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Wang X, Zhao J, Wang X, Zhang L. Metabolomic profiles predict clinical severity in patients with obstructive sleep apnea-hypopnea syndrome. J Clin Sleep Med 2024; 20:1445-1453. [PMID: 38652501 PMCID: PMC11367723 DOI: 10.5664/jcsm.11160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea-hypopnea syndrome (OSAHS) poses a significant health hazard, intermittent hypoxia inflicts damage throughout the body and is considered a critical risk factor for metabolic disorders. The aim of this study was to establish a metabolic profile for patients with OSAHS using nontargeted metabolomics detection techniques, providing a basis for OSAHS diagnosis and novel biological marker identification. METHODS 45 patients with OSAHS composed the OSAHS group, and 44 healthy volunteers composed the control group. Nontargeted metabolomics technology was used to analyze participants' urinary metabolites. Differentially abundant metabolites were screened and correlated through hierarchical clustering analysis. We constructed a composite metabolite diagnostic model using a random forest model. Simultaneously, we analyzed the relationships between 20 metabolites involved in model construction and OSAHS severity. RESULTS The urinary metabolomics pattern of the OSAHS group exhibited significant changes, demonstrating noticeable differences in metabolic products. Urinary metabolite analysis revealed differences between the mild-to-moderate OSAHS and severe OSAHS groups. The composite metabolite model constructed in this study demonstrated excellent diagnostic performance not only in distinguishing healthy control participants from patients with mild-to-moderate OSAHS (area under the curve = 0.78) and patients with severe OSAHS (area under the curve = 0.78), but also in discriminating between patients with mild-to-moderate and severe OSAHS (area under the curve = 0.71). CONCLUSIONS This study comprehensively analyzed the urinary metabolomic characteristics of patients with OSAHS. The established composite metabolite model provides robust support for OSAHS diagnosis and severity assessment. Twenty metabolites associated with OSAHS disease severity offer a new perspective for diagnosis. CITATION Wang X, Zhao J, Wang X, Zhang L. Metabolomic profiles predict clinical severity in patients with obstructive sleep apnea-hypopnea syndrome. J Clin Sleep Med. 2024;20(9):1445-1453.
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Affiliation(s)
- Xiaoyi Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jinming Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases, Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
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He J, Zhou H, Xiong J, Huang Y, Huang N, Jiang J. Association between elevated homocysteine levels and obstructive sleep apnea hypopnea syndrome: a systematic review and updated meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1378293. [PMID: 38887264 PMCID: PMC11180825 DOI: 10.3389/fendo.2024.1378293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Objective This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels. Methods To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages. Results In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 μmol/L, 95% CI: 2.60-5.91, P< 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, P = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels. Conclusion Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Haiying Zhou
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Rehabilitation, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Juan Xiong
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Emergency department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuanyuan Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jiaqing Jiang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
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Mohit, Tomar MS, Sharma D, Nandan S, Pateriya A, Shrivastava A, Chand P. Emerging role of metabolomics for biomarker discovery in obstructive sleep apnea. Sleep Breath 2023; 27:1247-1254. [PMID: 36322226 DOI: 10.1007/s11325-022-02730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 03/12/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by the complete or partial blockage of the upper airway passage during sleep which causes repetitive breaks in sleep and may result in excessive daytime sleepiness. OSA has been linked to various metabolic disorders and chronic health conditions, such as obesity, diabetes, hypertension, and depression. Profiling of alterations in metabolites and their regulation in OSA has been hypothesized to be an effective approach for early diagnosis and prognosis of OSA. Several studies have characterized metabolic fingerprints associated with sleep disorders. There is a lack of understanding of metabolite contents and their alterations in OSA that may help to identify specific biomarkers. The information provided in this review will help update new methodologies and interventions of high throughput advanced molecular/metabolomics tools which may clarify the metabolic aspects and mechanisms for improved management and treatment of OSA.
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Affiliation(s)
- Mohit
- Department of Prosthodontics, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Manendra Singh Tomar
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Deepak Sharma
- Council of Scientific & Industrial Research, Phytochemistry Division, National Botanical Research Institute, Uttar Pradesh, Lucknow, 226001, India
| | - Shiv Nandan
- Department of Biotechnology, Era's Lucknow Medical College & Hospital, Uttar Pradesh, Lucknow, 226003, India
| | - Ankit Pateriya
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Ashutosh Shrivastava
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India.
| | - Pooran Chand
- Department of Prosthodontics, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India.
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Tang SS, Liang CH, Liu YL, Wei W, Deng XR, Shi XY, Wang LM, Zhang LJ, Yuan HJ. Intermittent hypoxia is involved in gut microbial dysbiosis in type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome. World J Gastroenterol 2022; 28:2320-2333. [PMID: 35800187 PMCID: PMC9185213 DOI: 10.3748/wjg.v28.i21.2320] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/19/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA)-hypopnea syndrome (OSAHS) has been recognized as a comorbidity of type 2 diabetes mellitus (T2DM); more than half of T2DM patients suffer from OSAHS. Intermittent hypoxia (IH) plays an important role in metabolic diseases, such as obesity and OSAHS, through various mechanisms, including altering the gut microecological composition and function. Therefore, it is important to study the role of gut microbiota in T2DM patients with OSAHS, which has a high incidence and is prone to several complications.
