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Urquhart DS, McLellan AE, Hill LE, Carruthers E, Hill EA, Chin RF, Shetty J. A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children and young people with epilepsy. J Clin Sleep Med 2024; 20:1039-1047. [PMID: 38318844 PMCID: PMC11217635 DOI: 10.5664/jcsm.11054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
STUDY OBJECTIVES Epilepsy and obstructive sleep apnea syndrome (OSAS) are each relatively common in children. OSAS may affect cognition, such that recognition of OSAS is important for children and young people with epilepsy (CYPWE). Published pilot data reported 55% of CYPWE had symptoms suggestive of OSAS, compared with 7% of typically developing controls. The primary aim of this study was to ascertain OSAS prevalence by polysomnography in CYPWE, with secondary aims being to evaluate the utility of sleep questionnaires in CYPWE. METHODS CYPWE and age- and sex-matched typically developing controls were studied. A single night of level I attended polysomnography was undertaken, along with questionnaires (Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire, Pittsburgh Sleep Quality Index, and the childhood and adolescent Epworth Sleepiness Scale). OSAS was defined as obstructive apnea-hypopnea index of ≥ 1 event/h. RESULTS Polysomnography was performed in 72 children including 48 CYPWE (60% male) and 24 controls (54% male). Mean age (11 years) was similar for CYPWE and controls (P = .42), with slightly higher body mass index z scores (0.7 vs 0.1, P = .03) noted in CYPWE. Mean obstructive apnea-hypopnea index was 0.61 in CYPWE vs 0.42 in controls (P = .62). Despite higher Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire scores in CYPWE (0.38 vs 0.12, P < .001), no difference in OSAS prevalence (10% vs 4%, P = .78) was found. CYPWE had higher childhood and adolescent Epworth Sleepiness Scale (6 vs 3.5, P = .01) and Pittsburgh Sleep Quality Index (5 vs 3.3, P = .02) scores, indicating greater levels of daytime sleepiness and poorer sleep quality. CONCLUSIONS The study found no evidence for increased OSAS prevalence in CYPWE, and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in predicting OSAS appears limited for CYPWE. CYPWE are, however, demonstrably sleepier and have poorer sleep quality. The cause for these findings remains unclear. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Investigation of Sleep Quality and Prevalence of Sleep-disordered Breathing in Children and Young People With Epilepsy; URL: https://www.clinicaltrials.gov/study/NCT03103841; Identifier: NCT03103841. CITATION Urquhart DS, McLellan AE, Hill LE, et al. A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children and young people with epilepsy. J Clin Sleep Med. 2024;20(7):1039-1047.
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Affiliation(s)
- Donald S. Urquhart
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ailsa E. McLellan
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Laura E. Hill
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Emma Carruthers
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Elizabeth A. Hill
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Richard F. Chin
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jay Shetty
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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Dietary Addition of Antioxidant Complex Packs and Functional Amino Acids Can Improve the Digestion, Absorption, and Immunity of Huanjiang Minipigs. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1475831. [PMID: 33062668 PMCID: PMC7542500 DOI: 10.1155/2020/1475831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
To study the effect of functional amino acids and the antioxidant function compound package on Huanjiang minipigs and to lay a foundation for the formulation of green and efficient feed for Huanjiang minipigs, we added functional amino acids and the antioxidant function compound package to piglet feed for 28 days. After feeding, we detected the growth performance, biochemical indexes, inflammatory indexes, and intestinal disaccharidase of piglets. It was found that functional amino acids and the antioxidant compound package had certain effects on the growth performance and biochemical indexes of piglets and could reduce the level of IL-6 and increase the level of LZM and SIgA of piglets, and the levels of lactase and maltase in the intestine also increased significantly. The results showed that the compound package of functional amino acids and antioxidation could improve the growth performance and immunity of piglets and promote the digestion and absorption of nutrients in piglets.
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Lv L, Zhang H, Liu Z, Lei L, Feng Z, Zhang D, Ren Y, Zhao S. Comparative study of yeast selenium vs. sodium selenite on growth performance, nutrient digestibility, anti-inflammatory and anti-oxidative activity in weaned piglets challenged by Salmonella typhimurium. Innate Immun 2020; 26:248-258. [PMID: 31766926 PMCID: PMC7251790 DOI: 10.1177/1753425919888566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/06/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022] Open
Abstract
The present study was conducted to investigate the effects of dietary supplementation of selenium from different sources on the growth performance, nutrient digestibility, and blood immune indices of piglets orally challenged with Salmonella typhimurium (ST). In a 2 × 2 factorial arrangement, 32 piglets (6.43 ± 0.54 kg of body mass) were assigned into four groups with or without dietary inclusion of sodium selenite (SS) or yeast selenium (YS) and with or without ST challenge (5 ml 1 × 109 cfu/ml ST or 5 ml saline) on d 13. In each period, YS increased average daily feed intake and average daily gain but did not reach statistical significance. During the challenged stage, piglets fed YS had higher digestibility of dry matter, crude protein, crude fat, and YS reduced the amount of Escherichia coli in feces. Additionally, YS regulated the composition of T-lymphocyte subset and influenced the production of inflammatory cytokines. In conclusion, in this study selenium-enriched yeast was more effective in enhancing nutrient digestibility, and inhibiting inflammation and oxidative stress by inducing the activity of the lymphocytes, expression of antioxidant enzymes and so on.
