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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne) 2024; 15:1349794. [PMID: 38765954 PMCID: PMC11099266 DOI: 10.3389/fendo.2024.1349794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.
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Affiliation(s)
- Valeria Guglielmi
- Unit of Internal Medicine and Obesity Center, Department of Systems Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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3
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Hwang JS, Hwang IC, Ahn HY. The snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-BANG) score and kidney function in a general population. J Nephrol 2024; 37:1129-1131. [PMID: 38206474 DOI: 10.1007/s40620-023-01854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Ju Sam Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
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Liu M, Heizhati M, Li N, Lin M, Gan L, Zhu Q, Cai L, Yuan Y, Yao L, Li M, Li X, Aierken X, Wang H, Maitituersun A, Hong J, Luo Q. The relationship between obstructive sleep apnea and risk of renal impairment in patients with hypertension, a longitudinal study. Sleep Med 2023; 109:18-24. [PMID: 37393718 DOI: 10.1016/j.sleep.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Association of obstructive sleep apnea (OSA) with renal damage is undetermined, especially in the population with hypertension, a high-risk group for chronic kidney disease. Therefore, we aimed to explore whether OSA is an independent risk factor for renal impairment in patients with hypertension, by considering the effects of gender, age, obesity and OSA severity. METHODS The longitudinal observational study included patients with hypertension and suspected OSA without renal damage at baseline who visited Hypertension Center between January 2011 and December 2018, and followed up till renal outcomes, death, loss to follow-up, or May 31, 2022, using annual health check-ups, hospital readmission or out-patient visits. Main renal outcome was chronic kidney disease (CKD), defined as estimated glomerular filtration rate <60 ml/min per 1.73 m2 and/or positive proteinuria. Cox proportional hazard models were used to evaluate the association, and repeated after propensity score matching. Sensitivity analysis were performed by excluding those with primary aldosteronism. RESULTS 7961 patients with hypertension were included with 5022 ones with OSA, and 82% were followed up. During median follow-up of 3.42 years, 1486 patients developed CKD. Per 1000 person-year incidence of CKD was 56.72 in OSA group. In Cox regression analysis, OSA and severe OSA group respectively showed 1.21 (95% CI: 1.08-1.35) and 1.27 (95% CI: 1.09-1.47) fold risk for CKD in total, compared with non-OSA group. Overall results remained consistent in propensity score matching and sensitivity analysis. CONCLUSION OSA is independently associated with higher risk of chronic kidney disease in hypertension.
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Affiliation(s)
- Miaomiao Liu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China.
| | - Mengyue Lin
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Lin Gan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Qing Zhu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Li Cai
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Yujuan Yuan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Xiufang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Xiayire Aierken
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Hui Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Adalaiti Maitituersun
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Qin Luo
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region, Hypertension Research Laboratory, Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
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Lin M, Heizhati M, Gan L, Yao L, Yang W, Li M, Hong J, Wu Z, Wang H, Li N. Development and Validation of a Prediction Model for 5-Year Risk of Kidney Dysfunction in Patients with Hypertension and Glucose Metabolism Disorder. Risk Manag Healthc Policy 2022; 15:289-298. [PMID: 35221736 PMCID: PMC8880707 DOI: 10.2147/rmhp.s345059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Patients with hypertension and glucose metabolism disorder (GMD) are at high risk of developing kidney dysfunction (KD). Therefore, we aimed to develop a nomogram for predicting individuals’ 5-year risk of KD in hypertensives with GMD. Patients and Methods In total, 1961 hypertensives with GMD were consecutively included. Baseline data were extracted from medical electronic system, and follow-up data were obtained using annual health check-ups or hospital readmission. KD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Subjects were randomly divided into training and validation sets with a ratio of 7 to 3. Least absolute shrinkage and selection operator method was used to identify potential predictors. Cox proportional hazard model was applied to build a nomogram for predicting KD risk. The discriminative ability, calibration and usefulness of the model were evaluated. The prediction model was verified by internal validation. Results During the follow-up of 5351 person-years with a median follow-up of 32 (range: 3–91) months, 130 patients developed KD. Age, sex, ethnicity, hemoglobin A1c, uric acid, and baseline eGFR were identified as significant predictors for incident KD and used for establishing nomogram. The prediction model displayed good discrimination with C-index of 0.770 (95% CI: 0.712–0.828) and 0.763 (95% CI: 0.704–0.823) in training and validation sets, respectively. Calibration curve indicated good agreement between the predicted and actual probabilities. The decision curve analysis demonstrated that the model was clinically useful. Conclusion The prediction nomogram, including six common easy-to-obtain factors, shows good performance for predicting 5-year risk of KD in hypertensives with GMD. This quantitative tool could help clinicians, and even primary care providers, recognize potential KD patients early and make strategy for prevention and management.
