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Shafer BM, West CR, Foster GE. Advancements in the neurocirculatory reflex response to hypoxia. Am J Physiol Regul Integr Comp Physiol 2024; 327:R1-R13. [PMID: 38738293 PMCID: PMC11380992 DOI: 10.1152/ajpregu.00237.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Hypoxia is a pivotal factor in the pathophysiology of various clinical conditions, including obstructive sleep apnea, which has a strong association with cardiovascular diseases like hypertension, posing significant health risks. Although the precise mechanisms linking hypoxemia-associated clinical conditions with hypertension remains incompletely understood, compelling evidence suggests that hypoxia induces plasticity of the neurocirculatory control system. Despite variations in experimental designs and the severity, frequency, and duration of hypoxia exposure, evidence from animal and human models consistently demonstrates the robust effects of hypoxemia in triggering reflex-mediated sympathetic activation. Both acute and chronic hypoxia alters neurocirculatory regulation and, in some circumstances, leads to sympathetic outflow and elevated blood pressures that persist beyond the hypoxic stimulus. Dysregulation of autonomic control could lead to adverse cardiovascular outcomes and increase the risk of developing hypertension.
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Affiliation(s)
- Brooke M Shafer
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Christopher R West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, British Columbia, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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2
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Alvarez-Araos P, Jiménez S, Salazar-Ardiles C, Núñez-Espinosa C, Paez V, Rodriguez-Fernandez M, Raberin A, Millet GP, Iturriaga R, Andrade DC. Baroreflex and chemoreflex interaction in high-altitude exposure: possible role on exercise performance. Front Physiol 2024; 15:1422927. [PMID: 38895516 PMCID: PMC11184637 DOI: 10.3389/fphys.2024.1422927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
The hypoxic chemoreflex and the arterial baroreflex are implicated in the ventilatory response to exercise. It is well known that long-term exercise training increases parasympathetic and decreases sympathetic tone, both processes influenced by the arterial baroreflex and hypoxic chemoreflex function. Hypobaric hypoxia (i.e., high altitude [HA]) markedly reduces exercise capacity associated with autonomic reflexes. Indeed, a reduced exercise capacity has been found, paralleled by a baroreflex-related parasympathetic withdrawal and a pronounced chemoreflex potentiation. Additionally, it is well known that the baroreflex and chemoreflex interact, and during activation by hypoxia, the chemoreflex is predominant over the baroreflex. Thus, the baroreflex function impairment may likely facilitate the exercise deterioration through the reduction of parasympathetic tone following acute HA exposure, secondary to the chemoreflex activation. Therefore, the main goal of this review is to describe the main physiological mechanisms controlling baro- and chemoreflex function and their role in exercise capacity during HA exposure.
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Affiliation(s)
- Pablo Alvarez-Araos
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Sergio Jiménez
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile
| | - Camila Salazar-Ardiles
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Cristian Núñez-Espinosa
- Escuela de Medicina de la Universidad de Magallanes, Punta Arenas, Chile
- Centro Asistencial de Docencia e Investigación (CADI-UMAG), Santiago, Chile
| | - Valeria Paez
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Rodriguez-Fernandez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antoine Raberin
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Gregoire P. Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Rodrigo Iturriaga
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - David C. Andrade
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
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3
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Latief K, Akyirem S, Sithichoksakulchai S, Nurrika D, Sujarwadi M, Hasan F. The mediating effect of sleep disturbance on the association between hypertension and depression: a national data analysis. Clin Hypertens 2024; 30:5. [PMID: 38297373 PMCID: PMC10832256 DOI: 10.1186/s40885-024-00263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Sleep disturbance is a common among people with hypertension. However, the mediating role of sleep disturbance in the association between hypertension and depression remains unclear. This study aims to investigate the mediating role of sleep disturbance in the association between hypertension and depression. MATERIALS AND METHODS This was cross-sectional study. The data were derived from the Indonesian Family Life Survey Fifth Wave (2014-2015). We include a total of 19,138 adults' participants with age range from 18 to 65 years old who completed response on the variable of hypertension, sleep disturbance, and depression. The mediating model analysis was processed using the PROCESS macro ins SPSS from Hayes model. RESULTS Depression was reported by 22% of total respondents. The group with hypertension showed a substantially higher prevalence of depression than non-hypertension group (P < 0.001). Hypertension had a significant overall effect on depression (β = 0.682; 95%CI 0.489 to 0.875, P < 0.001). The direct effect of hypertension on depression was significant (β = 0.418; 95%CI 0.244 to 0.592, P < 0.001) and the indirect effect that mediated by sleep disturbance was also significant (β = 0.264, 95%CI 0.174 to 0.356, P < 0.001). It is worth noting that sleep disturbance partially mediated the association between hypertension and depression. CONCLUSION The findings of this study indicated that sleep disturbance contributed to the etiology of depression and hypertension in adult populations. Nurses should be involved in managing sleep disturbances, such as using behavioral therapy, as it may serve as both a treatment and primary prevention measure for depression and hypertension.
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Affiliation(s)
- Kamaluddin Latief
- Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Centre for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - Siriluk Sithichoksakulchai
- Department of Fundamental Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dieta Nurrika
- Public Health Study Program, Banten School of Health Science, South Tangerang, Indonesia
- Culture, Research, and Technology, The Ministry of Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
| | - Mokh Sujarwadi
- Faculty of Nursing, Universitas Jember, Jember, Indonesia
| | - Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Boromarajonani Srisataphat Building, 12th Floor Rama1 Road, Wang Mai, Pathum Wan, Bangkok, 10330, Thailand.
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4
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Osuna ED, Zamora AC, Buitrago AF, Salazar JF, Rosales SA, Galeano C, Guzman-Prado Y, Ferreira-Atuesta C. Is it Mandatory to do a 24 hour ABPM in all Patients with Moderate to Severe Obstructive Sleep Apnoea? Sleep Sci 2023; 16:197-205. [PMID: 37425971 PMCID: PMC10325839 DOI: 10.1055/s-0043-1770797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
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Affiliation(s)
- Edgar D. Osuna
- Department of Neurology, Fundación Santafé de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Adrián C. Zamora
- Department of Neurology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | | | | | - Camila Galeano
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Carolina Ferreira-Atuesta
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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5
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Nocera E, Connolly H. Pediatric obstructive sleep apnea syndrome and hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2023. [DOI: 10.1016/j.ppedcard.2023.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Epigenetic Modifications at the Center of the Barker Hypothesis and Their Transgenerational Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312728. [PMID: 34886453 PMCID: PMC8656758 DOI: 10.3390/ijerph182312728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
Embryo/fetal nutrition and the environment in the reproductive tract influence the subsequent risk of developing adult diseases and disorders, as formulated in the Barker hypothesis. Metabolic syndrome, obesity, heart disease, and hypertension in adulthood have all been linked to unwanted epigenetic programing in embryos and fetuses. Multiple studies support the conclusion that environmental challenges, such as a maternal low-protein diet, can change one-carbon amino acid metabolism and, thus, alter histone and DNA epigenetic modifications. Since histones influence gene expression and the program of embryo development, these epigenetic changes likely contribute to the risk of adult disease onset not just in the directly affected offspring, but for multiple generations to come. In this paper, we hypothesize that the effects of parental nutritional status on fetal epigenetic programming are transgenerational and warrant further investigation. Numerous studies supporting this hypothesis are reviewed, and potential research techniques to study these transgenerational epigenetic effects are offered.
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7
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Fernandes LG, Trenhago PR, Feijóo RA, Blanco PJ. Integrated cardiorespiratory system model with short timescale control mechanisms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3332. [PMID: 32189436 DOI: 10.1002/cnm.3332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 12/26/2019] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
A compartmental model of the cardiorespiratory system featuring pulsatile blood flow and gas transport, as well as closed loop mechanisms of cardiorespiratory regulation is presented. Short timescale regulatory action includes baroreflex, peripheral and central chemoreflex feedback. The cardiorespiratory model is composed by compartments to describe blood flow and gas exchange in the major systemic and pulmonic regions. The control systems include formulations to afferent activity of arterial baroreceptor and peripheral and central chemoreceptors. Simulations described here include situations of hypoxia, hypercapnia, and hemorrhage. The overall responses of our simulations agree with physiological (experimental) and theoretical data. Our results suggest that the present model could be used to further understand the interplay among major regulatory mechanisms in the functioning of the cardiovascular and respiratory systems in cases of normal and abnormal physiological conditions.