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Affiliation(s)
- Liangkang Lv
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Hui Zhang
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Zhengya Liu
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Long Lei
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Zhi Feng
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Dandan Zhang
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Ying Ren
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
| | - Shengjun Zhao
- Hubei Collaborative Innovation Center for Animal
Nutrition and Feed Safety, Hubei Key Laboratory of Animal Nutrition and Feed
Science,
Wuhan
Polytechnic University, China
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4
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Smith DF, Amin RS. OSA and Cardiovascular Risk in Pediatrics. Chest 2019; 156:402-413. [PMID: 30790552 DOI: 10.1016/j.chest.2019.02.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/21/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
OSA occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well documented. Although changes in BP regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease. Early pathophysiologic changes may lead to a lifetime burden of cardiovascular disease and early mortality. With this perspective in mind, our review discusses pathways leading to cardiovascular pathology in children with OSA and provides a comprehensive overview of recent research findings related to cardiovascular sequelae in the pediatric population.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Hirsch D, Evans CA, Wong M, Machaalani R, Waters KA. Biochemical markers of cardiac dysfunction in children with obstructive sleep apnoea (OSA). Sleep Breath 2018; 23:95-101. [DOI: 10.1007/s11325-018-1666-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022]
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Motamedi V, Kanefsky R, Matsangas P, Mithani S, Jeromin A, Brock MS, Mysliwiec V, Gill J. Elevated tau and interleukin-6 concentrations in adults with obstructive sleep apnea. Sleep Med 2018; 43:71-76. [DOI: 10.1016/j.sleep.2017.11.1121] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/04/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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Almeida GPL, Trombetta IC, Cepeda FX, Hatanaka E, Curi R, Mostarda C, Irigoyen MC, Barreto-Filho JAS, Krieger EM, Consolim-Colombo FM. The Role of Acute Intermittent Hypoxia in Neutrophil-Generated Superoxide, Sympathovagal Balance, and Vascular Function in Healthy Subjects. Front Physiol 2017; 8:4. [PMID: 28167915 PMCID: PMC5253395 DOI: 10.3389/fphys.2017.00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction: Recurrent hypoxia (HPX), a hallmark of the obstructive sleep apnea (OSA), impairs autonomic balance, and increases arterial blood pressure (BP). Oxidative stress is one of the mechanisms involved in these alterations. The cumulative effect of acute intermittent HPX and the chronicity may determine whether the response crosses the threshold from having protective value to pathology. However, the impact of acute intermittent HPX–reoxygenation on markers of oxidative stress in healthy individuals remains to be fully understood. Objective: To analyze the effects of the acute intermittent HPX on the generation of neutrophil-derived superoxide, sympathovagal balance, and vascular function in healthy subjects. Methods: We applied six cycles of intermittent HPX (10% O2 and 90% N2) for 5 min followed by 2 min of room-air in 15 healthy volunteers (34 ± 2 years; 22.3 ± 0.46 kg/m2), without OSA (polysomnography), during wakefulness. During the experimental protocol, we recorded O2 saturation, end-tidal CO2, heart rate (HR), systolic, and diastolic BP, cardiac output (CO) and peripheral resistance (PR). Cardiac sympathovagal balance was determined by HR variability analysis (low frequency and high frequency bands, LF/HF). Superoxide generation in polymorphonuclear neutrophil cells were established using relative luminescence units (PMNs RLU) at baseline (pre-HPX) and immediately after hypoxia induction (post-HPX6). Results: The studied subjects had normal levels of BP, plasma glucose, lipid profile, and inflammatory marker (C-reactive protein). Acute intermittent HPX increased HR, systolic BP, CO, and decreased PR. Additionally, acute intermittent HPX increased PMNs RLU, measured post-HPX6 (470 ± 50 vs. 741 ± 135, P < 0.05). We found a similar increase in LF/HF post-HPX6 (0.91 ± 0.11 vs. 2.85 ± 0.40, P < 0.05). PR was diminished from pre-HPX to post-HPX6 (1.0 ± 0.03 vs. 0.85 ± 0.06, P < 0.05). Further analysis showed significant association between O2 saturation and PMNs RLU (R = −0.62, P = 0.02), and with LF/HF (R = −0.79, P = 0.02) post-HPX6. In addition, an association was found between PMNs RLU and PR post-HPX6 (R = 0.58, P = 0.04). Conclusion: Acute exposure to intermittent HPX not only increased superoxide generation in neutrophils, but also impaired cardiac sympathovagal balance in healthy subjects. These data reinforce the role of intermittent HPX in superoxide generation on neutrophils, which may lead to an impairment in peripheral vascular resistance.
