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Zhang B, Lu S, Guo H, Xu J, Xiao Z, Tang J. Relationship between ODI and sleep structure of obstructive sleep apnea and cardiac remodeling. Sleep Breath 2024; 28:173-181. [PMID: 37453997 DOI: 10.1007/s11325-023-02872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the quantitative relationship between Oxygen Desaturation Index (ODI) and sleep structure of obstructive sleep apnea (OSA) and cardiac remodeling. METHODS In this study, patients were enrolled from January 2015 to October 2022, and were divided into 3 groups according to AHI: patients with AHI < 15, patients with 15 ≤ AHI < 30, and 260 patients with AHI ≥ 30. Stratified linear regression was used to analyze independent risk factors for cardiac remodeling in OSA. RESULTS A total of 479 patients were enrolled. We found that compared with AHI < 15 group (n = 120), the group with AHI > 30 (n = 260) had increased left atrial anteroposterior diameter, left ventricular end-diastolic internal diameter, left ventricular posterior wall thickness, right ventricular anteroposterior diameter, and interventricular septal thickness (P < 0.05). The group with 15 ≤ AHI ≤ 30 (n = 99) had increased left atrial anteroposterior diameter (P < 0.05). Multivariate linear regression revealed that N2 sleep was an independent risk factor for left ventricular posterior wall thickness, with positive correlation (p < 0.05). N3 sleep was an independent risk factor for transverse right atrial diameter and right ventricular anteroposterior diameter, with negative correlation (P < 0.05). ODI was an independent risk factor for interventricular septal thickness, with positive correlation (P < 0.05). The arousal index was an independent risk factor for increased left atrial anteroposterior diameter, with positive correlation (P < 0.05). CONCLUSIONS Increased ODI is an independent risk factor for interventricular septal thickness, while decreased slow wave sleep is an independent risk factor for right heart remodeling in OSA.
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Affiliation(s)
- Baokun Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766 Jingshi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Shanshan Lu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Huiying Guo
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Juanjuan Xu
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Zhang Xiao
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China
| | - Jiyou Tang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766 Jingshi Road, Jinan, Shandong, 250012, People's Republic of China.
- Department of Neurology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Jinan, People's Republic of China.
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Association of Obstructive Sleep Apnea Syndrome (OSA/OSAHS) with Coronary Atherosclerosis Risk: Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8905736. [PMID: 36035275 PMCID: PMC9402316 DOI: 10.1155/2022/8905736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Objective Obstructive sleep apnea syndrome (OSA) is the most common type of sleep disorders. This study aimed to systematically review the correlation between OSA and the risk of coronary atherosclerosis. Methods Literature on case-control studies on the relationship between coronary heart disease (CHD) and sleep apnea syndrome was collected and collated, and the incidence of SAS in CHD and non-CHD patients was observed and compared. RevMan 5.2 analysis software and Stata12SE analysis software were used for heterogeneity test and combination analysis of the included studies. The results were expressed with odds ratio (OR), 95% confidence intervals (CI) were calculated, and publication bias and sensitivity tests were evaluated. Results There was a statistical difference in OSA associated with the risk of coronary atherosclerosis between the experimental group and the control group [OR = 1.38, 95% CI (1.18, 1.62), P < 0.0001, I 2 = 0%, Z = 3.93]. OSA associated with vascular endothelial injury [OR = 3.59, 95% CI (3.00, 4.29), P < 0.00001, I 2 = 90%, Z = 14.09]. OSA is associated with vascular oxidation emergency [OR = 2.19, 95% CI (2.05, 2.33), P < 0.00001, I 2 = 94%, Z = 23.40]; OSA is associated with chronic vascular inflammation [OR = 1.70, 95% CI (1.39, 2.07), P < 0.00001, I 2 = 16%, Z = 5.18]. Conclusion The incidence of obstructive sleep apnea in patients with CHD was higher than that in non-CHD patients, and obstructive sleep apnea was a risk factor for CHD.
