1
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Ando SI. Can we obtain a reliable marker that shows the hypoxic burden in patients with sleep disordered breathing? Hypertens Res 2023; 46:2500-2502. [PMID: 37673960 DOI: 10.1038/s41440-023-01425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Shin-Ichi Ando
- Sleep medicine center, Cardiovascular division, Fukuokaken Saiseikai Futsukaichi Hospital, 3-13-1 Yumachi, Chikushino, Fukuoka, 818-8582, Japan.
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2
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Nozawa S, Urushihata K, Machida R, Hanaoka M. The positional characteristics of patients with obstructive sleep apnea: a single institute retrospective study in Japan. Sleep Biol Rhythms 2022; 20:115-121. [PMID: 38469073 PMCID: PMC10899958 DOI: 10.1007/s41105-021-00347-4] [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: 06/23/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) causes sleep-disordered breathing (SDB) due to upper airway obstruction. The severity of OSA changes with position during sleep. Patients with marked significant improvement in apnea-hypopnea index (AHI) level by sleep position change are defined as ''positional patients'' (PP), while those without improvement are defined as ''non-positional patients'' (NPP). We aimed to verify their clinical characteristics. Between May 2008 and May 2020, 237 patients with OSA were registered retrospectively and classified into two groups: PP (n = 158) and NPP (n = 79). The differences in clinical background and full-night polysomnography (PSG) between the two groups were observed. A logistic regression analysis was conducted to identify the risk factors for severe AHI (≥ 30 events/h) in the PP group. Moreover, confounding factor-adjusted sub-analysis by a propensity score matching method was performed, and the PSG results were compared between the two groups. The PP group was older than the NPP group. Furthermore, the PP group had lower body mass index (BMI) and AHI levels compared with the NPP group. The independent risk factors for severe AHI in the PP group were BMI and being in the supine position during sleep. The PP group had a significantly milder nocturnal hypoxemia despite having no significant difference in AHI levels between the two groups. The characteristics of PP were old age, low BMI, and low AHI associated with milder nocturnal hypoxemia. Moreover, they were less likely to worsen with nocturnal hypoxemia compared with NPP having similar severity.
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Affiliation(s)
- Shuhei Nozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Ryosuke Machida
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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3
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Recent advances in the management of secondary hypertension—obstructive sleep apnea. Hypertens Res 2020; 43:1338-1343. [DOI: 10.1038/s41440-020-0494-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/22/2022]
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4
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Gender differences in the preference for upper airway stimulation therapy among Japanese patients with obstructive sleep apnea already treated with continuous positive airway pressure. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00273-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Sawatari H, Chishaki A, Nishizaka M, Miyazono M, Tokunou T, Magota C, Yamamoto U, Handa SS, Ando SI. Accumulated nocturnal hypoxemia predict arterial endothelial function in patients with sleep-disordered breathing with or without chronic heart failure. Heart Vessels 2020; 35:800-807. [PMID: 31965227 DOI: 10.1007/s00380-020-01557-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Abstract
ABTSRACT Sleep-disordered breathing (SDB) is often accompanied with the chronic heart failure (CHF). Hypoxemia due to pulmonary congestion from CHF and concurrent SDB might synergistically impair endothelial function and worsen the prognosis. However, the main factors affecting deterioration of endothelial function are unknown and whether the influence of hypoxemia differs in SDB patients with and without CHF remains unclear. Fifty-three patients (CHF group, n = 23; non-CHF group, n = 30) underwent polysomnography to evaluate their SDB and flow-mediated vasodilation (FMD) measurements to assess arterial endothelial function. We examined the relationships between FMD and SDB-related parameters, including our original index of accumulated hypoxemia by SDB throughout one-night sleep: the time desaturation summation index (TDS), calculated as follows: (100% - averaged arterial oxygen saturation during sleep) × total sleep time. The mean age in the CHF and non-CHF groups was 59.0 ± 13.5 and 57.7 ± 11.4 years, respectively. Although the FMD in the 2 groups were not significantly different, well-known adverse factors for FMD such as serum lipid profiles, blood pressure levels, and conventional indices of SDB were worse in the non-CHF group. Only the TDS was not significantly different between 2 groups and associated with FMD as shown by the univariate analysis (CHF: p < 0.05, non-CHF: p < 0.01) and multivariate analysis (CHF: p < 0.05, non-CHF: p < 0.01). Accumulated hypoxemia (TDS) rather than the frequency of hypoxemia might more influence on the endothelial function irrespective of the cardiac state. Removal of accumulation of nocturnal hypoxemia might be a target for treatment equally in the patients with and without CHF.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Department of Health Care for Adult, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akiko Chishaki
- Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mari Nishizaka
- Department of Cardiovascular Medicine, Kimura Hospital, Fukuoka, Japan
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mami Miyazono
- Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Department of Nursing, Faculty of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Tomotake Tokunou
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Chie Magota
- School of Nursing, Kurume University, Fukuoka, Japan
| | - Umpei Yamamoto
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan
- Department of Cardiology, General Internal Medicine, Onga Hospital, Fukuoka, Japan
| | - Sakiko Shimizu Handa
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan
- Kirameki Projects Career Support Center, Kyushu University Hospital, Fukuoka, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan.
