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Sun Y, Wei L, Li F, Ling C, Zhai F, Lv Y, Zhou H, Zhang C, Ma J, Chen J, Sun W, Wang Z. Associations of sleep-related variables with reverse dipping patterns of blood pressure in α-synucleinopathies. Parkinsonism Relat Disord 2024; 121:106046. [PMID: 38367532 DOI: 10.1016/j.parkreldis.2024.106046] [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: 09/09/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The reverse dipping blood pressure (BP) pattern is very common in α-synucleinopathies. We aimed to explore the associations of sleep-related variables with abnormal BP circadian rhythms in Parkinson's disease (PD) and multiple system atrophy (MSA). METHODS A total of 126 patients, 76 with PD and 50 with MSA, were included. All participants underwent ambulatory BP monitoring and full-night polysomnography (PSG). We analyzed abnormal dipping patterns and sleep-related parameters, including moderate to severe obstructive sleep apnea (OSA), rapid eye movement behavior disorder (RBD), average oxygen saturation (SaO2%), lowest SaO2%, duration of SaO2% <90%, and apnea-hypopnea index (AHI). Binary logistic regression was performed to explore the associations between paraclinical variables, sleep-related variables, and reverse dipping patterns. RESULTS Reverse dipping patterns were predominant in patients with PD (58.5 %) and MSA (68.0 %). Patients with MSA had higher AHI, RBD, and lower average SaO2% than those with PD. Taking both diseases together as a whole group of α-synucleinopathies, logistic regression analysis indicates the Hoehn-Yahr stage (odds ratio [OR] = 2.00 for reverse systolic and 2.34 for reverse diastolic dipping patterns), moderate to severe OSA (OR = 2.71 for reverse systolic and 2.53 for reverse diastolic dipping patterns), average SaO2% (OR = 1.35 for reverse systolic dipping patterns), and male sex (OR = 2.70 for reverse diastolic dipping patterns) were independently associated with reverse dipping patterns. CONCLUSIONS Reverse dipping patterns were common in patients with PD and MSA. Hoehn-Yahr stage, moderate to severe OSA, average SaO2%, and male sex were associated with reverse dipping patterns in α-synucleinopathy.
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Affiliation(s)
- Yunchuang Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China
| | - Luhua Wei
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chen Ling
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fei Zhai
- Department of Neurology, Shijiazhuang People's Hospital, NO.9 Fangbei Road, Chang'an District, Shijiazhuang City, Hebei province, 050011, China
| | - Yunfeng Lv
- Department of Neurology, Northeast International Hospital, NO.169 ChangJiang South Street, HuangGu District, ShenYang City, Liaoning province, 110031, China
| | - Hong Zhou
- Department of Neurology, Civil Aviation General Hospital, Beijing, 100123, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Chen
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China.
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Heyman TD, Jayaram A, Eisenberg Y, Crivellaro S, Mohammed A, Briller JE. Pheochromocytoma: Secondary Hypertension in Pregnancy. JACC Case Rep 2024; 29:102217. [PMID: 38379658 PMCID: PMC10874976 DOI: 10.1016/j.jaccas.2023.102217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
Secondary hypertension can occur from a variety of renal and endocrine disorders. Pheochromocytoma, a rare catecholamine-secreting neuroendocrine tumor, is associated with adverse maternal and fetal outcomes in the absence of a timely diagnosis and a coordinated multidisciplinary approach. Clues to diagnosis include resistant hypertension or an adrenal mass on imaging.
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Affiliation(s)
- Taryn Dorn Heyman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Aswathi Jayaram
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yuval Eisenberg
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Abdul Mohammed
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Joan E. Briller
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
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3
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Wu H, Guo Y. Risk of resistant hypertension associated with insomnia in patients with obstructive sleep apnea. Sleep Med 2023; 101:445-451. [PMID: 36516601 DOI: 10.1016/j.sleep.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with obstructive sleep apnea (OSA) have a high prevalence of hypertension but vary in blood pressure (BP) control, which may be partially explained by comorbid insomnia. We investigated the association of insomnia symptoms with uncontrolled BP and resistant hypertension (RH) in OSA patients. METHODS Between 2018 and 2021, hypertensive patients with OSA were enrolled. Information on demographic characteristics, insomnia symptoms, class of antihypertensive medications, BP control and sleep study data were collected. Controlled BP was defined as systolic BP < 140 mm Hg and diastolic BP < 90 mm Hg (BP standard); uncontrolled BP as above BP standard with use of 1-2 classes of antihypertensive medication; and RH as above BP standard with the use of ≥3 classes of antihypertensive medication (including a diuretic). Multinomial logistic regression models were fit to determine the association between insomnia symptoms and uncontrolled BP or RH (versus controlled BP) after multivariable adjustment. RESULTS Among the analytic sample (n = 326), 64.1% of participants had uncontrolled BP and 15.6% had RH. OSA severity was associated with a higher odds of RH (OR, 2.92; 95% CI, 1.71-4.99). After adjustment for confounders including demographic characteristics, sedative hypnotics usage, sleepiness, OSA severity and quality of life, participants experiencing insomnia symptoms had a 3.0 times higher odds of RH. Insomnia was not associated with uncontrolled BP. CONCLUSIONS Experiencing insomnia was associated with increased odds of RH in OSA patients. These results suggest that comorbid insomnia may contribute to inadequate BP control in OSA patients.
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Affiliation(s)
- Hao Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
| | - Yaxin Guo
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China
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4
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Yao L, Heizhati M, Lin M, Gan L, Yao X, Wang Y, Zhu Q, Wang L, Yuan Y, Li M, Yang W, Li N. Elevated body mass index increases the risk of cardiovascular events in hypertensive patients accompanied with obstructive sleep apnea: A cohort study. Obes Res Clin Pract 2022; 16:491-499. [PMID: 36437224 DOI: 10.1016/j.orcp.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Effects of body mass index (BMI) on cardiovascular events are inconsistent. We aimed to investigate the association of BMI with cardiovascular events in hypertensives with obstructive sleep apnea (OSA). METHODS Hypertensives with OSA diagnosed with polysomnography between 2011 and 2013 in UROSAH cohort were followed up till Jan 2021. Outcomes were non-fatal cardiovascular events and cardiac death. Cox regression was used to estimate the relationship of continuous and categorical BMI with total and specific outcomes. Sensitivity analyses were performed by excluding those on OSA treatment or underweight patients. Stratified analyses were conducted by parameters including sex and age. RESULTS 2239 hypertensives with OSA were included with 405 normal weight (BMI<25 kg/m2), 1164 overweight (25-29.9 kg/m2) and 670 obesity (≥30 kg/m2). 206 non-fatal cardiovascular events and 18 cardiac death were recorded during 6.6 years follow-up. Compared with normal weight group, overweight (HR=1.53, 95%CI: 1.01-2.32, P = 0.047) and obesity groups (1.85, 1.19-2.86, P = 0.006) showed increased risk for cardiovascular events, significant in obesity group and marginal in overweight group in fully-adjusted model. In specific events, obesity showed significantly elevated HR for non-fatal cardiovascular events (1.64, 1.04-2.60, P = 0.035). Continuous BMI showed significantly increased HR for total and specific events in all models. Sensitivity analysis yielded consistent results. In stratification analysis, stronger association between obesity and cardiovascular events was observed in the young (HR=5.97, P interaction=0.030). CONCLUSIONS BMI is in positive association with cardiovascular events in hypertensives with OSA, emphasizing importance of maintaining healthy BMI for prevention of adverse events in this population, on the basis of guideline-recommended treatment.
