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Onuki K, Ikeda A, Muraki I, Tanaka M, Yamagishi K, Kiyama M, Okada T, Kubota Y, Imano H, Kitamura A, Sankai T, Umesawa M, Ohira T, Iso H, Tanigawa T. Nocturnal Intermittent Hypoxia and the Risk of Cardiovascular Disease among Japanese Populations: The Circulatory Risk in Communities Study (CIRCS). J Atheroscler Thromb 2023; 30:1276-1287. [PMID: 36642535 PMCID: PMC10499452 DOI: 10.5551/jat.63754] [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: 06/08/2022] [Accepted: 11/17/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS Information is limited about the influence of obstructive sleep apnea (OSA) on developing cardiovascular disease (CVD) among Asian community-dwelling populations. We examined the association between nocturnal intermittent hypoxia as a surrogate marker of OSA and the risk of CVD in a Japanese community-based cohort study. METHODS We used baseline surveys from 2000 to 2008 to study the cohort data of 5,313 residents from three Japanese communities who were between the ages of 40 and 74 years and initially free from ischemic heart disease and stroke. We assessed the number of 3% oxygen desaturation index (ODI) as the indicator of nocturnal intermittent hypoxia. We divided individuals into two groups depending on 3% ODI (3% ODI ≥ 5 or 3% ODI <5). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD according to 3% ODI. Age, sex, body mass index, alcohol, and smoking were adjusted in the multivariable models. RESULTS During 12.8 years of the median follow-up with 66,796 person-years, 185 cases with CVD (115 stroke and 70 coronary heart disease [CHD]) were recorded. The multivariable HRs (95% CIs) were 1.49 (1.09-2.03), 2.13 (1.08-4.22), and 1.93 (1.16-3.19) for the 3% ODI ≥ 5 group versus the 3% ODI <5 group of developing CVD, lacunar infarction, and CHD, respectively. CONCLUSIONS Nocturnal intermittent hypoxia may increase the risk of developing lacunar infarction and CHD among community-dwelling Japanese populations. However, we could not find a significant risk of developing total stroke or stroke subtypes such as intraparenchymal hemorrhage, subarachnoid hemorrhage, and total ischemic stroke.
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Affiliation(s)
- Keisuke Onuki
- Department of Public Health, Graduate School of Juntendo University, Tokyo, Japan
| | - Ai Ikeda
- Department of Public Health, Graduate School of Juntendo University, Tokyo, Japan
| | - Isao Muraki
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mari Tanaka
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Ibaraki Western Medical Center, Ibaraki, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Hironori Imano
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | | | - Tomoko Sankai
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Mitsumasa Umesawa
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University, Fukushima, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Graduate School of Juntendo University, Tokyo, Japan
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Babson KA, Del Re AC, Bonn-Miller MO, Woodward SH. The comorbidity of sleep apnea and mood, anxiety, and substance use disorders among obese military veterans within the Veterans Health Administration. J Clin Sleep Med 2013; 9:1253-8. [PMID: 24340286 DOI: 10.5664/jcsm.3262] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder. DESIGN Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities. SETTING The entire VA Health Care System. PATIENTS OR PARTICIPANTS Population-based sample of veterans with obesity (N = 2,485,658). MAIN OUTCOME MEASURES Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders. RESULTS Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder. CONCLUSIONS Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI.
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Affiliation(s)
- Kimberly A Babson
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA ; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Suzuki K, Miyamoto M, Miyamoto T, Suzuki S, Watanabe Y, Numao A, Iwanami M, Tatsumoto M, Sada T, Kadowaki T, Hashimoto K, Sakuta H, Hirata K. Snoring is associated with an impaired motor function, disease severity and the quality of life but not with excessive daytime sleepiness in patients with Parkinson's disease. Intern Med 2013; 52:863-9. [PMID: 23583989 DOI: 10.2169/internalmedicine.52.9083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE There are conflicting results regarding the frequency and clinical significance of sleep related breathing disorders in patients with Parkinson's disease (PD). The aim of this study was to investigate the relationship between snoring and its clinical correlates in patients with PD. METHODS A total of 93 PD patients and 93 controls were analyzed from a previously conducted cross-sectional study. Snoring was defined as a snoring frequency of ≥ 2 days/week (a score of 2 or higher on the PD Sleep Scale-2 subitem 15). Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of ≥ 10. RESULTS Snoring was more prevalent in the patients with PD than in the controls (14.0% vs. 1.1%). The PD patients who snored exhibited greater disease severity, worse scores on the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson fatigue scale and more impaired scores in several domains of the Parkinson's Disease Questionnaire, including the domains of mobility, activities of daily living, emotional well-being, communication and bodily discomfort, when compared to those who did not snore. No between-group differences were found in EDS. A higher proportion of the UPDRS motor scores for bradykinesia was seen in the PD patients who snored compared to that observed in the PD patients who did not snore. CONCLUSION We found that snoring was more frequent in PD patients than in controls. Furthermore, snoring in PD patients was associated with disease severity, an impaired motor function and a decreased quality of life, although it was not associated with EDS.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Japan.
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Tanigawa T. Obstructive sleep apnea: its prevention and screening may contribute to the prevention of hypertension, diabetes and cardiovascular diseases. EPMA J 2011. [PMID: 23199130 PMCID: PMC3405377 DOI: 10.1007/s13167-011-0073-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Relationships between obstructive sleep apnea and cardiovascular diseases have been reported by both clinical and epidemiological studies. To investigate whether nocturnal intermittent hypoxia (NIH), a surrogate marker for obstructive sleep apnea in the general population, is associated with cardiovascular risk factors, we have conducted epidemiological studies in Japan. The Circulatory Risk in Communities Study (CIRCS) is a cohort study conducted across Japan to examine the risk factors for cardiovascular diseases. In CIRCS participants, NIH was estimated by the hourly occurrences of oxygen desaturation ≥3% (3% oxygen desaturation index [3% ODI]) measured during sleep using a pulse-oximeter. Our studies showed that among middle-aged Japanese, 3% ODI levels were associated with hypertension, elevated serum CRP levels, accumulation of metabolic risk factors, and increased risk of developing type 2 diabetes. Screening for obstructive sleep apnea in the general population is a promising and widely broadly applicable strategy for predictive, preventive and personalized medicine.
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Affiliation(s)
- Takeshi Tanigawa
- Department of Public Health, Doctoral Program in Social Medicine,Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime-ken, 791-0295 Japan
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