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Das P, Wang Y, Angom RS, Dredla B, Wang E, Jansen-West K, Badi M, Ross O, Meschia JF, Mukhopadhyay D. Changes in plasma concentrations of novel vascular and inflammatory biomarkers in obstructive sleep apnea patients pre- and post-stroke. Sleep Med 2024; 119:518-525. [PMID: 38805859 DOI: 10.1016/j.sleep.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is increasingly recognized as a common condition in the general population and causes significant OSA-associated morbidities including cardiovascular and cerebrovascular events such as cerebral small vessel disease (CSVD) and stroke. METHODS In this study, using sensitive ELISA immunoassays, we measured subset of endothelial/vascular and inflammatory biomarkers as well as neurofilament light chain (NfL), a sensitive marker for neuroaxonal injury, using plasma from OSA patients post-stroke (Acute Cerebral Infarction (ACI), N = 26) to determine their usefulness as potential prognostic markers in disease progression. RESULTS Our results showed significantly increased plasma TNFα and NfL concentrations and decreased concentrations of platelet derived growth factor (PDGF-AA) in post-stroke OSA patients with more severe white matter hyperintensities (WMHs). And after separating the patients based on sex, compared to females, male post-stroke OSA patients with severe WMHs have increased circulating levels of inflammatory chemokine CXCL10 and cytokine Interleukin-10 (IL-10) and significantly decreased levels of Angiopoietin-1 (Ang-1) an important protein responsible for endothelial/vascular integrity functions. Importantly, in a subset of newly diagnosed OSA patients (without prior history of stroke), significantly increased plasma CXCL10 levels and decreased plasma Ang-1 levels were also readily observed when compared to healthy controls, indicating possible altered endothelial integrity and ongoing vascular inflammation in these newly diagnosed OSA patients. CONCLUSIONS In summary, our study has identified a novel set of plasma biomarkers including PDGF-AA, CXCL10 and Ang-1 for their potential prognostic value for disease outcomes pre- and post-stroke in OSA patients and use as surrogate markers to measure efficacy of treatment modalities.
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Affiliation(s)
- Pritam Das
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Ying Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Brynn Dredla
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Enfeng Wang
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Karen Jansen-West
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mohammed Badi
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Owen Ross
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
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Olszowka M, Hagström E, Hadziosmanovic N, Ljunggren M, Denchev S, Manolis A, Wallentin L, White HD, Stewart RAH, Held C. Excessive daytime sleepiness, morning tiredness, and prognostic biomarkers in patients with chronic coronary syndrome. Int J Cardiol 2024; 394:131395. [PMID: 37748524 DOI: 10.1016/j.ijcard.2023.131395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Sleep-related breathing disorders (SRBD) are related to cardiovascular outcomes in patients with chronic coronary syndrome (CCS). Whether SRBD-related symptoms are associated with prognostic biomarkers in patients with CCS is not established. METHODS Associations between frequency (never/rarely, sometimes, often, always) of self-reported SRBD-related symptoms (excessive daytime sleepiness [EDS]; morning tiredness [MT]; loud snoring; multiple awakenings/night; gasping, choking, or apnea when asleep) and levels of biomarkers related to cardiovascular prognosis (high-sensitivity C-reactive protein [hs-CRP], interleukin 6 [IL-6], high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro B-type natriuretic peptide [NT-proBNP], cystatin C, growth differentiation factor 15 [GDF-15] and lipoprotein-associated phospholipase A2 activity) were assessed at baseline in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. Cross-sectional associations were assessed by adjusted linear regression models testing for trends with the never/rarely category serving as reference. RESULTS EDS was associated (geometric mean ratio, 95% confidence interval) with increased levels of IL-6 (often 1.07 [1.03-1.10], always 1.15 [1.10-1.21]), GDF-15 (often 1.03 [1.01-1.06], always 1.07 [1.03-1.11]), NT-proBNP (always 1.22 [1.12-1.33]), and hs-cTnT (always 1.07 [1.01-1.12]). MT was associated with increased levels of IL-6 (often 1.05 [1.01-1.09], always 1.09 [1.04-1.15]), and GDF-15 (always 1.06 [1.03-1.10]). All symptoms were to some degree associated with higher levels of hs-CRP and loud snoring was also associated with decreased levels of NT-proBNP and hs-cTnT. CONCLUSIONS In patients with CCS, stepwise increased frequency of SRBD-related symptoms, such as EDS and MT, were associated with gradually higher levels of IL-6 and GDF-15, each reflecting distinct pathophysiological pathways.
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Affiliation(s)
- Maciej Olszowka
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
| | - Emil Hagström
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | | | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory-, allergy- and sleep research, Uppsala University, Uppsala, Sweden
| | - Stefan Denchev
- Medical Institute of Ministry of Interior, Sofia, Bulgaria
| | | | - Lars Wallentin
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Harvey D White
- Green Lane Cardiovascular Service, Te Whatu Ora Health New Zealand, Te Toka Tumai Auckland and University of Auckland, Auckland, New Zealand
| | - Ralph A H Stewart
- Green Lane Cardiovascular Service, Te Whatu Ora Health New Zealand, Te Toka Tumai Auckland and University of Auckland, Auckland, New Zealand
| | - Claes Held
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Plećaš D, Mraz N, Patanaude AM, Pribić T, Pavlinac Dodig I, Pecotić R, Lauc G, Polašek O, Đogaš Z. Not-So-Sweet Dreams: Plasma and IgG N-Glycome in the Severe Form of the Obstructive Sleep Apnea. Biomolecules 2023; 13:880. [PMID: 37371460 DOI: 10.3390/biom13060880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent disease associated with increased risk for cardiovascular and metabolic diseases and shortened lifespan. The aim of this study was to explore the possibility of using N-glycome as a biomarker for the severe form of OSA. Seventy subjects who underwent a whole-night polysomnography/polygraphy and had apnea-hypopnea index (AHI) over 30 were compared to 23 controls (AHI under 5). Plasma samples were used to extract 39 glycan peaks using ultra-high-performance liquid chromatography (UPLC) and 27 IgG peaks using capillary gel electrophoresis (CGE). We also measured glycan age, a molecular proxy for biological aging. Three plasma and one IgG peaks were significant in a multivariate model controlling for the effects of age, sex, and body mass index. These included decreased GP24 (disialylated triantennary glycans as major structure) and GP28 (trigalactosylated, triantennary, disialylated, and trisialylated glycans), and increased GP32 (trisialylated triantennary glycan). Only one IgG glycan peak was significantly increased (P26), which contains biantennary digalactosylated glycans with core fucose. Patients with severe OSA exhibited accelerated biological aging, with a median of 6.9 years more than their chronological age (p < 0.001). Plasma N-glycome can be used as a biomarker for severe OSA.
