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Weng L, Luo Y, Luo X, Yao K, Zhang Q, Tan J, Yin Y. The common link between sleep apnea syndrome and osteoarthritis: a literature review. Front Med (Lausanne) 2024; 11:1401309. [PMID: 39234045 PMCID: PMC11371730 DOI: 10.3389/fmed.2024.1401309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Patients with Osteoarthritis (OA) often also suffer from Sleep Apnea Syndrome (SAS), and many scholars have started to notice this link, although the relationship between the two is still unclear. In this review, we aim to summarize the current literature on these two diseases, integrate evidence of the OA and OSA connection, explore and discuss their potential common mechanisms, and thus identify effective treatment methods for patients with both OA and SAS. Some shared characteristics of the two conditions have been identified, notably aging and obesity as mutual risk factors. Both diseases are associated with various biological processes or molecular pathways, including mitochondrial dysfunction, reactive oxygen species production, the NF-kB pathway, HIF, IL-6, and IL-8. SAS serves as a risk factor for OA, and conversely, OA may influence the progression of SAS. The effects of OA on SAS are underreported in the literature and require more investigation. To effectively manage these patients, timely intervention for SAS is necessary while treating OA, with weight reduction being a primary requirement, alongside combined treatments such as Continuous positive airway pressure (CPAP) and medications. Additionally, numerous studies in drug development are now aimed at inhibiting or clearing certain molecular pathways, including ROS, NF-KB, IL-6, and IL-8. Improving mitochondrial function might represent a viable new strategy, with further research into mitochondrial updates or transplants being essential.
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Affiliation(s)
- Lian Weng
- Luzhou Longmatan District People's Hospital, Luzhou, China
| | - Yuxi Luo
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Xiongjunjie Luo
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Kaitao Yao
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Qian Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Junjie Tan
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Yiran Yin
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopedic Engineering, Luzhou, China
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
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Li Q, Yao J, Duan R, Feng T. Is there an association between serum 25-hydroxyvitamin D concentrations and obstructive sleep apnoea? A cross-sectional analysis of NHANES 2007-2008 data. BMJ Open 2024; 14:e085080. [PMID: 39117413 PMCID: PMC11404261 DOI: 10.1136/bmjopen-2024-085080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES The study aimed to investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentrations and obstructive sleep apnoea (OSA) and to assess the confounding effect of body mass index (BMI) on this relationship. DESIGN This was a cross-sectional analysis using data from the 2007-08 National Health and Nutrition Examination Survey (NHANES). SETTING Data were sourced from NHANES, a continuous survey sponsored by the Centres for Disease Control and Prevention, covering residents from 15 urban areas in the United States of America(USA). PARTICIPANTS The study included 4901 participants aged 16 years and older who had completed 25(OH)D data and responses to the OSA questionnaire. MAIN EXPOSURE MEASURE Serum 25(OH)D concentrations were measured using liquid chromatography-tandem mass spectrometry. MAIN OUTCOME MEASURE The primary outcome was the self-reported diagnosis of OSA from questionnaires. RESULTS After adjusting for age, sex and race (model 1), a significant negative association was observed between 25(OH)D and OSA (β=-3.21, 95% CI: -6.17 to -0.26). However, this association was no longer significant after further adjustment for BMI (model 2) (β=1.47, 95% CI: -1.48, 4.42). In the fully adjusted model (model 3), there was no significant association between 25(OH)D and OSA (β=0.92, 95% CI: -1.93, 3.76). Subgroup analyses stratified by sex, age, race or BMI also revealed no significant associations between 25(OH)D and OSA. CONCLUSIONS The study found no significant association between 25(OH)D and OSA. The observed correlation between lower levels of 25(OH)D and OSA may be due to confounding factors, such as higher BMI in the OSA group. Therefore, improving obesity management in OSA patients may be necessary to prevent 25(OH)D insufficiency. This underscores the importance of comprehensive management of both OSA and obesity to promote optimal health outcomes.
