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DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med 2024; 13:3223. [PMID: 38892933 PMCID: PMC11172971 DOI: 10.3390/jcm13113223] [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: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.
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Affiliation(s)
| | | | | | - Tahir Tak
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (M.V.D.); (K.L.); (B.Y.)
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Sasa Y, Nakai T, Ikeya Y, Kogawa R, Otsuka N, Kurokawa S, Nagashima K, Iida K, Okumura Y, Kunimoto S. Bradyarrhythmia Suspected to be Associated with Sleep Apnea Syndrome. Int Heart J 2022; 63:393-397. [PMID: 35296616 DOI: 10.1536/ihj.21-517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sleep apnea syndrome (SAS) is a condition in which apnea and hypoventilation at night cause hypoxemia and impaired wakefulness during the day, resulting in a general malaise and dozing. Sleep apnea has been implicated in the development of hypertension, ischemic heart disease, arrhythmia, heart failure, and cerebrovascular disease.1) Approximately 50% of patients with sleep-disordered breathing have an arrhythmia. In severe cases with an apnea-hypopnea index (AHI) of 30 or more, the frequency of arrhythmias during sleep is two to four times that of individuals without SAS. Bradyarrhythmias such as sinus bradycardia, sinus arrest, and atrioventricular block occurs at night in about 5%-10% of patients with sleep-disordered breathing.2)During nocturnal sleep, vagal excitation causes excessive muscle relaxation of the upper airway, leading to periodic airway diameter reduction, which increases snoring and obstructive apnea. As a result, hypoxemia is likely, further increasing vagal tone and leading to bradycardia. An increase in ventilation rate and volume quickly compensates for the decrease in arterial partial pressure of oxygen during apnea, which leads to new bradycardia due to a decrease in the partial pressure of oxygen in arterial blood, which suppresses vagal tone and respiration.3)We experienced a case of a 44-year-old patient with bradyarrhythmia that might be associated with SAS. After continuous positive airway pressure treatment, AHI decreased, and very long cardiac arrests resolved.
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Affiliation(s)
- Yusuke Sasa
- Department of Cardiology, Kawaguchi Municipal Medical Center
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Korehito Iida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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3
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Teo YH, Han R, Leong S, Teo YN, Syn NL, Wee CF, Tan BKJ, Wong RC, Chai P, Kojodjojo P, Kong WK, Lee CH, Sia CH, Yeo TC. Prevalence, types and treatment of bradycardia in obstructive sleep apnea - A systematic review and meta-analysis. Sleep Med 2021; 89:104-113. [PMID: 34971926 DOI: 10.1016/j.sleep.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We sought to clarify the prevalence of comorbid OSA and bradycardia, and the effect of continuous positive airway pressure (CPAP) therapy on bradycardia outcomes. METHODS We systematically searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) for randomized or observational studies reporting the co-prevalence of sleep apnea and bradycardia or evaluated the use of CPAP on the incidence of bradycardias. We used random-effects models in all meta-analyses and evaluated heterogeneity using I2. RESULTS We included 34 articles from 7204 records, comprising 4852 patients. Among patients with OSA, the pooled prevalence of daytime and nocturnal bradycardia were 25% (95% CI: 18.6 to 32.7) and 69.8% (95% CI: 41.7 to 88.2) respectively. Among patients with bradycardia, the pooled prevalence of OSA was 56.8% (95% CI: 21.5 to 86.3). CPAP treatment, compared to those without, did not significantly reduce the risk of daytime (two randomized trials; RR: 0.50; 95% CI: 0.11 to 2.21) or nocturnal bradycardia (one randomized-controlled trial and one cohort study; RR: 0.76; 95% CI: 0.48 to 1.20). CONCLUSIONS This meta-analysis demonstrates a high comorbid disease burden between OSA and bradycardia. Future research should explore the treatment effect of CPAP on bradycardia incidence, as compared to placebo.
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Affiliation(s)
- Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Ruobing Han
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Shariel Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Caitlin Fern Wee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Benjamin Kye Jyn Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Pipin Kojodjojo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228.
