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Kasai T, Kohno T, Shimizu W, Ando S, Joho S, Osada N, Kato M, Kario K, Shiina K, Tamura A, Yoshihisa A, Fukumoto Y, Takata Y, Yamauchi M, Shiota S, Chiba S, Terada J, Tonogi M, Suzuki K, Adachi T, Iwasaki Y, Naruse Y, Suda S, Misaka T, Tomita Y, Naito R, Goda A, Tokunou T, Sata M, Minamino T, Ide T, Chin K, Hagiwara N, Momomura S. JCS 2023 Guideline on Diagnosis and Treatment of Sleep Disordered Breathing in Cardiovascular Disease. Circ J 2024; 88:1865-1935. [PMID: 39183026 DOI: 10.1253/circj.cj-23-0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- Takatoshi Kasai
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Shinichi Ando
- Sleep Medicine Center, Fukuokaken Saiseikai Futsukaichi Hospital
| | - Shuji Joho
- Second Department of Internal Medicine, University of Toyama
| | - Naohiko Osada
- Department of Cardiology, St. Marianna University School of Medicine
| | - Masahiko Kato
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | | | | | - Akiomi Yoshihisa
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | | | - Motoo Yamauchi
- Department of Clinical Pathophysiology of Nursing and Department of Respiratory Medicine, Nara Medical University
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Jiro Terada
- Department of Respiratory Medicine, Japanese Red Cross Narita Hospital
| | - Morio Tonogi
- 1st Depertment of Oral & Maxillofacial Surgery, Nihon Univercity School of Dentistry
| | | | - Taro Adachi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine
| | - Tomofumi Misaka
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine
| | - Tomotake Tokunou
- Division of Cardiology, Department of Medicine, Fukuoka Dental College
| | - Makoto Sata
- Department of Pulmonology and Infectious Diseases, National Cerebral and Cardiovascular Center
| | | | - Tomomi Ide
- Faculty of Medical Sciences, Kyushu University
| | - Kazuo Chin
- Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Nobuhisa Hagiwara
- YUMINO Medical Corporation
- Department of Cardiology, Tokyo Women's Medical University
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Shiina K. Obstructive sleep apnea -related hypertension: a review of the literature and clinical management strategy. Hypertens Res 2024:10.1038/s41440-024-01852-y. [PMID: 39210083 DOI: 10.1038/s41440-024-01852-y] [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: 03/07/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Obstructive Sleep Apnea (OSA) and hypertension have a high rate of co-occurrence, with OSA being a causative factor for hypertension. Sympathetic activity due to intermittent hypoxia and/or fragmented sleep is the most important mechanisms triggering the elevation in blood pressure in OSA. OSA-related hypertension is characterized by resistant hypertension, nocturnal hypertension, abnormal blood pressure variability, and vascular remodeling. In particular, the prevalence of OSA is high in patients with resistant hypertension, and the mechanism proposed includes vascular remodeling due to the exacerbation of arterial stiffness by OSA. Continuous positive airway pressure therapy is effective at lowering blood pressure, however, the magnitude of the decrease in blood pressure is relatively modest, therefore, patients often need to also take antihypertensive medications to achieve optimal blood pressure control. Antihypertensive medications targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in OSA-related hypertension, Therefore, beta-blockers and renin-angiotensin system inhibitors may be effective in the management of OSA-related hypertension, but current evidence is limited. The characteristics of OSA-related hypertension, such as nocturnal hypertension and obesity-related hypertension, suggests potential for angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucose-dependent insulinotropic polypeptide receptor/ glucagon-like peptide-1 receptor agonist (GIP/GLP-1 RA). Recently, OSA has been considered to be caused not only by upper airway anatomy but also by several non-anatomic mechanisms, such as responsiveness of the upper airway response, ventilatory control instability, and reduced sleep arousal threshold. Elucidating the phenotypic mechanisms of OSA may potentially advance more personalized hypertension treatment strategies in the future. Clinical characteristics and management strategy of OSA-related hypertension. OSA obstructive sleep apnea, BP blood pressure, ABPM ambulatory blood pressure monitoring, CPAP continuous positive airway pressure, LVH left ventricular hypertrophy, ARB: angiotensin II receptor blocker, SGLT2i Sodium-glucose cotransporter 2 inhibitors, ARNI angiotensin receptor-neprilysin inhibitor, CCB calcium channel blocker, GIP/GLP-1 RA glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide-1 receptor agonist.
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Affiliation(s)
- Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
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Cichelero FT, Fuchs SC, Jorge JA, Martinez D, Oliveira GPF, Lucca MB, Oliveira ACT, Fuchs FD. Effect of antihypertensive agents on sleep apnea and ambulatory blood pressure in patients with hypertension: A randomized controlled trial. Sleep Med 2024; 119:417-423. [PMID: 38781664 DOI: 10.1016/j.sleep.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and hypertension are common conditions that may be linked through sympathetic activation and water retention. We hypothesized that diuretics, which reduce the body water content, may be more effective than amlodipine, a blood pressure (BP)-lowering agent implicated with edema, in controlling OSA in patients with hypertension. We also aimed to compare the effects of these treatments on ambulatory blood pressure monitoring (ABPM). METHODS In a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10-40 apneas/hour of sleep) and BP within the systolic range of 140-159 mmHg or diastolic range of 90-99 mmHg. RESULTS The individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference. CONCLUSION Chlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT01896661.
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Affiliation(s)
- Fabio T Cichelero
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; School of Medicine, Universidade Luterana do Brasil, Canoas, RS, Brazil
| | - Sandra C Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliano A Jorge
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denis Martinez
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Georgia P F Oliveira
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcelo B Lucca
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Claudia T Oliveira
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio D Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Huang WC, Liu FH, Cheng HM, Tsai YC, Huang YT, Lai TS, Lin YH, Wu VC, Kao HL, Jia-Yin Hou C, Wu KD, Chen ST, Er LK. Who needs to be screened for primary aldosteronism? J Formos Med Assoc 2024; 123 Suppl 2:S82-S90. [PMID: 37633770 DOI: 10.1016/j.jfma.2023.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
The prevalence of patients with primary aldosteronism (PA) is about 5%-15% in hypertensive patients, and it is common cause of secondary hypertension in clinical practice. Two major causes of PA are noted, namely bilateral adrenal hyperplasia and aldosterone-producing adenoma, and the general diagnosis is based on three steps: (1) screening, (2) confirmatory testing, and (3) subtype differentiation (Figure 1). The recommendation for screening patients is at an increased risk of PA, here we focus on which patients should be screened for PA, not only according to well-established guidelines but for potential patients with PA. We recommend screening for 1) patients with resistant or persistent hypertension, 2) hypertensive patients with hypokalemia (spontaneous or drug-induced), 3) young hypertensive patients (age <40 years), and 4) all hypertensive patients with a history of PA in first-degree relatives. Moreover, we suggest screening for 1) hypertensive patients themselves or first-degree relatives with early target organ damage, such as stroke and other diseases, 2) all hypertensive patients with a concurrent adrenal incidentaloma, 3) hypertensive patients with obstructive sleep apnea, 4) hypertensive patients with atrial fibrillation unexplained by structural heart defects and/or other conditions resulting in the arrhythmia, 5) hypertensive patients with anxiety and other psychosomatic symptoms, and 6) hypertensive patients without other comorbidities to maintain cost-effectiveness.
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Affiliation(s)
- Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hao-Min Cheng
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taiwan
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical, Taiwan; University Hospital, Kaohsiung University Hospital, Kaohsiung, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Kwan-Dun Wu
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Leay Kiaw Er
- The Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan.
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Park S, Shin J, Ihm SH, Kim KI, Kim HL, Kim HC, Lee EM, Lee JH, Ahn SY, Cho EJ, Kim JH, Kang HT, Lee HY, Lee S, Kim W, Park JM. Resistant hypertension: consensus document from the Korean society of hypertension. Clin Hypertens 2023; 29:30. [PMID: 37908019 PMCID: PMC10619268 DOI: 10.1186/s40885-023-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital327 Sosa-Ro, Wonmi-guGyunggi-do, Bucheon-si, 14647, Republic of Korea.