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Affiliation(s)
- Germana P L Almeida
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Departamento de Medicina Clínica, Federal University of CearáCeará, Brazil
| | - Ivani C Trombetta
- Graduate Program in Medicine, Uninove, Universidade Nove de Julho São Paulo, Brazil
| | - Felipe X Cepeda
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Elaine Hatanaka
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul São Paulo, Brazil
| | - Rui Curi
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | - Cristiano Mostarda
- Programa de Pós-Graduação em Saúde do Adulto e da Criança, Federal University of Maranhão Maranhão, Brazil
| | - Maria C Irigoyen
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | | | - Eduardo M Krieger
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Fernanda M Consolim-Colombo
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Graduate Program in Medicine, Uninove, Universidade Nove de JulhoSão Paulo, Brazil
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Toujani S, Kaabachi W, Mjid M, Hamzaoui K, Cherif J, Beji M. Vitamin D deficiency and interleukin-17 relationship in severe obstructive sleep apnea-hypopnea syndrome. Ann Thorac Med 2017; 12:107-113. [PMID: 28469721 PMCID: PMC5399684 DOI: 10.4103/atm.atm_301_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE We aimed to assess Vitamin D (VD) abnormalities in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS), to study its association with clinical and polygraphic data, and to correlate VD levels with interleukin-17 (IL-17). METHODS Ninety-two patients with severe OSAHS were consecutively enrolled between September 2014 and February 2016 and compared to age-, sex-, and body mass index (BMI)-matched controls. Anthropometric parameters and medical history were collected. The serum levels of VD and IL-17 were determined by radioimmunoassay and enzyme-linked immunosorbent assay, respectively. RESULTS Ninety-two severe OSAHS patients and thirty controls were enrolled in the study. All OSAHS patients had VD deficiency. The mean level of VD was at 7.9 ng/ml among OSAHS group versus 16.8 ng/ml among control group. IL-17A levels were elevated (20.3 pg/ml) in OSAHS group compared to healthy group (10.05 pg/ml). VD levels were negatively correlated with nocturia severity (r = -0.26; P = 0.01) and positively correlated with mean O2 saturation (r = 0.59; P = 0.02) and lowest O2 saturation (r = 0.3; P = 0.03). IL-17 levels were positively correlated with nocturia severity (r = 0.24; P = 0.03) and negatively correlated with mean O2 saturation (r = -0.42; P = 0.03). A significant negative association was observed between IL-7 and VD levels (r = -0.64, P = 0.2 10-4). The magnitude of this correlation was higher for important nocturia, lower MSaO2, or higher BMI. CONCLUSIONS VD deficiency in patients with severe OSAHS is common with a negative association between IL-17 and VD serum levels. Hypoxia could play an important role in this association. Further studies are needed to clarify this relationship.
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Affiliation(s)
- Sonia Toujani
- Department of Basic Sciences, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wajih Kaabachi
- Unit Research 12SP15 "Homeostasis and Cell Dysfunction", Abderrahman Mami Hospital, Ariana, Tunisia
| | - Meriem Mjid
- Department of Basic Sciences, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kamel Hamzaoui
- Unit Research 12SP15 "Homeostasis and Cell Dysfunction", Abderrahman Mami Hospital, Ariana, Tunisia
| | - Jouda Cherif
- Department of Basic Sciences, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Majed Beji
- Department of Basic Sciences, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Chen TI, Chen MYC. Zinc Is Indispensable in Exercise-Induced Cardioprotection against Intermittent Hypoxia-Induced Left Ventricular Function Impairment in Rats. PLoS One 2016; 11:e0168600. [PMID: 27977796 PMCID: PMC5158066 DOI: 10.1371/journal.pone.0168600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/03/2016] [Indexed: 01/19/2023] Open
Abstract
In obstructive sleep apnea (OSA), recurrent obstruction of the upper airway leads to intermittent hypoxia (IH) during sleep, which can result in impairment of cardiac function. Although exercise can have beneficial effects against IH-induced cardiac dysfunction, the mechanism remains unclear. This study aimed to investigate the interactions of zinc and exercise on IH-triggered left ventricular dysfunction in a rat model that mimics IH in OSA patients. Nine-week-old male Sprague-Dawley rats were randomly assigned to either a control group (CON) or to a group receiving 10 weeks of exercise training (EXE). During weeks 9 and 10, half the rats in each group were subjected to IH for 8 h per day for 14 days (IHCON, IHEXE), whereas the remainder continued to breathe room air. Rats within each of the CON, IHCON, EXE, and IHEXE groups were further randomly assigned to receive intraperitoneal injections of either zinc chloride, the zinc chelator N,N,N',N'-tetrakis(2-pyridylmethyl) ethylenediamine (TPEN), or injection vehicle only. IH induced a lower left ventricular fractional shortening, reduced ejection fraction, higher myocardial levels of inflammatory factors, increased levels oxidative stress, and lower levels of antioxidative capacity, all of which were abolished by zinc treatment. IHEXE rats exhibited higher levels of cardiac function and antioxidant capacity and lower levels of inflammatory factors and oxidative stress than IHCON rats; however, IHEXE rats receiving TPEN did not exhibit these better outcomes. In conclusion, zinc is required for protecting against IH-induced LV functional impairment and likely plays a critical role in exercise-induced cardioprotection by exerting a dual antioxidant and anti-inflammatory effect.