AIM To assess whether IH is involved in altering the fecal microbiome in T2DM patients with OSAHS.
METHODS Seventy-eight participants were enrolled from Henan Province People’s Hospital and divided into healthy control (HC, n = 26), T2DM (n = 25), and T2DM + OSA (n = 27) groups based on their conditions. The fecal bacterial DNA of the research participants was extracted and subjected to 16S ribosomal RNA sequencing. The clinical indices, such as insulin resistance index, homocysteine (HCY) concentration, and the concentrations of inflammatory factors in the peripheral blood, were assessed and recorded.
RESULTS Group T2DM + OSA had the highest apnea-hypopnea index (AHI) (2.3 vs 3.7 vs 13.7), oxygen desaturation index (0.65 vs 2.2 vs 9.1), HCY concentration (9.6 μmol/L vs 10.3 μmol/L vs 13.81 μmol/L) and C-reactive protein (CRP) concentrations (0.3 mg/L vs 1.43 mg/L vs 2.11 mg/L), and lowest mean oxygen saturation (97.05% vs 96.6% vs 94.7%) among the three groups. Twelve and fifteen key differences in amplicon sequence variants were identified when comparing group T2DM + OSA with groups T2DM and HC, respectively. We found progressively decreased levels of Faecalibacterium, Eubacterium, and Lachnospiraceae, and an increase in the level of Actinomyces, which strongly correlated with the HCY, CRP, fasting plasma glucose, and hemoglobin A1c concentrations, AHI, mean oxygen saturation, and insulin resistance index in group T2DM + OSA (P < 0.05).
CONCLUSION For T2DM patients with OSAHS, IH may be involved in selective alterations of the gut microbiota, which may affect the pathophysiological development of T2DM and DM-related complications.
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Affiliation(s)
- Sha-Sha Tang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Cheng-Hong Liang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Ya-Lei Liu
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Wei Wei
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Xin-Ru Deng
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Xiao-Yang Shi
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Li-Min Wang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Li-Jun Zhang
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
| | - Hui-Juan Yuan
- Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
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Fiedorczuk P, Stróżyński A, Olszewska E. Is the Oxidative Stress in Obstructive Sleep Apnea Associated With Cardiovascular Complications?-Systematic Review. J Clin Med 2020; 9:jcm9113734. [PMID: 33233796 PMCID: PMC7699884 DOI: 10.3390/jcm9113734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered an independent risk factor for cardiovascular disease. The exact mechanism of cardiovascular complications (CVC) development as a complication of OSA is not entirely understood. Oxidative stress is suspected to be the essential factor in initiating various comorbidities in OSA. Biomarkers of nonenzymatic lipid and protein peroxidation, DNA repair and antioxidant capabilities measured in serum, plasma and urine are frequently used to assess the presence of oxidative stress. We conducted a systematic review and quality assessment of available observational analytic studies to determine whether there is an association between oxidative stress and OSA in patients with prevalent CV disease compared to (a) patients with prevalent CV disease but no OSA, (b) patients with prevalent CV disease and less severe OSA and (c) patients with OSA and no overt CV disease. This systematic review demonstrated that, while oxidative stress is associated with OSA, there was no clear difference in the severity of oxidative stress between OSA patients with or without cardiovascular complications.
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Affiliation(s)
- Piotr Fiedorczuk
- Doctoral School of the Medical University of Bialystok, 15-328 Białystok, Poland;
| | | | - Ewa Olszewska
- Department of Otolaryngology Medical University of Bialystok, 15-328 Białystok, Poland
- Correspondence: ; Tel.: +48-(85)-831-8696
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Ko CY, Hu AK, Chou D, Huang LM, Su HZ, Yan FR, Zhang XB, Zhang HP, Zeng YM. Analysis of oral microbiota in patients with obstructive sleep apnea-associated hypertension. Hypertens Res 2019; 42:1692-1700. [PMID: 30976074 PMCID: PMC8075895 DOI: 10.1038/s41440-019-0260-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/28/2019] [Accepted: 03/09/2019] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for hypertension (HTN). The oral microbiota plays a pathophysiological role in cardiovascular diseases; however, there are few reports directly investigating and identifying the organisms involved in OSAHS-related HTN. Therefore, this study aimed to identify those organisms. We obtained 139 oral samples and determined the microbiome composition using pyrosequencing and bioinformatic analyses of the 16S rRNA. We examined the fasting levels of cytokines and homocysteine in all participants and analyzed the correlations between the oral microbiota and homocysteine levels. We determined the molecular mechanism underlying HTN by investigating the genetic composition of the strains in the blood. We detected higher relative abundances of Porphyromonas and Aggregatibacter and elevated proinflammatory cytokines in patients with OSAHS of varying severity compared with individuals without OSAHS; however, the two organisms were not measured in the blood samples from all participants. High levels of specific Porphyromonas bacteria were detected in patients with OSAHS with and without HTN, whereas the relative abundance of Aggregatibacter was negatively correlated with the homocysteine level. The receiver operating characteristic curve analysis of controls and patients with OSAHS resulted in area under the curve values of 0.759 and 0.641 for patients with OSAHS with or without HTN, respectively. We found that the predictive function of oral microbiota was different in patients with OSAHS with and without HTN. However, there was no direct invasion by the two organisms causing endothelial cell injury, leading to speculation regarding the other mechanisms that may lead to HTN. Elucidating the differences in the oral microbiome will help us understand the pathogenesis of OSAHS-related HTN.