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunki Lee
- Hallym University, Dongtan Hospital, Gyeonggi-do, Korea
| | - Woohyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
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Svedmyr S, Hedner J, Bailly S, Fanfulla F, Hein H, Lombardi C, Ludka O, Mihaicuta S, Parati G, Pataka A, Schiza S, Tasbakan S, Testelmans D, Zou D, Grote L. Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead109. [PMID: 38035035 PMCID: PMC10686603 DOI: 10.1093/ehjopen/oead109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023]
Abstract
Aims We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). Methods and results Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea-hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin-angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders. Conclusion In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.
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Affiliation(s)
- Sven Svedmyr
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Sebastien Bailly
- Université Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | - Francesco Fanfulla
- Unità Operativa di Medicina del Sonno, Istituto Scientifico di Pavia IRCCS, Pavia, Italy
| | - Holger Hein
- Sleep Disorders Center, St.Adolf Stift, Reinbeck, Germany
| | - Carolina Lombardi
- Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ondrej Ludka
- Department of Internal Medicine, University Hospital Brno, Brno, Czech Republic
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine and Pharmacy, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
| | - Gianfranco Parati
- Cardiology Unit, Sleep Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessalonikii, Thessalonikii, Greece
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete, Crete, Greece
| | - Sezai Tasbakan
- Department of Chest Diseases, Ege University, Izmir, Turkey
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ding Zou
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Medicinaregatan 8B, Box 421, 405 30 Gothenburg, Sweden
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Bradicich M, Siciliano M, Donfrancesco F, Cherneva R, Ferraz B, Testelmans D, Sánchez-de-la-Torre M, Randerath W, Schiza S, Cruz J. Sleep and Breathing Conference highlights 2023: a summary by ERS Assembly 4. Breathe (Sheff) 2023; 19:230168. [PMID: 38020339 PMCID: PMC10644110 DOI: 10.1183/20734735.0168-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
This paper presents some of the highlights of the Sleep and Breathing Conference 2023 https://bit.ly/46MxJml.
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Affiliation(s)
- Matteo Bradicich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Matteo Siciliano
- Università Cattolica del Sacro Cuore, Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- These authors contributed equally
| | - Federico Donfrancesco
- Università Cattolica del Sacro Cuore, Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- These authors contributed equally
| | - Radostina Cherneva
- Medical University, University Hospital “Ivan Rilski”, Respiratory Intensive Care Unit, Sofia, Bulgaria
- These authors contributed equally
| | - Beatriz Ferraz
- Pulmonology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- These authors contributed equally
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- These authors contributed equally
| | - Manuel Sánchez-de-la-Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Winfried Randerath
- Institute of Pneumology, University Cologne, Bethanien Hospital, Solingen, Germany
- These authors contributed equally
| | - Sophia Schiza
- Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- These authors contributed equally
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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Cistulli PA, Malhotra A, Cole KV, Malik AS, Pépin JL, Sert Kuniyoshi FH, Benjafield AV, Somers VK. Positive Airway Pressure Therapy Adherence and Health Care Resource Use in Patients With Obstructive Sleep Apnea and Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2023:e028733. [PMID: 37421282 PMCID: PMC10382094 DOI: 10.1161/jaha.122.028733] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/04/2023] [Indexed: 07/10/2023]
Abstract
Background Obstructive sleep apnea (OSA) is common in heart failure with preserved ejection fraction (HFpEF). However, current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in HFpEF. This study assessed the association between adherence to PAP therapy and health care resource use in patients with OSA and HFpEF. Methods and Results Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to determine associations between PAP adherence and a composite outcome including hospitalizations and emergency room visits. One-year PAP adherence was based on an adapted US Medicare definition. Propensity score methods were used to create groups with similar characteristics across PAP adherence levels. The study cohort included 4237 patients (54.0% female, mean age 64.1 years); 40% were considered adherent to PAP therapy (30% intermediate adherent, 30% nonadherent). In the matched cohort, PAP-adherent patients had fewer health care resource use visits than nonadherent patients, a 57% decrease in hospitalizations, and a 36% decrease in emergency room visits versus the year before PAP initiation. Total health care costs were lower in adherent patients than nonadherent patients ($12 732 versus $15 610, P<0.001). Outcomes for intermediately adherent patients were most similar to those for nonadherent patients. Conclusions Treating OSA with PAP therapy in patients with HFpEF was associated with a reduction in health care resource use. These data highlight the importance of managing concomitant OSA in patients with HFpEF, and the need for strategies to enhance PAP adherence in this population.
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Affiliation(s)
- Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Australia
- Department of Respiratory and Sleep Medicine Royal North Shore Hospital Sydney Australia
| | | | | | | | - Jean-Louis Pépin
- Institut National de la Santé et de la Recherche Médicale (INSERM) U 1300, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University Grenoble France
| | - Fatima H Sert Kuniyoshi
- ResMed Science Center San Diego CA USA
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | | | - Virend K Somers
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
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9
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Perger E, Bertoli S, Lombardi C. Pharmacotherapy for obstructive sleep apnea: targeting specific pathophysiological traits. Expert Rev Respir Med 2023; 17:663-673. [PMID: 37646222 DOI: 10.1080/17476348.2023.2241353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The pathophysiology of obstructive sleep apnea (OSA) is multi-factorial and complex. Varying OSA's pathophysiological traits have been identified, including pharyngeal collapsibility, upper airway muscle reactivity, arousal threshold, and regulation of the ventilatory drive. Being CPAP of difficult tolerance and other interventions reserved to specific subpopulations new pharmacological treatments for OSA might be resolutive. AREAS COVERED Several existing and newly developed pharmacological drugs can impact one or more endotypes and could therefore be proposed as treatment options for sleep disordered breathing. With this review we will explore different pathophysiological traits as new targets for OSA therapy. This review will summarize the most promising pharmacological treatment for OSA accordingly with their mechanisms of action on upper airway collapsibility, muscle responsiveness, arousal threshold, and loop gain. EXPERT OPINION Only understanding the pathophysiological traits causing OSA in each patient and placing the disease in the framework of patient comorbidities, we will be able to evolve interventions toward OSA. The development of new drug's combinations will permit different approaches and different choices beside conventional treatments. In the next future, we hope that sleep specialists will select the treatment for a specific patient on the base of its pathophysiology, defining a precision medicine for OSA.
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Affiliation(s)
- Elisa Perger
- Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Simona Bertoli
- Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Lab of Nutrition and Obesity Research, Istituto Auxologico Italiano, IRCCS, Milan, Carolina
| | - Carolina Lombardi
- Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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10
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Jorge JA, Foppa M, Santos ABS, Cichelero FT, Martinez D, Lucca MB, de Oliveira GPF, Fuchs FD, Fuchs SC. Effects of Antihypertensive Treatment on Left and Right Ventricular Global Longitudinal Strain and Diastolic Parameters in Patients with Hypertension and Obstructive Sleep Apnea: Randomized Clinical Trial of Chlorthalidone plus Amiloride vs. Amlodipine. J Clin Med 2023; 12:jcm12113785. [PMID: 37297980 DOI: 10.3390/jcm12113785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Hypertension is highly prevalent in patients with obstructive sleep apnea (OSA), and fluid retention with its nighttime rostral distribution is one potential mechanism. We tested whether or not diuretics differ from amlodipine in their impact on echocardiographic parameters. Patients with moderate OSA and hypertension were randomized to receive diuretics (chlorthalidone plus amiloride) or amlodipine daily for 8 weeks. We compared their effects on left and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively), on LV diastolic parameters, and on LV remodeling. In the 55 participants who had echocardiographic images feasible for strain analysis, all echocardiographic parameters were within normal ranges. After 8 weeks, the 24 h blood pressure (BP) reduction values were similar, while most echocardiographic metrics were kept unchanged, except for LV-GLS and LV mass. In conclusion, the use of diuretics or amlodipine had small and similar effects on echocardiographic parameters in patients with moderate OSA and hypertension, suggesting that they do not have important effects on mediating the interaction between OSA and hypertension.
