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Solelhac G, Sánchez-de-la-Torre M, Blanchard M, Berger M, Hirotsu C, Imler T, Sánchez-de-la-Torre A, Haba-Rubio J, Marchi NA, Bayon V, Bailly S, Goupil F, Waeber A, Heiniger G, Pigeanne T, Gracia-Lavedan E, Zapater A, Abad J, Ordax E, Masdeu MJ, Cabriada-Nuño V, Egea C, Van Den Broecke S, Vollenweider P, Marques-Vidal P, Vaucher J, Bernardi G, Betta M, Siclari F, Barbé F, Gagnadoux F, Heinzer R. Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2023; 207:1620-1632. [PMID: 37017487 PMCID: PMC10273112 DOI: 10.1164/rccm.202206-1223oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/04/2023] [Indexed: 04/06/2023] Open
Abstract
Rationale: It is currently unclear which patients with obstructive sleep apnea (OSA) are at increased cardiovascular risk. Objective: To investigate the value of pulse wave amplitude drops (PWADs), reflecting sympathetic activations and vasoreactivity, as a biomarker of cardiovascular risk in OSA. Methods: PWADs were derived from pulse oximetry-based photoplethysmography signals in three prospective cohorts: HypnoLaus (N = 1,941), the Pays-de-la-Loire Sleep Cohort (PLSC; N = 6,367), and "Impact of Sleep Apnea syndrome in the evolution of Acute Coronary syndrome. Effect of intervention with CPAP" (ISAACC) (N = 692). The PWAD index was the number of PWADs (>30%) per hour during sleep. All participants were divided into subgroups according to the presence or absence of OSA (defined as ⩾15 or more events per hour or <15/h, respectively, on the apnea-hypopnea index) and the median PWAD index. Primary outcome was the incidence of composite cardiovascular events. Measurements and Main Results: Using Cox models adjusted for cardiovascular risk factors (hazard ratio; HR [95% confidence interval]), patients with a low PWAD index and OSA had a higher incidence of cardiovascular events compared with the high-PWAD and OSA group and those without OSA in the HypnoLaus cohort (HR, 2.16 [1.07-4.34], P = 0.031; and 2.35 [1.12-4.93], P = 0.024) and in the PLSC (1.36 [1.13-1.63], P = 0.001; and 1.44 [1.06-1.94], P = 0.019), respectively. In the ISAACC cohort, the low-PWAD and OSA untreated group had a higher cardiovascular event recurrence rate than that of the no-OSA group (2.03 [1.08-3.81], P = 0.028). In the PLSC and HypnoLaus cohorts, every increase of 10 events per hour in the continuous PWAD index was negatively associated with incident cardiovascular events exclusively in patients with OSA (HR, 0.85 [0.73-0.99], P = 0.031; and HR, 0.91 [0.86-0.96], P < 0.001, respectively). This association was not significant in the no-OSA group and the ISAACC cohort. Conclusions: In patients with OSA, a low PWAD index reflecting poor autonomic and vascular reactivity was independently associated with a higher cardiovascular risk.
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Affiliation(s)
| | - Manuel Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Margaux Blanchard
- Ecole Supérieur D’Electronique de l’Ouest, Angers, France
- Laboratoire d’Acoustique de l’Université du Mans, Le Mans, France
| | | | | | - Théo Imler
- Center for Investigation and Research in Sleep
| | - Alicia Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | | | | | - Sébastien Bailly
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | | | | | - Thierry Pigeanne
- Unité respiratoire, Pôle santé des Olonnes, Olonne sur Mer, France
| | - Esther Gracia-Lavedan
- Translation Research in Respiratory Medicine, University hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
| | - Andrea Zapater
- Precision Medicine in Chronic Diseases and
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Jorge Abad
- Respiratory Department, University hospital Germans Trias I Pujol, Barcelona, Spain
| | - Estrella Ordax
- Respiratory Department, Burgos University hospital, Burgos, Spain
| | - María José Masdeu
- Respiratory Department, University hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Investigación OSI, Araba University hospital, IIS Bioaraba, Vitoria, Spain
| | - Sandra Van Den Broecke
- Center for Investigation and Research in Sleep
- Service de Pneumologie et Centre du Sommeil, Hôpital Neuchâtelois, site de Pourtalès, Neuchâtel, Switzerland
| | | | | | | | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Monica Betta
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Francesca Siclari
- Center for Investigation and Research in Sleep
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Ferran Barbé
- Translation Research in Respiratory Medicine, University hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; and
- INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep
- Pulmonary Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Impact of reboxetine plus oxybutynin treatment for obstructive sleep apnea on cardiovascular autonomic modulation. Sci Rep 2023; 13:3178. [PMID: 36823241 PMCID: PMC9950422 DOI: 10.1038/s41598-023-29436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
The combination of noradrenergic (reboxetine) plus antimuscarinic (oxybutynin) drugs (reb-oxy) reduced obstructive sleep apnea (OSA) severity but no data are available on its effects on cardiac autonomic modulation. We sought to evaluate the impact of 1-week reb-oxy treatment on cardiovascular autonomic control in OSA patients. OSA patients were randomized to a double-blind, crossover trial comparing 4 mg reboxetine plus 5 mg oxybutynin to a placebo for OSA treatment. Heart rate (HR) variability (HRV), ambulatory blood pressure (BP) monitoring (ABPM) over 24 h baseline and after treatment were performed. Baroreflex sensitivity was tested over beat-to-beat BP recordings. 16 subjects with (median [interquartile range]) age 57 [51-61] years and body mass index 30 [26-36]kg/m2 completed the study. The median nocturnal HR was 65 [60-69] bpm at baseline and increased to 69 [64-77] bpm on reb-oxy vs 66 [59-70] bpm on placebo (p = 0.02). The mean 24 h HR from ABPM was not different among treatment groups. Reb-oxy administration was not associated with any modification in HRV or BP. Reb-oxy increased the baroreflex sensitivity and did not induce orthostatic hypotension. In conclusion, administration of reb-oxy did not induce clinically relevant sympathetic overactivity over 1-week and, together with a reduction in OSA severity, it improved the baroreflex function.
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Pal A, Martinez F, Chatterjee R, Aysola RS, Harper RM, Macefield VG, Henderson LA, Macey PM. Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP. Sleep Med 2022; 97:73-81. [PMID: 35728308 DOI: 10.1016/j.sleep.2022.05.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/09/2022] [Accepted: 05/29/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) increases sympathetic vasoconstrictor drive and reduces baroreflex sensitivity (BRS), the degree to which blood pressure changes modify cardiac output. Whether nighttime continuous positive airway pressure (CPAP) corrects BRS in the awake state in OSA remains unclear. We assessed spontaneous BRS using non-invasive continuous BP and ECG recordings at rest and during handgrip and Valsalva challenges, maneuvers that increase vasoconstrictor drive with progressively higher BP, in untreated OSA (unOSA), CPAP-treated OSA (cpOSA) and healthy (CON) participants. METHODS In a cross-sectional study of 104 participants, 34 unOSA (age mean±std, 50.6±14.1years; Respiratory Event Index [REI] 21.0±15.3 events/hour; 22male), 31 cpOSA (49.6±14.5years; REI 23.0±14.2 events/hour; 22male; self-report 4+hours/night,5+days/week,6months), and 39 CON (42.2±15.0years; 17male), we calculated BRS at rest and during handgrip and Valsalva. Additionally, we correlated BP variability (BPV) with BRS during these protocols. RESULTS BRS in unOSA, cpOSA and CON was, respectively (mean±sdv in ms/mmHg), at rest: 14.8±11.8, 15.8±17.0, 16.1±11.3; during handgrip 13.3±7.6, 12.7±8.4, 16.4±8.7; and during Valsalva 12.7±8.0, 11.5±6.6, 15.1±8.9. BRS was lower in cpOSA than CON for handgrip (p=0.04) and Valsalva (p=0.03). BRS was negatively correlated with BPV in unOSA during Valsalva and handgrip for cpOSA, both R=-0.4 (p=0.02). BRS was negatively correlated with OSA severity (levels: none, mild, moderate, severe) at R=-0.2 (p=0.04,n=104). CONCLUSIONS As expected, BRS was lower and BPV higher in OSA during the pressor challenges, and disease severity negatively correlated with BRS. In this cross-sectional study, both CPAP-treated (self-reported) and untreated OSA showed reduced BRS, leaving open whether within-person CPAP improves BRS.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Fernando Martinez
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Roopsha Chatterjee
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Ravi S Aysola
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Ronald M Harper
- Neurobiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Melbourne, and Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, USA
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul M Macey
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.
