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Khalyfa A, Marin JM, Sanz-Rubio D, Lyu Z, Joshi T, Gozal D. Multi-Omics Analysis of Circulating Exosomes in Adherent Long-Term Treated OSA Patients. Int J Mol Sci 2023; 24:16074. [PMID: 38003263 PMCID: PMC10671639 DOI: 10.3390/ijms242216074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent chronic disease affecting nearly a billion people globally and increasing the risk of multi-organ morbidity and overall mortality. However, the mechanisms underlying such adverse outcomes remain incompletely delineated. Extracellular vesicles (exosomes) are secreted by most cells, are involved in both proximal and long-distance intercellular communication, and contribute toward homeostasis under physiological conditions. A multi-omics integrative assessment of plasma-derived exosomes from adult OSA patients prior to and after 1-year adherent CPAP treatment is lacking. We conducted multi-omic integrative assessments of plasma-derived exosomes from adult OSA patients prior to and following 1-year adherent CPAP treatment to identify potential specific disease candidates. Fasting morning plasma exosomes isolated from 12 adult patients with polysomnographically-diagnosed OSA were analyzed before and after 12 months of adherent CPAP therapy (mean ≥ 6 h/night) (OSAT). Exosomes were characterized by flow cytometry, transmission electron microscopy, and nanoparticle tracking analysis. Endothelial cell barrier integrity, wound healing, and tube formation were also performed. Multi-omics analysis for exosome cargos was integrated. Exosomes derived from OSAT improved endothelial permeability and dysfunction as well as significant improvement in tube formation compared with OSA. Multi-omic approaches for OSA circulating exosomes included lipidomic, proteomic, and small RNA (miRNAs) assessments. We found 30 differentially expressed proteins (DEPs), 72 lipids (DELs), and 13 miRNAs (DEMs). We found that the cholesterol metabolism (has04979) pathway is associated with lipid classes in OSA patients. Among the 12 subjects of OSA and OSAT, seven subjects had complete comprehensive exosome cargo information including lipids, proteins, and miRNAs. Multi-omic approaches identify potential signature biomarkers in plasma exosomes that are responsive to adherent OSA treatment. These differentially expressed molecules may also play a mechanistic role in OSA-induced morbidities and their reversibility. Our data suggest that a multi-omic integrative approach might be useful in understanding how exosomes function, their origin, and their potential clinical relevance, all of which merit future exploration in the context of relevant phenotypic variance. Developing an integrated molecular classification should lead to improved diagnostic classification, risk stratification, and patient management of OSA by assigning molecular disease-specific therapies.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65211, USA;
| | - Jose M. Marin
- Translational Research Unit, Hospital Universitario Miguel Servet & IISAragon, CIBERES, 50009 Zaragoza, Spain
| | - David Sanz-Rubio
- Translational Research Unit, Hospital Universitario Miguel Servet & IISAragon, CIBERES, 50009 Zaragoza, Spain
| | - Zhen Lyu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65201, USA; (Z.L.); (T.J.)
| | - Trupti Joshi
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65201, USA; (Z.L.); (T.J.)
- Department of Health Management and Informatics, MU Institute for Data Science and Informatics and Christopher S Bond Life Science Center, University of Missouri, Columbia, MO 65211, USA
| | - David Gozal
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65211, USA;
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
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Blaszczyk B, Wieckiewicz M, Kusztal M, Michalek-Zrabkowska M, Lachowicz G, Mazur G, Martynowicz H. Fabry disease and sleep disorders: a systematic review. Front Neurol 2023; 14:1217618. [PMID: 37869133 PMCID: PMC10586315 DOI: 10.3389/fneur.2023.1217618] [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: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Fabry disease (FD) is an X-chromosome-linked disorder characterized by a reduced or complete absence of the enzyme α-galactosidase, resulting in the accumulation of lysosomal globotriaosylceramide. Despite the presence of these deposits in multiple organs, the problem of sleep disorders within this population has very rarely been documented. Objective This study aimed to investigate the types and prevalence of sleep disorders among patients with FD. Methods Screening of the following medical databases using key terms was performed on 10 February 2023: PubMed, Scopus, and Embase. A total of 136 records were identified. The quality assessment of the studies was conducted by using tools from the National Institutes of Health (NIH) and critical appraisal tools from the Joanna Briggs Institute (JBI). Results The study included nine studies on sleep disorders in patients with FD. The overall quality of the majority of these studies was assessed as either poor or fair. Among 330 patients, there was a slightly higher representation of female patients (56%). Sleep problems manifested 4-5 years after the onset of FD and sometimes even after 10-11 years. Genotypes of disease associated with sleep problems were rarely described. Within the FD population, the most commonly reported conditions were excessive daytime sleepiness (EDS) as well as obstructive and central sleep apnea (OSA, CSA). However, EDS occurred more frequently in FD patients, while the prevalence of OSA and CSA was within the ranges observed in the general population. The studies included indicated a lack of association between organ impairment by primary disease and EDS and OSA. The effectiveness of enzyme replacement therapy (ERT) in treating sleep disorders was not demonstrated. Conclusion The findings of this report revealed the presence of many sleep-related disorders within the FD population. However, very few studies on this subject are available, and their limited results make it difficult to truly assess the real extent of the prevalence of sleep disturbances among these individuals. There is a need to conduct further studies on this topic, involving a larger group of patients. It is important to note that there are no guidelines available for the treatment of sleep disorders in patients with FD.
