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Garbarino S, Bragazzi NL. Revolutionizing Sleep Health: The Emergence and Impact of Personalized Sleep Medicine. J Pers Med 2024; 14:598. [PMID: 38929819 PMCID: PMC11204813 DOI: 10.3390/jpm14060598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Personalized sleep medicine represents a transformative shift in healthcare, emphasizing individualized approaches to optimizing sleep health, considering the bidirectional relationship between sleep and health. This field moves beyond conventional methods, tailoring care to the unique physiological and psychological needs of individuals to improve sleep quality and manage disorders. Key to this approach is the consideration of diverse factors like genetic predispositions, lifestyle habits, environmental factors, and underlying health conditions. This enables more accurate diagnoses, targeted treatments, and proactive management. Technological advancements play a pivotal role in this field: wearable devices, mobile health applications, and advanced diagnostic tools collect detailed sleep data for continuous monitoring and analysis. The integration of machine learning and artificial intelligence enhances data interpretation, offering personalized treatment plans based on individual sleep profiles. Moreover, research on circadian rhythms and sleep physiology is advancing our understanding of sleep's impact on overall health. The next generation of wearable technology will integrate more seamlessly with IoT and smart home systems, facilitating holistic sleep environment management. Telemedicine and virtual healthcare platforms will increase accessibility to specialized care, especially in remote areas. Advancements will also focus on integrating various data sources for comprehensive assessments and treatments. Genomic and molecular research could lead to breakthroughs in understanding individual sleep disorders, informing highly personalized treatment plans. Sophisticated methods for sleep stage estimation, including machine learning techniques, are improving diagnostic precision. Computational models, particularly for conditions like obstructive sleep apnea, are enabling patient-specific treatment strategies. The future of personalized sleep medicine will likely involve cross-disciplinary collaborations, integrating cognitive behavioral therapy and mental health interventions. Public awareness and education about personalized sleep approaches, alongside updated regulatory frameworks for data security and privacy, are essential. Longitudinal studies will provide insights into evolving sleep patterns, further refining treatment approaches. In conclusion, personalized sleep medicine is revolutionizing sleep disorder treatment, leveraging individual characteristics and advanced technologies for improved diagnosis, treatment, and management. This shift towards individualized care marks a significant advancement in healthcare, enhancing life quality for those with sleep disorders.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy;
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Human Nutrition Unit (HNU), Department of Food and Drugs, University of Parma, 43125 Parma, Italy
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Qin H, Fietze I, Mazzotti DR, Steenbergen N, Kraemer JF, Glos M, Wessel N, Song L, Penzel T, Zhang X. Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring. J Sleep Res 2024; 33:e14020. [PMID: 37709966 DOI: 10.1111/jsr.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.
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Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Information Processing and Analytics Group, School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, Medical School Berlin, Berlin, Germany
| | - Lijun Song
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Karuga FF, Kaczmarski P, Białasiewicz P, Szmyd B, Jaromirska J, Grzybowski F, Gebuza P, Sochal M, Gabryelska A. REM-OSA as a Tool to Understand Both the Architecture of Sleep and Pathogenesis of Sleep Apnea-Literature Review. J Clin Med 2023; 12:5907. [PMID: 37762848 PMCID: PMC10531579 DOI: 10.3390/jcm12185907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system activity, or metabolism. Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of pauses in breathing during sleep caused by blockage of the upper airways. This common condition has multifactorial ethiopathogenesis (e.g., anatomical predisposition, sex, obesity, and age). Within this heterogenous syndrome, some distinctive phenotypes sharing similar clinical features can be recognized, one of them being REM sleep predominant OSA (REM-OSA). The aim of this review was to describe the pathomechanism of REM-OSA phenotype, its specific clinical presentation, and its consequences. Available data suggest that in this group of patients, the severity of specific cardiovascular and metabolic complications is increased. Due to the impact of apneas and hypopneas predominance during REM sleep, patients are more prone to develop hypertension or glucose metabolism impairment. Additionally, due to the specific function of REM sleep, which is predominantly fragmented in the REM-OSA, this group presents with decreased neurocognitive performance, reflected in memory deterioration, and mood changes including depression. REM-OSA clinical diagnosis and treatment can alleviate these outcomes, surpassing the traditional treatment and focusing on a more personalized approach, such as using longer therapy of continuous positive airway pressure or oral appliance use.
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Affiliation(s)
- Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Kaczmarski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland
| | - Julia Jaromirska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Filip Grzybowski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Gebuza
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
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Chun S, Akle S, Teodosiadis A, Cade BE, Wang H, Sofer T, Evans DS, Stone KL, Gharib SA, Mukherjee S, Palmer LJ, Hillman D, Rotter JI, Hanis CL, Stamatoyannopoulos JA, Redline S, Cotsapas C, Sunyaev SR. Leveraging pleiotropy to discover and interpret GWAS results for sleep-associated traits. PLoS Genet 2022; 18:e1010557. [PMID: 36574455 PMCID: PMC9829185 DOI: 10.1371/journal.pgen.1010557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2023] [Accepted: 12/06/2022] [Indexed: 12/28/2022] Open
Abstract
Genetic association studies of many heritable traits resulting from physiological testing often have modest sample sizes due to the cost and burden of the required phenotyping. This reduces statistical power and limits discovery of multiple genetic associations. We present a strategy to leverage pleiotropy between traits to both discover new loci and to provide mechanistic hypotheses of the underlying pathophysiology. Specifically, we combine a colocalization test with a locus-level test of pleiotropy. In simulations, we show that this approach is highly selective for identifying true pleiotropy driven by the same causative variant, thereby improves the chance to replicate the associations in underpowered validation cohorts and leads to higher interpretability. Here, as an exemplar, we use Obstructive Sleep Apnea (OSA), a common disorder diagnosed using overnight multi-channel physiological testing. We leverage pleiotropy with relevant cellular and cardio-metabolic phenotypes and gene expression traits to map new risk loci in an underpowered OSA GWAS. We identify several pleiotropic loci harboring suggestive associations to OSA and genome-wide significant associations to other traits, and show that their OSA association replicates in independent cohorts of diverse ancestries. By investigating pleiotropic loci, our strategy allows proposing new hypotheses about OSA pathobiology across many physiological layers. For example, we identify and replicate the pleiotropy across the plateletcrit, OSA and an eQTL of DNA primase subunit 1 (PRIM1) in immune cells. We find suggestive links between OSA, a measure of lung function (FEV1/FVC), and an eQTL of matrix metallopeptidase 15 (MMP15) in lung tissue. We also link a previously known genome-wide significant peak for OSA in the hexokinase 1 (HK1) locus to hematocrit and other red blood cell related traits. Thus, the analysis of pleiotropic associations has the potential to assemble diverse phenotypes into a chain of mechanistic hypotheses that provide insight into the pathogenesis of complex human diseases.