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Affiliation(s)
- Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Mengyue Lin
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Lin Gan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Xiaoguang Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Yingchun Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Qing Zhu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Lin Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Yujuan Yuan
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Mei Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Wenbo Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, China; Xinjiang Hypertension Institute, China; National Health Committee Key Laboratory of Hypertension Clinical Research Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", China; Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, China.
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Kovács DK, Gede N, Szabó L, Hegyi P, Szakács Z, Faludi B, Sebők Á, Garami A, Solymár M, Kósa D, Hanák L, Rumbus Z, Balaskó M. Weight reduction added to CPAP decreases blood pressure and triglyceride level in OSA: systematic review and meta-analysis. Clin Transl Sci 2022; 15:1238-1248. [PMID: 35120399 PMCID: PMC9099124 DOI: 10.1111/cts.13241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/03/2022] [Accepted: 01/25/2022] [Indexed: 12/01/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with treatment‐resistant hypertension and high cardiovascular risk. Continuous positive airway pressure (CPAP) fails to reduce cardiovascular risks consistently. Obesity and OSA show reciprocal association and they synergistically increase hypertension via different pathways. Our meta‐analysis aimed to assess the cardiovascular benefits of combining weight loss (WL) with CPAP (vs. WL or CPAP alone) in OSA. Outcomes included systolic and diastolic blood pressure (BP) and blood lipid parameters. We explored Medline, Embase, Cochrane, and Scopus. Eight randomized controlled studies (2627 patients) were included. The combined therapy decreased systolic BP more than CPAP alone. Weighted mean difference (WMD) for CPAP + WL versus CPAP was −8.89 mmHg, 95% confidence interval (95% CI; −13.67 to −4.10, p < 0.001) for systolic BP. For diastolic BP, this decrease was not significant. In case of blood lipids, the combined treatment decreased triglyceride levels more than CPAP alone (WMD = −0.31, 95% CI −0.58 to −0.04, p = 0.027). On the other hand, addition of CPAP to WL failed to suppress BP further. The certainty of evidence according to GRADE was very low to moderate. In conclusion, our results showed that the addition of WL to CPAP significantly improved BP and blood lipid values in OSA. On the other hand, the addition of CPAP to WL could not significantly improve BP or blood lipid values. Review protocol: PROSPERO CRD42019138998.
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Affiliation(s)
- Dóra K Kovács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Szabó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division for Pancreatic Disorders, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Béla Faludi
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Ágnes Sebők
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - András Garami
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Kósa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
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Wang Y, Shou X, Wu Y, Fan Z, Cui J, Zhuang R, Luo R. Relationships Between Obstructive Sleep Apnea and Cardiovascular Disease: A Bibliometric Analysis (2010-2021). MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e933448. [PMID: 34975145 PMCID: PMC8739592 DOI: 10.12659/msm.933448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Obstructive sleep apnea (OSA) is a common disease that can lead to intermittent hypoxia, increased sympathetic overdrive, and excessive oxidative stress, and eventually lead to cardiovascular/cerebrovascular diseases and metabolic disorders. The prevalence of OSA is reported to be higher in people with certain cardiovascular diseases (CVD). Therefore, the relationship between OSA and CVD has been gradually favored by researchers. Material/Methods Data were downloaded from the Web of Science Core Collection database. Citespace was used to remove duplicated data and construct knowledge visual maps. Results A total of 7047 publications were obtained. The USA was the largest contributor as well as an important player in the cooperation network between nations. The leading institution was the Mayo Clinic. Our study ultimately identified the top 5 hotspots and 4 research frontiers in this field. Top 5 hotspots were: the specific types of obstructive sleep apnea-related cardiovascular and metabolic co-morbidities, the curative effects of CPAP on these co-morbidities, the specific mechanisms of co-morbidities, the importance of polysomnography on OSA and its co-morbidities with CVD, and the prevalence of OSA and its co-morbidities with CVD in particular populations. The top 4 frontiers were: the relationship between OSA and resistant hypertension, the molecular mechanisms of OSA and its co-morbidities with CVD, specific medications and treatment guidelines for the co-morbidities, and the mainstream research methods in this field. Conclusions This study provides insight and valuable information for researchers and helps to identify new perspectives concerning potential collaborators and cooperative institutions, hot topics, and research frontiers in this field.
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Affiliation(s)
- Yumeng Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Xintian Shou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China (mainland).,Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (mainland)
| | - Yang Wu
- Department of Cardiovascular, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Zongjing Fan
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (mainland)
| | - Jie Cui
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (mainland)
| | - Rui Zhuang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Ruixiang Luo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China (mainland)
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D'Souza J, Weuve J, Brook RD, Evans DA, Kaufman JD, Adar SD. Long-Term Exposures to Urban Noise and Blood Pressure Levels and Control Among Older Adults. Hypertension 2021; 78:1801-1808. [PMID: 34689591 DOI: 10.1161/hypertensionaha.121.17708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jennifer D'Souza
- School of Public Health, University of Michigan, Ann Arbor (J.D., S.D.A.)
| | | | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, MI (R.D.B.)
| | - Denis A Evans
- Rush University School of Medicine, Chicago, IL (D.A.E.)
| | - Joel D Kaufman
- School of Public Health, University of Washington, Seattle (J.D.K.)
| | - Sara D Adar
- School of Public Health, University of Michigan, Ann Arbor (J.D., S.D.A.)
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Dolgner SJ, Steinberg ZL, Jones TK, Reisman M, Buber J. Stroke in patients with secundum atrial septal defect and sequelae after transcatheter closure. Heart 2021; 107:1875-1880. [PMID: 34380660 DOI: 10.1136/heartjnl-2021-319050] [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: 01/25/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed. METHODS We retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF. RESULTS Of 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001). CONCLUSIONS In this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.
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Affiliation(s)
- Stephen J Dolgner
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA .,Adult Congenital Heart Program, Texas Children's Hospital, Houston, Texas, USA
| | - Zachary Louis Steinberg
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas K Jones
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark Reisman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan Buber
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Kang HH, Kim IK, Yeo CD, Kim SW, Lee HY, Im JH, Kwon HY, Lee SH. The Effects of Chronic Intermittent Hypoxia in Bleomycin-Induced Lung Injury on Pulmonary Fibrosis via Regulating the NF-κB/Nrf2 Signaling Pathway. Tuberc Respir Dis (Seoul) 2020; 83:S63-S74. [PMID: 33027868 PMCID: PMC7837382 DOI: 10.4046/trd.2020.0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with pulmonary fibrosis. Chronic intermittent hypoxia (CIH) is considered to be a surrogate of OSA. However, its exact role in pulmonary fibrosis remains uncertain. Therefore, we investigated the mechanism underlying CIH-induced pulmonary fibrosis and the role of the anti-fibrotic agent in bleomycin (BLE) induced lung injury. Methods Mice were divided into eight groups: the normoxia (NOR), CIH, NOR plus BLE, CIH plus BLE, NOR plus pirfenidone (PF), CIH plus PF, NOR plus BLE and PF, and CIH plus BLE and PF groups. BLE was administered intratracheally on day 14 following CIH or NOR exposure. Subsequently, the mice were exposed to CIH or NOR for an additional 4 weeks. PF was administered orally on day 5 after BLE instillation once daily for 3 weeks. Results In the BLE-treated groups, CIH-induced more collagen deposition in lung tissues than NOR, and significantly increased hydroxyproline and transforming growth factor-β expression. The CIH and BLE-treated groups showed increased lung inflammation compared to NOR or CIH groups. Following CIH with BLE treatment, nuclear factor-κB (NF-κB) protein expression was significantly increased, whereas nuclear factor-erythroid-related factor 2 (Nrf2) and heme oxygenase-1 protein levels were decreased. After PF treatment, NF-κB and Kelch-like ECH-associated protein 1 expression were suppressed, and Nrf2 expression was increased. Conclusion CIH accelerated lung fibrosis in BLE-induced lung injury in mice, potentially by regulating the NF-κB/Nrf2 signaling pathway. Our results implicate PF as a potential therapeutic agent for treating pulmonary fibrosis in individuals with OSA and idiopathic pulmonary fibrosis.
