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Zhang C, Li H, Li J, Hu J, Yang K, Tao L. Oxidative stress: A common pathological state in a high-risk population for osteoporosis. Biomed Pharmacother 2023; 163:114834. [PMID: 37163779 DOI: 10.1016/j.biopha.2023.114834] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
Osteoporosis is becoming a major concern in the field of public health. The process of bone loss is insidious and does not directly induce obvious symptoms. Complications indicate an irreversible decrease in bone mass. The high-risk populations of osteoporosis, including postmenopausal women, elderly men, diabetic patients and obese individuals need regular bone mineral density testing and appropriate preventive treatment. However, the primary changes in these populations are different, increasing the difficulty of effective treatment of osteoporosis. Determining the core pathogenesis of osteoporosis helps improve the efficiency and efficacy of treatment among these populations. Oxidative stress is a common pathological state secondary to estrogen deficiency, aging, hyperglycemia and hyperlipemia. In this review, we divided oxidative stress into the direct effect of reactive oxygen species (ROS) and the reduction of antioxidant enzyme activity to discuss their roles in the development of osteoporosis. ROS initiated mitochondrial apoptotic signaling and suppressed osteogenic marker expression to weaken osteogenesis. MAPK and NF-κB signaling pathways mediated the positive effect of ROS on osteoclast differentiation. Antioxidant enzymes not only eliminate the negative effects of ROS, but also directly participate in the regulation of bone metabolism. Additionally, we also described the roles of proinflammatory factors and HIF-1α under the pathophysiological changes of inflammation and hypoxia, which provided a supplement of oxidative stress-induced osteoporosis. In conclusion, our review showed that oxidative stress was a common pathological state in a high-risk population for osteoporosis. Targeted oxidative stress treatment would greatly optimize the therapeutic schedule of various osteoporosis treatments.
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Affiliation(s)
- Chi Zhang
- Department of Orthopedics, First Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, China
| | - Hao Li
- Department of Orthopedics, First Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, China
| | - Jie Li
- Department of Orthopedics, First Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, China
| | - Jiajin Hu
- Health Sciences Institute, China Medical University, Shenyang 110122, China
| | - Keda Yang
- Department of Orthopedics, First Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, China.
| | - Lin Tao
- Department of Orthopedics, First Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, China.
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2
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Maxwell MN, Marullo AL, Slyne AD, Lucking EF, O'Halloran KD. Ventilatory Effects of Acute Intermittent Hypoxia in Conscious Dystrophic Mice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1427:83-88. [PMID: 37322338 DOI: 10.1007/978-3-031-32371-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Exposure to acute intermittent hypoxia (AIH) elicits a form of respiratory plasticity known as long-term facilitation (LTF). Interest has grown in developing AIH interventions to treat ventilatory insufficiency, with promising results in spinal cord injury and amyotrophic lateral sclerosis. Therapeutic AIH may have application in neuromuscular disorders including muscular dystrophies. We sought to establish hypoxic ventilatory responsiveness and the expression of ventilatory LTF in X-linked muscular dystrophy (mdx) mice.Experiments were performed in 15 male wild-type (BL10) and 15 male mdx mice at 4 months of age. Ventilation was assessed using whole-body plethysmography. Baseline measures of ventilation and metabolism were established. Mice were exposed to 10 successive bouts of hypoxia, each lasting 5 min, interspersed with 5-min bouts of normoxia. Measurements were taken for 60 min following termination of AIH.In mdx mice, ventilation was significantly increased 60 min post-AIH compared to baseline. However, metabolic CO2 production was also increased. Therefore, ventilatory equivalent was unaffected by AIH exposure, i.e., no ventilatory LTF manifestation. In wild-type mice, ventilation and metabolism were not affected by AIH.Eliciting ventilatory LTF is dependent on many factors and may require concomitant isocapnia or hypercapnia during AIH exposures and/or repeated daily AIH exposures, which is worthy of further pursuit.
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Affiliation(s)
- Michael N Maxwell
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Anthony L Marullo
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Aoife D Slyne
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Eric F Lucking
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland.