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Affiliation(s)
- Chih-Yuan Ko
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China.
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China.
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China.
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China.
| | - An-Ke Hu
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China
| | - Dylan Chou
- Zhuhai Campus of Zunyi Medical University, Zhuhai, 519090, Guangdong, China
| | - Li-Mei Huang
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China
| | - Huan-Zhang Su
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China
| | - Fu-Rong Yan
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China
- Center for Molecular Diagnosis and Therapy, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
| | - Xiao-Bin Zhang
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China
| | - Hua-Ping Zhang
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China.
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China.
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China.
| | - Yi-Ming Zeng
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, 362000, Quanzhou, China.
- Respiratory Medicine Center of Fujian Province, 362000, Quanzhou, China.
- Key Laboratory of Fujian Medical University, Fujian Province University, 362000, Quanzhou, China.
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Gut microbiota in obstructive sleep apnea-hypopnea syndrome: disease-related dysbiosis and metabolic comorbidities. Clin Sci (Lond) 2019; 133:905-917. [PMID: 30957778 PMCID: PMC6465302 DOI: 10.1042/cs20180891] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
Abstract
Gut microbiota alterations manifest as intermittent hypoxia and fragmented sleep, thereby mimicking obstructive sleep apnea–hypopnea syndrome (OSAHS). Here, we sought to perform the first direct survey of gut microbial dysbiosis over a range of apnea–hypopnea indices (AHI) among patients with OSAHS. We obtained fecal samples from 93 patients with OSAHS [5 < AHI ≤ 15 (n=40), 15 < AHI ≤ 30 (n=23), and AHI ≥ 30 (n=30)] and 20 controls (AHI ≤ 5) and determined the microbiome composition via 16S rRNA pyrosequencing and bioinformatics analysis of variable regions 3–4. We measured fasting levels of homocysteine (HCY), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). Results revealed gut microbial dysbiosis in several patients with varying severities of OSAHS, reliably separating them from controls with a receiver operating characteristic-area under the curve (ROC-AUC) of 0.789. Functional analysis in the microbiomes of patients revealed alterations; additionally, decreased in short-chain fatty acid (SCFA)-producing bacteria and increased pathogens, accompanied by elevated levels of IL-6. Lactobacillus levels correlated with HCY levels. Stratification analysis revealed that the Ruminococcus enterotype posed the highest risk for patients with OSAHS. Our results show that the presence of an altered microbiome is associated with HCY among OSAHS patients. These changes in the levels of SCFA affect the levels of pathogens that play a pathophysiological role in OSAHS and related metabolic comorbidities.
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Kim J, Lee SK, Yoon DW, Shin C. Concurrent Presence of Obstructive Sleep Apnea and Elevated Homocysteine Levels Exacerbate the Development of Hypertension: A KoGES Six-year Follow-up Study. Sci Rep 2018; 8:2665. [PMID: 29422547 PMCID: PMC5805705 DOI: 10.1038/s41598-018-21033-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/29/2018] [Indexed: 01/29/2023] Open
Abstract
Accumulating evidence has revealed that obstructive sleep apnea (OSA) and high homocysteine (Hcy) levels play important roles in the increased risk of hypertension and cardiovascular disease. We investigated whether the presence of elevated Hcy levels among individuals with OSA increase the risk of hypertension in a cohort study. A total of 1825 participants were selected from the cohort study. A high homocysteine level (Hcy) was defined as those in the 75th percentile of Hcy levels of the study cohort. The prevalence of hypertension was higher among subjects with OSA and high Hcy levels than among the other groups stratified by the presence of OSA and high Hcy levels. The incidence of hypertension at 6-year follow-up was: Hcy[-]/OSA[-] vs. Hcy[+]/OSA[-] vs. Hcy[-]/OSA[+] vs. Hcy[+]/OSA[+], 14.2% vs. 19.8% vs. 24.2% vs. 36.1%. After adjusting for confounding factors, subjects with OSA and high Hcy levels had a 1.86-fold risk of developing hypertension compared to those without OSA and high Hcy levels. Moderate to severe OSA group with the highest tertile of Hcy levels had a 2.31-fold increased risk of developing hypertension. Interaction between Hcy and OSA on development of hypertension was significant, suggesting that these conditions may constitute an important determinant.