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Affiliation(s)
- Doris Plećaš
- Mediterranean Institute for Life Sciences, 21000 Split, Croatia
| | - Nikol Mraz
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
| | | | - Tea Pribić
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
| | - Ivana Pavlinac Dodig
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
| | - Renata Pecotić
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
| | - Gordan Lauc
- Genos Glycoscience Ltd., 10000 Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, 21000 Split, Croatia
- Department of General Courses, Algebra University, 10000 Zagreb, Croatia
| | - Zoran Đogaš
- Department for Neuroscience, School of Medicine, Sleep Medicine Center, University of Split, 21000 Split, Croatia
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Belkin M, Wussler D, Michou E, Strebel I, Kozhuharov N, Sabti Z, Nowak A, Shrestha S, Lopez-Ayala P, Prepoudis A, Stefanelli S, Schäfer I, Mork C, Albus M, Danier I, Simmen C, Zimmermann T, Diebold M, Breidthardt T, Mueller C. Prognostic Value of Self-Reported Subjective Exercise Capacity in Patients With Acute Dyspnea. JACC. ADVANCES 2023; 2:100342. [PMID: 38939580 PMCID: PMC11198416 DOI: 10.1016/j.jacadv.2023.100342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 06/29/2024]
Abstract
Background Self-reported exercise capacity is a well-established prognostic measure in stable ambulatory patients with cardiac and pulmonary disease. Objectives The authors aimed to directly compare the prognostic accuracy of quantified self-reported exercise capacity using the Duke Activity Status Index (DASI) with the established objective disease-severity marker B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea to the emergency department. Methods The DASI was obtained in a prospective multicenter diagnostic study recruiting unselected patients presenting with acute dyspnea to the emergency department. The prognostic accuracy of DASI and BNP for 90-day and 720-day all-cause mortality was evaluated using C-index. Results Among 1,019 patients eligible for this analysis, 75 (7%) and 297 (29%) patients died within 90 and 720 days after presentation, respectively. Unadjusted hazard ratios (HRs) and multivariable adjusted hazard ratios (aHRs) for 90- and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI quartile (worst self-reported exercise capacity). For 720-day mortality the HR of the first quartile vs the fourth was 9.1 (95% CI, 5.5-14.9) vs (aHR: 6.1, 95% CI: 3.7-10.1), of the second quartile 6.4 (95% CI: 3.9-10.6) vs (aHR: 4.4, 95% CI: 2.6-7.3), while of the third quartile the HR was 3.2 (95% CI: 1.9-5.5) vs (aHR: 2.4, 95% CI: 1.4-4.0). The prognostic accuracy of the DASI score was high, and higher than that of BNP concentrations (720-day mortality C-index: 0.67 vs 0.62; P = 0.024). Conclusions Quantification of self-reported subjective exercise capacity using the DASI provides high prognostic accuracy and may aid physicians in risk stratification. (Basics in Acute Shortness of Breath EvaLuation [BASEL V] Study [BASEL V]; NCT01831115).
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Affiliation(s)
- Maria Belkin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Eleni Michou
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Division of Internal Medicine, University Psychiatry Clinic Zurich, Zurich, Switzerland
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Alexandra Prepoudis
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Sabrina Stefanelli
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Ibrahim Schäfer
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Constantin Mork
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Miriam Albus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Isabelle Danier
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Cornelia Simmen
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Matthias Diebold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Tobias Breidthardt
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- GREAT network, Rome, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT network, Rome, Italy
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5
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Ooi EL, Rajendran S, Munawar DA, Hnin K, Mahadavan G, Pati P, Tavella R, Beltrame J, Arstall M. The Association of Obstructive Sleep Apnea in Ischemia with No Obstructive Coronary Artery Disease - A Pilot Study. Curr Probl Cardiol 2023; 48:101111. [PMID: 35021111 DOI: 10.1016/j.cpcardiol.2022.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
Obstructive sleep apnea (OSA) is increasingly recognized to be a risk factor for cardiovascular disease. This pilot study assessed the association of OSA and invasive coronary microvascular function in patients with ischemia with no obstructive coronary artery disease (INOCA). Forty-two patients with angina, were prospectively screened at a single tertiary centre covering the northern metropolitan area of South Australia, from February 2018 to December 2020 (ACTRN12618000149268). Forty patients were invited into to this observational study after coronary angiography demonstrated INOCA and functional coronary vasomotor disorder (n = 40). Twenty one participants subsequently underwent a sleep study for OSA diagnosis while 9 participants had prior formal diagnosis of OSA (ACTRN12618000227291). Of the 30 participants with OSA data, 87% (n = 26) had a diagnosis of OSA. Accordingly, 11 with mild severity, 7 with moderate severity and 8 with severe OSA. No OSA was observed in 4 participants. Participants with OSA were older [61.4±8.7 vs 49.9±9.7, P = 0.002] with similar clinical characteristics for the pattern and severity of angina and other co-morbidities. 73.3% (n = 22) had abnormal functional disorders of the epicardial coronary arteries and/or coronary microcirculation. On multivariate analysis, OSA was the only statistically significant association with functional coronary microvascular disorders [OR 53.95, 1.41 -2065.01, P = 0.032]. This study provided an observation of a significant correlation between INOCA with abnormal coronary vasomotor function and OSA in an Australian cohort. This correlation supports a possible pathophysiological interplay between these two conditions that needs to be further evaluated. The benefit of treatment of OSA in this subset remains unknown.