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Affiliation(s)
- Mengyue Lin
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Mulalibieke Heizhati
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Lin Gan
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Ling Yao
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Wenbo Yang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Mei Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Jing Hong
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Zihao Wu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
| | - Hui Wang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
- Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Nanfang Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute; National Health Committee Key Laboratory of Hypertension Clinical Research; Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, People’s Republic of China
- Correspondence: Nanfang Li, Email
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Beaudin AE, Raneri JK, Ahmed SB, Hirsch Allen AJM, Nocon A, Gomes T, Gakwaya S, Series F, Kimoff J, Skomro RP, Ayas NT, Hanly PJ. Risk of chronic kidney disease in patients with obstructive sleep apnea. Sleep 2021; 45:6425062. [PMID: 34757390 DOI: 10.1093/sleep/zsab267] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Chronic kidney disease (CKD) is a global health concern and a major risk factor for cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) may exacerbate this risk by contributing to the development of CKD. This study investigated the prevalence and patient awareness of the risk of CKD progression in individuals with OSA. METHODS Adults referred to five Canadian academic sleep centers for suspected OSA completed a questionnaire, a home sleep apnea test or in-lab polysomnography and provided blood and urine samples for measurement of estimated glomerular filtration rate (eGFR) and the albumin:creatinine ratio (ACR), respectively. The risk of CKD progression was estimated from a heat map incorporating both eGFR and ACR. RESULTS 1295 adults (42% female, 54±13y) were categorized based on the oxygen desaturation index (4% desaturation): <15 (no/mild OSA, n=552), 15-30 (moderate OSA, n=322), and >30 (severe OSA, n=421). After stratification, 13.6% of the no/mild OSA group, 28.9% of the moderate OSA group, and 30.9% of the severe OSA group had a moderate-to-very high risk of CKD progression (p<0.001), which was defined as an eGFR < 60 mL/min/1.73m2, an ACR ≥3 mg/mmol, or both. Compared to those with no/mild OSA, the odds ratio for moderate-to-very high risk of CKD progression was 2.63 (95% CI: 1.79-3.85) for moderate OSA and 2.96 (2.04-4.30) for severe OSA after adjustment for CKD risk factors. Among patients at increased risk of CKD progression, 73% were unaware they had abnormal kidney function. CONCLUSION Patients with moderate and severe OSA have an increased risk of CKD progression independent of other CKD risk factors; most patients are unaware of this increased risk.
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Affiliation(s)
- Andrew E Beaudin
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jill K Raneri
- Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, , Canada.,Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, , Canada
| | - A J Marcus Hirsch Allen
- Department of Medicine, Respiratory and Critical Care Division, University of British Columbia, Vancouver, BC, Canada
| | - Andrhea Nocon
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Teresa Gomes
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Simon Gakwaya
- Unité de recherche en pneumologie, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Fréderic Series
- Unité de recherche en pneumologie, Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Robert P Skomro
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Najib T Ayas
- Department of Medicine, Respiratory and Critical Care Division, University of British Columbia, Vancouver, BC, Canada
| | - Patrick J Hanly
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, , Canada
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7
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Voulgaris A, Bonsignore MR, Schiza S, Marrone O, Steiropoulos P. Is kidney a new organ target in patients with obstructive sleep apnea? Research priorities in a rapidly evolving field. Sleep Med 2021; 86:56-67. [PMID: 34474225 DOI: 10.1016/j.sleep.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
The bidirectional relationship between sleep disordered breathing and chronic kidney disease (CKD) has recently gained a lot of interest. Several lines of evidence suggest the high prevalence of coexistent obstructive sleep apnea (OSA) in patients with CKD and end-stage renal disease (ESRD). In addition, OSA seems to result in loss of kidney function in some patients, especially in those with cardio-metabolic comorbidities. Treatment of CKD/ESRD and OSA can alter the natural history of each other; still better phenotyping with selection of appropriate treatment approaches is urgently needed. The aim of this narrative review is to provide an update of recent studies on epidemiological associations, pathophysiological interactions, and management of patients with OSA and CKD or ESRD.