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3
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王 金, 方 金, 谢 宇, 马 薇, 惠 培, 苏 晓, 郭 斌, 陈 雪, 王 旭, 范 杰, 赵 媛. [Analysis of related factors in secondary erythrocytosis of obstructive sleep apnea hypopnea syndrome in Gansu province]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:338-342. [PMID: 35483682 PMCID: PMC10128252 DOI: 10.13201/j.issn.2096-7993.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Objective:To analyze the related factors of secondary erythrocytosis of obstructive sleep apnea(OSA) in Gansu province. Methods:Polysomnography recording and analysis from January 2013 to January 2021, A total of 448 OSA patients of long-resident Han nationality in Gansu province. Hemoglobin(Hb) values were divided into group A(Hb 120-160 g/L) 41 cases, B(Hb 161-179 g/L) 142 cases, C(Hb 180-199 g/L) 152 cases, D(Hb 200-219 g/L) 79 cases, and E(Hb ≥220 g/L) 30 cases. General clinical data, altitude of residence, disease course, apnea hypopnea index (AHI), and Lowest oxyhemoglobin(LSpO₂) were compared among these groups. Multivariate regression and ROC curves were used to analyze the influencing factors of OSA secondary erythrocytosis. Results:There were no significant differences in age, sex, and course of disease among groups A, B, C, D, and E (P>0.05).The altitude of group E was higher than that of groups A, B, C, and D (P<0.05), but there was no significant difference between groups A, B, C and D (P>0.05).AHI was significantly different among groups A, B, C, D, and E (P<0.05), groups C, D, and E were significantly higher than A; group D was significantly higher than B, C.LSpO₂ was significantly different among groups A, B, C, D, and E (P <0.05), groups B, C, D, and E was significantly lower than A; group D, E was significantly lower than B, C.MSpO₂ was significantly different among groups A, B, C, D, and E (P<0.05), groups B, C, D, and E was significantly lower A; groups D, E was significantly lower than B , C.Multivariate regression showed that the higher the altitude, the lower the MSpO₂, the more serious the secondary hyperhemoglobinemia.Age, course of the disease, AHI, and LSpO₂ were not the influencing factors of OSA secondary hemoglobin increase.The areas under the ROC curve for MSpO₂ and altitude to predict Hb≥180 g/L were 0.694(P<0.001) and 0.570(P=0.009), with statistically significant differences(Z=3.205, P=0.001). Conclusion:Altitude and MSpO₂ were independent risk factors for OSA secondary erythrocytosis; MSpO₂ predicted that Hb≥180 g/L in OSA patients was better than altitude.
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Affiliation(s)
- 金凤 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 金瑞 方
- 甘肃省人民医院日间诊疗中心Department of Day Care Center, Gansu Provincial Hospital
| | - 宇平 谢
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 薇 马
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 培林 惠
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 晓燕 苏
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 斌 郭
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 雪萍 陈
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 旭斌 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 杰 范
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 媛 赵
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
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Cunningham J, Hunter M, Budgeon C, Murray K, Knuiman M, Hui J, Hillman D, Singh B, James A. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med 2021; 17:2029-2039. [PMID: 34606440 DOI: 10.5664/jcsm.9378] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES Population surveys suggest the prevalence of obstructive sleep apnea (OSA) is high and increasing and that risk factors and outcomes differ between sexes. To explore these relationships we assessed current OSA prevalence, potential risk factors and comorbidities, and their changes relative to previous estimates in the same community. METHODS All adults on the Busselton, Australia, electoral roll born 1946-1964 were invited to participate in a general health survey. Of the 5,037 (62% response rate) respondents, 3,686 successfully completed overnight 2-channel (oximetry, airflow) sleep studies. These were scored and categorized as nil, mild, moderate, or severe OSA based on apnea-hypopnea index (< 5, ≥ 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/h, respectively). Sleep scores were related to participant characteristics and health profiles. OSA prevalence was compared with previous surveys in the community. RESULTS Prevalences of any and moderate-severe OSA were 57.7% and 20.2% in males and 41.7% and 10.0% in females. Matched for age group, the prevalence of moderate-severe OSA was similar to that in 2007 (males 24.6%, females 9.8%) and was higher than in 1995 (males 4.7%). OSA was associated with age, body mass index, and alcohol intake in males and age and body mass index in females. Conditions associated with OSA included hypertension and current depression in males and hypertension, skin cancer, and diabetes in females. CONCLUSIONS Prevalence of OSA in a middle-aged, predominantly White population in 2010-2015 was high, has increased since 1995, and has remained stable since 2007. Sex differences exist in associated features, including potential risk factors and comorbidities. CITATION Cunningham J, Hunter M, Budgeon C, et al. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med. 2021;17(10):2029-2039.
