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Mytych W, Bartusik-Aebisher D, Łoś A, Dynarowicz K, Myśliwiec A, Aebisher D. Photodynamic Therapy for Atherosclerosis. Int J Mol Sci 2024; 25:1958. [PMID: 38396639 PMCID: PMC10888721 DOI: 10.3390/ijms25041958] [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: 01/01/2024] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Atherosclerosis, which currently contributes to 31% of deaths globally, is of critical cardiovascular concern. Current diagnostic tools and biomarkers are limited, emphasizing the need for early detection. Lifestyle modifications and medications form the basis of treatment, and emerging therapies such as photodynamic therapy are being developed. Photodynamic therapy involves a photosensitizer selectively targeting components of atherosclerotic plaques. When activated by specific light wavelengths, it induces localized oxidative stress aiming to stabilize plaques and reduce inflammation. The key advantage lies in its selective targeting, sparing healthy tissues. While preclinical studies are encouraging, ongoing research and clinical trials are crucial for optimizing protocols and ensuring long-term safety and efficacy. The potential combination with other therapies makes photodynamic therapy a versatile and promising avenue for addressing atherosclerosis and associated cardiovascular disease. The investigations underscore the possibility of utilizing photodynamic therapy as a valuable treatment choice for atherosclerosis. As advancements in research continue, photodynamic therapy might become more seamlessly incorporated into clinical approaches for managing atherosclerosis, providing a blend of efficacy and limited invasiveness.
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Affiliation(s)
- Wiktoria Mytych
- Students English Division Science Club, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland; (W.M.); (A.Ł.)
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Aleksandra Łoś
- Students English Division Science Club, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland; (W.M.); (A.Ł.)
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of the University of Rzeszów, 35-310 Rzeszów, Poland; (K.D.); (A.M.)
| | - Angelika Myśliwiec
- Center for Innovative Research in Medical and Natural Sciences, Medical College of the University of Rzeszów, 35-310 Rzeszów, Poland; (K.D.); (A.M.)
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland
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Yao X, Li N, Heizhati M, Wang Y, Ma Y, Wang R, Zhang D, Luo Q, Hu J, Wang M, Zhu Q. The association between blood pressure control and long-term cardiovascular outcomes in Hypertension coexistent with obstructive sleep apnea. BMC Cardiovasc Disord 2023; 23:574. [PMID: 37990168 PMCID: PMC10664294 DOI: 10.1186/s12872-023-03595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE The goal of blood pressure (BP) control will be lower when hypertensive patients have comorbidities that can affect the risk of cardiovascular diseases. But, the goal of BP control for hypertensive patients coexistent with obstructive sleep apnea (OSA) is not discussed, which is a special population at high risk of cardiovascular diseases. PATIENTS AND METHODS Using data from a retrospective study(Urumqi Research on Sleep Apnea and Hypertension (UROSAH) study, we enrolled 3267 participants who were diagnosed with hypertension and performed polysomnography during 2011-2013 to explore the association between BP control and long-term major adverse cardiovascular and cerebrovascular event (MACCE). Outcomes of interest was the levels of BP control, MACCE, cardiac event and cerebrovascular event. Then we calculated the cumulative incidence of MACCE and performed Cox proportional hazards with stepwise models. RESULTS 379 of 3267 patients experienced MACCE during a median follow-up of 7.0 years. After full risk adjustment, BP control of 120-139/80-89mmHg was associated with the lowest risk of cerebrovascular event (HR: 0.53, 95%CI:0.35-0.82) rather than MACCE and cardiac event in the total cohort. The association did not change much in patients with OSA. When the SBP and DBP were discussed separately, the SBP control of 120-139mmHg or < 120mmHg was associated with the decreased incidence of MACCE and cerebrovascular event. When DBP control < 80 mm Hg, the risk of cerebrovascular event showed 54% decrease [(HR:0.46, 95%CI: 0.25-0.88)] in patients with hypertension and OSA. CONCLUSION In this retrospective study, antihypertensive-drug-induced office and home BP control at 120-139/80-89mmHg showed possible beneficial effect on incident MACCE. However, current results need to be verified in future studies.
