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Inoue M, Sakata S, Arima H, Yamato I, Oishi E, Ibaraki A, Goto K, Kitazono T. Sleep-related breathing disorder in a Japanese occupational population and its association with hypertension-stratified analysis by obesity status. Hypertens Res 2024; 47:1470-1478. [PMID: 38438727 PMCID: PMC11150150 DOI: 10.1038/s41440-024-01612-y] [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: 09/13/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Sleep-related breathing disorder (SRBD) causes hypertension, and obesity has been highly associated with SRBD, which has become a serious health problem in young and middle-aged Japanese males. However, the relation between SRBD and hypertension considering the effects of obesity remains unknown. In this cross-sectional study, we examined the relationship between SRBD and hypertension, with consideration for the effects of obesity, in Japanese occupational population. Using 3% oxygen desaturation index (3%ODI) obtained by simplified polysomnography (PSG), participants were classified into low (0 ≤ 3%ODI < 5), medium (5 ≤ 3%ODI < 15), and high (15 ≤ 3%ODI) 3%ODI groups. We excluded employees who had not undergone medical examination with simplified PSG in the same year from 2012 to 2018. Logistic regression analysis was performed to calculate odds ratios for having hypertension according to 3%ODI levels. In total, 2532 employees were included. Among them, 25% and 4% were categorized into the medium and high 3%ODI groups, respectively. The odds ratio for hypertension increased significantly with higher 3%ODI levels after adjustment for age, sex, alcohol drinking status and smoking status (p for trend < 0.0001). However, further adjustment for obesity status (body mass index ≥ 25 kg/m2) attenuated the associations. When we performed the stratified analysis by obesity status, the odds ratio for hypertension increased significantly with higher 3%ODI only for non-obese individuals, with significant interaction (p for interaction = 0.014). Higher 3%ODI was significantly associated with higher prevalence of hypertension especially in non-obese participants, suggesting the importance of vigilance for the presence of SRBD even in non-obese individuals. We investigated the association between SRBD and hypertension considering the effects of obesity, which would suggest the need to keep in mind the presence of SRBD even in non-obese individuals.
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Affiliation(s)
- Minako Inoue
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Satoko Sakata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Ikumi Yamato
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Emi Oishi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ai Ibaraki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Goto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Inamasu J, Akiyama T, Akaji K, Inaba M, Nishimoto M, Kojima A, Terao S, Hayashi T, Mizutani K, Toda M. Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors. J Stroke Cerebrovasc Dis 2024; 33:107591. [PMID: 38266691 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107591] [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: 11/30/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is known to be triggered by several specific human activities. Sleep, by contrast, has not been considered a triggering activity for aSAH, and clinical characteristics of patients who sustain aSAH during sleep have rarely been reported in the literature. METHODS This is a retrospective analysis on the data acquired through a multicenter aSAH registry. Between January 2019 and December 2021, a total of 732 aSAH patients had been registered into our database. After excluding 109 patients whose activities at aSAH onset had been unidentifiable, the remaining 623 aSAH patients were dichotomized to 59 patients who sustained aSAH during sleep (Sleep group) and 564 patients who sustained aSAH during daytime activities (Awake group). Two-group comparison of demographic variables and multivariate logistic regression analysis were performed to clarify their clinical characteristics and identify potential risk factors. RESULTS The Sleep group exhibited significantly higher frequencies of diabetes (15.5 % vs. 6.4 %, p = 0.01) and antiplatelet use (13.8 % vs. 4.6 %, p=0.004) than the Awake group. Furthermore, multivariate logistic regression analysis showed that diabetes (OR, 3.051; 95 % CI, 1.281-7.268; p = 0.012) and antiplatelet use (OR, 3.640; 95 % CI, 1.422-9.316; p = 0.007) were correlated with aSAH occurring during sleep. There were no significant inter-group differences in the patient outcomes evaluated at discharge. CONCLUSION The current results indicate that risk factors may exist for aSAH occurring during sleep. Further investigations on how comorbidities such as diabetes, antiplatelet use and sleep apnea affect human hemodynamic and hemostatic parameters during sleep is warranted to better understand those relationships.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya 321-0974, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Mihara Memorial Hospital, Isesaki, Japan
| | - Makoto Inaba
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Masaaki Nishimoto
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Atsuhiro Kojima
- Department of Neurosurgery, Saitama City Hospital, Saitama, Japan
| | - Satoshi Terao
- Department of Neurosurgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Takuro Hayashi
- Department of Neurosurgery, NHO Tokyo Medical Center, Tokyo, Japan
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Goyal A, Meena R, Gupta S, Kar A, Ali R, Bohra A, Solanki V, Chaudhary P, Pakhare A. Sex-specific differences in presenting symptoms of obstructive sleep apnea. Lung India 2024; 41:115-120. [PMID: 38700405 PMCID: PMC10959312 DOI: 10.4103/lungindia.lungindia_235_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: 05/02/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. METHODOLOGY Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. RESULTS Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}. CONCLUSION Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.
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Affiliation(s)
| | | | - Suruchi Gupta
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Avishek Kar
- Pulmonary Medicine, AIIMS Raipur, Chhattisgarh, India
| | - Rashida Ali
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | - Arwa Bohra
- Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | | | | | - Abhijit Pakhare
- Community and Family Medicine, AIIMS Bhopal, Madhya Pradesh, India
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Zhu Y, Liu Y, Xu H, Zhao X, Li X, Huang W, Zhang X, Zhu H, Qian D, Yi H, Guan J, Yin S. Anthropometric Determinants of Autonomic Control in Obstructive Sleep Apnea: A Large-Scale Study. Otolaryngol Head Neck Surg 2023; 169:1070-1079. [PMID: 37191322 DOI: 10.1002/ohn.347] [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: 08/10/2022] [Revised: 02/07/2023] [Accepted: 03/13/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Autonomic dysfunction is an independent risk factor for cardiovascular disease (CVD). Both obesity and obstructive sleep apnea (OSA) are associated with heart rate variability (HRV) (a hall marker of sympathetic arousal) and increased risk of CVD. This study aims to investigate whether anthropometric parameters could predict reduced HRV in adult OSA during wakefulness. STUDY DESIGN Cross-sectional study. SETTING Sleep center of Shanghai Jiao Tong University Affiliated Sixth Hospital from 2012 to 2017. METHODS Total of 2134 subjects (503 non-OSA and 1631 OSA) were included. Anthropometric parameters were recorded. HRV was recorded during a 5-minute wakefulness period and analyzed by using time-domain method and frequency-domain method. Multiple step-wise linear regressions were performed to determine significant predictors of HRV with and without adjustments. Multiplicative interactions between gender, OSA, and obesity on HRV were also determined and evaluated. RESULTS Waist circumference (WC) was significant negative determinant of root mean square of successive NN intervals (β = -.116, p < .001) and high-frequency power (β = -.155, p < .001). Age was the strongest determining factor of HRV. Significant multiplicative interactions between obesity and OSA on HRV, gender, and obesity on cardiovascular parameters were observed. CONCLUSION Anthropometric parameters could predict reduced HRV during wakefulness in patients with OSA, especially WC was the strongest influenceable factor. Obesity and OSA had significant multiplicative interaction on HRV. Gender and obesity had significant multiplicative interaction on cardiovascular parameters. Early intervention for obesity, especially centripetal obesity, may improve reduction of autonomic function and risk of CVD.