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Affiliation(s)
- Luciano G Fernandes
- Instituto de Ciências Biológicas e da Saúde, Universidade Federal Rural do Rio de Janeiro, Seropédica, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Rio de Janeiro, Brazil
| | - Paulo R Trenhago
- Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Rio de Janeiro, Brazil
- Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro, Brazil
| | - Raúl A Feijóo
- Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Rio de Janeiro, Brazil
- Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro, Brazil
| | - Pablo J Blanco
- Instituto Nacional de Ciência e Tecnologia em Medicina Assistida por Computação Científica, Petrópolis, Rio de Janeiro, Brazil
- Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro, Brazil
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8
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Rock CR, White TA, Piscopo BR, Sutherland AE, Miller SL, Camm EJ, Allison BJ. Cardiovascular and Cerebrovascular Implications of Growth Restriction: Mechanisms and Potential Treatments. Int J Mol Sci 2021; 22:ijms22147555. [PMID: 34299174 PMCID: PMC8303639 DOI: 10.3390/ijms22147555] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 01/25/2023] Open
Abstract
Fetal growth restriction (FGR) is a common complication of pregnancy, resulting in a fetus that fails to reach its genetically determined growth potential. Whilst the fetal cardiovascular response to acute hypoxia is well established, the fetal defence to chronic hypoxia is not well understood due to experiment constraints. Growth restriction results primarily from reduced oxygen and nutrient supply to the developing fetus, resulting in chronic hypoxia. The fetus adapts to chronic hypoxia by redistributing cardiac output via brain sparing in an attempt to preserve function in the developing brain. This review highlights the impact of brain sparing on the developing fetal cardiovascular and cerebrovascular systems, as well as emerging long-term effects in offspring that were growth restricted at birth. Here, we explore the pathogenesis associated with brain sparing within the cerebrovascular system. An increased understanding of the mechanistic pathways will be critical to preventing neuropathological outcomes, including motor dysfunction such as cerebral palsy, or behaviour dysfunctions including autism and attention-deficit/hyperactivity disorder (ADHD).
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Affiliation(s)
- Charmaine R. Rock
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Tegan A. White
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Beth R. Piscopo
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Amy E. Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
| | - Suzanne L. Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Emily J. Camm
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Beth J. Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
- Correspondence:
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Iturriaga R, Alcayaga J, Chapleau MW, Somers VK. Carotid body chemoreceptors: physiology, pathology, and implications for health and disease. Physiol Rev 2021; 101:1177-1235. [PMID: 33570461 PMCID: PMC8526340 DOI: 10.1152/physrev.00039.2019] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The carotid body (CB) is the main peripheral chemoreceptor for arterial respiratory gases O2 and CO2 and pH, eliciting reflex ventilatory, cardiovascular, and humoral responses to maintain homeostasis. This review examines the fundamental biology underlying CB chemoreceptor function, its contribution to integrated physiological responses, and its role in maintaining health and potentiating disease. Emphasis is placed on 1) transduction mechanisms in chemoreceptor (type I) cells, highlighting the role played by the hypoxic inhibition of O2-dependent K+ channels and mitochondrial oxidative metabolism, and their modification by intracellular molecules and other ion channels; 2) synaptic mechanisms linking type I cells and petrosal nerve terminals, focusing on the role played by the main proposed transmitters and modulatory gases, and the participation of glial cells in regulation of the chemosensory process; 3) integrated reflex responses to CB activation, emphasizing that the responses differ dramatically depending on the nature of the physiological, pathological, or environmental challenges, and the interactions of the chemoreceptor reflex with other reflexes in optimizing oxygen delivery to the tissues; and 4) the contribution of enhanced CB chemosensory discharge to autonomic and cardiorespiratory pathophysiology in obstructive sleep apnea, congestive heart failure, resistant hypertension, and metabolic diseases and how modulation of enhanced CB reactivity in disease conditions may attenuate pathophysiology.
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Affiliation(s)
- Rodrigo Iturriaga
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile, and Centro de Excelencia en Biomedicina de Magallanes, Universidad de Magallanes, Punta Arenas, Chile
| | - Julio Alcayaga
- Laboratorio de Fisiología Celular, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Mark W Chapleau
- Department of Internal Medicine, University of Iowa and Department of Veterans Affairs Medical Center, Iowa City, Iowa
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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10
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Chen J, Gu H, Wurster RD, Cheng ZJ. The protective role of SOD1 overexpression in central mediation of bradycardia following chronic intermittent hypoxia in mice. Am J Physiol Regul Integr Comp Physiol 2021; 320:R317-R330. [PMID: 33296277 PMCID: PMC7988771 DOI: 10.1152/ajpregu.00147.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/27/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is associated with many cardiovascular complications. Similar to OSA, chronic intermittent hypoxia (CIH) (a model for OSA) leads to oxidative stress and impairs baroreflex control of the heart rate (HR) in rodents. The baroreflex arc includes the aortic depressor nerve (ADN), vagal efferent, and central neurons. In this study, we used mice as a model to examine the effects of CIH on baroreflex sensitivity, aortic baroreceptor afferents, and central and vagal efferent components of the baroreflex circuitry. Furthermore, we tested whether human Cu/Zn Superoxide Dismutase (SOD1) overexpression in transgenic mice offers protection against CIH-induced deficit of the baroreflex arc. Wild-type C57BL/6J and SOD1 mice were exposed to room air (RA) or CIH and were then anesthetized, ventilated, and catheterized for measurement of mean arterial pressure (MAP) and HR. Compared with wild-type RA control, CIH impaired baroreflex sensitivity but increased maximum baroreceptor gain and bradycardic response to vagal efferent stimulation. Additionally, CIH reduced the bradycardic response to ADN stimulation, indicating a diminished central regulation of bradycardia. Interestingly, SOD1 overexpression prevented CIH-induced attenuation of HR responses to ADN stimulation and preserved HR responses to vagal efferent stimulation in transgenic mice. We suggest that CIH decreased central mediation of the baroreflex and SOD1 overexpression may prevent the CIH-induced central deficit.
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Affiliation(s)
- Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - He Gu
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - Robert D Wurster
- Department of Cellular and Molecular Physiology, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Zixi Jack Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
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11
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Cipriano LHC, Borges YG, Mill JG, Mauad H, Martins de Araújo MT, Gouvea SA. Effects of short-term aerobic training versus CPAP therapy on heart rate variability in moderate to severe OSA patients. Psychophysiology 2021; 58:e13771. [PMID: 33483990 DOI: 10.1111/psyp.13771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/08/2020] [Accepted: 12/30/2020] [Indexed: 01/11/2023]
Abstract
We compared the effects of 2-month CPAP or exercise training (ET) therapies on the autonomic balance in moderate to severe obstructive sleep apnea (OSA) through heart rate variability (HRV) analysis. Thirty-nine OSA patients were divided into CPAP (n = 18) and ET (n = 21) groups, being further split into hypertensive and non-hypertensive subgroups. All patients were submitted to continuous ECG recordings for HRV analysis. Hemodynamic parameters were recorded by oscillometry. Excessive daytime sleepiness and sleep quality were assessed through the Epworth Sleepiness Scale and the Pittsburgh questionnaire, respectively. ET decreased systolic arterial pressure in hypertensive and non-hypertensive participants when compared to baseline values, whereas diastolic arterial pressure was decreased only in non-hypertensive ones. CPAP had no effect over hemodynamic parameters in either subgroup. ET significantly increased the HRV parameters SDNN and pNN50 in non-hypertensive participants, while reducing the LF/HF ratio in both subgroups. CPAP significantly decreased SDNN in both subgroups. ET significantly decreased excessive daytime sleepiness in both subgroups, but did not affect sleep quality. CPAP significantly improved sleep quality in both subgroups, although global scores were still those of poor sleepers, while excessive daytime sleepiness was normalized only in hypertensive patients. In conclusion, while short-term ET modulated different HRV parameters, leading to a predominant vagal tone in the cardiac sympathovagal balance and decreasing blood pressure in moderate to severe OSA, short-term CPAP had next to no effect in these parameters. We believe ET should be considered as an adjunct interventional strategy in the conservative management of hypertensive or non-hypertensive OSA patients.
