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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cattazzo F, Pengo MF, Giontella A, Soranna D, Bilo G, Zambon A, Karalliedde J, Gnudi L, Martinez-Garcia MÁ, Minuz P, Lombardi C, Parati G, Fava C. Effect of Continuous Positive Airway Pressure on Glucose and Lipid Profiles in Patients With Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arch Bronconeumol 2023:S0300-2896(23)00111-4. [PMID: 37024342 DOI: 10.1016/j.arbres.2023.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND AIM Continuous Positive Airway Pressure (CPAP) is the most effective therapy for symptomatic obstructive sleep apnoea (OSA). However, uncertainty remains about the effectiveness of CPAP in improving OSA-related metabolic dysregulation. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments, could improve glucose or lipid metabolism in OSA patients. METHODS Relevant articles were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 6th Feb 2022 through specific search terms and selection criteria. RESULTS From a total of 5553 articles, 31 RCTs were included. CPAP modestly improved insulin sensitivity as determined by mean fasting plasma insulin and Homeostasis Model Assessment of Insulin Resistance reduction of 1.33mU/L and 0.287, respectively. In subgroup analyses pre-diabetic/type 2 diabetic patients as well as those with sleepy OSA showed a greater response to CPAP. Regarding lipid metabolism, CPAP was associated with a mean total cholesterol reduction of 0.064mmol/L. In subgroup analyses, the benefit was higher in patients that showed more severe OSA and oxygen desaturations at the baseline sleep study as well as in younger and obese subjects. Neither glycated haemoglobin nor triglycerides, HDL- and LDL-cholesterol were reduced by CPAP. CONCLUSION CPAP treatment may improve insulin sensitivity and total cholesterol levels in OSA patients but with low effect size. Our results suggest that CPAP does not substantially improve metabolic derangements in an unselected OSA population, but the effect may be higher in specific subgroups of OSA patients.
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Affiliation(s)
- Filippo Cattazzo
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Martino F Pengo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alice Giontella
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Davide Soranna
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Grzegorz Bilo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Janaka Karalliedde
- School of Cardiovascular Medicine & Sciences, Section Vascular Biology and Inflammation, Unit for Metabolic Medicine, King's College London, London, UK
| | - Luigi Gnudi
- School of Cardiovascular Medicine & Sciences, Section Vascular Biology and Inflammation, Unit for Metabolic Medicine, King's College London, London, UK
| | - Miguel Ángel Martinez-Garcia
- Department of Pneumology, Hospital Universitari i Politècnic la Fe, Valencia, Spain; CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Pietro Minuz
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Carolina Lombardi
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy.
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Zhang Y, Elgart M, Kurniansyah N, Spitzer BW, Wang H, Kim D, Shah N, Daviglus M, Zee PC, Cai J, Gottlieb DJ, Cade BE, Redline S, Sofer T. Genetic determinants of cardiometabolic and pulmonary phenotypes and obstructive sleep apnoea in HCHS/SOL. EBioMedicine 2022; 84:104288. [PMID: 36174398 PMCID: PMC9515437 DOI: 10.1016/j.ebiom.2022.104288] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obstructive Sleep Apnoea (OSA) often co-occurs with cardiometabolic and pulmonary diseases. This study is to apply genetic analysis methods to explain the associations between OSA and related phenotypes. METHODS In the Hispanic Community Healthy Study/Study of Latinos, we estimated genetic correlations ρg between the respiratory event index (REI) and 54 anthropometric, glycemic, cardiometabolic, and pulmonary phenotypes. We used summary statistics from published genome-wide association studies to construct Polygenic Risk Scores (PRSs) representing the genetic basis of each correlated phenotype (ρg>0.2 and p-value<0.05), and of OSA. We studied the association of the PRSs of the correlated phenotypes with both REI and OSA (REI≥5), and the association of OSA PRS with the correlated phenotypes. Causal relationships were tested using Mendelian Randomization (MR) analysis. FINDINGS The dataset included 11,155 participants, 31.03% with OSA. 22 phenotypes were genetically correlated with REI. 10 PRSs covering obesity and fat distribution (BMI, WHR, WHRadjBMI), blood pressure (DBP, PP, MAP), glycaemic control (fasting insulin, HbA1c, HOMA-B) and insomnia were associated with REI and/or OSA. OSA PRS was associated with BMI, WHR, DBP and glycaemic traits (fasting insulin, HbA1c, HOMA-B and HOMA-IR). MR analysis identified robust causal effects of BMI and WHR on OSA, and probable causal effects of DBP, PP, and HbA1c on OSA/REI. INTERPRETATION There are shared genetic underpinnings of anthropometric, blood pressure, and glycaemic phenotypes with OSA, with evidence for causal relationships between some phenotypes. FUNDING Described in Acknowledgments.
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Affiliation(s)
- Yuan Zhang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Michael Elgart
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nuzulul Kurniansyah
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian W. Spitzer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Doyoon Kim
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Neomi Shah
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel J. Gottlieb
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian E. Cade
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Corresponding author at: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
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Obesity as a mediator linking sleep-disordered breathing to both impaired fasting glucose and type 2 diabetes. Sleep Breath 2022; 27:1067-1080. [DOI: 10.1007/s11325-022-02705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
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Serednytskyy O, Alonso-Fernández A, Ribot C, Herranz A, Álvarez A, Sánchez A, Rodríguez P, Gil AV, Pía C, Cubero JP, Barceló M, Cerdà M, Codina M, D Peña M, Barceló A, Iglesias A, Morell-Garcia D, Peña JA, Giménez MP, Piñas MC, García-Río F. Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea. BMC Pulm Med 2022; 22:94. [PMID: 35303833 PMCID: PMC8933971 DOI: 10.1186/s12890-022-01888-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. METHODS OSA was identified by polysomnography and defined as an apnea-hypopnea index of ≥ 5 h-1. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. RESULTS We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59-134) vs. 68 (51-81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1-2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. CONCLUSIONS OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.
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Affiliation(s)
- Oleksandr Serednytskyy
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Alberto Alonso-Fernández
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain. .,Servicio de Neumología, Hospital Universitari Son Espases, Carretera de Valldemosa 79, 07010, Palma de Mallorca, Balearic Islands, Spain. .,CIBER Enfermedades Respiratorias, Madrid, Spain.