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
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Obstructive Sleep Apnea and Arrhythmias in the Elderly. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kubota K, Hoshide S, Kario K. Association of lower nighttime diastolic blood pressure and hypoxia with silent myocardial injury: The Japan Morning Surge-Home Blood Pressure study. J Clin Hypertens (Greenwich) 2020; 23:272-280. [PMID: 33314712 PMCID: PMC8029661 DOI: 10.1111/jch.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Whether marked nocturnal blood pressure (BP) reduction is associated with cardiovascular disease (CVD) is still controversial. In addition, no report has yet discussed the relationship between lower nocturnal BP and CVD, involving modification by nighttime hypoxia. We evaluated 840 patients who had one or more cardiovascular risk factors by measuring their high‐sensitivity cardiac troponin T (Hs‐cTnT), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP), and nighttime saturation levels and performing ambulatory BP monitoring. The lowest tertile in nighttime diastolic BP (DBP) (≤66 mmHg) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the second tertile (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.01–3.63), and the lowest tertile of minimum blood oxygen saturation (≤81%) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the third tertile (OR 2.15, 95% CI 1.13–4.10). Additionally, the patients with both lowest tertile of nighttime DBP and minimum SpO2 showed increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with those without this combination (OR 2.93, 95% CI 1.40–6.16). On the other hand, these associations were not found in the presence of ≥125 pg/ml of NT‐pro BNP. In the clinical population, each of lower nocturnal DBP and nighttime hypoxia was associated with asymptomatic myocardial injury, which was represented as higher Hs‐cTnT, and coexisting lower nocturnal DBP and nighttime hypoxia had an additive effect on the risk of myocardial injury.
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Affiliation(s)
- Kana Kubota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Application of the Variance Delay Fuzzy Approximate Entropy for Autonomic Nervous System Fluctuation Analysis in Obstructive Sleep Apnea Patients. ENTROPY 2020; 22:e22090915. [PMID: 33286684 PMCID: PMC7597154 DOI: 10.3390/e22090915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a fatal respiratory disease occurring in sleep. OSA can induce declined heart rate variability (HRV) and was reported to have autonomic nerve system (ANS) dysfunction. Variance delay fuzzy approximate entropy (VD_fApEn) was proposed as a nonlinear index to study the fluctuation change of ANS in OSA patients. Sixty electrocardiogram (ECG) recordings of the PhysioNet database (20 normal, 14 mild-moderate OSA, and 26 severe OSA) were intercepted for 6 h and divided into 5-min segments. HRV analysis were adopted in traditional frequency domain, and nonlinear HRV indices were also calculated. Among these indices, VD_fApEn could significantly differentiate among the three groups (p < 0.05) compared with the ratio of low frequency power and high frequency power (LF/HF ratio) and fuzzy approximate entropy (fApEn). Moreover, the VD_fApEn (90%) reached a higher OSA screening accuracy compared with LF/HF ratio (80%) and fApEn (78.3%). Therefore, VD_fApEn provides a potential clinical method for ANS fluctuation analysis in OSA patients and OSA severity analysis.
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Agaltsov МV, Drapkina OM. The relationship of obstructive sleep apnea and cardiovascular diseases from the perspective of evidence-based medicine. Part 1. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The results of prospective studies, meta-analyzes and systematic reviews on the associations of obstructive sleep apnea (OSA) with various cardiovascular diseases (CVD) were analyzed. Currently, the mechanisms related to high prevalence of breathing-related sleep disorders among population of economically developed countries are clear, and an increase in the number of OSA patients has been shown. The relationship between OSA and CVD has been widely confirmed in large cohort studies. The first review part discusses the relationship of hypertension (HTN) and various heart arrhythmias (atrial fibrillation (AF), bradyarrhythmias, premature ventricular contraction, sudden death during sleep) with breathing-related sleep disorders. These groups of cardiovascular disorders currently show the most proven relationship with sleep apnea. In addition to cross-sectional studies indicating the high prevalence of OSA in patients with HTN and AF, some observational studies indicate an increase in the number of patients with HTN and paroxysmal AF with history of untreated sleep apnea. An analysis of the current issues of OSA phenotypes (in particular, REM-related OSA in hypertensive patients) as the most unfavorable cardiovascular factors is carried out.