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Affiliation(s)
- Xiaoguang Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Nanfang Li
- National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, China.
| | - Mulalibieke Heizhati
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Yingchun Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Yue Ma
- Xinjiang Hypertension Institute, Urumqi, Xinjiang, China
| | - Run Wang
- Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Urumqi, China
| | - Delian Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Qin Luo
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Junli Hu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Menghui Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, NO. 91 Tianchi Road, 830001, Urumqi, Xinjiang, China
| | - Qing Zhu
- Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Urumqi, China
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Beri A, Pisulkar SG, Dubey SA, Sathe S, Bansod A, Shrivastava A. Appliances Therapy in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48280. [PMID: 38058324 PMCID: PMC10695854 DOI: 10.7759/cureus.48280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a recurrent partial or complete obstruction of the upper airway during sleep caused by narrowing or collapse of the pharyngeal wall. It leads to microstimulation and oxyhemoglobin desaturation, resulting in sleepiness and loud snoring. OSA negatively affects the cardiovascular system and may contribute to neurocognitive impairment. The aim of this systematic review is to evaluate the effectiveness and efficacy of appliance therapy in obstructive sleep apnea. The effectiveness was assessed by using the Apnea Hypopnea Index (AHI). An electronic search of the Cochrane Library, PubMed, and Google Scholar was conducted between 1998 and 2021. Articles were independently assessed by three reviewers. The quality of a randomised control trial (RCT) is assessed using the Cochrane risk of bias method. The tool GRADE was used to achieve the desired level of confidence for each outcome reported. Several studies used continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), and tongue retention devices (TRD). The meta-analysis included a total of six papers that met the inclusion criteria. Results showed that CPAP significantly improved AHI compared with an oral appliance (random effects: difference in means = 8.40, 95% CI = 7.21 to 9.60). It was also found that oral appliance (OA) therapy significantly improved AHI compared with baseline before appliance therapy (random effects: mean difference = 13.40, 95% CI = 10.87 to 15.93; p.00001). For mild to moderate OSA, CPAP is considered the gold standard. Our meta-analysis of six RCTs found favorable evidence for OSA patients receiving oral devices; however, they were less effective than CPAP. A subgroup analysis found that MAD may be a beneficial treatment for mild to moderate OSA patients who do not respond to CPAP. The findings suggest that oral appliances may be an effective treatment for OSA, especially in patients with mild to moderate OSA.
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Affiliation(s)
- Arushi Beri
- Prosthodontics, Sharad Pawar Dental College and Hospital, Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, IND
| | - Sweta G Pisulkar
- Prosthodontics and Crown & Bridge, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Surekha A Dubey
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Seema Sathe
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Akansha Bansod
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Akshay Shrivastava
- Orthodontics and Dentofacial Orthopaedics, Kalinga Institute of Dental Sciences, Orissa, IND
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Shyamsukha B, Nimonkar SV, Belkhode VM, Paul P, Godbole S. Assessment of emotional stress among patients suffering from obstructive sleep apnea: A cross-sectional study. J Family Med Prim Care 2023; 12:1389-1393. [PMID: 37649751 PMCID: PMC10465031 DOI: 10.4103/jfmpc.jfmpc_2310_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 09/01/2023] Open
Abstract
Background Obstructive sleep apnea (OSA) is a sleep disorder in which the upper airway is partially or completely blocked during sleep. As a result, sleep arousal and arterial oxygen saturation are reduced. According to the epidemiological survey, OAS is relatively common among people that may be associated with psychiatric illnesses. Objectives The primary objective was to evaluate the stress level among patients suffering from OSA. The secondary objective was to compare the gender preference for stress among patients suffering from OSA. Materials and Methods A cross-sectional study, approved by the Institutional Ethics Committee, was performed to assess emotional stress among patients suffering from OSA. The study involved 20 participants diagnosed with OSA and reported to the Respiratory Department. The stress levels of the study participants were evaluated with a validated, Perceived Stress Scale (PSS) questionnaire given by the American Sociological Association (ASA). Result The stress levels presented by the study participants showed that 40% (n = 8) subjects had moderate stress and 60% (n = 12) had severe stress and 30.3% of females depicted emotional stress and 26.2% of males for the same. Conclusion There is a high psychological stress level among patients suffering from OSA. The females had higher predictions when compared to males. Such patients should be offered an intervention program aimed at stress management to enhance their quality of life.
