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Modi NS, Bajoria PS, Dave PA, Rohit RK, Tibrewal C, Patel P, Gandhi SK, Gutlapalli SD, Diaz K, Nfonoyim J. Effectiveness of Continuous Positive Airway Pressure in Treating Hypertension in Obstructive Sleep Apnea: A Traditional Review. Cureus 2023; 15:e42111. [PMID: 37602019 PMCID: PMC10436127 DOI: 10.7759/cureus.42111] [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: 06/18/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Almost one billion individuals worldwide suffer from obstructive sleep apnea (OSA). The most widely used treatment for OSA has been continuous positive airway pressure (CPAP), but its effect on blood pressure (BP) has been challenged. Our review aims to evaluate the effects of treating OSA with CPAP on BP and BP-related morbidities in adult hypertensive patients. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on the use of CPAP in OSA patients with hypertension. We selected various forms of academic writing, encompassing complete texts that were published in the English language. The study included a total of 21 papers. OSA is a serious health concern associated with a higher risk of cardiovascular disease, kidney disease, pulmonary hypertension, and aortic stiffness, which is brought on by the periodic hypoxia caused by nocturnal respiratory episodes. For individuals with moderate-to-severe OSA, CPAP therapy has been shown to have a considerable long-term benefit with a median drop of 11 mm Hg, and high adherence results in a decrease in diastolic BP. CPAP therapy directly lowers BP in OSA patients with a body mass index (BMI) of more than 30 kg/m2 and has also demonstrated improvement in early signs of atherosclerosis with lower nocturnal systolic BP levels. OSA patients with resistant hypertension also experienced lower BP after using CPAP for a year. Therefore, our findings suggest that obesity, hypersomnolence, high nocturnal BP, prolonged CPAP usage, and resistant hypertension may all have a major impact on the BP response to CPAP therapy in individuals with severe OSA.
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Affiliation(s)
| | - Parth S Bajoria
- Department of Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College Gandhinagar, Gandhinagar, IND
| | | | - Ralph Kingsford Rohit
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Charu Tibrewal
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M.P. Shah Government Medical College, Jamnagar, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York City, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Keith Diaz
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
| | - Jay Nfonoyim
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
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2
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Yasir M, Pervaiz A, Sankari A. Cardiovascular Outcomes in Sleep-Disordered Breathing: Are We Under-estimating? Front Neurol 2022; 13:801167. [PMID: 35370882 PMCID: PMC8965583 DOI: 10.3389/fneur.2022.801167] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea is a growing health concern, affecting nearly one billion people worldwide; increasingly recognized as an independent cardiovascular risk factor associated with incident obesity, insulin resistance, hypertension, arrhythmias, stroke, coronary artery disease, and heart failure. The prevalence of obstructive sleep apnea could be underestimated in the previous studies, leading to only modest predictions of cardiovascular outcomes. Using more physiologic data will increase sensitivity for the diagnosis of obstructive sleep apnea. Individuals at high risk of obstructive sleep apnea should be identified so that treatment efforts can be focused on them. This review will assess the evidence for the relationship between obstructive sleep apnea and cardiovascular consequences in the past, present, and future. We will also explore the role of adding physiological data obtained from sleep studies and its ability to enhance the cardiovascular outcome's predictability. Finally, we will discuss future directions and gaps that need further research.
