytokines and symptom expression in mild obstructive sleep apnea. J Clin Sleep Med 2020; 16:715-723. [PMID: 32029067 PMCID: PMC7849796 DOI: 10.5664/jcsm.8332] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify the relationship between (1) cytokines and everyday symptoms and (2) cytokine diurnal variation and everyday symptoms in mild obstructive sleep apnea (OSA). METHODS An observational, single-night study of 20 adults with mild to moderate OSA undergoing diagnostic polysomnography. Everyday symptoms included sleepiness measured by Stanford Sleepiness Scale, fatigue and energy levels measured by Lee Fatigue Scale, and cytokine plasma concentrations including interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) measured concurrent with symptoms at presleep (8 pm to 10 pm; time 1) and postsleep (5 am to 6 am; time. 2) Cytokine diurnal variation was calculated as [time 2 - time 1]. Wilcoxon signed-rank tests and Spearman partial rank correlations adjusted for age, body mass index, cardiovascular disease, and type 2 diabetes were used. RESULTS Twenty patients (50% male, obese, median age = 51.0 years) with mild OSA (apnea-hypopnea index, AHI; median 9.5 events/h) were evaluated. Evening IL-6 was associated with evening symptoms, including sleepiness (r = .69, P = .002) and energy level (r = -0.68, P = .003); morning IL-8 (r = .73, P = .001), and TNF-α (r = .59, P = .015) were associated with morning fatigue. Only morning IL-8 (r = -0.57, P = .022) and diurnal variations in IL-8 (r = -0.60, P = .014) were associated with morning energy level. CONCLUSION There is scant evidence addressing the diurnal variation of inflammatory biomarkers and the relationship with symptom expression in mild OSA. The present findings provide preliminary mechanistic findings for symptom expression in OSA and contribute insight to mild OSA symptom phenotypes.
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Affiliation(s)
- Hyunju Yang
- Chonnam National University, College of Nursing, Gwangju, South Korea
| | - Christopher G. Engeland
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, Pennsylvania
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania
| | - Tonya S. King
- The Pennsylvania State University, College of Medicine, Department of Public Health Sciences, Hershey, Pennsylvania
| | - Amy M. Sawyer
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Perelman School of Medicine, Center for Sleep & Circadian Neurobiology, Philadelphia, Pennsylvania
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Alterations in Serum Adropin, Adiponectin, and Proinflammatory Cytokine Levels in OSAS. Can Respir J 2020; 2020:2571283. [PMID: 32454912 PMCID: PMC7225856 DOI: 10.1155/2020/2571283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 01/12/2023] Open
Abstract
Objective The present study was planned to examine the relationships between obstructive sleep apnea syndrome (OSAS) and the newly revealed adipokines adropin and adiponectin concentrations that display significant metabolic and cardiovascular functions and the levels of proinflammatory cytokine levels. Method A total of 166 overweight and obese male patients with a body mass index (BMI) >27 kg/m2 were included in the study. Among study participants, 84 were recently diagnosed with OSAS by polysomnography with an apnea-hypopnea index (AHI) ≥5, and 82 were nonapneic with normal polysomnography (AHI<5) findings. The serum adropin and adiponectin levels of all cases were analyzed via the enzyme-linked immunosorbent assay method. Serum interleukin-1 (IL-1) beta and tumor necrotizing factor-alpha (TNF-alpha) levels were determined using Luminex cytokine multiplex analyses. Results The mean age of the OSAS patients was 50.9 ± 5.7 years and BMI was 32.4 ± 6.0 kg/m2, and there was no statistically significant difference determined with the control group (49.3 ± 5.8 years and 30.6 ± 5, 6 kg/m2) (p > 0.05). There were no statistically significant differences between the OSAS and control groups concerning total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and glucose levels. Adiponectin was lower in the OSAS group at a statistically significant level in comparison with the control group and was related at a statistically significant level to OSAS intensity. Adropin concentration was determined to be higher in the OSAS group at a statistically significant level in comparison with the control group. Conclusion The results of our study suggest that increased adropin concentration may be an indicator of endothelium dysfunction in OSAS patients. Serum adropin and adiponectin levels may be new bioindicators used for diagnosis and risk assessment in OSAS patients.
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19
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Free Radical Oxidation and Sleep Disorders in Andro- and Menopause (Literature Review). ACTA BIOMEDICA SCIENTIFICA 2020. [DOI: 10.29413/abs.2020-5.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review presents data on changes in the physiology of sleep during reproductive aging. It is noted that insomnia and obstructive sleep apnea syndrome (OSAS) are the main sleep disorders. The results of foreign and domestic studies in the field of free radical oxidation during sleep deprivation in animal models are presented, indicating the dependence of processes on the duration of sleep deprivation. The largest number of studies of free radical processes in a person with somnological pathology was carried out in the study of OSAS. Blood, urine, saliva, condensate of exhaled air can be biomaterial for determining the parameters of free radical oxidation. It was shown that the intensity of oxidative stress depends on the severity of OSAS, as evidenced by the positive correlation of the level of active products of thiobarbituric acid, the products of oxidation of proteins and carbonyl groups with the apnea/hypopnea index, determining the development of not only oxidative, but also carbonyl stress in patients with a severe degree OSAS. Biomarkers such as thioredoxin, malondialdehyde, superoxide dismutase, and reduced iron have shown a more stable relationship between increased oxidative stress and OSA. Despite the results obtained, the question of the association of oxidative stress and hypoxia in OSA remains debatable, which is associated with the opposite results of some studies. Insomnia, which occurs mainly in females, is accompanied by a high level of end products of lipid peroxidation with a decrease in the activity of antioxidants such as paraoxonase, an enzymatic component of the glutathione system. Along with this, menopausal women present low levels of uric acid, which correlates with high scores of the Pittsburgh sleep quality index questionnaire. Recent studies have identified an association between the activity of the «lipoperoxidation – antioxidants» system and the Clock 3111T/C gene polymorphism in menopausal Caucasian women, indicating the protective role of the minor allele.