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Affiliation(s)
- Bhawna Shyamsukha
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu V. Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Vikram M. Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Priyanka Paul
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
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Belkhode V, Godbole S, Nimonkar S, Pisulkar S, Nimonkar P. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-a randomized controlled trial. Trials 2023; 24:73. [PMID: 36726182 PMCID: PMC9890424 DOI: 10.1186/s13063-022-07054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea. METHODS A prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15-30 were involved in the research. Study participants were randomly split up into two test groups: group I was the "Control Group" (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a "customized maxillary oral appliance" (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was "SPSS (Statistical Package for Social Sciences) Version 20.1." After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05. RESULTS The analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months. CONCLUSION The CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea. TRIAL REGISTRATION The study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936 . Registered on 31 July 2020.
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Affiliation(s)
- Vikram Belkhode
- grid.413489.30000 0004 1793 8759Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi, Wardha, Maharashtra India ,Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,New SBI Colony NisargNagri, Nagpur Road, Wardha, 442001 India
| | - Sweta Pisulkar
- grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
| | - Pranali Nimonkar
- grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
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Luo Y, Zhang FR, Wu JL, Jiang XJ. Efficacy of continuous positive airway pressure on TNF-α in obstructive sleep apnea patients: A meta-analysis. PLoS One 2023; 18:e0282172. [PMID: 36952521 PMCID: PMC10035913 DOI: 10.1371/journal.pone.0282172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Tumor necrosis factor-α (TNF-α) is an important mediator of the immune response. At present, the improvement of TNF-α after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is still controversial. METHODS We conducted a systematic review of the present evidence based on a meta-analysis to elucidate the effects of TNF-α on OSAHS after CPAP treatment. RESULTS To measure TNF-α, ten studies used enzyme-linked immunosorbent assay (ELISA), and one used radioimmunoassay. The forest plot outcome indicated that CPAP therapy would lower the TNF-α levels in OSAHS patients, with a weighted mean difference (WMD) of 1.08 (95% CI: 0.62-1.55; P < 0.001) based on the REM since there is highly significant heterogeneity (I2 = 90%) among the studies. Therefore, we used the subgroup and sensitivity analyses to investigate the source of heterogeneity. The findings of the sensitivity analysis revealed that the pooled WMD ranged from 0.91 (95% CI: 0.52-1.31; P < 0.001) to 1.18 (95% CI: 0.74-1.63; P < 0.001). The findings were not influenced by any single study. Notably, there was homogeneity in the Asia subgroup and publication year: 2019, implying that these subgroups could be the source of heterogeneity. CONCLUSION Our meta-analysis recommends that CPAP therapy will decrease the TNF-α level in OSAHS patients, but more related research should be conducted.