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Affiliation(s)
- М. V. Agaltsov
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Li Y, Pan W, Li K, Jiang Q, Liu G. Sliding Trend Fuzzy Approximate Entropy as a Novel Descriptor of Heart Rate Variability in Obstructive Sleep Apnea. IEEE J Biomed Health Inform 2019; 23:175-183. [DOI: 10.1109/jbhi.2018.2790968] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarkar P, Mukherjee S, Chai-Coetzer CL, McEvoy RD. The epidemiology of obstructive sleep apnoea and cardiovascular disease. J Thorac Dis 2018; 10:S4189-S4200. [PMID: 30687535 DOI: 10.21037/jtd.2018.12.56] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obstructive sleep apnoea, the most common form of sleep-disordered breathing, is highly prevalent in patients with cardiovascular disease. The last 30 years has seen a plethora of large scale epidemiological studies investigating the relationship between sleep apnoea and cardiovascular outcomes. This review highlights the key epidemiological studies addressing the links between sleep apnoea and hypertension, cardiac arrhythmias, cerebrovascular disease, coronary artery disease, heart failure and pulmonary hypertension, with a particular focus on some of the most recent reports.
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Affiliation(s)
- Paroma Sarkar
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sutapa Mukherjee
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ching Li Chai-Coetzer
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
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Salama A, Abdullah A, Wahab A, Eigbire G, Hoefen R, Kouides R, Ritter N, Mieszczanska H, Alweis R. Is obstructive sleep apnea associated with ventricular tachycardia? A retrospective study from the National Inpatient Sample and a literature review on the pathogenesis of Obstructive Sleep Apnea. Clin Cardiol 2018; 41:1543-1547. [PMID: 30294854 DOI: 10.1002/clc.23092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a known independent risk factor for a multiple cardiovascular morbidities and mortality. The association of OSA and ventricular arrhythmias is less well understood. The aim of this analysis is to study the relationship between OSA and ventricular tachyarrhythmias. HYPOTHESIS OSA is associated with increased ventricular arrhythmias. METHODS Data from the national inpatient sample (NIS) 2012 to 2014, were reviewed. Discharges associated with OSA were identified as the target population using the relevant ICD-9-CM codes. The primary outcome was a diagnosis of ventricular tachycardia (VT) in the OSA population. Secondary outcomes include the rate of ventricular fibrillation (VF) and cardiac arrest. Multivariable analyses were performed to examine the association of VT with multiple potential confounding clinical variables. RESULTS Of 18 013 878 health encounters, 943 978 subjects (5.24%) had a diagnosis of OSA. VT and VF were more prevalent among patients with OSA compared to those without a diagnosis of OSA (2.24% vs 1.16%; P < 0.001 and 0.3% vs 0.2%; P < 0.001, respectively). Odds ratio for cardiac arrest in OSA group was not statistically significant (1, 95% confidence interval 0.97-1.02, P < 0.76). In unadjusted analyses, all examined comorbidities were significantly more common in those with OSA, including diabetes mellitus, hypertension, chronic kidney disease, acute coronary syndrome, and heart failure. CONCLUSION OSA is associated with increased rates of ventricular tachyarrhythmia.
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Affiliation(s)
- Amr Salama
- Department of Medicine, Unity Hospital, Rochester, New York
| | | | - Abdul Wahab
- Department of Medicine, Unity Hospital, Rochester, New York
| | - George Eigbire
- Department of Medicine, Unity Hospital, Rochester, New York
| | - Ryan Hoefen
- Department of Cardiology, Rochester Regional Health, Rochester, New York
| | - Ruth Kouides
- Department of Medicine, Unity Hospital, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nathan Ritter
- Department of Medicine, Unity Hospital, Rochester, New York.,Department of Cardiology, Rochester Regional Health, Rochester, New York
| | - Hanna Mieszczanska
- Department of Cardiology, University of Rochester School of Medicine and Dentistry, New York
| | - Richard Alweis
- Department of Medicine, Unity Hospital, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,School of Health Sciences, Rochester Institute of Technology, Rochester, New York