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Li YE, Ren J. Association between obstructive sleep apnea and cardiovascular diseases. Acta Biochim Biophys Sin (Shanghai) 2022; 54:882-892. [PMID: 35838200 PMCID: PMC9828315 DOI: 10.3724/abbs.2022084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by partial obstruction of upper respiratory tract and repetitive cessation of breathing during sleep. The etiology behind OSA is associated with the occurrence of intermittent hypoxemia, recurrent arousals and intrathoracic pressure swings. These contributing factors may turn on various signaling mechanisms including elevated sympathetic tone, oxidative stress, inflammation, endothelial dysfunction, cardiovascular variability, abnormal coagulation and metabolic defect ( e.g., insulin resistance, leptin resistance and altered hepatic metabolism). Given its close tie with major cardiovascular risk factors, OSA is commonly linked to the pathogenesis of a wide array of cardiovascular diseases (CVDs) including hypertension, heart failure, arrhythmias, coronary artery disease, stroke, cerebrovascular disease and pulmonary hypertension (PH). The current standard treatment for OSA using adequate nasal continuous positive airway pressure (CPAP) confers a significant reduction in cardiovascular morbidity. Nonetheless, despite the availability of effective therapy, patients with CVDs are still deemed highly vulnerable to OSA and related adverse clinical outcomes. A better understanding of the etiology of OSA along with early diagnosis should be essential for this undertreated disorder in the clinical setting.
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Affiliation(s)
- Yiran E. Li
- Department of CardiologyZhongshan HospitalFudan University; Shanghai Institute of Cardiovascular DiseasesShanghai200032China
| | - Jun Ren
- Department of CardiologyZhongshan HospitalFudan University; Shanghai Institute of Cardiovascular DiseasesShanghai200032China,Department of Laboratory Medicine and PathologyUniversity of WashingtonSeattleWA98195USA,Correspondence address. Tel: +86-21-64041990; E-mail:
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Kim H, Jung HR, Kim JB, Kim DJ. Autonomic Dysfunction in Sleep Disorders: From Neurobiological Basis to Potential Therapeutic Approaches. J Clin Neurol 2022; 18:140-151. [PMID: 35274834 PMCID: PMC8926769 DOI: 10.3988/jcn.2022.18.2.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Sleep disorder has been portrayed as merely a common dissatisfaction with sleep quality and quantity. However, sleep disorder is actually a medical condition characterized by inconsistent sleep patterns that interfere with emotional dynamics, cognitive functioning, and even physical performance. This is consistent with sleep abnormalities being more common in patients with autonomic dysfunction than in the general population. The autonomic nervous system coordinates various visceral functions ranging from respiration to neuroendocrine secretion in order to maintain homeostasis of the body. Because the cell population and efferent signals involved in autonomic regulation are spatially adjacent to those that regulate the sleep-wake system, sleep architecture and autonomic coordination exert effects on each other, suggesting the presence of a bidirectional relationship in addition to shared pathology. The primary goal of this review is to highlight the bidirectional and shared relationship between sleep and autonomic regulation. It also introduces the effects of autonomic dysfunction on insomnia, breathing disorders, central disorders of hypersomnolence, parasomnias, and movement disorders. This information will assist clinicians in determining how neuromodulation can have the greatest therapeutic effects in patients with sleep disorders.
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Affiliation(s)
- Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Hee Ra Jung
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Jung Bin Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
- Department of Artificial Intelligence, Korea University, Seoul, Korea
- NeuroTx, Co., Ltd., Seoul, Korea
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Adaptive cardiorespiratory changes to chronic continuous and intermittent hypoxia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:103-123. [PMID: 35965023 PMCID: PMC9906984 DOI: 10.1016/b978-0-323-91534-2.00009-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This chapter reviews cardiorespiratory adaptations to chronic hypoxia (CH) experienced at high altitude and cardiorespiratory pathologies elicited by chronic intermittent hypoxia (CIH) occurring with obstructive sleep apnea (OSA). Short-term CH increases breathing (ventilatory acclimatization to hypoxia) and blood pressure (BP) through carotid body (CB) chemo reflex. Hyperplasia of glomus cells, alterations in ion channels, and recruitment of additional excitatory molecules are implicated in the heightened CB chemo reflex by CH. Transcriptional activation of hypoxia-inducible factors (HIF-1 and 2) is a major molecular mechanism underlying respiratory adaptations to short-term CH. High-altitude natives experiencing long-term CH exhibit blunted hypoxic ventilatory response (HVR) and reduced BP due to desensitization of CB response to hypoxia and impaired processing of CB sensory information at the central nervous system. Ventilatory changes evoked by long-term CH are not readily reversed after return to sea level. OSA patients and rodents subjected to CIH exhibit heightened CB chemo reflex, increased hypoxic ventilatory response, and hypertension. Increased generation of reactive oxygen species (ROS) is a major cellular mechanism underlying CIH-induced enhanced CB chemo reflex and the ensuing cardiorespiratory pathologies. ROS generation by CIH is mediated by nontranscriptional, disrupted HIF-1 and HIF-2-dependent transcriptions as well as epigenetic mechanisms.
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Kokubo A, Kuwabara M, Ota Y, Tomitani N, Yamashita S, Shiga T, Kario K. Nocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index. J Clin Hypertens (Greenwich) 2021; 24:271-282. [PMID: 34935266 PMCID: PMC8925009 DOI: 10.1111/jch.14383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
Nocturnal blood pressure (BP) surge in seconds (sec‐surge), which is characterized as acute transient BP elevation over several tens of seconds, could be a predictor of target organ damage. However, it is not clear that the severity of sec‐surge is different between sec‐surges induced by sleep apnea (SA) (apnea/hypopnea detected by polysomnography (PSG) or oxygen desaturation) and those induced by non‐SA factors (rapid eye movement, micro arousal, etc.), and sec‐surge variables associate with left ventricular hypertrophy (LVH) independently of conventional BP variables. The authors assessed these points with 41 patients (mean age 63.2±12.6 years, 29% female) who underwent full PSG, beat‐by‐beat (BbB) BP, and cuff‐oscillometric BP measurement during the night. All patients were included for the analysis comparing sec‐surge severity between inducing factors (SA and non‐SA factors). There were no significant differences in the number of sec‐surges/night between SA‐related sec‐surges and non‐SA‐related sec‐surges (19.5±26.0 vs. 16.4±29.8 events/night). There were also no significant differences in the peak of sec‐surges, defined as the maximum systolic BPs (SBPs) in each sec‐surge, between SA‐related sec‐surges and non‐SA‐related sec‐surges (148.2±18.5 vs. 149.3±19.2 mm Hg). Furthermore, as a result of multiple regression analysis (n = 18), the peak of sec‐surge was significantly and strongly associated with the left ventricular mass index (standardized β = 0.62, p = .02), compared with the mean nocturnal SBPs measured by oscillometric method (β = −0.04, p = .87). This study suggests that peak of sec‐surge could be a better predictor of LVH compared to parameters derived from regular nocturnal oscillometric SBP.
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Affiliation(s)
- Ayako Kokubo
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Mitsuo Kuwabara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Yuki Ota
- Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Toshikazu Shiga
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Hyponatremia accompanying volatile hypertension caused by baroreflex failure after neck surgery: case report and literature review. J Hypertens 2021; 38:1617-1624. [PMID: 32371768 DOI: 10.1097/hjh.0000000000002436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hyponatremia, and many disorders have been associated with it. Baroreflex failure is a rare disorder characterized by extreme blood pressure (BP) fluctuations, most frequently caused by neck or head trauma and irradiation. We report a case of a 48-year-old patient referred to our department for asymptomatic hyponatremia and volatile hypertension. His past medical history included nasopharyngeal carcinoma treated with surgery and bilateral neck radiation. Following the diagnostic algorithm for hyponatremia, the diagnosis of SIADH was made. Ambulatory BP monitoring revealed highly variable BP; extensive autonomic nervous system function testing suggested baroreflex-cardiovagal failure. We propose the hypothesis that not only labile hypertension because of baroreflex failure but also hyponatremia can develop as a late consequence of neck trauma and irradiation.
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Dissanayake HU, Bin YS, Ucak S, de Chazal P, Sutherland K, Cistulli PA. Association between autonomic function and obstructive sleep apnea: A systematic review. Sleep Med Rev 2021; 57:101470. [PMID: 33839505 DOI: 10.1016/j.smrv.2021.101470] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor for hypertension and cardiovascular disease. Effects of OSA on the autonomic nervous system may mediate this association. We performed a systematic literature review to determine the profile of autonomic function associated with OSA. Three electronic databases were searched for studies of OSA patients aged ≥18 years in which autonomic function was assessed. Studies comparing patients with and without OSA, or examining the association of OSA severity with changes in autonomic function were included. Seventy-one studies met the inclusion criteria and autonomic function has been assessed using a range of techniques. The profile of autonomic function found in OSA include increased sympathetic activity, reduced parasympathetic activity and less consistently found low heart rate variability. Altered autonomic function in OSA may explain the pathophysiology of increased cardiovascular risk. Evidence from intervention studies is required to determine if treatment improves autonomic function associated with OSA.