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Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
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Leentjens M, Bosschieter PFN, Al-Terki A, de Raaff CAL, de Vries CEE, Hammad M, Thanaraj TA, Al-Khairi I, Cherian P, Channanath A, Abu-Farha M, de Vries N, Abubaker J. The association between biomarker angiopoietin-like protein five and obstructive sleep apnea in patients undergoing bariatric surgery. Sleep Breath 2023; 27:1443-1454. [PMID: 36449218 DOI: 10.1007/s11325-022-02736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is prevalent in the bariatric population. OSA should be recognized in patients undergoing bariatric surgery preoperatively to prevent peri- and post-operative complications. Lipid metabolism-related biomarkers are associated with OSA. Triglyceride metabolism is, among others, regulated by angiopoietin-like protein five (ANGPTL5). We aimed to evaluate the level of ANGPTL5 in patients with OSA of different severity levels before and after bariatric surgery. METHODS We performed a single-center prospective cohort study including a consecutive series of patients who underwent bariatric surgery. We collected the clinical data, polysomnography (PSG) or polygraphy (PG) parameters, and plasma derived via venipuncture before and 6 to 12 months after surgery. Lipid profile, glucose levels, and ANGPTL5 levels were assessed. ANGPTL5 levels were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS The study included 88 patients for analysis. The patients were divided into two subgroups: no or mild OSA (apnea-hypopnea index (AHI) < 15 events/hour, n = 57) and moderate-to-severe OSA (AHI ≥ 15 events/hour, n = 31). The ANGPTL5 level was higher in the moderate-to-severe OSA group (20.5 [15.6, 26.5] ng/mL) compared to the no or mild OSA group (16.3 [12.5, 19.4] ng/mL) (p = 0.008). A significant positive correlation was observed between ANGPTL5 and AHI (ρ = 0.256, p = 0.017), apnea index (AI) (ρ = 0.318, p = 0.003), and triglyceride levels (ρ = 0.240, p = 0.025). ANGPTL5 levels were reduced significantly after bariatric surgery in both moderate-to-severe OSA (15.6 [10.3, 18.7] ng/mL) and no or mild OSA (13.4 [9.2, 15.8] ng/mL) groups, though to a lower level in the group without or mild OSA. Post-surgery, the significant positive correlation between ANGPTL5 and AHI (ρ = 0.210, p = 0.047), AI (ρ = 0.230, p = 0.034), and triglyceride (ρ = 0.397, p < 0.001) remained. CONCLUSION The data showed increased levels of ANGPTL5 in patients with moderate-to-severe OSA. Both AHI and ANGPTL5 levels decreased significantly after bariatric surgery. We also report an association between ANGPTL5 levels and OSA severity.
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Affiliation(s)
- M Leentjens
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - P F N Bosschieter
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
| | - Abdulmohsen Al-Terki
- Department of Otolaryngology - Head & Neck Surgery, Medical Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - C A L de Raaff
- Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - C E E de Vries
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Maha Hammad
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait
| | | | - Irina Al-Khairi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait
| | - Preethi Cherian
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait
| | - Arshad Channanath
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait.
| | - N de Vries
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
- Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jehad Abubaker
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait
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Mediating Effect of Self-Cognitive Oral Health Status on the Effect of Obstructive Sleep Apnea Risk Factors on Quality of Life (HINT-8) in Middle-Aged Korean Women: The Korea National Health and Nutrition Examination Survey. Life (Basel) 2022; 12:life12101569. [PMID: 36295003 PMCID: PMC9605353 DOI: 10.3390/life12101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Obstructive sleep apnea and oral health are highly correlated with quality of life. The purpose of this study is to determine the mediating effect of self-cognitive oral health status on the effect of obstructive sleep apnea (OSA) risk factors on quality of life in middle-aged Korean women using the 2019 National Health and Nutrition Examination Survey data. Methods: A hierarchical regression analysis was performed on the mediating effect of self-cognitive oral health status on the effects of OSA risk factors on health-related quality of life (Korean health-related quality of life instrument with 8 items; HINT-8). Results: Self-cognitive oral health status as a parameter had a significant effect on quality of life (β = 0.713, p < 0.001). Compared to the effect of the OSA risk factor of the second stage on the quality of life (β = −1.329, p < 0.001), the input of the third stage of self-cognitive oral health was partially mediated (β = −1.280, p <0.001). Conclusions: Therefore, if middle-aged women have OSA risk factors, they should try to improve their quality of life by managing oral health as well as OSA treatment.
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Pan W, Xia L, Liu L, Gu L, Xiang M, Zhang H, Wei X, Yang Z, Zhou X, Li J, Zeng D, Jiang J. Increased diastolic blood pressure and apnea time contribute to the poor apnea and hypopnea index and life quality of primary snoring: a cohort study combined with external validation. Sleep Biol Rhythms 2022; 20:561-568. [PMID: 38468624 PMCID: PMC10899998 DOI: 10.1007/s41105-022-00402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
Obstructive sleep apnea hypoventilation syndrome (OSAHS) is a common sleep breathing disorder closely associated with cardiovascular disease. However, the respiratory sleep and related cardiovascular parameters on the apnea and hypopnea index (AHI) and life quality of primary snoring are unclear. We launched a cohort study focused on the association between respiratory sleep and cardiovascular-related parameters and apnea and hypopnea index, incorporating data from 218 patients with primary snoring in our medical center between Jun 1, 2015, and Apr 1, 2016. Thirty patients from Sichuan Cancer Hospital were used for validation. Patients with longer apnea time were more likely to progress to higher AHI (> 30) than controls (OR = 5.66, 95% CI = [2.79, 11.97], p < 0.001). Similarly, if patients have a higher value of diastolic blood pressure, they will also have a higher AHI (> 30) (HR [95% CI] = 3.42 [1.14, 13.65], p = 0.043). According to multivariate analysis, longest apnea time, the mean percentage of SaO2, and neckline length were independent risk factors of overall survival. A predictive model developed based on these factors above yielded a favorable agreement (C-index = 0.872) on the calibration curve. Thirty patients conducted external validation from Sichuan Cancer Hospital, displaying an AUC of 0.833 (0.782-0.884). Increased diastolic blood pressure and apnea time affect AHI level. An AHI prediction model based on these factors above can help clinicians predict the risk of high AHI events.
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Affiliation(s)
- Wenying Pan
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Lei Xia
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Lingling Liu
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Ling Gu
- Department of Medicine, Respiratory, Emergency, and Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mengqi Xiang
- Department of Medical Oncology, Sichuan Cancer Hospital, Medical School of, University of Electronic Science and Technology of China, Chengdu, China
| | - Huachuan Zhang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Medical School of, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoying Wei
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Zhenyu Yang
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Xiaoli Zhou
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Jing Li
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Daxiong Zeng
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
| | - Junhong Jiang
- Department of Medicine, Respiratory, Emergency and Intensive Care Medicine, The Affiliated Dushu Lake Hospital of Soochow University, Suzhou, 215006 China
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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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Kinkead R, Gagnon M, Joseph V, Sériès F, Ambrozio-Marques D. Stress and Loss of Ovarian Function: Novel Insights into the Origins of Sex-Based Differences in the Manifestations of Respiratory Control Disorders During Sleep. Clin Chest Med 2021; 42:391-405. [PMID: 34353446 DOI: 10.1016/j.ccm.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The respiratory system of women and men develops and functions in distinct neuroendocrine milieus. Despite differences in anatomy and neural control, homeostasis of arterial blood gases is ensured in healthy individuals regardless of sex. This convergence in function differs from the sex-based differences observed in many respiratory diseases. Sleep-disordered breathing (SDB) results mainly from episodes of upper airway closure. This complex and multifactorial respiratory disorder shows significant sexual dimorphism in its clinical manifestations and comorbidities. Guided by recent progress from basic research, this review discusses the hypothesis that stress is necessary to reveal the sexual dimorphism of SDB.