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Caggiano S, Khirani S, Verrillo E, Barnerias C, Amaddeo A, Gitiaux C, Thierry B, Desguerre I, Cutrera R, Fauroux B. Sleep in infants with congenital myasthenic syndromes. Eur J Paediatr Neurol 2017; 21:842-851. [PMID: 28755803 DOI: 10.1016/j.ejpn.2017.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/11/2017] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Infants with congenital myasthenic syndrome (CMS) are at risk of brief resolved unexplained event (BRUE) and sleep-disordered breathing. The aim of the study was to explore sleep in infants with CMS with a particular focus on heart rate (HR) variability. METHODS Overnight polygraphy was performed and HR variations associated with respiratory events were analysed. Bradycardia and tachycardia were defined as a variation of HR of ±10 bpm from baseline and analysed as events/hour. RESULTS The data of 5 infants with CMS were analysed. Two patients had known mutations (COLQ and RAPSN). One patient had a tracheostomy. The apnoea-hypopnoea index (AHI) was abnormal in all the patients (range 2.8-47.7 events/h), with the highest AHI being observed in the 3 youngest infants. Nocturnal transcutaneous gas exchange was normal in all patients except the tracheostomised patient. Mean HR was 114 ± 23 bpm with a mean HR index of 4.5 ± 4.3 events/h. The amplitudes of HR variations (bradycardia or tachycardia) were around 15-20 bpm, regardless of the type of respiratory event, and comparable between patients. No correlations were found between HR indexes or variations and the type and mean duration of respiratory events. Ventilatory support was initiated in 3 infants immediately after the sleep study because of a high AHI and/or nocturnal hypoventilation. CONCLUSIONS All 5 infants had an abnormal AHI with younger infants having the highest AHI. Three infants required ventilatory support after the polygraphy, underlining its clinical usefulness. No significant abnormalities of HR were observed during the sleep studies.
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Affiliation(s)
- Serena Caggiano
- Respiratory Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy; AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Sonia Khirani
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; ASV Santé, Gennevilliers, France
| | - Elisabetta Verrillo
- Respiratory Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Christine Barnerias
- AP-HP, Hôpital Necker-Enfants Malades, Referral Center for Neuromuscular Diseases, Paris, France
| | - Alessandro Amaddeo
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; INSERM U955, Equipe 13, Créteil, France; Paris Descartes University, Paris, France
| | - Cyril Gitiaux
- AP-HP, Hôpital Necker-Enfants Malades, Referral Center for Neuromuscular Diseases, Paris, France; Paris Descartes University, Paris, France
| | - Briac Thierry
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Head and Neck Surgery, Paris, France
| | - Isabelle Desguerre
- AP-HP, Hôpital Necker-Enfants Malades, Referral Center for Neuromuscular Diseases, Paris, France; Paris Descartes University, Paris, France
| | - Renato Cutrera
- Respiratory Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; INSERM U955, Equipe 13, Créteil, France; Paris Descartes University, Paris, France.
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Barón A, Paez-Moya S. Repercusiones cardiovasculares del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
En la población de sujetos con síndrome de apnea-hipopnea obstructiva del sueño se describen entidades clínicas cardiovasculares asociadas con esta entidad y que afectan su curso y pronóstico. Dentro de estas se encuentran hipertensión arterial, arritmias, enfermedad coronaria, insuficiencia cardíaca, hipertensión pulmonar y tromboembolismo venoso. Del mismo modo, se describen los mecanismos fisiopatológicos de estas asociaciones, su prevalencia e impacto. Dado que afectan el curso de la enfermedad y, por tanto, la severidad de la misma, estas entidades juegan un papel muy importante en la toma de decisiones al momento de ofrecer el mejor manejo en cada caso, el cual debe ser abordado de forma multidisciplinaria.
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A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked: An Update for Advanced Practice Registered Nurses. CLIN NURSE SPEC 2016; 30:347-362. [PMID: 27753673 DOI: 10.1097/nur.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE/OBJECTIVES Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. DESCRIPTION OF THE PROJECT We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. OUTCOMES Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. CONCLUSIONS This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.