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Affiliation(s)
- Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Kyoung Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hea Yon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hyeon Im
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Young Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dassanayake S, Sole G, Wilkins G, Skinner M. Exercise: a therapeutic modality to treat blood pressure in resistant hypertension. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1733781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Suranga Dassanayake
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gisela Sole
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Gerard Wilkins
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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11
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Hein M, Lanquart JP, Hubain P, Loas G. Risk of resistant hypertension associated with restless legs syndrome and periodic limb movements during sleep: a study on 673 treated hypertensive individuals. Sleep Med 2019; 63:46-56. [PMID: 31606649 DOI: 10.1016/j.sleep.2019.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Given the limited data available in the literature, the aim of this study was to examine the risk of resistant hypertension (RHT) associated with restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS) in a large sample of treated hypertensive individuals. METHODS Demographic and polysomnographic (PSG) data from 673 treated hypertensive individuals recruited from the research database of the sleep laboratory of Erasme Hospital were analysed. After exclusion of the main causes of pseudo-resistance and secondary hypertension, RHT status was defined by the presence of an uncontrolled hypertension despite treatment with at least three antihypertensive agents (including a diuretic) from different classes in correct combination and at the highest tolerated doses or by the presence of controlled hypertension requiring the use of at least four antihypertensive agents. Logistic regression analyses were conducted to examine the risk of RHT associated with RLS and PLMS in treated hypertensive individuals. RESULTS After adjustment for major confounding factors associated with RHT, multivariate logistic regression analysis revealed that frequent RLS (≥2 episodes/week) combined with PLMS index ≥26/h [odds ratio (OR) 2.20; 95% confidence interval (CI) 1.35-3.61, p = 0.021] was a significant risk factor of RHT in treated hypertensive individuals. CONCLUSION In treated hypertensive individuals, frequent RLS combined with PLMS index ≥26/h is associated with higher risk of RHT which suggests that this pathology may be a secondary cause of RHT (eg, obstructive sleep apnoea syndrome and insomnia with short sleep duration) justifying the establishment of effective treatments in this particular subpopulation.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, ULB, Brussels, Belgium
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12
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Abstract
PURPOSE OF REVIEW The goal of the present review is to describe the current findings on the association of sleep with resistant hypertension (hypertension that remains uncontrolled despite the use of three or more antihypertensive medications from different classes, including a diuretic). RECENT FINDINGS Sleep disturbances, particularly obstructive sleep apnea (OSA), are highly prevalent among adults who have resistant hypertension. Randomized controlled trials indicate that treating OSA has modest effects on blood pressure lowering among those with the highest initial blood pressure. There is a paucity of research on the association of habitual sleep and other sleep disturbances with resistant hypertension. Of note, the most recent observational studies describing the association of OSA with resistant hypertension are comprised primarily of non-white race/ethnic groups who are far more likely to have resistant hypertension. OSA is associated with resistant hypertension, but there is limited data on associations between sleep characteristics and resistant hypertension. Future studies should investigate whether treating OSA can reduce disparities in resistant hypertension and whether other aspects of sleep also contribute to resistant hypertension.
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Affiliation(s)
- Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Johnson DA, Thomas SJ, Abdalla M, Guo N, Yano Y, Rueschman M, Tanner RM, Mittleman MA, Calhoun DA, Wilson JG, Muntner P, Redline S. Association Between Sleep Apnea and Blood Pressure Control Among Blacks. Circulation 2019; 139:1275-1284. [PMID: 30586763 PMCID: PMC6428682 DOI: 10.1161/circulationaha.118.036675] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blacks have a high prevalence of hypertension and uncontrolled blood pressure (BP), each of which may be partially explained by untreated sleep apnea. We investigated the association of sleep apnea with uncontrolled BP and resistant hypertension in blacks. METHODS Between 2012 and 2016, Jackson Heart Sleep Study participants (N=913) underwent an in-home Type 3 sleep apnea study, clinic BP measurements, and anthropometry. Moderate or severe obstructive sleep apnea (OSA) was defined as a respiratory event index ≥15, and nocturnal hypoxemia was quantified as percent sleep time with <90% oxyhemoglobin saturation. Prevalent hypertension was defined as either a systolic BP ≥130 mm Hg or diastolic BP >80mm Hg, use of antihypertensive medication, or self-report of a diagnosis of hypertension. Controlled BP was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg; uncontrolled BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with use of 1 to 2 classes of antihypertensive medication; and resistant BP as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg with the use of ≥3 classes of antihypertensive medication (including a diuretic) or use of ≥4 classes of antihypertensive medication regardless of BP level. Multinomial logistic regression models were fit to determine the association between OSA severity and uncontrolled BP or resistant hypertension (versus controlled BP) after multivariable adjustment. RESULTS The analytic sample with hypertension (N=664) had a mean age of 64.0 (SD,10.6) years, and were predominately female (69.1%), obese (58.6%), and college educated (51.3%). Among the sample, 25.7% had OSA, which was untreated in 94% of participants. Overall, 48% of participants had uncontrolled hypertension and 14% had resistant hypertension. After adjustment for confounders, participants with moderate or severe OSA had a 2.0 times higher odds of resistant hypertension (95% confidence interval [CI], 1.14-3.67). Each standard deviation higher than <90% oxyhemoglobin saturation was associated with an adjusted odds ratio for resistant hypertension of 1.25 (95% CI 1.01-1.55). OSA and <90% oxyhemoglobin saturation were not associated with uncontrolled BP. CONCLUSION Untreated moderate or severe OSA is associated with increased odds of resistant hypertension. These results suggest that untreated OSA may contribute to inadequate BP control in blacks.
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Affiliation(s)
- Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA (D.A.J., N.G., M.R., S.R.)
- Division of Sleep Medicine, Harvard Medical School, Boston, MA (D.A.J., S.R.)
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (D.A.J.)
| | - S Justin Thomas
- Departments of Psychiatry (S.J.T.), University of Alabama at Birmingham
| | - Marwah Abdalla
- Department of Medicine, Columbia University, New York, NY (M.A.)
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA (D.A.J., N.G., M.R., S.R.)
| | - Yuichiro Yano
- Department of Community and Family Medicine, Duke University, Durham, NC (Y.Y.)
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA (D.A.J., N.G., M.R., S.R.)
| | - Rikki M Tanner
- Epidemiology (R.M.T., P.M.), University of Alabama at Birmingham
| | - Murray A Mittleman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.A.M., S.R.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA (M.A.M., S.R.)
| | - David A Calhoun
- Medicine (D.A.C., P.M.), University of Alabama at Birmingham
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.G.W.)
| | - Paul Muntner
- Medicine (D.A.C., P.M.), University of Alabama at Birmingham
- Epidemiology (R.M.T., P.M.), University of Alabama at Birmingham
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA (D.A.J., N.G., M.R., S.R.)