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Affiliation(s)
- Richard Kinkead
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada.
| | - Marianne Gagnon
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
| | - Vincent Joseph
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
| | - Frédéric Sériès
- Department of Medicine, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Québec, Canada
| | - Danuzia Ambrozio-Marques
- Department of Pediatrics, Université Laval, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec G1V 4G5, Canada
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Fayssoil A, De Carnavalet MCDC, Mansencal N, Lofaso F, Davido B. Cardiopulmonary Pathophysiological Aspects in the Context of COVID-19 and Obesity. ACTA ACUST UNITED AC 2021; 3:1848-1857. [PMID: 34151188 PMCID: PMC8200316 DOI: 10.1007/s42399-021-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
Obesity is a significant public health concern associated with high morbidity. Obese patients are at risk of severe COVID-19 infection, and obesity is a high-risk factor for admission to the intensive care unit. We aimed to write a narrative review of cardiac and pulmonary pathophysiological aspects of obese patients in the context of COVID-19 infection. Obesity affects lung volume, with a decrease in expiratory reserve volume, which is associated with a decrease in lung and chest wall compliance, an increase in airway resistance, and an increase in work of breathing. Obesity affects cardiac structure and hemodynamics. Obesity is a risk factor for hypertension and cardiovascular disorders. Moreover, obesity is associated with a low-grade inflammatory state, endothelial dysfunction, hyperinsulinemia, and metabolic disorders. Obesity is associated with severe COVID-19 and invasive mechanical ventilation. These previous cardiopulmonary pathological aspects may explain the clinical severity in obese patients with COVID-19. Obese patients are at risk of severe COVID-19 infection. Understanding cardiorespiratory pathophysiological aspects may help physicians manage patients in hospitals.
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Affiliation(s)
- Abdallah Fayssoil
- Service de Cardiologie, Hôpital Raymond Poincaré, APHP, Garches, France.,Service de Cardiologie, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France.,INSERM U1179, END-ICAP, Montigny-le-Bretonneux, France
| | | | - Nicolas Mansencal
- Service de Cardiologie, Centre de Référence des Cardiomyopathies et des Troubles du Rythme Cardiaque Héréditaires ou Rares, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France.,INSERM U-1018, CESP, Clinical Epidemiology, UVSQ, Villejuif, France
| | - Frederic Lofaso
- Service de Physiologie - Explorations fonctionnelles, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Benjamin Davido
- Service de maladies infectieuses, Hôpital Raymond Poincaré, APHP, AP-HP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
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Alterki A, Joseph S, Thanaraj TA, Al-Khairi I, Cherian P, Channanath A, Sriraman D, Ebrahim MAK, Ibrahim A, Tiss A, Al-Mulla F, Rahman AMA, Abubaker J, Abu-Farha M. Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery. Metabolites 2020; 10:metabo10090358. [PMID: 32882816 PMCID: PMC7569907 DOI: 10.3390/metabo10090358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with an increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. METHODS This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and five months after surgery. RESULTS The mean Apnea-Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value < 0.001). Epworth's sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value < 0.001), indicating the success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value < 0.05), whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value < 0.05) after surgery. CONCLUSION This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in an improvement of the metabolic status that was characterized by decreased TG, PCs, and Cer metabolites after surgery, indicating that the success of the surgery positively impacted the metabolic status of these patients.
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Affiliation(s)
- Abdulmohsen Alterki
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Shibu Joseph
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Thangavel Alphonse Thanaraj
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman 15462, Kuwait; (T.A.T.); (A.C.)
| | - Irina Al-Khairi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Preethi Cherian
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Arshad Channanath
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman 15462, Kuwait; (T.A.T.); (A.C.)
| | - Devarajan Sriraman
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Mahmoud A. K. Ebrahim
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Alaaeldin Ibrahim
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Ali Tiss
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Fahd Al-Mulla
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Anas M. Abdel Rahman
- Department of Genetics, King Faisal Specialist Hospital and Research Centre (KFSHRC), Zahrawi Street, Al Maather, Riyadh 11211, Saudi Arabia;
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
| | - Jehad Abubaker
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
- Correspondence: (J.A.); (M.A.-F.); Tel.: +965-2224-2999 (ext. 3563) (J.A.); +965-2224-2999 (ext. 3010) (M.A.-F.)
| | - Mohamed Abu-Farha
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
- Correspondence: (J.A.); (M.A.-F.); Tel.: +965-2224-2999 (ext. 3563) (J.A.); +965-2224-2999 (ext. 3010) (M.A.-F.)
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Khalyfa A, Castro-Grattoni AL, Gozal D. Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles. Ther Adv Respir Dis 2020; 13:1753466619895229. [PMID: 31852426 PMCID: PMC6923690 DOI: 10.1177/1753466619895229] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse
during sleep resulting in impaired blood gas exchange, namely intermittent
hypoxia (IH) and hypercapnia, fragmented sleep (SF), increased oxidative stress
and systemic inflammation. Among a myriad of potential associated morbidities,
OSA has been particularly implicated as mechanistically contributing to the
prevalence and severity of cardiovascular diseases (CVD). However, the benefits
of continuous positive airway pressure (CPAP), which is generally employed in
OSA treatment, to either prevent or improve CVD outcomes remain unconvincing,
suggesting that the pathophysiological mechanisms underlying the incremental CVD
risk associated with OSA are not clearly understood. One of the challenges in
development of non-invasive diagnostic assays is the ability to identify
clinically and mechanistically relevant biomarkers. Circulating extracellular
vesicles (EVs) and their cargos reflect underlying changes in cellular
homeostasis and can provide insights into how cells and systems cope with
physiological perturbations by virtue of the identity and abundance of miRNAs,
mRNAs, proteins, and lipids that are packaged in the EVs under normal as well as
diseased states, such as OSA. EVs can not only provide unique insights into
coordinated cellular responses at the organ or systemic level, but can also
serve as reporters of the effects of OSA in CVD, either by their properties
enabling regeneration and repair of injured vascular cells or by damaging them.