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Affiliation(s)
- Yaxin Zhu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yupu Liu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huajun Xu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xiaolong Zhao
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Li
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Weijun Huang
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xiaoman Zhang
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huaming Zhu
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Di Qian
- Department of Otolaryngology, People's Hospital of Longhua, Shenzhen, China
| | - Hongliang Yi
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Sheta A, Thaher T, Surani SR, Turabieh H, Braik M, Too J, Abu-El-Rub N, Mafarjah M, Chantar H, Subramanian S. Diagnosis of Obstructive Sleep Apnea Using Feature Selection, Classification Methods, and Data Grouping Based Age, Sex, and Race. Diagnostics (Basel) 2023; 13:2417. [PMID: 37510161 PMCID: PMC10377846 DOI: 10.3390/diagnostics13142417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder that affects approximately 3-7% of males and 2-5% of females. In the United States alone, 50-70 million adults suffer from various sleep disorders. OSA is characterized by recurrent episodes of breathing cessation during sleep, thereby leading to adverse effects such as daytime sleepiness, cognitive impairment, and reduced concentration. It also contributes to an increased risk of cardiovascular conditions and adversely impacts patient overall quality of life. As a result, numerous researchers have focused on developing automated detection models to identify OSA and address these limitations effectively and accurately. This study explored the potential benefits of utilizing machine learning methods based on demographic information for diagnosing the OSA syndrome. We gathered a comprehensive dataset from the Torr Sleep Center in Corpus Christi, Texas, USA. The dataset comprises 31 features, including demographic characteristics such as race, age, sex, BMI, Epworth score, M. Friedman tongue position, snoring, and more. We devised a novel process encompassing pre-processing, data grouping, feature selection, and machine learning classification methods to achieve the research objectives. The classification methods employed in this study encompass decision tree (DT), naive Bayes (NB), k-nearest neighbor (kNN), support vector machine (SVM), linear discriminant analysis (LDA), logistic regression (LR), and subspace discriminant (Ensemble) classifiers. Through rigorous experimentation, the results indicated the superior performance of the optimized kNN and SVM classifiers for accurately classifying sleep apnea. Moreover, significant enhancements in model accuracy were observed when utilizing the selected demographic variables and employing data grouping techniques. For instance, the accuracy percentage demonstrated an approximate improvement of 4.5%, 5%, and 10% with the feature selection approach when applied to the grouped data of Caucasians, females, and individuals aged 50 or below, respectively. Furthermore, a comparison with prior studies confirmed that effective data grouping and proper feature selection yielded superior performance in OSA detection when combined with an appropriate classification method. Overall, the findings of this research highlight the importance of leveraging demographic information, employing proper feature selection techniques, and utilizing optimized classification models for accurate and efficient OSA diagnosis.
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Affiliation(s)
- Alaa Sheta
- Computer Science Department, Southern Connecticut State University, New Haven, CT 06514, USA
| | - Thaer Thaher
- Department of Computer Systems Engineering, Arab American University, Jenin P.O. Box 240, Palestine
| | - Salim R Surani
- Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, USA
| | - Hamza Turabieh
- Health Management and Informatics Department, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Malik Braik
- Department of Computer Science, Al-Balqa Applied University, Salt 19117, Jordan
| | - Jingwei Too
- Faculty of Electrical Engineering, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, Durian Tunggal 76100, Melaka, Malaysia
| | - Noor Abu-El-Rub
- Center of Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Majdi Mafarjah
- Department of Computer Science, Birzeit University, Birzeit P.O. Box 14, Palestine
| | - Hamouda Chantar
- Faculty of Information Technology, Sebha University, Sebha 18758, Libya
| | - Shyam Subramanian
- Pulmonary, Critical Care & Sleep Medicine, Sutter Health, Tracy, CA 95376, USA
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Chaudhary SC, Gupta P, Sawlani KK, Gupta KK, Singh A, Usman K, Kumar V, Himanshu D, Verma A, Singh AB. Obstructive Sleep Apnea in Hypertension. Cureus 2023; 15:e38229. [PMID: 37252498 PMCID: PMC10225023 DOI: 10.7759/cureus.38229] [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] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction About one-half of patients who have essential hypertension have obstructive sleep apnea (OSA), and about one-half of patients who have obstructive sleep apnea have essential hypertension. OSA can cause even resistant hypertension if left untreated. These two entities often co-exist and are seen as a continuum of the same process. Eighty percent to 90% of OSA cases are undiagnosed mostly because of a lack of awareness. Material and methods This was a cross-sectional study done over a period of one year in a tertiary care hospital. After taking informed consent, 179 hypertensive patients of >18 years were included in the study. All patients were screened for OSA by the STOP-BANG questionnaire. Patients having scores of ≥3 were subjected to overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Patients with a STOP-BANG score ≤2 or score ≥3 with AHI <5, were considered non-OSA. Results More than half (53.1%) of the patients enrolled in the study had OSA. Their age ranged from 18 to 78 years and the mean age was 52.07±11.40 years. The mean age of OSA cases was found to be slightly higher than that of non-OSA. The majority of OSA cases were males (73.7%). There was an increase in the prevalence, as well as the severity of OSA, with an increase in BMI. Most of the cases had snoring and a history of tiredness. Triglyceride (TG) and low-density lipoprotein (LDL) levels of the OSA group were found to be significantly higher and high-density lipoprotein (HDL) levels were significantly lower than that of the non-OSA group. Conclusion More than half of our hypertensive patients had OSA. These two conditions often co-exist and are known as a dangerous pair. Physicians ought to have increased suspicion for early diagnosis and treatment to improve cardiovascular outcomes, reduce road traffic accidents, and improve quality of life.