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Korostovtseva LS, Kravchenko SO, Sviryaev YV, Konradi AO, Oganesyan GA. Bradyarrythmias in the obstructive sleep apnea sundrome: a dangerous complication or defense mechanism? J EVOL BIOCHEM PHYS+ 2016. [DOI: 10.1134/s0022093016040050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Selim BJ, Koo BB, Qin L, Jeon S, Won C, Redeker NS, Lampert RJ, Concato JP, Bravata DM, Ferguson J, Strohl K, Bennett A, Zinchuk A, Yaggi HK. The Association between Nocturnal Cardiac Arrhythmias and Sleep-Disordered Breathing: The DREAM Study. J Clin Sleep Med 2016; 12:829-37. [PMID: 26951420 DOI: 10.5664/jcsm.5880] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/13/2016] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES To determine whether sleep-disordered breathing (SDB) is associated with cardiac arrhythmia in a clinic-based population with multiple cardiovascular comorbidities and severe SDB. METHODS This was a cross-sectional analysis of 697 veterans who underwent polysomnography for suspected SDB. SDB was categorized according to the apnea-hypopnea index (AHI): none (AHI < 5), mild (5 ≥ AHI < 15), and moderate-severe (AHI ≥ 15). Nocturnal cardiac arrhythmias consisted of: (1) complex ventricular ectopy, (CVE: non-sustained ventricular tachycardia, bigeminy, trigeminy, or quadrigeminy), (2) combined supraventricular tachycardia, (CST: atrial fibrillation or supraventricular tachycardia), (3) intraventricular conduction delay (ICD), (4) tachyarrhythmias (ventricular and supraventricular), and (5) any cardiac arrhythmia. Unadjusted, adjusted logistic regression, and Cochran-Armitage testing examined the association between SDB and cardiac arrhythmias. Linear regression models explored the association between hypoxia, arousals, and cardiac arrhythmias. RESULTS Compared to those without SDB, patients with moderate-severe SDB had almost three-fold unadjusted odds of any cardiac arrhythmia (2.94; CI 95%, 2.01-4.30; p < 0.0001), two-fold odds of tachyarrhythmias (2.16; CI 95%,1.47-3.18; p = 0.0011), two-fold odds of CVE (2.01; 1.36-2.96; p = 0.003), and two-fold odds of ICD (2.50; 1.58-3.95; p = 0.001). A linear trend was identified between SDB severity and all cardiac arrhythmia subtypes (p value linear trend < 0.0001). After adjusting for age, BMI, gender, and cardiovascular diseases, moderate-severe SDB patients had twice the odds of having nocturnal cardiac arrhythmias (2.24; 1.48-3.39; p = 0.004). Frequency of obstructive respiratory events and hypoxia were strong predictors of arrhythmia risk. CONCLUSIONS SDB is independently associated with nocturnal cardiac arrhythmias. Increasing severity of SDB was associated with an increasing risk for any cardiac arrhythmia.
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Affiliation(s)
- Bernardo J Selim
- Section of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Brian B Koo
- Department of Neurology, Connecticut Veterans Affairs Health System, West Haven, CT
| | - Li Qin
- Yale Center of Analytical Science (YCAS) Yale School of Epidemiology and Public Health, New Haven, CT
| | - Sangchoon Jeon
- Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT
| | - Christine Won
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT
| | - Nancy S Redeker
- Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, CT
| | - Rachel J Lampert
- Department of Internal Medicine, Section of Cardiology/Electrophysiology, Yale University School of Medicine, New Haven, CT
| | - John P Concato
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.,Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
| | - Dawn M Bravata
- Departments of Internal Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN.,Center of Excellence on Implementing Evidence-based Practice (CIEBP), Richard L. Roudebush VA Medical Center, Indianapolis IN
| | - Jared Ferguson
- Departments of Internal Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN
| | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Adam Bennett
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT
| | - Andrey Zinchuk
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.,Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
| | - Henry K Yaggi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine Yale University School of Medicine, New Haven, CT.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.,Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT
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Wu X, Liu Z, Chang SC, Fu C, Li W, Jiang H, Jiang L, Li S. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study. Respir Res 2016; 17:16. [PMID: 26879052 PMCID: PMC4754929 DOI: 10.1186/s12931-016-0333-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/09/2016] [Indexed: 11/22/2022] Open
Abstract
Background Nocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP). Methods Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP. Results The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of episodes of heart block, from 148.58 ± 379.44 to 16.07 ± 58.52 (p < 0.05), same to the change of the longest RR pausing time (from 4.38 ± 2.95 s to 0.57 ± 1.05 s, p = 0.169) in 51 patients. The optimal therapy pressure to make the observed arrhythmia disappeared is 12 cm H2O. Conclusion Concerning high prevalence of OSA in heart block patients, BQ provided an economical and efficient screening method for OSA. For better management, CPAP therapy is feasible to prevent heart blocks avoiding unnecessary concomitant pacemaker implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0333-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Su Chi Chang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuiping Fu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wenjing Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200032, China.