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Kuvat N, Tanriverdi H, Armutcu F. The relationship between obstructive sleep apnea syndrome and obesity: A new perspective on the pathogenesis in terms of organ crosstalk. CLINICAL RESPIRATORY JOURNAL 2020; 14:595-604. [PMID: 32112481 DOI: 10.1111/crj.13175] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common disorder that has a major impact on public health. The connection between OSAS and obesity is very complex and likely represents an interaction between biological and lifestyle factors. Oxidative stress, inflammation and metabolic dysregulation are both actors involved in the pathogenesis of OSAS and obesity. Also, the current evidence suggests that gut microbiota plays a significant role in the emergence and progression of some metabolic disorders. When the relationship between OSAS and obesity is evaluated extensively, it is understood that they show mutual causality with each other, and that metabolic challenges such as impaired microbiota affect this bidirectional organ interaction, and by ensuing organ injury. OBJECTIVES The aim of this study is to investigate the association between OSAS and obesity, and the effect of "organ crosstalk" on the pathogenesis of the relationship and to contribute to the diagnosis and treatment options in the light of current data. DATA SOURCE We performed an electronic database search including PubMed, EMBASE and Web of Science. We used the following search terms: OSAS, obesity, inflammation, metabolic dysregulation and gut microbiota. CONCLUSION Obesity and OSAS adversely affect many organs and systems. Besides the factors affecting the diagnosis of the OSAS-obesity relationship, mutual organ interactions among the respiratory system, adipose tissue and intestines should not be ignored for prevention and treatment of OSAS and obesity. Comprehensive clinical trials addressing the efficacy and efficiency of current or potential treatments on therapeutic applications in the OSAS-obesity relationship are needed.
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Affiliation(s)
- Nuray Kuvat
- Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Hakan Tanriverdi
- Department of Chest Diseases, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ferah Armutcu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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21
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Comparison of erythrocyte distribution width, mean platelet volume and platelet distribution width in patients with obstructive sleep apnea syndrome. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.622377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Finamore P, Scarlata S, Cardaci V, Incalzi RA. Exhaled Breath Analysis in Obstructive Sleep Apnea Syndrome: A Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E538. [PMID: 31461988 PMCID: PMC6780099 DOI: 10.3390/medicina55090538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) represents an independent risk factor for cardiovascular, metabolic and neurological events. Polysomnography is the gold-standard for the diagnosis, however is expensive and time-consuming and not suitable for widespread use. Breath analysis is an innovative, non-invasive technique, able to provide clinically relevant information about OSAS. This systematic review was aimed to outline available evidence on the role of exhaled breath analysis in OSAS, taking into account the techniques' level of adherence to the recently proposed technical standards. Materials and Methods: Articles reporting original data on exhaled breath analysis in OSAS were identified through a computerized and manual literature search and screened. Duplicate publications, case reports, case series, conference papers, expert opinions, comments, reviews and meta-analysis were excluded. Results: Fractional exhaled Nitric Oxide (FeNO) is higher in OSAS patients than controls, however its absolute value is within reported normal ranges. FeNO association with AHI is controversial, as well as its change after continuous positive airway pressure (C-PAP) therapy. Exhaled breath condensate (EBC) is acid in OSAS, cytokines and oxidative stress markers are elevated, they positively correlate with AHI and normalize after treatment. The analysis of volatile organic compounds (VOCs) by spectrometry or electronic nose is able to discriminate OSAS from healthy controls. The main technical issues regards the dilution of EBC and the lack of external validation in VOCs studies. Conclusions: Exhaled breath analysis has a promising role in the understanding of mechanisms underpinning OSAS and has demonstrated a clinical relevance in identifying individuals affected by the disease, in assessing the response to treatment and, potentially, to monitor patient's adherence to mechanical ventilation. Albeit the majority of the technical standards proposed by the ERS committee have been followed by existing papers, further work is needed to uniform the methodology.
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Affiliation(s)
- Panaiotis Finamore
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Simone Scarlata
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy.
| | - Vittorio Cardaci
- Pulmonary Rehabilitation, IRCCS San Raffaele Pisana, 00166 Rome, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy
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Kerget B, Araz O, Erdem HB, Akgün M. The Frequency of Monocyte Chemoattractant Protein-1 Gene Polymorphism in Obstructive Sleep Apnea Syndrome. Lung 2019; 197:585-592. [PMID: 31388753 DOI: 10.1007/s00408-019-00256-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE In obstructive sleep apnea syndrome (OSAS) many proinflammatory cytokines are released from activated endothelial cells due to repeated decreases in arterial oxygen saturation. Some of these proinflammatory cytokines are involved in the etiology of coronary artery disease (CAD). Although the association between OSAS and CAD is known, risk factors for CAD have not been determined in this patient group. Monocyte chemoattractant protein-1 (MCP-1) is a proinflammatory cytokine that plays a key role in the development of atherosclerosis. In this study, we compared the frequency of MCP1 rs1024610-rs1024611 single-nucleotide polymorphisms (SNPs) in OSAS patients with no comorbidity, OSAS patients with no comorbidity except CAD, and healthy individuals. MATERIAL AND METHODS The study included 301 subjects. Two hundred one patients with OSAS (OSAS only and OSAS + CAD groups) and 100 healthy control subjects underwent polysomnography. MCP1 rs1024610 and rs1024611 mutation frequencies were determined. RESULTS Body mass index, apnea-hypopnea index, triglyceride levels, and mean oxygen desaturation were significantly higher in the OSAS patients than in the healthy population (p < 0.05). In MCP1 rs1024611 SNP analysis, homozygous mutation was significantly more common in the OSAS + CAD group than in the OSAS and control groups (p < 0.001). MCP1 rs1024610 SNP analysis showed no significant differences among the study groups. CONCLUSION OSAS patients with homozygous MCP1 rs1024611 SNP are at higher risk for CAD. The MCP1 rs1024610 SNP was not associated with incidence of CAD. Patients with OSAS and MCP1 rs1024611 homozygous mutation are more susceptible to CAD and early detection and treatment may significantly reduce mortality and morbidity.