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Affiliation(s)
- Shyam C Chaudhary
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Pankaj Gupta
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - K K Sawlani
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Kamlesh K Gupta
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Abhishek Singh
- Department of Cardiology, King George's Medical University, Lucknow, IND
| | - Kauser Usman
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Vivek Kumar
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - D Himanshu
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Ajay Verma
- Department of Respiratory Medicine, King George's Medical University, Lucknow, IND
| | - Abhishek B Singh
- Department of Otolaryngology - Head and Neck Surgery, King George's Medical University, Lucknow, IND
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Lee DW, Lee J. The association between long working hours and obstructive sleep apnea assessed by STOP-BANG score: a cross-sectional study. Int Arch Occup Environ Health 2023; 96:191-200. [PMID: 36008500 DOI: 10.1007/s00420-022-01914-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/10/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE The relationship between night-shift work and obstructive sleep apnea (OSA) is well known, but that between OSA and long working hours is still unknown. This study explores the association between long working hours and OSA. METHODS Using cross-sectional Korean National Health and Nutrition Examination Survey 2020 data, we made multiple logistic regression models to calculate odds ratios (ORs) between weekly working hours and STOP-BANG scores for OSA screening. Stratified regression models by night or rotating shift work were also made. RESULTS In an adjusted model of STOP-BANG high-risk versus low-risk groups, the OR in the group exceeding 40 h/wk was higher but not statistically significant, 1.19 [95% confidence interval (CI) 0.66-2.15] compared to the group working 40 h/wk (standard working hours) or less. In the group exceeding 52 h/wk, the OR was 2.03 with statistical significance (95% CI 1.08-3.80). In the stratification analysis of daytime and night-shift work, the daytime worker results were similar to those in the non-stratified model. The point estimation values of ORs in the night-shift workers were higher than in the daytime workers; however, we did not observe a statistical significance. CONCLUSION Long working hours can increase the risk of OSA assessed by STOP-BANG scores.
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Affiliation(s)
- Dong-Wook Lee
- Public Healthcare Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jongin Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Jacob DW, Harper JL, Ivie CL, Ott EP, Limberg JK. Sex differences in the vascular response to sympathetic activation during acute hypoxaemia. Exp Physiol 2021; 106:1689-1698. [PMID: 34187092 DOI: 10.1113/ep089461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
NEW FINDINGS What is the central question of this study? Sympathetically mediated vasoconstriction is preserved during hypoxaemia in humans, but our understanding of vascular control comes from predominantly male cohorts. We tested the hypothesis that young women attenuate sympathetically mediated vasoconstriction during steady-state hypoxaemia, whereas men do not? What is the main finding and its importance? Sympathetically mediated vasoconstriction is preserved or even enhanced during steady-state hypoxia in young men, and the peripheral vascular response to sympathetic activation during hypoxaemia is attenuated in young women. These data advance our understanding of sex-related differences in hypoxic vascular control. ABSTRACT Activation of the sympathetic nervous system causes vasoconstriction and a reduction in peripheral blood flow. Sympathetically mediated vasoconstriction may be attenuated during systemic hypoxia to maintain oxygen delivery; however, in predominantly male participants sympathetically mediated vasoconstriction is preserved or even enhanced during hypoxaemia. Given the potential for sex-specific differences in hypoxic vascular control, prior results are limited in application. We tested the hypothesis that young women attenuate sympathetically mediated vasoconstriction during steady-state hypoxaemia, whereas men do not. Healthy young men (n = 13, 25 ± 4 years) and women (n = 11, 24 ± 4 years) completed two trials consisting of a 2-min cold pressor test (CPT, a well-established sympathoexcitatory stimulus) during baseline normoxia and steady-state hypoxaemia. Beat-to-beat blood pressure (finger photoplethysmography) and forearm blood flow (venous occlusion plethysmography) were measured continuously. Total and forearm vascular conductance (TVC and FVC, respectfully) were calculated. A change (Δ) in TVC and FVC from steady-state during the last 1 min of CPT was calculated and differences between normoxia and systemic hypoxia were assessed. In men, the reduction in TVC during CPT was greater during hypoxia compared to normoxia (ΔTVC, P = 0.02), whereas ΔTVC did not differ between conditions in women (P = 0.49). In men, ΔFVC did not differ between normoxia and hypoxia (P = 0.92). In women, the reduction in FVC during CPT was attenuated during hypoxia (ΔFVC, P < 0.01). We confirm sympathetically mediated vasoconstriction is preserved or enhanced during hypoxaemia in young men, whereas peripheral vascular responsiveness to sympathetic activation during hypoxaemia is attenuated in young women. The results advance our understanding of sex-related differences in hypoxic vascular control.
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Affiliation(s)
- Dain W Jacob
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Jennifer L Harper
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Clayton L Ivie
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Elizabeth P Ott
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Jacqueline K Limberg
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
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9
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Bauters FA, Hertegonne KB, Pevernagie D, De Buyzere ML, Chirinos JA, Rietzschel ER. Sex differences in the association between arterial hypertension, blood pressure, and sleep apnea in the general population. J Clin Sleep Med 2021; 17:1057-1066. [PMID: 33576736 DOI: 10.5664/jcsm.9142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess sex-related differences in the relationship between hypertension (HT), blood pressure (BP), and sleep apnea in the general population. METHODS We performed home polygraphy in a cohort of 1809 men and women in the general population. Office BP was measured. Presence of HT (drug-treated, physician-diagnosed, or high BP during study visit) was also recorded. HT rate and BP were assessed over a range of 7 sleep apnea severity categories based on the respiratory event index (REI). RESULTS The age-adjusted HT prevalence rate increased with higher REI in both sexes. After additional adjustment for obesity the association remained significant in women but not in men. In participants not treated with antihypertensive medications, age-adjusted BP increased with REI. Remarkably, the association was already significant within the normal range (REI < 5 events/h). The REI threshold for higher BP was situated at a distinctly lower cutoff point in women compared to men. After additional adjustment for obesity, the associations remained significant for diastolic but not systolic BP. CONCLUSIONS Significant increases in the age-adjusted BP and HT rate in the general population were present at lower REI cutoffs in women compared to men. Even a very low number of respiratory events was associated with higher BP and HT prevalence. Adjustment for obesity attenuated these associations, especially in men. Sex differences in BP susceptibility across the sleep apnea spectrum may be present.
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Affiliation(s)
- Fré A Bauters
- Ghent University Hospital, Department of Respiratory Medicine, Ghent, Belgium
| | - Katrien B Hertegonne
- Ghent University Hospital, Department of Respiratory Medicine, Ghent, Belgium.,Ghent University, Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent, Belgium
| | - Dirk Pevernagie
- Ghent University Hospital, Department of Respiratory Medicine, Ghent, Belgium.,Ghent University, Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent, Belgium
| | | | - Julio A Chirinos
- Hospital of the University of Pennsylvania and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ernst R Rietzschel
- Ghent University, Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent, Belgium.,Ghent University Hospital, Department of Cardiology, Ghent, Belgium
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10
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Jacob DW, Ott EP, Baker SE, Scruggs ZM, Ivie CL, Harper JL, Manrique-Acevedo CM, Limberg JK. Sex differences in integrated neurocardiovascular control of blood pressure following acute intermittent hypercapnic hypoxia. Am J Physiol Regul Integr Comp Physiol 2020; 319:R626-R636. [PMID: 32966122 DOI: 10.1152/ajpregu.00191.2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Repetitive hypoxic apneas, similar to those observed in sleep apnea, result in resetting of the sympathetic baroreflex to higher blood pressures (BP). This baroreflex resetting is associated with hypertension in preclinical models of sleep apnea (intermittent hypoxia, IH); however, the majority of understanding comes from males. There are data to suggest that female rats exposed to IH do not develop high BP. Clinical data further support sex differences in the development of hypertension in sleep apnea, but mechanistic data are lacking. Here we examined sex-related differences in the effect of IH on sympathetic control of BP in humans. We hypothesized that after acute IH we would observe a rise in muscle sympathetic nerve activity (MSNA) and arterial BP in young men (n = 30) that would be absent in young women (n = 19). BP and MSNA were measured during normoxic rest before and after 30 min of IH. Baroreflex sensitivity (modified Oxford) was evaluated before and after IH. A rise in mean BP following IH was observed in men (+2.0 ± 0.7 mmHg, P = 0.03), whereas no change was observed in women (-2.7 ± 1.2 mmHg, P = 0.11). The elevation in MSNA following IH was not different between groups (4.7 ± 1.1 vs. 3.8 ± 1.2 bursts/min, P = 0.65). Sympathetic baroreflex sensitivity did not change after IH in either group (P > 0.05). Our results support sex-related differences in the effect of IH on neurovascular control of BP and show that any BP-raising effects of IH are absent in young women. These data enhance our understanding of sex-specific mechanisms that may contribute to BP changes in sleep apnea.