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Affiliation(s)
- Juliano A Jorge
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Murilo Foppa
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Angela B S Santos
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Fábio T Cichelero
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Denis Martinez
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Marcelo B Lucca
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Geórgia P F de Oliveira
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Flávio D Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Sandra C Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
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11
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Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep 2023; 15:375-388. [PMID: 37220427 PMCID: PMC10200107 DOI: 10.2147/nss.s340946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Sleep is involved in many physiological processes and is essential for both physical and mental health. Obesity and sleep deprivation due to sleep disorders are major public health issues. Their incidence is increasing, and they have a wide range of adverse health-related consequences, including life-threatening cardiovascular disease. The impact of sleep on obesity and body composition is well-known, and many studies have shown an association between insufficient or excessive sleep duration and obesity, body fat percentage, and weight gain. However, there is growing evidence of the effects of body composition on sleep and sleep disorders (particularly sleep disordered breathing) through anatomical and physiological mechanisms (nocturnal fluid shift, core body temperature, or diet). Although some research has been conducted on the bidirectional effects of sleep-disordered breathing and body composition, the specific effects of obesity and body composition on sleep and the underlying mechanisms that explain these effects remain unclear. Therefore, this review summarizes the findings on the effects of body composition on sleep and draws conclusions and proposals for future research in this field.
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Affiliation(s)
- Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eri Kitamura
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
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12
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Svedmyr S, Hedner J, Bonsignore MR, Lombardi C, Parati G, Ludka O, Zou D, Grote L. Hypertension treatment in patients with sleep apnea from the European Sleep Apnea Database (ESADA) cohort - towards precision medicine. J Sleep Res 2022:e13811. [PMID: 36539972 DOI: 10.1111/jsr.13811] [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: 09/14/2022] [Revised: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.
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Affiliation(s)
- Sven Svedmyr
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ondrej Ludka
- Department of Internal, Geriatrics and Practical Medicine, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Ding Zou
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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13
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Zeng Z, Yang Y, Zhang Y, Wu X, Chen W, Gu D. Effect of antihypertensive medications on sleep status in hypertensive patients. Sleep Biol Rhythms 2022; 20:473-480. [PMID: 38468617 PMCID: PMC10899994 DOI: 10.1007/s41105-022-00391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose Antihypertensive medication is an effective way to control blood pressure. However, some studies reported that it may affect patients' sleep quality during the treatment. Due to the inconsistency of present results, a comprehensive systematic review and network meta-analysis are needed. Methods Electronic databases (MEDLINE, EMBASE, WEB OF SCIENCE, PUBMED) were searched up to April 10th, 2021 including no restriction of publication status. Randomized controlled trials (RCTs) or quasi-experimental studies or cohort studies were eligible. The network meta-analysis was used within a Bayesian framework. Results Finally, 16 publications (including 12 RCTs and 4 quasi-experimental studies) with 404 subjects were included in this study. Compared to placebo, the results of the network meta-analysis showed that diuretics were effective in improving sleep apnea with a mean difference (MD) of - 15.47 (95% confidence interval [CI]: - 23.56, - 6.59) which was consistent with the direct comparison result (MD: - 17.91; 95% CI - 21.60, - 14.23). In addition, diuretics were effective in increasing nocturnal oxygen saturation with an MD of 3.64 (95% CI 0.07, 7.46). However, the effects of β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and the others on sleep apnea were not statistically significant. Additionally, the effects of antihypertensive medication on the total sleep time (min), rapid eye movement (%), and sleep efficiency (%) were not statistically significant. Conclusion Our study found that diuretics could effectively reduce the severity of sleep apnea in hypertensive patients. However, the effects of antihypertensive drugs on sleep characteristics were not found. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00391-8.
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Affiliation(s)
- Ziqian Zeng
- First Affiliated Hospital, Army Medical University, Chongqing, 400038 China
| | - Yanan Yang
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan China
| | - Yuewen Zhang
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan China
| | - Xiuming Wu
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan China
| | - Weizhong Chen
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu, Sichuan China
| | - Dongqing Gu
- First Affiliated Hospital, Army Medical University, Chongqing, 400038 China
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Abstract
Despite extensive research, there is currently no approved drug for obstructive sleep apnea (OSA) treatment. OSA is a heterogeneous condition that involves multiple dominating pathophysiological traits. Drug development in this field needs to address both pathophysiological mechanisms and associated comorbid conditions in order to meet requirements for long-term therapy in OSA. Several drug candidates have been proposed and ongoing phase II trials that target various forms of sleep-disordered breathing have been initiated. The field is moving toward tailored therapeutic approaches in patients with OSA.
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15
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Brown J, Yazdi F, Jodari-Karimi M, Owen JG, Reisin E. Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship. Curr Hypertens Rep 2022; 24:173-184. [PMID: 35246797 PMCID: PMC8897114 DOI: 10.1007/s11906-022-01181-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 01/04/2023]
Abstract
Purpose of Review Obstructive sleep apnea (OSA) is an underdiagnosed illness linked to essential hypertension (HTN), resistant hypertension (r-HTN), and cardiovascular disease (CVD). This review provides updates on the epidemiology, pathophysiology, and treatments of OSA-associated HTN. Recent Findings Mild sleep apnea increases the risk for HTN. Eighty-nine percent of young patients aged 18–35 with HTN not attributed to secondary causes have underlying OSA. Home sleep studies are noninferior to formal polysomnography for OSA diagnosis. Nocturnal oxygen desaturation rate is positively correlated with HTN severity. Gut microbiome neo-colonization in response to high-fat diet cravings in patients with OSA alters immune function and worsens HTN. Carbonic anhydrase inhibitors and probiotics show newfound potential for OSA-associated HTN treatment. OSA recognition improves hospital outcomes after a STEMI. Hypoxia-inducible factor (HIF) transcription increases in a dose-dependent manner to hypoxia, and HIFs are strongly linked to cancer growth. Summary OSA and HTN are comorbid conditions with adversely connected pathophysiology including sympathetic hyperactivity, gut dysbiosis, proinflammation, endothelial damage, rostral fluid shifts, pharyngeal collapse, intravascular fluid retention, nocturnal energy expenditure, and metabolic derangements. The dose–response effect of OSA on HTN severity challenges blood pressure (BP) control, so those with refractory HTN should be screened for OSA.
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Affiliation(s)
- John Brown
- School of Medicine, Louisiana State University Health Sciences Center, Gravier Street, New Orleans, LA, 70112, USA
| | - Farshid Yazdi
- Section of Nephrology, Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Mona Jodari-Karimi
- School of Medicine, Louisiana State University Health Sciences Center, Gravier Street, New Orleans, LA, 70112, USA
| | - Jonathan G Owen
- Section of Nephrology, Department of Medicine, University of New Mexico School of Medicine, 2211 Lomas Blvd NE, Albuquerque, NM, 87131, USA
| | - Efrain Reisin
- Section of Nephrology, Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
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16
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Zhang CJ, Li H, Xiong YZ, Chang Y, Yang F, Ma XL, Wang XT, Shimosawa T, Ji ES, Xu QY. Chronic intermittent hypoxia induces renal fibrosis through MR activation. Exp Gerontol 2022; 163:111780. [DOI: 10.1016/j.exger.2022.111780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
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17
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Cao X, de Oliveira Francisco C, Bradley TD, Montazeri Ghahjaverestan N, Tarlo SM, Stanbrook MB, Chapman KR, Inman M, Yadollahi A. Association of Obstructive Apnea with Thoracic Fluid Shift and Small Airways Narrowing in Asthma During Sleep. Nat Sci Sleep 2022; 14:891-899. [PMID: 35573055 PMCID: PMC9091700 DOI: 10.2147/nss.s359021] [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] [Received: 01/19/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) is highly prevalent among patients with asthma, suggesting a pathophysiological link between the two, but a mechanism for this has not been identified. HYPOTHESIS Among patients with asthma, those with OSA will have greater overnight increases in thoracic fluid volume and small airways narrowing than those without OSA. METHODS We enrolled 19 participants with asthma: 9 with OSA (apnea-hypopnea index (AHI) ≥10) and 10 without OSA (AHI <10). All participants underwent overnight polysomnography. Before and after sleep, thoracic fluid volume was measured by bioelectrical impedance and small airways narrowing was primarily assessed by respiratory system reactance at 5Hz using oscillometry. RESULTS Patients with asthma and OSA (OSA group) had a greater overnight increase in thoracic fluid volume by 120.5 mL than patients without OSA (non-OSA group) (164.4 ± 44.0 vs 43.9 ± 47.3 mL, p=0.006). Compared to the non-OSA group, the OSA group had greater overnight decrease in reactance at 5Hz (-1.08 ± 0.75 vs 0.21 ± 0.27 cmH2O/L/s, p=0.02), and overnight increase in reactance area (14.81 ± 11.09 vs -1.20 ± 2.46 cmH2O/L, p=0.04), frequency dependence of resistance (1.02 ± 0.68 vs 0.05 ± 0.18 cmH2O/L/s, p=0.04), and resonance frequency (2.80 ± 4.14 vs -1.42 ± 2.13 cmH2O/L/s, p=0.04). CONCLUSION Patients with asthma and co-existing OSA had greater overnight accumulation of fluid in the thorax in association with greater small airways narrowing than those without OSA. This suggests OSA could contribute to worsening of asthma at night by increasing fluid accumulation in the thorax.