- Division of Sleep Medicine, Harvard Medical School, Boston, MA (D.A.J., S.R.)
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.A.M., S.R.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA (M.A.M., S.R.)
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14
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Smith DF, Amin RS. OSA and Cardiovascular Risk in Pediatrics. Chest 2019; 156:402-413. [PMID: 30790552 DOI: 10.1016/j.chest.2019.02.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/21/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
OSA occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well documented. Although changes in BP regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease. Early pathophysiologic changes may lead to a lifetime burden of cardiovascular disease and early mortality. With this perspective in mind, our review discusses pathways leading to cardiovascular pathology in children with OSA and provides a comprehensive overview of recent research findings related to cardiovascular sequelae in the pediatric population.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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15
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Neumannova K, Hobzova M, Sova M, Prasko J. Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial. Sleep Med 2018; 52:92-97. [DOI: 10.1016/j.sleep.2018.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/31/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
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Genta-Pereira DC, Furlan SF, Omote DQ, Giorgi DM, Bortolotto LA, Lorenzi-Filho G, Drager LF. Nondipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring. Hypertension 2018; 72:979-985. [DOI: 10.1161/hypertensionaha.118.11525] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A nondipping blood pressure (BP) pattern is common in patients with obstructive sleep apnea (OSA). However, it is unclear how useful a nondipping BP pattern is in screening for OSA. In this cross-sectional study, we recruited consecutive patients with clinical indications for performing ambulatory BP monitoring evaluating the following dipping patterns: (1) normal: ≥10% but <20%; (2) extreme: ≥20%; (3) reduced: ≥0% but <10%; and (4) reverse (riser): <0%. Sleep questionnaires and sleep studies were performed within 7 days after ambulatory BP monitoring. OSA was defined as an apnea-hypopnea index ≥15 events/h. We evaluated 153 patients (OSA frequency, 50.3%). Patients with OSA had higher BPs during sleep, were taking more antihypertensive drugs, and more frequently used hypertensive drugs during the night than patients without OSA. Considering systolic BP, the frequency of OSA in patients with reverse dippers (73.5%) was higher than normal (37.3%), extreme (46.2%), and reduced dippers (49.1%;
P
=0.012). For diastolic BP, OSA was more common in reduced (66.7%) and reverse dippers (69.6%) as compared to normal (41.4%) or extreme dippers (33.3%;
P
=0.007). In the regression analysis, reverse systolic dipper was independently associated with OSA (odds ratio, 3.92; 95% CI, 1.31–11.78). Both reduced and reverse diastolic dippers increased the likelihood of OSA for 2.7-fold and 3.5-fold, respectively. Snoring and positive sleep questionnaire findings were associated with a modest increase in the accuracy of reverse dipping pattern for predicting OSA. In conclusion, reverse systolic, as well as reduced and reverse diastolic dippers are independently associated with OSA.
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Affiliation(s)
- Daniel Castanho Genta-Pereira
- From the Program in Cardiology, Faculty of Medicine, University of São Paulo, Brazil (D.C.G.-P., S.F.F.)
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Sofia F. Furlan
- From the Program in Cardiology, Faculty of Medicine, University of São Paulo, Brazil (D.C.G.-P., S.F.F.)
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Daniel Q. Omote
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Dante M.A. Giorgi
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Luiz A. Bortolotto
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division (G.L.-F.), University of São Paulo Medical School, Brazil
| | - Luciano F. Drager
- Hypertension Unit, Heart Institute (InCor) (D.C.G.-P., S.F.F., D.Q.O., D.M.A.G., L.A.B., L.F.D.), University of São Paulo Medical School, Brazil
- Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil
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17
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Braun RK, Broytman O, Braun FM, Brinkman JA, Clithero A, Modi D, Pegelow DF, Eldridge M, Teodorescu M. Chronic intermittent hypoxia worsens bleomycin-induced lung fibrosis in rats. Respir Physiol Neurobiol 2018; 256:97-108. [PMID: 28456608 PMCID: PMC5659967 DOI: 10.1016/j.resp.2017.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/03/2017] [Accepted: 04/13/2017] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) has been linked to increased mortality in pulmonary fibrosis. Its key feature, chronic intermittent hypoxia (CIH), can lead to oxidative stress and inflammation, known to lead to fibrotic pathology in other organs. We tested the effects of CIH in an animal model of bleomycin-induced lung fibrosis. Sprague Dawley rats were instilled intratracheally with bleomycin (Blm) or saline (Sal), and exposed to CIH or normal air (Norm) for 9 or 30 days. Pulmonary function was tested and lungs were harvested for histological and molecular analyses. In Blm-treated animals, 30days of CIH compared to Norm increased total lung collagen content (p=0.008) and reduced Quasi-static lung compliance (p=0.04). CIH upregulated lipid peroxidation and increased NF-κB activation, IL-17 mRNA and Col1α1 mRNA expression. Our results indicate that following Blm-induced lung injury, CIH amplifies collagen deposition via oxidative and inflammatory pathways, culminating in stiffer lungs. Thus, OSA may augment fibrosis in patients with interstitial lung disease.
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Affiliation(s)
- Rudolf K Braun
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Oleg Broytman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, United States
| | - Felix M Braun
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Colorado College, Colorado Springs, CO, United States
| | - Jacqueline A Brinkman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, United States
| | - Andrew Clithero
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Dhruvangkumar Modi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - David F Pegelow
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Marlowe Eldridge
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Mihaela Teodorescu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Administration Hospital, Madison, WI, United States.
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DEL GRANDE LM, HERBELLA FAM, KATAYAMA RC, SCHLOTTMANN F, PATTI MG. THE ROLE OF THE TRANSDIAPHRAGMATIC PRESSURE GRADIENT IN THE PATHOPHYSIOLOGY OF GASTROESOPHAGEAL REFLUX DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:13-17. [DOI: 10.1590/s0004-2803.201800000-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 12/15/2022]
Abstract
ABSTRACT Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract in the Western world. GERD pathophysiology is multifactorial. Different mechanisms may contribute to GERD including an increase in the transdiaphragmatic pressure gradient (TPG). The pathophysiology of GERD linked to TPG is not entirely understood. This review shows that TPG is an important contributor to GERD even when an intact esophagogastric barrier is present in the setting of obesity and pulmonary diseases.
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Metoprolol has a similar therapeutic effect as amlodipine on BP lowering in hypertensive patients with obstructive sleep apnea. Sleep Breath 2018; 23:227-233. [DOI: 10.1007/s11325-018-1688-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
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20
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Arena R, Daugherty J, Bond S, Lavie CJ, Phillips S, Borghi-Silva A. The combination of obesity and hypertension: a highly unfavorable phenotype requiring attention. Curr Opin Cardiol 2018; 31:394-401. [PMID: 27070650 DOI: 10.1097/hco.0000000000000294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Body habitus is a key lifestyle characteristic whose current status and future projections are disconcerting. The percentage of the global population who are either overweight or obese has substantially increased, with no indication that any country has a solution to this issue. Hypertension is a key unfavorable health metric that, like obesity, has disastrous health implications if left uncontrolled. Poor lifestyle characteristics and health metrics often cluster together to create complex and difficult to treat phenotypes. Excess body mass is such an example, creating an obesity-hypertension phenotype, which is the focus of this review. RECENT FINDINGS An increased risk for hypertension is clearly linked to obesity, indicating that the two conditions are intimately linked. The cascade of obesity-induced pathophysiologic adaptations creates a clear path to hypertension. Adopting a healthy lifestyle is a primary intervention for the prevention as well as treatment of the obesity-hypertension phenotype. SUMMARY The obesity-hypertension phenotype is highly prevalent and has disastrous health implications. A primordial prevention strategy, focused on lifelong healthy lifestyle patterns, is the optimal approach for this condition. For those individuals already afflicted by the obesity-hypertension phenotype, interventions must aggressively focus on weight loss and blood pressure control.