| | - Caterina Ribot
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Andrea Herranz
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - Ainhoa Álvarez
- Unidad del Sueño, Hospital Universitari de Araba, Vitoria-Gasteiz, Ávala, Spain.,Instituto de Investigación BIOARABA, Vitoria-Gasteiz, Ávala, Spain
| | - Andrés Sánchez
- Servicio de Neumología, Hospital Universitario Miguiel Servet, Zaragoza, Zaragoza, Spain
| | - Paula Rodríguez
- Instituto de Investigación BIOARABA, Vitoria-Gasteiz, Ávala, Spain
| | - Ana V Gil
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Carla Pía
- Instituto de Investigación BIOARABA, Vitoria-Gasteiz, Ávala, Spain
| | - José P Cubero
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - María Barceló
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - María Cerdà
- Servicio de Neumología, Hospital Palma Planas, Palma, Balearic Islands, Spain
| | - Mercedes Codina
- Servicio de Endocrinología, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - Mónica D Peña
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Servicio de Neumología, Hospital Universitari Son Espases, Carretera de Valldemosa 79, 07010, Palma de Mallorca, Balearic Islands, Spain.,CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Antònia Barceló
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - Amanda Iglesias
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Daniel Morell-Garcia
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - José A Peña
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Servicio de Pediatría, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain
| | - María P Giménez
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - María C Piñas
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.,Servicio de Neumología, Hospital Universitari Son Espases, Carretera de Valldemosa 79, 07010, Palma de Mallorca, Balearic Islands, Spain
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García-Sánchez A, Villalaín I, Asencio M, García J, García-Rio F. Sleep apnea and eye diseases: evidence of association and potential pathogenic mechanisms. J Clin Sleep Med 2022; 18:265-278. [PMID: 34283018 PMCID: PMC8807908 DOI: 10.5664/jcsm.9552] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eye diseases are an important group of increasingly prevalent disorders that contribute very significantly to disability and represent a considerable health burden. Some data suggest that several of these diseases may be associated with sleep-disordered breathing, mainly obstructive sleep apnea (OSA), due to intermediate mechanisms, such as intermittent hypoxia or sleep fragmentation. The aims of this systematic review were to identify and critically evaluate the current evidence supporting the existence of a possible relationship between OSA and the more relevant eye diseases as well as to evaluate the potential pathogenic mechanisms. There is a body of largely low-level evidence for the association of OSA with glaucoma, nonarteritic ischemic optic neuropathy, central serous chorioretinopathy, and diabetic retinopathy. Meta-analysis of available case-control studies shows that OSA increases the risk of glaucoma (pooled odds ratio: 1.50; 95% confidence interval: 1.25 to 1.80; P < .001), nonarteritic ischemic optic neuropathy (3.62; 1.94 to 6.76; P < .001), and diabetic retinopathy (1.57; 1.09 to 2.27; P = .02). Moreover, several pathogenic pathways have been identified, mainly related to hypoxic damage, mechanical stress, systemic inflammation, oxidative stress, sympathetic tone, and endothelial dysfunction. In contrast, information about the effect of apnea-hypopnea suppression on the development and progression of eye damage is either nonexistent or of a very low level of evidence. In conclusion, OSA has emerged as an additional potential risk factor for many eye diseases, although their link is weak and contradictory, so further examination is required. CITATION García-Sánchez A, Villalaín I, Asencio M, García J, García-Rio F. Sleep apnea and eye diseases: evidence of association and potential pathogenic mechanisms. J Clin Sleep Med. 2022;18(1):265-278.
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Affiliation(s)
- Aldara García-Sánchez
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Isabel Villalaín
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Mónica Asencio
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Jesús García
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain,Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain,Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain,Address correspondence to: Francisco Garcia-Río, PhD, Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain;
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Roig Vazquez F. Trastornos respiratorios del sueño en la gestación y sus implicaciones maternofetales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Banghøj AM, Krogager C, Kristensen PL, Hansen KW, Laugesen E, Fleischer J, Lebech Cichosz S, Poulsen PL, Glymer Kirkegaard M, Thorsteinsson B, Tarnow L. Effect of 12-week continuous positive airway pressure therapy on glucose levels assessed by continuous glucose monitoring in people with type 2 diabetes and obstructive sleep apnoea; a randomized controlled trial. Endocrinol Diabetes Metab 2021; 4:e00148. [PMID: 33855195 PMCID: PMC8029513 DOI: 10.1002/edm2.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/18/2022] Open
Abstract
Aim Obstructive sleep apnoea (OSA) is frequent in type 2 diabetes (T2D). The aim was to investigate the effect of a 12-week treatment with continuous positive airway pressure (CPAP) on glycaemic control assessed by continuous glucose monitoring (CGM), HbA1c and fasting blood glucose in patients with T2D and newly detected OSA. Methods In a randomized controlled multicentre study, 72 participants with T2D and moderate to severe OSA (78% male, age 62 ± 7, AHI 35 ± 15) were recruited from outpatient clinics in three Danish hospitals and were randomized to CPAP intervention or control. The main outcome was glycaemic control assessed by 6 days CGM at baseline and after 12-week therapy, as well as by HbA1c and fasting blood glucose. Results No significant changes were found in average glucose levels, time in glucose range, time with hypoglycaemia, time with hyperglycaemia or coefficient of variability. HbA1c decreased 0.7 mmol/mol (0.07%; P = .8) in the CPAP group and increased 0.8 mmol/mol (0.08%; P = .6) in the control group (intergroup difference, P = .6). Fasting blood glucose increased by 0.2 mmol/L (P = .02) in the CPAP group and by 0.4 mmol/L (P = .01) in the control group (intergroup difference, P = .7). In a prespecified subgroup analysis comparing participants with high adherence (minimum usage of four hours/night for 70% of all nights) to CPAP to the control group, no significant changes were observed either, although these participants had a tendency towards better glycaemic indices. Conclusions CPAP treatment for 12 weeks does not significantly change glycaemic control in patients with type 2 diabetes and OSA.
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Affiliation(s)
| | - Christoffer Krogager
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Diagnostic CentreRegional HospitalSilkeborgDenmark
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | | | | | - Esben Laugesen
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | - Jesper Fleischer
- Steno Diabetes Center AarhusAarhusDenmark
- Steno Diabetes Center SjællandHolbækDenmark
| | | | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhusDenmark
| | | | - Birger Thorsteinsson
- Department of Endocrinology and NephrologyNordsjællands HospitalHillerødDenmark
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Lise Tarnow
- Steno Diabetes Center SjællandHolbækDenmark
- Department of Clinical ResearchNordsjællands HospitalHillerødDenmark
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9
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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis 2021; 12:570-585. [PMID: 33815883 PMCID: PMC7990374 DOI: 10.14336/ad.2020.0707] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.
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Affiliation(s)
- Hongxia Cai
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiao-Ping Wang
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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10
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Shang W, Zhang Y, Wang G, Han D. Benefits of continuous positive airway pressure on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea: A meta-analysis. Diabetes Obes Metab 2021; 23:540-548. [PMID: 33146450 DOI: 10.1111/dom.14247] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/09/2023]
Abstract
AIM To conduct a meta-analysis to determine the effects of continuous positive airway pressure (CPAP) treatment on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea (OSA). METHODS A systematic search was made of the MEDLINE, SCOPUS, ISI Web of Science, Cochrane databases, and clinicaltrials.gov, without language restrictions. Randomized controlled trials on treatment of type 2 diabetes and OSA with CPAP, compared with sham CPAP or no CPAP, were reviewed. Studies were pooled to obtain standardized mean differences (SMDs), with 95% confidence intervals (CIs). RESULTS Seven trials (enrolling 691 participants) met the inclusion criteria. CPAP showed significant effects on glycated haemoglobin (HbA1c; SMD -0.32, 95% CI -0.60 to -0.03; P = 0.029), fasting glucose (SMD -0.39, 95% CI -0.76 to -0.02; P = 0.040), homeostatic model assessment of insulin resistance (HOMA-IR; SMD -1.05, 95% CI -1.91 to -0.19; P = 0.016), systolic blood pressure (SMD -1.18, 95% CI -2.29 to -0.07 mm Hg; P = 0.037), and diastolic blood pressure (SMD -1.29, 95% CI -2.48 to -0.09; P = 0.035). CONCLUSIONS Continuous positive airway pressure treatment significantly improved glycaemic control and insulin resistance, as shown by the decreased HbA1c levels, fasting glucose levels and HOMA-IR values in patients with type 2 diabetes and OSA.