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Affiliation(s)
- Luis Henrique Ceia Cipriano
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - Ytalo Gonçalves Borges
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - José Geraldo Mill
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil.,Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | - Helder Mauad
- Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Sonia Alves Gouvea
- Physiological Sciences Graduation Program, Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil.,Physiological Sciences Department, Federal University of Espírito Santo, Vitória, Brazil
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Cavalcante GL, Ferreira FN, da Silva MTB, Soriano RN, Filho ALMM, Arcanjo DDR, Sabino JPJ. Acetylcholinesterase inhibition prevents alterations in cardiovascular autonomic control and gastric motility in L-NAME-induced hypertensive rats. Life Sci 2020; 256:117915. [DOI: 10.1016/j.lfs.2020.117915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
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13
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Gauda EB, Conde S, Bassi M, Zoccal DB, Almeida Colombari DS, Colombari E, Despotovic N. Leptin: Master Regulator of Biological Functions that Affects Breathing. Compr Physiol 2020; 10:1047-1083. [PMID: 32941688 DOI: 10.1002/cphy.c190031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obesity is a global epidemic in developed countries accounting for many of the metabolic and cardiorespiratory morbidities that occur in adults. These morbidities include type 2 diabetes, sleep-disordered breathing (SDB), obstructive sleep apnea, chronic intermittent hypoxia, and hypertension. Leptin, produced by adipocytes, is a master regulator of metabolism and of many other biological functions including central and peripheral circuits that control breathing. By binding to receptors on cells and neurons in the brainstem, hypothalamus, and carotid body, leptin links energy and metabolism to breathing. In this comprehensive article, we review the central and peripheral locations of leptin's actions that affect cardiorespiratory responses during health and disease, with a particular focus on obesity, SDB, and its effects during early development. Obesity-induced hyperleptinemia is associated with centrally mediated hypoventilation with decrease CO2 sensitivity. On the other hand, hyperleptinemia augments peripheral chemoreflexes to hypoxia and induces sympathoexcitation. Thus, "leptin resistance" in obesity is relative. We delineate the circuits responsible for these divergent effects, including signaling pathways. We review the unique effects of leptin during development on organogenesis, feeding behavior, and cardiorespiratory responses, and how undernutrition and overnutrition during critical periods of development can lead to cardiorespiratory comorbidities in adulthood. We conclude with suggestions for future directions to improve our understanding of leptin dysregulation and associated clinical diseases and possible therapeutic targets. Lastly, we briefly discuss the yin and the yang, specifically the contribution of relative adiponectin deficiency in adults with hyperleptinemia to the development of metabolic and cardiovascular disease. © 2020 American Physiological Society. Compr Physiol 10:1047-1083, 2020.
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Affiliation(s)
- Estelle B Gauda
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Silvia Conde
- CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Mirian Bassi
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Daniel B Zoccal
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Debora Simoes Almeida Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Eduardo Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Nikola Despotovic
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Bangash A, Wajid F, Poolacherla R, Mim FK, Rutkofsky IH. Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association. Cureus 2020; 12:e8241. [PMID: 32582500 PMCID: PMC7306640 DOI: 10.7759/cureus.8241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obstructive sleep apnea (OSA) is defined as episodes of hypopnea or apnea, which leads to a partial or complete block of airways. Hypertension, on the other hand, is defined as an increase in systemic arterial blood pressure to a certain threshold. OSA and hypertension share many common factors in pathophysiology, such as gender, obesity, unhealthy lifestyle, impaired quality of sleep, renin-angiotensin system, and increased fluid distribution. In order to manage our patients effectively, we need to explore further the correlation between the two conditions.
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Affiliation(s)
- Amna Bangash
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Fareha Wajid
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Raju Poolacherla
- Anesthesia and Perioperative Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.,Pediatric Anesthesia and Pain, Western University, London, CAN
| | - Fatiha Kabir Mim
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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15
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Miralles R, Valenzuela S, Marambio C, Gamboa NA, Fuentes AD, Santander H, Gutiérrez MF, Zúñiga C, Bull R. Effect of laterotrusive occlusal scheme on chewing duration, external intercostal muscular activity, heart rate, and oxygen saturation. Cranio 2020; 40:401-408. [PMID: 32362247 DOI: 10.1080/08869634.2020.1757893] [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: 10/24/2022]
Abstract
Objective: To evaluate the effect of the laterotrusive occlusal scheme on chewing duration, external intercostal (EIC) electromyographic (EMG) activity, heart rate (HR), and oxygen saturation (OS) during different tasks in the upright seated position.Methods: Fifty young participants, 25 with canine guidance and 25 with group function, were included. Chewing duration, bilateral EIC EMG activity, HR, and OS were recorded during the following tasks: 1) chewing until swallowing threshold; 2) laterotrusive teeth grinding.Results: Chewing duration, bilateral EIC EMG activity, HR, and OS showed no significant differences between the two laterotrusive occlusal schemes during the tasks studied.Conclusion: These results suggest that chewing duration, EIC muscle activity, HR, and OS were not significantly influenced by the laterotrusive occlusal scheme. Therefore, when a modification of the laterotrusive occlusal scheme is needed during oral rehabilitation or orthodontic treatment, canine guidance or group function should not significantly change EMG activity of EIC muscles.
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Affiliation(s)
- Rodolfo Miralles
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile
| | - Saúl Valenzuela
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile.,Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile, Santiago, Chile
| | - Camila Marambio
- Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile, Santiago, Chile
| | - Natalia Andrea Gamboa
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile.,Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile, Santiago, Chile
| | - Aler Daniel Fuentes
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile.,Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile, Santiago, Chile
| | - Hugo Santander
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile
| | - Mario Felipe Gutiérrez
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile.,Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile, Santiago, Chile
| | - Claudia Zúñiga
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile.,Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Ricardo Bull
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile, Santiago, Chile
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16
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McIntosh RC, Hoshi RA, Timpano KR. Take my breath away: Neural activation at breath-hold differentiates individuals with panic disorder from healthy controls. Respir Physiol Neurobiol 2020; 277:103427. [PMID: 32120012 DOI: 10.1016/j.resp.2020.103427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 01/04/2023]
Abstract
There is neuroanatomical evidence of an "extended fear network" of brain structures involved in the etiology of panic disorder (PD). Although ventilatory distrubance is a primary symptom of PD these sensations may also trigger onset of a panic attack (PA). Here, a voluntary breath-holding paradigm was used to mimic the hypercapnia state in order to compare blood oxygen level-dependent (BOLD) response, at the peak of a series of 18 s breath-holds, of 21 individuals with PD to 21 low anxiety matched controls. Compared to the rest condition, BOLD activity at the peak (12 - 18 s) of the breath-hold was greater for PD versus controls within a number of structures implicated in the extended fear network, including hippocampus, thalamus, and brainstem. Activation was also observed in cortical structures that are shown to be involved in interoceptive and self-referential processing, such as right insula, middle frontal gyrus, and precuneus/posterior cingulate. In lieu of amygdala activation, our findings show elevated activity throughout an extended network of cortical and subcortical structures involved in contextual, interoceptive and self-referential processing when individuals with PD engage in voluntary breath-holding.
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Affiliation(s)
- R C McIntosh
- Department of Psychology, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, United States.
| | - R A Hoshi
- Clinical and Epidemiological Research Center, Sao Paulo University. 2565 Professor Lineu Prestes Ave, Sao Paulo, 05508-000, Brazil
| | - K R Timpano
- Department of Psychology, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, United States
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17
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Ferreira‐Junior NC, Lagatta DC, Kuntze LB, Fujiwara EA, Firmino EMS, Borges‐Assis AB, Resstel LBM, Sampaio KN. Dorsal hippocampus cholinergic and nitrergic neurotransmission modulates the cardiac baroreflex function in rats. Eur J Neurosci 2020; 51:991-1010. [DOI: 10.1111/ejn.14599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - Davi Campos Lagatta
- Department of Pharmacology School of Medicine of Ribeirao Preto University of Sao Paulo Ribeirao Preto Brazil
| | - Luciana Bärg Kuntze
- Department of Pharmacology School of Medicine of Ribeirao Preto University of Sao Paulo Ribeirao Preto Brazil
| | - Eduardo Akira Fujiwara
- Department of Pharmaceutical Sciences Federal University of Espírito Santo Vitória Brazil
| | - Egidi Mayara Silva Firmino
- Department of Pharmacology School of Medicine of Ribeirao Preto University of Sao Paulo Ribeirao Preto Brazil
| | - Anna Bárbara Borges‐Assis
- Department of Pharmacology School of Medicine of Ribeirao Preto University of Sao Paulo Ribeirao Preto Brazil
| | | | - Karla Nívea Sampaio
- Department of Pharmaceutical Sciences Federal University of Espírito Santo Vitória Brazil
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18
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Chen HL, Huang CC, Lin HC, Lu CH, Chen PC, Chou KH, Su MC, Friedman M, Lin CP, Lin WC. White matter alteration and autonomic impairment in obstructive sleep apnea. J Clin Sleep Med 2020; 16:293-302. [PMID: 31992402 DOI: 10.5664/jcsm.8186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Autonomic impairment and white matter (WM) alterations have been noted as effects of obstructive sleep apnea (OSA). This study sought to evaluate the change of WM integrity in patients with OSA using diffusion tensor imaging (DTI) and to determine its relationship with autonomic impairment. METHODS A total of 30 patients with moderate and severe OSA and 19 healthy volunteers were recruited. A cardiovascular autonomic survey was performed and the baroreflex sensitivity (BRS) for each participant was derived from changes in heart rate and blood pressure during the early part of phase II of the Valsalva maneuver. DTI-related indices were derived from DTI. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) maps were compared using voxel-based statistics to determine differences between the patients with OSA and the healthy controls. The correlations among DTI indices, clinical severity, and autonomic parameters were investigated. RESULTS The BRS values were significantly worse in the OSA group than in the control patients. An exploratory group-wise comparison between the two groups revealed that the patients with OSA exhibited low FA, increased MD, AD, and RD in several brain locations. The declined DTI indices in autonomic-related areas were significantly correlated with increased clinical disease severity and baroreflex impairment. CONCLUSIONS OSA alters WM integrity in the cingulum and temporal lobe, and this impairment might play some role in autonomic dysfunction. The possible interaction between autonomic dysfunction and central nervous system microstructural alterations may represent variant hypoxic patterns, sympathetic activation, and their consequent processes in OSA.