Here, we highlight recent progress in the pathological CVD consequences of OSA,
and explore the putative roles of EVs in OSA-associated CVD, along with emerging
diagnostic and therapeutic opportunities. The reviews of this paper are available via the supplemental material
section.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Anabel L Castro-Grattoni
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Department of Child Health and MU Women's and Children's Hospital, University of Missouri School of Medicine, 400 N. Keene Street, Suite 010, Columbia, MO 65201, USA
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11
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Byun JI, Shin YY, Hwang KJ, Jung Y, Shin WC. Comparison of cardiac autonomic activity between positional and nonpositional obstructive sleep apnea using heart rate variability. Sleep Med 2019; 64:101-105. [DOI: 10.1016/j.sleep.2019.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/07/2023]
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Plasm YKL-40 Levels Are Associated with Hypertension in Patients with Obstructive Sleep Apnea. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5193597. [PMID: 31001555 PMCID: PMC6436335 DOI: 10.1155/2019/5193597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/27/2018] [Accepted: 01/24/2019] [Indexed: 01/06/2023]
Abstract
Background Obstructive sleep apnea (OSA) is a common disease. It can cause many serious complications. OSA may increase the risk of hypertension. However, the exact mechanism of OSA causing hypertension is not fully understood. YKL-40/chitinase-3-like protein-1 plays an important role in vascular injury, repair, and generation. We sought to explore the role of YKL-40 in endothelial dysfunction and hypertension in OSA patients. Methods All subjects were examined by polysomnography (PSG) and the expression of YKL-40 in the plasm of the subjects was measured by luminex. Carotid intima-media thickness (CIMT) was measured by B-mode ultrasound. Results According to the conditions of OSA and hypertension, we studied four groups of 157 subjects, including OSA group (OSA, N=77), OSA with hypertension group (OSA+HT, N=37), hypertension group (HT, N=20), and healthly group (Con, N=23). YKL-40 levels were significantly elevated in OSA, OSA+HT, and HT group compared to Con groups. We used the ROC to predict the sensitivity and specificity of YKL-40 in all OSA patients or all hyperpietic patients. For OSA patients, the AUC of YKL-40 is 0.807 (95% confidence interval 0.725–0.888; p<0.01). For hyperpietic patients, the AUC of YKL-40 is 0.656 (95% confidence interval 0.570–0.742, p=0.01). There was a significant correlation between the parameter of OSA and hypertension and YKL-40 (P<0.05) and a significant correlation between Max-CIMT and YKL-40 (P<0.05). Conclusion Elevated circulating levels of YKL-40 are associated with hypertension in OSA patients. The specificity of YKL-40 suggests that it could be a potential biomarker for OSA and hypertension.
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13
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Correlation of changes in the red blood cell distribution width with the response to continuous positive airway pressure in patients with obstructive sleep apnea. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0191-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Al-Terki A, Abu-Farha M, AlKhairi I, Cherian PT, Sriraman D, Shyamsundar A, Ali S, Almulla F, Tuomilehto J, Abubaker JA. Increased Level of Angiopoietin Like Proteins 4 and 8 in People With Sleep Apnea. Front Endocrinol (Lausanne) 2018; 9:651. [PMID: 30524367 PMCID: PMC6262344 DOI: 10.3389/fendo.2018.00651] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
Objective: Obstructive sleep apnea (OSA) is a sleep disorder caused by the complete or partial obstruction of the upper airways. The worldwide prevalence of OSA is increasing due to its close association with obesity epidemic and multiple health complications, such as hypertension, cardiovascular disease, and Type 2 diabetes. Angiopoietin-like protein (ANGPTL)-4 and ANGPTL8 (betatrophin) have been suggested to play a role in the development of these diseases through their role in regulating the metabolism of plasma lipid molecules. This study was designed to evaluate ANGPTL4 and 8 levels in an OSA group and a control group to clarify the effect of OSA on ANGPTL4 and 8 levels. Methods: In total, 74 subjects were enrolled in this study, including 22 age- and body mass index (BMI)-matched controls with the Apnea Hypopnea Index (AHI) score of <5 events/h and 52 subjects with an AHI score of >5 events/h. Sleep apnea was assessed using a portable sleep test. ANGPTL4 and 8 levels were measured in plasma samples using enzyme-linked immunosorbent assay. Results: Mean AHI score (2.5 ± 1.6) in the control group was significantly lower than that in the OSA group (22.9 ± 17.9; p < 0.0001). Leptin, interleukin-(IL) 6, insulin, and HOMA-IR values were higher in the OSA group than in the control group. ANGPTL8 level was higher in the OSA group (1130.0 ± 108.61 pg/mL) than in the control group (809.39 ± 108.78 pg/mL; p = 0.041). Similarly, ANGPTL4 was higher in the OSA group (179.26 ± 12.89 ng/mL) than in the control group (142.63 ±7.99 ng/mL; p = 0.018). Conclusion: Our findings demonstrate that ANGPTL4 and 8 levels were increased in subjects with OSA, suggesting that the upregulation of these lipid metabolism regulators might play a role in lipid dysregulation observed in people with OSA.
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Affiliation(s)
- Abdulmohsen Al-Terki
- Otolaryngology, Head & Neck Surgery, Medical Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Biochemistry and Molecular Biology Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Mohamed Abu-Farha ;
| | - Irina AlKhairi
- Biochemistry and Molecular Biology Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Preethi T. Cherian
- Biochemistry and Molecular Biology Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Devarajan Sriraman
- National Dasman Diabetes Biobank, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ambika Shyamsundar
- National Dasman Diabetes Biobank, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Shamsha Ali
- Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Fahd Almulla
- Research Division, Dasman Diabetes Institute, Kuwait City, Kuwait
| | | | - Jehad A. Abubaker
- Biochemistry and Molecular Biology Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- *Correspondence: Jehad A. Abubaker
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15
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Zhang GH, Yu FC, Li Y, Wei Q, Song SS, Zhou FP, Tong JY. Prolyl 4-Hydroxylase Domain Protein 3 Overexpression Improved Obstructive Sleep Apnea-Induced Cardiac Perivascular Fibrosis Partially by Suppressing Endothelial-to-Mesenchymal Transition. J Am Heart Assoc 2017; 6:JAHA.117.006680. [PMID: 29051216 PMCID: PMC5721870 DOI: 10.1161/jaha.117.006680] [Citation(s) in RCA: 14] [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] [Indexed: 01/19/2023]
Abstract
Background Intermittent hypoxia (IH) induced by obstructive sleep apnea is the key factor involved in cardiovascular fibrosis. Under persistent hypoxia condition, endothelial cells respond by endothelial‐to‐mesenchymal transition (EndMT), which is associated with cardiovascular fibrosis. Prolyl 4‐hydroxylase domain protein 3 (PHD3) is a cellular oxygen sensor and its expression increased in hypoxia. However, its role in obstructive sleep apnea–induced EndMT and cardiovascular fibrosis is still uncertain. We investigated the potential mechanism of obstructive sleep apnea–induced cardiac perivascular fibrosis and the role of PHD3 in it. Methods and Results In vivo, C56BL/6 mice were exposed to IH for 12 weeks. PHD3 expression was changed by lentivirus‐mediated short‐hairpin PHD3 and lentivirus carrying PHD3 cDNA. EndMT related protein levels, histological and functional parameters were detected after 12 weeks. In vitro, human umbilical vein endothelial cells were treated with IH/short‐hairpin PHD3/lentivirus carrying PHD3 cDNA to explore the mechanism of PHD3 in altered function of human umbilical vein endothelial cells. We found that chronic intermittent hypoxia increase PHD3 expression and EndMT. In vivo, IH accelerate cardiac dysfunction and aggravate collagen deposition via the process of EndMT. And, when PHD3 were overexpressed, cardiac dysfunction and collagen excessive deposition were improved. In vitro, IH induced EndMT, which endow human umbilical vein endothelial cells spindle morphology and an enhanced ability to migration and collagen secretion. PHD3 overexpression in cultured human umbilical vein endothelial cells ameliorated IH–induced EndMT through inactivating hypoxia‐inducible factor 1 alpha and small mothers against decapentaplegic 2 and 3. Conclusions Obstructive sleep apnea–induced cardiac perivascular fibrosis is associated with EndMT, and PHD3 overexpression might be beneficial in the prevention of it by inhibiting EndMT. PHD3 overexpression might have therapeutic potential in the treatment of the disease.