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Affiliation(s)
- Xiaoshu Cao
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | | | - T Douglas Bradley
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network Toronto General Hospital, Toronto, ON, Canada
| | - Nasim Montazeri Ghahjaverestan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Susan M Tarlo
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network Toronto Western Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew B Stanbrook
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network Toronto Western Hospital, Toronto, ON, Canada
| | - Kenneth R Chapman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network Toronto Western Hospital, Toronto, ON, Canada
| | - Mark Inman
- Faculty of Medicine (Respirology), McMaster University, Hamilton, ON, Canada
| | - Azadeh Yadollahi
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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18
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Pépin JL, Eastwood P, Eckert DJ. Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care. Eur Respir J 2021; 59:13993003.01788-2021. [PMID: 34824053 DOI: 10.1183/13993003.01788-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/16/2021] [Indexed: 11/05/2022]
Abstract
Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, "one size fits all", trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France .,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Peter Eastwood
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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19
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Tung NT, Lee YL, Lin SY, Wu CD, Dung HB, Thuy TPC, Kuan YC, Tsai CY, Lo CC, Lo K, Ho KF, Liu WT, Chuang HC. Associations of ambient air pollution with overnight changes in body composition and sleep-related parameters. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 791:148265. [PMID: 34119796 DOI: 10.1016/j.scitotenv.2021.148265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
This study aims to investigate the association of air pollution with overnight change in 4body composition and sleep-related parameters. Body composition of 197 subjects in New Taipei city was measured before and after sleep by bioelectric impedance analysis. Air pollutant data were collected from Taiwan Environmental Protection Administration. Sleep parameters were examined by polysomnography. We observed fine particulate matter (PM2.5) decreased arterial oxygen saturation (SaO2) and increased apnea-hypopnea index (AHI); NO2 increased arousal, AHI, and decreased mean SaO2; and O3 inmcreased mean SaO2. We observed 0.99-μg/m3 increase in PM2.5 was associated with 18.8% increase in changes of right arm fat percentage (95% confidence interval (CI): 0.004, 0.375) and 0.011-kg increase in changes of right arm fat mass (95% CI: 0.000, 0.021). 2.45-ppb increase in NO2 was associated with 0.181-kg decrease in changes of muscle mass (95% CI: -0.147, -0.001), 0.192-kg decrease in changes of fat free mass (95% CI: -0.155, -0.001), 21.1% increase in changes of right leg fat percentage (95% CI: 0.012, 0.160), and 21.3% increase in changes of left leg fat percentage (95% CI: 0.006, 0.168). 1.56-ppb increase in O3 was associated with 29.3% decrease in changes of right leg fat percentage (95% CI: -0.363, -0.013), 0.058-kg increase in changes of right leg fat free mass (95% CI: 0.008, 0.066), and 0.059-kg increase in changes of right leg muscle mass (95% CI: 0.010, 0.066). We observed AHI was associated with overnight changes in fat percentage, total fat mass, muscle mass, bone mass, fat free mass, extracellular water, basal metabolic rate, leg fat percentage, leg fat mass, and trunk fat percentage (p < 0.05). In conclusion, exposure to air pollutants was associated with overnight body composition changes and sleep-related parameters. Nocturnal changes in total muscle mass and leg fat percentage likely contribute to the relationship between air pollution and obstructive sleep apnea.
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Affiliation(s)
- Nguyen Thanh Tung
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Otorhinolaryngology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shang-Yang Lin
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
| | - Hoang Ba Dung
- Otorhinolaryngology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Tran Phan Chung Thuy
- Otorhinolaryngology Department, Faculty of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Yi-Chun Kuan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Chen-Chen Lo
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang Lo
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kin-Fai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Wen-Te Liu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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20
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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21
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Abstract
Rationale: Excessive sodium may have a role in the pathogenesis of obstructive sleep apnea (OSA) for patients with hypervolemic conditions, but it is unclear whether this is valid for all patients with OSA, including those with no significant comorbidities.Objectives: To test the association of urinary sodium and OSA in a large sample of participants from the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto-Brasil) Study. In addition, we stratified the analysis participants according to the presence of hypertension.Methods: In this cross-sectional study, OSA was defined by an apnea-hypopnea index ≥15 events/h. A validated 12-hour urine collection as representative of the 24-hour period was obtained from all participants to measure sodium excretion. We performed a logistic regression analysis to test the association of urinary sodium excretion with OSA (dependent variable) adjusting for age, sex, race and income, glomerular filtration rate, diabetes, physical activity, and antihypertensive classes related to sodium excretion. To address potential residual factors that may influence sodium excretion, we performed additional analysis replacing sodium excretion for salt intake (food frequency questionnaire) using the same models.Results: We studied 1,946 participants (age 49 ± 8 yr; 43.4% men). A third of them had OSA. Compared with those with no OSA, participants with OSA presented with higher sodium excretion (1.66 [1.19-2.29] vs. 1.99 [1.44-2.69] g/12 h; P < 0.001). After adjustments for confounding factors, we found no overall significant associations of sodium excretion with OSA (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.97-1.23; P = 0.150). Regardless of the OSA status, the sodium excretion was higher in hypertensive than in normotensive participants (1.93 [1.35-2.64] vs. 1.71 [1.22-2.37] g/12 h). An independent association of sodium excretion with OSA was observed in patients with hypertension only (OR, 1.326; 95% CI, 1.067-1.648; P = 0.011), but the interaction of urinary sodium with hypertension was not significant (P = 0.37). The analysis of salt intake revealed consistent findings.Conclusions: The potential role of sodium in the pathogenesis of OSA seems to be modest and limited for those with higher salt intake and, consequently, higher fluid retention such as observed in patients with hypertension.
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Schütz SG, Dunn A, Braley TJ, Pitt B, Shelgikar AV. New frontiers in pharmacologic obstructive sleep apnea treatment: A narrative review. Sleep Med Rev 2021; 57:101473. [PMID: 33853035 DOI: 10.1016/j.smrv.2021.101473] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing characterized by intermittent partial or complete closure of the upper airway during sleep. If left untreated, OSA is associated with adverse cardiovascular outcomes such as hypertension, coronary heart disease, heart failure, cardiac arrhythmia, stroke, and death. Positive airway pressure (PAP) is often considered the first-line treatment for OSA. While PAP can be very effective in reducing the number of obstructive apneas and hypopneas, its impact on prevention of adverse cardiovascular consequences remains controversial, and treatment adherence is often poor. Hence, the necessity for novel treatment options to help those who cannot adhere to positive airway pressure treatment. Different classes of medications have been tested with regards to their effect on OSA severity. This review 1) provides an update on the epidemiology and pathophysiology of OSA, 2) outlines the mechanistic rationale for medication classes tested as OSA treatment and 3) discusses the effects of these medications on OSA. Several wake-promoting medications are approved for management of persistent sleepiness despite OSA treatment; discussion of these symptomatic treatments is outside the scope of this review. Herein, the authors review the current evidence for pharmacological management of OSA and provide future directions.