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Affiliation(s)
- Muhammad Yasir
- Ascension Providence Hospital, Southfield, MI, United States
- Department of Internal Medicine, Michigan State University, East Lansing, MI, United States
| | - Amina Pervaiz
- Department of Internal Medicine, Wayne State University, Detroit, MI, United States
| | - Abdulghani Sankari
- Department of Internal Medicine, Michigan State University, East Lansing, MI, United States
- Department of Internal Medicine, Wayne State University, Detroit, MI, United States
- Director of Medical Education/Designated Institutional Official (DIO), Ascension Providence Hospital, Southfield, MI, United States
- *Correspondence: Abdulghani Sankari
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3
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Randerath W, Bonsignore MR, Herkenrath S. Obstructive sleep apnoea in acute coronary syndrome. Eur Respir Rev 2019; 28:28/153/180114. [PMID: 31366458 PMCID: PMC9488646 DOI: 10.1183/16000617.0114-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/12/2019] [Indexed: 12/25/2022] Open
Abstract
Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7–9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk. Evidence suggests a high prevalence of OSA in ACS. While some studies suggest hypoxia may have a protective effect, the majority show increased adverse cardiac outcomes. Treatment effectiveness on ACS outcome crucially depends on patients' adherence.http://bit.ly/2Id97ec
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Strub GM, Perkins JA. MicroRNAs for the pediatric otolaryngologist. Int J Pediatr Otorhinolaryngol 2018; 112:195-207. [PMID: 30055733 DOI: 10.1016/j.ijporl.2018.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023]
Abstract
The scope of pediatric otolaryngology is broad and encompasses a wide variety of diseases in which the fundamental phenotype-causing abnormality exists at the level of gene regulation and expression. Development of novel molecular biology instruments to diagnose disease, monitor treatment response, and prevent recurrence will facilitate the delivery of appropriate surgical and adjuvant medical treatments with lower morbidity. MicroRNAs (miRNAs) have emerged as a relatively new class of molecules that directly modulate gene expression and are abnormally expressed in a multitude of disease processes including those within the scope of pediatric otolaryngology. Functionally, miRNAs control multiple cellular functions including angiogenesis, cell proliferation, cell survival, genome stability, and inflammation. These short, non-protein coding RNA molecules are present and stable in tissue, blood, saliva, and urine, making them ideal disease biomarkers. The simple structure of miRNAs and their ability to directly modulate the expression of specific genes lends exciting therapeutic potential to miRNA-based therapies. Here we review the current literature of miRNAs as it relates to diseases within the scope of pediatric otolaryngology, and discuss their potential as diagnostic biomarkers and therapeutic targets.
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Affiliation(s)
- Graham M Strub
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, 98105, United States; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Jonathan A Perkins
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, 98105, United States; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, 98101, United States; Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital, Seattle, WA, 98105, United States.
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Light M, McCowen K, Malhotra A, Mesarwi OA. Sleep apnea, metabolic disease, and the cutting edge of therapy. Metabolism 2018; 84:94-98. [PMID: 28966076 PMCID: PMC5874161 DOI: 10.1016/j.metabol.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnea (OSA) is common, and many cross-sectional and longitudinal studies have established OSA as an independent risk factor for the development of a variety of adverse metabolic disease states, including hypertension, insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, dyslipidemia, and atherosclerosis. Nasal continuous positive airway pressure (CPAP) has long been the mainstay of therapy for OSA, but definitive studies demonstrating the efficacy of CPAP in improving metabolic outcomes, or in reducing incident disease burden, are lacking; moreover, CPAP has variable rates of adherence. Therefore, the future of OSA management, particularly with respect to limiting OSA-related metabolic dysfunction, likely lies in a coming wave of alternative approaches to endophenotyping OSA patients, personalized care, and defining and targeting mechanisms of OSA-induced adverse health outcomes.
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Affiliation(s)
- Matthew Light
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Karen McCowen
- Division of Endocrinology, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
| | - Omar A Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Department of Medicine, La Jolla, CA, United States.