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Affiliation(s)
- Guang-Hao Zhang
- Southeast University, Nanjing, Jiangsu, China.,Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Fu-Chao Yu
- Southeast University, Nanjing, Jiangsu, China.,Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Yang Li
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Qin Wei
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Song-Song Song
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Fang-Ping Zhou
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Jia-Yi Tong
- Southeast University, Nanjing, Jiangsu, China .,Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
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16
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Wang L, Chen J, Li G, Luo S, Wang R, Li W, Zhang J, Liu Y, Huang W, Cao Y, Zhou Y, Chen P, Pressman GS, Somers VK, Luo J. The Prevalence of Sleep Apnea in Type B Aortic Dissection: Implications for False Lumen Thrombosis. Sleep 2017; 40:3052719. [PMID: 28364434 DOI: 10.1093/sleep/zsw071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) has been implicated in aortic dissection. Thrombosis of the false lumen is associated with a prognosis of type B aortic dissection (AoD), and partial thrombosis has been reported to be an independent predictor of mortality. This study sought to explore whether the severity of OSA is associated with false lumen thrombosis. Aims and Methods In this observational study, 151 type B AoD patients were recruited consecutively from 2013 to 2015. The status of the false lumen was classified as patent, partially thrombosed, or completely thrombosed based on a computer tomography angiography image. Patients were divided into non-OSA group (apnea-hypopnea index [AHI] < 5), and mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), and severe OSA groups (AHI > 30) using the AHI. Results The prevalence of OSA in type B dissection was 66.2%. Among 151 cases, 51 patients (33.8%) were in the non-OSA group, 56 (37.1%) were in the mild group, 21 (13.9%) were in the moderate group, and 23 (15.2%) were in the severe group. Additionally, a partially thrombosed false lumen was observed in 88 patients (58.3%). Multivariable analysis revealed that OSA severity was positively associated with partial thrombosis (odds ratio, 1.784, 95% confidence interval: 1.182-2.691, P = .006) after adjusting for other confounding factors. Conclusions OSA was present in two-thirds of patients with type B AoD. The severity of OSA was significantly associated with an increased risk of partial false lumen thrombosis. OSA may therefore be implicated in both the etiology and prognosis of AoD.
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Affiliation(s)
- Ling Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guangxi Li
- Department of Respiratory, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rui Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiawei Zhang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuan Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhui Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingshu Cao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.,Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingyan Chen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.,Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Gregg S Pressman
- Division of Cardiology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Virend K Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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17
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Roubille F, Fischer K, Guensch DP, Tardif JC, Friedrich MG. Impact of hyperventilation and apnea on myocardial oxygenation in patients with obstructive sleep apnea – An oxygenation-sensitive CMR study. J Cardiol 2017; 69:489-494. [DOI: 10.1016/j.jjcc.2016.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/06/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
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18
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Matsuzawa Y, Suleiman M, Guddeti RR, Kwon TG, Monahan KH, Lerman LO, Friedman PA, Lerman A. Age-Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation. J Am Heart Assoc 2016; 5:JAHA.115.003183. [PMID: 27613771 PMCID: PMC5079006 DOI: 10.1161/jaha.115.003183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The mechanisms of atrial fibrillation (AF) are highly divergent. The prevalence of AF increases significantly with age, and underling mechanisms might vary with age. Endothelial dysfunction may be associated with AF and atrial arrhythmia recurrence after catheter ablation. We tested the hypothesis that the impact of endothelial dysfunction on arrhythmia recurrence following catheter ablation is age dependent. Methods and Results This study enrolled 92 participants with AF undergoing catheter ablation. Endothelial function was assessed by peripheral arterial tonometry before ablation, and the natural logarithmic transformation of reactive hyperemia index was calculated. Endothelial dysfunction was defined as a natural logarithmic transformation of reactive hyperemia index <0.618 (median). Participants were followed for atrial tachycardia, flutter, and fibrillation recurrence for a median of 14 months. The mean age was 57±10 years. There was significant interaction between age and endothelial dysfunction in association with recurrence of AF (P=0.029) and any atrial arrhythmia (P=0.015), and the risk associated with endothelial dysfunction for arrhythmia recurrence was higher in younger versus older participants. Participants were divided into 2 age groups at a threshold of 60 years. Among participants aged ≤60 years, multivariate Cox proportional hazards analysis revealed the independent association between endothelial dysfunction and increased risk of arrhythmia recurrence (hazard ratio for AF 4.18 [95% CI 1.33–15.82], P=0.014, and for any atrial arrhythmia 3.62 [95% CI 1.29–11.81], P=0.014). Kaplan–Meier analysis showed that participants with endothelial dysfunction had significantly higher rates of recurrence of AF (P=0.01) and any atrial arrhythmia (P=0.002). Conclusions The risk associated with endothelial dysfunction for arrhythmia recurrence following catheter ablation was age dependent and was higher in younger participants.