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Affiliation(s)
- Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy; Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Department, University of Palermo, and IRIB, National Research Council (CNR), Palermo, Italy
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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8
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Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis. Adv Ther 2021; 38:4195-4214. [PMID: 34273093 PMCID: PMC8342338 DOI: 10.1007/s12325-021-01791-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.
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9
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Fitzpatrick J, Kerns ES, Kim ED, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS, Bourjeily G. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in incident hemodialysis patients. J Clin Sleep Med 2021; 17:1707-1715. [PMID: 33779539 DOI: 10.5664/jcsm.9304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with end-stage kidney disease (ESKD) commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in hemodialysis patients, but the burden of symptoms from sleep disturbances has emerged as a marker that may shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary CV outcomes or mortality among adults initiating hemodialysis. METHODS In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular risk in ESRD (PACE) study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary CV outcomes included QTc [ms], heart rate variance [ms²], left ventricular mass index [g/m², LVMI], and left ventricular hypertrophy [LVH]. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, median BMI was 28 kg/m² (IQR 24,33), with 70% African Americans. Median FOSQ-10 score was 19.7 (IQR: 17.1,20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (HR 1.09, 95%CI 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTc duration and lower heart rate variance, but not LVMI or LVH. CONCLUSIONS In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in ESKD patients to identify individuals at increased risk for cardiovascular complications and death.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric S Kerns
- Lahey Hospital and Medical Center, Burlington, MA
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, OR
| | | | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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10
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Jackson CL, Umesi C, Gaston SA, Azarbarzin A, Lunyera J, McGrath JA, Jackson Ii WB, Diamantidis CJ, Boulware E, Lutsey PL, Redline S. Multiple, objectively measured sleep dimensions including hypoxic burden and chronic kidney disease: findings from the Multi-Ethnic Study of Atherosclerosis. Thorax 2020; 76:704-713. [PMID: 33277428 DOI: 10.1136/thoraxjnl-2020-214713] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Poor sleep may contribute to chronic kidney disease (CKD) through several pathways, including hypoxia-induced systemic and intraglomerular pressure, inflammation, oxidative stress and endothelial dysfunction. However, few studies have investigated the association between multiple objectively measured sleep dimensions and CKD. METHODS We investigated the cross-sectional association between sleep dimensions and CKD among 1895 Multi-Ethnic Study of Atherosclerosis Sleep Ancillary Study participants who completed in-home polysomnography, wrist actigraphy and a sleep questionnaire. Using Poisson regression models with robust variance, we estimated separate prevalence ratios (PR) and 95% CIs for moderate-to-severe CKD (glomerular filtration rate <60 mL/min/1.73 m2 or albuminuria >30 mg/g) among participants according to multiple sleep dimensions, including very short (≤5 hours) sleep, Apnoea-Hypopnoea Index and sleep apnoea-specific hypoxic burden (SASHB) (total area under the respiratory event-related desaturation curve divided by total sleep duration, %min/hour)). Regression models were adjusted for sociodemographic characteristics, health behaviours and clinical characteristics. RESULTS Of the 1895 participants, mean age was 68.2±9.1 years, 54% were women, 37% were white, 28% black, 24% Hispanic/Latino and 11% Asian. Several sleep metrics were associated with higher adjusted PR of moderate-to-severe CKD: very short versus recommended sleep duration (PR=1.40, 95% CI 1.06 to 1.83); SASHB (Box-Cox transformed SASHB: PR=1.06, 95% CI 1.02 to 1.12); and for participants in the highest quintile of SASHB plus sleep apnoea: PR=1.28, 95% CI 1.01 to 1.63. CONCLUSIONS Sleep apnoea associated hypoxia and very short sleep, likely representing independent biological mechanisms, were associated with a higher moderate-to-severe CKD prevalence, which highlights the potential role for novel interventions.
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Affiliation(s)
- Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA .,Intramural Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Chizoba Umesi
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Ali Azarbarzin
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Lunyera
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - John A McGrath
- Social & Scientific Systems Inc, Durham, North Carolina, USA
| | | | - Clarissa J Diamantidis
- Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ebony Boulware
- Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pamela L Lutsey
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Division of Pulmonary Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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11
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Umbro I, Fabiani V, Fabiani M, Angelico F, Del Ben M. A systematic review on the association between obstructive sleep apnea and chronic kidney disease. Sleep Med Rev 2020; 53:101337. [PMID: 32629235 DOI: 10.1016/j.smrv.2020.101337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
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12
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Sivam S, Yee BJ, Chadban SJ, Piper AJ, Hanly PJ, Wang D, Wong KK, Grunstein RR. Prevalence of chronic kidney disease in obesity hypoventilation syndrome and obstructive sleep apnoea with severe obesity. Sleep Med 2020; 74:73-77. [DOI: 10.1016/j.sleep.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/28/2023]
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13
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Rana D, Torrilus C, Ahmad W, Okam NA, Fatima T, Jahan N. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus 2020; 12:e10424. [PMID: 32953361 PMCID: PMC7494423 DOI: 10.7759/cureus.10424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/13/2020] [Indexed: 12/25/2022] Open
Abstract
In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. OSA can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.