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Affiliation(s)
- Jinkwan Kim
- Department of Biomedical Laboratory Science, College of Health Science, Jungwon University, Geo-San, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
| | - Dae Wui Yoon
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
| | - Chol Shin
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea.
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea.
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10
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Klobučníková K, Šiarnik P, Siváková M, Wágnerová H, Mucska I, Kollár B, Turčáni P. Carotid intima-media thickness is not associated with homocysteine and vitamin D levels in obstructive sleep apnea. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:263-266. [PMID: 28287278 DOI: 10.1080/00365513.2017.1299210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea syndrome (OSA) is associated with increased vascular morbidity. Accelerated atherosclerosis might be one of the most important mechanisms linking OSA with the development of vascular disorders. Homocysteine (HCY) and vitamin D has been associated with atherogenesis. The aim of this study was to assess a possible association between the levels of HCY and vitamin D and the carotid intima-media thickness (cIMT), which is a known marker for subclinical atherosclerosis in patients with OSA. We prospectively enrolled 110 patients with the history of snoring, who underwent standard overnight polysomnography. Clinical characteristics of the population were recorded on admission and blood samples were obtained in the fasting condition following morning. Extracranial cIMT measurements were performed according to the standardized scanning protocol. A significant correlation was found between cIMT and apnea-hypopnea index (r = .276, p = .006), age (r = .486, p < .001), diabetes mellitus (r = .377, p < .001), coronary artery disease (r = .274, p = .006) and history of stroke (r = .251, p = .012). We failed to find any significant correlation between cIMT and the levels of HCY (r = .036, p = .724) or vitamin D (r = .027, p = .800). In conclusion, our data suggest that the association of cIMT with the severity of OSA can be influenced by multiple metabolic consequences of OSA including traditional and non-traditional risk factors. HCY and vitamin D do not seem to play a superior role in this process.
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Affiliation(s)
- Katarína Klobučníková
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
| | - Pavel Šiarnik
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
| | - Monika Siváková
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
| | - Helena Wágnerová
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
| | - Imrich Mucska
- b Outpatient Clinic for Sleep-Disordered Breathing , University Hospital , Bratislava , Slovakia
| | - Branislav Kollár
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
| | - Peter Turčáni
- a 1st Department of Neurology, Faculty of Medicine , Comenius University , Bratislava , Slovakia
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Cherneva RV, Cherneva ZV, Georgiev OB, Petrova DS, Petrova JI. 8-isoprostanes and resistin as markers of vascular damage in non-hypersomnolent obstructive sleep apnoea patients. Clin Physiol Funct Imaging 2016; 37:695-702. [PMID: 27256793 DOI: 10.1111/cpf.12361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/25/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oxidative stress and inflammation are assumed as the main pathological triggers for vascular damage in hypersomnolent obstructive sleep apnoea (OSA) patients, whereas their exact role in less symptomatic population is currently unknown. AIM To determine whether oxidative stress (urinary 8-isoprostane concentration) and inflammation (plasma resistin levels) are associated with vascular damage in non-hypersomnolent (Epworth Sleep Score <11) OSA patients. METHODS A total of 325 consecutive patients have undergone standard polysomnography, and 256 of them were diagnosed with OSA. Excessive daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Only 86 patients with ESS <11 participated in the study. The control group was presented by 45 subjects without OSA. Endothelial function was assessed by ultrasonographic measurement of flow-mediated dilatation (FMD). Intima-media thickness (IMT) and ankle-brachial index (ABI) were determined by ultrasonography. Urinary 8-isoprostanes (Cayman Chemical, USA) were measured, applying mass spectrometry. Resistin (RayBio_ Human ResistinCat#:ELH-Resistin-001) plasma levels were detected by ELISA. RESULTS In patients with OSA, flow-mediated dilatation was significantly lower than in control subjects (4·62% ±1·9) and (7·1% ±2·8), respectively (P: 0·013). The prevalence of plaques in a.carotis communis was higher in OSA (16% versus 4%). The same is observed regarding a.tibialis posterior (81% vs. 29%). The average IMT and ABI in OSA and in the control group were, respectively, (IMT - 800 µm versus. 666 µm); (ABI -1·06 versus 1·20). Urinary isoprostanes were higher in OSA patients (0·091 versus 0·078) and correlated negatively to FMD (r: -0·825, P: 0·00), IMT (r: -0·324, P: 0·003) and ABI (r: -0·226, P: 0·043). No association between resistin and the degree of vascular injury was found. CONCLUSIONS In comparison with the control group, increased prevalence of endothelial dysfunction and vascular damage was established in OSA patients without excessive daytime sleepiness. Urinary 8-isoprostanes (oxidative stress markers) are closely associated with FMD (endothelial dysfunction), IMT and ABI (vascular damage). Resistin plasma levels correlated neither to FMD, nor to IMT or ABI.