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Affiliation(s)
- Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Yu S Bin
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Seren Ucak
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
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Chen J, Gu H, Wurster RD, Cheng ZJ. The protective role of SOD1 overexpression in central mediation of bradycardia following chronic intermittent hypoxia in mice. Am J Physiol Regul Integr Comp Physiol 2021; 320:R317-R330. [PMID: 33296277 PMCID: PMC7988771 DOI: 10.1152/ajpregu.00147.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/27/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is associated with many cardiovascular complications. Similar to OSA, chronic intermittent hypoxia (CIH) (a model for OSA) leads to oxidative stress and impairs baroreflex control of the heart rate (HR) in rodents. The baroreflex arc includes the aortic depressor nerve (ADN), vagal efferent, and central neurons. In this study, we used mice as a model to examine the effects of CIH on baroreflex sensitivity, aortic baroreceptor afferents, and central and vagal efferent components of the baroreflex circuitry. Furthermore, we tested whether human Cu/Zn Superoxide Dismutase (SOD1) overexpression in transgenic mice offers protection against CIH-induced deficit of the baroreflex arc. Wild-type C57BL/6J and SOD1 mice were exposed to room air (RA) or CIH and were then anesthetized, ventilated, and catheterized for measurement of mean arterial pressure (MAP) and HR. Compared with wild-type RA control, CIH impaired baroreflex sensitivity but increased maximum baroreceptor gain and bradycardic response to vagal efferent stimulation. Additionally, CIH reduced the bradycardic response to ADN stimulation, indicating a diminished central regulation of bradycardia. Interestingly, SOD1 overexpression prevented CIH-induced attenuation of HR responses to ADN stimulation and preserved HR responses to vagal efferent stimulation in transgenic mice. We suggest that CIH decreased central mediation of the baroreflex and SOD1 overexpression may prevent the CIH-induced central deficit.
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Affiliation(s)
- Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - He Gu
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - Robert D Wurster
- Department of Cellular and Molecular Physiology, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Zixi Jack Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida
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Prabhakar NR, Peng YJ, Nanduri J. Hypoxia-inducible factors and obstructive sleep apnea. J Clin Invest 2021; 130:5042-5051. [PMID: 32730232 DOI: 10.1172/jci137560] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intermittent hypoxia (IH) is a hallmark manifestation of obstructive sleep apnea (OSA), a widespread disorder of breathing. This Review focuses on the role of hypoxia-inducible factors (HIFs) in hypertension, type 2 diabetes (T2D), and cognitive decline in experimental models of IH patterned after O2 profiles seen in OSA. IH increases HIF-1α and decreases HIF-2α protein levels. Dysregulated HIFs increase reactive oxygen species (ROS) through HIF-1-dependent activation of pro-oxidant enzyme genes in addition to reduced transcription of antioxidant genes by HIF-2. ROS in turn activate chemoreflex and suppress baroreflex, thereby stimulating the sympathetic nervous system and causing hypertension. We also discuss how increased ROS generation by HIF-1 contributes to IH-induced insulin resistance and T2D as well as disrupted NMDA receptor signaling in the hippocampus, resulting in cognitive decline.
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12
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Qin H, Steenbergen N, Glos M, Wessel N, Kraemer JF, Vaquerizo-Villar F, Penzel T. The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea. Front Psychiatry 2021; 12:642333. [PMID: 34366907 PMCID: PMC8339263 DOI: 10.3389/fpsyt.2021.642333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Saratov State University, Russian Federation, Saratov, Russia
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13
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Buratti L, Cruciani C, Pulcini A, Rocchi C, Totaro V, Lattanzi S, Viticchi G, Falsetti L, Silvestrini M. Lacunar stroke and heart rate variability during sleep. Sleep Med 2020; 73:23-28. [PMID: 32769029 DOI: 10.1016/j.sleep.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Autonomic instability during sleep can influence the risk of cerebrovascular diseases. In this study, we performed a polygraphy to evaluate, heart rate variability (HRV) in a group of patients with lacunar stroke that is a condition at high risk of recurrence. METHODS Twenty-one lacunar stroke patients were enrolled one month after stroke occurrence. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The presence of common sleep disorders and autonomic changes during the night was investigated by a polygraphy monitoring. Results were compared with those obtained in a group of 21 healthy subjects. RESULTS Patients and controls were similar for age, sex distribution and main cardiovascular risk factors with the exception of the body mass index. Significant differences were detected for all polysomnographic (PSG) parameters and for the PSQI score. By considering HRV values, patients with pathologic values (12 patients, HRV>2) showed significantly higher values in BMI (31 ± 2.9 vs. 26.6 ± 3.6, p = 0.006) and PSQI scores (7.9 ± 2.6 vs. 4.2 ± 1.9) with respect to patients with normal HRV values (nine patients, HRV≤2). CONCLUSIONS The results of this study suggest that the prevalence of nocturnal autonomic dysfunction is high in lacunar stroke patients even in the absence of the commonest sleep-related disorders. An abnormal HRV may contribute to increase the risk of stroke recurrence. Based on our results, the indication to polygraphy in patients with lacunar stroke should be carefully considered.
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Affiliation(s)
- Laura Buratti
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Crizia Cruciani
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Alessandra Pulcini
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Chiara Rocchi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Viviana Totaro
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Simona Lattanzi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti, Via Conca 71, 60020, Ancona, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
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14
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Venkataraman S, Vungarala S, Covassin N, Somers VK. Sleep Apnea, Hypertension and the Sympathetic Nervous System in the Adult Population. J Clin Med 2020; 9:jcm9020591. [PMID: 32098169 PMCID: PMC7073618 DOI: 10.3390/jcm9020591] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Sleep apnea is very common in patients with cardiovascular disease, especially in patients with hypertension. Over the last few decades a number of discoveries have helped support a causal relationship between the two and even resistant hypertension. The role neurogenic mechanisms play has gathered more attention in the recent past due to their immediate bedside utility. Several innovative discoveries in pathogenesis including those exploring the role of baroreflex gain, cardiovascular variability, chemoreceptor reflex activation and the sympathetic nervous system have emerged. In this review, we discuss the epidemiology of sleep apnea and hypertension and the pathogenic mechanisms contributing to neurogenic hypertension. Furthermore, recent management strategies in addition to continuous positive airway pressure (CPAP), such as upper airway stimulation and renal denervation that target these pathogenic mechanisms, are also discussed.
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15
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Chen HL, Huang CC, Lin HC, Lu CH, Chen PC, Chou KH, Su MC, Friedman M, Lin CP, Lin WC. White matter alteration and autonomic impairment in obstructive sleep apnea. J Clin Sleep Med 2020; 16:293-302. [PMID: 31992402 DOI: 10.5664/jcsm.8186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Autonomic impairment and white matter (WM) alterations have been noted as effects of obstructive sleep apnea (OSA). This study sought to evaluate the change of WM integrity in patients with OSA using diffusion tensor imaging (DTI) and to determine its relationship with autonomic impairment. METHODS A total of 30 patients with moderate and severe OSA and 19 healthy volunteers were recruited. A cardiovascular autonomic survey was performed and the baroreflex sensitivity (BRS) for each participant was derived from changes in heart rate and blood pressure during the early part of phase II of the Valsalva maneuver. DTI-related indices were derived from DTI. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) maps were compared using voxel-based statistics to determine differences between the patients with OSA and the healthy controls. The correlations among DTI indices, clinical severity, and autonomic parameters were investigated. RESULTS The BRS values were significantly worse in the OSA group than in the control patients. An exploratory group-wise comparison between the two groups revealed that the patients with OSA exhibited low FA, increased MD, AD, and RD in several brain locations. The declined DTI indices in autonomic-related areas were significantly correlated with increased clinical disease severity and baroreflex impairment. CONCLUSIONS OSA alters WM integrity in the cingulum and temporal lobe, and this impairment might play some role in autonomic dysfunction. The possible interaction between autonomic dysfunction and central nervous system microstructural alterations may represent variant hypoxic patterns, sympathetic activation, and their consequent processes in OSA.
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Affiliation(s)
- Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Michael Friedman
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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16
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Winklewski PJ, Wolf J, Gruszecki M, Wszedybyl-Winklewska M, Narkiewicz K. Current understanding of the effects of inspiratory resistance on the interactions between systemic blood pressure, cerebral perfusion, intracranial pressure, and cerebrospinal fluid dynamics. J Appl Physiol (1985) 2019; 127:1206-1214. [DOI: 10.1152/japplphysiol.00058.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Negative intrathoracic pressure (nITP) is generated by the respiratory muscles during inspiration to overcome inspiratory resistance, thus enabling lung ventilation. Recently developed noninvasive techniques have made it possible to assess the effects of nITP in real time in several physiological aspects such as systemic blood pressure (BP), intracranial pressure (ICP), and cerebral blood flow (CBF). It has been shown that nITP from 0 to −20 cmH2O elevates BP and diminishes ICP, which facilitates brain perfusion. The effects of nITP from −20 to −40 cmH2O on BP, ICP, and CBF remain largely unrecognized, yet even nITP at −40 cmH2O may facilitate CBF by diminishing ICP. Importantly, nITP from −20 to −40 cmH2O has been documented in adults in commonly encountered obstructive sleep apnea, which justifies research in this area. Recent revelations about interactions between ICP and BP have opened up new fields of research in physiological regulation and the pathophysiology of common diseases, such as hypertension, brain injury, and respiratory disorders. A better understanding of these interactions may translate directly into new therapies in various fields of clinical medicine.