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Affiliation(s)
- Qingyuan Li
- Clinical Medical College, Chengdu Medical College, Chengdu, People's Republic of China
- Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Chengdu Medical College, Chengdu, People's Republic of China
- Laboratory of Geriatic Respiratory Diseases of Sichuan Higher Education Institute, Chengdu, People's Republic of China
| | - Jun Yao
- Department of Respiratory and Critical Care Medicine,Guangyuan Central Hospital, Guangyuan, People's Republic of China
| | - Ran Duan
- Clinical Medical College, Chengdu Medical College, Chengdu, People's Republic of China
- Department of Oncology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People's Republic of China
| | - Tong Feng
- Southern Medical University, Guangzhou, China
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Hou S, Zhu G, Liu X, Wang C, Liang J, Hao W, Kong L. Screening of preoperative obstructive sleep apnea by cardiopulmonary coupling and its risk factors in patients with plans to receive surgery under general anesthesia: a cross-sectional study. Front Neurol 2024; 15:1370609. [PMID: 39114535 PMCID: PMC11303281 DOI: 10.3389/fneur.2024.1370609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024] Open
Abstract
Objective Preoperative obstructive sleep apnea (OSA) is supposed to be the abnormally high occurrence of OSA the night before surgery under general anesthesia. This study aimed to evaluate the prevalence preoperative OSA using cardiopulmonary coupling (CPC) and its correlation with imbalance of sympathetic/parasympathetic nervous system. Methods A total of 550 patients with plans to receive surgery under general anesthesia were enrolled. All patients were assigned to wear CPC on the night before surgery until the next day. Sleep quality characteristics, heart rate variation parameters, and apnea-hypopnea index were acquired. The diagnosis of pre-existing OSA was not considered in the current study. Results According to apnea-hypopnea index, 28.4%, 32.2%, 26.2%, and 13.3% patients were assessed as no, mild, moderate, and severe operative OSA, respectively. Multivariate logistic regression model revealed that higher age [p < 0.001, odds ratio (OR) = 1.043] was independently and positively associated with preoperative OSA; heart rate variation parameters representing the imbalance of sympathetic/parasympathetic nervous system, such as higher low-frequency (p < 0.001, OR = 1.004), higher low-frequency/high-frequency ratio (p = 0.028, OR = 1.738), lower NN20 count divided by the total number of all NN intervals (pNN20; p < 0.001, OR = 0.950), and lower high-frequency (p < 0.001, OR = 0.998), showed independent relationships with a higher probability of preoperative OSA. Higher age (p = 0.005, OR = 1.024), higher very-low-frequency (p < 0.001, OR = 1.001), and higher low-frequency/high-frequency ratio (p = 0.003, OR = 1.655) were associated with a higher probability of moderate-to-severe preoperative OSA, but higher pNN10 (p < 0.001, OR = 0.951) was associated with a lower probability of moderate-to-severe preoperative OSA. Conclusion Preoperative OSA is prevalent. Higher age and imbalance of sympathetic/parasympathetic nervous system are independently and positively associated with a higher occurrence of preoperative OSA. CPC screening may promote the management of preoperative OSA.
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Affiliation(s)
- Shujie Hou
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Guojia Zhu
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xu Liu
- School of Basic Medicine, Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Chuan Wang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Junchao Liang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Lili Kong
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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Shaikh N, Tumlin P, Greathouse Z, Bulbul MG, Coutras SW. Effects of Soft Tissue Sleep Surgery on Morbidly Obese Patients. Ann Otol Rhinol Laryngol 2023; 132:138-147. [PMID: 35227070 DOI: 10.1177/00034894221081098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Morbidly obese patients with obstructive sleep apnea (OSA) are often intolerant of continuous positive airway pressure (CPAP). The effects of sleep surgery in this population is not well documented, and sleep surgery is generally avoided due to the expectation of poor outcomes, leaving these patients untreated. METHODS This retrospective study included 42 patients with a body mass index (BMI) ≥40.0 and OSA with a preoperative apnea hypopnea index (AHI) ≥5. Preoperative BMI ranged from 40.0 to 69.0 kg/m2. Preoperative AHI ranged from 7.2 to 130.0. Of 42 patients, 12 (28.6%) underwent concurrent pharyngeal and retrolingual surgery. Subgroup analysis of change in AHI was measured with respect to preoperative OSA severity, change in preoperative BMI, and BMI severity. Univariate linear and logistic regression was performed assessing change in AHI and surgical success with respect to age, sex, preoperative AHI, preoperative BMI, change in BMI, total procedures, palatal procedure, retrolingual procedure, nasal procedure, and multilevel procedures. RESULTS The mean AHI improved from 45.9 ± 31.8 to 31.9 ± 31.6 (P = .007). Epworth sleepiness score (ESS) improved from 13.2 ± 5.5 to 9.6 ± 5.4 (P = .00006). Lowest oxygen saturation (LSAT) improved from 74.4 ± 10.7 to 79.9 ± 10.4 (P = .002). About 33.3% of patients had surgical success (AHI < 20 with at least 50% reduction in AHI). Preoperative AHI was the most significant factor for change in AHI in univariate and multivariate models (P = .015). CONCLUSION Sleep surgery is effective in reducing OSA burden in most morbidly obese patients and can result in surgical cure for a third of patients.