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Affiliation(s)
- Ross Arena
- aDepartment of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences bDepartment of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois, Chicago, Illinois cDepartment of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine; New Orleans, Louisiana, USA dCardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil
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21
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Obstructive sleep apnea increases systolic and diastolic blood pressure variability in hypertensive patients. Blood Press Monit 2018; 22:208-212. [PMID: 28394772 DOI: 10.1097/mbp.0000000000000259] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) has been identified as the most common secondary contributing factor for the development and worsening of hypertension. However, the underlying relationships between blood pressure variability (BPV) and OSA are still not very clear. Therefore, we investigated the influences of OSA on BPV in hypertensive patients and explored the potential pathophysiologic mechanisms. PARTICIPANTS AND METHODS Ambulatory blood pressure (BP) monitoring was carried out and polysomnography was performed to detect sleep apnea. A total of 86 hypertensive individuals were divided into patients without OSA (n=43) and patients with severe OSA (n=43). Systolic and diastolic BPV were obtained by calculating the SD, coefficient of variation, and average real variability during day-time, night-time, and over 24 h. The relationship between OSA and BPV was assessed after adjustment for potential confounding variables (age, sex, BMI, neck circumference, heart rate, and snoring history). RESULTS Compared with participants without OSA, nocturnal systolic BPV and 24-h systolic BP average real variability from OSA participants were obviously increased (P<0.05), but there were no statistically significant differences in day-time and 24-h systolic BP SD and coefficient of variation (P>0.05). Compared with participants without OSA, 24-h diastolic BPV and day-time diastolic BP SD from OSA participants were markedly increased (P<0.05), but nocturnal indices showed no significant differences between the two groups. CONCLUSION OSA mainly increases night-time systolic and 24-h diastolic BPV in hypertensive patients. This may provide a plausible explanation for OSA remaining a major risk determinant for cardiovascular diseases.
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22
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The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertens Res 2017; 40:947-963. [DOI: 10.1038/hr.2017.75] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/07/2017] [Accepted: 04/14/2017] [Indexed: 02/07/2023]
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Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the Global SYMPLICITY Registry. J Hypertens 2017; 35:148-153. [PMID: 27906840 DOI: 10.1097/hjh.0000000000001142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep-disordered breathing, predominantly obstructive sleep apnea (OSA), is highly prevalent in patients with hypertension. OSA may underlie the progression to resistant hypertension, partly due to increased activation of the sympathetic nervous system. This analysis of patients with and without OSA evaluated the blood pressure (BP)-lowering effect of sympathetic modulation by renal denervation (RDN) in a real-world setting. METHODS The Global SYMPLICITY Registry (NCT01534299) is a prospective, open-label, multicenter registry conducted worldwide to evaluate the safety and effectiveness of RDN in patients with uncontrolled hypertension. Office and 24-h ambulatory BP were reported for all patients, based on the presence of OSA. RESULTS Among 1868 patients, self-reported OSA occurred in 205 patients, who were more likely to be men (76 vs 57%, P < 0.001), have a higher BMI (34 ± 6 vs 30 ± 5 kg/m, P < 0.001), chronic kidney disease (30 vs 21%, P = 0.003), left ventricular hypertrophy (25 vs 15%, P < 0.001), and type 2 diabetes (50 vs 36%, P < 0.001). Among OSA patients, the baseline office SBP (166 ± 26 mmHg) was reduced by 14.0 ± 25.3 mmHg at 6 months (P < 0.001). Ambulatory 24-h SBP was reduced by 4.9 ± 18.0 mmHg (n = 115, P = 0.005) from 155 ± 19 mmHg at baseline. The 6-month change in SBP from baseline was not statistically different between OSA and non-OSA patients. BP reduction after RDN was also similar in OSA patients already treated with and not treated with continuous positive airway pressure. CONCLUSION RDN resulted in significant BP reductions at 6 months in hypertensive patients with and without OSA, and regardless of continuous positive airway pressure usage in OSA patients.
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Abstract
PURPOSE OF REVIEW With the prevalence of obesity rapidly growing, bariatric anaesthesia becomes everyday anaesthesia rather than a subspecialty. In this review, we are aiming to draw attention to this complex group of patients and their comorbidities, relevant to everyday practice for contemporary anaesthetists. RECENT FINDINGS We wanted to focus greatly on sleep-related breathing disorders, because preoperative screening, diagnosis and treatment of the aforementioned make a huge impact in the improvement of preoperative morbidity and mortality, including positive effects on the cardiovascular system. The overview is touching on main obesity-related comorbidities and guides the anaesthetist and associated health professionals on how to approach and manage them. A multidisciplinary approach widely used in bariatric care may be adopted in the care of obese patients in order to reduce preoperative morbidity and mortality. We advocate the early involvement of the anaesthetic team in the preoperative assessment of obese patients in order to achieve appropriate risk stratification and optimise the care.
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Affiliation(s)
- Asta Lukosiute
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, London, W2 1NY, UK.
| | - Anil Karmali
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, London, W2 1NY, UK
| | - Jonathan Mark Cousins
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed St, London, W2 1NY, UK
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Ma Y, Sun S, Peng CK, Fang Y, Thomas RJ. Ambulatory Blood Pressure Monitoring in Chinese Patients with Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:433-439. [PMID: 27855748 DOI: 10.5664/jcsm.6498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 10/18/2016] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES Nocturnal blood pressure (BP) dipping in patients with obstructive sleep apnea (OSA) has not yet been well investigated in Chinese patients, in whom the relationship of OSA and body mass index (BMI) is weaker than that in Caucasians. The aim of this study was to evaluate the BP profile, and the relationships between nocturnal BP and the severity of OSA, in Chinese patients. METHODS Consecutive Chinese adult outpatients with suspected OSA had overnight polysomnography (PSG), office BP, and 24-h ambulatory BP monitoring (ABPM). The apnea-hypopnea index (AHI) and nocturnal oxygen saturation level were recorded, and BP patterns were classified based on the ABPM. RESULTS Fifty-six subjects (40 male and 16 female, 48.59 ± 13.27 y) were evaluated. There were 14 patients with mild OSA (25.0%, AHI: 10.56 ± 3.42 events/h), 16 with moderate OSA (28.6%, AHI: 23.536 ± 3.42 events/h) and 26 with severe OSA (46.4%, AHI: 51.52 ± 3.42 events/h). There were 18 dippers (32.1%), 27 non-dippers (48.2%), and 11 reverse dippers (19.6%). As OSA severity increased, non-dipping also increased. A total of 67.9% of the OSA patients showed overall hypertension on ABPM, 57.1% had daytime hypertension only, and 73.2% had nighttime hypertension. CONCLUSIONS OSA severity is associated with 24-h BP profiles in a population with only mild increases in BMI. These results can influence clinical practice, OSA management, and hypertension treatment policies.