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Affiliation(s)
- Yong Luo
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fa-Rong Zhang
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun-Lin Wu
- Department of Endocrinology, Fifth Hospital in Wuhan, Wuhan, Hubei, China
| | - Xi-Jiao Jiang
- Department of Otorhinolaryngology, The First People's Hospital of Jiangxia District, Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, China
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Hashemi D, Mende M, Trippel TD, Petutschnigg J, Hasenfuss G, Nolte K, Herrmann‐Lingen C, Feuerstein A, Langhammer R, Tschöpe C, Pieske B, Wachter R, Edelmann F. Evaluation of the HFA-PEFF Score: results from the prospective DIAST-CHF cohort. ESC Heart Fail 2022; 9:4120-4128. [PMID: 36070881 PMCID: PMC9773646 DOI: 10.1002/ehf2.14131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Although the number of patients suffering from heart failure with preserved ejection fraction (HFpEF) increases, the routine diagnosis remains a challenge. In the absence of a pathognomonic sign for HFpEF or specific treatment strategies, a prognosis-based characterization of suspected patients remains promising for both the risk stratification of the patients and a disease definition. The Heart Failure Association (HFA) of the European Society of Cardiology has introduced an algorithm with different levels of likelihood regarding the diagnosis of HFpEF, the HFA-PEFF score. We aimed to evaluate the predictive value of this algorithm in a large cohort regarding mortality, symptom burden, and the functional status. METHODS AND RESULTS DIAST-CHF is a multicentre, population-based, prospective, observational study in subjects with at least one risk factor for HFpEF between the age of 50 and 85. We calculated the HFA-PEFF score (n = 1668) and analysed the risk groups for overall mortality, cardiovascular hospitalization, and submaximal functional capacity (6-min walk distance) at baseline and after a follow-up period of 10 years. Patients with high HFA-PEFF score values 5&6 showed a higher mortality than those with an intermediate score (score values 2-4) and low score values (high 21.3% vs. intermediate 10.1% vs. low 4.3%, P < 0.001). Also, the burden of MACE (death, cardiovascular hospitalization, new myocardial infarction, first diagnosis of HF) was increased in the high score values group (high 40.7% vs. intermediate 25.9% vs. low 13.9%, P < 0.001). Similarly, patients with higher scores had higher cumulative incidences of cardiovascular hospitalizations (P = 0.011). Subjects with higher scores also had lower 6-min walk distance both at baseline and during follow-up. CONCLUSIONS The HFA-PEFF score provides a reliable instrument to stratify suspected HFpEF patients by their risk for mortality, symptom burden, and functional status in cohort at risk with a follow-up period of 10 years. As high HFA-PEFF scores are associated with worse outcome, the HFA-PEFF algorithm describes a defining approach towards HFpEF.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,Department of Internal Medicine and CardiologyGerman Heart Institute Berlin (DHZB)BerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Meinhard Mende
- Clinical Trial Centre and Institute for Medical Informatics, Statistics and Epidemiology (IMISE)University of LeipzigLeipzigGermany
| | - Tobias D. Trippel
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Johannes Petutschnigg
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Gerd Hasenfuss
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Cardiology and PneumologyGeorg‐August UniversityGöttingenGermany
| | - Kathleen Nolte
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Cardiology and PneumologyGeorg‐August UniversityGöttingenGermany
| | - Christoph Herrmann‐Lingen
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Anna Feuerstein
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Romy Langhammer
- Clinic and Policlinic for CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Carsten Tschöpe
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany,Berlin Institute of Health (BIH) & Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité ‐ Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany
| | - Burkert Pieske
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,Department of Internal Medicine and CardiologyGerman Heart Institute Berlin (DHZB)BerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Rolf Wachter
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Clinic and Policlinic for CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Frank Edelmann
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
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Tadic M, Gherbesi E, Faggiano A, Sala C, Carugo S, Cuspidi C. The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta-analysis of echocardiographic studies. J Clin Hypertens (Greenwich) 2022; 24:795-803. [PMID: 35695237 PMCID: PMC9278581 DOI: 10.1111/jch.14488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 01/02/2023]
Abstract
Current evidence on the effects of continuous positive airway pressure (CPAP) on cardiac mechanics in patients with obstructive sleep apnea (OSA) is based on a few single studies. The authors investigated this topic through a meta‐analysis of speckle tracking echocardiography (STE) studies that provided data on left ventricular (LV) and right ventricular (RV) mechanics as assessed by global longitudinal strain (GLS). The PubMed, OVID‐MEDLINE, and Cochrane library databases were systematically analyzed to search English‐language review papers published from inception to January 31, 2022. Studies were identified by crossing the following terms: “obstructive sleep apnea”, “sleep quality”, “sleep disordered breathing”, “continuous positive airway pressure therapy”, “noninvasive ventilation”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “left ventricular mechanics”, “right ventricular mechanics”, “echocardiography” and “STE echocardiography”. The meta‐analysis, including a total of 337 patients with OSA from nine studies (follow‐up 2–24 months) showed a significant GLS improvement in both LV and RV after CPAP, standard mean difference (SMD) being 0.51±0.08, CI:0.36–0.66, p = .0001 and 0.28±0.07, CI:0.15–0.42, p = .0001), respectively. Corresponding SMD values for LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) were 0.20±0.06, CI:0.08–0.33, p = .001 and 0.08±0.06, CI: ‐0.04/0.20, p = .21. Our meta‐analysis suggests that: I) CPAP treatment exerts beneficial effects on biventricular function in patients with OSA; II) the assessment of cardiac mechanics by STE should be routinely recommended for monitoring cardiac function in this setting, due to limitations of conventional echocardiography in evaluating biventricular performance.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Stefano Carugo
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review. Diseases 2021; 9:diseases9040088. [PMID: 34940026 PMCID: PMC8700568 DOI: 10.3390/diseases9040088] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m2; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.