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Affiliation(s)
- Noah Shaikh
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Parker Tumlin
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | | | - Mustafa G Bulbul
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Steven W Coutras
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
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Li P, Dong Z, Chen W, Yang G. Causal Relations Between Obstructive Sleep Apnea and Stroke: A Mendelian Randomization Study. Nat Sci Sleep 2023; 15:257-266. [PMID: 37155472 PMCID: PMC10122861 DOI: 10.2147/nss.s398544] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Background Previous studies of obstructive sleep apnea (OSA) in relation to stroke have been noted. However, the exact causality remains to be clearly defined. We aimed to adopt a two-sample Mendelian randomization study to investigate the causal effects of OSA on stroke and its subtypes. Methods A two-sample Mendelian randomization (MR) analysis was conducted to evaluate the causal effect of OSA on stroke and its subtypes, including, based on publicly genome-wide association studies (GWAS) databases. The inverse variance weighted (IVW) method was used as the main analysis. MR-Egger regression, weighted mode, weighted median, and MR pleiotropy residual sum and outlier (MR-PRESSO) were performed methods and were adopted as supplementary analysis to ensure the robustness of the results. Results Genetically predicted OSA was not related to the risk of stroke (odds ratio (OR), 0.99, 95% CI, 0.81-1.21, p = 0.909), and its subtypes, ischemic stroke (IS) (OR, 1.01, 95% CI, 0.82-1.23, p = 0.927), large vessel stroke (LVS) (OR, 1.05, 95% CI, 0.73-1.51, p = 0.795), cardioembolic stroke (CES) (OR, 1.03, 95% CI, 0.74-1.43, p = 0.855), small vessel stroke (SVS) (OR, 1.13, 95% CI, 0.88-1.46, p = 0.329), lacunar stroke (LS) (OR, 1.07, 95% CI, 0.74-1.56, p = 0.721) as well as intracerebral hemorrhage (ICH) (OR, 0.37, 95% CI = 0.09, 1.48, p = 0.160) (Wald ratio method). Other supplementary MR methods also confirmed similar results. Conclusion There may be no direct causal relationship between OSA and stroke or its subtypes.
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Affiliation(s)
- Po Li
- Department of General Surgery, Second People’s Hospital of Zhangye City, Zhangye, 734000, People’s Republic of China
| | - Zhiyong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Wenhui Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Wenhui Chen, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, People’s Republic of China, Tel +86 13129349492, Fax +86 20 38688608, Email
| | - Gang Yang
- Department of General Surgery, Second People’s Hospital of Zhangye City, Zhangye, 734000, People’s Republic of China
- Correspondence: Gang Yang, Department of General Surgery, Second People’s Hospital of Zhangye City, No. 270 Linsong West Street, Binhe New District, Ganzhou District, Zhangye, Gansu, People’s Republic of China, Tel +86 1899361927, Fax +0936 8215086, Email
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Chen JL, Moon TS, Schumann R. Bariatric surgery in patients with obstructive sleep apnea. Int Anesthesiol Clin 2022; 60:50-58. [PMID: 35125481 DOI: 10.1097/aia.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joy L Chen
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tiffany S Moon
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roman Schumann
- Department of Anesthesiology, Critical Care and Pain Medicine, VA Boston Healthcare System, Boston, Massachusetts
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Obesity hypoventilation syndrome in bariatric surgery patients: an underestimated disease. Surg Obes Relat Dis 2022; 18:894-901. [PMID: 35644806 DOI: 10.1016/j.soard.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
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Liu L, Su X, Zhao Z, Han J, Li J, Xu W, He Z, Gao Y, Chen K, Zhao L, Gao Y, Wang H, Guo J, Lin J, Li T, Fang X. Association of Metabolic Syndrome With Long-Term Cardiovascular Risks and All-Cause Mortality in Elderly Patients With Obstructive Sleep Apnea. Front Cardiovasc Med 2022; 8:813280. [PMID: 35198606 PMCID: PMC8859338 DOI: 10.3389/fcvm.2021.813280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background Evidence suggests that an increased risk of major adverse cardiac events (MACE) and all-cause mortality is associated with obstructive sleep apnea (OSA), particularly in the elderly. Metabolic syndrome (MetS) increases cardiovascular risk in the general population; however, less is known about its influence in patients with OSA. We aimed to assess whether MetS affected the risk of MACE and all-cause mortality in elderly patients with OSA. Methods From January 2015 to October 2017, 1,157 patients with OSA, aged ≥60 years, no myocardial infarction (MI), and hospitalization for unstable angina or heart failure were enrolled at baseline and were followed up prospectively. OSA is defined as an apnea-hypopnea index of ≥5 events per hour, as recorded by polysomnography. Patients were classified on the basis of the presence of MetS, according to the definition of the National Cholesterol Education Program (NCEP). Incidence rates were