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Affiliation(s)
- Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Shuchen Sun
- Department of Otolaryngology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,South Campus Sleep Center, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yeming Fang
- Cardiovascular Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Robert J Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Lu W, Kang J, Hu K, Tang S, Zhou X, Xu L, Li Y, Yu S. The role of the Nox4-derived ROS-mediated RhoA/Rho kinase pathway in rat hypertension induced by chronic intermittent hypoxia. Sleep Breath 2017; 21:667-677. [PMID: 28078487 DOI: 10.1007/s11325-016-1449-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 11/23/2016] [Accepted: 12/22/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome, which is a risk factor for resistant hypertension, is characterized by chronic intermittent hypoxia (CIH) and is associated with many cardiovascular diseases. CIH elicits systemic oxidative stress and sympathetic hyperactivity, which lead to hypertension. Rho kinases (ROCKs) are considered to be major effectors of the small GTPase RhoA and have been extensively studied in the cardiovascular field. Upregulation of the RhoA/ROCK signaling cascade is observed in various cardiovascular disorders, such as atherosclerosis, pulmonary hypertension, and stroke. However, the exact molecular function of RhoA/ROCK in CIH remains unclear and requires further study. OBJECTIVE This study aimed to investigate the role of the NADPH oxidase 4 (Nox4)-induced ROS/RhoA/ROCK pathway in CIH-induced hypertension in rats. METHODS Male Sprague-Dawley rats were exposed to CIH for 21 days (intermittent hypoxia of 21% O2 for 60 s and 5% O2 for 30 s, cyclically repeated for 8 h/day). We randomly assigned 56 male rats to groups of normoxia (RA) or vertically implemented CIH together with vehicle (CIH-V), GKT137831 (CIH-G), N-acetyl cysteine (NAC) (CIH-N), or Y27632 (CIH-Y). The rats in the RA group were continuously exposed to room air, whereas the rats in the other groups were exposed to CIH. Systolic blood pressure (BP) was monitored at the beginning of each week. After the experiment, renal sympathetic nerve activity (RSNA) was recorded, and serum and renal tissues were subjected to molecular biological and biochemical analyses. RESULTS Compared with the BP of RA rats, the BP of CIH-V rats started to increase 2 weeks after the beginning of the experiment, subsequently stabilizing at a high level at the end of the third week. CIH increased both RSNA and oxidative stress. This response was attenuated by treatment of the rats with GKT137831 or NAC. Inhibiting Nox4 activity or ROS production reduced RhoA/ROCK expression. Treatment with Y27632 reduced both BP and RSNA in rats exposed to CIH. CONCLUSION Hypertension can be induced by CIH in SD rats. The CIH-induced elevation of BP is at least partially mediated via the Nox4-induced ROS/RhoA/ROCK pathway.
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Affiliation(s)
- Wen Lu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Jing Kang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Ke Hu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China.
| | - Si Tang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Xiufang Zhou
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Lifang Xu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Yuanyuan Li
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Shuhui Yu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
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Bhushan B, Ayub B, Thompson DM, Abdullah F, Billings KR. Impact of short sleep on metabolic variables in obese children with obstructive sleep apnea. Laryngoscope 2016; 127:2176-2181. [PMID: 27868206 DOI: 10.1002/lary.26420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/14/2016] [Accepted: 10/13/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the association between sleep duration, metabolic variables, and insulin resistance in obese children with and without obstructive sleep apnea. The decline in sleep duration has paralleled a dramatic increase in the prevalence of obesity and diabetes, suggesting a mechanistic relationship. STUDY DESIGN Retrospective, case series. METHODS Consecutive obese patients 3 to 12 years of age who underwent polysomnography (PSG) and a metabolic panel and who completed a 14-item sleep questionnaire were analyzed. All laboratory testing was conducted within 3 months of PSG. Total sleep times were obtained from the PSG and confirmed by the questionnaire. RESULTS A total of 171 patients (55.0% male) were studied. All patients were obese (body mass index [BMI] z score > 95th percentile). Patients were categorized into three groups: short sleepers, borderline sleepers, and optimal sleepers. Eighty-six (50.3%) patients were short sleepers, 71 (41.5%) were borderline sleepers, and 14 (8.2%) were optimal sleepers. The mean BMI z score was 3.13 ± 1.3 in short sleepers, 3.3 ± 1.1 in borderline sleepers, and 3.5 ± 1.5 in optimal sleepers (P = .39). There was no statistical difference in high- and low-density lipoprotein levels (P = .21 and P = .76, respectively) and total cholesterol (P = .43) among subgroups. Triglycerides, blood glucose, insulin, and homeostasis model assessment-insulin resistance were significantly higher in short sleepers when compared to borderline or normal sleepers (P = .008, P < .001, P < .001, and P < .001, respectively). CONCLUSIONS Short sleep duration was correlated with alterations in metabolic variables and insulin resistance in obese patients. This raises concern for development of comorbid conditions that can persist into adulthood. LEVEL OF EVIDENCE 4 Laryngoscope, 127:2176-2181, 2017.
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Affiliation(s)
- Bharat Bhushan
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine
| | - Bushra Ayub
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Dana M Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Kathleen R Billings
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine
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Pijacka W, McBryde FD, Marvar PJ, Lincevicius GS, Abdala APL, Woodward L, Li D, Paterson DJ, Paton JFR. Carotid sinus denervation ameliorates renovascular hypertension in adult Wistar rats. J Physiol 2016; 594:6255-6266. [PMID: 27510951 DOI: 10.1113/jp272708] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/03/2016] [Indexed: 01/24/2023] Open
Abstract
KEY POINTS Peripheral chemoreflex sensitization is a feature of renovascular hypertension. Carotid sinus nerve denervation (CSD) has recently been shown to relieve hypertension and reduce sympathetic activity in other rat models of hypertension. We show that CSD in renovascular hypertension halts further increases in blood pressure. Possible mechanisms include improvements in baroreceptor reflex sensitivity and renal function, restoration of cardiac calcium signalling towards control levels, and reduced neural inflammation. Our data suggest that the peripheral chemoreflex may be a viable therapeutic target for renovascular hypertension. ABSTRACT The peripheral chemoreflex is known to be hyper-responsive in both spontaneously hypertensive (SHR) and Goldblatt hypertensive (two kidney one clip; 2K1C) rats. We have previously shown that carotid sinus nerve denervation (CSD) reduces arterial blood pressure (ABP) in SHR. In the present study, we show that CSD ameliorates 2K1C hypertension and reveal the potential underlying mechanisms. Adult Wistar rats were instrumented to record ABP via telemetry, and then underwent CSD (n = 9) or sham CSD (n = 9) 5 weeks after renal artery clipping, in comparison with normal Wistar rats (n = 5). After 21 days, renal function was assessed, and tissue was collected to assess sympathetic postganglionic intracellular calcium transients ([Ca2+ ]i ) and immune cell infiltrates. Hypertensive 2K1C rats showed a profound elevation in ABP (Wistar: 98 ± 4 mmHg vs. 2K1C: 147 ± 8 mmHg; P < 0.001), coupled with impairments in renal function and baroreflex sensitivity, increased neuroinflammatory markers and enhanced [Ca2+ ]I in stellate neurons (P < 0.05). CSD reduced ABP in 2K1C+CSD rats and prevented the further progressive increase in ABP seen in 2K1C+sham CSD rats, with a between-group difference of 14 ± 2 mmHg by week 3 (P < 0.01), which was accompanied by improvements in both baroreflex control and spectral indicators of cardiac sympatho-vagal balance. Furthermore, CSD improved protein and albuminuria, decreased [Ca2+ ]i evoked responses from stellate neurons, and also reduced indicators of brainstem inflammation. In summary, CSD in 2K1C rats reduces the hypertensive burden and improves renal function. This may be mediated by improvements in autonomic balance, functional remodelling of post-ganglionic neurons and reduced inflammation. Our results suggest that the peripheral chemoreflex may be considered as a potential therapeutic target for controlling renovascular hypertension.