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Affiliation(s)
- Jordan Cunningham
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Charley Budgeon
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Jennie Hui
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia.,PathWest Laboratory Medicine of Washington, Queen Elizabeth II Medical Centre, Nedlands, Western Australia
| | - David Hillman
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Alan James
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia; *Contributed equally
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5
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Drummond SE, Burns DP, O'Connor KM, Clarke G, O'Halloran KD. The role of NADPH oxidase in chronic intermittent hypoxia-induced respiratory plasticity in adult male mice. Respir Physiol Neurobiol 2021; 292:103713. [PMID: 34116239 DOI: 10.1016/j.resp.2021.103713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/18/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
Reactive oxygen species (ROS) are proposed as mediators of chronic intermittent hypoxia (CIH)-induced respiratory plasticity. We sought to determine if NADPH oxidase 2 (NOX2)-derived ROS underpin CIH-induced maladaptive changes in respiratory control. Adult male mice (C57BL/6 J) were assigned to one of three groups: normoxic controls (sham); chronic intermittent hypoxia-exposed (CIH, 12 cycles/hour, 8 h/day for 14 days); and CIH + apocynin (NOX2 inhibitor, 2 mM) given in the drinking water throughout exposure to CIH. In addition, we studied sham and CIH-exposed NOX2-null mice (B6.129S-CybbTM1Din/J). Whole-body plethysmography was used to measure breathing and metabolic parameters. Ventilation (V̇I/V̇CO2) during normoxia was unaffected by CIH, but apnoea index was increased, which was prevented by apocynin, but not by NOX2 deletion. The ventilatory response to hypercapnia following exposure to CIH was potentiated in NOX2-null mice. Our results reveal ROS-dependent influences on the control of breathing and point to antioxidant intervention as a potential adjunctive therapeutic strategy in respiratory control disorders.
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Affiliation(s)
- Sarah E Drummond
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - David P Burns
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Karen M O'Connor
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy & Neuroscience, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Cork, Ireland.
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6
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Guadagni V, Pun M. Untangling sex differences in obstructive sleep apnea: a significant step toward precision medicine. Sleep 2020; 43:5736395. [PMID: 32060516 DOI: 10.1093/sleep/zsaa022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/02/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Veronica Guadagni
- Laboratory of Human Cerebrovascular Physiology Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matiram Pun
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Lin ZP, Lin HL, Yu XP, Zheng YJ, Cheng SY. TLR4 mediates inflammation and hepatic fibrosis induced by chronic intermittent hypoxia in rats. Mol Med Rep 2020; 22:651-660. [PMID: 32626927 PMCID: PMC7339543 DOI: 10.3892/mmr.2020.11134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and complex disorder that is associated with liver injury. Moreover, previous studies have revealed that chronic intermittent hypoxia (CIH) is associated with the development of non-alcoholic fatty liver disease and hepatic fibrosis. However, the underlying molecular mechanisms remain largely unknown. The present study aimed to investigate whether chronic intermittent hypoxia induced hepatic fibrosis, in addition to determining its underlying mechanisms, in CIH model rats using immunohistochemistry, western blotting and reverse transcription-quantitative PCR. The present results suggested that CIH caused hepatic fibrosis and increased the expression levels of interleukin (IL)-1β, IL-8, monocyte chemotactic-1, tumor necrosis factor-α, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in the liver; these conditions could be reversed by Toll-like receptor 4 (TLR4) short hairpin RNA lentivirus treatment. Moreover, immunohistochemistry and western blotting results indicated that TLR4 and NF-κB expression levels were significantly increased in the CIH and CIH-TLR4 empty vector lentivirus group. However, protein expression levels of TLR4, NF-κB, inhibitor of NF-κB and phosphorylated-mitogen-activated protein kinase (MAPK)-1 in the hypoxia/reoxygenation group were significantly higher compared with the control group (P<0.05), and these results were reversed by the MAPK inhibitor U0126 in vitro. Collectively, the present preliminary results suggested that inflammation and the TLR4/NF-κB/MAPK signaling pathway may be involved in CIH-induced liver fibrosis.