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Affiliation(s)
- Wenli Shang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yingying Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Guizuo Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Dong Han
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
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11
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Zou J, Liu Y, Xu H, Meng L, Zou J, Qian Y, Chen B, Yi H, Guan J, Yin S. Association of apnea-hypopnea index during rapid eye movement sleep with insulin resistance in patients with suspected obstructive sleep apnea: a cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:243. [PMID: 33708870 PMCID: PMC7940895 DOI: 10.21037/atm-20-3165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Obstructive sleep apnea (OSA) is associated with insulin resistance. However, the association between special stages of OSA [rapid eye movement (REM) sleep] and insulin resistance is not clear. This study was designed to assess the association of the frequency of respiratory events during REM sleep with insulin resistance in adults with suspected OSA. Methods In this cross-sectional study, 4,062 adult participants with suspected OSA who underwent polysomnography in our sleep center between 2009 and 2016 were screened. Polysomnographic variables, biochemical indicators, and physical measurements were collected. Logistic regression analyses were conducted to determine the odds ratios (ORs) and 95% confidence intervals (95% CIs) for insulin resistance as assessed by the presence of hyperinsulinemia, the homeostasis model assessment of insulin resistance (HOMA-IR) index, the fasting insulin resistance index (FIRI), and Bennett’s insulin sensitivity index (ISI). Results The final analyses included 2,899 adults with suspected OSA. Multivariate adjustments, including the apnea-hypopnea index (AHI) during non-REM sleep (AHINREM), were performed. The AHI during REM sleep (AHIREM) was found to be independently associated with insulin resistance across increasing AHIREM quartiles. For hyperinsulinemia the ORs (95% CIs) followed the order of 1.340 (1.022, 1.757), 1.210 (0.882, 1.660), and 1.632 (1.103, 2.416). For abnormal HOMA-IR, ORs (95% CIs) were 1.287 (0.998, 1.661), 1.263 (0.933, 1.711), and 1.556 (1.056, 2.293). For abnormal FIRI, ORs (95% CIs) were 1.386 (1.048, 1.835), 1.317 (0.954, 1.818), and 1.888 (1.269, 2.807). For abnormal Bennett’s ISI, ORs (95% CIs) were 1.297 (1.003, 1.678), 1.287 (0.949, 1.747), and 1.663 (1.127, 2.452). All linear trends were statistically significant (P<0.01). Additionally, the results showed that REM sleep duration was independently associated with hyperinsulinemia (OR =0.777, 95% CI: 0.615–0.982; P<0.05). Conclusions AHIREM was independently associated with hyperinsulinemia and an abnormal HOMA-IR, FIRI, and Bennett’s ISI in adults with suspected OSA. Additionally, REM sleep duration was independently associated with hyperinsulinemia.
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Affiliation(s)
- Juanjuan Zou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Yupu Liu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University 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, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Lili Meng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jianyin Zou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yingjun Qian
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Bin Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University 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, Shanghai Jiao Tong University 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, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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12
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Prigent A, Gentina T, Launois S, Meurice JC, Pia d'Ortho M, Philippe C, Tamisier R, Gagnadoux F, Jaffuel D. [Telemonitoring in continuous positive airway pressure-treated patients with obstructive sleep apnoea syndrome: An algorithm proposal]. Rev Mal Respir 2020; 37:550-560. [PMID: 32402599 DOI: 10.1016/j.rmr.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
Most of the continuous positive airway pressure (CPAP) devices currently in use allow telemonitoring of observance, leaks and the apnoea-hypopnoea index (AHI). La Société française de recherche et de médecine du sommeil (SFRMS) and La Société de pneumologie de langue française (SPLF) workgroup offer to CPAP prescribers and to home care providers a scientific document which has the following purposes: to underline the relevance of the telemonitoring of leaks and the AHI, to define alert thresholds, to describe the principal mechanisms generating excessive leaks and high AHI, and to propose a diagnostic algorithm.
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Affiliation(s)
- A Prigent
- Groupe médical de pneumologie, polyclinique Saint-Laurent, 35000 Rennes, France.
| | - T Gentina
- Centre CESAL groupe Ramsay générale de Santé, hôpital privé Louvière, Lille, France
| | - S Launois
- CEREVES Paris Jean-Jaurès, hôpital Jean-Jaurès, 75019 Paris, France
| | - J C Meurice
- Département de pneumologie, CHU de Poitiers, Poitiers, France
| | - M Pia d'Ortho
- NeuroDiderot, Inserm, université de Paris, 75019 Paris, France; Département de physiologie - explorations fonctionnelles, hôpital Bichat, AP-HP, 75018 Paris, France
| | - C Philippe
- Unité des pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - R Tamisier
- Inserm, HP2, université Grenoble Alpes, CHU Grenoble Alpes, 38000 Grenoble, France
| | - F Gagnadoux
- Département de pneumologie et médecine du sommeil, CHU d'Angers, Angers, France; Inserm UMR 1063, université d'Angers, Angers, France
| | - D Jaffuel
- Département des maladies respiratoires, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34000 Montpellier, France; Unité des maladies respiratoires/troubles respiratoires du sommeil, polyclinique Saint-Privat, 34760 Boujan-sur-Libron, France
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13
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Efficacy of continuous positive airway pressure on subcutaneous adipose tissue in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2020; 25:1-8. [PMID: 32333260 DOI: 10.1007/s11325-020-02078-1] [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] [Received: 02/24/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE It remains inconclusive whether continuous positive airway pressure (CPAP) therapy can significantly reduce subcutaneous adipose tissue (SAT) in patients with obstructive sleep apnea (OSA). This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the impact of CPAP treatment on SAT in patients with OSA. METHODS We searched Pubmed, Cochrane, Web of Science, and Embase for RCTs, which investigated the effectiveness of CPAP treatment in reducing SAT among patients with OSA. Following the PRISMA guidelines, we extracted information on the study and patient characteristics, and pre- and post-CPAP measures of SAT. We then calculated the overall effects using the standardized mean difference (SMD) with a 95% confidence interval (CI). RESULTS A total of 5 RCTs (comprising 153 patients) met inclusion criteria for the meta-analysis. We found that the SAT did not change before and after CPAP treatment in patients with OSA (SMD = - 0.02, 95% CI - 0.25 to 0.2, z = 0.19, p = 0.85). Subgroup analyses indicated that the outcome was not affected by age, CPAP therapy duration, baseline body mass index, and measure utilized. CONCLUSION This meta-analysis of RCTs suggests that CPAP therapy does not significantly decrease the level of SAT among patients with OSA. Further large-scale, and high-quality randomized controlled trials are needed to better address this issue.
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14
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Diallo I, Pak VM. Metabolomics, sleepiness, and sleep duration in sleep apnea. Sleep Breath 2020; 24:1327-1332. [PMID: 31955318 DOI: 10.1007/s11325-019-01969-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Although the mechanism is unclear, daytime sleepiness, a common sequela of obstructive sleep apnea (OSA), has been found to be correlated with a adverse cardiovascular outcomes. Reviewing metabolomics mechanisms of sleep disturbances and cardiovascular disease may help to explain this correlation. METHODS This review examines the current literature on the relationships between sleepiness, sleep duration, and metabolites in sleep apnea. RESULTS Although there is a lack of comprehensive literature in this emerging area, existing studies point to a variety of metabolites in different pathways that are associated with sleepiness and sleep duration. CONCLUSION Advancing metabolomics research in sleep apnea will guide symptom research and provide alternate and novel opportunities for effective treatment for patients with OSA.