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Gautier-Veyret E, Bäck M, Arnaud C, Belaïdi E, Tamisier R, Lévy P, Arnol N, Perrin M, Pépin JL, Stanke-Labesque F. Cysteinyl-leukotriene pathway as a new therapeutic target for the treatment of atherosclerosis related to obstructive sleep apnea syndrome. Pharmacol Res 2018; 134:311-319. [PMID: 29920371 DOI: 10.1016/j.phrs.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 11/26/2022]
Abstract
AIMS Obstructive sleep apnea (OSA) characterized by nocturnal intermittent hypoxia (IH) is associated with atherosclerosis and cysteinyl-leukotrienes (CysLT) pathway activation. We aimed to identify the determinants of CysLT pathway activation and the role of CysLT in OSA-related atherosclerosis. METHODS AND RESULTS Determinants of the urinary excretion of LTE4 (U-LTE4) including history of cardiovascular events, polysomnographic and biological parameters were studied in a cohort of 170 OSA patients and 29 controls, and in a subgroup of OSA patients free of cardiovascular event (n = 136). Mechanisms linking IH, the CysLT pathway and atherogenesis were investigated in Apolipoprotein E deficient (ApoE-/-) mice exposed to 8-week IH. In the whole cohort, U-LTE4 was independently influenced by age, minimal oxygen saturation, and a history of cardiovascular events, and correlated significantly with intima-media thickness. In the subgroup of OSA patients free of cardiovascular event, increased U-LTE4 was increased compared to controls and independently related to hypoxia severity and traditional risk factors aggregated in the 10-year cardiovascular risk score of European Society of Cardiology. In IH mice, atherosclerosis lesion size and mRNA levels of 5-lipoxygenase, 5-lipoxygenase activating protein (FLAP) and CysLT1 receptor were significantly increased. This transcriptional activation was associated with the binding of HIF-1 to the FLAP promoter and was strongly associated with atherosclerosis lesion size. CysLT1 receptor antagonism (montelukast) significantly reduced atherosclerosis progression in IH mice. CONCLUSIONS IH-related CysLT pathway activation contributes to OSA-induced atherogenesis. In the era of personalized medicine, U-LTE4 may be a useful biomarker to identify OSA patients for whom CysLT1 blockade could represent a new therapeutic avenue for reducing cardiovascular risk.
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Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France; Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Magnus Bäck
- Department of Medicine, Karolinska Institute and University Hospital, Stockholm, Sweden.
| | - Claire Arnaud
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France.
| | - Elise Belaïdi
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France.
| | - Renaud Tamisier
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France; Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Patrick Lévy
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France; Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Nathalie Arnol
- Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Marion Perrin
- Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France; Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041, Grenoble, France; INSERM U1042, 38041, Grenoble, France; Centre Hospitalier Universitaire des Alpes, 38043, Grenoble, France.
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7
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Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J, Pepin JL, Pevernagie D, Pizza F, Polo O, Riha R, Ryan S, Verbraecken J, McNicholas WT. Challenges and perspectives in obstructive sleep apnoea. Eur Respir J 2018; 52:13993003.02616-2017. [DOI: 10.1183/13993003.02616-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
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8
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Gautier-Veyret E, Pépin JL, Stanke-Labesque F. Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther 2017; 186:45-59. [PMID: 29277633 DOI: 10.1016/j.pharmthera.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities. Various clusters of OSA phenotypes have been described leading to more highly personalized treatment. The aim of this review is to describe the various therapeutic strategies including continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and especially pharmacological interventions that have been evaluated to reduce vascular alterations in both OSA patients and preclinical animal models. Conventional therapies, predominantly CPAP, have a limited impact on vascular alterations in the presence of co-morbidities. A better knowledge of pharmacological therapies targeting IH-induced vascular alterations will facilitate the use of combined therapies and is crucial for designing clinical trials in well-defined OSA phenotypes.
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Affiliation(s)
- Elodie Gautier-Veyret
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France.
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
| | - Françoise Stanke-Labesque
- Univ. Grenoble Alpes, HP2, F-38041 Grenoble, France; INSERM U1042, 38041 Grenoble, France; Centre hospitalier Universitaire Grenoble Alpes, 38043 Grenoble, France
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9