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Affiliation(s)
- Sung Chun
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sebastian Akle
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | | | - Brian E. Cade
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California, United States of America
| | - Sina A. Gharib
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
- Computational Medicine Core at Center for Lung Biology, University of Washington, Seattle, Washington, United States of America
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyle J. Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - David Hillman
- Centre for Sleep Science, University of Western Australia, Perth, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Craig L. Hanis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - John A. Stamatoyannopoulos
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Chris Cotsapas
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shamil R. Sunyaev
- Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Altius Institute for Biomedical Sciences, Seattle, Washington, United States of America
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
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Evaluation of Blood Intercellular Adhesion Molecule-1 (ICAM-1) Level in Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101499. [PMID: 36295659 PMCID: PMC9607021 DOI: 10.3390/medicina58101499] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022]
Abstract
Background and objective: Intercellular adhesion molecule-1 (ICAM-1) appears to be an active and important biomarker for decreasing the risk of cardiovascular issues among individuals with obstructive sleep apnea (OSA). Herein, a systematic review and meta-analysis was designed to probe whether plasma/serum ICAM-1levels are different in adults with OSA compared to adults with no OSA, as well as adults with severe OSA compared to adults with mild/moderate OSA. Materials and methods: A thorough and systematic literature search was performed in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) until 17 July 2022, without any age and sample size restrictions to retrieve the relevant articles. The standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of ICAM-1 levels was reported. Analyses, including sensitivity analysis, subgroup analysis, trial sequential analysis, meta-regression, and a funnel plot analysis, were performed in the pooled analysis. Results: A total of 414 records were identified in the databases, and 17 articles including 22 studies were entered into the meta-analysis. The pooled SMD of serum/plasma ICAM-1 levels in adults with OSA compared to controls was 2.00 (95%CI: 1.41, 2.59; p < 0.00001). The pooled SMD of serum/plasma ICAM-1 levels in adults with severe compared to mild/moderate OSA was 3.62 (95%CI: 1.74, 5.51; p = 0.0002). Higher serum/plasma ICAM-1 levels were associated with a higher mean age of controls, higher scores for the apnea-hypopnea index, and with a lower mean age of adults with OSA and with smaller sample sizes. Conclusions: Th results of the present meta-analysis showed that serum/plasma ICAM-1 levels in adults with OSA was higher than serum/plasma ICAM-1 levels in controls. Similarly, serum/plasma ICAM-1 levels in adults with severe OSA were higher compared to serum/plasma ICAM-1 levels of adults with mild or moderate OSA. Therefore, ICAM-1 may be used as an additional diagnostic and therapeutic biomarker in adults with OSA.
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Najafi A, Mohammadi I, Sadeghi M, Brühl AB, Sadeghi-Bahmani D, Brand S. Evaluation of Plasma/Serum Adiponectin (an Anti-Inflammatory Factor) Levels in Adult Patients with Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12050738. [PMID: 35629405 PMCID: PMC9145771 DOI: 10.3390/life12050738] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022] Open
Abstract
Background and objective: A variety of diseases, including obesity, type ‖ diabetes, and cardiovascular diseases are associated with obstructive sleep apnea syndrome (OSAS), and decreased adiponectin levels have been shown to be associated with an increased risk of these diseases. However, the association of blood levels of adiponectin in OSAS patients is a challenging and unknown issue with conflicting results. Therefore, we performed a systematic review and a meta-analysis to evaluate plasma/serum adiponectin levels in adult patients with OSAS. Materials and methods: A comprehensive search in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) was performed in literature dated older than 12 March 2022, to retrieve the relevant articles. Effect sizes were calculated to show the standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of adiponectin between the OSAS patients and controls. The software RevMan 5.3, NCSS 21.0.2, CMA 2.0, trial sequential analysis (TSA) 0.9.5.10 beta, and GetData Graph Digitizer 2.26 were used for data synthesis in the meta-analysis. Results: A total of 28 articles including 36 studies were entered into the meta-analysis. The results showed that pooled SMD was −0.71 (95% CI: −0.92, 0.50; p < 0.00001; I2 = 79%) for plasma/serum levels of adiponectin in OSAS cases compared to the controls. The subgroup analyses showed that the geographical region and the Apnea-Hypopnea-Index (AHI) could be confounding factors in the pooled analysis of plasma/serum adiponectin levels. The sensitivity analysis showed the stability of the results. The radial and L’Abbé plots confirmed evidence of heterogeneity. Trial sequential analysis showed sufficient cases in the meta-analysis. Conclusions: With sufficient cases and stable results, the main finding of the meta-analysis identified significantly reduced plasma/serum levels of adiponectin in OSAS cases compared with the controls. This result suggests a potential role of adiponectin in the pathogenesis of OSAS.
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Affiliation(s)
- Amir Najafi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (A.N.); (I.M.)
| | - Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (A.N.); (I.M.)
| | - Masoud Sadeghi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran;
| | - Annette Beatrix Brühl
- Center for Affective, Stress and Sleep Disorders, University of Basel, Psychiatric Clinics, 4001 Basel, Switzerland; (A.B.B.); (D.S.-B.)
| | - Dena Sadeghi-Bahmani
- Center for Affective, Stress and Sleep Disorders, University of Basel, Psychiatric Clinics, 4001 Basel, Switzerland; (A.B.B.); (D.S.-B.)
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders, University of Basel, Psychiatric Clinics, 4001 Basel, Switzerland; (A.B.B.); (D.S.-B.)
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, 4052 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Tehran 1416753955, Iran
- Correspondence:
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Duarte J, Pauletto P, Polmann H, Réus JC, de Souza JF, Gaio DC, Brancher JA, Vieira A, Machado-Souza C, de Souza Melo G, Maia IS, De Luca Canto G. Is there an association of genetic polymorphisms of the catechol-O-methyltransferase gene (rs165656 and rs174675) and the 5-hydroxytryptamine receptor 2A gene (rs4941573 and rs6313) with sleep bruxism in individuals with obstructive sleep apnea? Arch Oral Biol 2021; 133:105315. [PMID: 34808513 DOI: 10.1016/j.archoralbio.2021.105315] [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: 08/22/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the association of single-nucleotide polymorphisms within the catechol-O-methyltransferase and 5-hydroxytryptamine receptor 2A genes with sleep bruxism in individuals diagnosed with obstructive sleep apnea. DESIGN Sixty-nine individuals with suspected sleep-related problems were evaluated by polysomnography, following the recommendations of the American Academy of Sleep Medicine. Deoxyribonucleic acid (DNA) samples were collected only from 48 of the study participants because of missing polysomnographic data. DNA samples were collected and two single-nucleotide polymorphisms in the 5-hydroxytryptamine receptor 2A encoding HTR2A gene (rs4941573 and rs6313) and two in the catechol-O-methyltransferase gene (rs165656 and rs174675) were selected to be genotyped using real-time polymerase chain reaction. The association between sleep bruxism and genetic polymorphisms was investigated by recessive and dominant models. Association analyses were performed using a 95% confidence interval and the level of statistical significance was p < 0.05. RESULTS From the 69 study participants, 48 were included in the polymorphism analysis and sleep bruxism was present in 35.4%. No significant differences were observed in the dominant and recessive models (p > 0.05). Haplotype and diplotype analyses revealed the predicted four haplotypes and two diplotypes were not associated with sleep bruxism. CONCLUSION Polymorphisms rs174675 and rs165656 in the catechol-O-methyltransferase gene and rs4941573 and rs6313 in the 5-hydroxytryptamine receptor 2A gene were not significantly associated with sleep bruxism in individuals with obstructive sleep apnea.
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Affiliation(s)
- Joyce Duarte
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil.
| | - Patrícia Pauletto
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Helena Polmann
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Jéssica Conti Réus
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | | | - André Vieira
- Graduate Program in Biotechnology Applied to Child and Adolescent Health - Pequeno Príncipe College, Pelé Research Institute, Curitiba, Paraná, Brazil
| | - Cleber Machado-Souza
- Graduate Program in Biotechnology Applied to Child and Adolescent Health - Pequeno Príncipe College, Pelé Research Institute, Curitiba, Paraná, Brazil
| | - Gilberto de Souza Melo
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Graziela De Luca Canto
- Brazilian Center for Evidence-Based Research (COBE), Federal University of Santa Catarina, Florianópolis, Brazil; Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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8
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Wieckiewicz M, Bogunia-Kubik K, Mazur G, Danel D, Smardz J, Wojakowska A, Poreba R, Dratwa M, Chaszczewska-Markowska M, Winocur E, Emodi-Perlman A, Martynowicz H. Genetic basis of sleep bruxism and sleep apnea-response to a medical puzzle. Sci Rep 2020; 10:7497. [PMID: 32367059 PMCID: PMC7198562 DOI: 10.1038/s41598-020-64615-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
Sleep bruxism (SB) and obstructive sleep apnea (OSA) are co-occurring sleep conditions. The study aimed to evaluate the association of selected single-nucleotide polymorphisms (SNPs) occurring within the genes of the serotonin and dopamine pathways in SB and OSA and investigate the relationship between them. The study group included 100 Caucasian patients. SB and OSA were diagnosed in 74 and 28 patients, respectively. In addition, 125 unrelated Caucasian healthy blood donors served as randomly selected controls to enable comparison of polymorphisms. The following SNPs were analyzed: rs2770304 and rs6313 within the serotonin receptor encoding gene (HTR2A), rs4680 polymorphism of the catechol-O-methyltransferase (COMT) gene, and rs686 within the dopamine receptor (DRD1) encoding gene. The prevalence of the DRD1 rs686 G variant (GG homozygosity) was found to be high in the study group compared to the control group. Bruxism episode index (BEI) was found to be significantly increased in the HTR2A rs6313 TT homozygotes compared to the heterozygous patients. Moreover, within a group of the HTR2A rs2770304 TT homozygous cases, a statistically significant correlation was observed between BEI and apnea-hypopnea index. These results indicate that DRD1 rs686 may potentially affect predisposition to SB, that HTR2A rs6313 SNP may be involved in SB pathogenesis, and that HTR2A rs2770304 polymorphism might contribute to the association between SB and OSA. This suggests a possible genetic contribution to the etiology of primary SB.