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Peker Y, Holtstrand-Hjälm H, Celik Y, Glantz H, Thunström E. Postoperative Atrial Fibrillation in Adults with Obstructive Sleep Apnea Undergoing Coronary Artery Bypass Grafting in the RICCADSA Cohort. J Clin Med 2022; 11:jcm11092459. [PMID: 35566586 PMCID: PMC9103536 DOI: 10.3390/jcm11092459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 02/08/2023] Open
Abstract
Postoperative atrial fibrillation (POAF) occurs in 20−50% of patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG). Obstructive sleep apnea (OSA) is also common in adults with CAD, and may contribute to POAF as well to the reoccurrence of AF in patients at long-term. In the current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure (CPAP) in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we included 147 patients with CABG, who underwent a home sleep apnea testing, in average 73 ± 30 days after the surgical intervention. POAF was defined as a new-onset AF occurring within the 30 days following the CABG. POAF was observed among 48 (32.7%) patients, occurring within the first week among 45 of those cases. The distribution of the apnea-hypopnea-index (AHI) categories < 5.0 events/h (no-OSA); 5.0−14.9 events/h (mild OSA); 15.0−29.9 events/h (moderate OSA); and ≥30 events/h (severe OSA), was 4.2%, 14.6%, 35.4%, and 45.8%, in the POAF group, and 16.2%, 17.2%, 39.4%, and 27.3%, respectively, in the no-POAF group. In a multivariate logistic regression model, there was a significant risk increase for POAF across the AHI categories, with the highest odds ratio (OR) for severe OSA (OR 6.82, 95% confidence interval 1.31−35.50; p = 0.023) vs. no-OSA, independent of age, sex, and body-mass-index. In the entire cohort, 90% were on β-blockers according to the clinical routines, they all had sinus rhythm on the electrocardiogram at baseline before the study start, and 28 out of 40 patients with moderate to severe OSA (70%) were allocated to CPAP. During a median follow-up period of 67 months, two patients (none with POAF) were hospitalized due to AF. To conclude, severe OSA was significantly associated with POAF in patients with CAD undergoing CABG. However, none of those individuals had an AF-reoccurrence at long term, and whether CPAP should be considered as an add-on treatment to β-blockers in secondary prevention models for OSA patients presenting POAF after CABG requires further studies in larger cohorts.
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Affiliation(s)
- Yüksel Peker
- Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine [KUTTAM], Istanbul 34450, Turkey;
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (H.H.-H.); (E.T.)
- Department of Clinical Sciences, Respiratory Medicine and Allergology, School of Medicine, Lund University, 22185 Lund, Sweden
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Correspondence:
| | - Henrik Holtstrand-Hjälm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (H.H.-H.); (E.T.)
| | - Yeliz Celik
- Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine [KUTTAM], Istanbul 34450, Turkey;
| | - Helena Glantz
- Department of Internal Medicine, Skaraborg Hospital, 53151 Lidköping, Sweden;
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (H.H.-H.); (E.T.)