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Affiliation(s)
- Pawel J. Winklewski
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland
- Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Slupsk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, Gdansk, Poland
| | | | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
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17
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Sari CI, Eikelis N, Head GA, Schlaich M, Meikle P, Lambert G, Lambert E. Android Fat Deposition and Its Association With Cardiovascular Risk Factors in Overweight Young Males. Front Physiol 2019; 10:1162. [PMID: 31620011 PMCID: PMC6759693 DOI: 10.3389/fphys.2019.01162] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
Objective Excess adiposity increases the risk of type-2 diabetes and cardiovascular disease development. Beyond the simple level of adiposity, the pattern of fat distribution may influence these risks. We sought to examine if higher android fat distribution was associated with different hemodynamic, metabolic or vascular profile compared to a lower accumulation of android fat deposits in young overweight males. Methods Forty-six participants underwent dual-energy X-ray absorptiometry and were stratified into two groups. Group 1: low level of android fat (<9.5%) and group 2: high level of android fat (>9.5%). Assessments comprised measures of plasma lipid and glucose profile, blood pressure, endothelial function [reactive hyperemia index (RHI)] and muscle sympathetic nerve activity (MSNA). Results There were no differences in weight, BMI, total body fat and lean mass between the two groups. Glucose tolerance and insulin resistance (fasting plasma insulin) were impaired in group 2 (p < 0.05). Levels of plasma triglycerides and 5 lipid species were higher in group 2 (p < 0.05). Endothelial function was less in group 2 (RHI: 1.64 vs. 2.26, p = 0.003) and heart rate was higher (76 vs. 67 bpm, p = 0.004). No difference occurred in MSNA nor blood pressure between the 2 groups. Conclusion Preferential fat accumulation in the android compartment is associated with increased cardiovascular and metabolic risk via alteration of endothelial function.
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Affiliation(s)
- Carolina Ika Sari
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Nina Eikelis
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Iverson Health Innovation Research Institute, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Peter Meikle
- Metabolomics Laboratories, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gavin Lambert
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Iverson Health Innovation Research Institute, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Elisabeth Lambert
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Iverson Health Innovation Research Institute, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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18
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Huang CC, Lin HC, Lai YR, Tsai NW, Lin WC, Wang HC, Kung CT, Cheng BC, Su YJ, Su CM, Hsiao SY, Lu CH. Long-term effects of surgical treatment on baroreflex function in patients with obstructive sleep apnea: an 18-month follow-up. Sleep Med 2019; 60:152-158. [DOI: 10.1016/j.sleep.2019.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/17/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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19
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Lombardi C, Pengo MF, Parati G. Obstructive sleep apnea syndrome and autonomic dysfunction. Auton Neurosci 2019; 221:102563. [PMID: 31445406 DOI: 10.1016/j.autneu.2019.102563] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/23/2019] [Accepted: 07/09/2019] [Indexed: 01/29/2023]
Abstract
Autonomic nervous system (ANS) has been extensively explored in obstructive sleep apnea (OSA). Autonomic alterations in these patients have been described by means of several methods, evaluating ANS function both directly with microneurography and indirectly through baroreflex sensitivity (BRS, by the sequence method or the cross-spectral approach), heart rate variability analysis (HRV, both in the time and frequency domain) during sleep and wake, or conventional laboratory tests, including cold pressor test, hand grip test or measurement of urinary cathecolamine excretion. Several studies in OSA patients have shown ANS alterations, in particular sympathetic overactivity, both acutely during apnea events and chronically during the daytime, being both also involved in cardiovascular consequences of sleep disordered breathing. The association between OSA and sympathetic dysregulation suggests a dose response relationship between OSA severity and the degree of sympathetic overactivity and this association seems to be reversible as the treatment of OSA is implemented. Additionally ANS is involved in regulating visceral and humoral functions to maintain the body homeostasis and in reaction and adaptation to external and internal stressor stimuli. However, the vast majority of studies have focussed on cardiovascular alterations, which are easier to measure, somewhat neglecting the other functions regulated by ANS. More evidence is therefore needed to better characterize the impact that sleep disorder breathing may have on ANS both in the short and long term.
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Affiliation(s)
- C Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - M F Pengo
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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20
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. The Association Between Obstructive Sleep Apnea and Arrhythmias. Cureus 2019; 11:e4429. [PMID: 31245216 PMCID: PMC6559391 DOI: 10.7759/cureus.4429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Obstructive sleep apnea (OSA) is caused by intermittent episodes of partial or complete closure of the upper airway, leading to apneic episodes while the patient is asleep. Atrial fibrillation (AF) leads to more than 750,000 hospitalizations per year and accounts for an estimated 130,000 deaths each year. The death rate from AF as the primary or a contributing cause of death has been rising for more than two decades. The material reviewed in this paper focuses on the association between OSA and arrhythmias. It goes into the details of the epidemiology, pathophysiology, and types of arrhythmias and the therapies seen in association with OSA.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Maoming People's Hospital, Maoming, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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21
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Parati G, Pengo MF, Lombardi C. Obstructive Sleep Apnea and Hypertension: Why Treatment Does Not Consistently Improve Blood Pressure. Curr Hypertens Rep 2019; 21:30. [PMID: 30949909 DOI: 10.1007/s11906-019-0935-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) and hypertension are two phenomena deeply linked together and, although a causal relationship has been suggested, a recent meta-analysis showed only a very modest effect of OSA treatment on blood pressure (BP). However, a vast number of randomized controlled trials published so far share some limitations, mainly of methodological nature: neither OSA nor BP is always assessed in a standardized way. Moreover, compliance with OSA treatment is often sub-optimal making the results of these trials difficult to interpret. RECENT FINDINGS Recent studies have shown that antihypertensive drugs can reduce BP more than OSA treatment, showing a better compliance profile and very few side effects. Considering the importance of reducing the overall cardiovascular risk of OSA patients, a more careful management of patient's antihypertensive medication could allow a better BP control also in this condition. In addition, greater efforts should be made to improve patient's acceptance of OSA treatment with the aim of improving their compliance.
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Affiliation(s)
- Gianfranco Parati
- Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, Milan, Italy. .,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Martino Francesco Pengo
- Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, Milan, Italy
| | - Carolina Lombardi
- Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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22
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Neumann K, Arzt M, Heid I, Böger C, Stadler S. Sleep-Disordered Breathing Is Associated with Metabolic Syndrome in Outpatients with Diabetes Mellitus Type 2. J Diabetes Res 2019; 2019:8417575. [PMID: 31179343 PMCID: PMC6501158 DOI: 10.1155/2019/8417575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MS) and sleep-disordered breathing (SDB) are highly prevalent in patients with diabetes mellitus type 2 (DM2). The present study examined whether there is an independent association between SDB and MS in a sample of outpatients with DM2. METHODS MS was determined in 679 patients of the DIACORE-SDB substudy, a study of outpatients with DM2. According to the National Cholesterol Education Program (NCEP) criteria, MS is defined by at least three of the following five criteria: waist circumference of >102 cm (men)/>88 cm (women), blood pressure of ≥130/85 mmHg, a fasting triglyceride level of >150 mg/dl, high-density lipoprotein (HDL) of <40 mg/dl (men)/<50 mg/dl (women), and a fasting glucose level of ≥110 mg/dl. The apnea-hypopnea index (AHI) was assessed with a 2-channel ambulatory monitoring device and used to define the severity of SDB (AHI < 15.0: no/mild SDB; AHI 15.0-29.9: moderate SDB; AHI ≥ 30.0: severe SDB). RESULTS 228 (34%) of the 679 participants (mean age 66 years, mean body mass index (BMI) 31.2 kg/m2, and mean AHI 14/hour) had SDB. MS was significantly more frequent in patients with more severe SDB (no/mild SDB vs. moderate SDB vs. severe SDB: 72% vs. 79% vs. 85%, respectively, p = 0.038). Logistic regression analysis adjusted for sex, age, obesity (BMI ≥ 30 kg/m2), and the HOMA index showed a significant association between the AHI and the presence of MS (OR (95%CI) = 1.039 (1.011; 1.068); p = 0.007). Further, male sex, obesity, and the HOMA index were significantly associated with MS. CONCLUSION SDB is significantly and independently associated with MS in outpatients with DM2.