expressed as cumulative incidence. Cox proportional hazards analysis was used to estimate the risk of all events. The primary outcomes were MACE, which included cardiovascular death, MI, and hospitalization for unstable angina or heart failure. Secondary outcomes were all-cause mortality, components of MACE, and a composite of all events. Results MetS was present in 703 out of 1,157 (60.8%) elderly patients with OSA. During the median follow-up of 42 months, 119 (10.3%) patients experienced MACE. MetS conferred a cumulative incidence of MACE in elderly patients with OSA (log-rank, P < 0.001). In addition, there was a trend for MACE incidence risk to gradually increase in individuals with ≥3 MetS components (P = 0.045). Multivariate analysis showed that MetS was associated with an incidence risk for MACE [adjusted hazard ratio (aHR), 1.86; 95% confidence interval (CI), 1.17–2.96; P = 0.009], a composite of all events (aHR, 1.54; 95% CI, 1.03–2.32; P = 0.036), and hospitalization for unstable angina (aHR, 2.01; 95% CI, 1.04–3.90; P = 0.039). No significant differences in the risk of all-cause mortality and other components of MACE between patients with and without MetS (P > 0.05). Subgroup analysis demonstrated that males (aHR, 2.23; 95% CI, 1.28–3.91, P = 0.05), individuals aged <70 years (aHR, 2.36; 95% CI, 1.27–4.39, P = 0.006), overweight and obese individuals (aHR, 2.32; 95% CI, 1.34–4.01, P = 0.003), and those with moderate-severe OSA (aHR, 1.81;95% CI: 1.05–3.12, P = 0.032) and concomitant MetS were at a higher risk for MACE. Conclusion MetS is common in elderly patients with OSA in the absence of MI, hospitalization for unstable angina or heart failure. Further, it confers an independent, increased risk of MACE, a composite of all events, and hospitalization for unstable angina. Overweight and obese males, aged <70 years with moderate-severe OSA combined with MetS presented a significantly higher MACE risk.
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Affiliation(s)
- Lin Liu
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiaofeng Su
- Medical College, Yan'an University, Yan'an, China
| | - Zhe Zhao
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jiming Han
- Medical College, Yan'an University, Yan'an, China
| | - Jianhua Li
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weihao Xu
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zijun He
- Medical College, Yan'an University, Yan'an, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Kaibing Chen
- Sleep Center, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou City, China
| | - Libo Zhao
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Gao
- Department of General Practice, 960th Hospital of PLA, Jinan, China
| | | | - JingJing Guo
- Department of Pulmonary and Critical Care Medicine, Sleep Medicine Center, Peking University People's Hospital, Beijing, China
| | - Junling Lin
- Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
- *Correspondence: Xiangqun Fang
| | - Tianzhi Li
- The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Tianzhi Li
| | - Xiangqun Fang
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Junling Lin
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Predictive Factors for Obstructive Sleep Apnea Diagnosis in Bariatric Surgery Candidates with or Without Chronic Insomnia Complaints. Obes Surg 2022; 32:33-41. [PMID: 34633613 DOI: 10.1007/s11695-021-05748-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to evaluate the frequency of insomnia complaints in bariatric patients and to assess obstructive sleep apnea (OSA) predictors according to the presence or absence of chronic insomnia. METHODS Insomnia was defined as the presence of at least one specific symptom: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than expected. Diagnosis of OSA was objectively obtained from in-laboratory polysomnography. Multivariate logistic regression analysis was used to assess OSA predictors. RESULTS This cross-sectional study contains 1,737 bariatric surgery candidates: 59.6% without insomnia and 40.4% with insomnia. OSA prevalence was similar among participants with or without insomnia either for any OSA (p = 0.168) or for moderate-to-severe OSA (p = 0.185). Patients without insomnia showed a higher prevalence of severe OSA than those with insomnia (p = 0.005). In both cohorts, five parameters were independent OSA predictors: sex, age, body mass index (BMI), neck circumference (NC), and excessive daytime sleepiness (EDS). Male sex was the most important predictor, whether in individuals without insomnia (adjusted odds ratio [OR] ranging from 4.874 to 8.369) or in those with insomnia (adjusted OR ranging from 5.672 to 12.441). CONCLUSIONS A considerable proportion of bariatric patients report insomnia complaints. The probability of suffering from OSA was similar among bariatric candidates with or without insomnia, except for severe OSA diagnosis. Sex, age, BMI, NC, and EDS were independent predictors for OSA diagnosis irrespective of insomnia symptoms, and male sex was the main predictor for OSA in bariatric individuals with or without insomnia.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo Dos Distúrbios Do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil.
