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Belzile D, Auclair A, Roberge J, Piché ME, Lebel A, Pettigrew M, Marceau S, Biertho L, Poirier P. Heart rate variability after bariatric surgery: The add-on value of exercise. Eur J Sport Sci 2023; 23:415-422. [PMID: 34890532 DOI: 10.1080/17461391.2021.2017488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. METHODS Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. RESULTS After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms2), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms2) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms2), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms2) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). CONCLUSION Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.
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Affiliation(s)
- D Belzile
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - A Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - J Roberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M E Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - A Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M Pettigrew
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
| | - S Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - L Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - P Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
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Bock JM, Vungarala S, Karim S, Somers VK. Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP. Can J Cardiol 2021; 37:756-765. [PMID: 33610689 DOI: 10.1016/j.cjca.2021.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience repetitive partial or complete airway collapse during sleep resulting in nocturnal hypoxia-normoxia cycling, and are at increased cardiovascular risk. The number of apneas and hypopneas indexed per hour of sleep (apnea-hypopnea index) along with the associated intermittent hypoxia predict the increased cardiovascular risk; thus, their attenuation or prevention are objectives of OSA therapy. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA and, when effective, mitigates the apnea-hypopnea index and hypoxemia. As such, it is reasonable to expect CPAP would decrease cardiovascular risk. However, 3 recent randomized clinical trials of CPAP vs usual care did not show any significant effects of CPAP in attenuating incident cardiovascular events in patients with OSA. In this review, we discuss these studies in addition to potential complementary therapeutic options to CPAP (eg, neurostimulation) and conclude with suggested therapeutic targets for future interventional studies (eg, the autonomic nervous system). Although these areas of research are exciting, they have yet to be tested to any similar degree of rigour as CPAP.
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Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Soumya Vungarala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Beydoun HA, Hossain S, Beydoun MA, Weiss J, Zonderman AB, Eid SM. Periodontal disease, sleep duration, and white blood cell markers in the 2009 to 2014 National Health and Nutrition Examination Surveys. J Periodontol 2019; 91:582-595. [PMID: 31554016 DOI: 10.1002/jper.19-0055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/22/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elevated levels of inflammatory biomarkers are consistently associated with chronic conditions, for which periodontitis and sleep are established risk factors. We examined the relationships between periodontitis, hours of sleep and white blood cell (WBC) markers among a nationally representative sample of US adults. METHODS Cross-sectional study using existing demographic, examination, laboratory and questionnaire data on 11,813 participants (5,814 men and 5,999 women, mean age ± SE; range: 52.74 ± 0.24; 30 to 80 years) from the 2009 to 2014 National Health and Nutrition Examination Surveys. Unadjusted, sex- and age-adjusted, as well as fully adjusted linear and logistic regression models were conducted in addition to generalized structural equations models, while considering sampling design complexity. β, odds ratios with their 95% confidence intervals, indirect effects and mediation proportions were estimated. RESULTS The weighted mean WBC count was 7,130 cells/µL, with the WBC 5-part differential estimated in terms of percentages of lymphocytes (29.50%), monocytes (7.99%), neutrophils (59.03%), eosinophils (2.84%), and basophils (71.88%). Furthermore, 36.2% of participants reported <7 hours of sleep and 49.8% had periodontitis. In fully adjusted models controlling for sociodemographic, lifestyle, and health characteristics, neither WBC markers nor periodontitis were related to hours of sleep. By contrast, periodontitis was directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men. However, the relationship of periodontitis with %neutrophils and %lymphocytes may be modified by hours of sleep, as it was specific to individuals reporting ≥7 hours of sleep. CONCLUSION Periodontitis may be directly related to WBC count and %neutrophils and inversely related to %lymphocytes, especially among men and individuals reporting ≥7 hours of sleep, with implications for primary and secondary prevention.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - Jordan Weiss
- Population Studies Center and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Carvalho NNC, de Oliveira Junior FA, da Silva G, Baccin Martins VJ, Braga VDA, da Costa-Silva JH, Fernandes Pimenta FC, de Brito Alves JL. Impact of arterial hypertension and type 2 diabetes on cardiac autonomic modulation in obese individuals with recommendation for bariatric surgery. Diabetes Metab Syndr Obes 2019; 12:1503-1511. [PMID: 31686874 PMCID: PMC6709514 DOI: 10.2147/dmso.s204414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/13/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND AIM Obese individuals with recommendation for bariatric surgery (BS) exhibit increased cardiovascular risk. The association of obesity with comorbidities, such as arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM) can worsen cardiovascular dysfunction. This study aimed to investigate the effect of HTN on cardiac autonomic function and whether diabetes exacerbates HTN-related impairment of autonomic function in obese subjects. METHODS Samples (n=63) were allocated to three groups: Obese without HTN and T2DM (n=29), Obese with HTN (OHTN, n=17) and OHTN with T2DM (OHTN+T2DM, n=17), in which anthropometric measures, body composition, blood biochemical parameters, blood pressure (BP) and heart rate variability (HRV) were evaluated. RESULTS The age was higher in OHTN+T2DM and OHTN than in obese groups (p<0.05). OHTN+T2DM individuals had increased neck circumference and compromised glycemic profile when compared to obese and OHTN groups (p<0.05). Mean values for standard deviation of RR (SDRR), square root of the mean squared differences of successive RR interval (RMSSD) and number of pairs of successive normal-to-normal beat intervals that differed by 50 ms (pRR50) were significantly lower in OHTN+T2DM and OHTN groups when compared to patients with obesity alone (p<0.05). The low frequency (LF), low frequency/high frequency (LF/HF) ratio were higher in the OHTN+T2DM and OHTN than subjects with obesity alone (p<0.05). Nonlinear parameters SD2 and SD1 were also lower in the OHTN+T2DM when compared to the obese group (p<0.05). However, the SD2/SD1 ratio was higher in the OHTN+T2DM and OHTN groups than the obese group. CONCLUSION T2DM and/or HTN impair the cardiac autonomic function in obese patients. However, the presence of T2DM did not exacerbate the hypertension-related impairment of autonomic function.