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Affiliation(s)
- Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Michael Friedman
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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19
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Lin HY, Su PL, Lin CY, Hung CH. Models of anatomically based oropharyngeal rehabilitation with a multilevel approach for patients with obstructive sleep apnea: a meta-synthesis and meta-analysis. Sleep Breath 2019; 24:1279-1291. [PMID: 31836993 DOI: 10.1007/s11325-019-01971-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/17/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a sleep-related breathing disorder associated with dysfunction of oropharyngeal muscles to maintain upper airway patency during sleep. Oropharyngeal rehabilitation (OPR) was developed to restore, reconstruct, and reeducate oropharyngeal muscle function, but current protocols and effectiveness of OPR have been inconsistent. The purpose of this study was to review (1) indications of OPR, (2) protocols of OPR, and (3) effectiveness of OPR. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library and then conducted both meta-synthesis and meta-analysis according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS A total of eight studies with 203 patients were included. By means of meta-synthesis, the patients with middle age, BMI < 40 kg/m2, mild-to-moderate OSA, and non-severe upper airway anatomical abnormality were found to benefit from OPR. The protocol of OPR was summarized to be an anatomically based, multilevel approach, including the retropalatal, retroglossal, hypopharyngeal, TMJ, and facial levels. By using meta-analysis, overall outcomes were presented as apnea hypopnea index (AHI) with significant improvement from 25.2 ± 7.8/h to 16.1 ± 6.6/h (mean difference [MD] - 9.8 [95% CI - 11.0 to - 8.6], p < 0.0001); the lowest oxygen saturation (LSAT) improved from 80.2 ± 4.7 to 83.8 ± 2.9% (MD 3.0% [95% CI 2.0 to 4.0], p < 0.0001); Epworth sleepiness scale (ESS) improved from 11.8 ± 1.9 to 6.3 ± 1.6 (MD - 5.9 [95% CI - 7.5 to - 4.2], p < 0.001), neck circumference (NC) from 35.2 ± 1.1 to 34.7 ± 0.9 cm (MD - 0.6 [95% CI - 0.9 to - 0.2], p = 0.002), BMI from 24.8 ± 3.7 to 24.8 ± 4.1 kg/m2 (MD - 0.0; 95% CI - 0.5 to 0.5, p = 0.95). All outcomes except BMI demonstrated significant improvement from OPR. CONCLUSIONS Meta-analysis of previous OPR reports shows an improvement in AHI of 39%, compared with the usual surgical definition of success at 50%. Only mild and moderate cases of OSA were referred for OPR in the prior studies. In order to improve outcomes with OPR, a comprehensive approach to rehabilitation should be emphasized.
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Affiliation(s)
- Hsin-Yu Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, Division of Pulmonary, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.,Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan.,Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, North District, Tainan City, 704, Taiwan
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan. .,Department of Physical Therapy, College of Medicine, National Cheng Kung University, No. 1 Ta-Hsueh Road, East District, Tainan City, 701, Taiwan.
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20
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Affiliation(s)
| | - Naima Covassin
- Department of Cardiovascular Diseases (N.C., V.K.S.), Mayo Clinic, Rochester, MN
| | - Virend K Somers
- Department of Cardiovascular Diseases (N.C., V.K.S.), Mayo Clinic, Rochester, MN
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21
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Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction. Sleep Breath 2019; 24:941-951. [DOI: 10.1007/s11325-019-01926-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/14/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
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22
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. The Association of Obstructive Sleep Apnea and Hypertension. Cureus 2019; 11:e4858. [PMID: 31410341 PMCID: PMC6684296 DOI: 10.7759/cureus.4858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. Hypertension (HTN) is defined by the presence of a chronic elevation of systemic arterial pressure above a certain threshold value (≥140 mm Hg systolic or ≥90 mm Hg diastolic). On the surface, OSA and HTN appear very different from one another. Despite this, they share several common risk factors including obesity, male gender, and advancing age. In 2003, the Seventh Joint National Committee (JNC VII) recognized OSA as a secondary cause of HTN. As physicians, our goal is to understand the OSA-HTN association better through academic study regarding its epidemiology, its pathophysiology, and its treatment.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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23
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Wang Y, Yu D, Yu Y, Zou W, Zeng X, Hu L, Gu Y. Potential role of sympathetic activity on the pathogenesis of massive pulmonary embolism with circulatory shock in rabbits. Respir Res 2019; 20:97. [PMID: 31118045 PMCID: PMC6530066 DOI: 10.1186/s12931-019-1069-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/06/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We recently showed that intravenous sodium nitroprusside treatment (SNP) could relieve the pulmonary vasospasm of pulmonary embolism (PE) and non-pulmonary embolism (non-PE) regions in a rabbit massive pulmonary embolism (MPE) model associated with shock. The present study explored the potential role of cardiopulmonary sympathetic activity on the pathogenesis and the impact of vasodilators on cardiopulmonary sympathetic activity in this model. METHODS Rabbits were randomly divided into sham operation group (S group, n = 8), model group (M, equal volume of saline intravenously, n = 11), SNP group (3.5 μg/kg/min intravenously, n = 10) and diltiazem group (DLZ, 6.0 μg/kg/min intravenously, n = 10). RESULTS MPE resulted in reduced mean arterial pressure and increased mean pulmonary arterial pressure as well as reduced PaO2 in the M, SNP and DLZ groups. Tyrosine hydroxylase (TH), neuropeptide Y (NPY) and endothelin-1 (ET-1) expression levels were significantly increased, while nitric oxide (NO) levels were reduced in both PE and non-PE regions in the M group. Both SNP and DLZ decreased mean pulmonary arterial pressure, reversed shock status, downregulated the expression of TH, NPY and ET-1, and increased NO levels in PE and non-PE regions. CONCLUSION Present results indicate that upregulation of the sympathetic medium transmitters TH and NPY in whole lung tissues serves one of the pathological features of MPE. The vasodilators SNP and DLZ could relieve pulmonary vasospasm in both embolization and non-embolization regions and reverse circulatory shock, thereby indirectly downregulating the sympathetic activation of the whole lung tissues and breaking a vicious cycle related to sympathetic activation in this model.
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Affiliation(s)
- Yuting Wang
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Delong Yu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Yijun Yu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Wusong Zou
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Xiaohui Zeng
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Liqun Hu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
| | - Ye Gu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473# QiaoKou District, Wuhan, 430033 China
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24
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Meelab S, Bunupuradah I, Suttiruang J, Sakulrojanawong S, Thongkua N, Chantawiboonchai C, Chirabandhu P, Lertthanaporn S, Suwanthip K, Songsaengthum C, Keattisaksri B, Trakulsuk P, Pittapun A, Nata N, Rangsin R, Sakboonyarat B. Prevalence and associated factors of uncontrolled blood pressure among hypertensive patients in the rural communities in the central areas in Thailand: A cross-sectional study. PLoS One 2019; 14:e0212572. [PMID: 30779818 PMCID: PMC6380583 DOI: 10.1371/journal.pone.0212572] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Hypertension is a common cardiovascular disease at present. Uncontrolled blood pressure leads to further complications including heart attack, stroke and chronic kidney disease. In Thailand, most of the information related to this issue is collected by hospitals or hospital-based organizations rather than at the community level. The objectives of this study were to determine the prevalence of uncontrolled hypertension and to assess the relationship between patient characteristics (socio-behavioral and clinical) and uncontrolled blood pressure among hypertensive patients in the rural communities in the central areas in Thailand. Materials and methods This was a cross-sectional study conducted in Na-Yao and Phra-Pleong rural communities of Thailand in 2018 using the total design method. In all, 406 individuals aged ≥18 years were interviewed using structured questionnaires related to demographic information, higher risk behavior, comorbidities and arthrometric measurement. Blood pressure was assessed for all participants. Uncontrolled hypertension was defined as BP ≥140/90 mmHg. Results The prevalence of uncontrolled hypertension was 54.4% (males: 59.8%; females: 52.4%). Uncontrolled blood pressure was associated with neck circumference more than 35.75 cm for males and 32.75 cm. for females (adjusted odds ratio; 1.66, 95% confidence interval; 1.03–2.68), sedentary behavior more than 5 hours a day (adjusted odds ratio; 2.03, 95% confidence interval; 1.28–3.23) and missed doctor appointments (adjusted odds ratio; 3.29, 95% confidence interval; 1.09–9.94). Conclusion Approximately one half of hypertensive patients in these rural communities had uncontrolled blood pressure. The Ministry of Public Health and health care providers should provide further strategies to prevent uncontrolled blood pressure’s complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Naowanit Nata
- Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
- * E-mail:
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25
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Valenzuela S, Miralles R, Muñoz MI, Santander H, Zúñiga C, Cavada G, Bull R, Gamboa NA, Fuentes AD. Awake teeth grinding in participants with canine guidance or group function: Effect on diaphragm EMG activity, heart rate, and oxygen saturation. Cranio 2019; 38:412-418. [PMID: 30696376 DOI: 10.1080/08869634.2019.1572283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To compare the effect of canine guidance or group function on diaphragm activity, heart rate, and oxygen saturation during awake teeth grinding at different body positions. Methods: Fifty healthy participants, 25 with canine guidance and 25 with group function, were included. Bilateral electromyographic (EMG) recordings of the diaphragm (DIA) during awake teeth grinding were performed in standing, seated upright, and right lateral decubitus positions. Simultaneously, heart rate and oxygen saturation were measured. Results: EMG activity of the DIA muscle was similar in the working side and non-working side between participants with canine guidance and group function in the different body positions studied. The heart rate and oxygen saturation showed no significant differences between the two groups. Conclusion: EMG activity of the DIA muscle, the heart rate, and oxygen saturation during teeth grinding are not significantly influenced by the type of laterotrusive occlusal scheme.