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Affiliation(s)
- Dibyata Rana
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chenet Torrilus
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wiqas Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nkechi A Okam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tehreem Fatima
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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14
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Abstract
Abstract
Purpose of Review
There are some uncertainties about the interactions between obstructive sleep apnea (OSA) and chronic kidney disease (CKD). We critically reviewed recent studies on this topic with a focus on experimental and clinical evidence of bidirectional influences between OSA and CKD, as well as the effects of treatment of either disease.
Recent Findings
Experimental intermittent hypoxia endangers the kidneys, possibly through activation of inflammatory pathways and increased blood pressure. In humans, severe OSA can independently decrease kidney function. Treatment of OSA by CPAP tends to blunt kidney function decline over time, although its effect may vary. OSA may increase cardiovascular complications and mortality in patients with end-stage renal disease (ESRD), while it seems of little harm after renal transplantation. Excessive fluid removal may explain some of the improvements in OSA severity in ESRD and after transplantation.
Summary
Severe OSA and CKD do interact negatively, mainly through hypoxia and fluid retention. The moderate mutually interactive benefits that treatment of each disease exerts on the other one warrant further studies to improve patient management.
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15
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Chang W, Han Y, Song X, Liu Y, Zhang W, Hao J, Chen JB. Relationship between trajectory of sleep quality and short-term changes in residual renal function in stage 3–5 chronic kidney disease patients. Clin Exp Nephrol 2020; 24:557-564. [DOI: 10.1007/s10157-020-01868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
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16
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Chuang LP, Lin SW, Chen NH. Author Response. J Clin Sleep Med 2020; 15:1697-1698. [PMID: 31739864 DOI: 10.5664/jcsm.8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Li-Pang Chuang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ning-Hung Chen
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
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17
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Lin CH, Lurie RC, Lyons OD. Sleep Apnea and Chronic Kidney Disease. Chest 2020; 157:673-685. [DOI: 10.1016/j.chest.2019.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 12/20/2022] Open
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18
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Somkearti P, Chattakul P, Khamsai S, Limpawattana P, Chindaprasirt J, Chotmongkol V, Sawanyawisuth K. Predictors of chronic kidney disease in obstructive sleep apnea patients. Multidiscip Respir Med 2020; 15:470. [PMID: 32153778 PMCID: PMC7037503 DOI: 10.4081/mrm.2020.470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD. Objective This study aimed to identifying the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients. Methods This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA via polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing ≥5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis. Results During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m2, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 vs 135 mmHg), proportion of patients with diabetes (55% vs 34%), and proportion of patients with Mallampati scores of 3-4 (73% vs 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.750), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi-square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively. Conclusions Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.
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Affiliation(s)
- Phunphai Somkearti
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Paiboon Chattakul
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Panita Limpawattana
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Jarin Chindaprasirt
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Verajit Chotmongkol
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
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19
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Wu J, Chu Y, Jiang Z, Yu Q. Losartan protects against intermittent hypoxia-induced peritubular capillary loss by modulating the renal renin-angiotensin system and angiogenesis factors. Acta Biochim Biophys Sin (Shanghai) 2020; 52:38-48. [PMID: 31836883 DOI: 10.1093/abbs/gmz136] [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: 03/10/2019] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea is characterized by chronic intermittent hypoxia (CIH), which is a risk factor for renal peritubular capillary (PTC) loss, and angiotensin II receptor blockers can alleviate PTC loss. However, the mechanism by which losartan (an angiotensin II receptor blocker) reduces CIH-induced PTC loss and attenuates kidney damage is still unknown. Thus, in this study, we examined the protective effects of losartan against CIH-induced PTC loss and explored the underlying mechanisms in rat CIH model. The immunohistochemical staining of CD34 and morphological examination showed that CIH reduced PTC density and damaged tubular epithelial cells. Immunohistochemistry, enzyme-linked immunosorbent assay (ELISA), real-time quantitative PCR, and western blot analysis results revealed that CIH increased the expression of hypoxia inducible factor-1α (HIF-1α), angiotensin II (Ang II), angiotensin II type 1 receptor (AT1R), pro-angiogenesis factor vascular endothelial growth factor (VEGF), and anti-angiogenesis factor thrombospondin-1 (TSP-1) in the renal cortex of rats. CIH may up-regulate VEGF expression and simultaneously increase TSP-1 production. By histopathological, immunohistochemistry, ELISA, RT-qPCR, and western blot analysis, we found that the expressions of renal renin-angiotensin system (RAS), HIF-1α, VEGF, and TSP-1 were decreased, and PTC loss and tubular epithelial cell injury were attenuated with losartan treatment. Losartan ameliorated CIH-induced PTC loss by modulating renal RAS to improve the crosstalk between endothelial cells and tubular epithelial cells and subsequently regulate the balance of angiogenesis factors. Our study provided novel insights into the mechanisms of CIH-induced kidney damage and indicated that losartan could be a potential therapeutic agent for renal protection by alleviating CIH-induced PTC loss.
