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Wang Z, Wallace DA, Spitzer BW, Huang T, Taylor K, Rotter JI, Rich SS, Liu PY, Daviglus ML, Hou L, Ramos AR, Kaur S, Durda JP, González HM, Fornage M, Redline S, Isasi CR, Sofer T. Analysis of C-reactive protein omics-measures associates methylation risk score with sleep health and related health outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.04.24313008. [PMID: 39281736 PMCID: PMC11398435 DOI: 10.1101/2024.09.04.24313008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Introduction DNA methylation (DNAm) predictors of high sensitivity C-reactive protein (CRP) offer a stable and accurate means of assessing chronic inflammation, bypassing the CRP protein fluctuations secondary to acute illness. Poor sleep health is associated with elevated inflammation (including elevated blood CRP levels) which may explain associations of sleep insufficiency with metabolic, cardiovascular and neurological diseases. Our study aims to characterize the relationships among sleep health phenotypes and CRP markers -blood, genetic, and epigenetic indicators-within the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods In HCHS/SOL, methylation risk scores (MRS)-CRP and polygenetic risk score (PRS)-CRP were constructed separately as weighted sums of methylation beta values or allele counts, respectively, for each individual. Sleep health phenotypes were measured using self-reported questionnaires and objective measurements. Survey-weighted linear regression established the association between the multiple sleep phenotypes (obstructive sleep apnea (OSA), sleep duration, insomnia and excessive sleepiness symptom), cognitive assessments, diabetes and hypertension with CRP markers while adjusting for age, sex, BMI, study center, and the first five principal components of genetic ancestry in HCHS/SOL. Results We included 2221 HCHS/SOL participants (age range 37-76 yrs, 65.7% female) in the analysis. Both the MRS-CRP (95% confidence interval (CI): 0.32-0.42, p = 3.3 × 10-38) and the PRS-CRP (95% CI: 0.15-0.25, p = 1 × 10-14) were associated with blood CRP level. Moreover, MRS-CRP was associated with sleep health phenotypes (OSA, long sleep duration) and related conditions (diabetes and hypertension), while PRS-CRP markers were not associated with these traits. Circulating CRP level was associated with sleep duration and diabetes. Associations between OSA traits and metabolic comorbidities weakened after adjusting for MRS-CRP, most strongly for diabetes, and least for hypertension. Conclusions MRS-CRP is a promising estimate for systemic and chronic inflammation as reflected by circulating CRP levels, which either mediates or serves as a common cause of the association between sleep phenotypes and related comorbidities, especially in the presence of diabetes.
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Affiliation(s)
- Ziqing Wang
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Danielle A Wallace
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian W Spitzer
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tianyi Huang
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Kent Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Peter Y Liu
- Division of Genetics, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Martha L Daviglus
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonya Kaur
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Peter Durda
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Center, University of California, San Diego, La Jolla, CA, USA
| | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tamar Sofer
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H Chan School of Public Health, Boston, MA, USA
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Hao L, Peng K, Bian Q, Guo S, Duan C, Feng L, Chen Z, Renzeng C, Pang H, Ma Z. Assessing the contribution of mild high-altitude exposure to obstructive sleep apnea-hypopnea syndrome comorbidities. Front Neurol 2024; 14:1191233. [PMID: 38259645 PMCID: PMC10800444 DOI: 10.3389/fneur.2023.1191233] [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: 04/26/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder. The lower atmospheric pressure and decreased oxygen levels of high-altitude areas can exacerbate the severity of OSAHS, but research into OSAHS in high-altitude areas remains limited. This study, from June 2015 to January 2020, involved 4,667 patients with suspected OSAHS and 38 healthy volunteers. The non-OSAHS group (AHI <5/h) had 395 patients, while the larger OSAHS group (AHI ≥5/h) comprised 4,272 patients. The significant size difference between the groups emphasized the study's focus on OSAHS, using the non-OSAHS mainly for comparison. Methods Sleep technicians monitored the OSAHS patient group overnight by polysomnography (PSG), the apnea-hypopnea index (AHI), the mean oxygen saturation (MSpO2), lowest oxygen saturation (LSpO2), the oxygen desaturation index (ODI) and the total sleep time with oxygen saturation less than 90% (TST-SpO2 <90%). Healthy volunteers self-monitored sleep patterns at home, using the CONTEC RS01 respiration sleep monitor with a wristwatch sleep apnea screen meter. The RSO1 wristwatch-style device has already been studied for consistency and sensitivity with the Alice-6 standard multi-lead sleep monitor and can be used for OSAHS screening in this region. Results LSpO2 recordings from healthy volunteers (86.36 ± 3.57%) and non-OSAHS (AHI <5/h) cohort (78.59 ± 11.99%) were much lower than previously reported normal values. Regression analysis identified no correlations between AHI levels and MSpO2 or TST-SpO2 <90%, weak correlations between AHI levels and LSpO2 or MSpO2, and a strongly significant correlation between AHI levels and the ODI (r = 0.76, p < 0.05). The data also indicated that the appropriate clinical thresholds for OSAHS patients living at mild high altitude are classified as mild, moderate, or severe based on LSpO2 saturation criteria of 0.85-0.90, 0.65-0.84, or <0.65, respectively. Conclusion The study findings suggest that individuals with an AHI score below 5 in OSAHS, who reside in high-altitude areas, also require closer monitoring due to the elevated risk of nocturnal hypoxia. Furthermore, the significant correlation between ODI values and the severity of OSAHS emphasizes the importance of considering treatment options. Additionally, the assessment of hypoxemia severity thresholds in OSAHS patients living in high-altitude regions provides valuable insights for refining diagnostic guidelines.