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Affiliation(s)
- Wioletta Pijacka
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Fiona D McBryde
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.,Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul J Marvar
- Department of Pharmacology and Physiology, The George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | - Gisele S Lincevicius
- Cardiovascular Division - Department of Physiology, Escola Paulista de Medicina, Universidade Federal de, Sao Paulo, Brazil
| | - Ana P L Abdala
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Lavinia Woodward
- Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Dan Li
- Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - David J Paterson
- Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.
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Metabolic consequences of snoring in adolescents and younger adults: a population study in Chile. Int J Obes (Lond) 2016; 40:1510-1514. [PMID: 27478923 DOI: 10.1038/ijo.2016.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/09/2016] [Accepted: 06/25/2016] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES To investigate the potential association between snoring and other symptoms indicative of sleep-disordered breathing and metabolic syndrome (MetS) in Hispanic adolescents and younger adults using a large population-based survey. METHODS Sleep-related information, anthropometric measurements and fasting blood samples markers of MetS were obtained from subjects aged 15-40 years collected through the 2nd Chilean Health Survey. Regression models were constructed to evaluate the associations of snoring with MetS, hypertension and serum cholesterol levels. The modulating effect of sleep duration was accounted for in the models. RESULTS A total of 2147 subjects (42% males, mean age 27.9±7.6 years) were included. Snoring and short sleep duration were present in 43.5 and 25% of the entire population, respectively. MetS was detected in 19.5% of the subjects. In the adjusted regression model, the odds of MetS among snoring subjects were 2.13 times higher (95% confidence interval (CI): 1.52-2.99; P<0.01), and 1.53-fold higher odds of elevated cholesterol also emerged (95% CI: 1.12-2.10; P<0.01). However, the odds of hypertension were not increased by the presence of snoring after adjusting for confounders. In addition, snoring was associated with an increase of 7.26 and 6.56 mg dl-1 for total and low-density lipoprotein cholesterol, respectively, even after adjusting for age, sex and body mass index. Short sleep duration was associated with a small albeit significant risk increase for high systolic blood pressure. CONCLUSIONS In this large population-based sample of young Hispanic adults and adolescents, snoring, but not sleep duration, emerged as an independent risk factor for dyslipidemia and MetS, but not for hypertension.
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30
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Uyar M, Davutoglu V. An update on cardiovascular effects of obstructive sleep apnoea syndrome. Postgrad Med J 2016; 92:540-4. [PMID: 27317753 DOI: 10.1136/postgradmedj-2016-134093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/24/2016] [Indexed: 01/25/2023]
Abstract
Obstructive sleep apnoea syndrome is an important health problem which may cause or worsen systemic diseases. Chronic intermittent hypoxia during repetitive airflow cessations may cause endothelial dysfunction. Sleep apnoea is also shown to be associated with hypercoagulability which may be due to decreased nitric oxide levels and impaired vasodilatation. Endothelial dysfunction, increased systemic inflammation, sympathetic nervous system activation, increased oxidative stress and dysglycaemia may all contribute to cardiovascular processes such as hypertension, arrhythmia, stroke, heart failure and coronary artery disease in patients with obstructive sleep apnoea. Treatment approaches in patients with obstructive sleep apnoea mainly focus on maintaining upper airway patency either with positive airway pressure devices or upper airway appliances. Strategies involving positive airway pressure therapy are associated with decreased morbidity and mortality. Obstructive sleep apnoea should be suspected as an underlying mechanism in patients with cardiovascular disease and warrants appropriate treatment.
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Affiliation(s)
- Meral Uyar
- Department of Respiratory Medicine, Gaziantep University, Gaziantep, Turkey
| | - Vedat Davutoglu
- Department of Cardiology, Gaziantep University, Gaziantep, Turkey
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31
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Maski MR, Thomas RJ, Karumanchi SA, Parikh SM. Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with Obstructive Sleep Apnea. PLoS One 2016; 11:e0154503. [PMID: 27149121 PMCID: PMC4858300 DOI: 10.1371/journal.pone.0154503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a well-established risk factor for hypertension and cardiovascular morbidity and mortality. More recently, OSA has been implicated as an independent risk factor for chronic kidney disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well-accepted early biomarker of subclinical kidney tubular injury, preceding an increase in serum creatinine. The goal of this study was to determine if an association exists between OSA and increased urinary NGAL levels. Methods We prospectively enrolled adult patients from the sleep clinic of an academic medical center. Each underwent polysomnography and submitted a urine specimen upon enrollment. We measured NGAL and creatinine levels on all urine samples before participants received treatment with continuous positive airway pressure (CPAP), and, in a subset of OSA patients, after CPAP therapy. We compared the urinary NGAL/creatinine ratio between untreated participants with and without OSA, and within a subset of 11 OSA patients also after CPAP therapy. Results A total of 49 subjects were enrolled: 16 controls based on an apnea-hypopnea index (events with at least 4% oxygen desaturation; AHI-4%) <5 events/hour (mean AHI-4% = 0.59 +/- 0.60); 33 OSA patients based on an AHI-4% >5 events/hour (mean AHI-4% = 43.3 +/- 28.1). OSA patients had a higher mean body-mass index than the control group (36.58 +/- 11.02 kg/m2 vs. 26.81 +/- 6.55 kg/m2, respectively; p = 0.0005) and were more likely to be treated for hypertension (54.5% vs. 6.25% of group members, respectively; p = 0.0014). The groups were otherwise similar in demographics, and there was no difference in the number of diabetic subjects or in the mean serum creatinine concentration (control = 0.86 +/- 0.15 mg/dl, OSA = 0.87 +/- 0.19 mg/dl; p = 0.7956). We found no difference between the urinary NGAL-to-creatinine ratios among untreated OSA patients versus control subjects (median NGAL/creatinine = 6.34 ng/mg vs. 6.41 ng/mg, respectively; p = 0.4148). Furthermore, CPAP therapy did not affect the urinary NGAL-to-creatinine ratio (p = 0.7758 for two-tailed, paired t-test). Conclusions In this prospective case-control study comparing patients with severe, hypoxic OSA to control subjects, all with normal serum creatinine, we found no difference between urinary levels of NGAL. Furthermore, CPAP therapy did not change these levels pre- and post-treatment.
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Affiliation(s)
- Manish R. Maski
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care, & Sleep Medicine/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - S. Ananth Karumanchi
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samir M. Parikh
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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Messias LR, Ferreira AG, de Miranda SMR, Teixeira JAC, de Azevedo JC, Messias ACNV, Maróstica E, Mesquita CT. Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction. Arq Bras Cardiol 2016; 106:358-66. [PMID: 27096522 PMCID: PMC4914000 DOI: 10.5935/abc.20160046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. OBJECTIVES To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. METHODS Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. RESULTS After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters. CONCLUSION Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.