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Affiliation(s)
- Buğra Kerget
- Department of Pulmonary Diseases, Health Sciences University Erzurum, Regional Education and Research Hospital, Erzurum, Turkey. .,Pulmonology Department, Health Sciences University Erzurum, Regional Education and Research Hospital, Yakutiye, 25240, Erzurum, Turkey.
| | - Omer Araz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey
| | - Haktan Bağış Erdem
- Medical Genetics Unit, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Metin Akgün
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey
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24
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Borges YG, Cipriano LHC, Aires R, Zovico PVC, Campos FV, de Araújo MTM, Gouvea SA. Oxidative stress and inflammatory profiles in obstructive sleep apnea: are short-term CPAP or aerobic exercise therapies effective? Sleep Breath 2019; 24:541-549. [PMID: 31313021 DOI: 10.1007/s11325-019-01898-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The effects of medium to long-term continuous positive airway pressure (CPAP) or physical activity in decreasing oxidative stress, inflammatory, and cell-free DNA markers in obstructive sleep apnea (OSA) have been explored. Here we evaluate oxidative stress markers (TBARS, AOPP, SOD), proinflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8), anti-inflammatory cytokines (IL-4, IL-10), and cell-free DNA levels before and after 8-week CPAP treatment or moderate-intensity aerobic training in moderate to severe OSA. METHODS Thirty-nine patients diagnosed with OSA were randomly divided into CPAP (N = 18), with or without humidifier, and exercise groups (N = 21). Excessive daytime sleepiness and sleep quality were assessed by the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. Biomarkers for lipid and protein oxidation, pro and anti-inflammatory cytokines, and cell-free DNA were quantified in blood samples, before and after 8 weeks of both treatments. RESULTS After 8 weeks of either CPAP or exercise, no significant differences were observed in the levels of cell-free DNA, oxidative stress, and inflammation markers, except for an increase in AOPP and IL-17A levels in individuals who went through CPAP, which were higher when the CPAP device was used without the humidifier. We have also observed that CPAP significantly decreased the Pittsburgh scores and improved sleep efficiency and hours of sleep, while ESS scores remained unaffected. CONCLUSIONS Short-term treatment for OSA, be it CPAP therapy or moderate-intensity aerobic exercise, was not sufficient to alter either the oxidative stress and inflammatory profiles or the cell-free DNA levels of moderate to severe OSA patients. Short-term CPAP did, however, improve self-reported sleep quality.
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Affiliation(s)
- Ytalo Gonçalves Borges
- Physiological Sciences Graduation Program, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-900, Brazil
| | - Luis Henrique Ceia Cipriano
- Physiological Sciences Graduation Program, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-900, Brazil
| | - Rafaela Aires
- Physiological Sciences Graduation Program, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-900, Brazil
| | - Paulo Vinicios Camuzi Zovico
- Physical Education Graduation Program, Physical Education and Sports Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Fabiana Vasconcelos Campos
- Biochemistry Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Maria Teresa Martins de Araújo
- Physiological Sciences Graduation Program, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-900, Brazil. .,Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, 29040-090, Brazil.
| | - Sonia Alves Gouvea
- Physiological Sciences Graduation Program, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos 1468, Maruípe, Vitória, ES, 29040-900, Brazil
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25
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Tashiro H, Shore SA. Obesity and severe asthma. Allergol Int 2019; 68:135-142. [PMID: 30509734 PMCID: PMC6540088 DOI: 10.1016/j.alit.2018.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022] Open
Abstract
Obesity is an important global health issue for both children and adults. Obesity increases the prevalence and incidence of asthma and also increases the risk for severe asthma. Here we describe the features of severe asthma phenotypes for which obesity is a defining characteristic, including steroid resistance, airway inflammation, and co-morbidities. We also review current concepts regarding the mechanistic basis for the impact of obesity in severe asthma, including possible roles for vitamin D deficiency, systemic inflammation, and the microbiome. Finally, we describe data indicating a role for diet, weight loss, and exercise in the treatment of severe asthma with obesity. Better understanding of the mechanistic basis for the role of obesity in severe asthma could lead to new therapeutic options for this population.
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Affiliation(s)
- Hiroki Tashiro
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie A Shore
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA.