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Affiliation(s)
- Saúl Valenzuela
- Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile , Santiago, Chile.,Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
| | - Rodolfo Miralles
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
| | - María Ignacia Muñoz
- Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile , Santiago, Chile
| | - Hugo Santander
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
| | - Claudia Zúñiga
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile.,Faculty of Dentistry, Universidad Finis Terrae
| | - Gabriel Cavada
- Faculty of Medicine, Public Health School, University of Chile , Santiago, Chile
| | - Ricardo Bull
- Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
| | - Natalia Andrea Gamboa
- Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile , Santiago, Chile.,Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
| | - Aler Daniel Fuentes
- Faculty of Dentistry, Institute for Research in Dental Sciences, University of Chile , Santiago, Chile.,Faculty of Medicine, Oral Physiology Laboratory, Biomedical Sciences Institute, University of Chile , Santiago, Chile
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Katayama PL, Castania JA, Fazan R, Salgado HC. Interaction between baroreflex and chemoreflex in the cardiorespiratory responses to stimulation of the carotid sinus/nerve in conscious rats. Auton Neurosci 2018; 216:17-24. [PMID: 30598121 DOI: 10.1016/j.autneu.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 11/29/2022]
Abstract
Electrical stimulation of the carotid baroreflex has been thoroughly investigated for treating drug-resistant hypertension in humans. However, a previous study from our laboratory, performed in conscious rats, has demonstrated that electrical stimulation of the carotid sinus/nerve (CS) activated both the carotid baroreflex as well as the carotid chemoreflex, resulting in hypotension. Additionally, we also demonstrated that the carotid chemoreceptor deactivation potentiated this hypotensive response. Therefore, to further investigate this carotid baroreflex/chemoreflex interaction, besides the hemodynamic responses, we evaluated the respiratory responses to the electrical stimulation of the CS in both intact (CONT) and carotid chemoreceptors deactivated (CHEMO-X) conscious rats. CONT rats showed increased ventilation in response to electrical stimulation of the CS as measured by the respiratory frequency (fR), tidal volume (VT) and minute ventilation (VE), suggesting a carotid chemoreflex activation. The carotid chemoreceptor deactivation abolished all respiratory responses to the electrical stimulation of the CS. Regarding the hemodynamic responses, the electrical stimulation of the CS caused hypotensive responses in CONT rats, which were potentiated by the carotid chemoreceptors deactivation. Heart rate (HR) responses did not differ between groups. In conclusion, the present study showed that the electrical stimulation of the CS, in conscious rats, activates both the carotid baroreflex and the carotid chemoreflex driving an increase in ventilation and a decrease in AP. These findings further contribute to our understanding of the electrical stimulation of CS.
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Affiliation(s)
- Pedro L Katayama
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaci A Castania
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rubens Fazan
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helio C Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Speretta GF, Lemes EV, Vendramini RC, Menani JV, Zoccal DB, Colombari E, Colombari DSA, Bassi M. High-fat diet increases respiratory frequency and abdominal expiratory motor activity during hypercapnia. Respir Physiol Neurobiol 2018; 258:32-39. [PMID: 30308245 PMCID: PMC6317333 DOI: 10.1016/j.resp.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 11/24/2022]
Abstract
Breathing disorders are commonly observed in association with obesity. Here we tested whether high-fat diet (HFD) impairs the chemoreflex ventilatory response. Male Holtzman rats (300-320 g) were fed with standard chow diet (SD) or HFD for 12 weeks. Then, tidal volume (VT), respiratory frequency (fR) and pulmonary ventilation (VE) were determined in conscious rats during basal condition, hypercapnia (7% or 10% CO2) or hypoxia (7% O2). The mean arterial pressure (MAP), heart rate (HR) and baroreflex sensitivity were also evaluated in conscious rats. A group of anesthetized rats was used for the measurements of the activity of inspiratory (diaphragm) and expiratory (abdominal) muscles under the same gas conditions. Baseline fR, VT and VE were similar between SD and HFD rats. During hypercapnia, the increase of fR was exacerbated in conscious HFD rats (60 ± 3, vs. SD: 47 ± 3 Δ breaths.min-1, P < 0.05). In anesthetized rats, hypercapnia strongly increased abdominal muscle activity in HFD group (238 ± 27, vs. basal condition: 100 ± 0.3%; P < 0.05), without significant change in SD group (129 ± 2.1, vs. basal condition: 100 ± 0.8%; P = 0.34). The ventilatory responses to hypoxia were similar between groups. In conscious HFD rats, MAP and HR were elevated and the baroreflex function was impaired (P < 0.05). These data demonstrated that 12 weeks of HFD exaggerate the ventilatory response activated by hypercapnia. The mechanisms involved in these responses need more investigation in future studies.
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Affiliation(s)
- Guilherme F Speretta
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil.
| | - Eduardo Vieira Lemes
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Regina C Vendramini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, UNESP, Araraquara, SP, Brazil
| | - José V Menani
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Daniel B Zoccal
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Eduardo Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Débora S A Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Mirian Bassi
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University (UNESP), Araraquara, SP, Brazil.
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Poonit ND, Cai XH. The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0146-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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30
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Korkmaz B, Benbir Şenel G, Kızıltan ME, Karadeniz D. Demonstration of sympathetic dysfunction in patients with obstructive sleep apnea syndrome by measuring sympathetic skin responses from the neck. Sleep Med 2016; 25:13-15. [PMID: 27823705 DOI: 10.1016/j.sleep.2016.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to study the sympathetic sudomotor responses via the sympathetic skin responses (SSR) from bilateral hands and right and left sides of the neck in patients with obstructive sleep apnea syndrome (OSAS). METHODS A total of 31 patients with OSAS diagnosed by whole-night polysomnography and 18 healthy volunteers were consecutively enrolled into this prospective study. RESULTS The SSRs from hands were not obtained in two patients with OSAS (6.4%) and in one volunteer (5.5%); the attainability of SSRs from hands was similar between patients and healthy controls (p = 0.698). The SSRs from neck were not obtained in 22 patients with OSAS (70.9%), but only in two healthy volunteers (11.1%, p <0.001). The mean amplitudes of SSRs from both right and left sides of neck were significantly lower in patients with OSAS than those in controls (p <0.001). After effective treatment of OSAS, the SSRs from hands were obtained in all patients (100% vs 93.6% before treatment, p = 0.560). The attainability of SSRs from bilateral sides of the neck was significantly improved after treatment (80%) in compared to before treatment (29.1%, p <0.001). The amplitudes of SSRs obtained from the neck were also significantly increased after treatment (p <0.004). CONCLUSIONS Our results show that there is sympathetic dysfunction in OSAS, which could be demonstrated by sudomotor response abnormalities from neck area and reversed following effective treatment of OSAS. SSR studies from the neck area may therefore be accepted as an easy and effective method for demonstrating the sympathetic dysfunction in OSAS and for monitoring the efficacy of OSAS treatment.
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Affiliation(s)
- Bektaş Korkmaz
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Gülçin Benbir Şenel
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Derya Karadeniz
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Abstract
Autonomic dysfunction is a frequent and relevant complication of diabetes mellitus, as it is associated with increased morbidity and mortality. In addition, it is today considered as predictive of the most severe diabetic complications, like nephropathy and retinopathy. The classical methods of screening are the cardiovascular reflex tests and were originally interpreted as evidence of nerve damage. A more modern approach, based on the integrated control of cardiovascular and respiratory function, reveals that these abnormalities are to a great extent functional, at least in the early stage of the disease, thus suggesting new potential interventions. Therefore, this review aims to go further investigating how the imbalance of the autonomic nervous system is altered and can be influenced in many chronic pathologies through a global view of cardio-respiratory and metabolic interactions and how the same mechanisms are applicable to diabetes.