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Chen YL, Chen YC, Wang HT, Chang YT, Fang YN, Hsueh S, Liu WH, Lin PT, Hsu PY, Su MC, Huang KT, Lin MC. The Impact of Intermittent Hypoxemia on Left Atrial Remodeling in Patients with Obstructive Sleep Apnea Syndrome. Life (Basel) 2022; 12:life12020148. [PMID: 35207436 PMCID: PMC8874769 DOI: 10.3390/life12020148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a significant risk factor for left atrial (LA) remodeling. Intermittent hypoxemia occurs during the sleep cycle in patients with OSAS and plays a crucial role in cardiovascular pathologies such as stroke, arrhythmia, and coronary artery disease. However, there is very little information about the role of intermittent hypoxemia in LA remodeling in patients with OSAS. In total, 154 patients with sleep-related breathing disorders (SRBD) were prospectively recruited for this study. All enrolled SRBD patients underwent polysomnography and echocardiography. Significant OSAS was defined as an oxygen desaturation index (ODI) of ≥10 per hour. Intermittent hypoxia/reoxygenation (IHR) stimulation was used to test the effect of hypoxia on the viability, reactive oxygen species, apoptosis, and inflammation-associated cytokine expression in the HL-1 cell line. To investigate the effect of patients’ exosomes on HIF-1 and inflammation-associated cytokine expression, as well as the relationship between ODI and their expression, exosomes were purified from the plasma of 95 patients with SRBD and incubated in HL-1 cells. The LA size was larger in patients with significant OSAS than in those without. There was a significant association between ODI, lowest SpO2, mean SpO2, and LA size (all p < 0.05) but not between the apnea–hypopnea index and LA size. IHR condition caused increased LDH activity, reactive oxygen species (ROS) levels, and apoptosis in HL-1 cells and decreased cellular viability (all p < 0.05). The expression of HIF-1α, TNF-α, IL-6, and TGF-β increased in the IHR condition compared with the control (all p < 0.05). The expression of HIF-1α, IL-1β, and IL-6 increased in the HL-1 cells incubated with exosomes from those patients with significant OSAS than those without (all p < 0.05). There was a significantly positive correlation between ODI and the expression of HIF-1α, TNF-α, IL-1β, IL-6, and TGF-β; a significantly negative correlation between mean SpO2 and IL-6 and TGF-β; and a significantly negative correlation between the lowest SpO2 and HIF-1α (all p < 0.05). In conclusion, intermittent hypoxemia was strongly associated with LA remodeling, which might be through increased ROS levels, LDH activity, apoptosis, and the expression of HIF-1α and inflammation-associated cytokines.
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Affiliation(s)
- Yung-Lung Chen
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Che Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Hui-Ting Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ya-Ting Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yen-Nan Fang
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Shukai Hsueh
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Wen-Hao Liu
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Pei-Ting Lin
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (Y.-L.C.); (Y.-N.F.); (S.H.); (W.-H.L.); (P.-T.L.)
| | - Po-Yuan Hsu
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Mao-Chang Su
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Kuo-Tung Huang
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
| | - Meng-Chih Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (H.-T.W.); (Y.-T.C.)
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (P.-Y.H.); (M.-C.S.); (K.-T.H.)
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8300)
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Zeng R, Jiang YT, Chen TW, Guo DD, Li R. Longitudinal associations of sleep duration and sleep quality with coronary heart disease risk among adult population: classical meta-analysis and Bayesian network meta-analysis. Sleep Biol Rhythms 2021; 19:265-276. [DOI: 10.1007/s41105-021-00312-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
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Obstructive sleep apnoea syndrome and left ventricular hypertrophy: a meta-analysis of echocardiographic studies. J Hypertens 2021; 38:1640-1649. [PMID: 32371766 DOI: 10.1097/hjh.0000000000002435] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM We investigated the association between obstructive sleep apnoea (OSA) and subclinical cardiac organ damage through a meta-analysis of echocardiographic studies that provided data on left ventricular hypertrophy (LVH), assessed as a categorical or continuous variable. DESIGN The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search English-language articles published from 1 January 2000 to 15 August 2019. Studies were detected by using the following terms: 'obstructive sleep apnea', 'sleep quality', 'sleep disordered breathing', 'cardiac damage', 'left ventricular mass', 'left ventricular hypertrophy', and 'echocardiography'. RESULTS Meta-analysis included 5550 patients with OSA and 2329 non-OSA controls from 39 studies. The prevalence of LVH in the pooled OSA population was 45% (CI 35--55%). Meta-analysis of studies comparing the prevalence of LVH in participants with OSA and controls showed that OSA was associated with an increased risk of LVH (OR = 1.70, CI 1.44-2.00, P < 0.001). LV mass was significantly increased in patients with severe OSA as compared with controls (SMD 0.46 ± 0.08, CI 0.29-0.62, P < 0.001) or with mild OSA. This was not the case for studies comparing patients with unselected or predominantly mild OSA and controls (0.33 ± 0.17, CI -0.01 to 0.67, P = 0.057). CONCLUSION The present meta-analysis expands previous information on the relationship between OSA and echocardiographic LVH, so far based on individual studies. The overall evidence strongly suggests that the likelihood of LVH increases with the severity of OSA, thus exhibiting a continuous relationship.