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Affiliation(s)
- Jiqiang Wu
- Department of Respiratory Medicine, the First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Yao Chu
- Department of Respiratory Medicine, the First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zhenxiu Jiang
- Department of Respiratory Medicine, the First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Qin Yu
- Department of Respiratory Medicine, the First Hospital of Lanzhou University, Lanzhou 730000, China
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20
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Voulgaris A, Marrone O, Bonsignore MR, Steiropoulos P. Chronic kidney disease in patients with obstructive sleep apnea. A narrative review. Sleep Med Rev 2019; 47:74-89. [PMID: 31376590 DOI: 10.1016/j.smrv.2019.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
Prevalence of both chronic kidney disease (CKD) and obstructive sleep apnea (OSA) is continuously increasing. Moreover, the prevalence of OSA increases as kidney function declines and is higher among patients with end-stage renal disease (ESRD). In addition, OSA is recognized as a potential nontraditional risk factor for development and progression of CKD. Continuous positive airway pressure (CPAP) plays a pivotal role in the management of OSA, eliminating patients' symptoms and improving their quality of life. Recent studies suggested that CPAP treatment may have beneficial effects on kidney function among patients with OSA. This narrative review summarizes the existing knowledge on the association between CKD and OSA, with emphasis on the epidemiology, the pathophysiology of the development of CKD in OSA and vice versa, as well as the effect of CPAP on renal function.
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Affiliation(s)
- Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy; Pulmonary Division, University Hospital AOUP Paolo Giaccone, PROMISE Department, University of Palermo, Palermo, Italy
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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21
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Guan P, Sun ZM, Luo LF, Zhou J, Yang S, Zhao YS, Yu FY, An JR, Wang N, Ji ES. Hydrogen protects against chronic intermittent hypoxia induced renal dysfunction by promoting autophagy and alleviating apoptosis. Life Sci 2019; 225:46-54. [PMID: 30951745 DOI: 10.1016/j.lfs.2019.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 12/23/2022]
Abstract
AIMS Hydrogen gas (H2) has a diversity of effects such as anti-apoptotic, anti-inflammatory and anti-oxidative properties. However, molecular mechanism underlying the potential effect of H2 on chronic intermittent hypoxia (CIH) induced renal injury remains obscure. MATERIALS AND METHODS In the present study, adult male Sprague-Dawley rats were randomly allocated into four groups: control (CON) group, CIH group, CIH with H2 treatment (CIH + H2) group, and control with H2 treatment (CON + H2) group. Oxidative stress, autophagy and endoplasmic reticulum (ER) stress were detected to determine how H2 affected the renal function of CIH exposed rats. KEY FINDINGS We demonstrated that rats who inhale hydrogen gas showed improved renal function, alleviated pathological damage, oxidative stress and apoptosis in CIH rats. Meanwhile, CIH-induced endoplasmic reticulum stress was decreased by H2 as the expressions of CHOP, caspase-12, and GRP78 were down-regulated. Furthermore, relative higher levels of LC3-II/I ratio and Beclin-1, with decreased expression of p62, were found after H2 administrated. Inhibition of mTOR may be involved in the upregulation of autophagy by H2. Finally, increased phosphorylation of p38 and JNK was involved in the CIH-induced pathological process. H2 could inhibit the activation of p38 and JNK, suggesting H2 played an active part in resisting renal injury via MAPK. SIGNIFICANCE Taken together, our study reveals that H2 can ameliorate CIH-induced kidney injury by decreasing endoplasmic reticulum stress and activating autophagy through inhibiting oxidative stress-dependent p38 and JNK MAPK activation.