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Affiliation(s)
- Dain W Jacob
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Elizabeth P Ott
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Clayton L Ivie
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Jennifer L Harper
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Camila M Manrique-Acevedo
- Department of Medicine, University of Missouri, Columbia, Missouri.,Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri
| | - Jacqueline K Limberg
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri.,Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
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Hashim Z, Nath A, Gupta M, Khan A, Mishra R, Srivastava S, Tripathi SK. Diagnosis of obstructive sleep apnea in women: Is there any difference?- Experience from a tertiary care hospital of North India. J Family Med Prim Care 2019; 8:3276-3281. [PMID: 31742155 PMCID: PMC6857356 DOI: 10.4103/jfmpc.jfmpc_609_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 01/09/2023] Open
Abstract
Context: Obstructive sleep apnea (OSA) considered classically to be a male-dominant disease, may have significant gender-based differences in clinical presentation and diagnosis. Aims: To evaluate gender-based differences in the clinical profile and polysomnographic features of Indian patients with OSA. Settings and Design: A prospective observational study was conducted over a period of 12 months involving adult ambulatory patients, referred for evaluation of OSA. Methods and Materials: Enrolled patients underwent detailed clinical evaluation followed by supervised polysomnography. Sleep studies were manually validated and analyzed. Statistical Analysis Used: Continuous variables were compared using two-tailed independent- sample t-test. For the univariate analysis, the Chi-square test was used. Results: Out of 150 enrolled patients, 94 (62.7%) were males (male-to-female: 1.7:1; age: 51.85 ± 12.60 years; BMI: 32.09 ± 5.53 kg/m2). Most common presenting features were excessive daytime somnolence, snoring, and easy fatiguability. Women with OSA were older than men. Insomnia and anxiety were significantly higher among females. Parameters defining sleep architecture were similar in both groups. Although obstructive apneas and hypopneas were similar, mean apnea hypopnea index was significantly higher (P < 0.05) in males compared to females with higher titratable continuous positive airway pressure. Conclusions: There are gender-specific differences in the clinical presentation of OSA due to various anatomical, physiological, and psychosocial factors. Their potential influence on the clinical features, natural history, and implications on treatment need further evaluation on a larger scale.
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Affiliation(s)
- Zia Hashim
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Alok Nath
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ravi Mishra
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Shivani Srivastava
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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12
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The effect of high evening blood pressure on obstructive sleep apnea-related morning blood pressure elevation: does sex modify this interaction effect? Sleep Breath 2019; 23:1255-1263. [PMID: 31183742 DOI: 10.1007/s11325-019-01869-5] [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: 12/05/2018] [Revised: 04/28/2019] [Accepted: 05/24/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) can lead to increased morning blood pressure (BP). We hypothesized that high evening BP may aggravate OSA-related morning BP elevation. Additionally, this interactional effect may be modified by sex. METHODS This retrospective, cross-sectional study included newly diagnosed OSA patients with an apnea-hypopnea index (AHI) ≥ 5 per hour on a full-night polysomnography. An analysis of covariance (ANCOVA) was used to determine whether severe OSA (AHI ≥ 30) was associated with higher morning BP than mild-to-moderate OSA (5 ≤ AHI < 30) and whether there was an interaction between apnea severity and evening BP on morning BP. To identify the sex effects, analyses were performed separately in each sex group. RESULTS A total of 1445 patients with an average age of 51.9 years (SD 11.7) (male 77.9% vs. female 22.1%; high evening BP group 22.4% vs. normal evening BP group 59.6%) were included in the study. Based on the ANCOVA, patients with severe OSA had significantly higher morning systolic BP (SBP) (p = 0.003), diastolic BP (DBP) (p < 0.001), and mean BP (MBP) (p < 0.001) than the mild-to-moderate group in male subjects. A significant interaction between apnea severity and evening BP was identified on morning DBP and MBP in male subjects. However, there were no differences in morning BP between severe and mild-to-moderate OSA groups in female subjects. CONCLUSIONS In male subjects, severe OSA contributed to higher morning BP than mild-to-moderate OSA. OSA-associated morning BP elevation was more prominent in the high evening BP group than in the normal BP group. Such relations were not found in female subjects.
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13
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Igami K, Maruyama K, Tomooka K, Ikeda A, Tabara Y, Kohara K, Saito I, Tanigawa T. Relationship between sleep-disordered breathing and central systolic blood pressure in a community-based population: the Toon Health Study. Hypertens Res 2019; 42:1074-1082. [DOI: 10.1038/s41440-019-0219-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/30/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022]
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Temple KA, Leproult R, Morselli L, Ehrmann DA, Van Cauter E, Mokhlesi B. Sex Differences in the Impact of Obstructive Sleep Apnea on Glucose Metabolism. Front Endocrinol (Lausanne) 2018; 9:376. [PMID: 30042734 PMCID: PMC6048262 DOI: 10.3389/fendo.2018.00376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives: Obstructive sleep apnea (OSA) is more prevalent in men and is an independent risk factor for type 2 diabetes. We aimed to determine if there are sex differences in the impact of OSA on glucose metabolism in nondiabetic overweight and obese adults. Methods: One hundred and forty-five men and women (age 33.4 ± 0.6, BMI 37.2 ± 0.7, 70.3% blacks) from the community underwent in-laboratory polysomnography. Severity of OSA was assessed by the apnea-hypopnea index (AHI). Glucose tolerance was assessed using fasting glucose, 1-h glucose, 2-h glucose and the area under the curve (AUC) during the 2-h oral glucose tolerance test (OGTT). Fasting insulin resistance was assessed by HOMA-IR, and insulin sensitivity during the OGTT was assessed by the Matsuda Index. Pancreatic beta-cell function was assessed by fasting HOMA-%B and by AUCinsulin/glucose, insulinogenic index, and oral disposition index (DIoral) during the OGTT. All comparisons were adjusted for age, BMI, race and severity of OSA. Results: There were no significant demographic differences between men and women without OSA. Men and women with OSA were similar in age, BMI, and severity of OSA, but there were more black women with OSA. Compared to women with OSA, men with OSA had significantly higher fasting glucose, 1-h glucose levels, AUCglucose, and AUC for insulin secretion rate (AUCISR) but similar 2-h glucose levels. These differences persisted in adjusted analyses. Men with OSA secreted significantly more insulin than women with OSA in order to achieve similar glucose levels. Men with OSA had significantly worse beta cell function as measured by the DIoral than women with OSA. In contrast, there were no significant sex differences in measures of glucose tolerance and beta-cell function in participants without OSA. Conclusion: Men with OSA secreted more insulin compared to women with OSA in order to maintain glucose homeostasis. The adverse impact of OSA on beta-cell responsiveness was larger in men, which may result in an overall greater risk of type 2 diabetes compared to women.