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Affiliation(s)
- K. Neumann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - M. Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - I. Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - C. Böger
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - S. Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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23
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Taralov ZZ, Terziyski KV, Dimov PK, Marinov BI, Kostianev SS. Assessment of the impact of 10-day intermittent hypoxia on the autonomic control measured by heart rate variability. Physiol Int 2018; 105:386-396. [DOI: 10.1556/2060.105.2018.4.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose
The purpose of this study is to establish the alterations in the activity of the autonomic nervous system (ANS) via heart rate variability (HRV) in subjects exposed to 1 h of exogenous hypoxia for 10 consecutive days.
Methods
Twelve healthy non-smoker males at mean age of 29.8 ± 7.4 (mean ± SD) breathed hypoxic air delivered through hypoxicator (FiО2 = 12.3% ± 1.5%) for 1 h in 10 consecutive days. Pulse oximetry and electrocardiography were monitored during the visit and HRV was calculated for the entire 1-h hypoxic period.
Results
Comparing the last hypoxic visit to the first, subjects had higher standard deviation of normal-to-normal interbeat intervals (SDNNs) (65.7 ± 32.5 vs. 81.1 ± 32.0 ms, p = 0.013) and root mean square of successive R–R interval difference (RMSSD) (58.1 ± 30.9 vs. 76.5 ± 34.6 ms, p = 0.029) as well as higher lnTotal power (8.1 ± 1.1 vs. 8.5 ± 0.9 ms2, p = 0.015) and high frequency (lnHF) (6.8 ± 1.3 vs. 7.5 ± 1.2 ms2, p = 0.05) and lower LF/HF (2.4 ± 1.4 vs. 1.5 ± 1.0, p = 0.026). Changes in saturation (87.0 ± 7.1 vs. 90.8 ± 5.0%, p = 0.039) and heart rate (67.1 ± 8.9 vs. 62.5 ± 6.0 beats/min, p = 0.040) were also observed.
Conclusions
Intermittent hypoxic training consisting of 1-h hypoxic exposure for 10 consecutive days could diminish the effects of acute exogenous hypoxia on the ANS characterized by an increased autonomic control (SDNN and total power) with augmentation of the parasympathetic nervous system activity (increased RMSSD and HF and decreased LF/HF). Therefore, it could be applied as a pre-acclimatization technique aiming at an increase in the autonomic control and oxygen saturation in subjects with upcoming sojourn to high altitude.
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Affiliation(s)
- ZZ Taralov
- 1 Department of Pathophysiology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - KV Terziyski
- 1 Department of Pathophysiology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - PK Dimov
- 1 Department of Pathophysiology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - BI Marinov
- 1 Department of Pathophysiology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - SS Kostianev
- 1 Department of Pathophysiology, Medical University of Plovdiv, Plovdiv, Bulgaria
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Lim H, Oh M, Chung YH, Ki H, Lee JJ. Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. J Clin Monit Comput 2018; 33:657-663. [PMID: 30284097 DOI: 10.1007/s10877-018-0202-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 09/21/2018] [Indexed: 01/13/2023]
Abstract
In patients with obstructive sleep apnea, short-term use of a continuous positive airway pressure mask improves oxygenation, decreases the apnea-hypopnea index, and reduces hemodynamic instability. In this study, we investigated the effects of use of a continuous positive airway pressure mask in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia. Forty patients who underwent propofol sedation after spinal anesthesia for transurethral bladder or prostate resection with a STOP-Bang score of 3 or more were enrolled in this study. Patients were randomly divided into two groups: a simple oxygen mask group (n = 20) and a continuous positive airway pressure mask group (n = 20). After spinal anesthesia, propofol was injected at a target concentration of 1.3 mcg/ml via a target concentration control injector. ApneaLink™ was applied to all patients. Patients in the simple oxygen mask group were administered oxygen at a rate of 6 L/min through a simple facial mask. Patients in the CPAP mask group were connected to a pressurizer, and oxygen (6 L/min, 5-15 cm H2O) was administered. Blood pressure, heart rate, respiratory rate, and oxygen saturation were recorded preoperatively, after spinal anesthesia, and every 5 min after the injection of propofol to observe hemodynamic changes. Apnea-hypopnea index was estimated using ApneaLink™. There were no significant differences in hemodynamic changes between the two groups. Apnea-hypopnea index was significantly reduced in the continuous positive airway pressure mask group compared to the simple facial mask group. Application of a continuous positive airway pressure mask in a patient at high risk of obstructive sleep apnea can lower the incidence of obstructive sleep apnea during sedation without a significant effect on hemodynamic stability.
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Affiliation(s)
- Hyunyoung Lim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Minseok Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hoon Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Hyunseo Ki
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jeong Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Guo W, Lv T, She F, Miao G, Liu Y, He R, Xue Y, Nu NK, Yang J, Li K, Zhang P. The impact of continuous positive airway pressure on heart rate variability in obstructive sleep apnea patients during sleep: A meta-analysis. Heart Lung 2018; 47:516-524. [PMID: 30031552 DOI: 10.1016/j.hrtlng.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart rate variability (HRV), modulated by cardiac autonomic function, is impaired in obstructive sleep apnea (OSA). However, the effect of continuous positive airway pressure (CPAP) on HRV is debated. OBJECTIVES To investigate the associations between CPAP and HRV in OSA. METHODS Based on literature from five databases published through August 2017, we performed a meta-analysis of cohort studies of OSA treated with CPAP. The change of low-frequency band (LF), high-frequency band (HF) and the ratio between LF and HF (LHR) were analyzed. RESULTS Eleven studies were included. Decreased LF (SMD = -0.32, 95%CI: -0.62,-0.01; P = 0.043) and HF (SMD = -0.51, 95%CI: -0.95, -0.08, P = 0.020) were shown while measured on CPAP. When measured off CPAP, HF was increased remarkably (SMD: 0.31, 95%CI: 0.02, 0.60, P = 0.034). CONCLUSIONS CPAP can improve autonomic activity, which might be one mechanism to reduce the risk of cardiovascular diseases in OSA.
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Affiliation(s)
- Wenjia Guo
- School of Clinical Medicine, Tsinghua University, NO.1, Tsinghua Yuan, Haidian District, Beijing, 100084, China
| | - Tingting Lv
- School of Medicine, Tsinghua University, NO.1, Tsinghua Yuan, Haidian District, Beijing, 100084, China
| | - Fei She
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Guobin Miao
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Yuanwei Liu
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Rong He
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Yajun Xue
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Nang Kham Nu
- School of Clinical Medicine, Tsinghua University, NO.1, Tsinghua Yuan, Haidian District, Beijing, 100084, China
| | - Jing Yang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China
| | - Kun Li
- School of Clinical Medicine, Tsinghua University, NO.1, Tsinghua Yuan, Haidian District, Beijing, 100084, China
| | - Ping Zhang
- School of Clinical Medicine, Tsinghua University, NO.1, Tsinghua Yuan, Haidian District, Beijing, 100084, China; Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, NO.168, LiTang Road, Beijing, 102218, China.
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Lambert EA, Sari CI, Eikelis N, Phillips SE, Grima M, Straznicky NE, Dixon JB, Esler M, Schlaich MP, Head GA, Lambert GW. Effects of Moxonidine and Low-Calorie Diet: Cardiometabolic Benefits from Combination of Both Therapies. Obesity (Silver Spring) 2017; 25:1894-1902. [PMID: 28865109 DOI: 10.1002/oby.21962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Because sympathetic nervous system activity plays a detrimental role in metabolic and cardiovascular health, this study compared the effects of a centrally acting sympatholytic agent, the effects of a weight loss (WL) program using a low-calorie diet, and the effects of a combination of both. METHODS Young (18-30 years) male subjects with overweight (BMI > 25 kg/m2 ) were allocated to a WL program (n = 10), a moxonidine treatment course (M; n = 10, 0.4 mg/d), a combination of both (WL + M; n = 11), or to a control (C) group (n = 6) for 6 months. Muscle sympathetic nerve activity (MSNA), endothelial function, renal function (Cockcroft-Gault formula), and the metabolic profile were assessed before and after intervention. RESULTS WL occurred in the WL and WL + M groups (-7.6 ± 1.9 kg, P < 0.001 in both). MSNA and systolic blood pressure decreased similarly in the WL, M, and WL + M groups (by ∼10 bursts/min, P < 0.001, and by ∼9 mm Hg, P < 0.05). All other parameters for the WL, C, and M groups remained unchanged. In the WL + M group, decreased total cholesterol (-0.78 ± 0.23 mmol/L, P < 0.001), decreased low-density lipoprotein cholesterol (-0.49 ± 0.16 mmol/L, P < 0.01), decreased insulin (-6.5 ± 2.8 mmol/L, P < 0.05), and attenuated glomerular hyperfiltration (-19 ± 5 mL/min, P < 0.01) occurred. CONCLUSIONS The combination of moxonidine with a WL program has beneficial effects on aspects of the metabolic profile and end organ damage in young males with overweight.