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Affiliation(s)
- Idiatou Diallo
- Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria M Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
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15
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Lee CP, Kushida CA, Abisheganaden JA. Epidemiological and pathophysiological evidence supporting links between obstructive sleep apnoea and Type 2 diabetes mellitus. Singapore Med J 2019; 60:54-56. [PMID: 30843078 DOI: 10.11622/smedj.2019015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnoea (OSA) and Type 2 diabetes mellitus (T2DM) are common diseases. The global prevalence of OSA is between 2% and 7% in general population cohorts. The worldwide prevalence of T2DM among adults (aged 20-79 years) was estimated to be 6.4%. The concurrent presence of OSA and T2DM can be expected in the same patient, given their high prevalence and similar predisposition. We reviewed the overlapping pathophysiology of OSA and T2DM in this article.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, United States
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16
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Dominguez JE, Krystal AD, Habib AS. Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesth Analg 2019; 127:1167-1177. [PMID: 29649034 DOI: 10.1213/ane.0000000000003335] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.
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Affiliation(s)
| | - Andrew D Krystal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry, University of California, San Francisco, San Francisco, California
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17
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Zheng D, Xu Y, You S, Hackett ML, Woodman RJ, Li Q, Woodward M, Loffler KA, Rodgers A, Drager LF, Lorenzi-Filho G, Wang X, Quan WW, Tripathi M, Mediano O, Ou Q, Chen R, Liu Z, Zhang X, Luo Y, McArdle N, Mukherjee S, McEvoy RD, Anderson CS. Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis. EClinicalMedicine 2019; 11:89-96. [PMID: 31312807 PMCID: PMC6610775 DOI: 10.1016/j.eclinm.2019.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. METHODS Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate-severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3·7 (SD 1·6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores ≥ 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients. FINDINGS CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0·80, 95% confidence interval [CI] 0·65-0·98, P = 0·031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was - 0·18 (95% CI - 0·24 to - 0·12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0·98, 95% CI 0·78-1·24, P = 0·89) and the systematic review. INTERPRETATION CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness.
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Affiliation(s)
- Danni Zheng
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ying Xu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Maree L. Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, Lancashire, UK
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly A. Loffler
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Luciano F. Drager
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Wei Wei Quan
- Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitario de Guadalajara, Universidad de Alcalá, Madrid, Spain
| | - Qiong Ou
- Sleep Center, Respiratory and Critical Medical Department, Guangdong Institute of Geriatrics, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510000, Guangdong PR, PR China
| | - Rui Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Zhihong Liu
- Department of Cardiology, Fuwai Hospital, Beijing, PR China
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, PR China
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia
| | - R. Douglas McEvoy
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia
| | - Craig S. Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia
- The George Institute for Global Health China at Peking University Health Science Center, Beijing, PR China
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18
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Circulating biomarkers to identify cardiometabolic complications in patients with Obstructive Sleep Apnea: A systematic review. Sleep Med Rev 2019; 44:48-57. [DOI: 10.1016/j.smrv.2018.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
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19
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Steffen A, Chamorro R, Buyny L, Windjäger A, Wilms B, Hasselbacher K, Wollenberg B, Lehnert H, Schmid SM. Upper airway stimulation in obstructive sleep apnea improves glucose metabolism and reduces hedonic drive for food. J Sleep Res 2018; 28:e12794. [PMID: 30450664 DOI: 10.1111/jsr.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 01/14/2023]
Abstract
Upper airway stimulation is a new and effective second-line treatment for obstructive sleep apnea, but possible consequences on glucose metabolism and central regulation of food intake are unclear. Twenty patients were prospectively studied before and 12 months after obstructive sleep apnea treatment by upper airway stimulation. Respiratory parameters and daytime sleepiness were assessed to document effectiveness of treatment. Glucose metabolism was assessed by the oral glucose tolerance test, and hedonic versus homeostatic drive to eat was characterized. At 12 months, upper airway stimulation significantly improved measures of obstructive sleep apnea (all p < 0.01). Despite no change in body weight, fasting C-peptide insulin resistance index (p = 0.01) as well as insulin and C-peptide levels at 60 min during the oral glucose tolerance test (p < 0.02) were reduced. Hedonic drive to eat was strongly reduced (p < 0.05), while leptin and ghrelin remained unchanged (p > 0.15). Upper airway stimulation is effective in treatment of obstructive sleep apnea and improves glucose metabolism. Reduced hedonic drive to eat might contribute to these metabolic improvements. These promising findings are in need for long-term controlled evaluation of metabolic sequelae of upper airway stimulation and to mechanistically evaluate the metabolic benefits of upper airway stimulation in patients with obstructive sleep apnea.
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Affiliation(s)
- Armin Steffen
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Rodrigo Chamorro
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.,Department of Nutrition, University of Chile, Santiago, Chile
| | - Laura Buyny
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Anne Windjäger
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Britta Wilms
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | | | - Barbara Wollenberg
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Sebastian M Schmid
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research, Neuherberg, Germany
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Quan W, Zheng D, Douglas McEvoy R, Barbe F, Chen R, Liu Z, Loffler K, Lorenzi-Filho G, Luo Y, Mukherjee S, Tripathi M, Woodman R, Li Q, Wang X, Arima H, Xiao Y, Zhang X, Anderson CS. High Risk Characteristics for Recurrent Cardiovascular Events among Patients with Obstructive Sleep Apnoea in the SAVE Study. EClinicalMedicine 2018; 2-3:59-65. [PMID: 31193555 PMCID: PMC6537527 DOI: 10.1016/j.eclinm.2018.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a common comorbidity in patients with cardiovascular (CV) disease. We aimed to identify specific OSA clinical phenotypes relating to risks of serious CV events and response to continuous positive airway pressure (CPAP) treatment. METHODS Post-hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) study in participants with moderate-to-severe OSA and coronary artery disease (CAD) and/or cerebrovascular disease (CeVD) randomised to CPAP plus usual care or usual care alone. Latent class analysis (LCA) was used to identify OSA clinical phenotypes among 2649 (out of 2687 total) patients with complete data on 19 patient-centered variables, supported by Bayesian information criteria and clinical interpretability. Cox regression models were used to evaluate risks of composite cardiac and stroke outcome events in phenotype groups. Preferential response to CPAP treatment was evaluated using interaction terms as well as the Chi-square test. FINDINGS LCA identified four OSA clinical phenotypes: CAD alone and with diabetes mellitus (CAD + DM), and CeVD alone and with DM (CeVD + DM), in 39%, 15%, 37% and 9% of participants, respectively. The rates of composite CV events were the highest in CAD + DM phenotype (HR 2.08, 95% CI 1.57-2.76) and for stroke were highest in CeVD + DM phenotype (HR 6.84, 95% CI 3.77-12.42). Adherence to CPAP treatment (nil or < 4 h vs ≥ 4 h in the first two years of the study) was shown to influence the risk of composite CV outcome in the phenotypes (P-interaction = 0.04); CPAP adherent patients of the CeVD + DM phenotype had the lowest risk of CV outcome (P = 0.02). INTERPRETATION High risk clinical phenotypes were identified in relation to CV events and response to CPAP treatment, which may allow improved targeting of therapies in OSA patients. FUNDING The National Health and Medical Research Council (NHMRC) of Australia, Fisher & Paykel Healthcare, and ResMed.
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Affiliation(s)
- Weiwei Quan
- Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Zheng
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - R. Douglas McEvoy
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Australia
| | - Ferran Barbe
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Lleida, Spain
| | - Riu Chen
- The Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhihong Liu
- Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Kelly Loffler
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | | | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Australia
| | - Manjari Tripathi
- Neurology Department, All India Institute of Medical Sciences, Delhi, India
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Yi Xiao
- Respiratory Department, Peking University Medical College, Beijing, China
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Craig S. Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The George Institute China at Peking University Health Science Center, Beijing, China
- Corresponding author at: The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia.