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Affiliation(s)
- Karla A. Temple
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Rachel Leproult
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Lisa Morselli
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - David A. Ehrmann
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Eve Van Cauter
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Babak Mokhlesi
- Department of Medicine, Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Pulmonary and Critical Care, Department of Medicine, Sleep Disorders Center, University of Chicago, Chicago, IL, United States
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15
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Hu W, Jin X, Chen C, Zhang P, Li D, Su Q, Yin G, Hang Y. Diastolic Blood Pressure Rises with the Exacerbation of Obstructive Sleep Apnea in Males. Obesity (Silver Spring) 2017; 25:1980-1987. [PMID: 28922573 DOI: 10.1002/oby.21960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To characterize the association pattern between blood pressure (BP), metabolism changes, and obstructive sleep apnea (OSA) severity within male OSA patients. METHODS The association between systolic BP (SBP), diastolic BP (DBP), glucose, lipids, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and arousal index (ArI) was evaluated after adjustment for BMI and waist circumference/hip circumference ratio (WHR) in 1,370 male OSA patients. RESULTS In the multiple linear regression models using SBP as an independent variable, SBP did not associate with the increase of any OSA indexes. BMI and glucose positively associated with AHI, ODI, and ArI elevation. WHR was also positively associated with increasing AHI and ODI. Total cholesterol levels increased with ODI and ArI increases. Triglyceride was associated with ArI. In the multiple linear regression models using DBP as an independent variable, DBP associated universally with AHI, ODI, and ArI with stable coefficients ranging from 0.19 to 0.20. The remaining independent variables were associated with AHI, ODI, and ArI with a similar trend to the models including SBP as an independent variable. CONCLUSIONS Apnea-hypopnea, hypoxemia, and arousal changed glycometabolism, fat metabolism, and BP profoundly in a particular pattern.
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Affiliation(s)
- Wei Hu
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xian Jin
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Chengjun Chen
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Dandan Li
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Qian Su
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Guizhi Yin
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanwen Hang
- Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
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16
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Sleep Apnea and Hypertension. Chest 2017; 152:742-750. [DOI: 10.1016/j.chest.2017.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/16/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
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17
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Dzierzewski JM, Wallace DM, Wohlgemuth WK. Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence. J Clin Sleep Med 2017; 12:169-76. [PMID: 26350607 DOI: 10.5664/jcsm.5478] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 07/24/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder associated with a myriad of sequelae. OSAHS is effectively treated with continuous positive airway pressure (CPAP) therapy. However, fewer than 50% of patients are compliant with their CPAP therapy prescriptions. The current study sought to explore an integrated, biopsychological approach to CPAP adherence among experienced CPAP users. METHODS We performed a retrospective, cross-sectional analysis of a cohort of veterans with a diagnosis of OSAHS (n = 191) who were prescribed CPAP therapy and returned for adherence download at the Miami VA Sleep Clinic. The relationships between biomedical characteristics (e.g., CPAP pressure, self-reported sleepiness, and change in sleep efficiency) and psychological factors (e.g., self-efficacy beliefs and psychological diagnoses) and objectively measured CPAP use were examined to determine whether psychological factors moderated the relationships between biomedical characteristics and CPAP adherence. RESULTS Hierarchical regression analyses predicting CPAP adherence (adjusting for time since CPAP prescription, age, education, prescribed CPAP pressure, daytime sleepiness, changes in sleep efficiency with CPAP, and psychiatric conditions) revealed the following: (1) CPAP self-efficacy and CPAP pressure were positively related to adherence, and (2) CPAP self-efficacy moderates the relationship between CPAP pressure and CPAP adherence. CONCLUSIONS There was no relationship between CPAP pressure and adherence in individuals with low self-efficacy beliefs. However, for individuals with high self-efficacy beliefs, there was a significant positive relationship between CPAP pressure and adherence. Self-efficacy beliefs appear to be a prime target for focused interventions aimed at improving CPAP adherence among those individuals with higher pressure prescriptions.
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Affiliation(s)
- Joseph M Dzierzewski
- David Geffen School of Medicine, University of California, Los Angeles, CA.,Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Douglas M Wallace
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL.,Neurology Service, Bruce W. Carter VA Medical Center, Miami, FL
| | - William K Wohlgemuth
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL
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18
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Cardiovascular comorbidities in obstructive sleep apnoea according to age: a sleep clinic population study. Aging Clin Exp Res 2015; 27:611-9. [PMID: 25618197 DOI: 10.1007/s40520-015-0318-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/14/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe the features of obstructive sleep apnoea (OSA) and its association with arterial hypertension (HT), coronary artery disease (CAD), and arrhythmias in elderly (≥65 years) versus younger patients. METHODS All adult patients referred to our Sleep Research Unit for suspected OSA were included and underwent a thorough medical examination and an in-laboratory polysomnography. The severity of OSA was defined by the apnoea-hypopnoea index (AHI) as mild [5-15/h), moderate [15-30/h), and severe (≥30/h). RESULTS Elderly patients (n = 136) and really old patients (>75 years) had higher prevalence of OSA (89 %) and severe OSA (36.8 %) as compared to younger patients (n = 439; 79.5 and 27.6 %, respectively, p < 0.05). In patients with OSA, the elderly group had a poorer sleep quality and more severe nocturnal oxygen desaturation than the younger group. Elderly patients presented higher percentages of HT (47.8 %), CAD (19.8 %), and arrhythmias (16.2 %) as compared to younger patients (p < 0.01). The odds ratio (OR) for HT increased with OSA severity from 1.0 to 1.65 (95 % confidence interval 0.83-3.27), 1.0 to 2.5 (95 % CI 1.25-5.00), and 1.0 to 3.77 (1.95-7.29) in younger patients, but not in elderly ones where the OR increased from 1.0 to 0.6 (0.17-2.04), 1.0 to 1.14 (0.34-3.82), and 1.0 to 1.46 (0.46-4.63), respectively. CONCLUSION Stronger relation of HT and OSA severity in younger patients should encourage us to screen OSA in these patients at very young age. Increased OSA severity without obesity in very old patients needs to be confirmed and further studied.