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Affiliation(s)
| | | | | | - Taek-Geun Kwon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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19
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Roles and Mechanisms of Obstructive Sleep Apnea-Hypopnea Syndrome and Chronic Intermittent Hypoxia in Atherosclerosis: Evidence and Prospective. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:8215082. [PMID: 27293515 PMCID: PMC4884866 DOI: 10.1155/2016/8215082] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 12/13/2022]
Abstract
The morbidity and mortality of obstructive sleep apnea-hypopnea syndrome (OSAHS) are regarded as consequences of its adverse effects on the cardiovascular system. Chronic intermittent hypoxia (CIH) induced by OSAHS can result in vascular endothelial injury, thus promoting development of atherosclerosis (AS). Studies have shown that CIH is an independent risk factor for the occurrence and development of AS, but the underlying mechanism remains unclear. Here, we review clinical and fundamental studies reported during the last 10 years on the occurrence and development of AS mediated by CIH, focusing on inflammation, oxidative stress, insulin resistance, cell apoptosis, vascular endothelial injury, platelet activation, and neuroendocrine disorders. This review will offer current evidence and perspective to researchers for the development of effective intervention strategies for OSAHS-related cardiocerebrovascular diseases.
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Quintero M, Olea E, Conde SV, Obeso A, Gallego-Martin T, Gonzalez C, Monserrat JM, Gómez-Niño A, Yubero S, Agapito T. Age protects from harmful effects produced by chronic intermittent hypoxia. J Physiol 2016; 594:1773-90. [PMID: 26752660 DOI: 10.1113/jp270878] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 01/06/2016] [Indexed: 12/23/2022] Open
Abstract
Obstructive sleep apnoea (OSA) affects an estimated 3–7% of the adult population, the frequency doubling at ages >60–65 years. As it evolves, OSA becomes frequently associated with cardiovascular, metabolic and neuropsychiatric pathologies defining OSA syndrome (OSAS). Exposing experimental animals to chronic intermittent hypoxia (CIH) can be used as a model of the recurrent hypoxic and O2 desaturation patterns observed in OSA patients. CIH is an important OSA event triggering associated pathologies; CIH induces carotid body (CB)-driven exaggerated sympathetic tone and overproduction of reactive oxygen species, related to the pathogenic mechanisms of associated pathologies observed in OSAS. Aiming to discover why OSAS is clinically less conspicuous in aged patients, the present study compares CIH effects in young (3–4 months) and aged (22–24 months) rats. To define potential distinctive patterns of these pathogenic mechanisms, mean arterial blood pressure as the final CIH outcome was measured. In young rats, CIH augmented CB sensory responses to hypoxia, decreased hypoxic ventilation and augmented sympathetic activity (plasma catecholamine levels and renal artery content and synthesis rate). An increased brainstem integration of CB sensory input as a trigger of sympathetic activity is suggested. CIH also caused an oxidative status decreasing aconitase/fumarase ratio and superoxide dismutase activity. In aged animals, CIH minimally affected CB responses, ventilation and sympathetic-related parameters leaving redox status unaltered. In young animals, CIH caused hypertension and in aged animals, whose baseline blood pressure was augmented, CIH did not augment it further. Plausible mechanisms of the differences and potential significance of these findings for the diagnosis and therapy of OSAS are discussed.
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Affiliation(s)
- M Quintero
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - E Olea
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - S V Conde
- Chronic Diseases Research Center (CEDOC), Nova Medical School, Faculdade de Ciências Médicas, University of Nova Lisboa, Lisbon, Portugal
| | - A Obeso
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - T Gallego-Martin
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - C Gonzalez
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Monserrat
- Laboratori de la Son, Pneumologia, Hospital Clínic-IDIBAPS, Barcelona, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - A Gómez-Niño
- Department of Cell Biology, Histology and Pharmacology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - S Yubero
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - T Agapito
- Department of Biochemistry and Molecular Biology and Physiology, School of Medicine, University of Valladolid and IBGM/CSIC, Valladolid, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Cuspidi C, Sala C, Rescaldani M, Tadic M, Grassi G. Effects of bariatric surgery on right ventricular structure and function. J Cardiovasc Med (Hagerstown) 2015; 15:731-7. [PMID: 24979120 DOI: 10.2459/jcm.0000000000000142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Left ventricular (LV) changes associated with obesity, including LV hypertrophy and impaired LV function, have been shown to be reverted by bariatric surgery. Little is known about the effects of bariatric procedures on right ventricle (RV). We analyzed the literature in order to provide a comprehensive information on RV structural and functional changes, as assessed by imaging techniques, after bariatric surgery. METHODS AND RESULTS The studies were identified by the following search terms: 'bariatric surgery', 'obesity', 'left ventricle', 'right ventricle', 'left ventricular hypertrophy', 'right ventricular hypertrophy', 'cardiac hypertrophy', 'ventricular dysfunction', 'echocardiography', 'magnetic resonance imaging' and 'cardiac imaging techniques'.In a pooled population of 537 obese patients with preserved systolic function enrolled in eight studies, bariatric surgery induced beneficial effects on RV morphology and function; the procedures reverted obesity-related right ventricular hypertrophy as suggested by a significant decrease in RV mass, and improved systolic and diastolic RV performance as assessed by traditional and newer echocardiographic indexes. Decrements in body mass index and improvement in obstructive sleep apnea were major factors independently related to the improved RV structure and function. CONCLUSION The present review shows that bariatric surgery exerts beneficial effects on RV structure and function in morbidly obese patients. As RV changes are independent predictors of outcomes, improvement of RV structure and function may contribute to the cardioprotective effects of bariatric surgery.