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Affiliation(s)
- Peng Guan
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Zhi-Min Sun
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Li-Fei Luo
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Jian Zhou
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Shengchang Yang
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Ya-Shuo Zhao
- Scientific Research Center, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Fu-Yang Yu
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Ji-Ren An
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - Na Wang
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China
| | - En-Sheng Ji
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, PR China.
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22
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Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 2019; 14:8. [PMID: 30809382 PMCID: PMC6374907 DOI: 10.1186/s40248-019-0172-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/20/2019] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.
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Affiliation(s)
- Maria R. Bonsignore
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
| | - Pierpaolo Baiamonte
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Emilia Mazzuca
- Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University Hospital Paolo Giaccone, University of Palermo, Piazza delle Cliniche, 2, 90100 Palermo, Italy
| | - Alessandra Castrogiovanni
- Clinic for Pneumology und Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Oreste Marrone
- National Research Council (CNR), Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy
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23
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Risk, Severity, and Predictors of Obstructive Sleep Apnea in Hemodialysis and Peritoneal Dialysis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112377. [PMID: 30373203 PMCID: PMC6267173 DOI: 10.3390/ijerph15112377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Abstract
Our study aimed to determine the incidence and severity of obstructive sleep apnea (OSA) in patients with end-stage renal disease (ESRD) and also whether different dialysis modalities confer different risk and treatment response for OSA. We used Taiwan's National Health Insurance Research Database for analysis and identified 29,561 incident dialysis patients as the study cohort between 2000 and 2011. Each dialysis patient was matched with four non-dialysis control cases by age, sex, and index date. Cox regression hazard models were used to identify the risk of OSA. The incidence rate of OSA was higher in the peritoneal dialysis (PD) cohort than the hemodialysis (HD) and control cohort (18.9, 7.03 vs. 5.5 per 10,000 person-years, respectively). The risk of OSA was significantly higher in the PD (crude subhazard ratio (cSHR) 3.50 [95% CI 2.71⁻4.50], p < 0.001) and HD cohort (cSHR 1.31 [95% CI 1.00⁻1.72], p < 0.05) compared with the control cohort. Independent risk factors for OSA in this population were age, sex, having coronary artery disease (CAD), hyperlipidemia, chronic obstructive pulmonary disease (COPD), and hypertension. Major OSA (MOSA) occurred in 68.6% in PD and 50.0% in HD patients with OSA. In the PD subgroup, the incidence of mortality was significantly higher in OSA patients without continuous positive airway pressure (CPAP) treatment compared with OSA patients undergoing CPAP treatment. The results of this study indicate that ESRD patients were at higher risk for OSA, especially PD patients, compared with control. The severity of OSA was higher in PD patients than HD patients. Treatment of MOSA with CPAP was associated with reduced mortality in PD patients.
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24
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Riggs JL, Pace CE, Ward HH, Gonzalez Bosc LV, Rios L, Barrera A, Kanagy NL. Intermittent hypoxia exacerbates increased blood pressure in rats with chronic kidney disease. Am J Physiol Renal Physiol 2018; 315:F927-F941. [PMID: 29897288 DOI: 10.1152/ajprenal.00420.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kidney injury and sleep apnea (SA) are independent risk factors for hypertension. Exposing rats to intermittent hypoxia (IH) to simulate SA increases blood pressure whereas adenine feeding causes persistent kidney damage to model chronic kidney disease (CKD). We hypothesized that exposing CKD rats to IH would exacerbate the development of hypertension and renal failure. Male Sprague-Dawley rats were fed a 0.2% adenine diet or control diet (Control) until blood urea nitrogen was >120 mg/dl in adenine-fed rats (14 ± 4 days, mean ± SE). After 2 wk of recovery on normal chow, rats were exposed to IH (20 exposures/h of 5% O2-5% CO2 7 h/day) or control conditions (Air) for 6 wk. Mean arterial pressure (MAP) was monitored with telemeters, and plasma and urine samples were collected weekly to calculate creatinine clearance as an index of glomerular filtration rate (GFR). Prior to IH, adenine-fed rats had higher blood pressure than rats on control diet. IH treatment increased MAP in both groups, and after 6 wk, MAP levels in the CKD/IH rats were greater than those in the CKD/Air and Control/IH rats. MAP levels in the Control/Air rats were lower than those in the other three groups. Kidney histology revealed crystalline deposits, tubule dilation, and interstitial fibrosis in both CKD groups. IH caused no additional kidney damage. Plasma creatinine was similarly increased in both CKD groups throughout whereas IH alone increased plasma creatinine. IH increases blood pressure further in CKD rats without augmenting declines in GFR but appears to impair GFR in healthy rats. We speculate that treating SA might decrease hypertension development in CKD patients and protect renal function in SA patients.