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26
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Huang ZW, Ouyang W, Zhang LJ, Li H, Ye YM, Lin XJ, Xu QZ, Lin L, Chen LD. Association of continuous positive airway pressure with F2-isoprostanes in adults with obstructive sleep apnea: a meta-analysis. Sleep Breath 2019; 23:1115-1122. [PMID: 30729407 DOI: 10.1007/s11325-019-01795-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with increased F2-isoprostanes, a reliable standard biomarker of oxidative stress. Treatment with continuous positive airway pressure (CPAP) is effective for all degrees of OSA. However, it remains unknown whether treatment with CPAP will decrease F2-isoprostanes. A meta-analysis was conducted to determine the effect of CPAP treatment on F2-isoprostanes among patients with OSA. METHODS The PubMed, Embase, Web of Science, and Cochrane library were searched before September, 2018. Eight articles assessing indices of F2-isoprostanes from various body fluids were identified. Pooled standardized mean difference (SMD) and weighted mean difference (WMD) were appropriately calculated through fixed or random effects models after assessing between-study heterogeneity. RESULTS A total of 4 studies with 108 patients were pooled for exhaled breath condensate (EBC) F2-isoprostanes; 3 studies with 93 patients were pooled for serum or plasma F2-isoprostanes; and 3 studies with 102 patients were pooled for urinary F2-isoprostanes. A significant decrease of EBC F2-isoprostanes was observed after CPAP treatment (WMD = 2.652, 95% CI = 0.168 to 5.136, z = 2.09, p = 0.036), as well as serum or plasma F2-isoprostanes and urinary F2-isoprostanes (SMD = 1.072, 95% CI = 0.276 to 1.868, z = 2.64, p = 0.008 and WMD = 85.907, 95% CI = 50.443 to 121.372, z = 4.75, p = 0.000, respectively). CONCLUSIONS This meta-analysis suggested that CPAP therapy was associated with a significant decrease in F2-isoprostanes in patients with OSA.
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Affiliation(s)
- Zhi-Wei Huang
- Department of Otolaryngology, Quanzhou First Hospital Affiliated to Fujian Medical University, Dongjie Road, Licheng District, Quanzhou, 362000, Fujian province, People's Republic of China
| | - Wu Ouyang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Liang-Ji Zhang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Yu-Ming Ye
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Xue-Jun Lin
- Department of Laboratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Qiao-Zhen Xu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Li Lin
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China
| | - Li-Da Chen
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, Fujian province, People's Republic of China. .,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No 20, Chazhong road, Taijiang District, Fuzhou, 350005, Fujian Province, People's Republic of China.
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Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci 2019; 20:ijms20030459. [PMID: 30678164 PMCID: PMC6387387 DOI: 10.3390/ijms20030459] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.
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28
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Abstract
Obstructive sleep apnea (OSA) is common among patients with cardiac rhythm disorders. OSA may contribute to arrhythmias due to acute mechanisms, such as generation of negative intrathoracic pressure during futile efforts to breath, intermittent hypoxia, and surges in sympathetic activity. In addition, OSA may lead to heart remodeling and increases arrhythmia susceptibility. Atrial distension and remodeling, that has been shown to be associated with OSA, is a well-known anatomical substrate for atrial fibrillation (AF). AF is the arrhythmia most commonly described in patients with OSA. Several observational studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) reduces recurrence of AF after electrical cardioversion and catheter ablation. There is also evidence that nocturnal hypoxemia, a hallmark of OSA, predicts sudden cardiac death (SCD) independently of well-established cardiovascular risk factors. Among patients with an implantable cardiac defibrillator, those with OSA have a higher risk of receiving treatment for life-threatening arrhythmias. Nocturnal hypoxemia may also increase vagal tone, which increases susceptibility to bradycardic and conduction rhythm disorders that have also been described in patients with OSA. In conclusion, there are several biological pathways linking OSA and increased cardiac arrhythmogenesis propensity. However, the independent association is derived from observational studies and the direction of the association still needs clarification due to the lack of large clinical trials. This review focuses on the current scientific evidence linking OSA to cardiac rhythm disorders and point out future directions.
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Affiliation(s)
- Glaucylara Reis Geovanini
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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29
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Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation. J Interv Card Electrophysiol 2018; 54:289-297. [PMID: 30415352 DOI: 10.1007/s10840-018-0482-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/30/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) has been recognized as an independent risk factor for the development and progression of atrial fibrillation (AF). We aimed to investigate the changes in heart rate and atrial and ventricular ectopy after continuous positive airway pressure (CPAP) treatment in patients with OSA and AF. METHODS Consecutive patients with AF underwent ambulatory sleep monitoring, and OSA was defined as an Apnea-Hypopnea-Index (AHI) ≥ 5/h. Treated patients completed in-laboratory CPAP titration study. A 24-h ECG Holter was performed at baseline and at 3 and 6 months after CPAP treatment. RESULTS One hundred patients (70% males) with AF were included in the final analysis. OSA was diagnosed in 85% of patients. There were no significant changes in mean 24-h heart rate in patients with paroxysmal or permanent AF at 3 and 6 months of treatment compared to baseline. In patients with paroxysmal AF (n = 29), atrial and ventricular ectopy counts/24 h significantly decreased at 3 months compared to baseline (median (IQR) 351 (2049) to 57 (182), P = 0.002; 68 (105) to 16 (133), P = 0.01 respectively). At 6 months follow-up, the atrial ectopy count/24 h significantly decreased in patients with paroxysmal AF compared to baseline (median (IQR) 351 (2049) to 31 (113), P = 0.016, n = 14). In patients with permanent AF (n = 15), there was a significant reduction in ventricular ectopy count/24 h at 3 months compared to baseline (median (IQR) 100 (1116) to 33 (418), P = 0.02). CONCLUSIONS There is a significant decrease in atrial and ventricular ectopy count/24 h in patients with AF and OSA at 3 and 6 months of CPAP treatment compared to baseline.