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Panta P, Sarode SC, Sarode GS, Gadbail AR, Gondivkar SM, Patiln S. "Mind" in Betel-quid Use and Related Disorders. J Contemp Dent Pract 2018; 19:629-630. [PMID: 29959286 DOI: 10.5005/jp-journals-10024-2309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Oral squamous cell carcinoma is characterized by a unique predisposing state called oral potentially malignant disorders (OPMDs). Wide variety of carcinogenic insult in the form of detrimental habits can contribute to the causation of variety of OPMDs.1,2.
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Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College & Hospital, Sangareddy, Telangana, India, Phone: +919701806830, e-mail:
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pune Maharashtra, India
| | - Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pune Maharashtra, India
| | - Amol R Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra, India
| | - Shailesh M Gondivkar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Shankargouda Patiln
- Division of Oral Pathology, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University Jazan, Kingdom of Saudi Arabia
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Tan X, van Egmond L, Chapman CD, Cedernaes J, Benedict C. Aiding sleep in type 2 diabetes: therapeutic considerations. Lancet Diabetes Endocrinol 2018; 6:60-68. [PMID: 28844889 DOI: 10.1016/s2213-8587(17)30233-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022]
Abstract
Insomnia and obstructive sleep apnoea (OSA) are more prevalent in patients with type 2 diabetes than in the general population. Both insomnia and OSA have been linked to cardiometabolic alterations (eg, hypertension, increased activity of the sympathetic nervous system, and systemic insulin resistance) that can exacerbate the pathophysiology of type 2 diabetes. Improvement of sleep in patients with diabetes could therefore aid the treatment of diabetes. To help health practitioners choose the best clinical tool to improve their patients' sleep without detrimentally affecting glucose regulation, this Review critically analyses the effects of common treatments for insomnia and OSA on both sleep and glucose metabolism in patients with type 2 diabetes. These treatments include pharmaceutical sleep aids (eg, benzodiazepine receptor agonists, melatonin) and cognitive behavioural therapy for insomnia, continuous positive airway pressure for OSA, and lifestyle interventions.
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Affiliation(s)
- Xiao Tan
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.
| | | | - Colin D Chapman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Archontogeorgis K, Papanas N, Nena E, Tzouvelekis A, Tsigalou C, Voulgaris A, Xanthoudaki M, Mouemin T, Froudarakis M, Steiropoulos P. Insulin Sensitivity and Insulin Resistance in Non-Diabetic Middle-Aged Patients with Obstructive Sleep Apnoea Syndrome. Open Cardiovasc Med J 2017; 11:159-168. [PMID: 29399212 PMCID: PMC5761020 DOI: 10.2174/1874192401711010159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023] Open
Abstract
Background: Obstructive sleep apnoea syndrome (OSAS) has been linked with abnormal glucose metabolism, insulin resistance (IR) and development of diabetes mellitus. Methods: Non-diabetic patients (n=69) with OSAS, diagnosed by polysomnography, were prospectively recruited. To evaluate IR among OSAS patients, the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Insulin sensitivity by Quantitative Insulin sensitivity Check Index (QUICKI) were used. Results: HOMA-IR was positively associated with body-mass index (BMI) (ρ=0.364, p=0.002), time with oxyhaemoglobin saturation <90% (ρ=0.291, p=0.015), arousal index (ρ=0.268, p=0.027), Epworth sleepiness scale (ESS) score (ρ=0.293, p=0.019) and negatively with average oxyhaemoglobin saturation (ρ=-0.398, p=0.001) and minimum oxyhaemoglobin saturation (ρ=-0.327, p=0.006). QUICKI was positively associated with forced vital capacity (r=0.301, p=0.014), average oxyhaemoglobin saturation (r=0.443, p<0.001), minimum oxyhaemoglobin saturation (ρ=0.318, p=0.008), and negatively associated with sleep stage transitions (r=-0.266, p=0.032), oxygen desaturation index (r=-0.404, p=0.005), time with oxyhaemoglobin saturation <90% (r=-0.311, p=0.019), arousal index (r=-0.344, p=0.004) and ESS score (r=-0.299, p=0.016). After adjustment for age and BMI, HOMA-IR was associated with sleep stage transitions, time with oxyhaemoglobin saturation <90%, average oxyhaemoglobin saturation, minimum oxyhaemoglobin saturation and arousal index. QUICKI was associated with oxygen desaturation index, sleep stage transitions, ESS score, minimum oxyhaemoglobin saturation and arousal index. Conclusions: An independent association between OSAS and IR in patients without pre-existing diabetes mellitus was observed. Recurrent hypoxia and sleep fragmentation in OSAS are associated with IR in these patients.
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Affiliation(s)
- K Archontogeorgis
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - E Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Tzouvelekis
- Division of Immunology, Biomedical Sciences Research Center "Alexander Fleming", Athens, Greece
| | - C Tsigalou
- Laboratory of Biopathology, University General Hospital of Evros, Alexandroupolis, Greece
| | - A Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis , Greece
| | - M Xanthoudaki
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis , Greece
| | - T Mouemin
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis , Greece
| | - M Froudarakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis , Greece
| | - P Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis , Greece
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Tan X, Chapman CD, Cedernaes J, Benedict C. Association between long sleep duration and increased risk of obesity and type 2 diabetes: A review of possible mechanisms. Sleep Med Rev 2017; 40:127-134. [PMID: 29233612 DOI: 10.1016/j.smrv.2017.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
For the last two decades research has revealed an alarming association between short sleep duration and metabolic disorders. In tandem, the hormonal, behavioral, and genetic mechanisms underlying this relationship have been extensively investigated and reviewed. However, emerging evidence is revealing that excessive sleep duration has remarkably similar deleterious effects. Unfortunately, to date there has been little attention to what drives this connection. This narrative review therefore aims to summarize existing epidemiological findings, experimental work, and most importantly putative molecular and behavioral mechanisms connecting excessive sleep duration with both obesity and type 2 diabetes mellitus. It will also address recent findings suggesting a worrisome bidirectional effect such that metabolic disorders create a positive feedback loop which further perpetuates excessive sleep.
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Affiliation(s)
- Xiao Tan
- Department of Neuroscience, Uppsala University, SE-751 24 Uppsala, Sweden.
| | - Colin D Chapman
- Department of Neuroscience, Uppsala University, SE-751 24 Uppsala, Sweden
| | - Jonathan Cedernaes
- Department of Neuroscience, Uppsala University, SE-751 24 Uppsala, Sweden
| | - Christian Benedict
- Department of Neuroscience, Uppsala University, SE-751 24 Uppsala, Sweden.