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Affiliation(s)
- Zhi-Peng Lin
- Department of Infectious Diseases, The First Quanzhou Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Hui-Li Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Xue-Ping Yu
- Department of Infectious Diseases, The First Quanzhou Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Yi-Juan Zheng
- Department of Infectious Diseases, The First Quanzhou Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Si-Yu Cheng
- Department of Infectious Diseases, The First Quanzhou Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
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8
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Effects of inflammation on the developing respiratory system: Focus on hypoglossal (XII) neuron morphology, brainstem neurochemistry, and control of breathing. Respir Physiol Neurobiol 2020; 275:103389. [PMID: 31958568 DOI: 10.1016/j.resp.2020.103389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
Breathing is fundamental to life and any adverse change in respiratory function can endanger the health of an organism or even be fatal. Perinatal inflammation is known to adversely affect breathing in preterm babies, but lung infection/inflammation impacts all stages of life from birth to death. Little is known about the role of inflammation in respiratory control, neuronal morphology, or neural function during development. Animal models of inflammation can provide understanding and insight into respiratory development and how inflammatory processes alter developmental phenotype in addition to providing insight into new treatment modalities. In this review, we focus on recent work concerning the development of neurons, models of perinatal inflammation with an emphasis on two common LPS-based models, inflammation and its impact on development, and current and potential treatments for inflammation within the respiratory control circuitry of the mammalian brainstem. We have also discussed models of inflammation in adults and have specifically focused on hypoglossal motoneurons (XII) and neurons of the nucleus tractus solitarii (nTS) as these nuclei have been studied more extensively than other brainstem nuclei participating in breathing and airway control. Understanding the impact of inflammation on the developmental aspects of respiratory control and breathing pattern is critical to addressing problems of cardiorespiratory dysregulation in disease and this overview points out many gaps in our current knowledge.
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9
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Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis G G, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2019; 50:101250. [PMID: 31881487 DOI: 10.1016/j.smrv.2019.101250] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence links cognitive-decline and Alzheimer's disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA's prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA's heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.
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Affiliation(s)
- Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Arlener D Turner
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Human Services and Psychology, National Louis University, Chicago, IL, USA
| | - Mony J de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girardin Jean-Louis G
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA.
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10
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Robertson BD, Lerner BS, Collen JF, Smith PR. The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series. J Clin Sleep Med 2019; 15:1529-1533. [PMID: 31596219 PMCID: PMC6778344 DOI: 10.5664/jcsm.7992] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/29/2022]
Abstract
None The effect of hormone therapy on sleep-disordered breathing in transgender patients has not been described. We present three cases of patients undergoing gender reassignment and treated with hormone replacement. The first case was a transgender woman (assigned male at birth) with a prolonged history of severe obstructive sleep apnea (OSA) that resolved following initiation of female sex hormones. The second and third cases both address transgender males (assigned female at birth) in whom OSA developed following initiation of male sex hormones (with pretreatment polysomnography documenting absence of OSA). The growing interest in transgender health warrants further evaluation of the effects of related therapies on sleep and sleep-disordered breathing.