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Affiliation(s)
- Sonja G Schütz
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA.
| | - Abbey Dunn
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA
| | - Tiffany J Braley
- Department of Neurology Multiple Sclerosis and Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA
| | - Bertram Pitt
- Department of Internal Medicine Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Anita V Shelgikar
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA
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Torres-Castro R, Vasconcello-Castillo L, Puppo H, Cabrera-Aguilera I, Otto-Yáñez M, Rosales-Fuentes J, Vilaró J. Effects of Exercise in Patients with Obstructive Sleep Apnoea. Clocks Sleep 2021; 3:227-235. [PMID: 33802403 PMCID: PMC7931110 DOI: 10.3390/clockssleep3010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.
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Affiliation(s)
- Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
- Correspondence: ; Tel.: +56-229-786-513
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | - Homero Puppo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | | | - Matías Otto-Yáñez
- Kinesiology School, Universidad Autónoma de Chile, Santiago 7500912, Chile;
| | - Javiera Rosales-Fuentes
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380453, Chile; (L.V.-C.); (H.P.); (J.R.-F.)
| | - Jordi Vilaró
- Grupo de Investigación Global Research on Wellbeing (GRoW), Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, 08025 Barcelona, Spain;
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Affiliation(s)
- Takatoshi Kasai
- Department of Cardiovascular Medicine and
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; and
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Zoccali C, Roumeliotis S, Mallamaci F. Sleep Apnea as a Cardiorenal Risk Factor in CKD and Renal Transplant Patients. Blood Purif 2021; 50:642-648. [PMID: 33588408 DOI: 10.1159/000513424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a public health priority of increasing concern worldwide. Sleep apnea (SA) of moderate-to-severe degree has a 3-9% prevalence in women and 10-17% in men in the general population. SUMMARY In CKD patients, the prevalence of SA parallels the decline of the GFR being 27% in CKD patients with a GFR of >60 mL/min/1.73 m2 and 57% in patients with end-stage kidney disease (ESKD). In the early CKD stages, fluid overload is probably the sole risk factor for SA in this population. At more severe CKD stages, disturbed central and peripheral chemosensitivity and the accumulation of uremic toxins might contribute to SA. Still, there is no direct evidence supporting this hypothesis in human studies. Observational studies coherently show that SA is a risk factor for CKD incidence and CKD progression as well as for cardiovascular disease and death in this population. However, there is no randomized clinical trial testing continuous positive airway pressure or other interventions documenting that attenuation of SA may have a favorable effect on renal and cardiovascular outcomes in CKD and ESKD patients. However, most likely, the causal nature of the association between SA and cardiorenal outcomes remains unproven. Renal transplantation is the most effective treatment of SA in patients with ESKD, but this disturbance re-emerges on long-term observation in this population. However, after renal transplantation, SA does not seem to be a predictor of adverse health outcomes.
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Affiliation(s)
- Carmine Zoccali
- CNR-IFC, Clinical Epidemiology of Renal Disease and Hypertension, Reggio Cal, Italy,
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Disease and Hypertension, Reggio Cal, Italy.,Nephrology, Dialysis and Renal Transplantation Unit, Grande Ospedale Metropolitano di Reggio Cal, Reggio Cal, Italy
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26
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Wang Y, Li CX, Lin YN, Zhang LY, Li SQ, Zhang L, Yan YR, Lu FY, Li N, Li QY. The Role of Aldosterone in OSA and OSA-Related Hypertension. Front Endocrinol (Lausanne) 2021; 12:801689. [PMID: 35095768 PMCID: PMC8791261 DOI: 10.3389/fendo.2021.801689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023] Open
Abstract
Obstructive sleep apnea (OSA) is regarded as an independent risk factor for hypertension. The possible mechanism includes oxidative stress, endothelial injury, sympathetic excitement, renin-angiotensin-aldosterone system activation, etc. Clinical studies have found that there is a high coexistence of OSA and primary aldosteronism in patients with hypertension and that elevated aldosterone levels are independently associated with OSA severity in resistant hypertension. The underlying mechanism is that aldosterone excess can exacerbate OSA through increasing overnight fluid shift and affecting the mass and function of upper airway muscles during the sleep period. Thus, a bidirectional influence between OSA and aldosterone exists and contributes to hypertension in OSA patients, especially resistant hypertension.
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Affiliation(s)
- Yi Wang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Chuan Xiang Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Tongren Hospital Affiliated to Wuhan University, The Third Hospital of Wuhan, Wuhan, China
| | - Ying Ni Lin
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Li Yue Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Shi Qi Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Liu Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Ya Ru Yan
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Fang Ying Lu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Ning Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
| | - Qing Yun Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai, China
- *Correspondence: Qing Yun Li,
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Abstract
AIMS Arterial hypertension is highly prevalent and difficult to control in patients with obstructive sleep apnea (OSA). High sympathoadrenergic activity is a hallmark physiological phenomenon in OSA. We hypothesized that an antihypertensive drug with inhibitory properties on this activity, such as beta blockers (BBs), may be particularly efficacious in OSA patients. METHODS Hypertensive OSA patients receiving blood pressure-lowing treatment in the European Sleep Apnea Database (ESADA) (n = 5818, 69% men, age 58 ± 11 years, body mass index 33 ± 7 kg/m2, apnea hypopnea index 34 ± 26 events/h) were analyzed. Reported medications [BB, diuretic, renin-angiotensin blocker (RAB), calcium channel blocker (CCB), and centrally acting antihypertensive (CAH)] were classified according to ATC code. Office blood pressure was compared in patients with monotherapy or combination therapy controlling for confounders. RESULTS Poorly controlled SBP according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 (95% CI 1.4-3.0), 3.0 (1.9-4.1) and 3.0 (1.7-4.7) mmHg higher SBP compared with those on BB (adjusted model, P = 0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, SBP was 5.5 (4.0-7.1), 5.1 (3.7-6.6), 4.3 (2.5-6.1) and 3.1 (1.6-4.6) mmHg higher in those on CCB/RAB, BB/RAB, BB/CCB or diuretic/RAB compared with those on BB/diuretic (adjusted model, P < 0.001, <0.001, 0.018 and 0.036, respectively). CONCLUSION Poorly controlled blood pressure was common in OSA patients with antihypertensive medication. Treatment with BB alone or BB in combination with a diuretic was associated with the lowest systolic pressure in this large clinical cohort.
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Tserenpil G, Gebre M, Zergham AS, Sekhon AK, Malik BH. Managements for Obstructive Sleep Apnea in Adults: Review. Cureus 2020; 12:e9905. [PMID: 32968568 PMCID: PMC7505527 DOI: 10.7759/cureus.9905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent obstruction of the pharyngeal airway during sleep, with resultant hypoxia and sleep fragmentation. It is more common in middle-aged obese men and prevalence is higher in most obese people. However, prevalence is high in African-Americans. OSA is associated with major comorbidities including excessive daytime sleepiness and increased risk of cardiovascular diseases. First and foremost, OSA management starts from educating patients about short-term consequences like motor vehicle accidents, behavioral modifications, long term consequences like cardiopulmonary disease, and resistant high blood pressure. Various types of management options are available for OSA such as weight loss, CPAP, oral appliances, and surgery. The review aims to explain the pathophysiology and cause of the obstruction of the airway in order to choose proper management carefully to decrease the symptoms and cure the disease.