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Affiliation(s)
- Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425, Wroclaw, Poland.
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 R. Weigla St., 53-114, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556, Wroclaw, Poland
| | - Dariusz Danel
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 R. Weigla St., 53-114, Wroclaw, Poland
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425, Wroclaw, Poland
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556, Wroclaw, Poland
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556, Wroclaw, Poland
| | - Marta Dratwa
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 R. Weigla St., 53-114, Wroclaw, Poland
| | - Monika Chaszczewska-Markowska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 R. Weigla St., 53-114, Wroclaw, Poland
| | - Efraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, 4 Klatchkin St., Tel Aviv, 69978, Israel
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, 4 Klatchkin St., Tel Aviv, 69978, Israel
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556, Wroclaw, Poland
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Tepebaşı MY, Şahin Calapoğlu N, Öztürk Ö, Sancer O, Gonca T. HLA-DRB1 allele frequency and immunological response in obstructive sleep apnea syndrome in Turkish population. CLINICAL RESPIRATORY JOURNAL 2018; 12:2505-2512. [PMID: 30015400 DOI: 10.1111/crj.12945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/29/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a complex, polygenic and multifactorial disease. The relationship between Human Leukocyte Antigen (HLA) polymorphisms and sleep disturbances has been established, but the relationship with HLA alleles has not been fully clarified. In addition, sleep deprivation in OSAS patients can cause changes that affect the components and responses of the immune system. OBJECTIVE The aim of this study has assessed the effect of HLA-DRB1 alleles on OSAS disease and the changes occurring in immune response cells in Turkish population. METHOD OSAS was diagnosed by polysomnography and severity was determined. PCR SSP and flow cytometry methods were used. RESULTS We found that DRB1*07 and DRB1*11 were significantly increased in the control group and DRB1*03 and DRB1*08 alleles in the patient group in our study (P = 0.048, P = 0.005, P = 0.012 and P = 0.030, respectively). DRB1*08 was significantly increased in patients with severe OSAS (P = 0.002). When the immunological response was examined in OSAS patients, there was a decrease in CD4, an increase in HLA DR, CD8 and NK cells (P = 0.002, P = 0.00, P = 0.020, P = 0.040, respectively). We also found that CD19 was reduced in severe OSAS (P = 0.048). CONCLUSION These results suggest that the DRB1*03 allele may play a predisposing role in OSAS disease and that the DRB1*08 allele may be related to the severity of the disease. In addition, the decrease in CD4, CD8, NK and HLA DR increase in this disease suggests that the disease causes impairment of the immunological system and may be associated with autoimmunity.
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Affiliation(s)
| | | | - Önder Öztürk
- Department of Chest Diseases, University of Süleyman Demirel, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology, University of Süleyman Demirel, Isparta, Turkey
| | - Taner Gonca
- Department of Chest Diseases, Isparta City Hospital, Isparta, Turkey
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Mukherjee S, Saxena R, Palmer LJ. The genetics of obstructive sleep apnoea. Respirology 2018; 23:18-27. [PMID: 29113020 PMCID: PMC7308164 DOI: 10.1111/resp.13212] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/11/2017] [Accepted: 09/29/2017] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common chronic disease and is associated with high social and economic costs. OSA is heritable, and there is evidence of both direct genetic contributions to OSA susceptibility and indirect contributions via 'intermediate' phenotypes such as obesity, craniofacial structure, neurological control of upper airway muscles and of sleep and circadian rhythm. Investigation of the genetics of OSA is an important research area and may lead to improved understanding of disease aetiology, pathogenesis, adverse health consequences and new preventive strategies and treatments. Genetic studies of OSA have lagged behind other chronic diseases; however recent gene discovery efforts have been successful in finding genetic loci contributing to OSA-associated intermediate phenotypes. Nevertheless, many of the seminal questions relating to the genetic epidemiology of OSA and associated factors remain unanswered. This paper reviews the current state of knowledge of the genetics of OSA, with a focus on genomic approaches to understanding sleep apnoea.
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Affiliation(s)
- Sutapa Mukherjee
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Richa Saxena
- Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Lyle J Palmer
- School of Public Health, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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Park JE, Bae SH, Choi YJ, Choi WC, Kim HW, Lee UL. The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients. Maxillofac Plast Reconstr Surg 2017; 39:22. [PMID: 28824888 PMCID: PMC5544661 DOI: 10.1186/s40902-017-0120-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery. METHODS A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring. RESULTS Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers. CONCLUSIONS This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.
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Affiliation(s)
- Jung-Eun Park
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seon-Hye Bae
- Department of orthodontics, Estar dental clinic, Seoul, Republic of Korea
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
| | - Won-Cheul Choi
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Hye-Won Kim
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Ui-Lyong Lee
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
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12
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de Paula LK, Alvim RO, Pedrosa RP, Horimoto AR, Krieger JE, Oliveira CM, Pereira AC, Lorenzi-Filho G. Heritability of OSA in a Rural Population. Chest 2016; 149:92-7. [DOI: 10.1378/chest.15-0843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Abstract
Primary sleep disorders include those not attributable to another medical or psychiatric condition: insomnia disorder, hypersomnolence disorder, narcolepsy, obstructive sleep apnea hypopnea syndrome, central sleep apnea syndrome, and the parasomnias. They are commonly encountered and are comorbid with many psychiatric disorders. It is important to recognize these disorders and be comfortable treating them or to know when to refer to a sleep disorders center and sleep specialist. Treatment of a comorbid sleep disorder can improve the overall quality of life, symptoms in mood disorders, and symptoms of excessive daytime sleepiness, and decrease cardiovascular morbidity and mortality.
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Zhang SXL, Wang Y, Gozal D. Pathological consequences of intermittent hypoxia in the central nervous system. Compr Physiol 2013; 2:1767-77. [PMID: 23723023 DOI: 10.1002/cphy.c100060] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intermittent hypoxia (IH) is a frequent occurrence in clinical settings. In the last decades, evidence has emerged implicating the gas exchange alterations and sleep disruption associated with those disorders in the high prevalence of cognitive and behavioral deficits afflicting these patients. In an effort to better characterize the role of IH, and to identify potential mechanisms of IH-induced central nervous system (CNS) dysfunction, a large number of rodent models have been recently developed. The cumulative evidence confirms that IH indeed induces a heterotopic pattern of injury in the brain, particularly affecting cortical, subcortical, and hippocampal regions, ultimately leading to neuronal apoptosis and activation of microglia. These IH-induced deleterious processes exhibit substantial variability across the lifespan, are under substantial modulatory influences of diet, physical or intellectual activity, and genetic factors, and preferentially recruit oxidative stress and inflammatory pathways.