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20
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Gaines J, Vgontzas AN, Fernandez-Mendoza J, Kritikou I, Basta M, Bixler EO. Gender differences in the association of sleep apnea and inflammation. Brain Behav Immun 2015; 47:211-7. [PMID: 25535861 PMCID: PMC4468024 DOI: 10.1016/j.bbi.2014.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 02/08/2023] Open
Abstract
Over the last 15years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-h polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p=0.01), CRP (p=0.005), leptin (p<0.001), and adiponectin (p<0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p=0.04), CRP (p=0.06) and IL-6 (p=0.11) relative to control men; in sleep apneic females, only CRP was elevated (p=0.04). Furthermore, CRP was associated with apnea severity in a dose-response manner (p-linear=0.04 in both genders) and was independently associated with comorbid hypertension in apnea (p-linear=0.005 for women; p-linear=0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity.
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Affiliation(s)
- Jordan Gaines
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Ilia Kritikou
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Maria Basta
- Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Edward O Bixler
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder which is characterized by recurrent upper closure with oxygen desaturation and sleep disruption. OSA increases the risk of vascular disorders in the form of stroke, myocardial infarction, congestive heart failure, and hypertension. The mechanisms underlying the vascular disorders are several and include intermittent hypoxia with release of cytokines, angiogenic inhibitors, free radicals, and adhesion molecules. During apneas, arterial blood pressure gradually rises and surges abruptly after the termination of apnea. Two thirds of patients with OSA will ultimately have diurnal hypertension. This review discusses the literature supporting the significant role of OSA in hypertension and the effect of OSA treatment on blood pressure.
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Affiliation(s)
- Vahid Mohsenin
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, P.O. Box 208057, LLCI 106, 15 York Street, New Haven, CT, 06510, USA,
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Valadares RJB, Sousa KG, Espindola MN, dos Santos CEVG, Viegas CAA. Gender Differences in Comorbidities and Sleep Patterns of Obese Patients with Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjns.2015.51006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jafari B, Elias JA, Mohsenin V. Increased plasma YKL-40/chitinase-3-like-protein-1 is associated with endothelial dysfunction in obstructive sleep apnea. PLoS One 2014; 9:e98629. [PMID: 24878721 PMCID: PMC4039537 DOI: 10.1371/journal.pone.0098629] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/06/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is a common disorder affecting 15–24% of the adults and is associated with increased risk of hypertension and atherosclerosis. The exact mechanisms underlying hypertension in OSA are not entirely clear. YKL-40/Chitinase-3-like protein-1 is a circulating moiety with roles in injury, repair and angiogenesis that is dysregulated in atherosclerosis and a number of other diseases. We sought to determine the role of YKL-40 in endothelial dysfunction and hypertension in OSA. Methods We studies 23 normotensive OSA (N-OSA) and 14 hypertensive OSA (H-OSA) without diabetes and apparent cardiovascular disease. Endothelial-dependent nitric oxide-mediated vasodilatory capacity was assessed by flow-mediated vasodilation (FMD). YKL-40, vascular endothelial growth factor (VEGF) and the soluble form of VEGF receptor-1or sFlt-1 were measured in plasma using ELISA methodology. Results N-OSA subjects aged 49.1±2.3 years and H-OSA aged 51.3±1.9 years with BMI 36.1±1.6 and 37.6±1.9 kg/m2, respectively. The apnea-hypopnea index (AHI) was 41±5 events/hr in N-OSA and 46±6 in H-OSA with comparable degree of oxygen desaturations during sleep. FMD was markedly impaired in H-OSA (8.3%±0.8) compared to N-OSA (13.2%±0.6, P<0.0001). Plasma YKL-40 was significantly elevated in H-OSA (55.2±7.9 ng/ml vs. 35.6±4.2 ng/ml in N-OSA, P = 0.02) and had an inverse relationship with FMD (r = −0.52, P = 0.013). There was a significant positive correlation between sFlt-1/VEGF, a measure of decreased VEGF availability, and YKL-40 (r = 0.42, P = 0.04). Conclusion The levels of plasma YKL-40 were elevated in H-OSA group and inversely correlated with the endothelial-dependent vasodilatory capacity whereas there was a positive correlation between sFlt-1/VEGF and YKL-40. These findings suggest that YKL-40 is dysregulated, in part, due to perturbation of VEGF signaling, and may contribute to endothelial dysfunction and hypertension in OSA.
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Affiliation(s)
- Behrouz Jafari
- Section of Pulmonary, Critical Care and Sleep Medicine, University of California, Irvine, California, United States of America
| | - Jack A. Elias
- Warren Alpert School of Medicine, Providence, Rhode Island, United States of America
| | - Vahid Mohsenin
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine and 4 John B. Pierce Laboratory, New Haven, Connecticut, United States of America
- * E-mail:
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Lee YJG, Jeong DU. Obstructive sleep apnea syndrome is associated with higher diastolic blood pressure in men but not in women. Am J Hypertens 2014; 27:325-30. [PMID: 24436323 DOI: 10.1093/ajh/hpt280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) and poor sleep quality both increase blood pressure (BP). This study aimed to find the sex effects and the role of poor sleep quality on systolic BP (SBP) and diastolic BP (DBP) in OSAS patients. METHODS Polysomnographic findings, morning BP values, and clinical data of 460 subjects (348 men; 112 women) diagnosed with OSAS were analyzed. Analyses were performed separately in each sex to examine the association of the apnea-hypopnea index (AHI) with BP, SBP, DBP, and sleep quality. RESULTS In male subjects, AHI predicted the high BP and high DBP groups but not the high SBP group. In female subjects, AHI did not predict any of the high BP, DBP, or SBP groups. Poor sleep quality, in the absence of AHI effect, weakly correlated with BP in both sexes, but the association between poor sleep quality and high AHI was stronger in male subjects than in females. CONCLUSIONS In male subjects only, OSAS was associated with DBP but not SBP. The significant association between OSAS and DBP may be responsible for the BP elevations in OSAS. It could be speculated that the stronger association between poor sleep quality and OSAS in male subjects compared with females may have partly contributed to the sex effect on BP.
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Affiliation(s)
- Yu-Jin G Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
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Hermans MP, Mahadeb YP, Katchunga P, Cikomola Cirhuza J, Ahn SA, Rousseau MF. Novel sexual dimorphisms of sleep apnea syndrome in diabetes. Diabetes Metab Syndr 2014; 8:36-44. [PMID: 24661757 DOI: 10.1016/j.dsx.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND OSAS, a frequently neglected, yet frequent comorbidity in T2DM, is associated with obesity, metabolic syndrome and central fat. OSAS is better documented in males, and this study explored novel gender dimorphisms in T2DM. METHODS Cross-sectional study: 815 T2DM (541 males; 274 females) classified into OSAS[-] and OSAS[+] were assessed for cardiometabolic risk factors, glucose homeostasis, micro/macroangiopathies, CV risk, autoimmune thyroid disease (AITD); and GAD65 antibodies. RESULTS There was a gender dimorphism in glucose control (worse in females), apolipoprotein B100 (higher in females), with apoB100/apoA1 and log(TG)/HDL-C sexually dimorphic. There was also a marked gender dimorphism in GAD65 positivity, higher (+793%) in OSAS[+] females vs. males. There were clear sexual dimorphisms in macro-/microangioathies, regarding stroke, retinopathy and polyneuropathy. OSAS was not sexually dimorphic regarding age; education; and diabetes duration. There was a significant dimorphism in ethnicity. There were no gender-specific dimorphisms related to OSAS in anthropometrics, nor in hypertension, insulin sensitivity, or hyperbolic product loss rate. CONCLUSION We report a series of novel OSAS-related sexual dimorphisms, concerning GAD65 auto-antibodies; polyneuropathy; atherogenic dyslipidemia [all increased in females]; diabetic retinopathy; North-Caucasian ethnicity; metabolic control; and TIA/stroke prevalence [all lower in females]. These findings raise challenging questions regarding the reciprocal pathophysiology between obstructive sleep disorders and cardiometabolic risk in T2DM.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium.