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Affiliation(s)
- Brian D. Robertson
- Walter Reed National Military Medical Center-Bethesda, Bethesda, Maryland
| | - Brian S. Lerner
- Walter Reed National Military Medical Center-Bethesda, Bethesda, Maryland
| | - Jacob F. Collen
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Patrick R. Smith
- Walter Reed National Military Medical Center-Bethesda, Bethesda, Maryland
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11
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Zhang L, Ou X, Zhu T, Lv X. Beneficial effects of estrogens in obstructive sleep apnea hypopnea syndrome. Sleep Breath 2019; 24:7-13. [PMID: 31309463 DOI: 10.1007/s11325-019-01896-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/01/2023]
Abstract
Epidemiological studies showing the higher frequency of obstructive sleep apnea hypopnea syndrome in men, polycystic ovary syndrome (PCOS), and in post-menopausal women suggest the beneficial role of estrogen. These findings are well supported by the pre-clinical studies (ten research studies described in this review) showing that estrogen and phytoestrogens attenuate the deleterious effects of chronic intermittent hypoxia (obstructive apnea in animals) on the genioglossal muscles and on other organs (co-morbidities) in ovariectomized rodents. Moreover, clinical studies (four research studies described in this review) have also shown the beneficial role of estrogen therapy on the parameters of obstructive apnea in post-menopausal women. The beneficial effects of estrogen and phytoestrogens on obstructive sleep apnea and its co morbidities have been attributed to increase in thioredoxin, Nrf-2, activation of p38 MAP kinases, inhibition of vagal C fibers, and attenuation of HIF-1α. It is possible that estrogen-mediated activation of p38 MAP kinase may inhibit HIF-1α to attenuate lung inflammation, which may inhibit the activation of vagal C fibers to attenuate bronchoconstriction and prevent obstruction during sleep. Moreover, estrogen-mediated increase in thioredoxin and Nrf-2 may also contribute in increasing antioxidant defense and attenuating inflammation.
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Affiliation(s)
- Lixiu Zhang
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Xiyan Ou
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Tonggang Zhu
- Experimental Center, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Xiaohong Lv
- Department of Respiratory Medicine, The First Hospital of Jilin University, No. 218 Ziqiang Road, Changchun, 130041, Jilin, China.
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12
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O'Halloran KD. Cardiovascular sequelae of the sleep apnoea syndrome: Sex, stress and therapeutic strategies. Acta Physiol (Oxf) 2019; 225:e13170. [PMID: 30102847 DOI: 10.1111/apha.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
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13
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Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci 2019; 20:ijms20030459. [PMID: 30678164 PMCID: PMC6387387 DOI: 10.3390/ijms20030459] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.
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14
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Li N, Li HP, Wang P, Yan YR, Li SQ, Li QY. Nocturnal Mean Oxygen Saturation Is Associated with Secondary Polycythemia in Young Adults with Obstructive Sleep Apnea, Especially in Men. Nat Sci Sleep 2019; 11:377-386. [PMID: 31824198 PMCID: PMC6901050 DOI: 10.2147/nss.s226143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Whether the severity of obstructive sleep apnea (OSA) contributes to clinical polycythemia is uncertain, especially in young adults. This study aimed to assess the correlation between untreated OSA and polycythemia, controlling for multiple confounders, and to observe the difference in both genders. METHODS All participants underwent nocturnal polysomnography. Medical comorbidities, and demographic and laboratory information were also recorded. The relationship between OSA and concomitant polycythemia in both genders was analyzed. RESULTS A total of 605 young participants (383 men and 222 women), aged 30.52 ± 7.21 years, were enrolled, with an average body mass index of 32.48 ± 6.06 kg/m2. Although 74.4% of patients were diagnosed with OSA, less than 10% had polycythemia. The levels of hemoglobin and hematocrit increased with the severity of OSA; only men with severe OSA had significantly higher hemoglobin, hematocrit, and polycythemia compared with those in the control group (P < 0.01). Hemoglobin and hematocrit significantly correlated with mean pulse oxygen saturation (SpO2) (P < 0.001), but the correlation coefficients were weaker in women than in men. In logistic regression analysis, mean SpO2, but not the apnea-hypopnea index (AHI), was found to be an independent predictor of polycythemia (P < 0.05). Areas under the receive operator characteristic analysis revealed that the cutoff values of hemoglobin and hematocrit were 155.5g/L and 44.6% (P < 0.001), respectively, for assessing nocturnal hypoxemia in men with OSA. CONCLUSION Nocturnal mean SpO2 was an independent predictor of polycythemia in young adults. Mean SpO2, compared with the AHI, was more associated with polycythemia. Men were more prone to suffer from polycythemia compared with women. Hemoglobin and hematocrit values might have diagnostic utility for assessing nocturnal hypoxia severity of OSA patients, especially in men.