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Affiliation(s)
- Jennifer L Riggs
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Carolyn E Pace
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Heather H Ward
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Laura V Gonzalez Bosc
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Lynnette Rios
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Adelaeda Barrera
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
| | - Nancy L Kanagy
- Department of Cell Biology and Physiology, University of New Mexico , Albuquerque, New Mexico
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25
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Mehta R, Cai X, Hodakowski A, Thyagarajan B, Zeng D, Zee PC, Wohlgemuth WK, Redline S, Lash JP, Wolf M, Isakova T. Sleep disordered breathing and fibroblast growth factor 23 in the Hispanic Community Health Study/Study of Latinos. Bone 2018; 114:278-284. [PMID: 29986841 PMCID: PMC6785996 DOI: 10.1016/j.bone.2018.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
Abstract
Preclinical data suggest that hypoxia stimulates fibroblast growth factor 23 (FGF23) transcription and cleavage in osteocytes, resulting in elevated circulating c-terminal (cFGF23) levels but normal intact FGF23 (iFGF23) levels. We conducted a case-control study within the Hispanic Community Health Study/Study of Latinos to investigate whether sleep disordered breathing, as a model of hypoxemia, is independently associated with elevated cFGF23 levels in the general population and with elevated cFGF23 and iFGF23 levels in patients with chronic kidney disease (CKD), in whom FGF23 cleavage may be impaired. Cases (n = 602) had severe sleep disordered breathing defined as an apnea/hypopnea index (AHI) of ≥30. Controls without severe sleep disordered breathing (n = 602) were matched for sex and CKD stage. The median AHI in the cases was 45.8 (IQR 35.5-62.5) compared to 2.6 (IQR 0.6-8.2) in the controls. Cases had higher cFGF23 levels than controls (66.2 RU/mL, IQR 52.8-98.4 vs. 61.2 RU/mL, IQR 49.5-80.1, p value <0.001). There were no differences in iFGF23 levels between cases and controls. In adjusted linear regression and multinomial regression analyses, body mass index attenuated the relationship between severe sleep disordered breathing and cFGF23 levels. No significant relationships were seen in analyses of severe sleep disordered breathing and iFGF23 levels or in analyses of iFGF23 and cFGF23 stratified by CKD status. Additional studies using other models of intermittent and chronic hypoxia are needed to confirm whether hypoxia stimulates FGF23 transcription in humans and to determine the impact on iFGF23 levels in CKD.
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Affiliation(s)
- Rupal Mehta
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA.
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander Hodakowski
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, Division of Molecular Pathology and Genomics, University of Minnesota, Minneapolis, MN, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Phyllis C Zee
- Division of Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William K Wohlgemuth
- Division of Neurology, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA; Division of Psychology, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, USA; Division of Sleep and Circadian Disorders, Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC, USA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Obstructive sleep apnea patients without hypertension or diabetes and subsequent incidence of chronic kidney disease. Sleep Breath 2018; 22:837-838. [DOI: 10.1007/s11325-017-1584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
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27
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Zhang Y, Su X, Zou F, Xu T, Pan P, Hu C. Toll-like receptor-4 deficiency alleviates chronic intermittent hypoxia-induced renal injury, inflammation, and fibrosis. Sleep Breath 2018; 23:503-513. [PMID: 30099700 DOI: 10.1007/s11325-018-1704-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA)-associated chronic kidney disease is mainly caused by chronic intermittent hypoxia (CIH) triggered renal damage. This study aims to investigate the role of toll-like receptor-4 (TLR4) in underlying mechanism involved chronic intermittent hypoxia (CIH)-induced renal damage. METHODS C57BL/6J mice with normal TLR4 (TLR4 WT) or deficient TLR4 (TLR4 KO) were divided into four groups and exposed to normal air (NA) and CIH: TLR4 WT + NA, TLR4 KO + NA, TLR4 WT + CIH, and TLR4 KO + CIH. CIH lasted for 8 h/day and 7 days/week for 6 weeks. Renal injury and inflammation were evaluated by histology and ELISA. Renal tubular apoptosis, macrophages, and fibroblasts recruitment were determined by TUNEL assay, immunofluorescence, and western blot. RESULTS In response to CIH, TLR4 deficiency alleviated renal histological injury, renal dysfunction, and fibrosis. TLR4 deficiency ameliorated renal dysfunction (serum BUN and creatinine) and tubular endothelial apoptosis determined by immunofluorescence staining of CD31 and TUNEL, and western blot of apoptotic protein (caspase-3, c-caspase-3, and Bax/Bcl-2 ratio). Furthermore, we also found TLR4 deficiency abrogated CIH-induced macrophages (CD68) and fibroblasts (α-SMA) recruitment, further reducing expression of extra-cellular matrix protein (collagen I and collagen IV) and inflammatory cytokines release (IL-6, TNF-α, and MCP-1). Finally, we used immunohistochemistry to demonstrate that TLR4 deficiency attenuated increased expression of MyD88 and NF-kB p65 after CIH treatment. CONCLUSIONS Our data suggest that TLR4 plays a vital role in CIH-induced renal injury, inflammation and fibrosis, and inhibition of TLR4 probably provides a therapeutic potential for CIH-induced kidney damage.