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Affiliation(s)
- Tsung-I Chen
- Center of Physical Education, Office of General and Basic Education, Tzu Chi University, Hualien, Taiwan
- * E-mail:
| | - Michael Yu-Chih Chen
- Department of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- PhD Program in Institute of Medicine, Tzu Chi University, Hualien, Taiwan
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Urquhart DS, Kehinde OO, Mclellan AE. Observational pilot study of reported symptoms of obstructive sleep apnoea in children with epilepsy. Dev Med Child Neurol 2016; 58:1063-8. [PMID: 27316368 DOI: 10.1111/dmcn.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/20/2022]
Abstract
AIM To estimate symptoms of obstructive sleep apnoea (OSA) and excessive daytime sleepiness (EDS) in children with epilepsy (CWE) compared with those in a typically developing comparison group. CWE are known to have poor sleep, with increased rates of OSA suggested. METHOD The Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD) was used to estimate OSA symptoms, with scores ≤0.33 known to be highly sensitive and specific for OSA. The Epworth Sleepiness Scale (ESS) was used to assess EDS, with scores of 10 or above considered abnormal. RESULTS Thirty-three CWE (21 males, 12 females) were studied (median age [interquartile range {IQR}] 9y [5-12]), along with 42 comparison children (20 males, 22 females; median age [IQR] 6y [4-8.5]). Fifty-five per cent of CWE scored 0.33 or higher on the PSQ-SRBD compared with 7% in the comparison group (p<0.001), and 30% of CWE had an abnormal ESS compared with 5% controls (p=0.003). Within the CWE cohort, PSQ-SRDB and ESS appeared higher in those taking antiepileptic drugs (AEDs); although PSQ-SRBD score for CWE not on AEDs was higher than in the comparison group. INTERPRETATION This study suggests higher rates of symptoms of OSA and EDS in CWE compared with typically developing children. AEDs may be a confounding factor, but do not alone account for the associations seen. Further studies including polysomnography to verify the presence (rather than suggestion by questionnaire) of OSA are warranted.
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Affiliation(s)
- Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Olaniyi O Kehinde
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ailsa E Mclellan
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.,Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
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Song YJ, Kwon JH, Kim JY, Kim BY, Cho KI. The platelet-to-lymphocyte ratio reflects the severity of obstructive sleep apnea syndrome and concurrent hypertension. Clin Hypertens 2016; 22:1. [PMID: 26893936 PMCID: PMC4750799 DOI: 10.1186/s40885-015-0036-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023] Open
Abstract
Background Chronic intermittent hypoxia, platelet activation and inflammation all play roles in the pathogenesis of obstructive sleep apnea syndrome (OSAS), which may increase the risk of cardiovascular disease (CVD). The aim of this study was to evaluate the relationship of the platelet-to-lymphocyte ratio (PLR) as a new biomarker showing systemic inflammation and platelet distribution width (PDW) as an indicator of platelet activation to the severity of OSAS. Methods A total of 290 patients suspected with OSAS who underwent a full night of polysomnography were included. The patients were placed into 4 separate groups according to their apnea-hypopnea index (AHI) scores; the control group (AHI <5), mild OSAS group (AHI 5–15), moderate OSAS group (AHI 16–30), and severe OSAS group (AHI >30). CVD risk was defined by the presence of hypertension, diabetes mellitus, current smoking, and dyslipidemia. Results Higher AHI groups were significantly correlated with increasing age, body mass index, systolic blood pressure and male sex. PLR and PDW were also significantly associated with AHI (r = 0.417 for PLR and r = 0.227 for PDW, all p-values < 0.001) and the Epworth sleepiness scale (r = 0.160 for PLR and r = 0.189 for PDW, all p-values <0.05). Multivariate regression analysis revealed that AHI ≥9.2 (adjusted odds ratios [OR] 5.03, 95 % confidential interval (CI) = 1.67-15.2, p = 0.004) and PLR ≥159 (adjusted OR 2.81, 95 % CI = 1.34-5.91, p = 0.006) were independently associated with the presence of hypertension. Conclusion PLR and PDW are associated with OSAS severity. PLR may also be useful as a systemic biomarker for the concurrent hypertension in OSAS patients.
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Affiliation(s)
- Yeo-Jeong Song
- Division of Cardiology, Department of Internal Medicine, Kim-Hae Jung Ang Hospital, Busan, Korea
| | - Jae Hwan Kwon
- Department of Otorhinolaryngology Head-Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Joo Yeon Kim
- Department of Otorhinolaryngology Head-Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Bo Young Kim
- Department of Otorhinolaryngology Head-Neck Surgery, Maryknoll Medical Center, Busan, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Kosin University School of Medicine, 34 Amnam-Dong, Seo-Ku, Busan, 602-702 Korea
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Korkmaz M, Korkmaz H, Küçüker F, Ayyıldız SN, Çankaya S. Evaluation of the association of sleep apnea-related systemic inflammation with CRP, ESR, and neutrophil-to-lymphocyte ratio. Med Sci Monit 2015; 21:477-81. [PMID: 25686632 PMCID: PMC4335587 DOI: 10.12659/msm.893175] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS) is characterized by cyclic episodes of hypoxemia and reoxygenation. It has been suggested that OSAS is associated with chronic inflammation within the microvasculature. This low-grade inflammation may play a role in the pathophysiology of OSAS-related comorbidities. Evaluation of the inflammatory markers may predict the degree of the systemic inflammation and this may be a prognostic factor for future adverse events such as cardiovascular risks. Proinflammatory cytokines have been extensively studied in sleep-disordered breathing. Neutrophil-to-lymphocyte ratio is a recently described indicator of systemic inflammation, but it has not been studied in OSAS patients. In this study we aimed to evaluate the easily measurable parameters of systemic inflammation in these patients. We conducted this study to examine the association among OSAS and C- reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio. Material/Methods OSAS patients who underwent overnight polysomnography were studied retrospectively. They were divided into 4 groups: control, mild, moderate, and severe OSAS patients. Blood test results and inflammatory markers were compared between the groups. One-way ANOVA and Kruskall-Wallis H test were used for statistical analysis. Results A total of 147 patients were included in the study. No differences in evaluated inflammatory markers were observed among the 4 groups. Conclusions Evaluation of the OSAS-related systemic inflammation is not likely to be possible by CRP, ESR, or neutrophil-to-lymphocyte ratio measurements. These markers do not seem to be associated with the degree of the upper airway obstruction.