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Affiliation(s)
- Eng Lee Ooi
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
| | - Sharmalar Rajendran
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Dian Andina Munawar
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Khin Hnin
- Norwood Specialist Clinic, Adelaide, SA Australia
| | - Gnanadevan Mahadavan
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Purendra Pati
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Rosanna Tavella
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - John Beltrame
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Margaret Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
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Kim J, An S, Kim Y, Yoon DW, Son SA, Park JW, Jhe W, Park CS, Shin HW. Surface Active Salivary Metabolites Indicate Oxidative Stress and Inflammation in Obstructive Sleep Apnea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:316-335. [PMID: 37075797 DOI: 10.4168/aair.2023.15.3.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA), a highly prevalent and potentially serious sleep disorder, requires effective screening tools. Saliva is a useful biological fluid with various metabolites that might also influence upper airway patency by affecting surface tension in the upper airway. However, little is known about the composition and role of salivary metabolites in OSA. Therefore, we investigated the metabolomics signature in saliva from the OSA patients and evaluated the associations between identified metabolites and salivary surface tension. METHODS We studied 68 subjects who visited sleep clinic due to the symptoms of OSA. All underwent full-night in-lab polysomnography. Patients with apnea-hypopnea index (AHI) < 10 were classified to the control, and those with AHI ≥ 10 were the OSA groups. Saliva samples were collected before and after sleep. The centrifuged saliva samples were analyzed by liquid chromatography with high-resolution mass spectrometry (ultra-performance liquid chromatography-tandem mass spectrometry; UPLC-MS/MS). Differentially expressed salivary metabolites were identified using open source software (XCMS) and Compound Discoverer 2.1. Metabolite set enrichment analysis (MSEA) was performed using MetaboAnalyst 5.0. The surface tension of the saliva samples was determined by the pendant drop method. RESULTS Three human-derived metabolites (1-palmitoyl-2-[5-hydroxyl-8-oxo-6-octenoyl]-sn-glycerol-3-phosphatidylcholine [PHOOA-PC], 1-palmitoyl-2-[5-keto-8-oxo-6-octenoyl]-sn-glycerol-3-phosphatidylcholine [KPOO-PC], and 9-nitrooleate) were significantly upregulated in the after-sleep salivary samples from the OSA patients compared to the control group samples. Among the candidate metabolites, only PHOOA-PC was correlated with the AHI. In OSA samples, salivary surface tension decreased after sleep. The differences in surface tension were negatively correlated with PHOOA-PC and 9-nitrooleate concentrations. Furthermore, MSEA revealed that arachidonic acid-related metabolism pathways were upregulated in the after-sleep samples from the OSA group. CONCLUSIONS This study revealed that salivary PHOOA-PC was correlated positively with the AHI and negatively with salivary surface tension in the OSA group. Salivary metabolomic analysis may improve our understanding of upper airway dynamics and provide new insights into novel biomarkers and therapeutic targets in OSA.
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Affiliation(s)
- Jiyoung Kim
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine, Seoul, Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sangmin An
- Department of Physics and Astronomy, Institute of Applied Physics, Seoul National University, Seoul, Korea
- Department of Physics, Research institute of Physics and Chemistry, Jeonbuk National University, Jeonju, Korea
| | - Yisook Kim
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Wui Yoon
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Ah Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Wan Park
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine, Seoul, Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonho Jhe
- Department of Physics and Astronomy, Institute of Applied Physics, Seoul National University, Seoul, Korea.
| | - Chan-Soon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.
| | - Hyun-Woo Shin
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine, Seoul, Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.
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7
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Kondratavičienė L, Tamulėnaitė E, Vasylė E, Januškevičius A, Ereminienė E, Malakauskas K, Žemaitis M, Miliauskas S. Changes in Left Heart Geometry, Function, and Blood Serum Biomarkers in Patients with Obstructive Sleep Apnea after Treatment with Continuous Positive Airway Pressure. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111511. [PMID: 36363468 PMCID: PMC9698941 DOI: 10.3390/medicina58111511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Background: Cardiovascular remodeling is essential in patients with obstructive sleep apnea (OSA), and continuous positive airway pressure (CPAP) therapy could improve these processes. Two-dimensional (2D) speckle-tracking (ST) echocardiography is a useful method for subclinical biventricular dysfunction diagnosis and thus might help as an earlier treatment for OSA patients. It is still not clear which blood serum biomarkers could be used to assess CPAP treatment efficacy. Objectives: To evaluate left heart geometry, function, deformation parameters, and blood serum biomarker (galectin-3, sST2, endothelin-1) levels in patients with OSA, as well as to assess changes after short-term CPAP treatment. Materials and Methods: Thirty-four patients diagnosed with moderate or severe OSA, as well as thirteen patients as a control group, were included in the study. All the subjects were obese (body mass index (BMI) > 30 kg/m2). Transthoracic 2D ST echocardiography was performed before and after 3 months of treatment with CPAP; for the control group, at baseline only. Peripheral blood samples for the testing of biomarkers were collected at the time of study enrolment before the initiation of CPAP therapy and after 3 months of CPAP treatment (blood samples were taken just for OSA group patients). Results: The left ventricle (LV) end-diastolic diameter and volume, as well as LV ejection fraction (EF), did not differ between groups, but an increased LV end-systolic volume and a reduced LV global longitudinal strain (GLS) were found in the OSA group patients (p = 0.015 and p = 0.035, respectively). Indexed by height, higher LV MMi in OSA patients (p = 0.007) and a higher prevalence of LV diastolic dysfunction (p = 0.023) were found in this group of patients. Although left atrium (LA) volume did not differ between groups, OSA group patients had significantly lower LA reservoir strain (p < 0.001). Conventional RV longitudinal and global function parameters (S′, fractional area change (FAC)) did not differ between groups; however, RV GLS was reduced in OSA patients (p = 0.026). OSA patients had a significantly higher right atrium (RA) diameter and mean pulmonary artery pressure (PAP) (p < 0.05). Galectin-3 and sST2 concentrations significantly decreased after 3 months of CPAP treatment. Conclusions: OSA is associated with the left heart remodeling process—increased LV myocardial mass index, LV diastolic dysfunction, reduced LV and RV longitudinal strain, and reduced LA reservoir function. A short-term, 3-months CPAP treatment improves LV global longitudinal strain and LA reservoir function and positively affects blood serum biomarkers. This new indexing system for LV myocardial mass by height helps to identify myocardial structural changes in obese patients with OSA.