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Affiliation(s)
- Lijuan Hao
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Kangkang Peng
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Qi Bian
- Department of Otolaryngology, Graduate School of Qinghai University, Xining, China
| | - Suting Guo
- Department of Otolaryngology, Graduate School of Qinghai University, Xining, China
| | - Chengmin Duan
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Lei Feng
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Zhenguo Chen
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Caiang Renzeng
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Huaixia Pang
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
| | - Zhen Ma
- Department of Sleep Medicine, Qinghai Red Cross Hospital, Xining, China
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Smoking-Induced Disturbed Sleep. A Distinct Sleep-Related Disorder Pattern? Healthcare (Basel) 2023; 11:healthcare11020205. [PMID: 36673573 PMCID: PMC9858764 DOI: 10.3390/healthcare11020205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
The relationship between smoking and sleep disorders has not been investigated sufficiently yet. Many aspects, especially regarding non-obstructive sleep apnea−hypopnea (OSA)-related disorders, are still to be addressed. All adult patients who visited a tertiary sleep clinic and provided information about their smoking history were included in this cross-sectional study. In total, 4347 patients were divided into current, former and never smokers, while current and former smokers were also grouped, forming a group of ever smokers. Sleep-related characteristics, derived from questionnaires and sleep studies, were compared between those groups. Ever smokers presented with significantly greater body mass index (BMI), neck and waist circumference and with increased frequency of metabolic and cardiovascular co-morbidities compared to never smokers. They also presented significantly higher apnea−hypopnea index (AHI) compared to never smokers (34.4 ± 24.6 events/h vs. 31.7 ± 23.6 events/h, p < 0.001) and were diagnosed more frequently with severe and moderate OSA (50.3% vs. 46.9% and 26.2% vs. 24.8% respectively). Epworth sleepiness scale (ESS) (p = 0.13) did not differ between groups. Ever smokers, compared to never smokers, presented more frequent episodes of sleep talking (30.8% vs. 26.6%, p = 0.004), abnormal movements (31.1% vs. 27.7%, p = 0.021), restless sleep (59.1% vs. 51.6%, p < 0.001) and leg movements (p = 0.002) during sleep. Those were more evident in current smokers and correlated significantly with increasing AHI. These significant findings suggest the existence of a smoking-induced disturbed sleep pattern.
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Dodds S, Williams LJ, Roguski A, Vennelle M, Douglas NJ, Kotoulas SC, Riha RL. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res 2020; 6:00057-2020. [PMID: 32963994 PMCID: PMC7487348 DOI: 10.1183/23120541.00057-2020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) carries substantial negative health consequences. This study examines factors affecting mortality and morbidity according to continuous positive airway pressure (CPAP) use and predictors affecting CPAP adherence in a longitudinal cohort of OSAHS patients. Materials and methods This prospective, cohort study comprised 4502 patients who were diagnosed with OSAHS at a tertiary sleep disorders centre between 1982 and 2003. Of these, 1174 patients completed follow-up in 2012. Data collected included anthropometric, sleep and demographic characteristics, including comorbidities, ongoing medications and CPAP adherence. Patients were followed up for an average of 14.8±3.7 years. Results Imputation analysis showed that long-term CPAP users (>5 years) were 5.63 times more likely to be alive at study end than non-CPAP users (95% CI: 4.83–6.58, p<0.001) and 1.74-times more likely than short-term CPAP users (≤5 years) (95% CI: 1.49–2.02, p<0.001). Females had a significantly higher mortality rate during the follow-up period (26.8% versus 19.6%, p<0.001). Respiratory mortality was more common in patients with OSAHS, in particular those who did not use CPAP, compared to the general population (17.2% versus 12.2%, p=0.002 respectively), whereas deaths from cancer were less common compared to the general population (16.2% versus 25.6%, p<0.001). Compared to CPAP users, non-CPAP-users had a significantly increased incidence of type II diabetes mellitus (DMII) (27.9% versus 18.7%, p=0.003), ischaemic heart disease (IHD) (25.5% versus 12.7%, p<0.001) and myocardial infarction (MI) (14.7% versus 4.2%, p<0.001) at long-term follow-up. Conclusions Long-term CPAP use in men and women with OSAHS reduces mortality and decreases the incidence of DMII and cardiovascular disease. In this first long-term prospective cohort study to use imputation analysis in OSAHS patients, all-cause morbidity and mortality were significantly reduced in long-term CPAP users (>5 years), and equivalent for both males and femaleshttps://bit.ly/3cKL2HK
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Affiliation(s)