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Affiliation(s)
- Radostina Vlaeva Cherneva
- Department of Internal Medicine, Division of Pulmonary Medicine, Medical University Sofia, Georgi Sofiiski 1str, Sofia, Bulgaria
| | - Zheina Vlaeva Cherneva
- Department of Cardiology, Medical University Sofia, Georgi Sofiiski 1str, Sofia, Bulgaria
| | - Ognian Borisov Georgiev
- Department of Internal Medicine, Division of Pulmonary Medicine, Medical University Sofia, Georgi Sofiiski 1str, Sofia, Bulgaria
| | - Daniela Stoichkova Petrova
- Department of Internal Medicine, Division of Pulmonary Medicine, Medical University Sofia, Georgi Sofiiski 1str, Sofia, Bulgaria
| | - Julia Ivanova Petrova
- Department of Neurology, Medical University, Sofia; Georgi Sofiiski 1 str, Sofia, Bulgaria
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Krause BJ, Del Rio R, Moya EA, Marquez-Gutierrez M, Casanello P, Iturriaga R. Arginase-endothelial nitric oxide synthase imbalance contributes to endothelial dysfunction during chronic intermittent hypoxia. J Hypertens 2016; 33:515-24; discussion 524. [PMID: 25629363 DOI: 10.1097/hjh.0000000000000453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic intermittent hypoxia (CIH), the main feature of obstructive sleep apnoea, is associated with impaired vascular function despite unaltered response to nitric oxide donors. This study addressed whether arginase contributes to the endothelial dysfunction in CIH rats. METHODS Adult male Sprague-Dawley rats were exposed for 21 days to CIH (5% oxygen, 12 times/h, 8 h/day). The internal carotid arteries were isolated to study endothelial nitric oxide synthase (eNOS) and arginase-1 levels by western blot and immunohistochemistry, and their vasoactive responses using wire myography. Relaxation to sodium nitroprusside (SNP; nitric oxide donor) in the presence or absence of soluble guanylyl cyclase inhibitor, and acetylcholine with and without a NOS inhibitor [N(G)-nitro-L-arginine (L-NA)] and the arginase inhibitor BEC were determined. RESULTS Arteries from the CIH rats presented higher active contraction induced by KCl (3.5 ± 0.4 vs. 2.3 ± 0.2 N/m2), augmented media-to-lumen ratio (∼40%), decreased relaxation to acetylcholine (12.8 ± 1.5 vs. 30.5 ± 4.6%) and increased sensitivity to SNP (pD2 7.3 ± 0.1 vs. 6.7 ± 0.1). Arginase inhibition reversed the impaired acetylcholine-induced relaxation in CIH arteries (49.5 ± 7.4%), an effect completely blocked by L-NA. In the carotid arteries, arginase-1 protein level was increased, whereas eNOS levels decreased in the CIH arteries. CONCLUSION The current results suggest that endothelial dysfunction in CIH-induced hypertension may result from imbalanced arginase-1 to eNOS expression, vascular remodelling and increased contractile capacity, rather than decreased vascular response to nitric oxide.
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Affiliation(s)
- Bernardo J Krause
- aDivision of Obstetrics and Gynaecology bDivision of Paediatrics, Faculty of Medicine, School of Medicine cLaboratory of Neurobiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile dLaboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile, Santiago, Chile
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Monneret D, Tamisier R, Ducros V, Faure P, Halimi S, Baguet JP, Lévy P, Pépin JL, Borel AL. Glucose tolerance and cardiovascular risk biomarkers in non-diabetic non-obese obstructive sleep apnea patients: Effects of long-term continuous positive airway pressure. Respir Med 2016; 112:119-25. [PMID: 26847407 DOI: 10.1016/j.rmed.2016.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Insulin resistance, glucose dyshomeostasis and oxidative stress are associated to the cardiovascular consequences of obstructive sleep apnea (OSA). The effects of a long-term continuous positive airway pressure (LT-CPAP) treatment on such mechanisms still remain conflicting. OBJECTIVE To investigate the effect of LT-CPAP on glucose tolerance, insulin sensitivity, oxidative stress and cardiovascular biomarkers in non-obese non-diabetic OSA patients. PATIENTS & METHODS Twenty-eight apneic, otherwise healthy, men suffering from OSA (mean age = 48.9 ± 9.4 years; apnea-hypopnea index = 41.1 ± 16.1 events/h; BMI = 26.6 ± 2.8 kg/m(2); fasting glucose = 4.98 ± 0.37 mmol/L) were evaluated before and after LT-CPAP by an oral glucose tolerance test (OGTT), measuring plasma glucose, insulin and proinsulin. Glycated hemoglobin, homeostasis model assessment resistance insulin, blood lipids, oxidative stress, homocysteine and NT-pro-brain natriuretic peptide (NT-proBNP) were also measured. RESULTS LT-CPAP treatment lasted 13.9 ± 6.5 months. At baseline, the time spent at SaO2<90%, minimal and mean SaO2 were associated with insulin area under the curve during OGTT (r = 0.448, P = 0.011; r = -0.382; P = 0.047 and r = -0.424; P = 0.028, respectively) and most other glucose/insulin homeostasis biomarkers, as well as with homocysteine (r = 0.531, P = 0.006; r = -0.487; P = 0.011 and r = -0.409; P = 0.034, respectively). LT-CPAP had no effect on all the OGTT-related measurements, but increased plasma total antioxidant status (+7.74%; P = 0.035) in a duration-dependent manner (r = 0.607; P < 0.001), and decreased both homocysteine (-15.2%; P = 0.002) and NT-proBNP levels (-39.3%; P = 0.002). CONCLUSIONS In non-obese non-diabetic OSA patients, nocturnal oxygen desaturation is strongly associated to insulin resistance. LT-CPAP does not improve glucose homeostasis nor insulin sensitivity but has a favorable effect on antioxidant capacity and cardiovascular risk biomarkers.