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Affiliation(s)
- Cesare Cuspidi
- aDepartment of Health Science, University of Milano-Bicocca bIstituto Auxologico Italiano cDepartment of Clinical Sciences and Community Health, University of Milano and Fondazione Policlinico di Milano, Milan, Italy dUniversity Clinical Hospital Centre 'Dragisa Misovic', Belgrade, Serbia eIstituto di Ricerche a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy
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Sharples L, Glover M, Clutterbuck-James A, Bennett M, Jordan J, Chadwick R, Pittman M, East C, Cameron M, Davies M, Oscroft N, Smith I, Morrell M, Fox-Rushby J, Quinnell T. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. Health Technol Assess 2015; 18:1-296. [PMID: 25359435 DOI: 10.3310/hta18670] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. META-ANALYSIS A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p < 0.001); CPAP -25.4/hour (p < 0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p < 0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p < 0.001); CPAP 1.6 (p < 0.001)]. LONG-TERM COST-EFFECTIVENESS An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) £6687/QALY]. From a willingness to pay (WTP) of £15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p = 0.48) and CPAP (p = 0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP £20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became £44,066. The ICER for SP1 compared with CM was £1552, and for bMAD compared with CM the ICER was £13,836. The ICER for CPAP compared with SP1 was £89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2. CONCLUSIONS Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates. TRIAL REGISTRATION This trial is registered as ISRCTN02309506. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Sharples
- University of Leeds Clinical Trials Research Unit, Leeds, UK
| | - Matthew Glover
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | | | - Maxine Bennett
- Medical Research Council Biostatistics Unit, Cambridge, UK
| | - Jake Jordan
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | - Rebecca Chadwick
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Marcus Pittman
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Clare East
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Malcolm Cameron
- Maxillofacial Unit, Addenbrooke's NHS Foundation Trust, Cambridge, UK
| | - Mike Davies
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Nick Oscroft
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Ian Smith
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Mary Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Timothy Quinnell
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
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Jiang Y, Tian JP, Wang H, Chen BX, Du FH. Diagnostic value of combined parameters derived from ambulatory electrocardiography for detecting coronary artery disease in non-active chest pain patients. Pak J Med Sci 2015; 30:1331-5. [PMID: 25674134 PMCID: PMC4320726 DOI: 10.12669/pjms.306.5176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 01/10/2023] Open
Abstract
Background and Objective: The diagnostic value of ST-segment deviation detected by ambulatory electrocardiography (AECG) is controversial in identifying coronary artery disease (CAD) referred for coronary angiography (CAG). Recently, many parameters which evaluate CAD can be derived from AECG. Therefore, we aimed to investigate the diagnostic value of AECG in screening CAD referred for CAG when several parameters were combined. Methods: We studied the 104 chest pain inpatients. All patients received the CAG and AECG. A lumen diameter reduction of ≥ 50% was considered CAD according to CAG. The parameters derived from AECG included ST-segment deviation, apnea hypopnea index (AHI), QT interval dispersion (QTd) and heart rate variability (HRV). The diagnostic value of AECG in screening CAD was evaluated. Results: Of the 104 patients, 57 (54.8%) had CAD according to CAG. The sensitivity of ST-segment deviation in screening CAD was 64.9%; the specificity was 89.4%; and the Kappa value was 0.528. The sensitivity of at least three combined parameters including ST-segment deviation, AHI, QTd and HRV was 89.5%; the specificity was 87.2%; and the Kappa value was 0.767. Conclusion: AECG is very useful in screening CAD referred for CAG, especially while several parameters including ST-segment deviation, AHI, HRV and QTd are combined.
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Affiliation(s)
- Yue Jiang
- Yue Jiang, Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ping Tian
- Jun-Ping Tian, Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Hong Wang
- Hong Wang, Department of Endocrinology, Aerospace Central Hospital, Beijing, China
| | - Bu-Xing Chen
- Bu-Xing Chen, Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Feng-He Du
- Feng-He Du, Department of Cardiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Obstructive Sleep Apnea Syndrome: A Risk Factor for Stanford's Type B Aortic Dissection. Ann Vasc Surg 2014; 28:1901-8. [DOI: 10.1016/j.avsg.2014.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 04/19/2014] [Accepted: 07/17/2014] [Indexed: 01/23/2023]
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Brass SD, Li CS, Auerbach S. The underdiagnosis of sleep disorders in patients with multiple sclerosis. J Clin Sleep Med 2014; 10:1025-31. [PMID: 25142763 PMCID: PMC4153120 DOI: 10.5664/jcsm.4044] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES To report at a population level the prevalence of restless legs syndrome, insomnia, and the risk of obstructive sleep apnea in multiple sclerosis patients. Sleep patterns and associations with fatigue and daytime sleepiness were identified. METHODS A cross-sectional study was performed using a written survey that was mailed to 11,400 individuals from the Northern California Chapter of the National Multiple Sclerosis (MS) Society Database who self-identified as having MS. The survey included individual questions relating to demographics as well as several standard validated questionnaires related to primary sleep disorders, sleepiness, fatigue severity, and sleep patterns. RESULTS Among the 11,400 surveys mailed out, 2,810 (24.6%) were returned. Of these, 2,375 (84.5%) met the inclusion criteria. Among the completed surveys, 898 (37.8%) screened positive for obstructive sleep apnea, 746 (31.6%) for moderate to severe insomnia, and 866 (36.8%) for restless legs syndrome. In contrast, only 4%, 11%, and 12% of the cohort reported being diagnosed by a health care provider with obstructive sleep apnea, insomnia, and restless legs syndrome, respectively. Excessive daytime sleepiness was noted in 30% of respondents based on the Epworth Sleepiness Scale. More than 60% of the respondents reported an abnormal level of fatigue based on the Fatigue Severity Scale. Both abnormal fatigue and sleepiness scores were associated with screening positive for obstructive sleep apnea, insomnia, and restless legs syndrome. CONCLUSION A significant percentage of MS subjects in our sample screened positive for one or more sleep disorders. The vast majority of these sleep disorders were undiagnosed. Greater attention to sleep problems in this population is warranted, especially in view of fatigue being the most common and disabling symptom of MS.
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Affiliation(s)
- Steven D. Brass
- Department of Neurology, University of California Davis, School of Medicine, Sacramento, CA
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, CA
| | - Sanford Auerbach
- Department of Neurology, Boston University, School of Medicine; Boston, MA
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Fournier S, Gulemetova R, Joseph V, Kinkead R. Testosterone potentiates the hypoxic ventilatory response of adult male rats subjected to neonatal stress. Exp Physiol 2014; 99:824-34. [DOI: 10.1113/expphysiol.2013.077073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sébastien Fournier
- Department of Pediatrics; Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
| | - Roumiana Gulemetova
- Department of Pediatrics; Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
| | - Vincent Joseph
- Department of Pediatrics; Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
| | - Richard Kinkead
- Department of Pediatrics; Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
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Sun Y, Yuan H, Zhao MQ, Wang Y, Xia M, Li YZ. Cardiac structural and functional changes in old elderly patients with obstructive sleep apnoea-hypopnoea syndrome. J Int Med Res 2014; 42:395-404. [PMID: 24445697 DOI: 10.1177/0300060513502890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate cardiac structural changes in elderly patients with obstructive sleep apnoea-hypopnoea syndrome (OSAHS) and the impact on left ventricular systolic and diastolic function. METHODS The study enrolled elderly patients with OSAHS and age-matched healthy control subjects. Cardiac structure, left ventricular diastolic function and left ventricular systolic function were measured using a Doppler ultrasound scanner and compared between the two groups. RESULTS The study included 136 patients with OSAHS and 50 healthy control subjects. There were significant differences in the echocardiography indicators that reflect cardiac structure, including interventricular septum, left ventricle posterior wall thickness, and left ventricular mass and mass index between the two groups. There were significant differences between the two groups in the ventricular septal early diastolic myocardial peak velocity/late diastolic myocardial peak velocity (Em/Am), mitral annulus Em/Am, and left ventricle posterior wall Em/Am. There were also significant differences in the indicators of interventricular septum, mitral annulus and left ventricular posterior wall systolic peak velocity between the two groups. CONCLUSION Elderly patients with OSAHS demonstrated cardiac structural changes and their left ventricular diastolic and systolic functions were significantly diminished.