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Affiliation(s)
- Elisabeth A Lambert
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Carolina I Sari
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nina Eikelis
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Sarah E Phillips
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Mariee Grima
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nora E Straznicky
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - John B Dixon
- Clinical Obesity Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Murray Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Gavin W Lambert
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
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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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Ziegler MG, Milic M, Lu X, Gharaibeh M, Elayan H. Effect of obstructive sleep apnea on the response to hypertension therapy. Clin Exp Hypertens 2017; 39:409-415. [DOI: 10.1080/10641963.2016.1259327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael G. Ziegler
- Department of Medicine, University of California, San Diego, California, USA
| | - Milos Milic
- Department of Medicine, University of California, San Diego, California, USA
| | - Xiaojiong Lu
- Department of Medicine, University of California, San Diego, California, USA
| | - Munir Gharaibeh
- Department of Pharmacology, University of Jordan, Amman, Jordan
| | - Hamzeh Elayan
- Department of Pharmacology, University of Jordan, Amman, Jordan
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Kuwabara M, Hamasaki H, Tomitani N, Shiga T, Kario K. Novel Triggered Nocturnal Blood Pressure Monitoring for Sleep Apnea Syndrome: Distribution and Reproducibility of Hypoxia-Triggered Nocturnal Blood Pressure Measurements. J Clin Hypertens (Greenwich) 2017; 19:30-37. [PMID: 27411291 PMCID: PMC8031313 DOI: 10.1111/jch.12878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/07/2016] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea (OSA) causes blood pressure (BP) surges during sleep, which may lead to increased sleep-onset cardiovascular events. The authors recently developed a triggered nocturnal BP monitoring system that initiates BP measurements when oxygen desaturation falls below a variable threshold. The distribution and reproducibility of hypoxia-triggered nocturnal BP parameters compared with those of fixed-interval nocturnal BP parameters for two consecutive nights in 147 OSA patients (mean age 59.4 years, 86.4% men) were evaluated. The mean and distribution (standard deviation [SD]) of the hypoxia-peak systolic BP (SBP) were significantly greater than that of the mean nocturnal SBP (mean±SD: 148.8±20.5 vs 123.4±14.2 mm Hg, P<.001). The repeatability coefficient (expressed as %MV) of hypoxia-peak SBP between night 1 and night 2 was comparable to that of mean nocturnal SBP (43% vs 32%). In conclusion, hypoxia-peak nocturnal BP was much higher than mean nocturnal BP, and it was as reproducible as mean nocturnal BP.
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Affiliation(s)
- Mitsuo Kuwabara
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
- Omron Healthcare Co., Ltd.KyotoJapan
| | - Haruna Hamasaki
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Naoko Tomitani
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | | | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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Bartels W, Buck D, Glos M, Fietze I, Penzel T. Definition and Importance of Autonomic Arousal in Patients with Sleep Disordered Breathing. Sleep Med Clin 2016; 11:435-444. [PMID: 28118868 DOI: 10.1016/j.jsmc.2016.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autonomic arousal at the end of sleep apnea events are not well-explored. We prospectively studied 20 patients with obstructive sleep apnea (OSA) and 24 healthy volunteers for 2 nights with cardiorespiratory polysomnography and continuous noninvasive blood pressure (Portapres). Recordings were scored visually for cortical and autonomic arousal. In the OSA group, 2151 cortical arousals and in the controls 1089 cortical arousals were scored. Respiratory arousal caused most frequently an increase of highest mean arterial blood pressure in patients and controls. A useful definition for autonomic arousal for OSA and controls based on blood pressure and heart rate analysis was developed.
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Affiliation(s)
- Wibke Bartels
- Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Dana Buck
- Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany; Department of Oto-Rhino-Laryngology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin 10117, Germany.
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Sforza E, Martin MS, Barthélémy JC, Roche F. Is there an association between altered baroreceptor sensitivity and obstructive sleep apnoea in the healthy elderly? ERJ Open Res 2016; 2:00072-2016. [PMID: 27957483 PMCID: PMC5140016 DOI: 10.1183/23120541.00072-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/24/2016] [Indexed: 11/05/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is associated with a rise in cardiovascular risk in which increased sympathetic activity and depressed baroreceptor reflex sensitivity (BRS) have been proposed. We examined this association in a sample of healthy elderly subjects with unrecognised OSA. 801 healthy elderly (aged ≥65 years) subjects undergoing clinical, respiratory polygraphy and vascular assessment were examined. According to the apnoea-hypopnoea index (AHI), the subjects were stratified into no OSA, mild-moderate OSA and severe OSA cases. OSA was present in 62% of the sample, 62% being mild-moderate and 38% severe. No differences were found for BRS value according to sex and OSA severity. 54% of the group had normal BRS value, 36% mild impairment and 10% severe dysfunction. BRS was negatively associated with body mass index (p=0.006), 24-h systolic (p=0.001) and diastolic pressure (p=0.001), and oxygen desaturation index (ODI) (p=0.03). Regression analyses revealed that subjects with lower BRS were those with hypertension (OR 0.41, 95% CI 0.24-0.81; p=0.002) and overweight (OR 0.42, 95% CI 0.25-0.81; p=0.008), without the effect of AHI and ODI. In the healthy elderly, the presence of a severe BRS dysfunction affects a small amount of severe cases without effect on snorers and mild OSA. Hypertension and obesity seem to play a great role in BRS impairment.
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Affiliation(s)
- Emilia Sforza
- Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France
| | - Magali Saint Martin
- Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France; Centre Hélio Marin de la Côte D'Azur, Hyeres, France
| | - Jean Claude Barthélémy
- Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France
| | - Frédéric Roche
- Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France
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Shiina K, Tomiyama H, Takata Y, Matsumoto C, Odaira M, Kato K, Yamaguchi T, Usui Y, Yamashina A. Obstructive Sleep Apnea as Possible Causal Factor for Visit-to-Visit Blood Pressure Variability. Circ J 2016; 80:1787-94. [PMID: 27301410 DOI: 10.1253/circj.cj-16-0302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies have shown that visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular disease. However, it has not been clarified whether obstructive sleep apnea (OSA) is associated with visit-to-visit BPV. METHODS AND RESULTS The 56 subjects with OSA and 26 control subjects without OSA were examined. Office BP was measured on 5 separate consecutive occasions prior to a polysomnography examination. The visit-to-visit BPV was expressed as the standard deviation and the coefficient of variation of the 5 systolic BP measurements. In subjects with an apnea-hypopnea index (AHI) of more than 20 episodes per hour, the visit-to-visit BPV was also measured after the start of continuous positive airway pressure (CPAP) therapy. Overall, the AHI positively correlated with the standard deviation and the coefficient of variation of systolic BP. In a multivariate analysis, the plasma noradrenaline level and the AHI were independently and positively correlated with the standard deviation and the coefficient of variation of the systolic BP. Among the patients who underwent CPAP therapy, good adherence with CPAP therapy significantly reduced the visit-to-visit BPV. CONCLUSIONS OSA is associated with abnormal visit-to-visit BPV and sympathetic activation seems to be related in some way. (Circ J 2016; 80: 1787-1794).
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Abstract
Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.
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Xu X, Huang H, Sethi S, Zuzuárregui JRP, Weinberg J, Hohler AD. A survey based study on sleep disturbance in postural tachycardia syndrome. J Neurol Sci 2016; 365:199-202. [PMID: 27206906 DOI: 10.1016/j.jns.2016.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/22/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postural tachycardia syndrome (POTS) is an autonomic disturbance characterized by an excessive increase in heart rate when an individual moves from a sitting to an upright position. POTS patients often complain of fatigue, daytime sleepiness and insomnia, but there is limited evidence to elucidate the mechanism or the prevalence of sleep-related symptoms in POTS, as well as the effect on patient quality of life. Here, we investigated the prevalence of sleep disturbances in POTS patients, as well as the use of medication and effects on daily life. METHODS A survey was administered to 30 patients with POTS. The survey contained 22 questions on various characteristics of sleep disturbances in POTS. Answers were recorded on a five-point Likert rating scale. RESULTS The majority of the patients reported fatigue (96.7%) and low energy (93.3%) during the day. Most (83.3%) patients reported that they do not feel well rested when waking up in the morning. More than half of the patients reported trouble falling asleep at night (63.3%) and maintaining sleep through the night (62.1%). Despite the frequent complaint of sleep disturbance, a very low percentage of POTS patient actually report seeking treatment. CONCLUSION In this study, we explored the prevalence of sleep disturbance in patients with POTS. Almost all POTS patients reported trouble with sleep and fatigue; however, there is major discrepancy between the high percentage of symptoms and small percentage of patients seeking medical assistance for better sleep quality.