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Affiliation(s)
- Laima Kondratavičienė
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Correspondence:
| | - Eglė Tamulėnaitė
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Eglė Vasylė
- Laboratory of Pulmonology, Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Andrius Januškevičius
- Laboratory of Pulmonology, Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Kęstutis Malakauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marius Žemaitis
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Skaidrius Miliauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Seshadri S, Shokr H, Gherghel D. Retinal Microvascular Abnormalities and Systemic Arterial Stiffness Are the First Manifestation of Cardiovascular Abnormalities in Patients with Untreated Moderate to Severe Obstructive Sleep Apnoea and with Low to Intermediate Cardiovascular Risk-A Pilot Study. Biomedicines 2022; 10:biomedicines10102669. [PMID: 36289930 PMCID: PMC9599073 DOI: 10.3390/biomedicines10102669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate macro- and microvascular function parameters and their relationship with known markers of cardiovascular risk in patients with untreated moderate to severe obstructive sleep apnoea (OSA). Fourteen patients with moderate to severe OSA and fourteen controls were included in the present study. General assessments included BMI, systemic blood pressure (BP) and circulating markers for oxidative stress and endothelial function. Additional assessments included 24 h BP and heart rate monitoring, as well as the assessment of heart rate variability. Macro- and microvascular assessments included augmentation index, carotid intima-media thickness, brachial artery flow-mediated dilation, as well as various retinal microvascular function assessments, using the Dynamic Retinal Vessel Analyzer. All participants completed the Short Form Health Survey, Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale. The results show that, in comparison to controls, BMI (p = 0.003) and AIx (p = 0.025) were significantly higher in the OSA group. There was, however, no significant difference between groups with regard to other measured systemic general, vascular and circulatory parameters (all p > 0.05). Nevertheless, the retinal microvascular function showed various alterations in the OSA patients, including a delayed reaction time in response to flicker (p = 0.047), as well as a decreased dilation amplitude (p = 0.004), dilation slope (p = 0.004), and post-flicker constriction (p = 0.015). In addition, the observed SlopeAD alterations correlated negatively with BMI values only in the OSA group (r = −0.46, p = 0.045). In conclusion, individuals with untreated moderate to severe OSA but without overt CVD, exhibit signs of increased arterial stiffness and retinal microvascular dysfunction, which can be early indicators for future vascular complications.
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Affiliation(s)
- Swathi Seshadri
- Vascular Research Laboratory, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Hala Shokr
- Vascular Research Laboratory, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Pharmacy Division, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Correspondence: (H.S.); (D.G.)
| | - Doina Gherghel
- Vascular Research Laboratory, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
- Correspondence: (H.S.); (D.G.)
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9
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Kazukauskiene N, Fineberg NA, Podlipskyte A, Bunevicius A, Linares NFN, Poitras M, Plamondon H, Pranckeviciene A, Gecaite-Stonciene J, Mickuviene N, Varoneckas G, Burkauskas J. Contribution of Obstructive Sleep Apnoea to Cognitive Functioning of Males With Coronary Artery Disease: A Relationship With Endocrine and Inflammatory Biomarkers. Front Neurosci 2022; 16:899597. [PMID: 35924228 PMCID: PMC9340787 DOI: 10.3389/fnins.2022.899597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Our exploratory study aimed to determine whether obstructive sleep apnoea (OSA) could affect cognitive functioning in males with coronary artery disease (CAD), and whether such impact could be associated with changes in thyroid hormones and inflammatory marker regulation on cognitive functioning. Method We evaluated different endocrine and inflammatory biomarkers, including free triiodothyronine [fT3], free tetraiodothyronine [fT4], N-terminal pro-B-type natriuretic peptide [NT-pro-BNP], and high-sensitivity C-reactive protein [hs-CRP] serum levels in 328 males (x¯ = 57 ± 10 years), undergoing cardiac rehabilitation after an acute coronary event. Participants underwent full-night polysomnography and were classified in mild/non-OSA (n = 253) and OSA (n = 75) according to an apnoea-hypopnoea index ≥ 15 event/h. Cognitive functioning testing included the Digit Span Test, Digit Symbol Test (DSST), and Trail Making Test. Analyses of variance assessed the impact of OSA on cognitive functioning and possible relationships of fT3/fT4, NT-pro-BNP and with hs-CRP on cognitive measures. Results Significant group (OSA, mild/non-OSA) × NT-pro-BNP (<157.0 vs. ≥157.0, ng/L) interactions were found for the DSST raw score (F(2,324) = 3.58, p = 0.014). Decomposition of interactions showed that the DSST scores of the OSA group with NT-pro-BNP ≥ 157.0 ng/L (M = 33.2; SD = 8.1) were significantly lower, p = 0.031, than those of the mild/non-OSA with NT-pro-BNP < 157.0 ng/L (M = 37.7; SD = 8.9). Conclusion These findings indicate that males with OSA and clinically elevated NT-pro-BNP levels experienced inferior psychomotor performance compared to those without OSA and reduced NT-pro-BNP levels.