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Affiliation(s)
- Shelley X L Zhang
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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15
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de Carvalho TBO, Suman M, Molina FD, Piatto VB, Maniglia JV. Relationship of obstructive sleep apnea syndrome with the 5-HT2A receptor gene in Brazilian patients. Sleep Breath 2012; 17:57-62. [PMID: 22281949 DOI: 10.1007/s11325-012-0645-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 01/04/2012] [Accepted: 01/09/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Serotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Polymorphisms in the 5-HT2A receptor gene can alter its transcription, affecting the number of receptors in the serotoninergic system, contributing to obstructive sleep apnea syndrome (OSAS). OBJECTIVE The aim of this study was to determine the prevalence of the 102T-C and -1438G-A polymorphisms in the 5-HTR2A gene in Brazilian patients with and without OSAS. SUBJECTS AND METHODS A cross-sectional study performed at the Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School, FAMERP. One hundred patients were examined as index cases and 100 persons as controls, of both genders to both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed both polymorphisms were amplified by PCR-RFLP. RESULTS There was a significant prevalence of the male gender in index cases compared with the control group gender (p < 0.0001). There was no significant genotypic difference in the 102T-C polymorphism between the case and control groups (p = 1.000). The AA genotype of the -1438G-A polymorphism was more prevalent in the patients with OSAS compared with the controls (OR, 2.3; CI 95% 1.20-4.38; p = 0.01). CONCLUSIONS There was no difference in the prevalence of the 102T-C polymorphism between patients with OSAS and the control group. Serotoninergic system dysfunction appeared to be related to OSAS. The -1438G-A polymorphism and OSAS are related in this studied Brazilian population.
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Varvarigou V, Dahabreh IJ, Malhotra A, Kales SN. A review of genetic association studies of obstructive sleep apnea: field synopsis and meta-analysis. Sleep 2011; 34:1461-8. [PMID: 22043116 DOI: 10.5665/sleep.1376] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a multifactorial disorder with a heritable component. We performed a field synopsis of genetic association studies of OSA to synthesize the available evidence. DESIGN Systematic literature review and meta-analysis. SETTING Genetic association studies. PATIENTS OR PARTICIPANTS We searched multiple databases to identify studies of non-HLA genetic associations in OSA. We assessed the power of the primary studies to identify odds ratios (OR) in a plausible range and performed random effects meta-analyses for genetic associations investigated by at least 3 studies. We explored the consistency of the findings between population- and family-based studies. INTERVENTIONS None MEASUREMENTS AND RESULTS We identified a total of 31 population-based case-control studies reporting allele-frequency data on 48 polymorphism-OSA associations. Sample sizes were generally small (median number of cases = 102, 25th-75th percentile = 55-151; median number of controls = 79, 25th-75th percentile = 58-137), and genetic effects were moderate in magnitude (median OR = 1.15, 25th-75th percentile = 0.89-1.40). Studies were severely underpowered to detect ORs as high as 2; only eight comparisons (in 6 studies) had more than 90% power to identify a genetic effect of that magnitude at its current sample size. Four genetic associations had been investigated in ≥ 3 studies: TNFA (-308 A/G) rs1800629, ACE I/D, APOE ε2, and APOE ε4. Only TNFA rs1800629 was significantly associated with OSA under an allele frequency model (3 studies, odds ratio [OR] = 1.82, 95% confidence interval [CI] 1.26-2.61). These results were robust to alternative genetic models; findings for APOE variants were consistent with those from family-based studies. CONCLUSIONS The developing field of OSA genetics is currently dominated by small and underpowered investigations. Promising findings regarding TNFA rs1800629 need to be replicated in larger studies using more comprehensive genotyping methods.
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Affiliation(s)
- Vasileia Varvarigou
- Department of Environmental and Occupational Medicine & Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Cobo Plana J, de Carlos Villafranca F. Trastornos respiratorios del sueño y desarrollo dentofacial en los niños. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61 Suppl 1:33-9. [DOI: 10.1016/s0001-6519(10)71243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med 2010; 31:179-86. [PMID: 20488280 DOI: 10.1016/j.ccm.2010.02.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objectives of this article are to (1) understand how respiratory event definitions and syndrome threshold values affect prevalence estimates of obstructive sleep apnea in adults, (2) recognize important risk factors for obstructive sleep apnea in adults, and (3) understand current theories of the underlying mechanisms for airway obstruction during sleep.
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Ibrahim LH, Jacono FJ, Patel SR, Thomas RJ, Larkin EK, Mietus JE, Peng CK, Goldberger AL, Redline S. Heritability of abnormalities in cardiopulmonary coupling in sleep apnea: use of an electrocardiogram-based technique. Sleep 2010; 33:643-6. [PMID: 20469806 PMCID: PMC2864879 DOI: 10.1093/sleep/33.5.643] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
RATIONALE Studies of the genetics of obstructive sleep apnea may be facilitated by identifying intermediate traits with high heritability that quantify etiological pathways, such as those related to respiratory control. Electrocardiogram (ECG)-based sleep spectrograms, measuring the coupling between respiratory modulation of ECG QRS-wave amplitude and heart rate variability, may provide measures of sleep state and ventilatory dynamics during sleep. We evaluated the familial aggregation of distinctive spectrographic biomarkers of unstable sleep, related to elevated-low frequency cardiopulmonary coupling (e-LFC), to assess their utility in genetic studies. METHODS 622 participants from 137 families from the Cleveland Family Study underwent standardized polysomnography (PSG). From the ECG signal on the PSG, the interbeat interval time series and the corresponding ECG-derived respiratory signal were extracted, and the low frequency (0.01-0.1 Hz) component of their coupling was computed using a fully automated method. Narrow sense heritability of e-LFC was calculated using variance component methods. RESULTS A spectral marker of abnormal low frequency cardiopulmonary coupling (e-LFC) demonstrated moderate correlation with apnea hypopnea index (AHI; r = 0.35, P < 0.0001). The heritability estimate for e-LFC, after adjusting for age and sex was 0.32 (P < 10-5) and remained unchanged after additionally adjusting for body mass index or AHI. In biological relatives of those with sleep apnea, a related marker of e-LFC was more prevalent than in controls (P = 0.05). CONCLUSIONS Approximately 30% of the variability of e-LFC, measured from a continuous ECG during sleep, is explained by familial factors other than BMI. ECG-based spectrographic measures of cardiopulmonary coupling may provide novel phenotypes for characterizing subgroups of individuals with different propensities and genetic etiologies for sleep apnea or for other conditions associated with sleep fragmentation.
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Affiliation(s)
- Lamia H Ibrahim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106-6003, USA.
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Insertion/Deletion Polymorphism and Serum Activity of the Angiotensin-Converting Enzyme in Turkish Patients with Obstructive Sleep Apnea Syndrome. Biochem Genet 2010; 48:516-23. [DOI: 10.1007/s10528-010-9335-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 02/02/2010] [Indexed: 01/06/2023]
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Eastwood PR, Malhotra A, Palmer LJ, Kezirian EJ, Horner RL, Ip MS, Thurnheer R, Antic NA, Hillman DR. Obstructive Sleep Apnoea: From pathogenesis to treatment: Current controversies and future directions. Respirology 2010; 15:587-95. [PMID: 20136736 DOI: 10.1111/j.1440-1843.2009.01699.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common disease, recognized as an independent risk factor for a range of clinical conditions, such as hypertension, stroke, depression and diabetes. Despite extensive research over the past two decades, the mechanistic links between OSA and other associated clinical conditions, including metabolic disorders and cardiovascular disease, remain unclear. Indeed, the pathogenesis of OSA itself remains incompletely understood. This review provides opinions from a number of leading experts on issues related to OSA and its pathogenesis, interaction with anaesthesia, metabolic consequences and comorbidities, cardiovascular disease, genetics, measurement and diagnosis, surgical treatment and pharmacotherapeutic targets.