- Sophie Dodds
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Linda J Williams
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amber Roguski
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Neil J Douglas
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mohammadi H, Rezaei M, Sharafkhaneh A, Khazaie H, Ghadami MR. Serum testosterone/cortisol ratio in people with obstructive sleep apnea. J Clin Lab Anal 2019; 34:e23011. [PMID: 31549459 PMCID: PMC6977109 DOI: 10.1002/jcla.23011] [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] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/21/2019] [Accepted: 07/30/2019] [Indexed: 01/13/2023] Open
Abstract
Objectives Obstructive sleep apnea (OSA) is a major health problem that has been associated with endocrine dysfunction in the hypothalamic‐pituitary‐gonadal (HPG) and hypothalamic‐pituitary‐adrenal (HPA) axes. This study investigated cortisol, testosterone, and the testosterone/cortisol ratio in patients with OSA compared to normal sleepers. Methods Thirty‐nine OSA patients diagnosed by overnight polysomnography (PSG) were divided into three groups, including ten mild OSA patients, 16 patients with moderate OSA, and 13 patients with severe OSA according to the apnea‐hypopnea index (AHI). In addition, 13 normal sleepers with normal PSG findings were recruited as the control group. Serum levels of cortisol, testosterone, and sex hormone‐binding globulin (SHBG) were measured using enzyme‐linked immunosorbent assay (ELISA). Results There were no significant differences between the normal sleepers and the three subtypes of OSA in terms of total and free testosterone levels (P > .1). The results showed significantly higher levels of cortisol in the severe OSA group compared to the normal sleepers and the two other subtypes of OSA (P < .01). In addition, the testosterone/cortisol (T/C) ratio was significantly lower among the severe OSA compared to the moderate OSA patients (P = .01). A significant correlation was observed between minimal SpO2 and AHI (r=−0.69, P < .01), cortisol and AHI (r = .47, P < .01) and cortisol and minimal SpO2 (r = −.26, P = .06). Conclusion According to the findings, OSA is linked to HPA axis activity in severe OSA patients but not among the mild and moderate subtypes of the disorder.
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Affiliation(s)
- Hiwa Mohammadi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rezaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Sharafkhaneh
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rasoul Ghadami
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Wächter M, Kantelhardt JW, Bonsignore MR, Bouloukaki I, Escourrou P, Fietze I, Grote L, Korzybski D, Lombardi C, Marrone O, Paranicova I, Pataka A, Ryan S, Schiza SE, Sliwinski P, Steiropoulos P, Verbraecken J, Penzel T. Unique sleep-stage transitions determined by obstructive sleep apnea severity, age and gender. J Sleep Res 2019; 29:e12895. [PMID: 31347213 DOI: 10.1111/jsr.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/06/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023]
Abstract
In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co-morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two-step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two-step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep-states for power-laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake-state durations followed a power-law distribution, while sleep-state durations were characterized by an exponential distribution. Sleep-stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea-related clinical outcomes like arterial hypertension and daytime sleepiness.
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Affiliation(s)
- Marcel Wächter
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan W Kantelhardt
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Maria R Bonsignore
- PROMISE Department, University of Palermo, and National Research Council, IBIM, Palermo, Palermo, Italy
| | | | | | - Ingo Fietze
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ludger Grote
- Sleep Medicine Center, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Damian Korzybski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS-Milano Bicocca University, Milano, Italy
| | - Oreste Marrone
- PROMISE Department, University of Palermo, and National Research Council, IBIM, Palermo, Palermo, Italy
| | | | | | - Silke Ryan
- University College Dublin, Dublin, Ireland
| | | | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Paschalis Steiropoulos
- Medical School, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Thomas Penzel
- Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Proimos E, Kiagiadaki D, Kaprana A, Chimona TS, Maroudias NJ, Papadakis CE. Clinical Application of Subjective Measurements for OSAS Assessment: Predictive Factors of Syndrome Severity. ACTA ACUST UNITED AC 2012; 74:240-5. [DOI: 10.1159/000342278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/02/2012] [Indexed: 12/24/2022]
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