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The Study of Neurocognitive Outcomes, Radiological and Retinal Effects of Aspirin in Sleep Apnoea- rationale and methodology of the SNORE-ASA study. Contemp Clin Trials 2017; 64:101-111. [PMID: 29097299 DOI: 10.1016/j.cct.2017.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Sleep disordered breathing (SDB) is highly prevalent in older adults. Increasing evidence links SDB to the risk of dementia, mediated via a number of pathways, some of which may be attenuated by low-dose aspirin. This study will evaluate, in a healthy older cohort, the prospective relationship between SDB and cognitive function, changes in retinal and cerebral microvasculature, and determine whether low-dose aspirin ameliorates the effects of SDB on these outcomes over 3years. DESIGN SNORE-ASA is a sub-study of the ASPirin in Reducing Events in the Elderly (ASPREE) randomised, multi-centre, placebo-controlled trial evaluating the effect of daily 100mg aspirin on disability-free and dementia-free survival in the healthy older adult aged 70 and over. At baseline, 1400 ASPREE participants successfully underwent a home sleep study with a home sleep study screening device for SDB; and 296 underwent both 1.5 Tesla brain magnetic resonance imaging (MRI) and retinal vascular imaging (RVI). Cognitive testing, brain MRI and RVI is being repeated after 3years. PRIMARY OUTCOME MEASURES Change in the modified mini-mental state examination score. Secondary outcome measures are changes in other cognitive tests, and changes in abnormal parameters on RVI and volume of white matter hyper-intensities on brain MRI. CONCLUSION Identifying preventive therapies for delaying the onset of dementia is of paramount importance. The results of this study will help clarify the impact of the SDB on risk of cognitive decline and cerebral small vessel disease, and whether low-dose aspirin can ameliorate cognitive decline in the setting of SDB. SNORE-ASA TRIAL REGISTRATION ACTRN12612000891820: The Principal ASPREE study is registered with the International Standardized Randomized Controlled Trials Register, ASPirin in Reducing Events in the Elderly, Number: ISRCTN83772183 and clinicaltrials.gov Number NCT01038583.
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冯 媛, 郭 东, 罗 淼, 许 婷, 李 丹, 雷 娅, 李 涛. [One-hour post-load plasma glucose: a better indicator of glucose metabolism for obstructive sleep apnea?]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1315-1321. [PMID: 29070460 PMCID: PMC6743957 DOI: 10.3969/j.issn.1673-4254.2017.10.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the value of blood glucose at different time points in oral glucose tolerance test (OGTT), particularly one?hour post load plasma glucose (1 hPG), in evaluating glucose metabolism in adult patients with obstructive sleep apnea (OSA). METHODS Eighty nine adultswith newly diagnosed OSA were analyzed retrospectively for sleep architecture assessed using polysomnography and glucose metabolism assessed by OGTT at different time points (0, 30, 60, 120, and 180 min). Pearson's correlatives and multiple linear regression models were established to investigate the correlations between glucose metabolism and other indices including sleep architecture, apnea hypopnea index (AHI), mean and lowest oxygen saturation (MSO2 and LSO2) and obesity measurements. RESULTS The majority (67.4%) of the patients had abnormal 1 hPG, and 41.6% had abnormal 2 hPG. 1 hPG was positively correlated with neck circumference (r=0.245), abdomen circumference (r=0.231), systolic blood pressure (r=0.213), diastolic blood pressure (r=0.276) and AHI (r=0.324), and was negatively associated with MSO2 (r=-0.341) and LSO2 (r=-0.387) (all P<0.05). After controlling for age, BMI, neck and abdomen circumferences, 1 hPG was found to inversely correlated with MSO2 (r=-0.253, P=0.032) and LSO2 (r=-0.311, P=0.008). In non-obese OSA subgroup, 1 hPG was significantly associated with OSA-related indices, and regression models showed that LSO2 and N2 were the two most important contributors to 1 hPG (adjusted R2=0.349, P<0.001); plasma glucose at other time points did not show such correlations. CONCLUSIONS 1 hPG abnormality occurs earlier than 2 hPG in OSA patients. 1 hPG is significantly associated with OSA independent of obesity and may serve as a better index for measuring OSA-related glucose disorder.
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Affiliation(s)
- 媛 冯
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 东英 郭
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 淼 罗
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 婷 许
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 丹青 李
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 娅辉 雷
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 涛平 李
- />南方医科大学南方医院睡眠医学中心, 广东 广州 510515Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Zhu B, Ma C, Chaiard J, Shi C. Effect of continuous positive airway pressure on glucose metabolism in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Sleep Breath 2017; 22:287-295. [DOI: 10.1007/s11325-017-1554-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
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Li K, Wei P, Qin Y, Wei Y. MicroRNA expression profiling and bioinformatics analysis of dysregulated microRNAs in obstructive sleep apnea patients. Medicine (Baltimore) 2017; 96:e7917. [PMID: 28834917 PMCID: PMC5572039 DOI: 10.1097/md.0000000000007917] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 12/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common chronic obstructive sleep disease in clinic. The purpose of our study was to use bioinformatics analysis to identify microRNAs (miRNAs) that are differentially expressed between OSA patients and healthy controls.Serum samples were collected from OSA patients and healthy controls. To better reveal the sample specificity of differentially expressed microRNAs, supervised hierarchical clustering was conducted. We used the microT-CDS and TargetScan databases to predict target genes of the differentially expressed microRNAs and selected the common genes. The Search Tool for the Retrieval of Interacting Genes (STRING) was used to evaluate many coexpression relationships. Moreover, we used these potential microRNA-target pairs and coexpression relationships to construct a regulatory coexpression network using Cytoscape software. Functional analysis of microRNA target genes was conducted with FunRich.A total of 104 microRNAs that were differentially expressed between OSA patients and healthy controls were identified. Supervised hierarchical clustering was conducted based on the expression of the 104 microRNAs in the OSA patients and healthy controls. Overall, 6621 potential target genes were predicted, and 119 target genes were screened based on coexpression coefficients in the STRING database. A regulatory coexpression network was constructed that included 23 differentially expressed microRNAs and 18 of the most related potential target genes. Metabolic signaling pathways were the most highly enriched category. Differentially expressed microRNAs, such as hsa-miR-485-5p, hsa-miR-107, hsa-miR-574-5p, and hsa-miR-199-3p, might participate in OSA. The target gene CAD might also be closely related to OSA.Our results may provide a basis for the pathogenesis of OSA and the study of disease diagnosis, prevention, and treatment. However, more experiments are needed to verify these predictions.
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Rawshani A, Rawshani A, Gudbjörnsdottir S. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med 2017; 377:300. [PMID: 28723317 DOI: 10.1056/nejmc1706292] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Martínez-Cerón E, Barquiel B, Bezos AM, Casitas R, Galera R, García-Benito C, Hernanz A, Alonso-Fernández A, Garcia-Rio F. Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial. Am J Respir Crit Care Med 2017; 194:476-85. [PMID: 26910598 DOI: 10.1164/rccm.201510-1942oc] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. OBJECTIVES To assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with suboptimally controlled type 2 diabetes and OSA, and to identify its determinants. METHODS In a 6-month, open-label, parallel, and randomized clinical trial, 50 patients with OSA and type 2 diabetes and two HbA1c levels equal to or exceeding 6.5% were randomized to CPAP (n = 26) or no CPAP (control; n = 24), while their usual medication for diabetes remained unchanged. MEASUREMENTS AND MAIN RESULTS HbA1c levels, Homeostasis Model Assessment and Qualitative Insulin Sensitivity Check Index scores, systemic biomarkers, and health-related quality of life were measured at 3 and 6 months. After 6 months, the CPAP group achieved a greater decrease in HbA1c levels compared with the control group. Insulin resistance and sensitivity measurements (in noninsulin users) and serum levels of IL-1β, IL-6, and adiponectin also improved in the CPAP group compared with the control group after 6 months. In patients treated with CPAP, mean nocturnal oxygen saturation and baseline IL-1β were independently related to the 6-month change in HbA1c levels (r(2) = 0.510, P = 0.002). CONCLUSIONS Among patients with suboptimally controlled type 2 diabetes and OSA, CPAP treatment for 6 months resulted in improved glycemic control and insulin resistance compared with results for a control group. Clinical trial registered with www.clinicaltrials.gov (NCT01801150).