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Affiliation(s)
- Nijole Kazukauskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Naomi A. Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership University, NHS Foundation Trust, Welwyn Garden City, United Kingdom
| | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Adomas Bunevicius
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | | | - Marilou Poitras
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Hélène Plamondon
- Behavioural Neuroscience Group, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Aiste Pranckeviciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Giedrius Varoneckas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
- *Correspondence: Julius Burkauskas,
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10
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Ooi EL, Rajendran S. Obstructive Sleep Apnea in Coronary Artery Disease. Curr Probl Cardiol 2022:101178. [PMID: 35341799 DOI: 10.1016/j.cpcardiol.2022.101178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder, characterised by obstruction of upper airways during sleep, resulting in repetitive breathing pauses accompanied by oxygen desaturation and arousal from sleep. OSA patients commonly suffers from poor sleep quality and reduced quality of life. Further, OSA is associated with cardiovascular risk factors and linked independently to both structural coronary artery disease (CAD) as well as functional CAD. Structural CAD is depicted by atherosclerosis (either obstructive or non-obstructive) of the epicardial coronary arteries, while functional CAD, encompasses the spectrum of coronary vasomotor disorders (CVD). There are multiple factors including intermittent hypoxia (IH), sleep fragmentation, and intra-thoracic pressure swings leading to altered cardiopulmonary vascular hemodynamic. IH and its downstream maladaptive responses has the most robust evidence for OSA's role in atherogenesis. CPAP therapy has been linked with reduction in major adverse cardiovascular events in meta-analyses, however, pivotal randomised controlled trials failed to demonstrate its significance.
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Affiliation(s)
- Eng Lee Ooi
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia 5005
| | - Sharmalar Rajendran
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia 5005; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.
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11
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Zhang L, Zhang X, Li YM, Xiang BY, Han T, Wang Y, Wang C. Association of Craniofacial and Upper Airway Morphology with Cardiovascular Risk in Adults with OSA. Nat Sci Sleep 2021; 13:1689-1700. [PMID: 34629918 PMCID: PMC8493274 DOI: 10.2147/nss.s332117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Clinical and population-based studies have demonstrated a strong association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD). Anatomical abnormalities of the craniofacial region and upper airway are important risk factors for OSA. The objective of this study was to investigate the association of craniofacial and upper airway morphology with CVD risk biomarkers. METHODS One hundred and sixty-nine male patients with OSA underwent in-laboratory polysomnography (PSG) and upper airway computed tomography (CT) scanning. Ten-year Framingham CVD risk score (FRS) was calculated and categorized into low- and moderate-to-high-risk groups. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured as a biomarker of increased myocardial wall stress. RESULTS Compared to the low-risk group, total sleep time (TST), the proportion of N3 (N3%) and mean oxygen saturation (SpO2mean) were lower, while the arousal index of non-rapid eye movement (NREM) sleep, apnea index (AI) of NREM sleep, apnea hypopnea index (AHI) of NREM sleep, oxygen desaturation index (ODI) and percentage of total sleep time spent with oxyhemoglobin saturation below 90% (TST90) were higher in the moderate-to-high risk group. The corrected upper airway length (UAL), ANB angle and gonion-gnathion-hyoid angle were larger for subjects in the moderate-to-high risk group than those in the low-risk group. In multiple regression analysis, TST, AINREM and adjusted UAL were independently associated with moderate-to-high CVD risk. Plasma NT-proBNP levels were higher in patients in the moderate- to high-risk group, and among the PSG and CT scan parameters, only SPO2mean was marginally associated with NT-proBNP (r=0.183, P=0.054). CONCLUSION Craniofacial and upper airway features may contain valid cues about CVD risk, and sleep duration, obstructive event type and occurrence phase may be closely related to CVD risk for patients with OSA.
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Affiliation(s)
- Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Bo Yun Xiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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12
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Hauquiert B, Drion E, Deflandre E. [The role of biomarkers in the detection of the OSA syndrome. A narrative review of the literature]. Rev Mal Respir 2021; 38:455-465. [PMID: 33958251 DOI: 10.1016/j.rmr.2021.04.005] [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: 10/28/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is a common sleep-related breath disorder associated with cardiovascular and cerebrovascular complications, such as hypertension, arrhythmia, coronary artery disease and stroke. Unfortunately, OSA is underdiagnosed. BACKGROUND Because of its clinical and therapeutic variability, OSA could benefit a personalized medicine approach. Diagnosis with polysomnography is expensive and access is limited. Clinical scoring systems allow screening of OSA, but many limitations exist. Because of this, biomarkers could be useful for the detection of OSA. OUTLOOK Biomarkers specific to OSA would allow for better mass screening and more personalized treatment of the disease. This narrative review of the literature aims to summarize the biomarkers already described for the diagnosis of OSA and clarify both their advantages and limitations in daily practice. CONCLUSIONS Our review of the literature did not actually identify an ideal biomarker even if promising research is ongoing.
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Affiliation(s)
- B Hauquiert
- Département d'anesthésie-réanimation, Université catholique de Louvain, Bruxelles, Belgique
| | - E Drion
- Département de neurologie, Université de Liège, Liège, Belgique
| | - E Deflandre
- Chef de service et maître de stages, Département d'anesthésie-réanimation, Clinique Saint-Luc-de-Bouge, Namur, Belgique.