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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17
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Cintra FD, Leite RP, Storti LJ, Bittencourt LA, Poyares D, Castro LDS, Tufik S, de Paola A. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study. Arq Bras Cardiol 2014; 103:368-374. [PMID: 25252161 PMCID: PMC4262096 DOI: 10.5935/abc.20140142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 06/26/2014] [Accepted: 07/04/2014] [Indexed: 12/20/2022] Open
Abstract
Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.
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Affiliation(s)
| | | | | | | | - Dalva Poyares
- Universidade Federal de São Paulo - Unifesp, São Paulo, SP - Brazil
| | | | - Sergio Tufik
- Universidade Federal de São Paulo - Unifesp, São Paulo, SP - Brazil
| | - Angelo de Paola
- Universidade Federal de São Paulo - Unifesp, São Paulo, SP - Brazil
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18
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Li Z, Du L, Li Y, Huang L, Lei F, Yang L, Li T, Tang X. Characterization of primary symptoms leading to Chinese patients presenting at hospital with suspected obstructive sleep apnea. J Thorac Dis 2014; 6:444-51. [PMID: 24822101 DOI: 10.3978/j.issn.2072-1439.2014.02.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/18/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We identified the primary symptoms leading to Chinese patients presenting at hospital with suspected obstructive sleep apnea (OSA) and studied the prevalence and characteristics of OSA in confirmed cases. METHODS We collected data on 350 consecutive patients (302 males and 43±11 years old) with suspected OSA who underwent overnight polysomnography (PSG). RESULTS Among all patients, rankings of primary symptoms that led to the patients presenting at hospital for PSG were observed apnea (33%), snoring alone (29%), choking/gasping (13%), daytime sleepiness (5%) and other (20%). For severe OSA, prevalence rate was 61%, apnea hypopnea index (AHI) was 64±18, age was 44±10 years old, body mass index (BMI) was 28±3.5 kg/m(2), and hypertension rate was 28%. CONCLUSIONS Self-awareness of symptoms led a majority of the patients to present at hospital in China. Compared to currently available case series studies, our results suggest that OSA patients in East Asian countries are characterized by higher prevalence and more severe apnea, younger age, poorer sleep quality, but less obesity and less comorbidity with hypertension, relative to countries in North America, South America and Europe.
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Affiliation(s)
- Zhe Li
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Lina Du
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Yun Li
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Lili Huang
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Fei Lei
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Linghui Yang
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Tao Li
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| | - Xiangdong Tang
- 1 Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Pharmaceutical College, Heilongjiang University of Chinese Medicine, Harbin 150040, China
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19
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Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med 2012; 23:586-93. [PMID: 22939801 DOI: 10.1016/j.ejim.2012.05.013] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/08/2012] [Accepted: 05/11/2012] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) syndrome is a common but often unrecognized disorder caused by pharyngeal collapse during sleep and characterized by frequent awakenings, disrupted sleep and consequent excessive daytime sleepiness. With the increasing epidemic of obesity, the most important risk factor for OSA, prevalence of the disease will increase over the coming years thus representing an important public-health problem. In fact, it is now recognized that there is an association between OSA and hypertension, metabolic syndrome, diabetes, heart failure, coronary artery disease, arrhythmias, stroke, pulmonary hypertension, neurocognitive and mood disorders. Diagnosis is based on the combined evaluation of clinical manifestations and objective sleep study findings. Cardinal symptoms include snoring, sleepiness and significant reports of sleep apnea episodes. Polysomnography represents the gold standard to confirm the clinical suspicion of OSA syndrome, to assess its severity and to guide therapeutic choices. Behavioral, medical and surgical options are available for the treatment. Continuous positive airway pressure (CPAP) represents the treatment of choice in most patients. CPAP has been demonstrated to be effective in reducing symptoms, cardiovascular morbidity and mortality and neurocognitive sequelae, but it is often poorly tolerated. The results of clinical studies do not support surgery and pharmacological therapy as first-line treatment, but these approaches might be useful in selected patients. A better understanding of mechanisms underlying the disease could improve therapeutic strategies and reduce the social impact of OSA syndrome.