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Causal effects of dietary calcium, zinc and iron intakes on coronary artery disease in men: G-estimation and inverse probability of treatment weighting (IPTW) analyses. Clin Nutr ESPEN 2021; 42:73-81. [PMID: 33745624 DOI: 10.1016/j.clnesp.2020.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/01/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Dietary minerals have significant effects on the risk of cardiovascular disease. However, the results of previous studies were not uniform across different countries. The current study aims to determine the causal effects of dietary calcium, zinc, and iron intakes on coronary artery disease (CAD) among Nepalese men. METHODS A matched case-control study was carried out at Shahid Gangalal National Heart Center. Dietary intakes of 466 male participants over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. G-estimation and inverse probability treatment weighting (IPTW) analyses were performed to determine the causal odds of CAD due to dietary calcium, zinc, and iron intakes. RESULTS Daily dietary calcium, zinc, and iron intakes were categorized into two groups: less than versus more than the median value and less than versus equal or more than recommended daily allowance (RDA). In G-estimation, dietary calcium intake was inversely associated with CAD in both medians (OR: 91; 91%CI: 0.86, 95) and RDA categories (OR: 0.88: 95%CI: 0.84, 0.97). However, in IPTW analysis, only median calcium intake was significantly associated with CAD (OR: 7; 91%CI: 0.5, 98). We observed a significant inverse association of equal or more than RDA of dietary zinc intake with CAD (OR: 0.91: 95%CI: 0.87, 0.96 in G-estimation, OR: 0.73: 95%CI: 0.66, 0.82 in IPTW); however, more than median dietary zinc intake showed inverse but not significant association with CAD in both analyses. Dietary iron intake was inversely but not significantly associated with CAD in G-estimation in both groups. Nevertheless, in IPTW analysis, equal or more than RDA iron intake was significantly positively (OR: 1.4; 95%CI: 1.14, 1.73) related to CAD. CONCLUSIONS A significant inverse association of dietary zinc intake above RDA indicates the potential protective effect of higher dietary zinc against CAD. However, causal odds of CAD are inconsistent across the median or RDA of calcium and iron intakes. Therefore, cohort and randomized clinical trial studies with a large sample size are recommended to substantiate these nutrients' causal link with CAD development in the Nepalese population.
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Alonderis A, Raskauskiene N, Gelziniene V, Zaliunaite V, Brozaitiene J. Undiagnosed sleep apnoea in cardiac rehabilitation: Age-dependent effect on diastolic function in coronary artery disease patients with preserved ejection fraction. Eur J Cardiovasc Nurs 2021; 20:202–211. [PMID: 33611367 DOI: 10.1177/1474515120941373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea. METHODS AND RESULTS This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed. CONCLUSIONS Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.