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Affiliation(s)
- Gantuya Tserenpil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meklit Gebre
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azka Shahid Zergham
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amanpreet Kaur Sekhon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Sleep disturbances: one of the culprits of obesity-related cardiovascular risk? INTERNATIONAL JOURNAL OF OBESITY SUPPLEMENTS 2020; 10:62-72. [PMID: 32714513 DOI: 10.1038/s41367-020-0019-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Growing evidence suggested that Sleep Disorders (SD) could increase the risk of developing obesity and could contribute to worsen obesity-related cardiovascular risk. Further, obesity per se has been reported to blunt sleep homeostasis. This happens through several mechanisms. First of all, the excessive adipose tissue at neck and chest levels could represent a mechanical obstacle to breathe. Moreover, the visceral adipose tissue is known to release cytokines contributing to low-grade chronic inflammation that could impair the circadian rhythm. Also, nutrition plays an important role in sleep homeostasis. High fat and/or high carbohydrate diets are known to have a negative impact on both sleep quality and duration. In addition, obesity predisposes to a condition called "obstructive sleep apnea" that has a detrimental effect on sleep. SD could increase the risk and/or could contribute to worsen cardiovascular risk usually associated with obesity. The chronic low grade inflammation associated with obesity has been reported to increase the risk of developing hypertension, type 2 diabetes and dyslipidemia. In turn, improving quality of sleep has been reported to improve the management of these cardiovascular risk factors. Thus, the aim of this manuscript is to provide evidence on the association of obesity and SD and on how they could contribute to the risk of developing cardiovascular risk factors such as hypertension, dyslipidemia and type 2 diabetes in obesity.
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Revol B, Jullian-Desayes I, Bailly S, Tamisier R, Grillet Y, Sapène M, Joyeux-Faure M, Pépin JL, Grillet Y, Sapène M, Pépin JL. Who May Benefit From Diuretics in OSA? Chest 2020; 158:359-364. [DOI: 10.1016/j.chest.2020.01.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022] Open
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Pecori A, Buffolo F, Pieroni J, Forestiero V, Sconfienza E, Veglio F, Mulatero P, Monticone S. Primary Aldosteronism and Obstructive Sleep Apnea: Casual Association or Pathophysiological Link? Horm Metab Res 2020; 52:366-372. [PMID: 32219799 DOI: 10.1055/a-1133-7255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The coexistence of aldosterone oversecretion and obstructive sleep apnea is frequently observed, especially in patients with resistant hypertension, obesity, and metabolic syndrome. Since aldosterone excess and sleep apnea are both independently associated with an increased risk of cardiovascular disease, to investigate whether their coexistence might be attributed to common predisposing conditions, such as metabolic disorders, or to an actual pathophysiological interconnection appears of great importance. Fluid overload and metabolic abnormalities relating to aldosterone oversecretion may be implicated in obstructive sleep apnea development. Nocturnal intermittent hypoxia may in turn exacerbate renin-angiotensin-aldosterone system activity, thus leading to hyperaldosteronism. Furthermore, fat tissue excess and adipocyte secretory products might predispose to both sleep apnea and aldosterone oversecretion in subjects with obesity. Consistent with these evidences, obstructive sleep apnea frequently affects patients with primary aldosteronism. Conversely, whether primary aldosteronism is more prevalent in individuals affected by obstructive sleep apnea compared to the general population remains controversial.
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Affiliation(s)
- Alessio Pecori
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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Associations between primary aldosteronism and diabetes, poor bone health, and sleep apnea-what do we know so far? J Hum Hypertens 2019; 34:5-15. [PMID: 31822780 DOI: 10.1038/s41371-019-0294-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
Primary aldosteronism (PA), the most common cause of secondary hypertension, is a well-recognized condition that can lead to cardiovascular and renal complications. PA is frequently left undiagnosed and untreated, leading to aldosterone-specific morbidity and mortality. In this review we highlight the evidence linking PA with other conditions such as (i) diabetes mellitus, (ii) obstructive sleep apnea, and (iii) bone health, along with clinical implications and proposed underlying mechanisms.
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The Demystification of Secondary Hypertension: Diagnostic Strategies and Treatment Algorithms. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:90. [DOI: 10.1007/s11936-019-0790-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tang Y, Sun Q, Bai XY, Zhou YF, Zhou QL, Zhang M. Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study. Nutr Diabetes 2019; 9:32. [PMID: 31685792 PMCID: PMC6828696 DOI: 10.1038/s41387-019-0098-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/23/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this case-control study was to assess the efficacy of dapagliflozin combined with metformin for type-2 diabetes mellitus (T2DM) with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of 36 patients with newly-diagnosed T2DM and OSAHS were randomized divided into two groups. Eighteen OSAHS patients with T2DM, who were treated with dapagliflozin and metformin, were assigned as the dapagliflozin group. These patients were given dapagliflozin and metformin for 24 weeks between February 2017 and February 2018. Another 18 OSAHS patients with T2DM, who were treated with glimepiride and metformin for 24 weeks, were assigned as the control group. Fasting plasma glucose (FPG) level, postprandial blood glucose (PPG), hemoglobin A1C (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, body mass index (BMI), blood pressure, apnea-hypopnea index (AHI), minimum oxygen saturation (LSpO2), and Epworth Somnolence Scale (ESS) score were measured before and at 24 weeks after the initiation of treatment. Results In the dapagliflozin group, triglyceride (TG), systolic pressure (SBP) and diastolic pressure (DBP) significantly decreased following treatment, while high-density lipoprotein cholesterol (HDL-C) significantly increased (P < 0.05). Furthermore, a reduction in AHI, an increase in LSpO2 and a decrease in ESS score were observed in the dapagliflozin group (P < 0.05), but not in the control group. Moreover, blood glucose, HbA1c, HOMA-IR, and BMI significantly decreased in these two groups, and the decrease was more significant in the dapagliflozin group. Conclusion These present results indicate that dapagliflozin can significantly reduce glucose, BMI, blood pressure and AHI, and improve hypoxemia during sleep and excessive daytime sleepiness, which thereby has potential as an effective treatment approach for OSAHS.
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Affiliation(s)
- Yi Tang
- Department of Endocrinology, The Fifth People's Hospital of Chengdu, 611130, Chengdu, P.R. China
| | - Qin Sun
- Center of Diabetes Mellitus, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 610072, Chengdu, P. R. China.
| | - Xiao-Yan Bai
- Department of Respiratory, The Fifth People's Hospital of Chengdu, 611130, Chengdu, P.R. China
| | - Yun-Fan Zhou
- Department of Endocrinology, The Third People's Hospital of Chengdu, 610000, Chengdu, P.R. China
| | - Qiong-Lan Zhou
- Department of Endocrinology, People's Hospital of Yilong County, 637676, Yilong, P.R. China
| | - Min Zhang
- Center of Diabetes Mellitus, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 610072, Chengdu, P. R. China.
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35
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Buffolo F, Li Q, Monticone S, Heinrich DA, Mattei A, Pieroni J, Mei M, Yang S, Hu YH, Yang MC, Sabbadin C, Pizzolo F, Giacchetti G, Fallo F, Veglio F, Reincke M, Wu VC, Mulatero P. Primary Aldosteronism and Obstructive Sleep Apnea: A Cross-Sectional Multi-Ethnic Study. Hypertension 2019; 74:1532-1540. [PMID: 31679423 DOI: 10.1161/hypertensionaha.119.13833] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between primary aldosteronism (PA) and obstructive sleep apnea (OSA) has been a matter of debate. 2016 Endocrine Society guideline recommends screening for PA all hypertensive patients with OSA. We designed a multicenter, multiethnic, cross-sectional study to evaluate the prevalence of PA in patients with OSA and the prevalence of OSA in unselected patients with PA. Two hundred and three patients with OSA (102 whites and 101 Chinese) were screened for PA, and 207 patients with PA (104 whites, 100 Chinese, and 3 of African descent) were screened for OSA by cardiorespiratory polygraphy. Eighteen patients with OSA (8.9%) had PA (11.8% of white and 5.9% of Chinese ethnicity). In patients without other indications for PA screening, the prevalence of PA dropped to 1.5%. The prevalence of OSA in patients with PA was 67.6%, consistent in both white and Chinese patients. A correlation between aldosterone levels and apnea/hypopnea index was observed in white patients with PA (R2=0.225, P=0.016) but not in Chinese patients. Multinomial logistic regression confirmed a significant and independent association between plasma aldosterone levels and moderate to severe OSA diagnosis in white patients (odds ratio, 1.002; P=0.002). In conclusion, aldosterone levels may contribute to the severity of OSA in white patients with hyperaldosteronism, but patients with OSA are not at high risk of PA. Results of the present study challenge the current recommendation of the Endocrine Society guideline that all patients with OSA should be screened for PA, irrespective of the grade of hypertension.