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Affiliation(s)
- Luciano Bernardi
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
- Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
- , Villaggio dei Pioppi 2, 27020, Torre d'Isola, Italy.
| | - Lucio Bianchi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, CRNH-IdF, Paris-Nord University, Bondy, France
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32
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McKay JAA, McCulloch CL, Querido JS, Foster GE, Koehle MS, Sheel AW. The effect of consistent practice of yogic breathing exercises on the human cardiorespiratory system. Respir Physiol Neurobiol 2016; 233:41-51. [PMID: 27453559 DOI: 10.1016/j.resp.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 07/09/2016] [Accepted: 07/20/2016] [Indexed: 11/28/2022]
Abstract
The purpose of this investigation was to quantify the cardiovascular, respiratory, and cerebrovascular effects of two common yogic breathing exercises (YBE): bhastrika and chaturbhuj; and to determine the effect of their consistent practice on chemosensitivity. The first study was cross-sectional and compared experienced yogic breathers (YB) with matched controls; whereas the second was a 10-week longitudinal training study. The results support four major findings. First chaturbhuj resulted in a hypoxic stimulus in experienced YB compared to control [end-tidal oxygen tension (PETO2), YB: 77.5±5.7mmHg, P<0.05; control: 94.3±12.0mmHg]. Second, performance of chaturbhuj resulted in cyclic oscillations of mean arterial pressure (MAP), heart rate (HR), and middle cerebral artery velocity (MCAv) consistent with the phases of respiration. Third, post training, performance of bhastrika reduced PETO2 (end breath-hold: 90.8 8±12.1mmHg) compared to rest (100.1±7.4, P<0.05); it also resulted in significantly increased MAP at end breath-hold (96.7±13.0mmHg) compared to rest (83.0±6.6mmHg, P<0.05) and significantly increased mean MCAv (end breath-hold: 87.4±23.0cm/s, P<0.05; rest: 55.8±26.3cm/s). Fourth, experienced YB had lower central chemosensitivity than controls (YB: 3.4±0.4; control: 4.6±1.2L/min/mmHg; P<0.05). In conclusion, YBE significantly alter end-tidal gases, resulting in complex oscillations of cardiovascular and cerebrovascular variables, and if practiced consistently, may reduce chemosensitivity.
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Affiliation(s)
- Joshua A A McKay
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Cara L McCulloch
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
| | - Jordan S Querido
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Glen E Foster
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Division of Sports Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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33
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Krejčí J, Botek M, McKune AJ. Dynamics of the heart rate variability and oxygen saturation response to acute normobaric hypoxia within the first 10 min of exposure. Clin Physiol Funct Imaging 2016; 38:56-62. [DOI: 10.1111/cpf.12381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jakub Krejčí
- Department of Natural Sciences in Kinanthropology; Faculty of Physical Culture; Palacký University Olomouc; Olomouc Czech Republic
| | - Michal Botek
- Department of Natural Sciences in Kinanthropology; Faculty of Physical Culture; Palacký University Olomouc; Olomouc Czech Republic
| | - Andrew J. McKune
- Discipline of Sport and Exercise Science; Faculty of Health; UC-Research Institute for Sport and Exercise; University of Canberra; Canberra ACT Australia
- Discipline of Biokinetics; Exercise and Leisure Sciences; School of Health Sciences; University of KwaZulu-Natal; Durban South Africa
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Ciriello J, Moreau JM, McCoy A, Jones DL. Effect of intermittent hypoxia on arcuate nucleus in the leptin-deficient rat. Neurosci Lett 2016; 626:112-8. [PMID: 27222924 DOI: 10.1016/j.neulet.2016.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 04/27/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
Intermittent hypoxia (IH) is a major pathophysiological consequence of obstructive sleep apnea. Recently, it has been shown that IH results in changes in body energy balance, leptin secretion and concomitant alterations in arcuate nucleus (ARC). In this study, the role of leptin on these changes was investigated in leptin-deficient rats exposed to IH or normoxic control conditions. Body weights, consumatory and locomotor behaviours, and protein signaling in ARC were assessed immediately after IH exposure. Compared to normoxia, IH altered body weight, food intake, locomotor pattern, and the plasma concentration of leptin and angiotensin II in the wild-type rat. However, these changes were not observed in the leptin-deficient rat. Within ARC of wild-type animals, IH increased phosphorylated signal transducer and activator of transcription 3 and pro-opiomelanocortin protein expression, but not in the leptin-deficient rat. The long-form leptin receptor protein expression was not altered following IH in either rat strain. These data suggest that leptin is involved in mediating the alterations to body energy balance and ARC activity following IH.
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Affiliation(s)
- John Ciriello
- Department of Physiology and Pharmacology, The University of Western Ontario, London N6A 5C1, Canada.
| | - Jason M Moreau
- Department of Physiology and Pharmacology, The University of Western Ontario, London N6A 5C1, Canada
| | - Aaron McCoy
- Sigma Advanced Genetic Engineering Labs, Sigma-Aldrich Corp., St. Louis, MO, USA
| | - Douglas L Jones
- Department of Physiology and Pharmacology, The University of Western Ontario, London N6A 5C1, Canada; Department of Medicine, The University of Western Ontario, London N6A 5C1, Canada
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35
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Abstract
Background Hypoxia causes secondary headaches such as high-altitude headache (HAH) and headache due to acute mountain sickness. These secondary headaches mimic primary headaches such as migraine, which suggests a common link. We review and discuss the possible role of hypoxia in migraine and cluster headache. Methods This narrative review investigates the current level of knowledge on the relation of hypoxia in migraine and cluster headache based on epidemiological and experimental studies. Findings Epidemiological studies suggest that living in high-altitude areas increases the risk of migraine and especially migraine with aura. Human provocation models show that hypoxia provokes migraine with and without aura, whereas cluster headache has not been reliably induced by hypoxia. Possible pathophysiological mechanisms include hypoxia-induced release of nitric oxide and calcitonin gene-related peptide, cortical spreading depression and leakage of the blood-brain barrier. Conclusion There is a possible link between hypoxia and migraine and maybe cluster headache, but the exact mechanism is currently unknown. Provocation models of hypoxia have yielded interesting results suggesting a novel approach to study in depth the mechanism underlying hypoxia and primary headaches.
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Affiliation(s)
- Josefine Britze
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nanna Arngrim
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Kuntze LB, Ferreira-Junior NC, Lagatta DC, Resstel LBM. Ventral hippocampus modulates bradycardic response to peripheral chemoreflex activation in awake rats. Exp Physiol 2016; 101:482-93. [PMID: 26700468 DOI: 10.1113/ep085393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/22/2015] [Indexed: 12/15/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does reversible synaptic inactivation by CoCl2 in the dorsal (DH) or ventral (VH) portions of the hippocampus have a modulatory effect on cardiovascular and respiratory responses evoked by chemoreflex activation in awake rats? What is the main finding and its importance? Using i.v. infusion of KCN to activate the peripheral chemoreflex before and after microinjection of CoCl2 into VH, we showed that the bradycardic response was increased, but not the pressor and tachypnoeic responses even if the tidal volume had been increased. Thus, VH but not DH may be involved in the modulation of the parasympathoexcitatory component of the peripheral chemoreflex. In rats, peripheral chemoreflex activation evokes pressor and bradycardic responses as well as a tachypnoeic response. Studies have shown that limbic structures, such as the hippocampus, can modulate autonomic reflexes. Evidence suggests that the dorsal (DH) and the ventral (VH) portions of the hippocampus are structurally and functionally distinct; therefore, in the present study we tested the hypothesis that local neurotransmission of the DH and VH are involved in the neural pathways of the cardiovascular and ventilatory responses to chemoreflex activation. Thus, the goal of the present study was to compare the chemoreflex responses elicited by i.v. injection of KCN (40 μg per rat) in awake rats before and after DH and VH synaptic transmission was temporarily inhibited by bilateral microinjections of 500 nl of the unspecific synapse blocker, CoCl2 (1 mm). Bilateral inhibition of VH, but not DH, 10 min before KCN infusion was able to enhance the bradycardic response (P < 0.05), with no changes in the typical pressor and tachypnoeic responses evoked by chemoreflex activation (P > 0.05). Furthermore, the tidal volume was significantly increased (P < 0.05) even though no other respiratory parameter had been significantly changed (P > 0.05), suggesting that VH can exert a tonic modulatory action on tidal volume. Therefore, the present study reports, for the first time, that DH neurotransmission did not exert an influence on chemoreflex responses, whereas VH mediates, at least in part, the parasympathoexcitatory component of the peripheral chemoreflex.