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Chen Q, Lin G, Chen Y, Li C, Wu L, Hu X, Lin Q. miR-3574 ameliorates intermittent hypoxia-induced cardiomyocyte injury through inhibiting Axin1. Aging (Albany NY) 2021; 13:8068-8077. [PMID: 33582657 PMCID: PMC8034950 DOI: 10.18632/aging.202480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/31/2020] [Indexed: 12/11/2022]
Abstract
Objective: miRNAs play critical roles in the regulation of many cardiovascular diseases. However, its role and potential mechanism in cardiac injury caused by obstructive sleep apnea (OSA) remain poorly elucidated. In the present study, we aimed to investigate the effects of miR-3574 on cardiomyocyte injury under intermittent hypoxia (IH). Results: We confirmed that IH inhibited cell viability, induced cell apoptosis and suppressed miR-3574 expression in the H9c2. miR-3574 overexpression could ameliorate the effects of IH on the cell viability and cell apoptosis in the H9c2. Axin1 was a target gene of miR-3574, and miR-3574 overexpression reduced the expression of Axin1. miR-3574 could inhibit the IH-induced cardiomyocyte injury via downregulating Axin1. However, Axin1 could partially reverse these effects of miR-3574. Conclusion: Our study first reveals that miR-3574 could alleviate IH-induced cardiomyocyte injury by targeting Axin1, which may function as a novel and promising therapy target for OSA-associated cardiovascular diseases. Methods: H9c2 were exposed to IH condition. CCK-8 assay was applied to determine cell viability of H9c2. qRT-PCR was conducted to measure the expression level of mRNA and miRNA. Western blot assay was then performed to detect the protein levels. Finally, we used dual-luciferase reporter assay identify the potential target of miR-3574.
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Affiliation(s)
- Qingshi Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China.,Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
| | - Guofu Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
| | - Yongfa Chen
- The First Affiliated Hospital of Xiamen University, Siming, Xiamen 361001, China
| | - Chaowei Li
- The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Lizhen Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Xin Hu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Fengze, Quanzhou 362000, China
| | - Qichang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Taijiang, Fuzhou 350005, China
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Polesel DN, Nozoe KT, Bittencourt L, Tufik S, Andersen ML, Fernandes MTB, Hachul H. Waist-to-height ratio and waist circumference as the main measures to evaluate obstructive sleep apnea in the woman's reproductive life stages. Women Health 2021; 61:277-288. [PMID: 33390097 DOI: 10.1080/03630242.2020.1862386] [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] [Indexed: 10/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder. In women, the frequency of OSA increases substantially during and after the menopause, as does the prevalence of obesity in this reproductive life stage. This cross-sectional study uses data from the Sao Paulo Epidemiologic Sleep Study (EPISONO, 2007), and comprises a sample of 500 women aged 20-80 years. Multiple logistic regression analysis was used to assess the factors associated with OSA in premenopausal and postmenopausal women. All participants underwent polysomnography, and obesity was assessed using the waist-to-height ratio (WHtR), body mass index, neck and waist circumference, measured using standard methods. WHtR was the factor most associated with a significant increase in risk of OSA in premenopausal women. Waist circumference was the factor most associated with OSA in postmenopausal women, for all severities of the disease. Anthropometric factors presented a high rate of accuracy in the classification of women with OSA. The study found that different obesity-related anthropometric measures should be considered in the diagnosis of OSA, according to the woman's reproductive stage.