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6
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Meyring-Wösten A, Luo Y, Zhang H, Preciado P, Thijssen S, Wang Y, Kotanko P. Intradialytic hypertension is associated with low intradialytic arterial oxygen saturation. Nephrol Dial Transplant 2019; 33:1040-1045. [PMID: 29186549 PMCID: PMC5982811 DOI: 10.1093/ndt/gfx309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background The pathophysiology of a paradoxical systolic blood pressure (SBP) rise during hemodialysis (HD) is not yet fully understood. Recent research indicated that 10% of chronic HD patients suffer from prolonged intradialytic hypoxemia. Since hypoxemia induces a sympathetic response we entertained the hypothesis that peridialytic SBP change is associated with arterial oxygen saturation (SaO2). Methods We retrospectively analyzed intradialytic SaO2 and peridialytic SBP change in chronic HD patients with arteriovenous vascular access. Patients were followed for 6 months. We defined persistent intradialytic hypertension (piHTN) as average peridialytic SBP increase ≥10 mmHg over 6 months. Linear mixed effects (LME) models were used to explore associations between peridialytic SBP change and intradialytic SaO2 in univariate and adjusted analyses. Results We assessed 982 patients (29 872 HD treatments; 59% males; 53% whites). Pre-dialysis SBP was 146.7 ± 26.5 mmHg and decreased on average by 10.1 ± 24.5 mmHg. Fifty-three (5.7%) patients had piHTN. piHTN patients had lower intradialytic SaO2, body weight and interdialytic weight gain. LME models revealed that with every percentage point lower mean SaO2, the peridialytic SBP change increased by 0.46 mmHg (P < 0.001). This finding was corroborated in multivariate analyses. Conclusion We observed an inverse relationship between intradialytic SaO2 and the blood pressure response to HD. These findings support the notion that hypoxemia activates mechanisms that partially blunt the intradialytic blood pressure decline, possibly by sympathetic activation and endothelin-1 secretion. To further explore that hypothesis, specifically designed prospective studies are required.
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Affiliation(s)
| | - Ya Luo
- University of California at Santa Barbara, Department of Statistics and Applied Probability, Santa Barbara, CA, USA
| | - Hanjie Zhang
- Renal Research Institute, Research Department, New York, NY, USA
| | | | - Stephan Thijssen
- Renal Research Institute, Research Department, New York, NY, USA
| | - Yuedong Wang
- University of California at Santa Barbara, Department of Statistics and Applied Probability, Santa Barbara, CA, USA
| | - Peter Kotanko
- Renal Research Institute, Research Department, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Yamamoto U, Nishizaka M, Tsuda H, Tsutsui H, Ando SI. Crossover comparison between CPAP and mandibular advancement device with adherence monitor about the effects on endothelial function, blood pressure and symptoms in patients with obstructive sleep apnea. Heart Vessels 2019; 34:1692-1702. [PMID: 30927057 DOI: 10.1007/s00380-019-01392-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/22/2019] [Indexed: 01/22/2023]
Abstract
Mandibular advancement device (MAD) is an alternative therapeutic option for CPAP to treat obstructive sleep apnea (OSA). While MAD showed the better adherence, patients with over moderate OSA have been treated more frequently with CPAP despite increasing positive evidence on the cardiovascular outcome with MAD, even in severe patients. Thus, more information is needed regarding the cardiovascular and symptomatic outcome of MAD treatment objectively compared to CPAP. Forty-five supine-dependent OSA patients (apnea-hypopnea index 20-40/h) were randomized to either CPAP or MAD and treated for 8 weeks and switched to another for 8 weeks. The primary endpoint was improvement in the endothelial function, indexed by the flow-mediated dilatation (FMD), and the secondary endpoint was the sleep-time blood pressure (BP). The duration of MAD use was evaluated objectively by an implanted adherence monitor. Treatment efficacy was also evaluated by home sleep monitor and a questionnaire about the symptoms. The adherence was not significantly different (CPAP vs. MAD: 274.5 ± 108.9 min/night vs. 314.8 ± 127.0 min/night, p = 0.095). FMD and sleep-time mean BP were not markedly changed from the baseline with either approach (CPAP vs. MAD: FMD, + 0.47% ± 3.1% vs. + 0.85% ± 2.6%, p = 0.64; BP, - 1.5 ± 5.7 mmHg vs. - 1.2 ± 7.5 mmHg, p = 0.48), although sleepiness, nocturia, and sleep-related parameters were similarly improved and more patients preferred MAD. As MAD and CPAP showed similar effects on cardiovascular outcome and symptomatic relief even with a comparable length of usage, we might expect MAD as an alternative treatment option for CPAP in this range of OSA group.