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Affiliation(s)
- Xixi Xu
- Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States.
| | - Hao Huang
- Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States
| | - Sunjay Sethi
- Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States
| | - José Rafael P Zuzuárregui
- Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States
| | - Janice Weinberg
- Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, CT - 330, Boston, MA 02118, United States
| | - Anna DePold Hohler
- Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States
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Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016; 26:43-56. [DOI: 10.1016/j.smrv.2015.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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Walia HK, Griffith SD, Foldvary-Schaefer N, Thomas G, Bravo EL, Moul DE, Mehra R. Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort. Chest 2016. [PMID: 26225487 DOI: 10.1378/chest.15-0697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Clinic-based effectiveness studies of sleep-disordered breathing (SDB) treatment in reducing BP in resistant hypertension (RHTN) vs non-RHTN are sparse. We hypothesize that CPAP use in SDB reduces BP significantly in RHTN and non-RHTN in a large clinic-based cohort. METHODS Electronic medical records were reviewed in patients with SDB and comorbid RHTN and non-RHTN for CPAP therapy initiation (baseline) and subsequent visits. We estimated generalizable BP changes from multivariable mixed-effects linear models for systolic BP (SBP), diastolic BP, and mean arterial pressure, adjusting for RHTN status, age, sex, race, BMI, cardiac history, and diabetes and repeated measure correlation. RESULTS Of 894 patients, 130 (15%) had RHTN at baseline (age, 58 ± 12 years; 52% men; BMI, 36 ± 9 kg/m(2)). Patients with RHTN had significantly higher BP overall (P < .001), most notably for SBP (6.9 mm Hg; 95% CI, 3.84, 9.94). In the year following CPAP initiation, improvements in BP indexes did not generally differ based on RHTN status in which RHTN status was a fixed effect. However, there was a significant decrease in SBP (3.08 mm Hg; 95% CI, 1.79, 4.37), diastolic BP (2.28; 95% CI, 1.56, 3.00), and mean arterial pressure (2.54 mm Hg; 95% CI, 1.73, 3.36) in both groups. CONCLUSIONS In this clinic-based effectiveness study involving patients closely followed for BP control, a significant reduction of BP measures (strongest for SBP) was observed in response to CPAP which was similar in RHTN and non-RHTN groups thus informing expected clinical CPAP treatment response.
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Affiliation(s)
- Harneet K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | - Sandra D Griffith
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | | | - George Thomas
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
| | - Emmanuel L Bravo
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
| | - Douglas E Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Does experimental paradoxical sleep deprivation (EPSD) is an appropriate model for evaluation of cardiovascular complications of obstructive sleep apnea? Sleep Breath 2015; 20:787-93. [DOI: 10.1007/s11325-015-1299-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/15/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
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Huang CC, Lin WC, Chen HL, Friedman M, Lin MC, Lin HC, Lu CH. Improvement of baroreflex sensitivity in patients with obstructive sleep apnea following surgical treatment. Clin Neurophysiol 2015; 127:544-550. [PMID: 26116297 DOI: 10.1016/j.clinph.2015.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/05/2015] [Accepted: 05/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressed baroreflex sensitivity (BRS) have been reported in patients with obstructive sleep apnea (OSA). This study aimed to determine if surgery can improve the clinical outcomes by investigating changes in BRS and in other cardiovascular autonomic parameters. METHODS Eighty-one OSA patients were enrolled. They were classified as mild OSA if their apnea-hypopnea index (AHI) was 5-15, moderate OSA if their AHI was 15-30, and sever OSA if their AHI was >30. Twenty-three subjects with AHI<5 were recruited as controls. For patients who received surgery, polysomnography (PSG) and autonomic tests were evaluated upon enrollment and six-months after surgery. RESULTS The patient number for mild, moderate, and severe OSA was 22, 22, and 37, respectively. BRS on enrollment showed significant difference among the four groups, with the highest BRS in the control group, follow by the mild, moderate, and severe OSA groups. There were significant correlations between BRS and all PSG parameters. The depressed BRS significantly improved after surgery. CONCLUSIONS Surgical modifications of the upper airways can improve the depressed BRS in OSA patients. SIGNIFICANCE The study offers the promise that surgical treatment for OSA not only improves the index of PSG, but also reduces the possibility of cardiovascular risk.
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Affiliation(s)
- Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Michael Friedman
- Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, IL, USA; Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
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Blomster H, Laitinen TP, Hartikainen JE, Laitinen TM, Vanninen E, Gylling H, Sahlman J, Kokkarinen J, Randell J, Seppä J, Tuomilehto H. Mild obstructive sleep apnea does not modulate baroreflex sensitivity in adult patients. Nat Sci Sleep 2015. [PMID: 26203292 PMCID: PMC4487157 DOI: 10.2147/nss.s82443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic and progressive disease. OSA is associated with increased cardiovascular morbidity and mortality, the risk being more frequently encountered with severe degrees of OSA. Increased sympathetic activation and impaired cardiac autonomic control as reflected by depressed baroreceptor reflex sensitivity (BRS) are possible mechanisms involved in the cardiovascular complications of OSA. However, it is not known at what stage of OSA that changes in BRS appear. The aim of this study was to evaluate BRS in patients with mild OSA. METHODS The study population consisted of 81 overweight patients with mild OSA and 46 body weight-matched non-OSA subjects. BRS, apnea-hypopnea index, body mass index, and metabolic parameters were assessed. The phenylephrine test was used to measure BRS. RESULTS Patients in the OSA group were slightly but significantly older than the non-OSA population (50.3±9.3 years vs 45.7±11.1 years, P=0.02). Body mass index, percentage body fat, blood pressure, fasting glucose, insulin, and lipid levels did not differ between the OSA patients and non-OSA subjects. Absolute BRS values in patients with mild OSA and non-OSA subjects (9.97±6.70 ms/mmHg vs 10.51±7.16 ms/mmHg, P=0.67) and BRS values proportional to age-related and sex-related reference values (91.4%±22.7% vs 92.2%±21.8%, P=0.84) did not differ from each other. BRS <50% of the sex-specific reference value was found in 6% of patients with mild OSA and in 2% of non-OSA subjects (P=0.29). CONCLUSION Patients with mild OSA did not show evidence of disturbed BRS in comparison with weight-matched non-OSA controls.
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Affiliation(s)
- Henry Blomster
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Ek Hartikainen
- Department of Internal Medicine, University of Eastern Finland, Kuopio, Finland ; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esko Vanninen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Gylling
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Department of Medicine, Division of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Sahlman
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jouko Kokkarinen
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Randell
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Juha Seppä
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Henri Tuomilehto
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Oivauni Sleep Clinic, Kuopio, Finland
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Dergacheva O. Chronic intermittent hypoxia alters neurotransmission from lateral paragigantocellular nucleus to parasympathetic cardiac neurons in the brain stem. J Neurophysiol 2014; 113:380-9. [PMID: 25318765 DOI: 10.1152/jn.00302.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with sleep-related disorders, including obstructive sleep apnea (OSA), have an increased risk of cardiovascular diseases. OSA events are more severe in rapid eye movement (REM) sleep. REM sleep further increases the risk of adverse cardiovascular events by diminishing cardioprotective parasympathetic activity. The mechanisms underlying REM sleep-related reduction in parasympathetic activity likely include activation of inhibitory input to cardiac vagal neurons (CVNs) in the brain stem originating from the lateral paragigantocellular nucleus (LPGi), a nucleus that plays a role in REM sleep control. This study tests the hypothesis that chronic intermittent hypoxia and hypercapnia (CIHH), an animal model of OSA, inhibits CVNs because of exaggeration of the GABAergic pathway from the LPGi to CVNs. GABAergic neurotransmission to CVNs evoked by electrical stimulation of the LPGi was examined with whole cell patch-clamp recordings in an in vitro brain slice preparation in rats exposed to CIHH and control rats. GABAergic synaptic events were enhanced after 4-wk CIHH in both male and female rats, to a greater degree in males. Acute hypoxia and hypercapnia (H/H) reversibly diminished the LPGi-evoked GABAergic neurotransmission to CVNs. However, GABAergic synaptic events were enhanced after acute H/H in CIHH male animals. Orexin-A elicited a reversible inhibition of LPGi-evoked GABAergic currents in control animals but evoked no significant changes in CIHH male rats. In conclusion, exaggerated inhibitory neurotransmission from the LPGi to CVNs in CIHH animals would reduce cardioprotective parasympathetic activity and enhance the risk of adverse cardiovascular events.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, Washington, District of Columbia
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Dergacheva O, Dyavanapalli J, Piñol RA, Mendelowitz D. Chronic intermittent hypoxia and hypercapnia inhibit the hypothalamic paraventricular nucleus neurotransmission to parasympathetic cardiac neurons in the brain stem. Hypertension 2014; 64:597-603. [PMID: 24958501 DOI: 10.1161/hypertensionaha.114.03603] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obstructive sleep apnea is associated with chronic intermittent hypoxia/hypercapnia (CIHH) episodes during sleep that heighten sympathetic and diminish parasympathetic activity to the heart. Although one population of neurons in the paraventricular nucleus of the hypothalamus strongly influences sympathetic tone and has increased activity after CIHH, little is known about the role of this pathway to parasympathetic neurons and how this network is altered in CIHH. We hypothesized that CIHH inhibits the excitatory pathway from the paraventricular nucleus of the hypothalamus to parasympathetic cardiac vagal neurons in the brain stem. To test this hypothesis, channelrhodopsin was selectively expressed, using viral vectors, in neurons in the paraventricular nucleus of the hypothalamus and channelrhodopsin-expressing fibers were photoactivated to evoke postsynaptic currents in cardiac vagal neurons in brain stem slices. Excitatory postsynaptic currents were diminished in animals exposed to CIHH. The paired-pulse and prolonged facilitation of the postsynaptic current amplitudes and frequencies evoked by paired and bursts of photoactivation of channelrhodopsin fibers, respectively, occurred in unexposed rats but were blunted in CIHH animals. In response to an acute challenge of hypoxia/hypercapnia, the amplitude of postsynaptic events was unchanged during, but increased after hypoxia/hypercapnia in unexposed animals. In contrast, postsynaptic currents were inhibited during hypoxia/hypercapnia in rats exposed to CIHH. In conclusion, the excitatory pathway to cardiac vagal neurons is diminished in response to both acute and chronic exposures to hypoxia/hypercapnia. This could elicit a reduced cardioprotective parasympathetic activity and an enhanced risk of adverse cardiovascular events in episodes of apnea and chronic obstructive sleep apnea.