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Affiliation(s)
| | - Karen Tieme Nozoe
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Lia Bittencourt
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | - Monica Levy Andersen
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
| | | | - Helena Hachul
- Departmento de Psicobiologia, Universidade Federal De São Paulo, São Paulo, SP, Brazil
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Cuspidi C, Tadic M, Gherbesi E, Sala C, Grassi G. Targeting subclinical organ damage in obstructive sleep apnea: a narrative review. J Hum Hypertens 2021; 35:26-36. [PMID: 32801297 DOI: 10.1038/s41371-020-00397-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 12/19/2022]
Abstract
Subclinical abnormalities in cardiac and vascular structure reflect the adverse effects triggered by a variety of risk factors on the cardiovascular (CV) system thereby representing an intermediate step in the cardiovascular continuum; such alterations are recognized as reliable markers of increased cardiovascular risk in different clinical settings including obstructive sleep apnea (OSA). The mechanisms underlying subclinical organ damage (OD) in the OSA setting are multifactorial. Hypoxemia and hypercapnia, induced by repeated collapses of upper airways, have been suggested to trigger a cascade of events such as activation of the sympathetic tone, renin-angiotensin-aldosterone system leading to endothelial dysfunction, vasoconstriction, myocardial and vascular remodeling, and hypertension. Furthermore, coexisting non-haemodynamic alterations such as increased oxidative stress, release of inflammatory substances, enhanced lipolysis and insulin resistance have been reported to play a role in the pathogenesis of both cardiac and extra-cardiac OD. In this article we reviewed available evidence on the association between OSA and subclinical cardiac (i.e., left and right ventricular hypertrophy, left atrial dilatation) and extra-cardiac organ damage (i.e., carotid atherosclerosis, arterial stiffness, microvascular retinal changes, and microalbuminuria). This association is apparently stronger for cardiac and carotid subclinical damage than for other markers (i.e., arterial stiffness and retinal changes) and mostly evident in the setting of severe OSA.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
- Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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12
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Cuspidi C, Tadic M, Sala C, Grassi G. Is the association between sleep apnea and left ventricular hypertrophy obesity-independent? J Clin Hypertens (Greenwich) 2020; 22:1282-1283. [PMID: 32530548 DOI: 10.1111/jch.13908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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13
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Metoprolol prevents neuronal dendrite remodeling in a canine model of chronic obstructive sleep apnea. Acta Pharmacol Sin 2020; 41:620-628. [PMID: 31863057 PMCID: PMC7470867 DOI: 10.1038/s41401-019-0323-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/26/2019] [Indexed: 12/30/2022] Open
Abstract
Obstructive sleep apnea (OSA) is closely associated with central nervous system diseases and could lead to autonomic nerve dysfunction, which is often seen in neurodegenerative diseases. Previous studies have shown that metoprolol prevents several chronic OSA-induced cardiovascular diseases through inhibiting autonomic nerve hyperactivity. It remains unclear whether chronic OSA can lead to dendritic remodeling in the brain, and whether metoprolol affects the dendritic remodeling. In this study we investigated the effect of metoprolol on dendrite morphology in a canine model of chronic OSA, which was established in beagles through clamping and reopening the endotracheal tube for 4 h every other day for 12 weeks. OSA beagles were administered metoprolol (5 mg· kg−1· d−1). The dendritic number, length, crossings and spine density of neurons in hippocampi and prefrontal cortices were assessed by Golgi staining. And the protein levels of hypoxia-inducible factor-1α (HIF-1α) and brain-derived neurotrophic factor (BDNF) were measured by Western blotting. We showed that chronic OSA successfully induced significant brain hypoxia evidenced by increased HIF-1α levels in CA1 region and dentate gyrus of hippocampi, as well as in prefrontal cortex. Furthermore, OSA led to markedly decreased dendrite number, length and intersections, spine loss as well as reduced BDNF levels. Administration of metoprolol effectively prevented the dendritic remodeling and spine loss induced by chronic OSA. In addition, administration of metoprolol reversed the decreased BDNF, which might be associated with the metoprolol-induced neuronal protection. In conclusion, metoprolol protects against neuronal dendritic remodeling in hippocampi and prefrontal cortices induced by chronic OSA in canine.
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14
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Sleep-Disordered Breathing and Diastolic Heart Disease. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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16
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Aziz EF, Selby A, Argulian E, Aziz J, Herzog E. Pathway for the Management of Sleep Apnea in the Cardiac Patient. Crit Pathw Cardiol 2017; 16:81-88. [PMID: 28742642 DOI: 10.1097/hpc.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sleep-disordered breathing is a highly prevalent medical condition, which if undiagnosed leads to increased morbidity and mortality, particularly related to increased incidence of cardiovascular events. It is therefore imperative that we identify patient population at high risk for sleep apnea and refer them to the appropriate therapy as early as possible. Up-to-date there is no management guideline specifically geared towards cardiac patients. Thus, we propose a (SAP) Sleep Apnea Pathway to correctly identify and triage these patients to the appropriate therapy.