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Affiliation(s)
- Umpei Yamamoto
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi Higashiku, Fukuoka, Japan
- Cardiology, General Internal Medicine, Onga Hospital, Fukuoka, Japan
| | - Mari Nishizaka
- Kirameki Projects Career Support Center, Kyushu University Hospital, Fukuoka, Japan
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroko Tsuda
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi Higashiku, Fukuoka, Japan
- General Dentistry, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi Higashiku, Fukuoka, Japan.
- Saiseikai Futsukaichi Hospital, Futsukaichi, Japan.
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8
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Handa SS, Baba S, Yamashita K, Nishizaka M, Ando S. The severity of obstructive sleep apnea syndrome cannot predict the accumulation of brain amyloid by imaging with [11C]-Pittsburgh compound B PET computed tomography in patients with a normal cognitive function. Ann Nucl Med 2019; 33:541-544. [PMID: 30887231 DOI: 10.1007/s12149-019-01349-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Disturbed sleep due to obstructive sleep apnea syndrome (OSAS) might accelerate amyloidβ (Aβ) deposition, which can be a crucial factor in Alzheimer's disease. We studied Aβ deposition in untreated OSAS patients with normal cognition. METHOD We performed polysomnography (PSG) and Aβ imaging with [11C]-Pittsburgh compound B PET computed tomography (11C-PiB PET CT) in 14 untreated OSAS patients (apnea-hypopnea index: 43.8 ± 26.3/h). RESULTS The abnormal accumulation of enhanced 11C-PiB PET was observed only one patient with severe, but not the most severe. CONCLUSIONS The OSAS severity alone may not predict Aβ deposition in OSAS patients with normal cognition.
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Affiliation(s)
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamashita
- Department of Neurology Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mari Nishizaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Ando
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan.
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9
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Abstract
Sleep disordered breathing (SDB), which causes sleep deprivation, intermittent hypoxia, and negative intrathoracic pressure swings, can be accompanied by other harmful pathophysiologies relating to cardiovascular diseases (CVD), including sudden death, atrial fibrillation, stroke, and coronary artery disease leading to heart failure. Continuous positive airway pressure (CPAP) therapy for SDB has been reported to provide favorable effects such as lowered systemic blood pressure and improved endothelial function. However, in recent randomized controlled trials, CPAP has failed to demonstrate its beneficial prognostic impact on the primary or secondary setting of CVD. In this review article, we describe the characteristics of SDB complicated with CVD, the prognostic impacts of SDB in CVD, and the beneficial effects of CPAP on CVD.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University
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10
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Gabryelska A, Łukasik ZM, Makowska JS, Białasiewicz P. Obstructive Sleep Apnea: From Intermittent Hypoxia to Cardiovascular Complications via Blood Platelets. Front Neurol 2018; 9:635. [PMID: 30123179 PMCID: PMC6085466 DOI: 10.3389/fneur.2018.00635] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea is a chronic condition characterized by recurrent episodes of apneas or hypopneas during sleep leading to intermittent hypoxemia and arousals. The prevalence of the sleep disordered breathing is estimated that almost 50% of men and 24% of women suffer from moderate to severe form of the disorder. Snoring, collapse of upper airways and intermittent hypoxia are main causes of smoldering systemic inflammation in patients suffering from obstructive sleep apnea. The systematic inflammation is considered one of the key mechanisms leading to significant cardiovascular complications. Blood platelets, formerly not even recognized as cells, are currently gaining attention as crucial players in the immune continuum. Platelet surface is endowed with receptors characteristic for cells classically belonging to the immune system, which enables them to recognize pathogens, immune complexes, and interact in a homo- and heterotypic aggregates. Platelets participate in the process of transcellular production of bioactive lipids by delivering both specific enzymes and substrate molecules. Despite their lack of nucleus, platelets synthetize proteins in a stimuli-dependent manner. Atherosclerosis and consequent cardiovascular complications result from disruption in homeostasis of both of the platelet roles: blood coagulation and inflammatory processes modulation. Platelet parameters, routinely evaluated as a part of complete blood count test, were proposed as markers of cardiovascular comorbidity in patients with obstructive sleep apnea. Platelets were found to be excessively activated in this group of patients, especially in obese subjects. Persistent activation results in enhanced spontaneous aggregability and change in cytokine production. Platelet-lymphocyte ratio was suggested as an independent marker for cardiovascular disease in obstructive sleep apnea syndrome and continuous positive air pressure therapy was found to have an impact on platelet parameters and phenotype. In this literature review we summarize the current knowledge on the subject of platelets involvement in obstructive sleep apnea syndrome and consider the possible pathways in which they contribute to cardiovascular comorbidity.