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Affiliation(s)
- Luciana Bärg Kuntze
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14090-090, Brazil
| | - Nilson Carlos Ferreira-Junior
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14090-090, Brazil
| | - Davi Campos Lagatta
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14090-090, Brazil
| | - Leonardo Barbosa Moraes Resstel
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14090-090, Brazil
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Svitok P, Molcan L, Stebelova K, Vesela A, Sedlackova N, Ujhazy E, Mach M, Zeman M. Prenatal hypoxia in rats increased blood pressure and sympathetic drive of the adult offspring. Hypertens Res 2016; 39:501-5. [DOI: 10.1038/hr.2016.21] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/12/2016] [Accepted: 01/29/2016] [Indexed: 01/04/2023]
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38
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Nocturnal Blood Pressure Variability in Patients with Obstructive Sleep Apnea Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 952:9-15. [DOI: 10.1007/5584_2016_64] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shoemaker JK, Badrov MB, Al-Khazraji BK, Jackson DN. Neural Control of Vascular Function in Skeletal Muscle. Compr Physiol 2015; 6:303-29. [PMID: 26756634 DOI: 10.1002/cphy.c150004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The sympathetic nervous system represents a fundamental homeostatic system that exerts considerable control over blood pressure and the distribution of blood flow. This process has been referred to as neurovascular control. Overall, the concept of neurovascular control includes the following elements: efferent postganglionic sympathetic nerve activity, neurotransmitter release, and the end organ response. Each of these elements reflects multiple levels of control that, in turn, affect complex patterns of change in vascular contractile state. Primarily, this review discusses several of these control layers that combine to produce the integrative physiology of reflex vascular control observed in skeletal muscle. Beginning with three reflexes that provide somewhat dissimilar vascular patterns of response despite similar changes in efferent sympathetic nerve activity, namely, the baroreflex, chemoreflex, and muscle metaboreflex, the article discusses the anatomical and physiological bases of postganglionic sympathetic discharge patterns and recruitment, neurotransmitter release and management, and details of regional variations of receptor density and responses within the microvascular bed. Challenges are addressed regarding the fundamentals of measurement and how conclusions from one response or vascular segment should not be used as an indication of neurovascular control as a generalized physiological dogma. Whereas the bulk of the article focuses on the vasoconstrictor function of sympathetic neurovascular integration, attention is also given to the issues of sympathetic vasodilation as well as the impact of chronic changes in sympathetic activation and innervation on vascular health. © 2016 American Physiological Society.
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Affiliation(s)
- J K Shoemaker
- School of Kinesiology, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - M B Badrov
- School of Kinesiology, Western University, London, Ontario, Canada
| | - B K Al-Khazraji
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - D N Jackson
- Department of Medical Biophysics, Western University, London, Ontario, Canada
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40
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Chronic intermittent hypoxia induces changes in expression of synaptic proteins in the nucleus of the solitary tract. Brain Res 2015; 1622:300-7. [DOI: 10.1016/j.brainres.2015.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/27/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
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41
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Gozal D. Diet and exercise in obstructive sleep apnea patients with obesity: I'll breathe to that! Obesity (Silver Spring) 2015; 23:1526-7. [PMID: 26180039 PMCID: PMC5374509 DOI: 10.1002/oby.21178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/08/2022]
Affiliation(s)
- David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, the University of Chicago, Chicago, Illinois, USA
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42
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Mansukhani MP, Wang S, Somers VK. Sleep, death, and the heart. Am J Physiol Heart Circ Physiol 2015; 309:H739-49. [PMID: 26188022 DOI: 10.1152/ajpheart.00285.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022]
Abstract
Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death.
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Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Community Medical Centers, Willmar, Minnesota; and
| | - Shihan Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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43
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Dumais IE, Lavigne GJ, Carra MC, Rompré PH, Huynh NT. Could transient hypoxia be associated with rhythmic masticatory muscle activity in sleep bruxism in the absence of sleep-disordered breathing? A preliminary report. J Oral Rehabil 2015; 42:810-8. [PMID: 26139077 DOI: 10.1111/joor.12323] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 12/20/2022]
Abstract
Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth during sleep. Sleep bruxism activity is characterised by rhythmic masticatory muscle activity (RMMA). Many but not all RMMA episodes are associated with sleep arousal. The aim of this study was to evaluate whether transient oxygen saturation level change can be temporally associated with genesis of RMMA/SB. Sleep laboratory or home recordings data from 22 SB (tooth grinding history in the absence of reported sleep-disordered breathing) and healthy subjects were analysed. A total of 143 RMMA/SB episodes were classified in four categories: (i) no arousal + no body movement; (ii) arousal + no body movement; (iii) no arousal + body movement; (iv) arousal + body movement. Blood oxygen levels (SaO2 ) were assessed from finger oximetry signal at the baseline (before RMMA), and during RMMA. Significant variation in SaO2 over time (P = 0·001) was found after RMMA onset (+7 to +9 s). No difference between categories (P = 0·91) and no interaction between categories and SaO2 variation over time (P = 0·10) were observed. SaO2 of six of 22 subjects (27%) remained equal or slight increase after the RMMA/SB onset (+8 s) compared to baseline; 10 subjects (45%) slightly decreased (drop 0·01-1%) and the remaining (27%) decreased between 1% and 2%. These preliminary findings suggest that a subgroup of SB subjects had (i) a minor transient hypoxia potentially associated with the onset of RMMA episodes, and this (ii) independently of concomitant sleep arousal or body movements.
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Affiliation(s)
- I E Dumais
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - G J Lavigne
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada.,Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - M C Carra
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - P H Rompré
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
| | - N T Huynh
- Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada
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Mansukhani MP, Kara T, Caples SM, Somers VK. Chemoreflexes, sleep apnea, and sympathetic dysregulation. Curr Hypertens Rep 2015; 16:476. [PMID: 25097113 DOI: 10.1007/s11906-014-0476-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an occluded airway while asleep, resulting in a marked sympathetic response. This is predominantly due to hypoxemia activating the chemoreflexes, resulting in reflex increases in sympathetic neural outflow. In addition, apnea - and the consequent lack of inhibition of the sympathetic system that occurs with lung inflation during normal breathing - potentiates central sympathetic outflow. Sympathetic activation persists into the daytime, and is thought to contribute to hypertension and other adverse cardiovascular outcomes. This review discusses chemoreflex physiology and sympathetic modulation during normal sleep, as well as the sympathetic dysregulation seen in OSA, its extension into wakefulness, and changes after treatment. Evidence supporting the role of the peripheral chemoreflex in the sympathetic dysregulation seen in OSA, including in the context of comorbid obesity, metabolic syndrome, and systemic hypertension, is reviewed. Finally, alterations in cardiovascular variability and other potential mechanisms that may play a role in the autonomic imbalance in OSA are also discussed.
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Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Communities Medical Center, 101 Willmar Avenue SW, Willmar, MN, USA,
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45
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Chen X, Chen T, Yun F, Huang Y, Li J. Effect of repetitive end-inspiration breath holding on very short-term heart rate variability in healthy humans. Physiol Meas 2014; 35:2429-45. [PMID: 25389629 DOI: 10.1088/0967-3334/35/12/2429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Very short-term heart rate variability (HRV) is thought to reflect dynamic changes in autonomic nervous activity, which is helpful in understanding the role of autonomic nervous function (ANF) in the mechanisms underlying apnea-induced cardiac arrhythmias. The goal of this study was to investigate the effect of repetitive end-inspiration breath holding on very short-term HRV. A total of 32 young healthy participants took part in the experiments. Three trials were performed, each involving seven repetitive end-inspiration breath holding and a 30 s recovery period between breath holding. Durations of breath holding in the three trials were 1:2:3. The study first evaluated the effect of analyzed data lengths on the stability of HRV indices and determined three HRV indices suitable for very short-term analysis. The results showed that in most cases, during breath holding, the square root of the mean squared differences of successive normal RR intervals (rMSSD) was significantly lower, but normalized units of the power in the low frequency band ranging from 0.04 to 0.15 Hz (nLF) and LF/high frequency (HF) were significantly higher than those during corresponding durations under the normal breathing conditions. On the contrary, during recovery after breath holding, rMSSD was significantly higher but nLF and LF/HF were lower than normal. Moreover, the durations of breath holding had no significant influence on the variations of LF/HF. In addition, as participants repeated the breath holding, HRV indices varied non-linearly. HRV changes may indicate sympathetic activation during breath holding and parasympathetic activation during recovery after breath holding. In conjunction with the existing physiological interpretation based on changes in heart rate, the results may imply that breath holding leads to both cardiac sympathetic and parasympathetic activation simultaneously, which may be a possible pathogenic factor of apnea-induced arrhythmias.