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Affiliation(s)
- Emad F Aziz
- From Mount Sinai St. Luke's and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
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Holtstrand Hjälm H, Fu M, Hansson PO, Zhong Y, Caidahl K, Mandalenakis Z, Morales D, Ergatoudes C, Rosengren A, Grote L, Thunström E. Association between left atrial enlargement and obstructive sleep apnea in a general population of 71-year-old men. J Sleep Res 2017; 27:252-258. [PMID: 28836321 DOI: 10.1111/jsr.12585] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/14/2017] [Indexed: 01/10/2023]
Abstract
Left atrial enlargement has been shown to be associated with obstructive sleep apnea in patients with coronary artery disease and in sleep clinic cohorts. However, data from the general population are limited. The aim of this study was to investigate whether there is an association between obstructive sleep apnea and left atrial enlargement in a random sample from a general population of 71-year-old men. As part of the longitudinal population study The Study of Men Born in 1943, we analysed cross-sectional data for 411 men, all 71 years old, who had participated in an overnight home sleep study and a standardized echocardiographic examination. Of the 411 men, 29.4% had moderate to severe obstructive sleep apnea [apnea-hypopnea index score of ≥15 (n = 121)]. These participants showed a significantly higher frequency of systolic heart failure, hypertension, overweight, had greater waist circumference as well as higher left atrial areas compared with men with no or mild obstructive sleep apnea (23.7 ± 5.5 cm2 versus 21.6 ± 4.5 cm2 , P < 0.001). In a linear regression analysis, obstructive sleep apnea was significantly associated with left atrial enlargement after adjusting for overweight, atrial fibrillation, heart failure with reduced ejection fraction, hypertension and mitral regurgitation. Compared with individuals without obstructive sleep apnea, the mean left atrial area was 1.7 ± 1.5 cm2 larger in men with severe obstructive sleep apnea (P < 0.05) and 1.3 ± 1.1 cm2 larger among men with moderate obstructive sleep apnea (P < 0.05). In this cross-sectional study of 71-year-old men from the general population, left atrial area was independently associated with prevalence and severity of obstructive sleep apnea.
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Affiliation(s)
- Henrik Holtstrand Hjälm
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden.,Skaraborg Hospital, Skövde, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - You Zhong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - David Morales
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Constantinos Ergatoudes
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy/Sahlgrenska Academy Hospital, University of Gothenburg, Gothenburg, Sweden
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18
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Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial. Int J Cardiol 2017; 241:12-18. [PMID: 28408103 DOI: 10.1016/j.ijcard.2017.03.100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/24/2017] [Accepted: 03/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA. METHODS Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] score<10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months. RESULTS A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline. CONCLUSIONS CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.
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19
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de Batlle J, Turino C, Sánchez-de-la-Torre A, Abad J, Duran-Cantolla J, McEvoy RD, Antic NA, Mediano O, Cabriada V, Masdeu MJ, Teran J, Valls J, Barbé F, Sánchez-de-la-Torre M. Predictors of obstructive sleep apnoea in patients admitted for acute coronary syndrome. Eur Respir J 2017; 49:49/3/1600550. [DOI: 10.1183/13993003.00550-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/20/2016] [Indexed: 11/05/2022]
Abstract
Identifying undiagnosed obstructive sleep apnoea (OSA) patients in cardiovascular clinics could improve their management. Aiming to build an OSA predictive model, a broad analysis of clinical variables was performed in a cohort of acute coronary syndrome (ACS) patients.Sociodemographic, anthropometric, life-style and pharmacological variables were recorded. Clinical measures included blood pressure, electrocardiography, echocardiography, blood count, troponin levels and a metabolic panel. OSA was diagnosed using respiratory polygraphy. Logistic regression models and classification and regression trees were used to create predictive models.A total of 978 patients were included (298 subjects with apnoea–hypopnoea index (AHI) <15 events·h−1and 680 with AHI ≥15 events·h−1). Age, BMI, Epworth sleepiness scale, peak troponin levels and use of calcium antagonists were the main determinants of AHI ≥15 events·h−1(C statistic 0.71; sensitivity 94%; specificity 24%). Age, BMI, blood triglycerides, peak troponin levels and Killip class ≥II were determinants of AHI ≥30 events·h−1(C statistic of 0.67; sensitivity 31%; specificity 86%).Although a set of variables associated with OSA was identified, no model could successfully predict OSA in patients admitted for ACS. Given the high prevalence of OSA, the authors propose respiratory polygraphy as a to-be-explored strategy to identify OSA in ACS patients.