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Affiliation(s)
- Elisabet Martínez-Cerón
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Raquel Casitas
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Raúl Galera
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Angel Hernanz
- 6 Servicio de Bioquímica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Francisco Garcia-Rio
- 1 Servicio de Neumología.,2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.,8 Universidad Autónoma de Madrid, Madrid, Spain
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Almendros I, García-Río F. Sleep apnoea, insulin resistance and diabetes: the first step is in the fat. Eur Respir J 2017; 49:49/4/1700179. [PMID: 28424366 DOI: 10.1183/13993003.00179-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultad de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain .,Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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32
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Ioachimescu OC, Anthony J, Constantin T, Ciavatta MM, McCarver K, Sweeney ME. VAMONOS (Veterans Affairs' Metabolism, Obstructed and Non-Obstructed Sleep) Study: Effects of CPAP Therapy on Glucose Metabolism in Patients with Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:455-466. [PMID: 28095965 DOI: 10.5664/jcsm.6502] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/23/2016] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are prevalent disorders that pose increased risk of cardiovascular disease and death. The objective of this study was to clarify if continuous positive airway pressure (CPAP) therapy for OSA affects T2DM control and emergence. METHODS Point-of-care, comparative effectiveness study; cross-sectional and longitudinal analyses. RESULTS Our cohort included 928 consecutive patients; 13% were women; 36% were Caucasians and 61% African-Americans. OSA was diagnosed in approximately 738 patients and CPAP was initiated in 718 patients; median duration of therapy was 5 mo (25% to 75% interquartile range [IQR] 3-14). Patients with OSA used CPAP therapy for a median duration of 4.8 h, 34.5% of the nights. Adherence to CPAP was prespecified as follows: good (≥ 70% nights and ≥ 4 h/night), excellent (≥ 80% nights and ≥ 6 h/night) or outstanding (≥ 90% of nights and 8 h/night). Based on objective data, good, excellent, and outstanding compliance were found in only 30%, 20%, and 6%, respectively. Three percent of subjects without CPAP follow-up and less than 4% of those nonadherent to CPAP therapy (based on the established criteria) developed incident T2DM. Incident T2DM developed in only 0.8% of those with good compliance and in none (0%) of those in the excellent and outstanding groups. During follow-up, median weight change was +0.3 kg (IQR -1.8 to 2.7). CONCLUSIONS We found that an outstanding compliance to CPAP reduced fasting blood glucose in patients with OSA. Longitudinally, higher levels of therapeutic adherence may affect the rate of incident impaired fasting glucose, prediabetes, and T2DM, despite the observed weight gains. COMMENTARY A commentary on this article appears in this issue on page 365.
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Affiliation(s)
| | | | - Tina Constantin
- Atlanta VA Medical Center, Decatur, GA.,Emory University, Atlanta, GA
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33
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Potter GDM, Skene DJ, Arendt J, Cade JE, Grant PJ, Hardie LJ. Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures. Endocr Rev 2016; 37:584-608. [PMID: 27763782 PMCID: PMC5142605 DOI: 10.1210/er.2016-1083] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Circadian (∼24-hour) timing systems pervade all kingdoms of life and temporally optimize behavior and physiology in humans. Relatively recent changes to our environments, such as the introduction of artificial lighting, can disorganize the circadian system, from the level of the molecular clocks that regulate the timing of cellular activities to the level of synchronization between our daily cycles of behavior and the solar day. Sleep/wake cycles are intertwined with the circadian system, and global trends indicate that these, too, are increasingly subject to disruption. A large proportion of the world's population is at increased risk of environmentally driven circadian rhythm and sleep disruption, and a minority of individuals are also genetically predisposed to circadian misalignment and sleep disorders. The consequences of disruption to the circadian system and sleep are profound and include myriad metabolic ramifications, some of which may be compounded by adverse effects on dietary choices. If not addressed, the deleterious effects of such disruption will continue to cause widespread health problems; therefore, implementation of the numerous behavioral and pharmaceutical interventions that can help restore circadian system alignment and enhance sleep will be important.
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Affiliation(s)
- Gregory D M Potter
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Debra J Skene
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Josephine Arendt
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Janet E Cade
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Peter J Grant
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Laura J Hardie
- Division of Epidemiology and Biostatistics (G.D.M.P., L.J.H.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom; Chronobiology Section (D.J.S., J.A.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Nutritional Epidemiology Group (J.E.C.), School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, United Kingdom; and Division of Cardiovascular & Diabetes Research (P.J.G.), LIGHT Laboratories, University of Leeds, Leeds LS2 9JT, United Kingdom
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Feliciano A, Vaz F, Torres VM, Valentim-Coelho C, Silva R, Prosinecki V, Alexandre BM, Carvalho AS, Matthiesen R, Malhotra A, Pinto P, Bárbara C, Penque D. Evening and morning peroxiredoxin-2 redox/oligomeric state changes in obstructive sleep apnea red blood cells: Correlation with polysomnographic and metabolic parameters. Biochim Biophys Acta Mol Basis Dis 2016; 1863:621-629. [PMID: 27864139 DOI: 10.1016/j.bbadis.2016.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/18/2016] [Accepted: 11/14/2016] [Indexed: 12/20/2022]
Abstract
We have examined the effects of Obstructive Sleep Apnea (OSA) on red blood cell (RBC) proteome variation at evening/morning day time to uncover new insights into OSA-induced RBC dysfunction that may lead to OSA manifestations. Dysregulated proteins mainly fall in the group of catalytic enzymes, stress response and redox regulators such as peroxiredoxin 2 (PRDX2). Validation assays confirmed that at morning the monomeric/dimeric forms of PRDX2 were more overoxidized in OSA RBC compared to evening samples. Six month of positive airway pressure (PAP) treatment decreased this overoxidation and generated multimeric overoxidized forms associated with chaperone/transduction signaling activity of PRDX2. Morning levels of overoxidized PRDX2 correlated with polysomnographic (PSG)-arousal index and metabolic parameters whereas the evening level of disulfide-linked dimer (associated with peroxidase activity of PRDX2) correlated with PSG parameters. After treatment, morning overoxidized multimer of PRDX2 negatively correlated with fasting glucose and dopamine levels. Overall, these data point toward severe oxidative stress and altered antioxidant homeostasis in OSA RBC occurring mainly at morning time but with consequences till evening. The beneficial effect of PAP involves modulation of the redox/oligomeric state of PRDX2, whose mechanism and associated chaperone/transduction signaling functions deserves further investigation. RBC PRDX2 is a promising candidate biomarker for OSA severity and treatment monitoring, warranting further investigation and validation.
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Affiliation(s)
- Amélia Feliciano
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Fátima Vaz
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal
| | - Vukosava M Torres
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal
| | - Cristina Valentim-Coelho
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Rita Silva
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Vesna Prosinecki
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Bruno M Alexandre
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Ana S Carvalho
- Departamento da Promoção da Saúde, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Rune Matthiesen
- Departamento da Promoção da Saúde, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Atul Malhotra
- Pulmonary, Critical Care and Sleep Medicine Division, University of California San Diego, CA, USA
| | - Paula Pinto
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cristina Bárbara
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Deborah Penque
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal..
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Abstract
Sleep is important for regulating many physiologic functions that relate to metabolism. Because of this, there is substantial evidence to suggest that sleep habits and sleep disorders are related to diabetes risk. In specific, insufficient sleep duration and/or sleep restriction in the laboratory, poor sleep quality, and sleep disorders such as insomnia and sleep apnea have all been associated with diabetes risk. This research spans epidemiologic and laboratory studies. Both physiologic mechanisms such as insulin resistance, decreased leptin, and increased ghrelin and inflammation and behavioral mechanisms such as increased food intake, impaired decision-making, and increased likelihood of other behavioral risk factors such as smoking, sedentary behavior, and alcohol use predispose to both diabetes and obesity, which itself is an important diabetes risk factor. This review describes the evidence linking sleep and diabetes risk at the population and laboratory levels.