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Affiliation(s)
- Peter R Eastwood
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
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Su M, Zhang X, Su S. Association of adiponectin genotype polymorphisms at positions 45 and 276 with obstructive sleep apnea hypopnea syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1007-4376(09)60070-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sundquist J, Li X, Friberg D, Hemminki K, Sundquist K. Obstructive sleep apnea syndrome in siblings: an 8-year Swedish follow-up study. Sleep 2008; 31:817-23. [PMID: 18548826 DOI: 10.1093/sleep/31.6.817] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Understanding the genetic transmission of obstructive sleep apnea syndrome (OSAS) will help clinicians identify patients at risk and offer opportunities for intervention and treatment at specialist clinics. OBJECTIVE To estimate familial risk of hospitalization for OSAS in the adult population of Sweden, and to determine if there are any differences by age and sex. DESIGN, SETTING, AND PARTICIPANTS Using the MigMed database at the Karolinska Institute, we divided the population of Sweden into sibling groups based on a shared mother and father and ascertained the presence or absence of a primary hospital diagnosis of OSAS in each individual during the follow-up period, 1997 to 2004. Individuals were categorized as having or not having a sibling with OSAS, based on the presence or absence of the disorder in at least 1 of their siblings. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were estimated for men and women with a sibling with OSAS, compared with men and women in the reference group (SIR = 1). RESULTS After accounting for socioeconomic status, age, geographic region, and period of diagnosis, men with at least 1 sibling who had OSAS had a SIR of 3.42 (95% CI, 2.18-5.36); the corresponding SIR in women was 3.25 (95% CI, 1.84-5.65). CONCLUSIONS Our results indicate that physicians should consider family history of OSAS when deciding whether to refer a patient for further sleep examinations.
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Affiliation(s)
- Jan Sundquist
- Karolinska Institute, Center for Family and Community Medicine, Huddinge, Sweden
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Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2008; 5:185-92. [PMID: 18250211 PMCID: PMC2645252 DOI: 10.1513/pats.200708-137mg] [Citation(s) in RCA: 405] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 09/21/2007] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.
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Affiliation(s)
- Alan R Schwartz
- Johns Hopkins Sleep Disorders Center, Baltimore, MD 21224, USA.
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Abstract
Zusammenfassung
Die Entstehung komplexer Erkrankungen wie koronare Herzkrankheit oder Diabetes mellitus wird durch zahlreiche Gene beeinflusst, von welchen jedes einzelne einen oft eher geringen Beitrag liefert. Der Nachweis, dass bestimmte genetische Varianten mit komplexen Erkrankungen assoziiert sind, ist oft schwer zu führen und bedarf großer, gut charakterisierter Patienten- und Kontrollgruppen. Alternativ und Erfolg versprechend ist die Untersuchung so genannter intermediärer Phänotypen. Dabei handelt es sich um Parameter, die mit der Entstehung der Erkrankung in Zusammenhang stehen, genetisch determiniert sind und einen Teilaspekt unter mehreren im Entstehungsmechanismus der Erkrankung repräsentieren. Dadurch kommt es zu einer Schärfung des Phänotyps und zu einer Reduktion der genetischen Heterogenität. Durch Untersuchung der Genetik solcher intermediärer Phänotypen statt der Genetik der Erkrankung an sich kann dieser Teilaspekt aufgeklärt werden. Besonders geeignet als intermediäre Phänotypen sind quantitative, gut messbare biochemische Parameter, wodurch im Gegensatz zu qualitativen Parametern eine deutlich verbesserte statistische Power erreicht werden kann.
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Affiliation(s)
- F. Kronenberg
- Aff1_36 grid.5361.1 0000000088532677 Division für Genetische Epidemiologie, Department für Medizinische Genetik, Molekulare und Klinische Pharmakologie Medizinische Universität Innsbruck Schöpfstraße 41 6020 Innsbruck Österreich
| | - I.M. Heid
- Aff2_36 grid.4567.0 0000000404832525 Institut für Epidemiologie GSF-Forschungszentrum für Umwelt und Gesundheit Neuherberg Deutschland
- Aff3_36 grid.5252.0 000000041936973X Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie Ludwig-Maximilian-Universität München München Deutschland
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Cuellar NG, Rogers AE, Hisghman V, Volpe SL. Assessment and Treatment of Sleep Disorders in the Older Adult. Geriatr Nurs 2007; 28:254-64. [PMID: 17711790 DOI: 10.1016/j.gerinurse.2007.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 01/22/2007] [Accepted: 01/27/2007] [Indexed: 11/20/2022]
Affiliation(s)
- Norma G Cuellar
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
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Montserrat JM, Garcia-Rio F, Barbe F. Diagnostic and therapeutic approach to nonsleepy apnea. Am J Respir Crit Care Med 2007; 176:6-9. [PMID: 17431227 DOI: 10.1164/rccm.200606-795pp] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Epidemiological and observational studies suggest that sleep-disordered breathing is associated with the subsequent development of hypertension and ultimately with cardiovascular consequences. It may therefore be assumed that continuous positive airway pressure (CPAP) not only avoids sleep-related symptoms but could also mitigate cardiovascular consequences. Short-term studies have revealed a drop in blood pressure, especially in more severe, symptomatic cases of obstructive sleep apnea. Two recent studies have reported that nonsleepy obstructive sleep apnea is associated with an absence of reduced blood pressure after CPAP treatment. This suggests that this group of patients is less susceptible to the consequences of apneas, even those with mild-moderate hypertension or other cardiovascular disorders. However, in patients with severe cardiovascular disease or a higher number of obstructive events, CPAP treatment should be seriously considered.
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Affiliation(s)
- Josep M Montserrat
- Spanish Group of Sleep Disorders Sleep Lab, Hospital Clinic Provincial-IDIBAPS, Barcelona, Spain.
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Chen F, Terada K, Hua Y, Saito I. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities. Am J Orthod Dentofacial Orthop 2007; 131:372-7. [PMID: 17346593 DOI: 10.1016/j.ajodo.2005.06.028] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 06/01/2005] [Accepted: 06/01/2005] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the short-term and long-term effects of bimaxillary surgery with those of mandibular setback surgery concerning pharyngeal airway measurements at 3 levels: nasopharynx, oropharynx, and hypopharynx. METHODS The sample included 66 Japanese women in 2 groups who had been diagnosed with Class III skeletal deformities and had undergone surgical-orthodontic treatment. Those in group A (35 patients) underwent bilateral sagittal split ramus osteotomies; those in group B (31 patients) underwent LeFort I procedures with bilateral sagittal split ramus osteotomies. Lateral cephalograms were assessed within 6 months before surgery and at short-term (3-6 months after surgery) and long-term (at least 2 years after surgery) follow-ups. RESULTS In group A, the pharyngeal airway was constricted significantly at the oropharyngeal and hypopharyngeal levels at both the short-term and the long-term follow-ups. In group B, significant changes were shown at the 3 pharyngeal levels at the short-term follow-up, whereas no significant changes were shown at the long-term follow-up. CONCLUSIONS These results indicate that, when possible, bimaxillary surgery rather than only mandibular setback surgery is preferable to correct a Class III deformity to prevent narrowing of the pharyngeal airway space, a possible predisposing factor in the development of obstructive sleep apnea.
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Affiliation(s)
- Fengshan Chen
- Department of Orthodontics, Dental School, Tongji University, Shanghai, China.
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Kalra M, Chakraborty R. Genetic susceptibility to obstructive sleep apnea in the obese child. Sleep Med 2007; 8:169-75. [PMID: 17275401 DOI: 10.1016/j.sleep.2006.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 10/23/2022]
Abstract
The etiology of obstructive sleep apnea (OSA) is multifactorial, consisting of a complex interplay between anatomic and neuromuscular factors and an underlying genetic predisposition toward this disease. Several of the factors that have been reported to play a role in the pathogenesis of OSA can serve as intermediate phenotypes in investigations targeting genetic susceptibility to OSA. A precise underpinning of the genetic basis of OSA has been thus far difficult because it is still unknown whether or not the recognized candidate genes for OSA are directly causal to the phenotype, or whether their effects on OSA are mediated through the intermediate phenotypes of OSA. Future studies utilizing phenotypically homogenous groups such as those with childhood OSA and technological advances such as haplotype analysis in a case control design are extremely promising. Developing predictive models that incorporate genetic and phenotypic markers will enable early diagnosis and, therefore, intervention, ultimately resulting in reduction of morbidity and of the public health concerns associated with OSA in obese children.