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Gagnadoux F, Pépin JL, Vielle B, Bironneau V, Chouet-Girard F, Launois S, Meslier N, Meurice JC, Nguyen XL, Paris A, Priou P, Tamisier R, Trzepizur W, Goupil F, Fleury B. Reply: The Choice of Indicators for Obstructive Sleep Apnea Treatment Outcome Evaluation: A Matter of Time-Dependent Response? Am J Respir Crit Care Med 2017; 196:1357-1359. [DOI: 10.1164/rccm.201706-1089le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Frédéric Gagnadoux
- Université Bretagne LoireAngers, France
- Centre Hospitalier Universitaire d’AngersAngers, France
| | - Jean-Louis Pépin
- Université Grenoble AlpesGrenoble, France
- Clinique Universitaire de PhysiologieGrenoble, France
| | - Bruno Vielle
- Université Bretagne LoireAngers, France
- Centre Hospitalier Universitaire d’AngersAngers, France
| | | | | | - Sandrine Launois
- Université Grenoble AlpesGrenoble, France
- Clinique Universitaire de PhysiologieGrenoble, France
| | - Nicole Meslier
- Université Bretagne LoireAngers, France
- Centre Hospitalier Universitaire d’AngersAngers, France
| | | | | | | | - Pascaline Priou
- Université Bretagne LoireAngers, France
- Centre Hospitalier Universitaire d’AngersAngers, France
| | - Renaud Tamisier
- Université Grenoble AlpesGrenoble, France
- Clinique Universitaire de PhysiologieGrenoble, France
| | - Wojciech Trzepizur
- Université Bretagne LoireAngers, France
- Centre Hospitalier Universitaire d’AngersAngers, France
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10
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Pépin JL. Syndrome d’apnées obstructives du sommeil : redéfinir les parcours de soins et accéder à la médecine personnalisée. Presse Med 2017; 46:465-467. [DOI: 10.1016/j.lpm.2017.05.012] [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: 10/19/2022] Open
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Drager LF. New Challenges for Sleep Apnea Research: Simple Diagnostic Tools, Biomarkers, New Treatments and Precision Medicine. ACTA ACUST UNITED AC 2017; 10:55-56. [PMID: 28966739 PMCID: PMC5611773 DOI: 10.5935/1984-0063.20170009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Luciano F Drager
- Hypertension Units from Heart Institute (InCor) and Renal Division, University of Sao Paulo Medical School, Brazil
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12
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Cortese R, Zhang C, Bao R, Andrade J, Khalyfa A, Mokhlesi B, Gozal D. DNA Methylation Profiling of Blood Monocytes in Patients With Obesity Hypoventilation Syndrome: Effect of Positive Airway Pressure Treatment. Chest 2016; 150:91-101. [PMID: 26923628 DOI: 10.1016/j.chest.2016.02.648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND OSA is a highly prevalent condition that is associated with a wide range of long-term morbidities including metabolic, cardiovascular, and cognitive alterations, possibly via activation of systemic inflammatory and oxidative stress pathways. Implementation of positive airway pressure (PAP) is the first-line treatment for OSA, as well as for obesity hypoventilation syndrome (OHS), its most severe phenotype. However, the molecular and cellular mechanisms underlying OHS-induced morbidities and their response to PAP treatment remain unclear, and could be mediated, in part, by OSA-induced epigenetic changes. METHODS Blood was collected before starting PAP treatment (PRE group), as well as 6 weeks after PAP treatment (POST group) in 15 adult patients with OHS. DNA methylation profiles were studied by methylated DNA immunoprecipitation coupled to microarrays (MeDIP-chip) in six representative patients and further verified in a cohort of 15 patients by MeDIP-quantitative PCR. RESULTS We identified 1,847 regions showing significant differential DNA methylation (P < .001; model-based analysis of tiling arrays score, > 4) between the groups. Analysis of biochemical pathways and gene networks demonstrated that differentially methylated regions were associated with immune responses, and particularly with mechanisms governing gene regulation by peroxisome proliferation-activated receptors (PPARs). Single-locus quantitative PCR analysis revealed that DNA methylation was increased at the PPAR-responsive elements (PPAREs) of eight genes in the post-treatment samples (PRE/POST fold changes: ABCA1, 3.11; ABCG1, 1.72; CD36, 5.04; FABP4, 2.49; HMOX, 2.74; NOS2, 7.78; PEPCK, 9.27; and ADIPOQ, 1.73), suggesting that PAP treatment leads to an increase in DNA methylation at PPAREs, possibly affecting the binding of the PPAR-γ complex and downstream gene expression. CONCLUSIONS Our work provides initial evidence of epigenetic regulation particularly involving metabolic pathways in patients with OHS who are responsive to PAP treatment.
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Affiliation(s)
- Rene Cortese
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Chunling Zhang
- Center for Research Informatics, University of Chicago, Chicago, IL
| | - Riyue Bao
- Center for Research Informatics, University of Chicago, Chicago, IL
| | - Jorge Andrade
- Center for Research Informatics, University of Chicago, Chicago, IL
| | - Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Babak Mokhlesi
- Sleep Disorders Center and Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL.
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