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Affiliation(s)
- Mukadder Korkmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Ordu University Medical School, Ordu, Turkey
| | - Hakan Korkmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Ordu University Medical School, Ordu, Turkey
| | - Fatma Küçüker
- Department of Pulmonary Diseases, Ordu State Hospital, Ordu, Turkey
| | - Sema Nur Ayyıldız
- Department of Biochemistry, Ordu University Medical School, Ordu, Turkey
| | - Soner Çankaya
- Department of Biostatistics, Ordu University Medical School, Ordu, Turkey
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Serebrovskaya TV, Xi L. Intermittent hypoxia in childhood: the harmful consequences versus potential benefits of therapeutic uses. Front Pediatr 2015; 3:44. [PMID: 26042211 PMCID: PMC4436817 DOI: 10.3389/fped.2015.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 12/04/2022] Open
Abstract
Intermittent hypoxia (IH) often occurs in early infancy in both preterm and term infants and especially at 36-44 weeks postmenstrual age. These episodes of IH could result from sleep-disordered breathing or may be temporally unrelated to apnea or bradycardia events. There are numerous reports indicating adverse effects of IH on development, behavior, academic achievement, and cognition in children with sleep apnea syndrome. It remains uncertain about the exact causative relationship between the neurocognitive and behavioral morbidities and IH and/or its associated sleep fragmentation. On the other hand, well-controlled and moderate IH conditioning/training has been used in sick children for treating their various forms of bronchial asthma, allergic dermatoses, autoimmune thyroiditis, cerebral palsy, and obesity. This review article provides an updated and impartial analysis on the currently available evidence in supporting either side of the seemingly contradictory scenarios. We wish to stimulate a comprehensive understanding of such a complex physiological phenomenon as intermittent hypoxia, which may be accompanied by other confounding factors (e.g., hypercapnia, polycythemia), in order to prevent or reduce its harmful consequences, while maximizing its potential utility as an effective therapeutic tool in pediatric patients.
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Affiliation(s)
| | - Lei Xi
- Department of Internal Medicine, Virginia Commonwealth University , Richmond, VA , USA
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Souza A, Dussan-Sarria JA, Medeiros LF, Souza AC, Oliveira C, Scarabelot VL, Adachi LN, Winkelmann-Duarte EC, Philippi-Martins BB, Netto CA, Caumo W, Torres ILS. Neonatal hypoxic-ischemic encephalopathy reduces c-Fos activation in the rat hippocampus: evidence of a long-lasting effect. Int J Dev Neurosci 2014; 38:213-22. [PMID: 25262910 DOI: 10.1016/j.ijdevneu.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 01/16/2023] Open
Abstract
The effect of neonatal hypoxic-ischemic encephalopathy (HIE) on maturation of nociceptive pathways has been sparsely explored. To investigate whether neonatal HIE alters neuronal activity, nociceptive behavior, and serum neuroplasticity mediators (brain-derived neurotrophic factor [BDNF] and tumor necrosis factor-α [TNF]) in the short, medium, and long term. Neonate male Wistar rats were randomized to receive a brain insult that could be either ischemic (left carotid artery ligation [LCAL]), hypoxic (8% oxygen chamber), hypoxic-ischemic (LCAL and hypoxic chamber), sham-ischemic, or sham-hypoxic. Neuronal activity (c-Fos activation at region CA1 and dentate gyrus of the hippocampus), nociceptive behavior (von Frey, tail-flick, and hot-plate tests), neuroplasticity mediators (BDNF, TNF), and a cellular injury marker (lactase dehydrogenase [LDH]) were assessed in blood serum 14, 30, and 60 days after birth. Neonatal HIE persistently reduced c-Fos activation in the ipsilateral hippocampal region CA1; however, contralateral c-Fos reduction appeared only 7 weeks after the event. Neonatal HIE acutely reduced the paw withdrawal threshold (von Frey test), but this returned to normal by the 30th postnatal day. Hypoxia reduced serum LDH levels. Serum neuroplasticity mediators increased with age, and neonatal HIE did not affect their ontogeny. Neonatal HIE-induced reduction in neuronal activity occurs acutely in the ipsilateral hippocampal region CA1 and persists for at least 60 days, but the contralateral effect of the insult is delayed. Alterations in the nociceptive response are acute and self-limited. Serum neuroplasticity mediators increase with age, and remain unaffected by HIE.
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Affiliation(s)
- Andressa Souza
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil; Graduate Program in Health and Human Development, Centro Universitário Unilasalle, 92010-000, Canoas, Brazil
| | - Jairo Alberto Dussan-Sarria
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil
| | - Liciane Fernandes Medeiros
- Graduate Program in Biological Sciences: Physiology, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil
| | - Ana Cláudia Souza
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil
| | - Carla Oliveira
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil
| | - Vanessa Leal Scarabelot
- Graduate Program in Biological Sciences: Physiology, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil
| | - Lauren Naomi Adachi
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil
| | | | | | - Carlos Alexandre Netto
- Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil
| | - Wolnei Caumo
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil
| | - Iraci L S Torres
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Graduate Program in Biological Sciences: Physiology, Universidade Federal do Rio Grande do Sul, 90035-003, Porto Alegre, Brazil; Pain Pharmacology and Animal Models of Neuromodulation Laboratory, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, 90050-170, Porto Alegre, Brazil; Animal Experimentation Unit, Hospital de Clínicas de Porto Alegre Graduate Research Group, 90035-003, Porto Alegre, Brazil.