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Affiliation(s)
- D Monneret
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Biochemistry Toxicology and Pharmacology, Biology & Pathology Institute, Grenoble University Hospital, Grenoble, France.
| | - R Tamisier
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Sleep, Exercise and Physiology Laboratory, EFCR, Grenoble University Hospital, Grenoble, France
| | - V Ducros
- Department of Biochemistry Toxicology and Pharmacology, Biology & Pathology Institute, Grenoble University Hospital, Grenoble, France
| | - P Faure
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Biochemistry Toxicology and Pharmacology, Biology & Pathology Institute, Grenoble University Hospital, Grenoble, France
| | - S Halimi
- Department of Endocrinology, Pole DIGIDUNE, Grenoble University Hospital, Grenoble, France
| | - J P Baguet
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | - P Lévy
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Sleep, Exercise and Physiology Laboratory, EFCR, Grenoble University Hospital, Grenoble, France
| | - J L Pépin
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Sleep, Exercise and Physiology Laboratory, EFCR, Grenoble University Hospital, Grenoble, France
| | - A L Borel
- HP2 Laboratory, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Endocrinology, Pole DIGIDUNE, Grenoble University Hospital, Grenoble, France
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Malan-Müller S, Kilian S, van den Heuvel LL, Bardien S, Asmal L, Warnich L, Emsley RA, Hemmings SMJ, Seedat S. A systematic review of genetic variants associated with metabolic syndrome in patients with schizophrenia. Schizophr Res 2016; 170:1-17. [PMID: 26621002 DOI: 10.1016/j.schres.2015.11.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
Abstract
Metabolic syndrome (MetS) is a cluster of factors that increases the risk of cardiovascular disease (CVD), one of the leading causes of mortality in patients with schizophrenia. Incidence rates of MetS are significantly higher in patients with schizophrenia compared to the general population. Several factors contribute to this high comorbidity. This systematic review focuses on genetic factors and interrogates data from association studies of genes implicated in the development of MetS in patients with schizophrenia. We aimed to identify variants that potentially contribute to the high comorbidity between these disorders. PubMed, Web of Science and Scopus databases were accessed and a systematic review of published studies was conducted. Several genes showed strong evidence for an association with MetS in patients with schizophrenia, including the fat mass and obesity associated gene (FTO), leptin and leptin receptor genes (LEP, LEPR), methylenetetrahydrofolate reductase (MTHFR) gene and the serotonin receptor 2C gene (HTR2C). Genetic association studies in complex disorders are convoluted by the multifactorial nature of these disorders, further complicating investigations of comorbidity. Recommendations for future studies include assessment of larger samples, inclusion of healthy controls, longitudinal rather than cross-sectional study designs, detailed capturing of data on confounding variables for both disorders and verification of significant findings in other populations. In future, big genomic datasets may allow for the calculation of polygenic risk scores in risk prediction of MetS in patients with schizophrenia. This could ultimately facilitate early, precise, and patient-specific pharmacological and non-pharmacological interventions to minimise CVD associated morbidity and mortality.