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Affiliation(s)
- Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Qifu Li
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.).,Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | | | - Daniel A Heinrich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.A.H., M.R.)
| | - Alessio Mattei
- Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy (A.M.)
| | - Jacopo Pieroni
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Mei Mei
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | - Shumin Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | - Ya-Hui Hu
- Division of Endocrine and Metabolism (Y.-H.H.), Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine (M.C.Y.), Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Chiara Sabbadin
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy (C.B., F.F.)
| | - Francesca Pizzolo
- Department of Medicine, Unit of Internal Medicine, University of Verona, Italy (F.P.)
| | - Gilberta Giacchetti
- Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy (G.G.)
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy (C.B., F.F.)
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.A.H., M.R.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (V.C.W.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
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Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature. J Clin Med 2019; 8:jcm8111846. [PMID: 31684047 PMCID: PMC6912255 DOI: 10.3390/jcm8111846] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent condition with few therapeutic options. To date there is no approved pharmacotherapy for this disorder, but several attempts have been made in the past and are currently ongoing to find one. The recent identification of multiple endotypes underlying this disorder has oriented the pharmacological research towards tailored therapies targeting specific pathophysiological traits that contribute differently to cause OSA in each patient. In this review we retrospectively analyze the literature on OSA pharmacotherapy dividing the medications tested on the basis of the four main endotypes: anatomy, upper airway muscle activity, arousal threshold and ventilatory instability (loop gain). We show how recently introduced drugs for weight loss that modify upper airway anatomy may play an important role in the management of OSA in the near future, and promising results have been obtained with drugs that increase upper airway muscle activity during sleep and reduce loop gain. The lack of a medication that can effectively increase the arousal threshold makes this strategy less encouraging, although recent studies have shown that the use of certain sedatives do not worsen OSA severity and could actually improve patients' sleep quality.
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37
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Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea. Curr Opin Pulm Med 2019; 25:594-601. [DOI: 10.1097/mcp.0000000000000628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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38
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Krasińska B, Cofta S, Szczepaniak-Chicheł L, Rzymski P, Trafas T, Paluszkiewicz L, Tykarski A, Krasiński Z. The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension-A Randomized, Controlled Trial. J Clin Med 2019; 8:jcm8101671. [PMID: 31614891 PMCID: PMC6832448 DOI: 10.3390/jcm8101671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022] Open
Abstract
The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (n = 51) and the control group, remaining on their standard antihypertensive therapy (n = 51). After that period, a significant reduction in the night-time BP parameters in the treatment group including an increased night blood pressure fall from 4.6 to 8.9% was noted. Additionally, the number of non-dipper patients was reduced by 45.1%. The treatment group also revealed a decrease in left ventricular hypertrophy and in the apnea-hypopnea index (AHI) with a positive correlation being observed between these two parameters. This study is the first to report the improvement of the circadian BP profile and the improvement of the left ventricle geometry in patients with OSA and RAH following the addition of selective mineralocorticoid receptor antagonists to antihypertensive therapy.
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Affiliation(s)
- Beata Krasińska
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Szczepan Cofta
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Ludwina Szczepaniak-Chicheł
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland.
| | - Tomasz Trafas
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Lech Paluszkiewicz
- Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany.
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Zbigniew Krasiński
- Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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40
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Thoracic fluid accumulation and asthma symptoms: A new contributor mechanism. Porto Biomed J 2019; 4:e40. [PMID: 33501392 PMCID: PMC7819536 DOI: 10.1097/j.pbj.0000000000000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022] Open
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41
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Fiori CZ, Martinez D, Montanari CC, Lopez P, Camargo R, Sezerá L, Gonçalves SC, Fuchs FD. Diuretic or sodium-restricted diet for obstructive sleep apnea-a randomized trial. Sleep 2019; 41:4829728. [PMID: 29669139 DOI: 10.1093/sleep/zsy016] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/26/2017] [Indexed: 01/10/2023] Open
Abstract
Study Objectives Interventions that decrease leg fluid retention reduce obstructive sleep apnea (OSA) severity in nonrandomized experiments. We aimed to investigate in a randomized trial the effect of interventions that reduce fluid volume on OSA severity. Methods Men diagnosed with severe OSA were randomized to receive daily spironolactone 100 mg + furosemide 20 mg or nutritional counseling to sodium-restricted diet plus placebo pill or placebo pill. All participants underwent home sleep apnea testing at baseline and after 1 week follow-up. The change in apnea-hypopnea index (AHI) was the primary outcome. Results The study included 54 participants and all were assessed at follow-up. The average baseline value of the AHI was similar among groups and from baseline to follow-up the AHI reduced 14.4 per cent (δ value -7.3 events per hour; 95% confidence interval, -13.8 to -0.9) in the diuretic group, 22.3 per cent (-10.7; 95% CI, -15.6 to -5.7) in the diet group, and 0.8 per cent (0.4; 95% CI, -2.5 to 3.2) in the placebo group (p = .001 for time × group interaction). None of the patients had their AHI returned to normal. The reduction in the total body water was 2.2 ± 2.2 L in the diuretic group (p < .001) and 1.0 ± 1.6 l in the low salt diet group (p = .002). Sleepiness and neck circumference were significantly reduced only in the diet group (p = .007 and p < .001 for the time × group interactions, respectively). Conclusions Interventions to reduce bodily fluid content in men with severe OSA promoted a limited decrease of apnea frequency. This finding suggests that rostral fluid displacement affects only partially the OSA severity and/or that other factors prevail in determining pharyngeal collapsibility. Clinical Trial Sodium-Restricted Diet and Diuretic in the Treatment of Severe Sleep Apnea (DESALT), https://clinicaltrials.gov/ct2/show/NCT01945801 ClinicalTrials.gov number: NCT01945801.
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Affiliation(s)
- Cintia Zappe Fiori
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil
| | - Denis Martinez
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil.,Graduate Studies Program in Medical Sciences, School of Medicine, UFRGS, Brazil.,Division of Cardiology, HCPA, Porto Alegre, RS, Brazil
| | - Carolina Caruccio Montanari
- Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil.,Graduate Studies Program in Medical Sciences, School of Medicine, UFRGS, Brazil
| | - Pedro Lopez
- Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil.,Exercise Research Laboratory, UFRGS, Porto Alegre, RS, Brazil
| | - Rodrigo Camargo
- Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil
| | - Lauren Sezerá
- Interdisciplinary Sleep Research Laboratory, Hospital de Clínicas de Porto Alegre (LIPES-HCPA), Porto Alegre, RS, Brazil
| | - Sandro Cadaval Gonçalves
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Division of Cardiology, HCPA, Porto Alegre, RS, Brazil
| | - Flavio Danni Fuchs
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Division of Cardiology, HCPA, Porto Alegre, RS, Brazil
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 595] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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Vena D, Lyons O, Fernie GR, Popovic MR, Malta D, Alshaer H, Yadollahi A. Effect of calf muscle electrical stimulation on rostral fluid shift, snoring and obstructive sleep apnea. Sleep Med 2019; 57:36-42. [PMID: 30897454 DOI: 10.1016/j.sleep.2019.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/17/2018] [Accepted: 01/27/2019] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVES Overnight fluid shift from the legs into the neck may contribute to the pathogenesis of snoring and obstructive sleep apnea (OSA). The present study investigates the effects of calf muscle electrical stimulation (ES) on reducing leg fluid accumulation while seated, subsequent rostral fluid shift on lying down, and the impact on snoring and OSA. METHODS Sixteen non-obese, normotensive men with OSA participated in the study. On the first study day, participants sat for 150 min receiving either active or sham ES through random allocation, then lied supine for 60 min. While seated and supine, leg and neck fluid volumes were measured using bioelectrical impedance to determine the magnitude of fluid shift. On the night of the study day, participants wore a portable sleep apnea diagnostic device overnight to measure snoring and sleep apnea severity. One week later, participants crossed over to the other study condition. RESULTS Active calf muscle ES reduced leg fluid accumulation by 46% while seated. Upon lying supine, active ES reduced fluid shift out of the legs by 17% and reduced neck fluid accumulation by 31%. This led to a 15% reduction in snoring index, but did not alleviate OSA. CONCLUSIONS One session of calf muscle ES was effective at reducing leg fluid accumulation and rostral fluid shift, which led to a modest reduction in the snoring index, but not OSA. Despite this lack of effect of calf muscle ES in attenuating OSA severity, the reduction in the snoring index suggests that it did have an effect, albeit mild, on upper-airway mechanics.