- Instituto de Doenças Do Tórax da Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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Bhattacharya S, Kalra S, Kapoor N, Singla R, Dutta D, Aggarwal S, Khandelwal D, Surana V, Dhingra A, Kantroo V, Chittawar S, Deka N, Bindal V, Dutta P. Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery. World J Diabetes 2021; 12:1587-1621. [PMID: 34754367 PMCID: PMC8554368 DOI: 10.4239/wjd.v12.i10.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/18/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
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Affiliation(s)
| | - Sanjay Kalra
- Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
| | - Nitin Kapoor
- Endocrinology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Rajiv Singla
- Endocrinology, Kalpavriksh Super Speciality Center, New Delhi 110075, India
| | - Deep Dutta
- Endocrinology, CEDAR Superspecialty Clinic, New Delhi 110075, India
| | - Sameer Aggarwal
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak 124001, Haryana, India
| | | | - Vineet Surana
- Endocrinology, Manipal Hospitals, New Delhi 110075, India
| | - Atul Dhingra
- Endocrinology, Gangaram Bansal Super Speciality Hospital, Sri Ganganagar 335001, Rajasthan, India
| | - Viny Kantroo
- Respiratory Medicine & Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
| | - Sachin Chittawar
- Endocrinology, Gandhi Medical College, Bhopal 462001, Madhya Pardesh, India
| | - Nilakshi Deka
- Endocrinology, Apollo Hospitals, Guwahati 781005, Assam, India
| | - Vivek Bindal
- Minimal Access, Metabolic and Bariatric surgery, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
| | - Puja Dutta
- Nutrition, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Nocturnal oximetry in bariatric surgery patients referred to overnight in-lab polysomnography. Obesity (Silver Spring) 2021; 29:1469-1476. [PMID: 34328276 DOI: 10.1002/oby.23231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to evaluate nocturnal oximetry approaches in identifying obstructive sleep apnea (OSA) among bariatric surgical candidates. METHODS This was a cross-sectional study involving adult bariatric patients who were undergoing in-lab polysomnography and who were previously screened with the GOAL questionnaire. OSA severity was established as any OSA, moderate/severe OSA, and severe OSA. Oximetry data were evaluated as oxygen saturation (average and nadir), oxygen desaturation index (ODI) at 3%, and proportion of time spent with oxygen saturation <90%. Associations between oximetry data and the apnea-hypopnea index (AHI) were assessed by Spearman correlation index (r), linear regression, logistic regression, and discrimination. RESULTS All oximetry values were significantly correlated with the AHI among 1,178 individuals, with the ODI emerging as the better parameter (r = 0.911, p < 0.001). Using linear regression, the ODI was the only predictor of the AHI (β = 0.952, p < 0.001). In the multivariate analysis, the ODI was the only independent parameter predicting OSA at all severity levels. In addition, the ODI exhibited excellent discrimination to predict OSA and displayed improved performance among individuals screened as being at high risk versus those at low risk with the GOAL instrument. CONCLUSIONS The ODI emerges as a valid surrogate predictor of the AHI, particularly among those screened as being at high risk for OSA.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil
- Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, USA
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Chen TY, Chung CH, Chang HA, Kao YC, Chang SY, Kuo TBJ, Yang CCH, Chien WC, Tzeng NS. Long-term atomoxetine-oxybutynin combination use may be beneficial for the prevention of obstructive sleep apnea. Sci Rep 2021; 11:12526. [PMID: 34131226 PMCID: PMC8206122 DOI: 10.1038/s41598-021-91988-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
One recent study showed that atomoxetine-oxybutynin combination (AOC) use is effective in reducing obstructive sleep apnea (OSA) severity. We used a nationwide database to examine the association between AOC use and the risk of OSA incidence. This retrospective cohort study used Taiwan's National Health Insurance Research Database between the years 2000 and 2015. The patients who used atomoxetine or oxybutynin were included as an exposed cohort. The exposed and unexposed groups were selected in a ratio of 1:3 with sex, age, and index year matching. We used the multivariate Cox proportional regression model to evaluate the association between AOC use and the risk of an incident diagnosis of OSA. The incidence rates of OSA in the exposed cohort (N = 8940) and the unexposed cohort (N = 26,820), were 21.92 and 22.93 per 100,000 person-years, respectively. The adjusted hazard ratio of oxybutynin use only and AOC with a treatment duration of ≥ 366 days were 0.307 (95% CI 0.204-0.995, P = 0.045) and 0.299 (95% CI 0.102-0.933, P = 0.002), respectively. Long-term atomoxetine-oxybutynin combination therapy may be beneficial to reduce the risk of obstructive sleep apnea. Further studies to examine these mechanisms are warranted.