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Affiliation(s)
- Nara Nóbrega Crispim Carvalho
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil
- Department of Endocrinology, Lauro Wanderley University Hospital, Federal University of Paraiba, João Pessoa, Brazil
| | | | - Gitana da Silva
- Lauro Wanderley Hospital, Federal University of Paraiba, João Pessoa, Brazil
| | - Vinícius José Baccin Martins
- Department of Physiology and Pathology, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil
| | - Valdir de Andrade Braga
- Department of Biotechnology, Center of Biotechnology, Federal University of Paraíba, João Pessoa, Brazil
| | - João Henrique da Costa-Silva
- Department of Physical Education and Sport Sciences, Federal University of Pernambuco, Vitória De Santo Antão, PE, Brazil
| | | | - José Luiz de Brito Alves
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil
- Correspondence: José Luiz de Brito Alves; Nara Nóbrega Crispim CarvalhoDepartment of Nutrition, Federal University of Paraiba, Campus I – Jd. Cidade Universitária, João Pessoa, PBCEP: 58051-900, BrazilTel/fax +55 8 199 845 5485 Email ;
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5
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High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients. Surg Endosc 2018; 33:1626-1631. [DOI: 10.1007/s00464-018-6437-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
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6
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Schiavon CA, Bersch-Ferreira AC, Santucci EV, Oliveira JD, Torreglosa CR, Bueno PT, Frayha JC, Santos RN, Damiani LP, Noujaim PM, Halpern H, Monteiro FLJ, Cohen RV, Uchoa CH, de Souza MG, Amodeo C, Bortolotto L, Ikeoka D, Drager LF, Cavalcanti AB, Berwanger O. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation 2018; 137:1132-1142. [PMID: 29133606 PMCID: PMC5865494 DOI: 10.1161/circulationaha.117.032130] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution. Randomized trials designed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed. METHODS In this randomized, single-center, nonblinded trial, we included patients with hypertension (using ≥2 medications at maximum doses or >2 at moderate doses) and a body mass index between 30.0 and 39.9 kg/m2. Patients were randomized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone. The primary end point was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm Hg and 90 mm Hg, respectively, at 12 months. RESULTS We included 100 patients (70% female, mean age 43.8±9.2 years, mean body mass index 36.9±2.7 kg/m2), and 96% completed follow-up. Reduction of ≥30% of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group (83.7%) compared with 6 of 47 patients (12.8%) from the control group with a rate ratio of 6.6 (95% confidence interval, 3.1-14.0; P<0.001). Remission of hypertension was present in 25 of 49 (51%) and 22 of 48 (45.8%) patients randomized to gastric bypass, considering office and 24-hour ambulatory blood pressure monitoring, respectively, whereas no patient submitted to medical therapy was free of antihypertensive drugs at 12 months. A post hoc analysis for the primary end point considering the SPRINT (Systolic Blood Pressure Intervention Trial) target reached consistent results, with a rate ratio of 3.8 (95% confidence interval, 1.4-10.6; P=0.005). Eleven patients (22.4%) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives. Waist circumference, body mass index, fasting plasma glucose, glycohemoglobin, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and 10-year Framingham risk score were lower in the gastric bypass than in the control group. CONCLUSIONS Bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients with obesity and hypertension. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT01784848.
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Affiliation(s)
- Carlos Aurelio Schiavon
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Angela Cristine Bersch-Ferreira
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Eliana Vieira Santucci
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Juliana Dantas Oliveira
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Camila Ragne Torreglosa
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Priscila Torres Bueno
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Julia Caldas Frayha
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Renato Nakagawa Santos
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Lucas Petri Damiani
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | | | | | | | | | - Carlos H Uchoa
- Heart Institute, Hypertension Unit, São Paulo, Brazil (C.H.U., L.B., L.F.D.)
| | - Marcio Gonçalves de Souza
- Department of Hypertension, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil (M.G.d.S., C.A.)
| | - Celso Amodeo
- Department of Hypertension, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil (M.G.d.S., C.A.)
| | - Luiz Bortolotto
- Heart Institute, Hypertension Unit, São Paulo, Brazil (C.H.U., L.B., L.F.D.)
| | - Dimas Ikeoka
- Intensive Unit (D.I.), Heart Hospital, São Paulo, Brazil
| | - Luciano F Drager
- Heart Institute, Hypertension Unit, São Paulo, Brazil (C.H.U., L.B., L.F.D.)
| | - Alexandre Biasi Cavalcanti
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
| | - Otavio Berwanger
- Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
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