| | - Yovan P Mahadeb
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Katchunga
- Faculty of Medicine, Catholic University of Bukavu, Democratic Republic of the Congo
| | | | - Sylvie A Ahn
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
| | - Michel F Rousseau
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
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Jafari B, Mohsenin V. Endothelial dysfunction and hypertension in obstructive sleep apnea - Is it due to intermittent hypoxia? J Cardiovasc Dis Res 2013; 4:87-91. [PMID: 24027362 DOI: 10.1016/j.jcdr.2013.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/03/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a prevalent disorder causing hypertension. Endothelial dysfunction appears to underlie development of hypertension. It is not known whether hypoxia during sleep is necessarily the prerequisite process for endothelial dysfunction and hypertension in OSA. We therefore examined the relationship between endothelial-dependent vasodilatory capacity, hypoxia and circulating angiogenesis inhibitors in OSA. METHODS AND RESULTS We studies 95 subjects with and without OSA and hypertension. Endothelial-dependent vasodilation was assessed using brachial artery flow-mediated vasodilation method (FMD). Plasma angiogenesis inhibitors, endoglin (sEng) and fms-like tyrosine kinase-1 (sFlt-1), were measured using ELISA. The apnea-hypopnea indexes were 41 ± 5 and 48 ± 4 events/hr in normotensive OSA (N-OSA) and hypertensive OSA (H-OSA), respectively, indicating severe OSA. The sleep time spent with SaO2 < 90% (T < 90%) were 34 ± 8 and 40 ± 9 min, respectively. FMD was markedly impaired in H-OSA (8.0% ± 0.5) compared to N-OSA (13.5% ± 0.5, P < 0.0001), H-non-OSA (10.5% ± 0.8, P < 0.01), and N-non-OSA (16.1% ± 1.0, P < 0.0001). There was no correlation between T < 90% and FMD. Both OSA groups had elevated levels of sFlt-1 (62.4 ± 5.9 and 63.9 ± 4.7 pg/ml) compared to N-non-OSA (32.1 ± 6.5, P = 0.0008 and P = 0.0004, respectively) and H-non-OSA (41.2 ± 7.0, P < 0.05 and P = 0.03, respectively). In contrast, sEng was only elevated in H-OSA (4.20 ± 0.17 ng/ml) compared with N-OSA (3.64 ± 0.14, P = 0.01) and N-non-OSA (3.48 ± 0.20, P = 0.01). There was a modest but statistically significant inverse correlation between sEng and FMD in only H-OSA group (r = -0.38, P < 0.05). CONCLUSION These data show that patients with OSA and hypertension have marked impairment of FMD, independent of hypoxia exposure, which is associated with increased sEng.
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Affiliation(s)
- Behrouz Jafari
- Section of Pulmonary, Critical Care and Sleep Medicine, University of California, Irvine, CA 90822, USA
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Sharpe AL, Andrade MA, Herrera-Rosales M, Britton SL, Koch LG, Toney GM. Rats selectively bred for differences in aerobic capacity have similar hypertensive responses to chronic intermittent hypoxia. Am J Physiol Heart Circ Physiol 2013; 305:H403-9. [PMID: 23709603 DOI: 10.1152/ajpheart.00317.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Exposure to chronic intermittent hypoxia (CIH) is an animal model that mimics the repetitive bouts of hypoxemia experienced by humans with sleep apnea. Rats exposed to CIH develop hypertension that depends on the activation of sympathetic nerve activity (SNA). Since obesity and metabolic syndrome have been linked to neurogenic hypertension and sleep apnea, and because sleep apnea can adversely affect aerobic exercise capacity, we tested the hypothesis that rats bred for selection of low aerobic capacity running (LCR) would have a greater hypertensive response to CIH than rats bred for high aerobic capacity running (HCR). Blockade of ganglionic transmission was performed to compare the contribution of SNA to the maintenance of resting mean arterial pressure (MAP). Next, hypertensive responses to 7 days of CIH were compared across LCR and HCR rats (14-16 mo old). Finally, the contribution of the hypothalamic paraventricular nucleus (PVN) to the maintenance of SNA and hypertension after CIH was determined and compared across groups. Although LCR rats were less active and had greater body weights than HCR rats, resting MAP, the contribution of ongoing SNA to the maintenance of MAP, and hypertensive responses to CIH were similar between groups. Contrary to our hypothesis, chemical inhibition of the PVN with muscimol (1 mmol/100 nl) caused a larger fall of MAP in HCR rats than in LCR rats. We conclude that LCR rats do not have resting hypertension or an exaggerated hypertensive response to CIH. Interestingly, the maintenance of CIH hypertension in LCR rats compared with HCR rats appears less reliant on ongoing PVN neuronal activity.
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Affiliation(s)
- Amanda L Sharpe
- Department of Pharmaceutical Sciences, Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209, USA.
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Sex-related Differences in Cardiometabolic Outcomes Associated With Obstructive Sleep Apnea. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/cpm.0b013e31828fce1b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Islam MR, Khan I, Attia J, Hassan SMN, McEvoy M, D’Este C, Azim S, Akhter A, Akter S, Shahidullah SM, Milton AH. Association between hypertension and chronic arsenic exposure in drinking water: a cross-sectional study in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:4522-36. [PMID: 23222207 PMCID: PMC3546776 DOI: 10.3390/ijerph9124522] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/27/2012] [Accepted: 11/29/2012] [Indexed: 12/12/2022]
Abstract
Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1-8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50 μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46-8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41-19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.
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Affiliation(s)
- Mohammad Rafiqul Islam
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Ismail Khan
- Department of Pharmacology, Dhaka Medical College, Dhaka 1000, Bangladesh; E-Mail:
| | - John Attia
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | | | - Mark McEvoy
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Catherine D’Este
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
| | - Syed Azim
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; E-Mail:
| | - Ayesha Akhter
- Department of Obstetrics and Gynaecology, Tairunnessa Memorial Medical College, Targas, Kunia, Gazipur, Dhaka, Gazipur 1701, Bangladesh; E-Mail:
| | - Shahnaz Akter
- Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Demra, Dhaka 1362, Bangladesh; E-Mail:
| | | | - Abul Hasnat Milton
- Centre for Clinical Epidemiology & Biostatistics (CCEB), The University of Newcastle, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mails: (M.R.I.); (J.A.); (M.M.); (C.D.)