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Affiliation(s)
- Maninder Kalra
- Cincinnati Children's Hospital, Division of Pulmonary Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, United States.
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Abstract
PURPOSE OF REVIEW Obstructive sleep apnea continues to be a significant public health problem. A variety of imaging modalities have been used recently to gain insight into the pathogenesis of this disease, as well as to identify therapeutic options. RECENT FINDINGS Data from more recent imaging studies have highlighted key findings regarding the anatomic sites of collapse and local tissue factors promoting upper airway compromise. The role of genetics, aging, gender and ethnicity in the development of sleep apnea and the identification of predictors for successful treatment outcomes for sleep-disordered breathing are also reviewed. SUMMARY As our understanding of obstructive sleep apnea evolves, newer imaging techniques and computerized models may be able to further enhance our understanding of the pathogenesis and treatment of this disease.
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Affiliation(s)
- Murtuza M Ahmed
- Division of Pulmonary, Allergy and Critical Care Medicine, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Intermittent Hypoxia and Cognitive Function: Implications from Chronic Animal Models. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2007; 618:51-67. [DOI: 10.1007/978-0-387-75434-5_5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T, Freidman B, Goldbart AD, Tal A, Reuveni H. Elevated morbidity and health care use in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2006; 175:55-61. [PMID: 17038661 DOI: 10.1164/rccm.200604-577oc] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Health care use, a reliable measure of morbidity, is noticeably higher 1 yr before obstructive sleep apnea syndrome (OSAS) diagnosis in preschool children. It is not clear at what age OSAS-related morbidity becomes expressed. OBJECTIVE To explore morbidity and health care use among children with OSAS starting from first year of life. METHODS Case-control study, starting from the first year of life to date of OSAS diagnosis, among 156 patients (age range, 3-5 yr) and their pair-matched healthy control subjects, by age, sex, primary care physician, and geographic location. MEASUREMENTS Patients with OSAS underwent nocturnal polysomnography studies. Medical records during hospital visits were reviewed for diagnosis. Variables of health care use were obtained from computerized databases of Clalit Health Care Services, the largest health maintenance organization in Israel. MAIN RESULTS From the first year of life to date of OSAS diagnosis, children with OSAS had 40% more (p = 0.048) hospital visits, 20% more repeated (two or more) visits (p < 0.0001), and higher consumption of antiinfective and respiratory system drugs (p < 0.0001). Referrals of children with OSAS to otolaryngology surgeons and pediatric pulmonologists were higher from Year 1 (p < 0.0001) to date of OSAS diagnosis, especially in Year 4 (odds ratio, 9.4; 95% confidence interval, 4.2-21.1). The 215% elevation (p < 0.0001) in health care use of the OSAS group was due mainly to higher occurrence of respiratory tract morbidity (p < 0.0001). CONCLUSIONS Practitioners should be aware that starting in Year 1 until date of diagnosis, children with OSAS have higher health care use, mostly related to respiratory diseases.
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Affiliation(s)
- Ariel Tarasiuk
- Department of Physiology, Faculty of Health Sciences, P.O. Box 653, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
The pathogenesis of obstructive sleep apnea (OSA) has been under investigation for over 25 years, during which a number of factors that contribute to upper airway (UA) collapse during sleep have been identified. Structural/anatomic factors that constrict space for the soft tissues surrounding the pharynx and its lumen are crucial to the development of OSA in many patients. Enlargement of soft tissues enveloping the pharynx, including hypertrophied tonsils, adenoids, and tongue, is also an important factor predisposing to UA collapse, inasmuch as this can impinge on the pharyngeal lumen and narrow it during sleep. Other factors, including impairment of UA mechanoreceptor sensitivity and reflexes that maintain pharyngeal patency and respiratory control system instability, have also been identified as possible mechanisms facilitating UA instability. This suggests that OSA may be a heterogeneous disorder, rather than a single disease entity. Therefore, the extent to which various pathogenic factors contribute to the phenomenon of repetitive collapse of the UA during sleep probably varies from patient to patient. Further elucidation of specific pathogenic mechanisms in individuals with OSA may facilitate the development of new therapies that can be tailored to individual patient needs according to the underlying mechanism(s) of their disease.
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Affiliation(s)
- Clodagh M Ryan
- Sleep Research Laboratory of Toronto Rehabilitation Institute, Toronto General Hospital/University Health Network, ON, Canada
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Abstract
There is a scarcity of adult prevalence studies of OSA outside the Caucasian populations of North America, Europe and Australia, and comparisons have been complicated by methodological differences in sleep study settings, respiratory events definition, measured risk factors and clinical outcomes, and the lack of objective parameters for the measurement of ethnicity itself. Comparing studies with the same methodological design and respiratory events definition, recent large-scale prevalence studies from Hong Kong, Korea and India show similar OSA rates to populations of mainly Caucasian composition. OSA is a very complex disorder determined by several phenotypes such as obesity, craniofacial structure and abnormalities in neuromuscular and ventilatory control. Genetics may partially explain some of the ethnic clustering of these phenotypes, modulated by cultural and environmental factors. The exact contribution of these component phenotypes to overall OSA risk will be determined by their varying prevalence and relative risk conferred across ethnic groups. For lesser degrees of obesity, Asians are at risk for a more severe degree of illness compared with Caucasians. Inter-ethnic studies suggests that African-American ethnicity may also be a significant risk factor for OSA. The increased prevalences of OSA among American Indians and Hispanic adults, and increased severity among Pacific Islanders and Maoris, were mainly explained by increased obesity parameters. Most cephalometric studies have largely been conducted without specific regard to ethnicity and comparisons of findings across studies have been mainly limited by differences in sampling methods and the varying selection and definition of measured cephalometric variables. The limited number of studies with inter-ethnic comparative data suggest cephalometric variables and their degree of contribution to OSA vary across ethnic groups.
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Affiliation(s)
- Anna Tessa C Villaneuva
- Sleep Research Group, Woolcock Institute of Medical Research, University of Sydney, Australia
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Schwab RJ, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI. Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 2005; 173:453-63. [PMID: 16210668 PMCID: PMC2662941 DOI: 10.1164/rccm.200412-1736oc] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Sleep apnea is believed to be a genetic disorder. Thus, we hypothesized that anatomic risk factors for sleep apnea would demonstrate family aggregation. OBJECTIVES We used volumetric magnetic resonance imaging in a sib pair "quad" design to study the family aggregation of the size of upper airway soft tissue structures that are associated with increased risk for obstructive sleep apnea. METHODS We examined 55 sleep apnea probands (apnea-hypopnea index [AHI]: 43.2 +/- 26.3 events/h), 55 proband siblings (AHI: 11.8 +/- 16.6 events/h), 55 control subjects (AHI: 2.1 +/- 1.7 events/h), and 55 control siblings (AHI: 4.2 +/- 4.0 events/h). The study design used exact matching on ethnicity and sex, frequency matching on age, and statistical control for visceral neck fat and craniofacial dimensions. MEASUREMENTS AND MAIN RESULTS The data support our a priori hypothesis that the volume of the important upper airway soft tissue structures is heritable. The volume of the lateral pharyngeal walls (h(2) = 36.8%; p = 0.001), tongue (h(2) = 36.5%; p = 0.0001), and total soft tissue (h(2) = 37.5%; p = 0.0001) demonstrated significant levels of heritability after adjusting for sex, ethnicity, age, visceral neck fat, and craniofacial dimensions. In addition, our data indicate that heritability of the upper airway soft tissue structures is found in normal subjects and patients with apnea. Thus, it is not simply a consequence of the prevalence of apnea. CONCLUSIONS This is the first time family aggregation of size of the upper airway soft tissue structures has been demonstrated.