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Ooi EL, Rajendran S, Tavella R, Air T, Mahadavan G, Arstall M, Sinhal A, Worthley M, Zeitz C, Beltrame J. Predictors of Obstructive Sleep Apnoea (OSA) Population in the Coronary Angiogram Database of South Australia (CADOSA). Curr Probl Cardiol 2021; 47:100846. [PMID: 33994030 DOI: 10.1016/j.cpcardiol.2021.100846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022]
Abstract
Obstructive sleep apnoea (OSA) is increasingly recognized to be a risk factor for cardiovascular disease. This study assessed the prevalence and clinical predictors of OSA in patients undergoing coronary angiography. Consecutive patients undergoing coronary angiography in South Australian public hospitals from 2015 to 2018 were included. Clinical details for consecutive patients undergoing coronary angiography in South Australian public hospitals were captured by the Coronary Angiogram Database of South Australia (CADOSA) registry staff, with OSA identified by patient report. Among the 9,885 patients undergoing coronary angiography for the investigation of chest pain, 11% (n = 1,089) were documented as having OSA. Independent clinical predictors of OSA included male gender (OR 2.22, 1.86-2.65, P < 0.001), diabetes mellitus (OR 1.84, 1.58-2.14, P < 0.001), depression (OR 1.81, 1.55-2.12, P < 0.001), prior heart failure (OR 1.63, 1.22-2.18, P = 0.001), hypertension (OR 1.61, 1.32-1.95, P ≤ 0.001), asthma (OR 1.61, 1.34-1.93, P < 0.001), not a current smoker (OR 1.60, 1.30-1.96, P < 0.001), dyslipidaemia (OR 1.46, 1.22-1.76, P < 0.001), non-acute coronary syndrome presentation (OR 1.45, 1.25-1.69, P < 0.001), chronic lung disease (OR 1.40, 1.12-1.73, P = 0.003), cerebrovascular disease (OR 1.36, 1.07-1.73, P = 0.012), non-obstructive coronary artery disease (NOCAD) (OR 1.30, 1.10-1.55, P = 0.003) and atrial fibrillation/flutter (OR 1.30, 1.06-1.60, P = 0.012). Finally, stable angina (32.1% vs 22.7%) and NOCAD (29.1% vs 26.3%, P = 0.051) were trended more common in patients with OSA versus no OSA. In addition to established risk factors for OSA, this study found NOCAD to be independent predictor of OSA; especially in those presenting with a stable angina presentation. This suggests that coronary vasomotor disorders may be associated with OSA, although further detailed studies are required.
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Affiliation(s)
- Eng Lee Ooi
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Sharmalar Rajendran
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Rosanna Tavella
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Tracy Air
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Gnanadevan Mahadavan
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Margaret Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Ajay Sinhal
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Flinders Medical Centre, Bedford Park, Australia
| | - Matthew Worthley
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Christopher Zeitz
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia
| | - John Beltrame
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, Australia.
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14
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Cheong CS, Lee CH. Reply to letter to the editor obstructive sleep apnea and cardiac biomarkers in patients with acute coronary syndrome. Sleep Med 2021; 81:245. [PMID: 33725491 DOI: 10.1016/j.sleep.2021.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Crystal Sj Cheong
- Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Center Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore.
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15
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Obstructive sleep apnea and cardiac biomarkers in patients with acute coronary syndrome. Sleep Med 2021; 81:244. [PMID: 33725490 DOI: 10.1016/j.sleep.2021.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
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Xu L, Keenan BT, Maislin D, Gislason T, Benediktsdóttir B, Gudmundsdóttir S, Gardarsdottir M, Staley B, Pack FM, Guo X, Feng Y, Chahwala J, Manaktala P, Hussein A, Reddy-Koppula M, Hashmath Z, Lee J, Townsend RR, Schwab RJ, Pack AI, Kuna ST, Chirinos JA. Effect of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Cardiac Remodeling as Assessed by Cardiac Biomarker and Magnetic Resonance Imaging in Nonobese and Obese Adults. Hypertension 2021; 77:980-992. [PMID: 33461313 DOI: 10.1161/hypertensionaha.120.15882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m2) and obese (n=136; body mass index ≥30 kg/m2) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP (P<0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index (P=0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01578031.
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Affiliation(s)
- Liyue Xu
- From the Sleep Center, Peking University People's Hospital, Beijing, China (L.X.).,Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - David Maislin
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Thorarinn Gislason
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Bryndís Benediktsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Sigrun Gudmundsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik
| | | | - Bethany Staley
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Frances M Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Xiaofeng Guo
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.F.)
| | - Jugal Chahwala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Pritika Manaktala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Anila Hussein
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Maheshwara Reddy-Koppula
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Zeba Hashmath
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Jonathan Lee
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia.,Sleep Medicine Section, Crescenz Veterans Affairs Medical Center, Philadelphia (S.T.K.)
| | - Julio A Chirinos
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
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17
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Lebkuchen A, Freitas LS, Cardozo KHM, Drager LF. Advances and challenges in pursuing biomarkers for obstructive sleep apnea: Implications for the cardiovascular risk. Trends Cardiovasc Med 2020; 31:242-249. [PMID: 32413393 DOI: 10.1016/j.tcm.2020.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnea (OSA) is a common clinical condition associated with increased cardiovascular morbidity and mortality. Recent evidence from clinical studies and animal models suggest that OSA can promote cardiovascular disease by inducing autonomic, hemodynamic, inflammatory and metabolic dysregulation. However, most of the evidence addressing hard endpoints in humans is derived from observational studies. Several challenges have been noted in the pursuit of a comprehensive knowledge base about the impact of OSA including: 1) the precise mechanisms by which OSA causes metabolic and cardiovascular consequences are not clear, which limits our current ability to address potential targets in OSA; 2) several patients with OSA, even with severe forms, present with no or mild daytime symptoms. Beyond the obvious challenges for obtaining good adherence for conventional OSA treatments, there is evidence that symptomatic vs. asymptomatic patients with OSA do not necessarily have the same metabolic and cardiovascular outcomes; and 3) the cardiovascular response to OSA treatment may vary even in those patients with good adherence. In this scenario, there is an obvious need to develop biomarkers in the OSA research area. This review focuses on describing the advances that have occurred so far in exploring potential OSA biomarkers with clear emphasis for the cardiovascular risk. Particular attention will be devoted to discuss molecular biomarkers including the potential role of microRNAs, proteomics and metabolomics. We also discuss the major challenges and perspectives in this growing research field.