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Li QY, Li M, Feng Y, Guo Q, Gu SY, Liu JL, Zhang RF, Wan HY. Chronic intermittent hypoxia induces thioredoxin system changes in a gender-specific fashion in mice. Am J Med Sci 2012; 343:458-61. [PMID: 22112787 DOI: 10.1097/maj.0b013e318235b03e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor of multisystem injury including liver and cardiovascular system. Chronic intermittent hypoxia (CIH) associated with recurrent apneas in patients with OSA is one of the most important causes of the increased various systems injury and oxidative stress induced by CIH is an important pathogenic mechanism. Reports indicated that females are less susceptible to oxidative stress injury. The goal of this study was to explore if there exists gender deference of thioredoxin system (Trx/Txnip) alterations by CIH and to clarify a clue for studying gender disparity of OSA-related multisystem injury. C57BL/6J mice of each gender were exposed to CIH with a fractional inspired O2 (FiO2) nadir of 5%. The oxidative and antioxidant biomarkers were evaluated, including serum OxLDL level and Trx/Txnip expression of liver tissue. Male mice exposed to CIH exhibited significant increases in serum OxLDL level than that of the male control (73.24 ± 22.43 μg/dL, 45.20 ± 28.53 μg/dL, P = 0.032) but no significant difference in the females. Male mice exposed to CIH also exhibited decreased expression of Trx than the female (0.4460 ± 0.1023 versus 1.0454 ± 0.1777, P = 0.013) and increased expression of Txnip than the female (0.0123 ± 0.0476 versus 0.0065 ± 0.0058, P = 0.022). These data suggest that CIH induces thioredoxin system change in a gender-specific fashion in mice.
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Affiliation(s)
- Qing Yun Li
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Activation of heme oxygenase and suppression of cGMP are associated with impaired endothelial function in obstructive sleep apnea with hypertension. Am J Hypertens 2012; 25:854-61. [PMID: 22647785 DOI: 10.1038/ajh.2012.56] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent disorder that increases the risk of systemic hypertension and cardiovascular diseases. Heme oxygenase (HO) has been shown to be upregulated in patients with OSA and its overexpression in mice causes hypertension. End products of HO are carbon monoxide (CO) and bilirubin. CO exerts a pleiotropic action on vasoregulation. Despite high prevalence and incident of hypertension in OSA, its pathophysiology is not well-understood, particularly in regard to varying susceptibility of patients to hypertension. We investigated the role of HO in endothelial dysfunction and hypertension in OSA. METHODS We determined flow-mediated vasodilatation (FMD) as a measure of endothelial-dependent vasodilatory capacity, exhaled CO, bilirubin, and guanosine 3',5'-cyclic monophosphate (cGMP) in 63 subjects with OSA (normotensive 27, hypertensive 36) and in 32 subjects without OSA (normotensive 19, hypertensive 13). RESULTS Hypertensive OSA demonstrated marked impairment in FMD (8.0 ± 0.5% vasodilatation) compared to 10.5 ± 0.8% in hypertensives non-OSA (P < 0.01) and 13.5 ± 0.5% in normotensive OSA (P < 0.001) and 16.1 ± 1.1% in normotensive non-OSA (P < 0.0001). HO was upregulated and plasma nitric oxide (NO) was significantly increased in hypertensive OSA compared to normotensive OSA and hypertensive non-OSA. Conversely, serum cGMP was markedly decreased in hypertensive OSA (12.9 ± 1.8 pmol/ml vs. 20.6 ± 3.7 in normotensive OSA, P = 0.032). There was an inverse relationship between FMD and CO and bilirubin concentrations (r = 0.43, P = 0.0001 and r = 0.28, P = 0.01, respectively). CONCLUSIONS These data show that increased CO in the setting of elevated NO concentrations is associated with decreased cGMP, impaired FMD, and hypertension in patient with OSA.
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Combined effect of obstructive sleep apnea and age on daytime blood pressure. Eur Arch Otorhinolaryngol 2011; 269:1527-32. [PMID: 22002463 DOI: 10.1007/s00405-011-1800-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 09/28/2011] [Indexed: 02/01/2023]
Abstract
Epidemiologic studies have shown obstructive sleep apnea (OSA) is an independent risk factor for systemic hypertension. The prevalence of systemic hypertension also increases gradually with age. The purpose of this study was to assess the combined effect of OSA and age on daytime blood pressure. Patients who received nocturnal polysomnography in Tainan Municipal Hospital were invited between October 2008 and February 2010. Daytime blood pressure was measured. Participants were classified into three groups: nonapnea (n = 14, 18%) with RDI <5 episodes/h; mild to moderate OSA (n = 34, 43%) with RDI ≧ 5 and <30; and severe OSA (n = 31, 39%) with RDI ≧ 30. Seventy-nine patients (79/101, 78.2%) (63 males) completed the study. The mean of age, severity of OSA (RDI) and systolic blood pressure (SBP) was 40.3 ± 15.4 years, 28.1 ± 26.0/h and 132.6 ± 19.7 mmHg, respectively. RDI and age were significant risk factors for SBP (P < 0.05). SBP became severe when patients were older in the group of mild to moderate OSA (p = 0.0067) and diastolic blood pressure (DBP) became severe when patients were older in the group of nonapnea and mild to moderate OSA (P = 0.0042 and 0.0168, respectively). But the daytime blood pressure and age were not correlated significantly for the severe OSA subjects. This study revealed that age and RDI were risk factors in development of daytime hypertension. For patients with mild to moderate OSA, SBP was significantly worse when getting older and for patients with nonapnea and mild to moderate OSA, DBP was significantly worse with increasing age.
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Abstract
Obstructive sleep apnea (OSA) is a condition in which the upper airway becomes constricted or occluded during sleep, leading to decreased or absent airflow, hypoxia, and sympathetic activation. This chain of events, occurring dozens of times an hour, can contribute to the development of hypertension, coronary artery disease, heart failure, and stroke. This article discusses the epidemiology of comorbid OSA and cardiovascular disease, the pathophysiology of OSA, how it acts as a risk factor for cardiovascular problems, and how appropriate treatment of OSA ameliorates the consequences. The importance of having a high suspicion for OSA in people with risk factors (including obesity, middle age, male or postmenopausal female) or symptoms (snoring, excessive daytime sleepiness, difficulty concentrating) is pointed out. The article concludes with clinical and research implications.
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Affiliation(s)
- Judith L Reishtein
- College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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Mohsenin V, Urbano F. Circulating antiangiogenic proteins in obstructive sleep apnea and hypertension. Respir Med 2011; 105:801-7. [DOI: 10.1016/j.rmed.2011.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/03/2011] [Accepted: 01/05/2011] [Indexed: 01/09/2023]
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