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20
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Le Grande MR, Neubeck L, Murphy BM, McIvor D, Lynch D, McLean H, Jackson AC. Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association. Eur J Prev Cardiol 2016; 23:1466-75. [DOI: 10.1177/2047487316652975] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Dawn McIvor
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- CNC Cardiology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Dianna Lynch
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Ashford Hospital, Australia
| | - Helen McLean
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Royal Perth Hospital, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- University of Hong Kong, Centre on Behavioural Health, Hong Kong
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21
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Korcarz CE, Peppard PE, Young TB, Chapman CB, Hla KM, Barnet JH, Hagen E, Stein JH. Effects of Obstructive Sleep Apnea and Obesity on Cardiac Remodeling: The Wisconsin Sleep Cohort Study. Sleep 2016; 39:1187-95. [PMID: 27091525 PMCID: PMC4863205 DOI: 10.5665/sleep.5828] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/11/2016] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVES To characterize the prospective associations of obstructive sleep apnea (OSA) with future echocardiographic measures of adverse cardiac remodeling. METHODS This was a prospective long-term observational study. Participants had overnight polysomnography followed by transthoracic echocardiography a mean (standard deviation) of 18.0 (3.7) y later. OSA was characterized by the apnea-hypopnea index (AHI, events/hour). Echocardiography was used to assess left ventricular (LV) systolic and diastolic function and mass, left atrial volume and pressure, cardiac output, systemic vascular resistance, and right ventricular (RV) systolic function, size, and hemodynamics. Multivariate regression models estimated associations between log10(AHI+1) and future echocardiographic findings. A secondary analysis looked at oxygen desaturation indices and future echocardiographic findings. RESULTS At entry, the 601 participants were mean (standard deviation) 47 (8) y old (47% female). After adjustment for age, sex, and body mass index, baseline log10(AHI+1) was associated significantly with future reduced LV ejection fraction and tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm. After further adjustment for cardiovascular risk factors, participants with higher baseline log10(AHI+1) had lower future LV ejection fraction (β = -1.35 [standard error = 0.6]/log10(AHI+1), P = 0.03) and higher odds of TAPSE ≤ 15 mm (odds ratio = 6.3/log10(AHI+1), 95% confidence interval = 1.3-30.5, P = 0.02). SaO2 desaturation indices were associated independently with LV mass, LV wall thickness, and RV area (all P < 0.03). CONCLUSIONS OSA is associated independently with decreasing LV systolic function and with reduced RV function. Echocardiographic measures of adverse cardiac remodeling are strongly associated with OSA but are confounded by obesity. Hypoxia may be a stimulus for hypertrophy in individuals with OSA.
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Affiliation(s)
- Claudia E. Korcarz
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul E. Peppard
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Terry B. Young
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carrie B. Chapman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - K. Mae Hla
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jodi H. Barnet
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Erika Hagen
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James H. Stein
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Maeder MT, Schoch OD, Rickli H. A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vasc Health Risk Manag 2016; 12:85-103. [PMID: 27051291 PMCID: PMC4807890 DOI: 10.2147/vhrm.s74703] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.
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Affiliation(s)
- Micha T Maeder
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Otto D Schoch
- Department of Respiratory Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
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