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Affiliation(s)
- Stefanie Malan-Müller
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa; SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sanja Kilian
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa
| | | | - Soraya Bardien
- SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Laila Asmal
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa
| | - Louise Warnich
- Department of Genetics, Stellenbosch University, Stellenbosch, South Africa
| | - Robin A Emsley
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa
| | - Sîan M J Hemmings
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa; SA MRC Centre for TB Research, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Stellenbosch University, Department of Psychiatry, Cape Town, South Africa
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Xu H, Zheng X, Jia W, Yin S. Chromatography/Mass Spectrometry-Based Biomarkers in the Field of Obstructive Sleep Apnea. Medicine (Baltimore) 2015; 94:e1541. [PMID: 26448002 PMCID: PMC4616745 DOI: 10.1097/md.0000000000001541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biomarker assessment is based on quantifying several proteins and metabolites. Recent developments in proteomics and metabolomics have enabled detection of these small molecules in biological samples and exploration of the underlying disease mechanisms in obstructive sleep apnea (OSA). This systemic review was performed to identify biomarkers, which were only detected by chromatography and/or mass spectrometry (MS) and to discuss the role of these biomarkers in the field of OSA. We systemically reviewed relevant articles from PubMed and EMBASE referring to proteins and metabolite profiles of biological samples in patients with OSA. The analytical platforms in this review were focused on chromatography and/or MS. In total, 30 studies evaluating biomarkers in patients with OSA using chromatography and/or MS methods were included. Numerous proteins and metabolites, including lipid profiles, adrenergic/dopaminergic biomarkers and derivatives, amino acids, oxidative stress biomarkers, and other micromolecules were identified in patients with OSA. Applying chromatography and/or MS methods to detect biomarkers helps develop an understanding of OSA mechanisms. More proteomic and metabolomic studies are warranted to develop potential diagnostic and clinical monitoring methods for OSA.
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Affiliation(s)
- Huajun Xu
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China (HX, XZ, SY); and Center for Translational Medicine, and Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (HX, XZ, WJ)
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Daulatzai MA. “Boomerang Neuropathology” of Late-Onset Alzheimer’s Disease is Shrouded in Harmful “BDDS”: Breathing, Diet, Drinking, and Sleep During Aging. Neurotox Res 2015; 28:55-93. [DOI: 10.1007/s12640-015-9528-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 12/12/2022]
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17
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Samaja M, Milano G. Editorial - Hypoxia and Reoxygenation: From Basic Science to Bedside. Front Pediatr 2015; 3:86. [PMID: 26539421 PMCID: PMC4609843 DOI: 10.3389/fped.2015.00086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michele Samaja
- Department of Health Science, University of Milan , Milan , Italy
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18
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Iturriaga R, Andrade DC, Del Rio R. Enhanced carotid body chemosensory activity and the cardiovascular alterations induced by intermittent hypoxia. Front Physiol 2014; 5:468. [PMID: 25520668 PMCID: PMC4251310 DOI: 10.3389/fphys.2014.00468] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023] Open
Abstract
The carotid body (CB) plays a main role in the maintenance of the oxygen homeostasis. The hypoxic stimulation of the CB increases the chemosensory discharge, which in turn elicits reflex sympathetic, cardiovascular, and ventilatory adjustments. An exacerbate carotid chemosensory activity has been associated with human sympathetic-mediated diseases such as hypertension, insulin resistance, heart failure, and obstructive sleep apnea (OSA). Indeed, the CB chemosensory discharge becomes tonically hypereactive in experimental models of OSA and heart failure. Chronic intermittent hypoxia (CIH), a main feature of OSA, enhances CB chemosensory baseline discharges in normoxia and in response to hypoxia, inducing sympathetic overactivity and hypertension. Oxidative stress, increased levels of ET-1, Angiotensin II and pro-inflammatory cytokines, along with a reduced production of NO in the CB, have been associated with the enhanced carotid chemosensory activity. In this review, we will discuss new evidence supporting a main role for the CB chemoreceptor in the autonomic and cardiorespiratory alterations induced by intermittent hypoxia, as well as the molecular mechanisms involved in the CB chemosensory potentiation.
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Affiliation(s)
- Rodrigo Iturriaga
- Laboratorio de Neurobiología, Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile Santiago, Chile
| | - David C Andrade
- Laboratorio de Neurobiología, Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile Santiago, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile Santiago, Chile
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Abstract
Hydrogen sulfide (H2S) has emerged as a key regulator of cardiovascular function. This gasotransmitter is produced in the vasculature and is involved in numerous processes that promote vascular homeostasis, including vasodilation and endothelial cell proliferation. Although H2S plays a role under physiological conditions, it has become clear in recent years that hypoxia modulates the production and action of H2S. Furthermore, there is growing evidence that H2S is cytoprotective in the face of hypoxic insults. This review focuses on the synthesis and signaling of H2S in hypoxic conditions in the vasculature, and highlights recent studies providing evidence that H2S is a potential therapy for preventing tissue damage in hypoxic conditions.