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Affiliation(s)
- Yan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Fangfang Zou
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Tengjuan Xu
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Pinhua Pan
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Key Cite of National Clinical Research Center for Respiratory Disease, Central South University, Changsha, 410008, Hunan, People's Republic of China
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28
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Poonit ND, Cai XH. The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0146-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Marrone O, Bonsignore MR. Obstructive sleep apnea and chronic kidney disease: open questions on a potential public health problem. J Thorac Dis 2018; 10:45-48. [PMID: 29600018 DOI: 10.21037/jtd.2017.12.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Oreste Marrone
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy.,Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), University of Palermo, Palermo, Italy
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30
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Lin YS, Liu PH, Chen NH. Reply to "Obstructive sleep apnea patients without hypertension or diabetes and subsequent incidence of chronic kidney disease" by Kawada (letter to the editor). Sleep Breath 2017; 22:839-840. [PMID: 29103198 DOI: 10.1007/s11325-017-1585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Yu-Sheng Lin
- Healthcare Center, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan.,Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pi-Hua Liu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No.123, Dinghu RD., Guishan, Township, Taoyuan County, Taiwan.
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31
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Chung SY, Sylvester MJ, Patel VR, Zaki M, Baredes S, Liu JK, Eloy JA. Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data. Laryngoscope 2017; 128:1027-1032. [PMID: 28671280 DOI: 10.1002/lary.26731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although previous studies have reported increased perioperative complications among obstructive sleep apnea (OSA) patients undergoing any surgery requiring general anesthesia, there is a paucity of literature addressing the impact of OSA on postoperative transsphenoidal surgery (TSS) complications. The aim of this study was to analyze postoperative outcomes in transsphenoidal pituitary surgery patients with OSA. Secondarily, we examined patient characteristics and comorbidities. STUDY DESIGN Retrospective analysis. METHODS The 2002 to 2013 National Inpatient Sample was queried for patients undergoing TSS for pituitary neoplasm. Patients with an additional diagnosis of OSA were identified, and compared to a non-OSA cohort. RESULTS There were 17,777 patients identified; 5.0% (N = 889) had an additional diagnosis of OSA. The OSA cohort had more comorbidities including diabetes mellitus, congestive heart failure, chronic pulmonary disease, coagulopathy, hypertension, hypothyroidism, liver disease, obesity, peripheral vascular disease, renal failure, acromegaly, and Cushing's syndrome. Postoperatively, OSA was independently associated with increased risks of tracheostomy (P = .015) and hypoxemia (P < .001), and decreased risk of cardiac complications (P = .034). OSA patients did not have increased rates of cerebrospinal fluid rhinorrhea, diabetes insipidus, reintubation, aspiration pneumonia, infectious pneumonia, thromboembolic complications, or urinary/renal complications. In-hospital mortality rates did not vary between the two cohorts. CONCLUSIONS In patients who underwent transsphenoidal pituitary surgery, OSA was associated with higher rates of certain pulmonary and airway complications. OSA was not associated with increased non-pulmonary/airway complications or inpatient mortality, despite older average age and higher comorbidity rates. LEVEL OF EVIDENCE 2C. Laryngoscope, 128:1027-1032, 2018.
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Affiliation(s)
- Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael J Sylvester
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Varesh R Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Zaki
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Ophthalmology and Visual Science , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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