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Affiliation(s)
- Xiang Chen
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China. Postdoctoral Mobile Station of Electronic Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China. Solid State Lighting Engineering Research Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
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Dergacheva O. Chronic intermittent hypoxia alters neurotransmission from lateral paragigantocellular nucleus to parasympathetic cardiac neurons in the brain stem. J Neurophysiol 2014; 113:380-9. [PMID: 25318765 DOI: 10.1152/jn.00302.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with sleep-related disorders, including obstructive sleep apnea (OSA), have an increased risk of cardiovascular diseases. OSA events are more severe in rapid eye movement (REM) sleep. REM sleep further increases the risk of adverse cardiovascular events by diminishing cardioprotective parasympathetic activity. The mechanisms underlying REM sleep-related reduction in parasympathetic activity likely include activation of inhibitory input to cardiac vagal neurons (CVNs) in the brain stem originating from the lateral paragigantocellular nucleus (LPGi), a nucleus that plays a role in REM sleep control. This study tests the hypothesis that chronic intermittent hypoxia and hypercapnia (CIHH), an animal model of OSA, inhibits CVNs because of exaggeration of the GABAergic pathway from the LPGi to CVNs. GABAergic neurotransmission to CVNs evoked by electrical stimulation of the LPGi was examined with whole cell patch-clamp recordings in an in vitro brain slice preparation in rats exposed to CIHH and control rats. GABAergic synaptic events were enhanced after 4-wk CIHH in both male and female rats, to a greater degree in males. Acute hypoxia and hypercapnia (H/H) reversibly diminished the LPGi-evoked GABAergic neurotransmission to CVNs. However, GABAergic synaptic events were enhanced after acute H/H in CIHH male animals. Orexin-A elicited a reversible inhibition of LPGi-evoked GABAergic currents in control animals but evoked no significant changes in CIHH male rats. In conclusion, exaggerated inhibitory neurotransmission from the LPGi to CVNs in CIHH animals would reduce cardioprotective parasympathetic activity and enhance the risk of adverse cardiovascular events.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, Washington, District of Columbia
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Olea E, Agapito MT, Gallego-Martin T, Rocher A, Gomez-Niño A, Obeso A, Gonzalez C, Yubero S. Intermittent hypoxia and diet-induced obesity: effects on oxidative status, sympathetic tone, plasma glucose and insulin levels, and arterial pressure. J Appl Physiol (1985) 2014; 117:706-19. [DOI: 10.1152/japplphysiol.00454.2014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) consists of sleep-related repetitive obstructions of upper airways that generate episodes of recurrent or intermittent hypoxia (IH). OSA commonly generates cardiovascular and metabolic pathologies defining the obstructive sleep apnea syndrome (OSAS). Literature usually links OSA-associated pathologies to IH episodes that would cause an oxidative status and a carotid body-mediated sympathetic hyperactivity. Because cardiovascular and metabolic pathologies in obese patients and those with OSAS are analogous, we used models (24-wk-old Wistar rats) of IH (applied from weeks 22 to 24) and diet-induced obesity (O; animals fed a high-fat diet from weeks 12 to 24) to define the effect of each individual maneuver and their combination on the oxidative status and sympathetic tone of animals, and to quantify cardiovascular and metabolic parameters and their deviation from normality. We found that IH and O cause an oxidative status (increased lipid peroxides and diminished activities of superoxide dismutases), an inflammatory status (augmented C-reactive protein and nuclear factor kappa-B activation), and sympathetic hyperactivity (augmented plasma and renal artery catecholamine levels and synthesis rate); combined treatments worsened those alterations. IH and O augmented liver lipid content and plasma cholesterol, triglycerides, leptin, glycemia, insulin levels, and HOMA index, and caused hypertension; most of these parameters were aggravated when IH and O were combined. IH diminished ventilatory response to hypoxia, and hypercapnia and O created a restrictive ventilatory pattern; a combination of treatments led to restrictive hypoventilation. Data demonstrate that IH and O cause comparable metabolic and cardiovascular pathologies via misregulation of the redox status and sympathetic hyperactivity.
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Affiliation(s)
- Elena Olea
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Maria Teresa Agapito
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Teresa Gallego-Martin
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Asuncion Rocher
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Angela Gomez-Niño
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Ana Obeso
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Constancio Gonzalez
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
| | - Sara Yubero
- Department of Biochemistry and Molecular Biology and Physiology, University of Valladolid, School of Medicine, Vallodolid, Spain; and Institute of Molecular Biology and Genetics, CIBER Enfermedades Respiratorias, CIBERES, Institute of Salud Carlos III, Vallodolid, Spain
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48
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Dergacheva O, Dyavanapalli J, Piñol RA, Mendelowitz D. Chronic intermittent hypoxia and hypercapnia inhibit the hypothalamic paraventricular nucleus neurotransmission to parasympathetic cardiac neurons in the brain stem. Hypertension 2014; 64:597-603. [PMID: 24958501 DOI: 10.1161/hypertensionaha.114.03603] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obstructive sleep apnea is associated with chronic intermittent hypoxia/hypercapnia (CIHH) episodes during sleep that heighten sympathetic and diminish parasympathetic activity to the heart. Although one population of neurons in the paraventricular nucleus of the hypothalamus strongly influences sympathetic tone and has increased activity after CIHH, little is known about the role of this pathway to parasympathetic neurons and how this network is altered in CIHH. We hypothesized that CIHH inhibits the excitatory pathway from the paraventricular nucleus of the hypothalamus to parasympathetic cardiac vagal neurons in the brain stem. To test this hypothesis, channelrhodopsin was selectively expressed, using viral vectors, in neurons in the paraventricular nucleus of the hypothalamus and channelrhodopsin-expressing fibers were photoactivated to evoke postsynaptic currents in cardiac vagal neurons in brain stem slices. Excitatory postsynaptic currents were diminished in animals exposed to CIHH. The paired-pulse and prolonged facilitation of the postsynaptic current amplitudes and frequencies evoked by paired and bursts of photoactivation of channelrhodopsin fibers, respectively, occurred in unexposed rats but were blunted in CIHH animals. In response to an acute challenge of hypoxia/hypercapnia, the amplitude of postsynaptic events was unchanged during, but increased after hypoxia/hypercapnia in unexposed animals. In contrast, postsynaptic currents were inhibited during hypoxia/hypercapnia in rats exposed to CIHH. In conclusion, the excitatory pathway to cardiac vagal neurons is diminished in response to both acute and chronic exposures to hypoxia/hypercapnia. This could elicit a reduced cardioprotective parasympathetic activity and an enhanced risk of adverse cardiovascular events in episodes of apnea and chronic obstructive sleep apnea.
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Affiliation(s)
- Olga Dergacheva
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Jhansi Dyavanapalli
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Ramón A Piñol
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - David Mendelowitz
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC.
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49
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Dyavanapalli J, Jameson H, Dergacheva O, Jain V, Alhusayyen M, Mendelowitz D. Chronic intermittent hypoxia-hypercapnia blunts heart rate responses and alters neurotransmission to cardiac vagal neurons. J Physiol 2014; 592:2799-811. [PMID: 24835174 DOI: 10.1113/jphysiol.2014.273482] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with obstructive sleep apnoea experience chronic intermittent hypoxia-hypercapnia (CIHH) during sleep that elicit sympathetic overactivity and diminished parasympathetic activity to the heart, leading to hypertension and depressed baroreflex sensitivity. The parasympathetic control of heart rate arises from pre-motor cardiac vagal neurons (CVNs) located in nucleus ambiguus (NA) and dorsal motor nucleus of the vagus (DMNX). The mechanisms underlying diminished vagal control of heart rate were investigated by studying the changes in blood pressure, heart rate, and neurotransmission to CVNs evoked by acute hypoxia-hypercapnia (H-H) and CIHH. In vivo telemetry recordings of blood pressure and heart rate were obtained in adult rats during 4 weeks of CIHH exposure. Retrogradely labelled CVNs were identified in an in vitro brainstem slice preparation obtained from adult rats exposed either to air or CIHH for 4 weeks. Postsynaptic inhibitory or excitatory currents were recorded using whole cell voltage clamp techniques. Rats exposed to CIHH had increases in blood pressure, leading to hypertension, and blunted heart rate responses to acute H-H. CIHH induced an increase in GABAergic and glycinergic neurotransmission to CVNs in NA and DMNX, respectively; and a reduction in glutamatergic neurotransmission to CVNs in both nuclei. CIHH blunted the bradycardia evoked by acute H-H and abolished the acute H-H evoked inhibition of GABAergic transmission while enhancing glycinergic neurotransmission to CVNs in NA. These changes with CIHH inhibit CVNs and vagal outflow to the heart, both in acute and chronic exposures to H-H, resulting in diminished levels of cardioprotective parasympathetic activity to the heart as seen in OSA patients.
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Affiliation(s)
- Jhansi Dyavanapalli
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA
| | - Heather Jameson
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA
| | - Olga Dergacheva
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA
| | - Vivek Jain
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA Department of Medicine, Medical Faculty Associates, The George Washington University, Washington, DC, 20037, USA
| | - Mona Alhusayyen
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA
| | - David Mendelowitz
- Department of Pharmacology and Physiology, 2300 Eye Street NW, The George Washington University, Washington, DC, 20037, USA
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50
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Affiliation(s)
- Tomas Konecny
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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