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Armentaro G, Pelaia C, Condoleo V, Severini G, Crudo G, De Marco M, Pastura CA, Tallarico V, Pezzella R, Aiello D, Miceli S, Maio R, Savarese G, Rosano GMC, Sciacqua A. Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea. Biomedicines 2024; 12:937. [PMID: 38790899 PMCID: PMC11117816 DOI: 10.3390/biomedicines12050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are the most common comorbidities in Heart Failure (HF) that are strongly associated with all-cause mortality. Several therapeutic approaches have been used to treat CSA and OSA, but none have been shown to significantly improve HF prognosis. Our study evaluated the effects of a 3-months treatment with sodium-glucose cotransporter type 2 inhibitor (SGLT2i) on polygraphic parameters in patients with sleep apnea (SA) and HF, across the spectrum of ejection fraction, not treated with continuous positive air pressure (CPAP). A group of 514 consecutive elderly outpatients with HF, type 2 diabetes mellitus (T2DM) and SA, eligible for treatment with SGLT2i, were included in the investigation before starting any CPAP therapy. The two groups were compared with the t-test and Mann-Whitney test for unpaired data when appropriate. Then, a simple logistic regression model was built using 50% reduction in AHI as the dependent variable and other variables as covariates. A multivariate stepwise logistic regression model was constructed using the variables that linked with the dependent variable to calculate the odds ratio (OR) for the independent predictors associated with the reduction of 50% in AHI. The treated group experienced significant improvements in polygraphic parameters between baseline values and follow-up with reduction in AHI (28.4 ± 12.9 e/h vs. 15.2 ± 6.5 e/h; p < 0.0001), ODI (15.4 ± 3.3 e/h vs. 11.1 ± 2.6 e/h; p < 0.0001), and TC90 (14.1 ± 4.2% vs. 8.2 ± 2.0%; p < 0.0001), while mean SpO2 improved (91. 3 ± 2.3 vs. 93.8 ± 2.5); p < 0.0001. These benefits were not seen in the untreated population. The use of SGLT2i in patients suffering from HF and mixed-type SA not on CPAP therapy significantly contributes to improving polygraphic parameters.
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Affiliation(s)
- Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Valentino Condoleo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Giandomenico Severini
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Giulia Crudo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Mario De Marco
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Carlo Alberto Pastura
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | | | - Rita Pezzella
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Domenico Aiello
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Giuseppe M. C. Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, 00166 Rome, Italy;
- Cardiology, San Raffaele Cassino Hospital, 03043 Cassino, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
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Kidawara Y, Kadoya M, Morimoto A, Daimon T, Kakutani-Hatayama M, Kosaka-Hamamoto K, Miyoshi A, Konishi K, Kusunoki Y, Shoji T, Goda A, Asakura M, Ishihara M, Koyama H. Sleep Apnea and Physical Movement During Sleep, But Not Sleep Duration, Are Independently Associated With Progression of Left Ventricular Diastolic Dysfunction: Prospective Hyogo Sleep Cardio-Autonomic Atherosclerosis Cohort Study. J Am Heart Assoc 2022; 11:e024948. [PMID: 36129028 PMCID: PMC9673706 DOI: 10.1161/jaha.121.024948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Although co‐occurrence of sleep disorder with heart failure is known, it is not clear whether that condition is a cause or consequence of heart failure. The present study was conducted as a longitudinal examination of the predictive value of sleep parameters on progression of left ventricular diastolic dysfunction. Methods and Results Four‐hundred fifty‐two subjects were followed for a mean of 34.7 months. An outcome of diastolic dysfunction was defined as increase in early inflow velocity/early diastolic tissue velocity >14. Sleep apnea‐hypopnea index, minimal oxygen saturation, sleep duration, and activity index (physical movement during sleep time, a potential parameter of poor sleep quality) were determined using apnomonitor and actigraphy findings, while heart rate variability was measured with a 24‐hour active tracer device. Sixty‐six of the patients developed diastolic dysfunction during the follow‐up period, with a median time of 25 months. Kaplan–Meier analysis results revealed that those with sleep apnea classified as moderate (apnea‐hypopnea index 15 to <30, P<0.01 versus none) or severe (apnea‐hypopnea index ≥30, P<0.01 versus none), and with a high activity index (Q3 or Q4, P<0.01 versus Q1), but not short sleep duration (P=0.27) had a significantly greater risk for a diastolic dysfunction event. Results of multivariable Cox proportional hazards regression analysis indicated that moderate to severe sleep apnea after a follow‐up period of 3 years (hazard ratio [HR], 9.26 [95% CI, 1.89–45.26], P<0.01) and high activity index (HR, 1.85 [95% CI, 1.01–3.39], P=0.04) were significantly and independently associated with future diastolic dysfunction. Moreover, significant association of high activity index with the outcome was not confounded by either minimal oxygen saturation or heart rate variability. Conclusions Sleep apnea and physical movement during sleep, but not sleep duration and autonomic nervous dysfunction, are independent important predictors for progression of left ventricular diastolic dysfunction.
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Affiliation(s)
- Yonekazu Kidawara
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Manabu Kadoya
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Akiko Morimoto
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Takashi Daimon
- Department of Biostatistics, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Miki Kakutani-Hatayama
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Kae Kosaka-Hamamoto
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Akio Miyoshi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Kosuke Konishi
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Yoshiki Kusunoki
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Takuhito Shoji
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Masanori Asakura
- Department of Cardiovascular and Renal Medicine, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine Hyogo Medical University Nishinomiya Hyogo Japan
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Respir Investig 2022; 60:3-32. [PMID: 34986992 DOI: 10.1016/j.resinv.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rho Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan; Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Japan.