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30
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van 't Erve TJ. Strategies to decrease oxidative stress biomarker levels in human medical conditions: A meta-analysis on 8-iso-prostaglandin F 2α. Redox Biol 2018; 17:284-296. [PMID: 29775960 PMCID: PMC6007822 DOI: 10.1016/j.redox.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023] Open
Abstract
The widespread detection of elevated oxidative stress levels in many medical conditions has led to numerous efforts to design interventions to reduce its effects. Efforts have been wide-ranging, from dietary changes to administration of antioxidants, supplements, e.g., omega-3-fatty acids, and many medications. However, there is still no systemic assessment of the efficacy of treatments for oxidative stress reduction across a variety of medical conditions. The goal of this meta-analysis is, by combining multiple studies, to quantitate the change in the levels of the popular oxidative stress biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) after a variety of treatment strategies in human populations. Nearly 350 unique publications with 180 distinct strategies were included in the analysis. For each strategy, the difference between pre- or placebo and post-treatment levels calculated using Hedges' g value of effect. In general, administration of antibiotics, antihyperlipidemic agents, or changes in lifestyle (g = - 0.63, - 0.54, and 0.56) had the largest effect. Administration of supplements, antioxidants, or changes in diet (g = - 0.09, - 0.28, - 0.12) had small quantitative effects. To fully interpret the effectiveness of these treatments, comparisons to the increase in g value for each medical condition is required. For example, antioxidants in populations with coronary artery disease (CAD) reduce the 8-iso-PGF2α levels by g = - 0.34 ± 0.1, which is quantitatively considered a small effect. However, CAD populations, in comparison to healthy populations, have an increase in 8-iso-PGF2α levels by g = 0.38 ± 0.04; therefore, the overall reduction of 8-iso-PGF2α levels is ≈ 90% by this treatment in this specific medical condition. In conclusion, 8-iso-PGF2α levels can be reduced not only by antioxidants but by many other strategies. Not all strategies are equally effective at reducing 8-iso-PGF2α levels. In addition, the effectiveness of any strategy can be assessed only in relation to the medical condition investigated.
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Affiliation(s)
- Thomas J van 't Erve
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, 27709 NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, 27709 NC, USA.
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Li Q, Zheng X. Tumor necrosis factor alpha is a promising circulating biomarker for the development of obstructive sleep apnea syndrome: a meta-analysis. Oncotarget 2018; 8:27616-27626. [PMID: 28187003 PMCID: PMC5432362 DOI: 10.18632/oncotarget.15203] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/27/2017] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a chronic inflammatory disorder. The relationship between tumor necrosis factor alpha (TNF-alpha) and OSAS has been widely evaluated, but the results thus far remain inconclusive. We thereby decided to quantify the changes of TNF-alpha between OSAS patients and controls by a meta-analysis. This study complies with the MOOSE guidelines. Two reviewers independently searched articles and abstracted relevant data. In total, 47 articles (59 studies) were analyzed, including 2857 OSAS patients and 2115 controls. Overall, OSAS patients had a significantly higher level of circulating TNF-alpha than controls (weighted mean difference [WMD]: 9.66 pg/mL, 95% confidence interval [CI]: 8.66 to 11.24, P<0.001), but with significant heterogeneity (I2: 99.7%). After adjusting for potential missing studies, the overall estimate was weakened but still significant (filled WMD: 2.63 pg/mL, 95% CI: 2.56 to 2.70, P<0.001). When studies were stratified by OSAS severity, the changes in circulating TNF-alpha between patients and controls increased gradually with the more severe grades of OSAS. In patients with mild, mild-to-moderate, moderate, moderate-to-severe and severe OSAS, circulating TNF-alpha was higher than respective controls by 0.99, 1.48. 7.79, 10.08 and 8.85 pg/mL, with significant heterogeneity (I2: 91.2%, 74.5%, 97.6%, 99.0% and 98.1%). In conclusion, our findings demonstrated that circulating TNF-alpha was significantly higher in OSAS patients than in controls, and this difference became more pronounced with the more severe grades of OSAS, indicating that TNF-alpha might be a promising circulating biomarker for the development of OSAS.
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Affiliation(s)
- Qingsheng Li
- Department of Emergency Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin Zheng
- Department of Basic Medicine, Fujian Health Collage, Fuzhou, China
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32
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Rogers L. Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma. Immunol Allergy Clin North Am 2017; 36:461-71. [PMID: 27401619 DOI: 10.1016/j.iac.2016.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastroesophageal reflux and obstructive sleep apnea syndrome are conditions that practitioners have been encouraged to evaluate and treat as part of a comprehensive approach to achieving asthma control. In this review, the author looks at the evidence linking these two conditions as factors that may impact difficult-to-control asthma and looks critically at the evidence suggesting that evaluation and treatment of these conditions when present impacts asthma control.
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Affiliation(s)
- Linda Rogers
- Department of Medicine, Mount Sinai-National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA.
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Bikov A, Losonczy G, Kunos L. Role of lung volume and airway inflammation in obstructive sleep apnea. Respir Investig 2017; 55:326-333. [PMID: 29153412 DOI: 10.1016/j.resinv.2017.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/06/2017] [Accepted: 08/23/2017] [Indexed: 06/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a prevalent disorder that affects not only the upper airways but also the intrathoracic airways. In this review, we summarize the results of studies on lung function and airway inflammation. We provide evidence that the alterations in intrathoracic airways observed in OSA are not purely consequences of mechanical trauma and oxidative stress during apneic events but have a causal role in the structural changes associated with OSA and increasing severity of this disorder.