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Affiliation(s)
| | - Lunara S Freitas
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School
| | | | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School; Hypertension Unit, Renal Division, University of Sao Paulo Medical School.
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18
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Sun H, Fang F, Li K, Zhang H, Zhang M, Zhang L, Li J, Qin Y, Wei Y. Circulating ESM-1 levels are correlated with the presence of coronary artery disease in patients with obstructive sleep apnea. Respir Res 2019; 20:188. [PMID: 31429753 PMCID: PMC6701084 DOI: 10.1186/s12931-019-1143-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/24/2019] [Indexed: 12/26/2022] Open
Abstract
Background Endothelial dysfunction is one of the most important early indicators of atherosclerosis in obstructive sleep apnea (OSA) patients. Endothelial cell specific molecules-1 (ESM-1), which is a novel endothelial dysfunction marker that may be linked to cardiovascular disease. We investigated to assess whether circulating ESM-1 levels are correlated with the presence of coronary artery disease (CAD) in patients with OSA. Methods We performed a cross-sectional study in 228 Chinese OSA subjects, including 185 patients with OSA and 43 controls. The Gensini stenosis scoring system was used to assess the severity of CAD. Circulating ESM-1 levels were measured by Human Magnetic Luminex Screening Assay. The associations between circulating ESM-1 levels and CAD were determined by multivariate logistic regression analysis. The association between ESM-1 levels and Gensini scores was determined by multivariate linear regression analysis. Results CAD patients had significantly higher circulating ESM-1 levels compared with non-CAD patients (1279.01[918.52–1770.71] pg/ml vs 585.46[423.61–812.56] pg/ml, P < 0.001). After adjusting for confounding factors, we found that circulating ESM-1 levels were an independent risk factor for CAD (OR = 1.633/100 pg ESM-1, 95%CI =1.179–2.262, P = 0.003), while circulating ESM-1 levels have no significant correlation with the Gensini score. Furthermore, circulating ESM-1 showed higher discriminatory accuracy in predicting the presence of OSA (AUC:0.910). Conclusions Circulating ESM-1 might function as a useful biomarker for monitoring the development and progression of CAD in OSA patients. Electronic supplementary material The online version of this article (10.1186/s12931-019-1143-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haili Sun
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China
| | - Fang Fang
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China.,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China
| | - Kun Li
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China
| | - Huina Zhang
- Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China
| | - Ming Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China
| | - Lichuan Zhang
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China
| | - Juan Li
- Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China
| | - Yanwen Qin
- Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China
| | - Yongxiang Wei
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, NO.2 Anzhen Road, Beijing, 100029, China. .,Key Laboratory of Upper Airway Dysfunction-related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, No. 2 Anzhen Road, Beijing, 100029, China.
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19
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Franczak A, Bil-Lula I, Sawicki G, Fenton M, Ayas N, Skomro R. Matrix metalloproteinases as possible biomarkers of obstructive sleep apnea severity - A systematic review. Sleep Med Rev 2019; 46:9-16. [PMID: 31060030 DOI: 10.1016/j.smrv.2019.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea is an underdiagnosed sleep-related breathing disorder affecting millions of people. Recurrent episodes of apnea/hypopnea result in intermittent hypoxia leading to oxidative stress. Obstructive sleep apnea is considered an independent risk factor for cardiovascular disease but the exact pathophysiology of adverse cardiovascular outcomes of obstructive sleep apnea has not been fully elucidated. Matrix metalloproteinases (MMPs) have been associated with both oxidative stress and cardiovascular diseases. Hypoxic conditions were shown to influence MMP expression, secretion and activity. Moreover, matrix metalloproteinases contribute to ischemia/reperfusion injury. Therefore, action of matrix metalloproteinases can provide a possible molecular mechanism linking obstructive sleep apnea with oxidative stress and cardiovascular disease. The aim of this paper was to review the current evidence of association between matrix metalloproteinases and obstructive sleep apnea with focus on hypoxemia and severity of obstructive sleep apnea.
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Affiliation(s)
- Aleksandra Franczak
- Division of Respiratory, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada; Department of Medical Laboratory Diagnostics, Division of Clinical Chemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Iwona Bil-Lula
- Department of Medical Laboratory Diagnostics, Division of Clinical Chemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Sawicki
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada; Department of Medical Laboratory Diagnostics, Division of Clinical Chemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Mark Fenton
- Division of Respiratory, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada; Canadian Sleep and Circadian Network
| | - Najib Ayas
- University of British Columbia, Vancouver, B.C. Canada; Canadian Sleep and Circadian Network
| | - Robert Skomro
- Division of Respiratory, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada; Canadian Sleep and Circadian Network; Division of Angiology, Wroclaw Medical University, Wroclaw, Poland.