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Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.,Clinical Research Center, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
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13
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Chen W, Feng J, Wang Y, Wang C, Dong Z. Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea in Bariatric Surgery Candidates. Nat Sci Sleep 2021; 13:1013-1023. [PMID: 34234604 PMCID: PMC8254541 DOI: 10.2147/nss.s316674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in bariatric surgery patients and can lead to potential perioperative risks, but some screening tools lack adequate performance in this population. Thus, we aimed to develop and validate a clinical nomogram for predicting OSA in bariatric surgery candidates. METHODS We retrospectively collected the data of 482 bariatric surgery patients between September 2015 and January 2020. Patients were randomly classified into training cohort (n=338) and validation cohort (n=144). The Lasso regression was used to select potentially relevant features; then, multivariable logistic regression analysis was used to establish the nomogram. Discrimination, calibration and clinical usefulness of the nomogram were assessed using the C-index, calibration curve and decision curve analysis (DCA). RESULTS The overall prevalence of OSA was 71.0% and higher in males (88.2%) compared to females (60.1%). Of these, 26.1% had mild OSA, 14.9% had moderate OSA, and 44.8% had severe OSA. The nomogram consisted of gender, habitual snoring, type 2 diabetes mellitus (T2DM), neck circumference, body mass index (BMI) and age. The nomogram provided favorable discrimination, with a C-indexes for the training and validation cohort of 0.856 (95% CI: 0.816-0.897) and 0.829 (95% CI: 0.76-0.895), respectively, and good calibration. The DCA displayed that the nomogram was clinically useful. CONCLUSION We established a concise and practical nomogram that could facilitate the preoperative individualized prediction of OSA before bariatric surgery, which may help clinicians select bariatric surgery patients with high-risk OSA for polysomnography (PSG).
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Affiliation(s)
- Wenhui Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Jia Feng
- Department of Cellular Biology, Institute of Biomedicine, Jinan University, Guangzhou, People's Republic of China
| | - Yucheng Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
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Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis 2020; 17:215-220. [PMID: 33371935 DOI: 10.1016/j.soard.2020.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is closely related to obesity and can cause multiple organs and systems damage. Metabolic bariatric surgery (MBS) is presently the only long-term effective treatment and an important strategy for severely obese population, which also provides a novel therapeutic for obese patients with OSAHS, especially in patients with poor continuous positive air pressure (CPAP) adherence. To date, the resolution mechanism of OSAHS in obese patients after MBS has not been fully clarified. In addition, there is no specific metabolic bariatric surgical treatment of OSAHS guidelines. Therefore, this review provides an update on the relationship between OSAHS and MBS for highlighting the importance of weight loss strategies for obese patients with OSAHS.
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Affiliation(s)
- Xiaoping Ming
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Minlan Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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15
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Albaugh VL. Comment on: Prevalence of obstructive sleep apnea in an Asian bariatric population. An undiagnosed dilemma. Surg Obes Relat Dis 2020; 16:783-785. [DOI: 10.1016/j.soard.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
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