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Salari N, Khazaie H, Abolfathi M, Ghasemi H, Shabani S, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B. The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta-analysis. Neurol Sci 2021; 43:219-231. [PMID: 34797460 DOI: 10.1007/s10072-021-05765-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a disorder characterized by intermittent airway obstruction during sleep. The association between OSA and the incidence of cardiovascular disease (CVD) has been investigated in many studies; however, the results are not entirely consistent between studies. The aim of this study was to investigate the relationship between OSA and the risk of CVD through a meta-analysis of cohort studies. METHODS A systematic review and meta-analysis of literature was conducted using the PubMed, WoS, Embase, ScienceDirect, Scopus, and Web of Science databases up to the year 2020. In order to analyze the eligible studies, the stochastic effects model was used and the heterogeneity of the studies with the I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2). RESULTS A total of 24 studies were included in the meta-analysis according to the inclusion criteria. Twelve studies reported CVD results, 11 studies reported stroke results, 9 studies reported mortality results, and 8 studies reported CVD results. The odds ratio of CVD in patients with OSA 1.71 (1.17-2.27: 95% confidence interval) stroke in patients with OSA, 1.86 (1.28-2.69: 95% confidence interval), mortality in patients with OSA, 1.77 (1.37-2.29: 95% confidence interval) and CHD in patients with OSA, and 1.48 (1.06-2.28: 95% confidence interval) was obtained. CONCLUSION OSA is considered a cardiovascular risk factor. There is a relationship between the severity of OSA and the risk of cardiovascular disease. OSA increases the risk of heart attack, CHD, and death from cardiovascular disease.
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Affiliation(s)
- Nader Salari
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Abolfathi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shervin Shabani
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shna Rasoulpoor
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
| | - Shabnam Rasoulpoor
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnam Khaledi-Paveh
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Belkhode V, Godbole S, Nimonkar S, Parhad S, Nimonkar P. Oral appliances for obstructive sleep apnea: Emerging issues, upcoming challenges, and possible solutions. J Family Med Prim Care 2021; 10:3172-3175. [PMID: 34760725 PMCID: PMC8565156 DOI: 10.4103/jfmpc.jfmpc_54_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background As per the current epidemiological studies, the prevalence of obstructive sleep apnea (OSA) among the adult population is very high. Oral appliances (OAs) have emerged as the most recommended alternative treatment option for mild to moderate OSA. Objective The objective of this article is to propose or develop a new design of OA named "customized maxillary oral appliance (CMOA)," for managing moderate OSA syndrome. Methods The design proposed in this article is first of its kind that is fabricated on the maxillary arch. CMOA is developed by combining the principles of the three most popular OAs used in OSA, namely, soft palate lifters, tongue retaining devices, and mandibular advancement devices. Conclusions Given the potential impact of OSA on general and mental health and the side effects of existing appliances, there is a need for a new remedy to be introduced in the field of sleep medicine. This novel design can provide a new therapeutic option for patients with moderate OSA.
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Affiliation(s)
- Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sameer Parhad
- Department of Orthodontics, Dr. Rajesh Ramdasji Kambe Dental College and Hospital, Akola, Maharashtra, India
| | - Pranali Nimonkar
- Trauma Care Centre, Government Medical College and Hospital, Nagpur, Maharashtra, India
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