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Affiliation(s)
- Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Zuzanna M Łukasik
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
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11
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Ando SI. Influence of hypoxia induced by sleep disordered breathing in case of hypertension and atrial fibrillation. J Cardiol 2018; 72:10-18. [PMID: 29627145 DOI: 10.1016/j.jjcc.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022]
Abstract
Sleep disordered breathing (SDB) has been recognized as one of the important causes or factors of worsening for various cerebro- and cardiovascular diseases. On the other hand, a recent large randomized study and meta-analysis about the effect of continuous positive airway pressure (CPAP) indicated no or only minor effects to improve the outcome of SDB patients. Accumulating evidence has indicated that the key factor of the link between SDB and cardiovascular diseases might be hypoxia caused during repetitive long apneic episodes. Hypertension and atrial fibrillation (AF) are two important cardiovascular diseases that relate to SDB and the therapeutic consequences by CPAP treatment have been studied. As for the mechanism that elevates blood pressure during night, stimulation of chemoreceptors by hypoxia and the resultant increase in sympathetic nervous activity is the first step and repetitive hypoxic stimulation changes the characteristics of chemoreceptors and baroreceptors resulting in daytime hypertension. Pathological changes in the atrial muscle in SDB patients might be a result of repetitive hypoxia and atrial expansion. As for triggering AF, several animal studies revealed that the changes in autonomic nervous system caused by hypoxia and negative intra-thoracic pressure might be crucial. However, a recent observational study could not show the relation between SDB and AF. The difference between the previous studies and this negative study seems to exist in the difference of the severity of SDB or the degree of hypoxia. Such a difference might be also one of the reasons why a recent randomized trial to prove the effect of CPAP in cardio- or cerebrovascular patients failed to improve the patient prognosis. Hence, in this review, the relationship between hypoxia and onset or continuation of hypertension and AF will be reconsidered to understand the fundamental and robust relationship between SDB and these cardiovascular diseases.
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Affiliation(s)
- Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan.
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12
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Atrial Fibrillation and Sleep Apnoea: Guilt by Association? Heart Lung Circ 2017; 26:902-910. [DOI: 10.1016/j.hlc.2017.05.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/21/2017] [Indexed: 12/18/2022]
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13
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Bironneau V, Goupil F, Ducluzeau PH, Le Vaillant M, Abraham P, Henni S, Dubois S, Paris A, Priou P, Meslier N, Sanguin C, Trzépizur W, Andriantsitohaina R, Martinez MC, Gagnadoux F. Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes. Cardiovasc Diabetol 2017; 16:39. [PMID: 28327146 PMCID: PMC5361793 DOI: 10.1186/s12933-017-0521-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 12/11/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D. Methods 140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function. Results 21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04). Conclusions Moderate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.
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Affiliation(s)
| | | | - Pierre Henri Ducluzeau
- Unité d'Endocrinologie-Diabétologie-Nutrition, Pole de Médecine, CHRU de Tours, Tours, France
| | - Marc Le Vaillant
- Centre de Recherche Médecine, Sciences, Santé, Santé mentale, Société, CNRS UMR 8211, INSERM UMR U988-EHESS, Villejuif, France
| | - Pierre Abraham
- Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Samir Henni
- Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Séverine Dubois
- Département d'Endocrinologie, Diabétologie, Nutrition, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Audrey Paris
- Service de Pneumologie, Centre Hospitalier, Le Mans, France
| | - Pascaline Priou
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Nicole Meslier
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Claire Sanguin
- Service d'Endocrinologie, Diabétologie, Centre Hospitalier, Le Mans, France
| | - Wojciech Trzépizur
- Université Bretagne Loire, INSERM UMR 1063, Angers, France.,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | | | | | - Frédéric Gagnadoux
- Université Bretagne Loire, INSERM UMR 1063, Angers, France. .,Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
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14
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Ando SI. Is the heart still in danger after stopping CPAP? Respirology 2016; 21:980-1. [DOI: 10.1111/resp.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Shin-Ichi Ando
- Sleep Apnea Center; Kyushu University Hospital; Fukuoka Japan
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