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Affiliation(s)
| | | | | | | | - Jader Cunha de Azevedo
- Universidade Federal Fluminense, Rio de Janeiro, RJ -
Brazil
- Hospital Procardíaco, Rio de Janeiro, RJ -
Brazil
| | | | | | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense, Rio de Janeiro, RJ -
Brazil
- Hospital Procardíaco, Rio de Janeiro, RJ -
Brazil
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Brockmann PE. Cardiovascular Consequences in Children with Obstructive Sleep Apnea: Is It Possible to Predict Them? Sleep 2015; 38:1343-4. [PMID: 26237778 DOI: 10.5665/sleep.4960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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35
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Delmonte Piovezan R, Tufik S, Poyares D. OSACS score--a new simple tool for identifying high risk for obstructive sleep apnea syndrome based on clinical parameters. Anatol J Cardiol 2015; 15:676. [PMID: 26301352 PMCID: PMC5336873 DOI: 10.5152/anatoljcardiol.2015.6370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ronaldo Delmonte Piovezan
- Sleep Medicine Division, Psychobiology Department, Universidade Federal de Sao Paulo; Sao Paulo-Brazil.
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Nadaleto BF, Herbella FAM, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surgery 2015; 159:475-86. [PMID: 26054318 DOI: 10.1016/j.surg.2015.04.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Obesity is a condition that has increased all over the world in the last 3 decades. Overweight and gastroesophageal reflux disease (GERD) are related. GERD may have different causative factors in the obese compared with lean individuals. This review focuses on the proper treatment for GERD in the obese based on its pathophysiology. Increased abdominal pressure may play a more significant role in obese subjects with GERD than the defective esophagogastric barrier usually found in nonobese individuals. A fundoplication may be used to treat GERD in these individuals; however, outcomes may be not as good as in nonobese patients and it does not act on the pathophysiology of the disease. All bariatric techniques may ameliorate GERD symptoms owing to a decrease in abdominal pressure secondary to weight loss. However, some operations may lead to a disruption of natural anatomic antireflux mechanisms or even lead to slow gastric emptying and/or esophageal clearance and thus be a refluxogenic procedure. Roux-en-Y gastric bypass decreases both acid and bile reflux from the stomach into the esophagus. On the other hand, gastric banding is a refluxogenic operation, and sleeve gastrectomy may show different outcomes based on the anatomy of the gastric tube.
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Affiliation(s)
- Barbara F Nadaleto
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marco G Patti
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL
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Magyar MT. [Beneficial effect of continuous positive airway pressure therapy in obstructive sleep apnea syndrome]. Orv Hetil 2014; 155:1855-9. [PMID: 25403278 DOI: 10.1556/oh.2014.30040] [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: 11/19/2022]
Abstract
Continuous positive airway pressure therapy is an evidence based therapy of obstructive sleep apnea syndrome. The effective treatment of obstructive sleep apnea can decrease sympaticotonia and, consequently, blood pressure. Furthermore, it can improve inflammatory and metabolic parameters resulting in a decreased cardiovascular risk. This article summarizes the positive effects of continuous positive airway pressure therapy on cardiovascular risk factors in obstructive sleep apnea syndrome.
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Affiliation(s)
- Mária Tünde Magyar
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Neurológiai Klinika Debrecen Móricz Zs. krt. 22 4032
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38
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Fink GD, Osborn JW. Renal nerves: time for reassessment of their role in hypertension? Am J Hypertens 2014; 27:1245-7. [PMID: 24871630 DOI: 10.1093/ajh/hpu096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gregory D Fink
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan;
| | - John W Osborn
- Department of Integrative Biology and Physiology, University of Minnesota, Minnesota, Minneapolis
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Mancuso P, O′Brien E, Prano J, Goel D, Aronoff DM. No Impairment in host defense against Streptococcus pneumoniae in obese CPEfat/fat mice. PLoS One 2014; 9:e106420. [PMID: 25203099 PMCID: PMC4159279 DOI: 10.1371/journal.pone.0106420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/06/2014] [Indexed: 12/16/2022] Open
Abstract
In the US and globally, dramatic increases in the prevalence of adult and childhood obesity have been reported during the last 30 years. In addition to cardiovascular disease, type II diabetes, and liver disease, obesity has recently been recognized as an important risk factor for influenza pneumonia. During the influenza pandemic of 2009, obese individuals experienced a greater severity of illness from the H1N1 virus. In addition, obese mice have also been shown to exhibit increased lethality and aberrant pulmonary inflammatory responses following influenza infection. In contrast to influenza, the impact of obesity on bacterial pneumonia in human patients is controversial. In this report, we compared the responses of lean WT and obese CPEfat/fat mice following an intratracheal infection with Streptococcus pneumoniae, the leading cause of community-acquired pneumonia. At 16 weeks of age, CPEfat/fat mice develop severe obesity, hyperglycemia, elevated serum triglycerides and leptin, and increased blood neutrophil counts. There were no differences between lean WT and obese CPEfat/fat mice in survival or lung and spleen bacterial burdens following intratracheal infection with S. pneumoniae. Besides a modest increase in TNF-α levels and increased peripheral blood neutrophil counts in CPEfat/fat mice, there were not differences in lung or serum cytokines after infection. These results suggest that obesity, accompanied by hyperglycemia and modestly elevated triglycerides, at least in the case of CPEfat/fat mice, does not impair innate immunity against pneumococcal pneumonia.
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Affiliation(s)
- Peter Mancuso
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
- Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Edmund O′Brien
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Joseph Prano
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Deepti Goel
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David M. Aronoff
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
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Kawada N, Nakanishi K, Ohama T, Nishida M, Yamauchi-Takihara K, Moriyama T. Gender differences in the relationship between blood pressure and body mass index during adolescence. Obes Res Clin Pract 2014; 9:141-51. [PMID: 25081807 DOI: 10.1016/j.orcp.2014.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/27/2014] [Accepted: 07/08/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In adults, gender and obesity play significant roles in the regulation of blood pressure (BP). This study investigated the effects of gender and body mass index (BMI) on BP during adolescence. DESIGN AND SETTING A cross-sectional and longitudinal study involving 6838 students under twenty years old (median, eighteen years old; male, 4624; female, 2214) at Osaka University visited the Healthcare Center for their matriculation health examination from April to May in the years 2008, 2009, and 2010, and re-visited the Healthcare Center for their student health examination from May to June in the years 2011, 2012, and 2013. METHODS Height, body weight, and BP were measured in students both on and 3 years after admission to Osaka University. RESULTS On admission, the slope of the regression line for BMI and systolic BP (SBP) in non-underweight students was significantly different between genders. SBP and diastolic BP (DBP) increased in both genders during the observation period. Among male students who had a normal BMI on admission, those who had an increase in BMI of over 4% during the observation period showed a greater increase in SBP than those who had a change in BMI of -4% to 4%. On the other hand, female students showed no change in BP with the increase in BMI. CONCLUSIONS The magnitude of BP elevation with increased BMI was associated with gender during adolescence. This may be a cause of the higher prevalence of hypertension in adult males.
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Affiliation(s)
| | | | - Tohru Ohama
- Health Care Center, Osaka University, Toyonaka, Japan
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Jhamb M, Brown LK, Unruh M. Resistant Hypertension in Obstructive Sleep Apnea: Is Continuous Positive Airway Pressure the Next Step? Am J Kidney Dis 2014; 64:13-5. [DOI: 10.1053/j.ajkd.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/11/2022]
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Maliha G, Townsend RR. An Update on Treatment Options for Drug Resistant Hypertension. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genta-Pereira DC, Pedrosa RP, Lorenzi-Filho G, Drager LF. Sleep Disturbances and Resistant Hypertension: Association or Causality? Curr Hypertens Rep 2014; 16:459. [DOI: 10.1007/s11906-014-0459-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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