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Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
| | - Gyorgy Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
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34
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Xu Q, Du J, Ling X, Lu Y. Evaluation of MIh Scoring System in Diagnosis of Obstructive Sleep Apnea Syndrome. Med Sci Monit 2017; 23:4715-4722. [PMID: 28966342 PMCID: PMC5635950 DOI: 10.12659/msm.904087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background The objective of the present study was to investigate whether the analysis of magnesium (Mg), high-sensitivity C-reactive protein (hsCRP), and ischemia-modified albumin (IMA) concentrations can be used as a non-invasive and convenient method for diagnosing obstructive sleep apnea syndrome (OSAS). Material/Methods After polysomnography, venous blood was collected from 33 patients with OSAS and 30 control individuals. Serum levels of Mg, hsCRP, and IMA were investigated. The relationship between these factors and apnea–hypopnea index (AHI) was analyzed using the Pearson correlation coefficient. The role of the factors was determined using a receiver operating characteristic (ROC) curve and multivariate logistic regression analysis. Results The levels of hsCRP and IMA were significantly higher in patients with OSAS than in control subjects, while the levels of Mg were lower (P<0.05 for all). A significant correlation was noted between serum IMA (r=0.614; P<0.001) and hsCRP (r=0.453; P<0.001) levels and the AHI. The ROC showed that serum Mg (AUC=0.74(0.62–0.85)), hsCRP (AUC=0.77(0.65–0.87)), and IMA (AUC=0.78(0.66–0.87)) levels could be used as markers to diagnose OSAS. Moreover, our new model, MIh, which is obtained by multivariate analysis, yielded an AUC value of 0.93 (0.83–0.98). Continuous positive airway pressure (CPAP) treatment reversed the changes in the serum levels of Mg, hsCRP, and IMA. Conclusions Patients with OSAS show reduced serum Mg levels and elevated serum hsCRP and IMA levels. These observed alterations can be reversed by CPAP treatment. A novel model, named MIh, may be a promising tool for OSAS diagnosis.
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Affiliation(s)
- Qinxing Xu
- Department of Respiratory Medicine, Hangzhou Fuyang First People's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Junwei Du
- Department of Respiratory Medicine, Hangzhou Fuyang First People's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xiaobo Ling
- Department of Respiratory Medicine, Hangzhou Fuyang First People's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Yangfei Lu
- Department of Respiratory Medicine, Hangzhou Fuyang First People's Hospital, Hangzhou, Zhejiang, China (mainland)
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Ren H, Hu K. Inflammatory and oxidative stress‑associated factors in chronic intermittent hypoxia in Chinese patients, rats, lymphocytes and endotheliocytes. Mol Med Rep 2017; 16:8092-8102. [PMID: 28983603 PMCID: PMC5779894 DOI: 10.3892/mmr.2017.7632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/05/2017] [Indexed: 01/08/2023] Open
Abstract
In order to investigate the association between inflammatory and oxidative stress (OS)-associated factors in chronic intermittent hypoxia (CIH), 238 CIH patients and 156 healthy volunteers were included. CIH rat and lymphocytes were used as experimental models. Interleukin (IL)-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), nitric oxide (NO) and nitric oxide synthase (NOS) were analyzed. Patients with CIH were older, with hypertension, increased heart rate (HR) and body mass index (BMI), and there were more males than females. Those with a history of smoking or type 2 diabetes (T2DM) history exhibited an increased risk of CIH. Serum IL-6, TNF-α and CRP in patients with CIH were increased, while NO and NOS were decreased. Hakka patients exhibited increased BMI measurements and NO expression, and decreased systolic arterial pressure, IL-6 and TNF-α compared with non-Hakka patients. Rats with CIH exhibited hypertension and stable weight, less activity and decreased appetite, increased HR and serum IL-6, TNF-α and CRP, and decreased NO and NOS. IL-6, TNF-α, CRP, NO and induced-NOS (iNOS) were increased in the lymphocytes of CIH rats compared with healthy ones. In rat endotheliocytes induced by CIH, IL-6, TNF-α, CRP and iNOS increased, while NO and endothelial-NOS (eNOS) decreased. In the supernatant of co-cultured lymphocytes and endotheliocytes, IL-6, TNF-α and CRP increased, although NO and NOS decreased. In conclusion, age, male gender, BMI, smoking and T2DM history, serum IL-6, TNF-α and CRP were positively correlated with CIH combined with hypertension, while NO and NOS were negatively correlated with CIH. Serum NO was predominantly synthesized and released by eNOS. Hakka patients exhibited decreased inflammation and OS with CIH. Increasing IL-6, TNF-α and CRP, and decreasing NO and NOS are biomarkers of CIH, which could be targets in diagnosis, treatment and prevention of CIH.
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Affiliation(s)
- Hui Ren
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Ke Hu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Schwarz EI, Engler A, Kohler M. Exhaled breath analysis in obstructive sleep apnea. Expert Rev Respir Med 2017; 11:631-639. [DOI: 10.1080/17476348.2017.1338950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Esther I Schwarz
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Anna Engler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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Effect of modern surgical treatment on the inflammatory/anti-inflammatory balance in patients with obstructive sleep apnoea. The Journal of Laryngology & Otology 2017; 131:719-727. [PMID: 28534455 DOI: 10.1017/s0022215117001116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the inflammatory/anti-inflammatory cytokine balance - T helper 1/T helper 2 ratios - in obstructive sleep apnoea patients, before and after treatment. METHODS Twenty-eight patients received continuous positive airway pressure treatment and 29 patients who could not tolerate continuous positive airway pressure were scheduled for surgery. Serum levels of interleukins 2, 4 and 10, tumour necrosis factor-alpha, and interferon gamma were analysed by enzyme-linked immunosorbent assays before and three months after treatment. RESULTS The success rate of surgical treatment was 65.5 per cent. Mean compliance for the continuous positive airway pressure group was 40.9 per cent. The apnoea/hypopnoea index significantly decreased in both groups after treatment (p < 0.001). The interferon gamma/interleukin-4 ratio decreased following surgical treatment (p = 0.014), and the interleukin-2/interleukin-4 ratio decreased after treatment in 57 patients in the overall cohort (p = 0.032). CONCLUSION After treatment for obstructive sleep apnoea, some ratios reflecting T helper 1/T helper 2 cytokine balance favoured the T helper 2 direction, suggesting a shift to an anti-inflammatory state. Successful surgery and better continuous positive airway pressure compliance can help ameliorate inflammation in obstructive sleep apnoea patients, which may reduce associated morbidities.