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Affiliation(s)
- Jessica M Osmond
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Nancy L Kanagy
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Metabolic syndrome in patients taking clozapine: prevalence and influence of catechol-O-methyltransferase genotype. Psychopharmacology (Berl) 2014; 231:2211-8. [PMID: 24448899 DOI: 10.1007/s00213-013-3410-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 11/23/2013] [Indexed: 12/31/2022]
Abstract
RATIONALE Metabolic syndrome (MetS) has consistently been identified as an adverse effect of long-term treatment with atypical antipsychotics (AAPs) such as clozapine. Elevated serum homocysteine concentration has been found to act as an independent risk factor for MetS, and catechol-O-methyltransferase (COMT) catalyzes the homocysteine metabolism. We accordingly hypothesized that COMT dysregulation may confer the susceptibility to MetS induced by AAPs, potentially in a gender-specific manner, because the interaction effects of COMT and gender have been consistently reported. OBJECTIVES This study aimed at determining the prevalence and influence of COMT on MetS among a population undergoing long-term clozapine treatment. METHODS A total of 468 schizophrenia patients taking clozapine were divided into two groups, those experiencing MetS and non-MetS. We genotyped three functional variants (rs4633, rs4680, and rs4818) in COMT and measured the serum levels of fasting homocysteine, glucose, triglyceride (TG), and high-density lipoprotein cholesterol. RESULTS MetS was found in 202/468 (43.2 %) of all the patients, with 40.2 % prevalence (138/343) in males and 51.2 % (64/125) in females. Patients with MetS had notably higher metabolic parameters than those without MetS. The mean levels of homocysteine in patients with MetS were significantly higher than those without MetS. We found a positive association between the rs4680 polymorphism and the serum triglyceride levels (corrected P = 0.024). Further analysis revealed that the rs4680 Met allele was significantly associated with increased triglyceride levels among female patients (P = 0.009), but not among males (P = 0.07). CONCLUSIONS Our findings suggest a potential association between rs4680 in COMT and elevated TG levels, particularly among female patients.
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Niu X, Chen X, Xiao Y, Dong J, Zhang R, Lu M, Kong W. The differences in homocysteine level between obstructive sleep apnea patients and controls: a meta-analysis. PLoS One 2014; 9:e95794. [PMID: 24769854 PMCID: PMC4000194 DOI: 10.1371/journal.pone.0095794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/31/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies have reported inconsistent findings regarding the relationship between obstructive sleep apnea (OSA) and homocysteine (HCY) level. This study aimed to assess the difference in plasma HCY level between OSA patients and controls by conducting a meta-analysis of published studies. METHODS Database of PubMed, SCI, and China National Knowledge Internet (CNKI) were comprehensively searched. Eligible studies regarding plasma HCY level in OSA patients were identified by two independent reviewers. RevMan (version 5.2) and STATA (version 12.0) were employed for data synthesis. RESULTS A total of 10 studies involving 432 subjects were included. Meta-analysis showed that plasma HCY levels in OSA group were 3.11 µmol/l higher than that in control group (95% confidence interval: 2.08 to 4.15, P<0.01). Subgroup analysis revealed a more significant differences between OSA patients and controls when average body mass index ≥ 30 (the total weighted mean difference (WMD) was 3.64), average age<50 (the total WMD was 3.96) and average apnea hypopnea index ≥ 35 (the total WMD was 4.54). CONCLUSIONS In this meta-analysis, plasma HCY levels were found to be higher in OSA patients compared to control subjects.
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Affiliation(s)
- Xun Niu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Chen
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xiao
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Dong
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zhang
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meixia Lu
- Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weijia Kong
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Institute of Otorhinolaryngology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail:
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Effect of continuous positive airway pressure on homocysteine levels in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 2014; 18:687-94. [DOI: 10.1007/s11325-014-0940-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/15/2013] [Accepted: 01/13/2014] [Indexed: 02/07/2023]
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Patients with obstructive sleep apnea display increased carotid intima media: a meta-analysis. Int J Vasc Med 2013; 2013:839582. [PMID: 24066233 PMCID: PMC3771445 DOI: 10.1155/2013/839582] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/13/2013] [Accepted: 07/19/2013] [Indexed: 12/17/2022] Open
Abstract
Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from -0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P < 0.0001). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process.
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Sales LV, Bruin VMSD, D'Almeida V, Pompéia S, Bueno OFA, Tufik S, Bittencourt L. Cognition and biomarkers of oxidative stress in obstructive sleep apnea. Clinics (Sao Paulo) 2013; 68:449-55. [PMID: 23778335 PMCID: PMC3634962 DOI: 10.6061/clinics/2013(04)03] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/07/2012] [Accepted: 12/04/2012] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old) with obstructive sleep apnea and 13 controls (37.3±6.9 years old). All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006), superoxide dismutase (p<0.001) and vitamin B11 (p<0.001), as well as higher concentrations of homocysteine (p<0.02). Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F = 15.9; p = 0.002) and this correlation remained after controlling for age and body mass index (F = 6.3, p = 0.01). A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F = 7.9; p = 0.01) was also observed. CONCLUSIONS Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population.
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Affiliation(s)
- Leticia Viana Sales
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo/SP, Brazil
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