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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4
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Sleep Biol Rhythms 2022; 20:5-37. [PMID: 38469064 PMCID: PMC10900032 DOI: 10.1007/s41105-021-00353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610 Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Pelaia C, Armentaro G, Miceli S, Perticone M, Toscani AF, Condoleo V, Spinali M, Cassano V, Maio R, Caroleo B, Lombardo N, Arturi F, Perticone F, Sciacqua A. Association Between Sleep Apnea and Valvular Heart Diseases. Front Med (Lausanne) 2021; 8:667522. [PMID: 34434938 PMCID: PMC8380810 DOI: 10.3389/fmed.2021.667522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Although sleep respiratory disorders are known as a relevant source of cardiovascular risk, there is a substantial lack of trials aimed to evaluate the eventual occurrence of associations between sleep apnea (SA) and valvular heart diseases (VHD). Methods: We recruited 411 patients referring to our sleep disorder unit, among which 371 had SA. Ninety-three subjects with SA also suffered from VHD. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient. Patient subgroups were comparatively evaluated through cross-sectional analysis. Results: A statistically significant increase in the prevalence of VHD was detected in relation to high apnea hypopnea index (AHI) values (p = 0.011). Obstructive sleep apnea occurrence was higher in SA patients without VHD (p < 0.0001). Conversely, central and mixed sleep apneas were more frequent among SA patients with VHD (p = 0.0003 and p = 0.002, respectively). We observed a direct correlation between AHI and BMI values (p < 0.0001), as well as between AHI and serum uric acid levels (p < 0.0001), high sensitivity C-reactive protein (p < 0.0001), and indexed left ventricular end-diastolic volume (p < 0.015), respectively. BMI and VHD resulted to be the main predictors of AHI values (p < 0.0001). Conclusions: Our study suggests that a significant association can occur between SA and VHD. It is clinically relevant that when compared to SA patients without VHD, higher frequencies of central and mixed apneas were found in subjects with SA and VHD. Moreover, after elevated BMI, VHD represented the second predictor of AHI values.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | | | - Valentino Condoleo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Martina Spinali
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Benedetto Caroleo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
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Should Multilevel Phase I Surgical Therapy be Recommended as Treatment for Moderate Obstructive Sleep Apnea due to Oropharyngeal and Hypopharyngeal Obstruction? J Oral Maxillofac Surg 2020; 78:2282-2288. [PMID: 32898482 DOI: 10.1016/j.joms.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of multilevel phase I surgery for the treatment of moderate obstructive sleep apnea (OSA) in retrognathic patients with oropharyngeal and hypopharyngeal obstruction. MATERIALS AND METHODS This was a 10-year retrospective cohort study of patients treated by a single surgeon at the Boston University Medical Center. From 2000 to 2010, retrognathic patients with moderate OSA and verified palatal and tongue base obstruction were treated with multilevel phase I surgery that included uvulopalatopharyngoplasty, hyoid suspension, and genioglossus advancement. All patients were evaluated clinically and received polysomnographic studies at three time points: preoperatively (T1), between 6 and 12 months postoperatively (T2), and a minimum of 24 months postoperatively (T3). RESULTS Twenty-five subjects composed the final study sample. At T2, 11 patients (44.0%) experienced a complete response, 13 (52.0%) experienced a partial response, and 1 (4.0%) experienced no response. Although phase I surgery was associated with significant changes in AHI (F(2,48) = 119.3; P < .01) throughout the follow-up period, only one patient at T3 (4.0%) met the criteria for a complete response. The remaining patients were divided evenly between partial response (48.0%) and treatment failure (48.0%), of whom 4 (16.0%) patients had worsening of their obstruction. Thirteen of these patients subsequently elected to undergo maxillomandibular advancement, while 11 elected to continue using continuous positive airway pressure. CONCLUSIONS Although phase I surgery was associated with AHI changes, this reduction was not sufficient to produce a long-term treatment response in over half of our patients. Treatment response was worse after 2 years than at 6 to 12 months. Patients with moderate OSA should understand that multilevel phase I surgery has a greater chance of failure than success and that transient improvements may not be durable.
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Ogilvie RP, Genuardi MV, Magnani JW, Redline S, Daviglus ML, Shah N, Kansal M, Cai J, Ramos AR, Hurwitz BE, Ponce S, Patel SR, Rodriguez CJ. Association Between Sleep Disordered Breathing and Left Ventricular Function: A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study. Circ Cardiovasc Imaging 2020; 13:e009074. [PMID: 32408831 PMCID: PMC8117672 DOI: 10.1161/circimaging.119.009074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. METHODS We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. RESULTS Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. CONCLUSIONS Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.
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Affiliation(s)
- Rachel P. Ogilvie
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Michael V. Genuardi
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Cardiology, University of Pittsburgh Medical Center
| | - Jared W. Magnani
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Cardiology, University of Pittsburgh Medical Center
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago
| | | | | | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Alberto R. Ramos
- Department of Neurology, University of Miami, Miller School of Medicine
| | - Barry E. Hurwitz
- Behavioral Medicine Research Center, University of Miami, Department of Psychology and Miller School of Medicine
| | | | - Sanjay R. Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh
| | - Carlos J. Rodriguez
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine
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Abstract
PURPOSE OF REVIEW Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. RECENT FINDINGS Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. SUMMARY Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.
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