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20
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Monneret D. N-terminal pro-brain natriuretic peptide: a potential follow-up biomarker of mandibular advancement device efficacy on cardiac function in obstructive sleep apnea. F1000Res 2019; 7:1818. [PMID: 30906526 PMCID: PMC6415324 DOI: 10.12688/f1000research.17081.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 12/26/2022] Open
Abstract
Interrelationships between obstructive sleep apnea (OSA) and cardiovascular diseases are now recognized, but some underlying pathophysiological mechanisms remain controversial. Circulating cardiac biomarkers are diagnostic tools that can help understand them, in particular the N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of myocardial stretch, and a potential indicator of subclinical cardiac stress in OSA. Continuous positive airway pressure (CPAP), the first-line treatment of moderate to severe OSA, may be considered as uncomfortable, resulting in poor adherence, and reduced effectiveness. In this case, mandibular advancement devices (MAD) are an effective alternative therapy, more comfortable, and generally well accepted, with higher compliance. To date, few studies have compared the cardiovascular effects of CPAP and MAD. From recent literature reviews, it emerges that both therapies are effective in blood pressure reduction. However, the effects of MAD on other cardiovascular outcomes are conflicting, in particular as regards to its impact on circulating cardiac biomarkers. In a recent ancillary study from a randomized controlled trial, Recoquillon
et al concluded that two months of MAD treatment had no effect on NT-proBNP plasma levels in patients with severe OSA. The present discussion analyses this result from a biological, statistical, and analytical standpoint, in light of results from other studies evaluating natriuretic peptides in MAD-treated OSA, with the aim to support further longitudinal studies designed with a high methodological quality.
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Affiliation(s)
- Denis Monneret
- Department of Biochemistry and Molecular Biology, South Lyon Hospital Group, Hospices Civils de Lyon, Pierre-Bénite, 69495, France
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21
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Steiropoulos P, Voulgaris A, Papanas N. Cardiovascular disease and obstructive sleep apnea: an underappreciated role for increased platelet activity? Expert Opin Pharmacother 2018; 19:1043-1044. [DOI: 10.1080/14656566.2018.1491242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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22
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Fleming WE, Holty JEC, Bogan RK, Hwang D, Ferouz-Colborn AS, Budhiraja R, Redline S, Mensah-Osman E, Osman NI, Li Q, Azad A, Podolak S, Samoszuk MK, Cruz AB, Bai Y, Lu J, Riley JS, Southwick PC. Use of blood biomarkers to screen for obstructive sleep apnea. Nat Sci Sleep 2018; 10:159-167. [PMID: 29942168 PMCID: PMC6005302 DOI: 10.2147/nss.s164488] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study. PATIENTS AND METHODS This multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c), C-reactive protein (CRP), uric acid, erythropoietin (EPO), and interleukin-6 (IL-6). RESULTS The study enrolled 264 subjects. The combination of HbA1c+CRP+EPO (area under the curve 0.78) was superior to the Epworth Sleepiness Scale (ESS; 0.53) and STOP-Bang (0.70) questionnaires. In non-obese subjects, the combination of biomarkers (0.75) was superior to body mass index (BMI; 0.61). Sensitivity and specificity results, respectively, were: HbA1c+CRP+EPO (81% and 60%), ESS (78% and 19%), STOP-Bang (75% and 52%), BMI (81% and 56%), and BMI in non-obese patients (81% and 38%). CONCLUSION We verify our hypothesis and replicate our prior feasibility findings that OSA is associated with a characteristic signature cluster of biomarker changes in men. Concurrent elevations of HbA1c, CRP, and EPO levels should generate a high suspicion of OSA and may have utility as an OSA screening tool. Biomarker combinations correlate with OSA severity and, therefore, may assist sleep centers in identifying and triaging higher risk patients for sleep study diagnosis and treatment.
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Affiliation(s)
| | - Jon-Erik C Holty
- Stanford Medical School, VA Palo Alto Health Care System, Pulmonary, Critical Care and Sleep Medicine Section, Palo Alto, CA, USA
| | - Richard K Bogan
- SleepMed Inc., Bogan Sleep Consultants, LLC, Columbia, SC, USA
| | - Dennis Hwang
- Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA
| | - Aliya S Ferouz-Colborn
- Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA
| | - Rohit Budhiraja
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Nadir Ishag Osman
- EENA Comprehensive Neurology and Sleep Center, Boynton Beach, FL, USA
| | - Qing Li
- South Bend Medical Foundation, New Technology and Test Development, South Bend, IN, USA
| | | | | | | | - Amabelle B Cruz
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - Yang Bai
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - Jiuliu Lu
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - John S Riley
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
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23
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Wilton KM, Matteson EL, Crowson CS. Risk of Obstructive Sleep Apnea and Its Association with Cardiovascular and Noncardiac Vascular Risk in Patients with Rheumatoid Arthritis: A Population-based Study. J Rheumatol 2017; 45:45-52. [PMID: 28765254 DOI: 10.3899/jrheum.170460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To define the incidence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA) and determine whether OSA diagnosis predicts future cardiovascular disease (CVD) and noncardiac vascular events. METHODS Medical information pertaining to RA, OSA, CVD, and vascular diagnoses was extracted from a comprehensive medical record system for a geographically defined population of 813 patients previously diagnosed with RA and 813 age- and sex-matched comparator subjects. RESULTS The risk for OSA in persons with RA versus comparators was elevated, although not reaching statistical significance (HR 1.32, 95% CI 0.98-1.77; p = 0.07). Patients with RA were more likely to be diagnosed with OSA if they had traditional risk factors for OSA, including male sex, current smoking status, hypertension, diabetes, dyslipidemia, and increased body mass index. Features of RA disease associated with OSA included large joint swelling and joint surgery. Patients with RA with decreased renal function were also at higher risk of OSA. The increased risk of overall CVD among patients with RA who have OSA was similar to the increased CVD risk associated with OSA in the comparator cohort (interaction p = 0.86). OSA diagnosis was associated with an increased risk of both CVD (HR 1.9, 95% CI 1.08-3.27), and cerebrovascular disease (HR 2.4, 95% CI 1.14-5.26) in patients with RA. CONCLUSION Patients with RA may be at increased risk of OSA secondary to both traditional and RA-related risk factors. Diagnosis with OSA predicts future CVD in RA and may provide an opportunity for CVD intervention.
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Affiliation(s)
- Katelynn M Wilton
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Eric L Matteson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Cynthia S Crowson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. .,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic.
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24
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
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Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
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