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Affiliation(s)
- Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245002, Tucson, AZ, 85724-5002, USA.
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA.
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Safal Shetty
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sundeep Shenoy
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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36
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Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med 2016; 31:10-17. [PMID: 28065687 DOI: 10.1016/j.sleep.2016.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022]
Abstract
In this paper, we first critically appraise the epidemiologic literature examining the association of restless legs syndrome (RLS) with cardiovascular disease (CVD) and then consider whether lessons learned from the study of cardiovascular consequences of other sleep disorders might inform a research agenda to examine the potential mechanisms of cardiovascular morbidity of RLS. Cross-sectional and longitudinal studies are both mixed as to whether there is a meaningful association of RLS and CVD. On the other hand, numerous cross-sectional and longitudinal observational studies have shown a strong association of obstructive sleep apnea (OSA) with CVD risk. Each of the potential mediating mechanisms in OSA may also be assessed in RLS, including 1) neural mechanisms such as increased central sympathetic outflow, impaired baroreflex function, diminished heart rate and blood pressure variability, and increased chemoreflex sensitivity, 2) metabolic mechanisms such as glucose intolerance and reduced insulin sensitivity/diabetes as a result of sleep disturbance in RLS, 3) oxidative stress, 4) systemic or vascular inflammatory mechanisms, and 5) vascular mechanisms including impaired endothelial functioning, increased aortic stiffness, hypothalamic-pituitary axis activation or renin-angiotensin-aldosterone activation. Three known characteristics of RLS may contribute to these specific mechanisms of increased cardiovascular risk: 1) periodic limb movements of sleep, which are associated with large increases in heart rate and blood pressure, 2) sleep fragmentation and sleep deprivation, which are known to produce adverse consequences for neural, metabolic, oxidative, inflammatory, and vascular systems, and 3) iron deficiency, which is an emerging risk for cardiovascular disease. Future research priorities include additional epidemiologic studies which characterize multiple CVD risk factors, case-control studies which examine known markers of cardiovascular risk, and small clinical trials which assess the effects of RLS treatment on intermediate physiological markers such as sympathetic activity or baroreflex control, measures of vascular stiffness and reactivity, or measures of insulin sensitivity and glucose tolerance.
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Giunta J, Salifu MO, McFarlane SI. Sleep Disorders and Cardio-Renal Disease: Implications for Minority Populations. ACTA ACUST UNITED AC 2016; 6. [PMID: 27478683 DOI: 10.4172/2161-1165.1000e120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obesity is a major public health problem that is reaching pandemic proportion. Currently two thirds of the American population is either overweight or obese and worldwide, 39% of the population is overweight and 13% are considered obese [1,2]. This rapid rise in obesity is associated with increased in diabetes mellitus type 2 (DM2), hypertension (HTN), chronic kidney disease (CKD) and cardiovascular diseases (CVD), the major killer of adults in the USA. Parallel to this epidemic is the rapid rise of sleep disorders such as Obstructive Sleep Apnea (OSA). These disorders lead to increased morbidity and mortality and generally go undiagnosed and undertreated, particularly among minority groups. Accumulating evidence indicates common pathophysiologic background underlying all of these related disorders. Among these include: increased inflammation, increased oxidative stress, endothelial dysfunction, dyslipidemia and hypercoagulability. We discuss the rising epidemic of sleep disorders and its interrelationship with DM2, HTN, CVD and renal disease highlighting the racial disparity in diagnosis and treatment of these disorders that disproportionately affects minority populations. We also discuss the various treatment modalities and the cutting edge developments in this field.
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Affiliation(s)
- Judith Giunta
- Divisions of Endocrinology and Nephrology, Department of Medicine, SUNY-Downstate Medical Center, USA
| | - Moro O Salifu
- Divisions of Endocrinology and Nephrology, Department of Medicine, SUNY-Downstate Medical Center, USA
| | - Samy I McFarlane
- Divisions of Endocrinology and Nephrology, Department of Medicine, SUNY-Downstate Medical Center, USA
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Roles and Mechanisms of Obstructive Sleep Apnea-Hypopnea Syndrome and Chronic Intermittent Hypoxia in Atherosclerosis: Evidence and Prospective. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:8215082. [PMID: 27293515 PMCID: PMC4884866 DOI: 10.1155/2016/8215082] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 12/13/2022]
Abstract
The morbidity and mortality of obstructive sleep apnea-hypopnea syndrome (OSAHS) are regarded as consequences of its adverse effects on the cardiovascular system. Chronic intermittent hypoxia (CIH) induced by OSAHS can result in vascular endothelial injury, thus promoting development of atherosclerosis (AS). Studies have shown that CIH is an independent risk factor for the occurrence and development of AS, but the underlying mechanism remains unclear. Here, we review clinical and fundamental studies reported during the last 10 years on the occurrence and development of AS mediated by CIH, focusing on inflammation, oxidative stress, insulin resistance, cell apoptosis, vascular endothelial injury, platelet activation, and neuroendocrine disorders. This review will offer current evidence and perspective to researchers for the development of effective intervention strategies for OSAHS-related cardiocerebrovascular diseases.
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Gileles-Hillel A, Kheirandish-Gozal L, Gozal D. Biological plausibility linking sleep apnoea and metabolic dysfunction. Nat Rev Endocrinol 2016; 12:290-8. [PMID: 26939978 DOI: 10.1038/nrendo.2016.22] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnoea (OSA) is a very common disorder that affects 10-25% of the general population. In the past two decades, OSA has emerged as a cardiometabolic risk factor in both paediatric and adult populations. OSA-induced metabolic perturbations include dyslipidaemia, atherogenesis, liver dysfunction and abnormal glucose metabolism. The mainstay of treatment for OSA is adenotonsillectomy in children and continuous positive airway pressure therapy in adults. Although these therapies are effective at resolving the sleep-disordered breathing component of OSA, they do not always produce beneficial effects on metabolic function. Thus, a deeper understanding of the underlying mechanisms by which OSA influences metabolic dysfunction might yield improved therapeutic approaches and outcomes. In this Review, we summarize the evidence obtained from animal models and studies of patients with OSA of potential mechanistic pathways linking the hallmarks of OSA (intermittent hypoxia and sleep fragmentation) with metabolic dysfunction. Special emphasis is given to adipose tissue dysfunction induced by sleep apnoea, which bears a striking resemblance to adipose dysfunction resulting from obesity. In addition, important gaps in current knowledge and promising lines of future investigation are identified.
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Affiliation(s)
- Alex Gileles-Hillel
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
| | - Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Knapp Center for Biomedical Discovery, Room 4100, 900 East 57th Street, Mailbox 4, Chicago, Illinois 60637-1470, USA
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Abstract
IN BRIEF Obstructive sleep apnea (OSA) alters glucose metabolism, promotes insulin resistance, and is associated with development of type 2 diabetes. Obesity is a key moderator of the effect of OSA on type 2 diabetes. However, chronic exposure to intermittent hypoxia and other pathophysiological effects of OSA affect glucose metabolism directly, and treatment of OSA can improve glucose homeostasis.
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Affiliation(s)
- Jimmy Doumit
- Jesse Brown VA Medical Center and University of Illinois at Chicago, Chicago, IL
| | - Bharati Prasad
- Jesse Brown VA Medical Center and University of Illinois at Chicago, Chicago, IL
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