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Affiliation(s)
- Ning Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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15
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Baum DM, Saussereau M, Jeton F, Planes C, Voituron N, Cardot P, Fiamma MN, Bodineau L. Effect of Gender on Chronic Intermittent Hypoxic Fosb Expression in Cardiorespiratory-Related Brain Structures in Mice. Front Physiol 2018; 9:788. [PMID: 29988603 PMCID: PMC6026892 DOI: 10.3389/fphys.2018.00788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
We aimed to delineate sex-based differences in neuroplasticity that may be associated with previously reported sex-based differences in physiological alterations caused by repetitive succession of hypoxemia-reoxygenation encountered during obstructive sleep apnea (OSA). We examined long-term changes in the activity of brainstem and diencephalic cardiorespiratory neuronal populations induced by chronic intermittent hypoxia (CIH) in male and female mice by analyzing Fosb expression. Whereas the overall baseline and CIH-induced Fosb expression in females was higher than in males, possibly reflecting different neuroplastic dynamics, in contrast, structures responded to CIH by Fosb upregulation in males only. There was a sex-based difference at the level of the rostral ventrolateral reticular nucleus of the medulla, with an increase in the number of FOSB/ΔFOSB-positive cells induced by CIH in males but not females. This structure contains neurons that generate the sympathetic tone and which are involved in CIH-induced sustained hypertension during waking hours. We suggest that the sex-based difference in neuroplasticity of this structure contributes to the reported sex-based difference in CIH-induced hypertension. Moreover, we highlighted a sex-based dimorphic phenomenon in serotoninergic systems induced by CIH, with increased serotoninergic immunoreactivity in the hypoglossal nucleus and a decreased number of serotoninergic cells in the dorsal raphe nucleus in male but not female mice. We suggest that this dimorphism in the neuroplasticity of serotoninergic systems predisposes males to a greater alteration of neuronal control of the upper respiratory tract associated with the greater collapsibility of upper airways described in male OSA subjects.
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Affiliation(s)
- David M Baum
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, UMR-S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Maud Saussereau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, UMR-S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Florine Jeton
- Sorbonne Paris Cité, Université Paris 13, EA2363 Hypoxie et Poumon, Bobigny, France
| | - Carole Planes
- Sorbonne Paris Cité, Université Paris 13, EA2363 Hypoxie et Poumon, Bobigny, France
| | - Nicolas Voituron
- Sorbonne Paris Cité, Université Paris 13, EA2363 Hypoxie et Poumon, Bobigny, France
| | - Philippe Cardot
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, UMR-S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Marie-Noëlle Fiamma
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, UMR-S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Laurence Bodineau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, UMR-S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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16
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Greising SM, Ottenheijm CAC, O'Halloran KD, Barreiro E. Diaphragm plasticity in aging and disease: therapies for muscle weakness go from strength to strength. J Appl Physiol (1985) 2018; 125:243-253. [PMID: 29672230 DOI: 10.1152/japplphysiol.01059.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The diaphragm is the main inspiratory muscle and is required to be highly active throughout the life span. The diaphragm muscle must be able to produce and sustain various behaviors that range from ventilatory to nonventilatory such as those required for airway maintenance and clearance. Throughout the life span various circumstances and conditions may affect the ability of the diaphragm muscle to generate requisite forces, and in turn the diaphragm muscle may undergo significant weakness and dysfunction. For example, hypoxic stress, critical illness, cancer cachexia, chronic obstructive pulmonary disorder, and age-related sarcopenia all represent conditions in which significant diaphragm muscle dysfunction exits. This perspective review article presents several interesting topics involving diaphragm plasticity in aging and disease that were presented at the International Union of Physiological Sciences Conference in 2017. This review seeks to maximize the broad and collective research impact on diaphragm muscle dysfunction in the search for transformative treatment approaches to improve the diaphragm muscle health during aging and disease.