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Affiliation(s)
- Massimo R Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
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20
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Abstract
Normal-sleeping individuals experience a lower metabolic rate and relative cardiovascular quiescent state with lower heart rate and blood pressure that naturally occurs during sleep compared with the waking state. In patients with obstructive sleep apnea (OSA), this quiescent state becomes disrupted. Research has shown a higher risk for several medical disorders, most ominous being a myocardial infarction or stroke. This article serves as an overview to the cardiovascular, cerebrovascular, metabolic, and gastroesophageal effects of OSA.
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Affiliation(s)
- Sabin R Bista
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-5300, USA.
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21
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Namtvedt SK, Randby A, Einvik G, Hrubos-Strøm H, Somers VK, Røsjø H, Omland T. Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project). Am J Cardiol 2011; 108:1141-6. [PMID: 21798493 DOI: 10.1016/j.amjcard.2011.06.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 10/17/2022]
Abstract
Increased prevalence of cardiac arrhythmias has been reported in patients with severe obstructive sleep apnea (OSA), but this may not be generalizable to patients from the general population with a milder form of the condition. The aim of this study was to assess the association between cardiac arrhythmias and OSA of mainly mild and moderate severity. In total, 486 subjects (mean age 49 years, 55% men) recruited from a population-based study in Norway underwent polysomnography for OSA assessment and Holter recordings for arrhythmia assessment. Of these, 271 patients were diagnosed with OSA (apnea-hypopnea index [AHI] ≥5, median AHI 16.8, quartiles 1 to 3 8.9 to 32.6). Mean nadir oxygen saturations were 82% and 89% in patients with and without OSA, respectively. Ventricular premature complexes (≥5/hour) were more prevalent in subjects with OSA compared to subjects without OSA (median AHI 1.4, quartiles 1 to 3 0.5 to 3.0) during the night (12.2% vs 4.7%, p = 0.005) and day (14% vs 5.1%, p = 0.002). In multivariate analysis after adjusting for relevant confounders, AHI was independently associated with an increased prevalence of ventricular premature complexes at night (odds ratio per 1-U increase of log-transformed AHI 1.5, 95% confidence interval 1.1 to 2.0, p = 0.008) and during the day (odds ratio 1.37, 95% confidence interval 1.0 to 1.8, p = 0.035). In conclusion, the prevalence of ventricular premature complexes is increased in middle-aged patients with mainly mild or moderate OSA, suggesting an association between OSA and ventricular arrhythmias even in mild OSA.
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22
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Vagheggini G, Digiorgio M, Reitano S. BPCO, sindrome delle apnee ostruttive del sonno e disturbi del sonno. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Koshino Y, Satoh M, Katayose Y, Kuroki K, Sekiguchi Y, Yamasaki H, Yoshida K, Yasuda K, Tanigawa T, Kuga K, Aonuma K. Sleep apnea and ventricular arrhythmias: Clinical outcome, electrophysiologic characteristics, and follow-up after catheter ablation. J Cardiol 2010; 55:211-6. [DOI: 10.1016/j.jjcc.2009.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/28/2022]
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Abstract
Sleep-induced apnea and disordered breathing refers to intermittent, cyclical cessations or reductions of airflow, with or without obstructions of the upper airway (OSA). In the presence of an anatomically compromised, collapsible airway, the sleep-induced loss of compensatory tonic input to the upper airway dilator muscle motor neurons leads to collapse of the pharyngeal airway. In turn, the ability of the sleeping subject to compensate for this airway obstruction will determine the degree of cycling of these events. Several of the classic neurotransmitters and a growing list of neuromodulators have now been identified that contribute to neurochemical regulation of pharyngeal motor neuron activity and airway patency. Limited progress has been made in developing pharmacotherapies with acceptable specificity for the treatment of sleep-induced airway obstruction. We review three types of major long-term sequelae to severe OSA that have been assessed in humans through use of continuous positive airway pressure (CPAP) treatment and in animal models via long-term intermittent hypoxemia (IH): 1) cardiovascular. The evidence is strongest to support daytime systemic hypertension as a consequence of severe OSA, with less conclusive effects on pulmonary hypertension, stroke, coronary artery disease, and cardiac arrhythmias. The underlying mechanisms mediating hypertension include enhanced chemoreceptor sensitivity causing excessive daytime sympathetic vasoconstrictor activity, combined with overproduction of superoxide ion and inflammatory effects on resistance vessels. 2) Insulin sensitivity and homeostasis of glucose regulation are negatively impacted by both intermittent hypoxemia and sleep disruption, but whether these influences of OSA are sufficient, independent of obesity, to contribute significantly to the "metabolic syndrome" remains unsettled. 3) Neurocognitive effects include daytime sleepiness and impaired memory and concentration. These effects reflect hypoxic-induced "neural injury." We discuss future research into understanding the pathophysiology of sleep apnea as a basis for uncovering newer forms of treatment of both the ventilatory disorder and its multiple sequelae.