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Affiliation(s)
- Richard J Schwab
- Center for Sleep and Respiratory Neurobiology, 893 Maloney Building, University of Pennsylvania Medical Center, 3600 Spruce Street, Philadelphia, PA 19104-4283, USA.
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Chen F, Terada K, Hanada K, Saito I. Predicting the Pharyngeal Airway Space After Mandibular Setback Surgery. J Oral Maxillofac Surg 2005; 63:1509-14. [PMID: 16182920 DOI: 10.1016/j.joms.2005.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to propose a mathematical model to predict the change in pharyngeal airway space (PAS) associated with mandibular setback surgery. PATIENTS AND METHODS Twenty-three female adults, who were diagnosed as having skeletal Class III deformity, underwent mandibular setback surgery by bilateral sagittal split ramus osteotomy (BSSO) and orthodontic multibracket treatment. The subjects were assessed within 6 months before operation (T1) and 1 to 1.5 years after mandibular setback surgery (T2). The PAS change in the level of the base of the tongue was predicted. RESULTS The equation is: PAS narrowing = 0.386 - 0.541 ANB (T1 - T2) + 0.253 Co-Gn (T1 - T2) - 0.098 SN-GoGn (T1 - T2), where ANB is the angle formed by the planes nasion-point A and nasion-point B, Co is condylion, Go is gonion, and Gn is gnathion. The PAS change can be predicted by the mandibular changes after setback surgery 66.2% with the regression equation using the change of the ANB angle, the total mandibular length (Co-Gn) and the mandibular plane (SN-GoGn), where SN is sella-nasion. CONCLUSIONS The equation can be used to predict the change of pharyngeal airway space after mandibular setback surgery. In patients who have other risk factors, such as obesity, short neck, macroglossia, large uvula, and excessive soft tissue around the nasopharyngeal region, a mandibular setback surgery could possibly predispose to the development of sleep apnea syndrome.
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Affiliation(s)
- Fengshan Chen
- Division of Orthodontics, Graduate School of Medical and Dental Sciences, Niigata University, 1-574 Asahimachi-Dori, Niigata 951, Japan
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Zhang XL, Yin KS, Wang H, Su S. Serum adiponectin levels in adult male patients with obstructive sleep apnea hypopnea syndrome. Respiration 2005; 73:73-7. [PMID: 16205042 DOI: 10.1159/000088690] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 01/24/2005] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adiponectin has been found to be associated with the pathogenesis of diabetes, obesity and some cardiovascular diseases, which usually coexist with obstructive sleep apnea hypopnea syndrome (OSAHS). However, an association between adiponectin and OSAHS has rarely been reported. OBJECTIVES To investigate the levels of serum adiponectin in adult male patients with OSAHS. METHODS Following polysomnographic examination, 86 adult male habitual snorers were divided into simple snorers (control group) and OSAHS patients (OSAHS group) who were further divided into mild, moderate and severe OSAHS subgroups based on their apnea hypopnea index (AHI). There was no significant difference in age, body mass index (BMI), fasting blood glucose (FBG) and insulin resistance expressed as homeostasis model assessment (HOMA) between the two groups. The serum adiponectin levels were measured by radioimmunoassay. RESULTS Serum adiponectin levels were significantly lower in the OSAHS group than in the control (p < 0.01). Such a decrease in adiponectin level was most significant in patients with moderate and severe OSAHS. Pearson correlation analysis showed that in OSAHS patients, serum adiponectin level was negatively correlated with BMI, waist (WC) and neck (NC) circumferences, AHI and HOMA, but positively correlated with nadir pulse oxyhemoglobin saturation (nadir SpO2). After controlling for HOMA, BMI, NC and WC in OSAHS patients, a partial correlation analysis showed that adiponectin levels were negatively correlated with AHI but positively correlated with nadir SpO2. Multiple logistic regression analysis indicated that adiponectin was independently associated with OSAHS. CONCLUSIONS Serum adiponectin levels were significantly lower in OSAHS patients than in simple snorers. OSAHS may cause a decrease in serum adiponectin level.
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Affiliation(s)
- Xi-Long Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Schwab RJ. Genetic determinants of upper airway structures that predispose to obstructive sleep apnea. Respir Physiol Neurobiol 2005; 147:289-98. [PMID: 16043425 DOI: 10.1016/j.resp.2005.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 05/19/2005] [Accepted: 06/13/2005] [Indexed: 11/22/2022]
Abstract
Genetic factors are thought to play an important role in human development. Recent data indicate that obstructive sleep apnea may have a genetic basis. Sleep apnea is a very common disorder with significant cardiovascular and neurophysiologic morbidity. The pathogenesis of sleep apnea is related to a reduction in the size of the upper airway. The reduction in airway size is secondary to increased adipose tissue (enlargement of the parapharyngeal fat pads), alterations in craniofacial structure (reduction in mandibular size) and enlargement of the surrounding soft tissue structures (tongue, lateral pharyngeal walls). Genetic factors are one of the factors that have been proposed to mediate the size of each of these anatomic risk factors for sleep apnea. Recent evidence is accumulating about the genetic loci for these structural risk factors that predispose to the development of obstructive sleep apnea.
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Affiliation(s)
- Richard J Schwab
- Center for Sleep and Respiratory Neurobiology, Pulmonary, Allergy and Critical Care Division, Dept. of Medicine, University of Pennsylvania Medical Center, 893 Maloney Building, 3600 Spruce St., Philadelphia, PA 19104-4283, USA.
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Pack AI, Gislason T, Hakonarson H. Linkage to apnea-hypopnea index across the life-span: is this a viable strategy? Am J Respir Crit Care Med 2005; 170:1260; author reply 1260-1. [PMID: 15563643 DOI: 10.1164/ajrccm.170.11.951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jean-Louis G, Zizi F, Casimir G, DiPalma J, Mukherji R. Sleep-disordered breathing and hypertension among African Americans. J Hum Hypertens 2005; 19:485-90. [PMID: 15800665 DOI: 10.1038/sj.jhh.1001855] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated differences in sleep-disordered breathing (SDB) between hypertensives without a family history of hypertension and hypertensives with a family history. Furthermore, it examined whether these two groups differed in the severity of SDB. Patients were African Americans (n=162, mean age=51.19+/-13.77 years; mean body mass index (BMI)=37.85+/-9.51 kg/m2, male=57%), who were referred to the clinic because of a sleep complaint. Sleep was recorded in the laboratory using standard physiological parameters; all parameters were analysed by a trained scorer. Altogether, 91% of the patients received an SDB diagnosis. Of these patients, 25% were hypertensives without a family history, 20% were hypertensives with a family history, and 55% were normotensives. We found a significant difference between these patient groups regarding the severity of SDB (F14,158=1.823, P<0.05), but no significant group difference was observed in the rate of SDB. Increasing weight was accompanied by increasing severity of SDB. The finding that hypertensive patients with or without a positive family history showed worse oxygenation and respiratory characteristics than did normotensives is consistent with previous research. Of note, hypertensives reporting a family history were characterized by a greater number of oxygen desaturations and apnoea hypopnoea index than those typified only by a current diagnosis of hypertension. Hypertensives with a family history are likely to show a profile of greater blood pressure, higher BMI, and more severe SDB, which by all accounts are more common among African Americans.