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Navarrete-Opazo A, Mitchell GS. Therapeutic potential of intermittent hypoxia: a matter of dose. Am J Physiol Regul Integr Comp Physiol 2014; 307:R1181-97. [PMID: 25231353 DOI: 10.1152/ajpregu.00208.2014] [Citation(s) in RCA: 294] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intermittent hypoxia (IH) has been the subject of considerable research in recent years, and triggers a bewildering array of both detrimental and beneficial effects in multiple physiological systems. Here, we review the extensive literature concerning IH and its impact on the respiratory, cardiovascular, immune, metabolic, bone, and nervous systems. One major goal is to define relevant IH characteristics leading to safe, protective, and/or therapeutic effects vs. pathogenesis. To understand the impact of IH, it is essential to define critical characteristics of the IH protocol under investigation, including potentially the severity of hypoxia within episodes, the duration of hypoxic episodes, the number of hypoxic episodes per day, the pattern of presentation across time (e.g., within vs. consecutive vs. alternating days), and the cumulative time of exposure. Not surprisingly, severe/chronic IH protocols tend to be pathogenic, whereas any beneficial effects are more likely to arise from modest/acute IH exposures. Features of the IH protocol most highly associated with beneficial vs. pathogenic outcomes include the level of hypoxemia within episodes and the number of episodes per day. Modest hypoxia (9-16% inspired O2) and low cycle numbers (3-15 episodes per day) most often lead to beneficial effects without pathology, whereas severe hypoxia (2-8% inspired O2) and more episodes per day (48-2,400 episodes/day) elicit progressively greater pathology. Accumulating evidence suggests that "low dose" IH (modest hypoxia, few episodes) may be a simple, safe, and effective treatment with considerable therapeutic potential for multiple clinical disorders.
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Affiliation(s)
- Angela Navarrete-Opazo
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gordon S Mitchell
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
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16
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Kilicdag H, Daglioglu YK, Erdogan S, Zorludemir S. Effects of caffeine on neuronal apoptosis in neonatal hypoxic-ischemic brain injury. J Matern Fetal Neonatal Med 2014; 27:1470-5. [PMID: 24392823 DOI: 10.3109/14767058.2013.878694] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hypoxia-ischemia (HI) in rat pups leads to strong activation of apoptosis, and apoptosis contributes significantly to cerebral damage in the perinatal period. Caffeine displays a broad array of actions on the brain. The aim of this study was to investigate the effects of caffeine on neuronal apoptosis in a hypoxic-ischemic neonatal model. METHODS Twenty-four seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia for 2 h. Sham group (n = 8) had a median neck incision, but the rats were not subjected to ligation or hypoxia. The pups were treated with 20 mg/kg/day caffeine citrate (n = 8) or saline (n = 8) immediately before HI and at 0, 24, 48 and 72 h post-hypoxia. Neuronal apoptosis was evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) and caspase-3 in the hippocampus and parietal cortex of both hemispheres. RESULTS The numbers of apoptotic cells in the hippocampus and parietal cortex were significantly higher in the saline group than they were in the sham group (p < 0.0001). The number of apoptotic cells in the hippocampus (p < 0.0001) and parietal cortex (p < 0.0001, TUNEL and p = 0.001, caspase-3) were higher in the caffeine-treated group than they were in the sham group, but the number of apoptotic cells decreased significantly in the caffeine-treated group compared with the saline group in the hippocampus (p < 0.0001, TUNEL and p = 0.001, caspase-3) and parietal cortex (p = 0.001, TUNEL and p = 0.002, caspase-3). CONCLUSIONS We show that caffeine administration in hypoxic-ischemic brain injury reduces neuronal apoptosis in the developing brain. We suggest that caffeine may be effective in reducing brain injury.
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Affiliation(s)
- Hasan Kilicdag
- Division of Neonatology, Department of Paediatrics, Acıbadem Hospital , Adana , Turkey
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17
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Pancreatic β cell proliferation by intermittent hypoxia via up-regulation of Reg family genes and HGF gene. Life Sci 2013; 93:664-72. [DOI: 10.1016/j.lfs.2013.09.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/30/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022]
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18
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Urquhart D. Investigation and management of childhood sleep apnoea. Hippokratia 2013; 17:196-202. [PMID: 24470727 PMCID: PMC3872453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sleep-disordered breathing includes disorders of breathing that affect airway patency, e.g. obstructive sleep apnoea syndrome, and also conditions that affect respiratory drive (central sleep disorders) or cause hypoventilation, either as a direct central effect or due to peripheral muscle weakness. Obstructive sleep apnoea syndrome (OSAS) is an increasingly-recognised clinical entity affecting up to 5.7% of children, which, if left untreated, is associated with adverse effects on growth and development including deleterious cognitive and behavioural outcomes. Evidence exists also that untreated OSAS impacts on cardiovascular risk. Close attention should be paid to assessment and investigation of this relatively common condition, instigating early and appropriate treatment to children with OSAS. First-line treatment in younger children is adenotonsillectomy, although other treatment options available include continuous positive airways pressure (CPAP), anti-inflammatory therapies (nasal corticosteroids and anti-leukotrienes), airway adjuncts and orthodontic appliances. Central sleep-disordered breathing may be related to immaturity of respiratory control and can be associated with prematurity as well as disorders such as Prader-Willi syndrome. In some cases, central apnoeas occur as part of a central hypoventilation disorder, which may be inherited, e.g. Congenital Central hypoventilation Syndrome, or acquired, e.g. Arnold-Chiari malformation, brain tumour, or spinal injury. The treatments of central breathing problems depend upon the underlying aetiology.