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Affiliation(s)
- Jerome A Dempsey
- The John Rankin Laboratory of Pulmonary Medicine, Departments of Population Health Sciences and of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53706, USA.
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25
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de Araújo CM, Solimene MC, Grupi CJ, Genta PR, Lorenzi-Filho G, Da Luz PL. Evidence that the degree of obstructive sleep apnea may not increase myocardial ischemia and arrhythmias in patients with stable coronary artery disease. Clinics (Sao Paulo) 2009; 64:223-30. [PMID: 19330249 PMCID: PMC2666450 DOI: 10.1590/s1807-59322009000300013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/08/2008] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED There is controversy regarding whether obstructive sleep apnea is responsible for triggering myocardial ischemia, arrhythmias and heart rate variability in patients with coronary artery disease. OBJECTIVE The objective of this study was to identify relationships between sleep apnea, myocardial ischemia and cardiac arrhythmia in patients with coronary artery disease. METHODS Fifty-three patients with stable coronary disease underwent simultaneous polysomnography and electrocardiographic Holter recording. The apnea-hypopnea index (AHI) was defined as the number of apneas/hypopneas per hour of sleep. Patients were divided into a Control group (AHI15, n=23 pts) and an Apnea group (AHI>15, n=30 pts). A subgroup of 13 patients with an AHI>30 (Severe Apnea group) was also studied. We analyzed ischemic episodes (ST-segment depressions >1 mm, > 1 min), heart rate variability and the occurrence of arrhythmias during wakefulness and sleep. RESULTS Baseline clinical characteristics among the groups were similar except for higher blood pressure in the Apnea groups (p<0.05). Myocardial ischemia was recorded in 39 (73.6%) patients. The number and duration of ischemic episodes significantly decreased during sleep in all groups; during wakefulness, patients with severe apnea exhibited fewer and shorter episodes in comparison with the controls. There were no significant differences in heart rate variability or in the occurrence of arrhythmias among the groups. Malignant ventricular arrhythmias, atrial fibrillation/flutter, bradycardia and high-degree atrioventricular blocks were not detected. CONCLUSION Obstructive sleep apnea was not related to myocardial ischemia, heart rate variability or arrhythmias in patients with stable coronary artery disease and did not alter the circadian pattern of myocardial ischemia.
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Affiliation(s)
- Cristiana Marques de Araújo
- Departament of Clinical Cardiology, Instituto do Coração (InCor) do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
| | - Maria Cecilia Solimene
- Departament of Clinical Cardiology, Instituto do Coração (InCor) do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
| | - Cesar Jose Grupi
- Departament of Clinical Cardiology, Instituto do Coração (InCor) do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
| | - Pedro Rodrigues Genta
- Division of Pulmonology and Sleep Laboratory, Instituto do Coração (InCor) do Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brasil. Tel.: 55 11 3069.5447,
| | - Geraldo Lorenzi-Filho
- Division of Pulmonology and Sleep Laboratory, Instituto do Coração (InCor) do Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brasil. Tel.: 55 11 3069.5447,
| | - Protásio Lemos Da Luz
- Departament of Clinical Cardiology, Instituto do Coração (InCor) do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
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Jelic S. Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea. Int J Chron Obstruct Pulmon Dis 2008; 3:269-75. [PMID: 18686735 PMCID: PMC2629968 DOI: 10.2147/copd.s2168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The high prevalence of both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in Western societies is well documented. However, OSA frequently remains unrecognized and untreated among patients with COPD. Patients with both conditions have a greater risk for fatal and nonfatal cardiovascular events compared with patients with COPD or OSA alone. Efficacious treatment with continuous positive airway pressure reduces the risk of cardiovascular complications in patients with OSA. The aim of the present review is to discuss the diagnostic approach to patients with both conditions and to delineate the benefits of timely recognition and treatment of OSA in patients with COPD.
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Affiliation(s)
- Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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