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Affiliation(s)
- Olga Dergacheva
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Jhansi Dyavanapalli
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Ramón A Piñol
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - David Mendelowitz
- From the Department of Pharmacology and Physiology, Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC.
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Parati G, Ochoa JE, Bilo G, Mattaliano P, Salvi P, Kario K, Lombardi C. Obstructive sleep apnea syndrome as a cause of resistant hypertension. Hypertens Res 2014; 37:601-13. [DOI: 10.1038/hr.2014.80] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/12/2013] [Accepted: 01/06/2014] [Indexed: 12/18/2022]
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Nocturnal snoring decreases daytime baroreceptor sensitivity. Respir Med 2014; 108:1049-55. [PMID: 24735916 DOI: 10.1016/j.rmed.2014.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/16/2014] [Accepted: 03/24/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with obstructive sleep apnea heart rate variability and baroreceptor sensitivity during night and daytime are impaired. Snoring without obstructive sleep apnea may already influence heart rate variability and baroreceptor sensitivity during daytime. METHODS Cardiovascular daytime testing was performed in 11 snorers and age, BMI, and gender matched controls. Sleep apnea and snoring were quantified by sleep recordings. Paced breathing was performed during daytime with ECG, non-invasive blood pressure, and respiration recorded. Heart rate variability and blood pressure variability were analyzed in the time and frequency domain. Baroreceptor sensitivity (alpha gain) was calculated. RESULTS In snorers a significant increase in high frequency systolic blood pressure variability (SBPV-HF) compared to control group (0.37 mm Hg(2) vs. 0.11 mm Hg(2) for 12 breaths and 0.35 mm Hg(2) vs. 0.10 mm Hg(2) for 15 breaths) was demonstrated. Furthermore a lower baroreceptor sensitivity was found in snorers compared to controls (9.2 ms/mm Hg vs. 16.2 ms/mm Hg for 12 breaths and 8.5 ms/mm Hg vs. 17.4 ms/mm Hg for 15 breaths per minute) using the paced breathing protocol. Mean heart rate was elevated in snorers as well. CONCLUSIONS Snorers may have a reduced parasympathetic tone during daytime rather than an increased sympathetic tone.
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Chan KH, Wilcox I. Obstructive sleep apnea: novel trigger and potential therapeutic target for cardiac arrhythmias. Expert Rev Cardiovasc Ther 2014; 8:981-94. [DOI: 10.1586/erc.10.80] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sleep-related changes in autonomic control in obstructive sleep apnea: a model-based perspective. Respir Physiol Neurobiol 2013; 188:267-76. [PMID: 23707878 DOI: 10.1016/j.resp.2013.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/23/2022]
Abstract
This paper reviews our current understanding of the long-term effects of obstructive sleep apnea (OSA) on cardiovascular autonomic function in humans, focusing directly on the knowledge derived from noninvasive measurements of heart rate, beat-to-beat blood pressure (BP), and respiration during wakefulness and sleep. While heart rate variability (HRV) as a means of autonomic assessment has become ubiquitous, there are serious limitations with the conventional time-domain and spectral methods of analysis. These shortcomings can be overcome with the application of a multivariate mathematical model that incorporates BP, respiration and other external factors as physiological sources of HRV. Using this approach, we have found that: (a) both respiratory-cardiac coupling and baroreflex dynamics are impaired in OSA; (b) continuous positive airway pressure therapy partially restores autonomic function; (c) baroreflex gain, which increases during sleep in normals, remains unchanged or decreases in OSA subjects; and (d) the autonomic changes that accompany transient arousal from NREM sleep in normals are largely absent in patients with OSA.
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Jurysta F, Kempenaers C, Lanquart JP, Noseda A, van de Borne P, Linkowski P. Long-term CPAP treatment partially improves the link between cardiac vagal influence and delta sleep. BMC Pulm Med 2013; 13:29. [PMID: 23628083 PMCID: PMC3685543 DOI: 10.1186/1471-2466-13-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/18/2013] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) treatment improves the risk of cardiovascular events in patients suffering from severe sleep apnea-hypopnea syndrome (SAHS) but its effect on the link between delta power band that is related to deep sleep and the relative cardiac vagal component of heart rate variability, HF(nu) of HRV, is unknown. Therefore, we tested the hypothesis that CPAP restores the link between cardiac autonomic activity and delta sleep across the night. METHODS Eight patients suffering from severe SAHS before and after 4 ± 3 years of nasal CPAP treatment were matched with fourteen healthy controls. Sleep EEG and ECG were analysed to obtain spectral sleep and HRV components. Coherence analysis was applied between HF(nu) and delta power bands across the first three sleep cycles. RESULTS Sleep characteristics and spectral HRV components were similar between untreated patients, treated patients and controls, with the exception of decreased Rapid Eye Movement duration in untreated patients. Coherence and gain values between HF(nu) and delta EEG variability were decreased in untreated patients while gain values normalized in treated patients. In patients before and during long-term CPAP treatment, phase shift and delay between modifications in HF(nu) and delta EEG variability did not differ from controls but were not different from zero. In healthy men, changes in cardiac vagal activity appeared 9 ± 7 minutes before modifications in delta sleep. CONCLUSIONS Long-term nasal CPAP restored, in severe SAHS, the information between cardiovascular and sleep brainstem structures by increasing gain, but did not improve its tightness or time shift.
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Affiliation(s)
- Fabrice Jurysta
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Chantal Kempenaers
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Jean-Pol Lanquart
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - André Noseda
- Chest Department, Erasme Academic Hospital-ULB, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology and Hypertension Clinic, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Paul Linkowski
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
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Narayan J, Amatoury J, Verma M, Kairaitis K, Wheatley JR, Amis TC. Resetting the baroreflex during snoring: role of resistive loading and intra-thoracic pressure. Respir Physiol Neurobiol 2013; 185:489-96. [PMID: 23219813 DOI: 10.1016/j.resp.2012.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 12/20/2022]
Abstract
Baroreflex sensitivity (BRS) is reduced during snoring in humans and animal models. We utilised our rabbit model to examine the contribution of increased upper airway resistance to baroreflex resetting during snoring, by comparing BRS and baroreflex operating point (OP) values during IS to those obtained during tracheostomised breathing through an external resistive load (RL) titrated to match IS levels of peak inspiratory pleural pressure (Ppl). During both IS and RL, BRS decreased by 45% and 49%. There was a linear relationship between the change in Ppl and the decrease in BRS, which was similar for IS and RL. During both RL and IS, there was a shift in OP driven by ~16% increase in HR and no change in arterial pressure. Snoring related depression of BRS is likely mediated via a HR driven change in OP, which itself may be the outcome of negative intra-thoracic pressure mediated effects on right atrial wall stretch reflex control of heart rate.
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Affiliation(s)
- Jyotishna Narayan
- Ludwig Engel Centre for Respiratory Research, Department of Respiratory and Sleep Medicine, Sydney, NSW, Australia.
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Abstract
Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.
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Affiliation(s)
- Craig L Phillips
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia ; National Health and Medical Research Council Center for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Discipline of Sleep Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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Muzumdar H, Arens R. Restoration of autonomic dysfunction in children with obstructive sleep apnea after adenotonsillectomy. Sleep 2012; 35:1311-2. [PMID: 23024424 DOI: 10.5665/sleep.2094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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