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Affiliation(s)
- Ds Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland, UK ; Department of Child Life and Health, University of Edinburgh, Edinburgh, Scotland, UK
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19
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Atrial arrhythmias in obstructive sleep apnea: underlying mechanisms and implications in the clinical setting. Pulm Med 2013; 2013:426758. [PMID: 23691306 PMCID: PMC3649713 DOI: 10.1155/2013/426758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/12/2013] [Indexed: 11/30/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications.
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20
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O'Connor JJ. Targeting tumour necrosis factor-α in hypoxia and synaptic signalling. Ir J Med Sci 2013; 182:157-62. [PMID: 23361632 DOI: 10.1007/s11845-013-0911-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/15/2013] [Indexed: 01/06/2023]
Abstract
Tumour necrosis factor (TNF)-α is a pro-inflammatory cytokine, which is synthesised and released in the brain by astrocytes, microglia and neurons in response to numerous internal and external stimuli. It is involved in many physiological and pathophysiological processes such as gene transcription, cell proliferation, apoptosis, synaptic signalling and neuroprotection. The complex actions of TNF-α in the brain are under intense investigation. TNF-α has the ability to induce selective necrosis of some cells whilst sparing others and this has led researchers to discover multiple activated signalling cascades. In many human diseases including acute stroke and inflammation and those involving hypoxia, levels of TNF-α are increased throughout different brain regions. TNF-α signalling may also have several positive and negative effects on neuronal function including glutamatergic synaptic transmission and plasticity. Exogenous TNF-α may also exacerbate the neuronal response to hypoxia. This review will summarise the actions of TNF-α in the central nervous system on synaptic signalling and its effects during hypoxia.
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Affiliation(s)
- J J O'Connor
- UCD School of Biomolecular and Biomedical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Abstract
OSA is increasingly recognized as a major health problem in developed countries. Obesity is the most common risk factor in OSA and hence, the prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is highly associated with the metabolic syndrome, and it is postulated that OSA contributes to cardiometabolic dysfunction, and subsequently vasculopathy. Current evidence regarding the magnitude of impact on ultimate cardiovascular morbidity or mortality attributable to OSA-induced metabolic dysregulation is scarce. Given the known pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA, the potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. There is accumulating evidence from human and animal/cell models of intermittent hypoxia to map out these mechanistic pathways. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, a healthy diet and appropriate lifestyle modifications towards better control of metabolic function are equally important as CPAP treatment in the holistic management of OSA.
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Affiliation(s)
- Jamie Chung Mei Lam
- Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Effects of 10 days of modest intermittent hypoxia on circulating measures of inflammation in healthy humans. Sleep Breath 2011; 16:657-62. [PMID: 21743982 DOI: 10.1007/s11325-011-0555-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/28/2011] [Accepted: 06/30/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common disease which is associated with elevated inflammatory markers and adhesion molecules, possibly due to nightly intermittent hypoxia (IH). The purpose of this study was to test the hypothesis that IH would increase systemic inflammatory markers in healthy human males. METHODS Healthy, young male subjects (n = 9; 24 ± 2 years) were exposed to a single daily isocapnic hypoxia exposure (oxyhemoglobin saturation = 80%, 1 h/day) for 10 consecutive days. Serum granulocyte macrophage colony-stimulating factor, interferon-γ, interleukin-1β, interleukin-6, interleukin-8, leptin, monocyte chemotactic protein-1, vascular endothelial growth factor, intracellular adhesion molecule-1, and vascular cell adhesion molecule-1 were measured before and following the 10 days of IH using Luminex. RESULTS Nine subjects completed the study (24 ± 2 years; 24 ± 2 kg/m(2)). The mean oxyhemoglobin saturation was 80.8 ± 1.6% during the hypoxia exposures. There was no significant change in any of the markers of inflammation (paired t test, P > 0.2 all cytokines). CONCLUSIONS These findings suggest that (1) a more substantial or a different pattern of hypoxemia might be necessary to activate systemic inflammation, (2) the system may need to be primed before hypoxic exposure, or (3) increases in inflammatory markers in patients with OSA may be more related to other factors such as obesity or nocturnal arousal.