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Shaker A. Study of obstructive sleep apnea (OSA) in asthmatics. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Objective: To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment. Data Sources: Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms “OSA” and “asthma” as the main keywords. Highly regarded older publications were also included. Study Selection: Information about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized. Results: Both OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome – “alternative overlap syndrome,” and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure. Conclusions: OSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.
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Affiliation(s)
| | - Yi Xiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Chen WS, Chang YS, Chang CC, Chang DM, Chen YH, Tsai CY, Chen JH. Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan. Sleep 2016; 39:1883-1890. [PMID: 27397567 DOI: 10.5665/sleep.6174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/24/2016] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. METHODS This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time-dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. RESULTS Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). CONCLUSIONS Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.
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Affiliation(s)
- Wei-Sheng Chen
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University.,Institute of Clinical Medicine, National Yang Ming University, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chi-Ching Chang
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Deh-Ming Chang
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University.,Institute of Clinical Medicine, National Yang Ming University, Taiwan.,National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Biostatistics Center, College of Management, Taipei Medical University
| | - Chang-Youh Tsai
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University
| | - Jin-Hua Chen
- Biostatistics Center and School of Health Care Administration, College of Management, Taipei Medical University
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Yildirim Z, Bozkurt B, Ozol D, Armutcu F, Akgedik R, Karamanli H, Kizilirmak D, İkizek M. Increased Exhaled 8-Isoprostane and Interleukin-6 in Patients with Helicobacter pylori Infection. Helicobacter 2016; 21:389-94. [PMID: 27061444 DOI: 10.1111/hel.12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection triggers both local inflammation, usually in gastric mucosa, and chronic systemic inflammation. It is assumed that this local and systemic inflammation is caused by extracellular products excreted by H. pylori. The aim of this study was to investigate the possible association between H. pylori infection and a local inflammatory response in the airway by using exhaled breath condensate technique. MATERIALS AND METHODS This study includes 41 H. pylori seropositive patients who have gastric symptoms and 27 healthy control subjects. Pulmonary function tests (PFT), chest X ray, and physical examination were performed in all patients and interleukin-6 (IL-6), 8-isoprostane and nitrotyrosine levels were measured in exhaled breath condensate. RESULTS Levels of IL-6 and 8-isoprostane in exhaled breath condensate (EBC) were significantly higher in H. pylori positive patients than control subjects (p < 0.05). Nitrotyrosine levels were also higher in H. pylori positive patients but the difference was not statistically significant. Both groups had similar leukocyte counts, C-reactive protein (CRP) levels and PFT parameters. CONCLUSION H. pylori infection causes an asymptomatic airway inflammation which can be detected by exhaled breath condensate. The clinical importance of this inflammation remains unclear.
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Affiliation(s)
- Zeki Yildirim
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Bulent Bozkurt
- Department of Pulmonary Medicine, Turgut Ozal University, Ankara, Turkey
| | - Duygu Ozol
- Department of Pulmonary Medicine, Turgut Ozal University, Ankara, Turkey
| | - Ferah Armutcu
- Department of Biochemistry, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Recep Akgedik
- Department of Pulmonary Medicine, Ordu University School of Medicine, Ordu, Turkey
| | - Harun Karamanli
- Department of Pulmonary Medicine, Ataturk Chest Disease and Chest Surgery Research and Education Hospital, Konya, Turkey
| | - Deniz Kizilirmak
- Department of Pulmonary Medicine, Hakkari State Hospital, Hakkari, Turkey
| | - Mustafa İkizek
- Department of Internal Medicine, Tatvan State Hospital, Bitlis, Turkey
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Effect of Continuous Positive Airway Pressure on Airway Inflammation and Oxidative Stress in Patients with Obstructive Sleep Apnea. Can Respir J 2016; 2016:3107324. [PMID: 27445526 PMCID: PMC4944043 DOI: 10.1155/2016/3107324] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 01/02/2023] Open
Abstract
Background. Airway inflammation and oxidative stress may be linked in obstructive sleep apnea (OSA) patients. We determined the effectiveness of continuous positive airway pressure (CPAP) therapy in reducing fractional exhaled nitric oxide (FeNO) and malondialdehyde (MDA) levels in OSA patients. Methods. Thirteen patients with OSA and 13 normal controls were recruited. FeNO and MDA levels were measured in the controls and in OSA patients before and after three months of CPAP therapy. Results. FeNO and MDA levels were higher in the patients compared to the age and gender matched controls (FeNO: 25.9 ± 5.0 versus 17.5 ± 5.9 ppb, P < 0.001; MDA: 14.6 ± 7.8 versus 2.1 ± 0.3 μmol/L, P < 0.001). FeNO and MDA levels were lower post-CPAP compared to pre-CPAP (FeNO: 25.9 ± 5.0 versus 17.0 ± 2.3 ppb, P < 0.001; MDA: 14.6 ± 7.8 versus 10.0 ± 6.4 μmol/L, P < 0.01). Apnea-hypopnea index (15.9 ± 6.6 versus 4.1 ± 2.1/h, P < 0.001) and mean arterial pressure (P < 0.01) decreased following CPAP treatment. Daytime mean SpO2 (P < 0.05) increased. Conclusion. Our study demonstrates that CPAP therapy yields clinical benefits by reducing upper airway inflammation and oxidative stress in OSA patients.