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Affiliation(s)
- Daniel Vena
- KITE, Toronto Rehab - University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Owen Lyons
- KITE, Toronto Rehab - University Health Network, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Geoff R Fernie
- KITE, Toronto Rehab - University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Milos R Popovic
- KITE, Toronto Rehab - University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Daniela Malta
- Department of Nutritional Science, University of Toronto, Toronto, Canada; Division of Cardiology, Department of Medicine, Sinai Health System, Toronto, Canada
| | - Hisham Alshaer
- KITE, Toronto Rehab - University Health Network, Toronto, Canada
| | - Azadeh Yadollahi
- KITE, Toronto Rehab - University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
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44
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Targeting volume overload and overnight rostral fluid shift: A new perspective to treat sleep apnea. Sleep Med Rev 2018; 42:160-170. [DOI: 10.1016/j.smrv.2018.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023]
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Abstract
PURPOSE OF REVIEW Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. RECENT FINDINGS To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
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Affiliation(s)
- N P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA.
| | - S S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - M X Herzig
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - S A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
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Azizi M, Amar L, Lorthioir A. Resistant Hypertension and Obstructive Sleep Apnea: Is There a Specific Indication for Endovascular Renal Denervation? Hypertension 2018; 72:281-282. [PMID: 29941511 DOI: 10.1161/hypertensionaha.118.11368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michel Azizi
- From the Paris-Descartes University, F-75006 Paris, France (M.A., L.A.) .,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France (M.A., L.A., A.L.).,INSERM, CIC1418, F-75015 Paris, France (M.A., A.L.)
| | - Laurence Amar
- From the Paris-Descartes University, F-75006 Paris, France (M.A., L.A.).,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France (M.A., L.A., A.L.)
| | - Aurélien Lorthioir
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France (M.A., L.A., A.L.).,INSERM, CIC1418, F-75015 Paris, France (M.A., A.L.)
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Fatureto-Borges F, Jenner R, Costa-Hong V, Lopes HF, Teixeira SH, Marum E, Giorgi DAM, Consolim-Colombo FM, Bortolotto LA, Lorenzi-Filho G, Krieger EM, Drager LF. Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment? Hypertension 2018; 72:399-407. [PMID: 29941513 DOI: 10.1161/hypertensionaha.118.10825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 11/16/2022]
Abstract
Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55±9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mm Hg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9±11.8 versus -0.3±10.3 mm Hg; 18 months, -6.7±11.1 versus -1.2±10.6 mm Hg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3±1.9 versus 9.2±1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.
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Affiliation(s)
- Fernanda Fatureto-Borges
- From the Program in Cardiology, Faculty of Medicine, University of São Paulo, Brazil (F.F.-B.).,Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | - Raimundo Jenner
- University of São Paulo Medical School, Brazil; and Department of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil (R.J., H.F.L., F.M.C.-C.)
| | - Valéria Costa-Hong
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | - Heno F Lopes
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.).,University of São Paulo Medical School, Brazil; and Department of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil (R.J., H.F.L., F.M.C.-C.)
| | - Sandra H Teixeira
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | - Elias Marum
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | - Dante A M Giorgi
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | - Fernanda M Consolim-Colombo
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.).,University of São Paulo Medical School, Brazil; and Department of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil (R.J., H.F.L., F.M.C.-C.)
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.)
| | | | | | - Luciano F Drager
- Hypertension Unit, Heart Institute-InCor (F.F.-B., V.C.-H., H.F.L., S.H.T., E.M., D.A.M.G., F.M.C.-C., L.A.B., L.F.D.) .,Hypertension Unit, Renal Division (L.F.D.)
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Wolf J, Narkiewicz K. Managing comorbid cardiovascular disease and sleep apnea with pharmacotherapy. Expert Opin Pharmacother 2018; 19:961-969. [PMID: 29792524 DOI: 10.1080/14656566.2018.1476489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Highly prevalent sleep disordered breathing (SDB) has been recognized as an independent cardiovascular disease (CVD) risk factor. Although these two entities often coexist, there is a shortage of sufficiently-powered studies testing the interplay between the course of sleep apnea and CVD pharmacotherapy. The mutual relationship between treated/untreated obstructive sleep apnea (OSA) with ongoing cardiovascular pharmacotherapies is an evident gap in clinical expertise. AREAS COVERED In this article, the authors review the available evidence and outline future research directions concerning the reciprocal relationship between the pharmacological treatment of CVD and SDB. Several attempts have been made to identify the most efficacious hypotensive agents for patients with both OSA and hypertension. Various cardiovascular drugs are also evaluated in terms of their influence on sleep apnea severity. EXPERT OPINION The question of whether OSA should be included in cardiovascular pharmacotherapy individualization algorithms is a matter of debate and more evidence is needed. Cautious intensification of diuretics with the use of aldosterone receptor antagonists deserves attention when both high blood pressure and sleep apnea coexist.
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Affiliation(s)
- Jacek Wolf
- a Faculty of Medicine, Department of Hypertension and Diabetology , Medical University of Gdańsk , Gdańsk , Poland
| | - Krzysztof Narkiewicz
- a Faculty of Medicine, Department of Hypertension and Diabetology , Medical University of Gdańsk , Gdańsk , Poland
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Sawada K, Karashima S, Kometani M, Oka R, Takeda Y, Sawamura T, Fujimoto A, Demura M, Wakayama A, Usukura M, Yagi K, Takeda Y, Yoneda T. Effect of sodium glucose cotransporter 2 inhibitors on obstructive sleep apnea in patients with type 2 diabetes. Endocr J 2018; 65:461-467. [PMID: 29459554 DOI: 10.1507/endocrj.ej17-0440] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is often associated with metabolic disorders such as obesity and type 2 diabetes and may contribute to cardiovascular events. A novel class of antidiabetic drugs, the sodium glucose cotransporter 2 inhibitors (SGLT2i) reduce body weight (BW), although there is limited data on their impact on OSAS. We therefore evaluated the effect of SGLT2i on OSAS in patients with type 2 diabetes. The presented study was a retrospective design in 18 patients with type 2 diabetes with OSAS (4 males, age range 39-81 yr) administrated a SGLT2i. HbA1c, BW, body mass index (BMI), blood pressure (BP) and apnea hypopnea index (AHI) were evaluated before and after SGLT2i administration. The relationships between the reduction in AHI and the other variables were examined using Pearson correlation analysis. We have got result that SGLT2i reduced AHI from 31.9 ± 18.0 to 18.8 ± 11.5 events per hr (p = 0.003). HbA1c, BW and BMI decreased significantly, whereas BP did not. The Pearson correlation analysis showed a significant relationship between the reduction in AHI and pre-administration of AHI. In conclusion, SGLT2i reduced not only HbA1c, BW and BMI but also AHI significantly and therefore has potential as an effective treatment of OSAS.
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Affiliation(s)
- Kei Sawada
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Shigehiro Karashima
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Mitsuhiro Kometani
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Rie Oka
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Yoshimichi Takeda
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Toshitaka Sawamura
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Aya Fujimoto
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Masashi Demura
- Department of Hygiene, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Ayako Wakayama
- Department of Internal Medicine, Houju Memorial Hospital, Ishikawa 923-1226, Japan
| | - Mikiya Usukura
- Department of Internal Medicine, Houju Memorial Hospital, Ishikawa 923-1226, Japan
| | - Kunimasa Yagi
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Yoshiyu Takeda
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
| | - Takashi Yoneda
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Ishikawa 920-8641, Japan
- Program management office for Paradigms Establishing Centers for Fostering Medical Researchers of the Future, Kanazawa University, Ishikawa 920-8641, Japan
- Institute of Liberal Arts and Science, Kanazawa University, Ishikawa 920-8641, Japan
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