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Affiliation(s)
- Yi Sun
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
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Abstract
PURPOSE OF REVIEW An inconsistent link between sleep-disordered breathing (SDB) and allergic rhinitis has been reported in the literature for decades. This review attempts to highlight some of the recent epidemiological studies purporting and refuting this connection, discuss possible mechanisms for this relationship and discuss how treatment of allergic rhinitis can help ameliorate SDB. RECENT FINDINGS Recently, a large systematic review that included 18 studies and 27 000 individuals of the association between allergic rhinitis and SDB in children was published supporting a correlation between SDB and allergic rhinitis. SUMMARY Although the evidence generally supports a connection between SDB and allergic rhinitis, this connection is not definitive and the mechanism linking these two diseases remains poorly understood. In addition to epidemiological studies, several small studies have demonstrated an improvement in SDB upon treatment of allergic rhinitis; however, large studies using objective measures to quantify SDB and allergic rhinitis are needed.
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Xie X, Pan L, Ren D, Du C, Guo Y. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med 2013; 14:1139-50. [PMID: 24054505 DOI: 10.1016/j.sleep.2013.07.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 06/03/2013] [Accepted: 07/03/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Our meta-analysis was performed to estimate the effect of continuous positive airway pressure (CPAP) therapy on systemic inflammation in patients with obstructive sleep apnea (OSA). METHODS A comprehensive literature search of PubMed and EMBASE was performed for literature published up to January 2013. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-CPAP therapy. RESULTS A total of 35 studies involving 1985 OSA patients were included in the meta-analysis. Each study investigated one or more inflammatory markers: 24 studies on C-reactive protein (CRP), 16 studies on IL-6, 3 studies on IL-8, and 12 studies on tumor necrosis factor α (TNF-α). The results showed that the SMD (95% confidence interval [CI]) for CRP, IL-6, IL-8, and TNF-α were 0.452 (95% CI, 0.252-0.651), 0.299 (95% CI, 0.001-0.596), 0.645 (95% CI, 0.362-0.929), and 0.478 (95% CI, 0.219-0.736) in pre- and post-CPAP therapy, respectively. The subgroup analyses seemed to support better benefits with therapy duration of ≥3 months and more adequate compliance (≥4 h/night). CONCLUSIONS CPAP therapy could partially suppress systemic inflammation in OSA patients, and substantial differences were present among the various inflammatory markers.
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Affiliation(s)
- XiaoMei Xie
- Department of Radiotherapy, Xuzhou Central Hospital, Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
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The treg/th17 imbalance in patients with obstructive sleep apnoea syndrome. Mediators Inflamm 2012; 2012:815308. [PMID: 23345934 PMCID: PMC3549368 DOI: 10.1155/2012/815308] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/10/2012] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a chronic inflammatory disease regulated by T lymphocytes. Our purpose is to assess the pattern of Th17 cells and CD4+CD25+Foxp3+ regulatory T (Treg) cells in peripheral blood of patients with OSAS. Fourty-four OSAS men and 20 healthy volunteers were enrolled. Twenty-three patients were classified into mild to moderate group and 21 cases were classified into severe group according to the severity of OSAS. We detected the frequencies of Th17 and Treg and related serum cytokines secretion and expressions of key transcription factors. OSAS patients revealed significant increase in peripheral Th17 number, Th17-related cytokines (IL-17 and IL-6), and RORγt mRNA levels. They also presented a significant decrease in Treg number, Treg-related cytokines (TGF-β1), and Foxp3 mRNA levels as compared with normal persons. As a result, the Th17/Treg ratios were markedly more upregulated in OSAS patients than those in control group. Furthermore, the Th17/Treg ratio was positively related to the severity of OSAS and serum levels of C-reactive protein. The development of OSAS may be associated with peripheral Th17/Treg imbalance and characterized by a proinflammatory cytokine microenvironment. These results opened an alternative explanation for the substantial activation of immune cells in OSAS and the development of related complications.
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Cook ZC, Gray MA, Cann MJ. Elevated carbon dioxide blunts mammalian cAMP signaling dependent on inositol 1,4,5-triphosphate receptor-mediated Ca2+ release. J Biol Chem 2012; 287:26291-301. [PMID: 22654111 PMCID: PMC3406713 DOI: 10.1074/jbc.m112.349191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/15/2012] [Indexed: 12/11/2022] Open
Abstract
Elevated CO(2) is generally detrimental to animal cells, suggesting an interaction with core processes in cell biology. We demonstrate that elevated CO(2) blunts G protein-activated cAMP signaling. The effect of CO(2) is independent of changes in intracellular and extracellular pH, independent of the mechanism used to activate the cAMP signaling pathway, and is independent of cell context. A combination of pharmacological and genetic tools demonstrated that the effect of elevated CO(2) on cAMP levels required the activity of the IP(3) receptor. Consistent with these findings, CO(2) caused an increase in steady state cytoplasmic Ca(2+) concentrations not observed in the absence of the IP(3) receptor or under nonspecific acidotic conditions. We examined the well characterized cAMP-dependent inhibition of the isoform 3 Na(+)/H(+) antiporter (NHE3) to demonstrate a functional relevance for CO(2)-mediated reductions in cellular cAMP. Consistent with the cellular biochemistry, elevated CO(2) abrogated the inhibitory effect of cAMP on NHE3 function via an IP(3) receptor-dependent mechanism.
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Affiliation(s)
- Zara C. Cook
- From the School of Biological and Biomedical Sciences and
- Biophysical Sciences Institute, Durham University, South Road, Durham DH1 3LE, United Kingdom and
| | - Michael A. Gray
- Institute for Cell and Molecular Biosciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Martin J. Cann
- From the School of Biological and Biomedical Sciences and
- Biophysical Sciences Institute, Durham University, South Road, Durham DH1 3LE, United Kingdom and
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Kostapanos MS, Elisaf MS, Mikhailidis DP. Obstructive sleep apnea and cardiovascular risk: is metabolic syndrome the link? Angiology 2012; 63:569-73. [PMID: 22323837 DOI: 10.1177/0003319711436077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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