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Yang CH, Shen YJ, Lai CJ, Kou YR. Inflammatory Role of ROS-Sensitive AMP-Activated Protein Kinase in the Hypersensitivity of Lung Vagal C Fibers Induced by Intermittent Hypoxia in Rats. Front Physiol 2016; 7:263. [PMID: 27445853 PMCID: PMC4922301 DOI: 10.3389/fphys.2016.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA), manifested by airway exposure to intermittent hypoxia (IH), is associated with excess reactive oxygen species (ROS) production in airways, airway inflammation, and hyperreactive airway diseases. The cause-effect relationship for these events remains unclear. We investigated the inflammatory role of ROS-sensitive AMP-activated protein kinase (AMPK) in IH-induced airway hypersensitivity mediated by lung vagal C fibers (LVCFs) in rats. Conscious rats were exposed to room air (RA) or IH with or without treatment with N-acetyl-L-cysteine (NAC, an antioxidant), Compound C (an AMPK inhibitor), ibuprofen (a cyclooxygenase inhibitor), or their vehicles. Immediately after exposure (24 h), we found that intravenous capsaicin, phenylbiguanide, or α,β-methylene-ATP evoked augmented LVCF-mediated apneic responses and LVCF afferent responses in rats subjected to IH exposure in comparison with those in RA rats. The potentiating effect of IH on LVCF responses decreased at 6 h after and vanished at 12 h after the termination of IH exposure. The potentiating effect of IH on LVCF-mediated apneic and LVCF afferent responses was significantly attenuated by treatment with NAC, compound C, or ibuprofen, but not by their vehicles. Further biochemical analysis revealed that rats exposed to IH displayed increased lung levels of lipid peroxidation (an index of oxidative stress), AMPK phosphorylation (an index of AMPK activation), and prostaglandin E2 (a cyclooxygenase metabolite), compared with those exposed to RA. IH-induced increase in lipid peroxidation was considerably suppressed by treatment with NAC but not by compound C or ibuprofen. IH-induced increase in AMPK phosphorylation was totally abolished by NAC or compound C but not by ibuprofen. IH-induced increase in prostaglandin E2 was considerably prevented by any of these three inhibitor treatments. The vehicles of these inhibitors exerted no significant effect on the three IH-induced responses. These results suggest that 24-h IH exposure sensitizes LVCFs, leading to an exaggerated reflex and afferent responses to chemical stimulants in rats. Moreover, this IH-induced LVCF sensitization is mediated through a cascade of inflammatory responses in the airways involving increases in ROS, AMPK activation, and cyclooxygenase metabolite release.
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Affiliation(s)
- Chang-Huan Yang
- Institute of Physiology, School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Yan-Jhih Shen
- Department of Pharmacology and Toxicology, School of Medicine, Tzu Chi University Hualien, Taiwan
| | - Ching Jung Lai
- Department of Physiology, Tzu Chi University Hualien, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, School of Medicine, National Yang-Ming University Taipei, Taiwan
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Bikov A, Hull JH, Kunos L. Exhaled breath analysis, a simple tool to study the pathophysiology of obstructive sleep apnoea. Sleep Med Rev 2016; 27:1-8. [DOI: 10.1016/j.smrv.2015.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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Snoring as a Determinant Factor of Oxidative Stress in the Airway of Patients with Obstructive Sleep Apnea. Lung 2016; 194:469-73. [PMID: 27048175 DOI: 10.1007/s00408-016-9869-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/21/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE In obstructive sleep apnea-hypopnea syndrome (OSAS), airway collapses and vibrations cause local and systemic inflammatory response and oxidative stress (OS). Our objective was to determine the presence of OS in the airway of patients with OSAS compared with controls without OSAS and determine its relation to treatment with CPAP and other clinical variables. METHOD We performed a prospective observational case-control study with repeated measures. We recruited consecutive patients with SAHS diagnosed using complete polysomnography, and a parallel control group. We collected a sample of exhaled breath condensate (EBC) prior to nasal continuous positive airway pressure (CPAP) treatment and again after 4 months. The marker of OS used was 8-isoprostane (8-IPN). The variables analyzed were age, sex, anthropometric variables, apnea-hypopnea index (AHI), snoring, oxygenation, and polysomnographic variables. RESULTS The study included 20 patients and 10 controls. In cases, the initial value of 8-IPN was 6.8 (1.9), and after nasal CPAP, it was 5.3 (1.2) pg/ml (p = 0.02). In controls, the value of 8-IPN was 5.6 (1.1) pg/ml (p = 0.04 compared to initial values). 8-IPN showed significant correlation with snoring, AHI, BMI, nocturnal desaturation index, and non-REM sleep. On multivariate analysis, only snoring was a significant predictor of 8-IPN. CONCLUSIONS Snoring, and not OSAS severity, could be the phenomenon underlying the presence of local OS measured in the airway of patients with OSAS.
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Linz D, Linz B, Hohl M, Böhm M. Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications. Sleep Med Rev 2016; 26:87-94. [DOI: 10.1016/j.smrv.2015.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Roles of interleukin (IL)-6 gene polymorphisms, serum IL-6 levels, and treatment in obstructive sleep apnea: a meta-analysis. Sleep Breath 2015; 20:719-31. [DOI: 10.1007/s11325-015-1288-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/21/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022]
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Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia – Revisited – The bad ugly and good: Implications to the heart and brain. Sleep Med Rev 2015; 20:27-45. [DOI: 10.1016/j.smrv.2014.07.003] [Citation(s) in RCA: 289] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 12/14/2022]
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49
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What can blood biomarkers tell us about cardiovascular risk in obstructive sleep apnea? Sleep Breath 2015; 19:755-68. [DOI: 10.1007/s11325-015-1143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/01/2015] [Accepted: 02/08/2015] [Indexed: 12/31/2022]
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50
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Jeong JI, Kim SJ, Hong SD, Chung SK, Dhong HJ, Kim HY. Differences of Short-Term Systemic Responses in Obstructive Sleep Apnea Patient by Compliance of Continuous Positive Airway Pressure. JOURNAL OF RHINOLOGY 2015. [DOI: 10.18787/jr.2015.22.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jong In Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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