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Affiliation(s)
- G Jean-Louis
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
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de Geus EJC, Posthuma D, Kupper N, van den Berg M, Willemsen G, Beem AL, Slagboom PE, Boomsma DI. A whole-genome scan for 24-hour respiration rate: a major locus at 10q26 influences respiration during sleep. Am J Hum Genet 2005; 76:100-11. [PMID: 15558495 PMCID: PMC1196413 DOI: 10.1086/427267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 11/08/2004] [Indexed: 11/03/2022] Open
Abstract
Identification of genes causing variation in daytime and nighttime respiration rates could advance our understanding of the basic molecular processes of human respiratory rhythmogenesis. This could also serve an important clinical purpose, because dysfunction of such processes has been identified as critically important in sleep disorders. We performed a sib-pair-based linkage analysis on ambulatory respiration rate, using the data from 270 sibling pairs who were genotyped at 374 markers on the autosomes, with an average distance of 9.65 cM. Uni- and multivariate variance-components-based multipoint linkage analyses were performed for respiration rate during three daytime periods (morning, afternoon, and evening) and during nighttime sleep. Evidence of linkage was found at chromosomal locations 3q27, 7p22, 10q26, and 22q12. The strongest evidence of linkage was found for respiration rate during sleep, with LOD scores of 2.36 at 3q27, 3.86 at 10q26, and 1.59 at 22q12. In a simultaneous analysis of these three loci, >50% of the variance in sleep respiration rate could be attributed to a quantitative-trait loci near marker D10S1248 at 10q. Genes in this area (GFRA1, ADORA2L, FGR2, EMX2, and HMX2) can be considered promising positional candidates for genetic association studies of respiratory control during sleep.
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Affiliation(s)
- E J C de Geus
- Department of Biological Psychology, Vrije Universiteit, Van der Boechorststraat 1, 1081-BT Amsterdam, The Netherlands.
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Larkin EK, Elston RC, Patel SR, Tishler PV, Palmer LJ, Jenny NS, Redline S. Linkage of serum leptin levels in families with sleep apnea. Int J Obes (Lond) 2004; 29:260-7. [PMID: 15611783 DOI: 10.1038/sj.ijo.0802872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify regions on the genome linked to plasma leptin levels. DESIGN Full genome scan with 402 microsatellite markers, spaced approximately 10 cM apart. Data were analyzed using the Haseman-Elston regression linkage analysis. SUBJECTS A total of 160 sibling pairs from 59 predominantly African American, obese families recruited to participate in a genetic-epidemiological study of obstructive sleep apnea. MEASUREMENTS Serum leptin levels adjusted for age, sex, race and body mass index (BMI). RESULTS Suggestive linkage peaks were observed on chromosomes 2 (P=0.00170; marker D2S1384), 3 (P=0.00007; marker D3S3034), 4 (P=0.00020; marker D4S1652) and 21 (P=0.00053; marker D21s1411). CONCLUSION The peak on chromosome 3 is near the gene for glycogensynthase kinase 2 beta, an important factor in glucose homeostasis. Linkage was generally stronger after BMI adjustment, suggesting the potential influence of a number of metabolic pathways on leptin levels other than those that directly determine obesity levels. The evidence of linkage for leptin levels is consistent with prior linkage analyses for cholesterol, hypertension and other metabolic phenotypes.
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Affiliation(s)
- E K Larkin
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
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Lin L, Finn L, Zhang J, Young T, Mignot E. Angiotensin-converting enzyme, sleep-disordered breathing, and hypertension. Am J Respir Crit Care Med 2004; 170:1349-53. [PMID: 15447944 DOI: 10.1164/rccm.200405-616oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism influences ACE activity, cardiovascular risk, blood pressure, and possibly the risk of developing Alzheimer's dementia. We explored the association of the insertion/deletion polymorphism with sleep-disordered breathing (SDB) and hypertension in 1,100 subjects of the Wisconsin Sleep Cohort. The polymorphism did not influence body mass index or the occurrence of SDB, but was dose-dependently associated with blood pressure. Interestingly, SDB and the insertion/deletion polymorphism interacted significantly to modulate blood pressure independently of age, sex, ethnicity, and body mass index. Most specifically, the association of the deletion allele with hypertension was most pronounced in subjects with mild to moderate degrees of sleep apnea (5 < or = apnea-hypopnea index < or = 30). We hypothesize that in the absence of SDB the effect of the deletion allele alone may not be sufficient to increase blood pressure. At severe levels of SDB, the effect of sleep apnea on blood pressure overwhelms any association of the deletion allele with hypertension and occurs independent of any ACE gene genotype.
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Affiliation(s)
- Ling Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94304-5742, USA
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44
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Abstract
The genetic approach to respiratory control is opening up new paths for research into developmental respiratory control disorders. Despite the identification of numerous genes involved in respiratory control, none of the genetically engineered mice developed to date fully replicate the human respiratory phenotype of human developmental respiratory disorders. However, combining studies in humans and studies in mouse models has proved useful in identifying candidate genes for human developmental respiratory control disorders and providing pathogenic information. In clinical practice, the development of databases that incorporate clinical phenotypes and genetic samples from patients would facilitate further genetic studies. International multicentre studies would advance the area of respiratory control research.
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Affiliation(s)
- Claude Gaultier
- Department of Physiology, INSERM 9935, Hôpital Robert, Faculté de Médecine Lariboisière, Université Paris VII, France.
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45
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Iyengar SK, Stein CM, Russo K, Erokwu BO, Strohl KP. The fa leptin receptor mutation and the heritability of respiratory frequency in a Brown Norway and Zucker intercross. J Appl Physiol (1985) 2004; 97:811-20. [PMID: 15033967 DOI: 10.1152/japplphysiol.01187.2003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We sought to determine whether the fa (leptin receptor) mutation was a major determinant of the putative obesity effects on respiratory frequency in an intercross between the Brown Norway (low breathing frequency, nonobese strain) and the Zucker (moderately high breathing frequency, with the fa mutation) strains. The hypothesis was that rats bearing one (heterozygote) or two (homozygote) alleles of the Glu296Pro point mutation (fa) would have a uniformly high respiratory frequency in the second filial (F2) generation, compared with wild-type animals. In addition to breathing frequency, tidal volume and minute ventilation were assessed during baseline, acute hypoxic (10% O2-0% CO2-balance nitrogen), hypercapnic (93% O2-7% CO2), hyperoxic (100% O2-0% CO2), and combined (10% O2-3% CO2-balance nitrogen) challenges in fa homozygote (fa/fa; n = 24), fa heterozygote (fa/wt; n = 33), and wild-type (wt/wt; n = 19) animals. Phenotypes were adjusted with stepwise regression analyses for the effects of age, sex, length, and litter size. Broad-sense heritability was estimated by examining the variance of the traits in first filial and F2 generations. ANOVAs were used to determine the mode of inheritance of the fa allele in the F2 generation. As anticipated, weight demonstrated the greatest overall broad-sense heritability (77%) and was the result of the recessive mutation. Breathing parameters during the hypoxic, hypercapnic, and combined challenges demonstrated a wide range of heritability from 5 to 96%, with a very nonuniform proportion of heritability explained by the leptin receptor. At best, for frequency 4.5 min into the hypercapnic hypoxic challenge, approximately 20% of the total heritability (approximately 67%) could be attributed to an effect of the leptin receptor mutation. We conclude that, unlike its major effect on weight, the effect of the fa allele is not a major gene involved in the regulation of breathing frequency.
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Affiliation(s)
- Sudha K Iyengar
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio 44106, USA
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46
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Abstract
Functional genomics is a systematic and high-throughput effort to analyze the functions of genes and gene products. Functional genomics is divided into gene- and phenotype-driven approaches. Gene-driven approaches to the functional genomics of sleep have demonstrated that transcripts of many genes change as a function of behavioral state. A phenotype-driven approach includes identification and characterization of gene function through the analyses of natural polygenic traits, creation of transgenic animals or high-throughput mutagenesis. Identification of a gene for narcolepsy through QTL analyses and concomitantly using a transgenic approach is one example of the phenotype-driven approach to the functional genomics of sleep. Though the majority of functional genomics is currently performed in mice, the rat is emerging as an important model for genomic research. Since rest in Drosophila shares many features with mammalian sleep, this allows a comparative functional genomics approach to the study of rest and sleep. The concepts outlined here for the functional genomics of sleep are applicable to respiration research.
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Affiliation(s)
- Miroslaw Mackiewicz
- Department of Medicine, Division of Sleep Medicine, Center for Sleep and Respiratory Neurobiology, Hospital of the University of Pennsylvania, 991 Maloney Building, Philadelphia, PA 19104-4283, USA
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