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Chukwumah C, Zorron R, Marks JM, Ponsky JL. Current Status of Natural Orifice Translumenal Endoscopic Surgery (NOTES). Curr Probl Surg 2010; 47:630-68. [DOI: 10.1067/j.cpsurg.2010.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Al Lawati N, Mulgrew A, Cheema R, vanEeden S, Butt A, Fleetham J, Ryan F, Ayas N. Pro-atherogenic cytokine profile of patients with suspected obstructive sleep apnea. Sleep Breath 2009; 13:391-5. [DOI: 10.1007/s11325-009-0259-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/24/2009] [Indexed: 12/01/2022]
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Vilahur G, Hernández-Vera R, Molins B, Casaní L, Duran X, Padró T, Badimon L. Short-term myocardial ischemia induces cardiac modified C-reactive protein expression and proinflammatory gene (cyclo-oxygenase-2, monocyte chemoattractant protein-1, and tissue factor) upregulation in peripheral blood mononuclear cells. J Thromb Haemost 2009; 7:485-93. [PMID: 19036073 DOI: 10.1111/j.1538-7836.2008.03244.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prompt coronary thrombus resolution, reducing time of ischemia, improves cardiac recovery. The factors triggered by ischemia that contribute to the clinical outcome are not fully known. We hypothesize that unabated inflammation due to cardiac ischemia may be a contributing factor. AIMS As a proof-of-concept, we evaluated the effect of short-term myocardial ischemia on the local and systemic inflammatory response. METHODS Pigs underwent either 90-min mid-left anterior descending (LAD) coronary artery balloon occlusion (infarct size 25% +/- 1% left ventricle; 29% heart function deterioration) or a sham-operation procedure. Peri-infarcted and non-ischemic cardiac tissue was obtained for histopathologic, molecular and immunohistochemical analysis of inflammatory markers [interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), modified C-reactive protein (mCRP), and human alveolar macrophage-56 (HAM-56)]. Blood (femoral vein) was withdrawn prior to myocardial infarction (MI) induction (t = 0) and at 30 and 90 min to evaluate: (i) systemic cytokine levels (IL-6, TNF-alpha, CRP); (ii) proinflammatory gene and protein expression in peripheral blood mononuclear cells (PBMCs) of tissue factor (TF), cyclo-oxygenase-2 (Cox-2), monocyte chemoattractant protein-1 (MCP-1), and CRP; and (iii) platelet activation (assessed by perfusion studies and RhoA activation). RESULTS Short-term ischemia triggered cardiac IL-6 and TNF-alpha expression, recruitment of inflammatory cells, and mCRP expression in infiltrated macrophages (P < 0.05 vs. t = 0 and sham). PBMC mRNA and protein expression of MCP-1, Cox-2 and TF was significantly increased by ischemia, whereas no differences were detected in CRP. Ischemia increased cardiac troponin-I, IL-6 and TNF-alpha systemic levels, and was associated with higher platelet deposition and RhoA activation (P < 0.001 vs. t = 0 and sham). CONCLUSION Short-term myocardial ischemia, even without atherosclerosis, induces an inflammatory phenotype by inducing local recruitment of macrophages and systemic activation of mononuclear cells, and renders platelets more susceptible to activation.
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Affiliation(s)
- G Vilahur
- Cardiovascular Research Centre, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is a prevalent disorder with clinically well known mid-term and long-term consequences. It is difficult, however, to investigate the mechanisms causing morbidity in OSA from human studies, owing to confounding factors in patients. Animal research is useful to analyze the various injurious stimuli--intermittent hypoxia/hypercapnia, mechanical stress and sleep disruption--that potentially cause OSA morbidity. This review is focused on the most recent advances in our understanding of the consequences of OSA, achieved as a result of animal models. RECENT FINDINGS Animal research has improved our knowledge of various aspects of the cardiovascular consequences of OSA: myocardial damage, left ventricular dysfunction, vasoconstriction, hypertension and atherosclerosis. The systemic and metabolic consequences of OSA--inflammation, insulin resistance, alterations in lipid metabolism and hepatic morbidity--have also been investigated with animal models. Our understanding of the mechanisms involved in the neurocognitive consequences of OSA--neuronal and brain alterations and cognitive dysfunctions--has also been improved through animal research. Moreover, animal models have recently been used to investigate the mechanisms of upper airway inflammation and dysfunction. SUMMARY The simple experimental models used to investigate OSA morbidity are useful for investigating isolated mechanisms. However, more complex and realistic models incorporating the various injurious challenges characterizing OSA are required to more precisely translate the results of animal research to patients and to design potentially preventive and therapeutic strategies.
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Current World Literature. Curr Opin Pulm Med 2008; 14:600-2. [DOI: 10.1097/mcp.0b013e328316ea6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mehra R, Redline S. Sleep apnea: a proinflammatory disorder that coaggregates with obesity. J Allergy Clin Immunol 2008; 121:1096-102. [PMID: 18466782 DOI: 10.1016/j.jaci.2008.04.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 04/01/2008] [Accepted: 04/03/2008] [Indexed: 11/26/2022]
Abstract
Both obesity and sleep apnea are prevalent health conditions that frequently coaggregate. Obesity-associated inflammation may influence asthma control; the relation of sleep apnea to asthma or allergic rhinitis may be bidirectional. Both obesity and sleep apnea are associated with augmented levels of inflammation and oxidative stress, and it is biologically plausible that the proinflammatory effects of one disorder influence the expression of the other disorder. This article elucidates mechanistic associations among obesity, sleep apnea, and systemic inflammation; highlights interrelationships between these factors with cardiopulmonary disease; and identifies specific areas for future research directions.
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Affiliation(s)
- Reena Mehra
- Department of Medicine, Case Comprehensive Cancer Center, Case School of Medicine, Cleveland, OH 44106-6003, USA.
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