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Affiliation(s)
- Sarah M Greising
- Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota.,School of Kinesiology, University of Minnesota , Minneapolis, Minnesota
| | - Coen A C Ottenheijm
- Department of Physiology, VU University Medical Center , Amsterdam , The Netherlands.,Cellular and Molecular Medicine, University of Arizona , Tucson, Arizona
| | - Ken D O'Halloran
- Department of Physiology, University College Cork , Cork , Ireland
| | - Esther Barreiro
- Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona , Spain.,Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III , Barcelona , Spain
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17
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Kinkead R, Schlenker E. Sex-based differences in respiratory control: Progress in basic physiology and clinical research. Respir Physiol Neurobiol 2017; 245:1-3. [PMID: 28826885 DOI: 10.1016/j.resp.2017.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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O'Halloran KD, Lewis P. Respiratory muscle dysfunction in animal models of hypoxic disease: antioxidant therapy goes from strength to strength. HYPOXIA 2017; 5:75-84. [PMID: 28770235 PMCID: PMC5529115 DOI: 10.2147/hp.s141283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The striated muscles of breathing play a critical role in respiratory homeostasis governing blood oxygenation and pH regulation. Upper airway dilator and thoracic pump muscles retain a remarkable capacity for plasticity throughout life, both in health and disease states. Hypoxia, whatever the cause, is a potent driver of respiratory muscle remodeling with evidence of adaptive and maladaptive outcomes for system performance. The pattern, duration, and intensity of hypoxia are key determinants of respiratory muscle structural-, metabolic-, and functional responses and adaptation. Age and sex also influence respiratory muscle tolerance of hypoxia. Redox stress emerges as the principal protagonist driving respiratory muscle malady in rodent models of hypoxic disease. There is a growing body of evidence demonstrating that antioxidant intervention alleviates hypoxia-induced respiratory muscle dysfunction, and that N-acetyl cysteine, approved for use in humans, is highly effective in preventing hypoxia-induced respiratory muscle weakness and fatigue. We posit that oxygen homeostasis is a key driver of respiratory muscle form and function. Hypoxic stress is likely a major contributor to respiratory muscle malaise in diseases of the lungs and respiratory control network. Animal studies provide an evidence base in strong support of the need to explore adjunctive antioxidant therapies for muscle dysfunction in human respiratory disease.
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Affiliation(s)
- Ken D O'Halloran
- Department of Physiology, School of Medicine, University College Cork, Cork, Ireland
| | - Philip Lewis
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Preventative Research, University Hospital of Cologne, Germany
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19
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Khazaie H, Veronese M, Noori K, Emamian F, Zarei M, Ashkan K, Leschziner GD, Eickhoff CR, Eickhoff SB, Morrell MJ, Osorio RS, Spiegelhalder K, Tahmasian M, Rosenzweig I. Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI. Neurosci Biobehav Rev 2017; 77:219-231. [PMID: 28344075 PMCID: PMC6167921 DOI: 10.1016/j.neubiorev.2017.03.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/24/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
Resting state functional MRI studies is a promising non-invasive tool for better understanding of the pathophysiology of sleep disorders. The salience network is involved in hyperarousal and affective symptoms in insomnia. The posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea. Disruption of intrinsic networks have been demonstrated in major depression, which is a common co-morbidity of sleep disorders.
Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mattia Veronese
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Keyoumars Ashkan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Department of Neurosurgery, King's College Hospital, London, UK
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust,Sydney Street, London, SW3 6NP, UK
| | - Ricardo S Osorio
- Center for Brain Health, NYU School of Medicine, New York, NY, United States
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
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