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Taylor CE, Mendenhall LE, Sunshine MD, Wilson JN, Calulot CM, Sun RC, Johnson LA, Alilain WJ. Sex and APOE genotype influence respiratory function under hypoxic and hypoxic-hypercapnic conditions. J Neurophysiol 2024; 132:23-33. [PMID: 38748407 DOI: 10.1152/jn.00255.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
The apolipoprotein E (APOE) gene has been studied due to its influence on Alzheimer's disease (AD) development and work in an APOE mouse model recently demonstrated impaired respiratory motor plasticity following spinal cord injury (SCI). Individuals with AD often copresent with obstructive sleep apnea (OSA) characterized by cessations in breathing during sleep. Despite the prominence of APOE genotype and sex as factors in AD progression, little is known about the impact of these variables on respiratory control. Ventilation is tightly regulated across many systems, with respiratory rhythm formation occurring in the brainstem but modulated in response to chemoreception. Alterations within these modulatory systems may result in disruptions of appropriate respiratory control and ultimately, disease. Using mice expressing two different humanized APOE alleles, we characterized how sex and the presence of APOE3 or APOE4 influences ventilation during baseline breathing (normoxia) and during respiratory challenges. We show that sex and APOE genotype influence breathing during hypoxic challenge, which may have clinical implications in the context of AD and OSA. In addition, female mice, while responding robustly to hypoxia, were unable to recover to baseline respiratory levels, emphasizing sex differences in disordered breathing.NEW & NOTEWORTHY This study is the first to use whole body plethysmography (WBP) to measure the impact of APOE alleles on breathing under normoxia and during adverse respiratory challenges in a targeted replacement Alzheimer's model. Both sex and genotype were shown to affect breathing under normoxia, hypoxic challenge, and hypoxic-hypercapnic challenge. This work has important implications regarding the impact of genetics on respiratory control as well as applications pertaining to conditions of disordered breathing including sleep apnea and neurotrauma.
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Affiliation(s)
- Chase E Taylor
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, United States
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
| | - Laura E Mendenhall
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
| | - Michael D Sunshine
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
| | - Jessica N Wilson
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, United States
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
| | - Chris M Calulot
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
| | - Ramon C Sun
- Department of Biochemistry & Molecular Biology, College of Medicine, University of Florida, Gainesville, Florida, United States
- Department of Biochemistry, University of Florida, Gainesville, Florida, United States
- Center for Advanced Spatial Biomolecule Research, University of Florida, Gainesville, Florida, United States
| | - Lance A Johnson
- Department of Physiology, University of Kentucky, Lexington, Kentucky, United States
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, United States
| | - Warren J Alilain
- Department of Neuroscience, University of Kentucky, Lexington, Kentucky, United States
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, United States
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Tregub PP, Komleva YK, Kulikov VP, Chekulaev PA, Tregub OF, Maltseva LD, Manasova ZS, Popova IA, Andriutsa NS, Samburova NV, Salmina AB, Litvitskiy PF. Relationship between Hypoxia and Hypercapnia Tolerance and Life Expectancy. Int J Mol Sci 2024; 25:6512. [PMID: 38928217 PMCID: PMC11204369 DOI: 10.3390/ijms25126512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
The review discusses the potential relationship between hypoxia resistance and longevity, the influence of carbon dioxide on the mechanisms of aging of the mammalian organism, and intermittent hypercapnic-hypoxic effects on the signaling pathways of aging mechanisms. In the article, we focused on the potential mechanisms of the gero-protective efficacy of carbon dioxide when combined with hypoxia. The review summarizes the possible influence of intermittent hypoxia and hypercapnia on aging processes in the nervous system. We considered the perspective variants of the application of hypercapnic-hypoxic influences for achieving active longevity and the prospects for the possibilities of developing hypercapnic-hypoxic training methods.
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Affiliation(s)
- Pavel P. Tregub
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Brain Science Institute, Research Center of Neurology, 125367 Moscow, Russia; (Y.K.K.)
- Scientific and Educational Resource Center “Innovative Technologies of Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis”, RUDN University, 117198 Moscow, Russia
| | - Yulia K. Komleva
- Brain Science Institute, Research Center of Neurology, 125367 Moscow, Russia; (Y.K.K.)
| | - Vladimir P. Kulikov
- Department of Ultrasound and Functional Diagnostics, Altay State Medical University, 656040 Barnaul, Russia
| | - Pavel A. Chekulaev
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | | | - Larisa D. Maltseva
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Zaripat Sh. Manasova
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Inga A. Popova
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Natalia S. Andriutsa
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Natalia V. Samburova
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Alla B. Salmina
- Brain Science Institute, Research Center of Neurology, 125367 Moscow, Russia; (Y.K.K.)
| | - Peter F. Litvitskiy
- Department of Pathophysiology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
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Tian Q, Sun J, Li X, Liu J, Zhou H, Deng J, Li J. Association between sleep apnoea and risk of cognitive impairment and Alzheimer's disease: a meta-analysis of cohort-based studies. Sleep Breath 2024; 28:585-595. [PMID: 37857768 DOI: 10.1007/s11325-023-02934-w] [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: 05/12/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To provide updated evidence on the association of obstructive sleep apnoea (OSA)/sleep-disordered breathing (SDB) with risk of all-cause cognitive impairment/dementia and Alzheimer's disease (AD). METHODS A systematic literature search was done in PubMed, EMBASE and Scopus databases for cohort studies (retrospective or prospective) that documented the association of SDB/OSA with the risk of cognitive impairment or all-cause dementia or AD. Only studies that were published in the year 2000 and onwards were included. The random-effects model was used for all the analyses and effect sizes were reported as hazards ratio (HR) with 95% confidence intervals. RESULTS Of 15 studies were included in the meta-analysis, SDB/OSA was diagnosed with at-home polysomnography in six studies, while five studies relied on self-report or questionnaires. In the remaining studies, International Classification of Diseases (ICD) codes determined the diagnosis of SDB. The overall pooled analysis showed that patients with SDB/OSA had higher risk of cognitive impairment and/or all-cause dementia (HR 1.52, 95% CI: 1.32, 1.74), when compared to patients without SDB/OSA. However, when studies with diagnosis of SDB based on polysomnography were pooled together, the strength of association for all-cause cognitive impairment was weaker (HR 1.32, 95% CI: 1.00, 1.74). CONCLUSION Findings suggest a possible association of SDB/OSA with risk of all-cause cognitive impairment and/or dementia. However, careful interpretation is warranted as the majority of the studies did not rely on objective assessment based on polysomnography.
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Affiliation(s)
- Qianqian Tian
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jiadong Sun
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Xuemei Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Junling Liu
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Hao Zhou
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jian Deng
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China
| | - Jie Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang, Shandong, China.
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Ercolano E, Bencivenga L, Palaia ME, Carbone G, Scognamiglio F, Rengo G, Femminella GD. Intricate relationship between obstructive sleep apnea and dementia in older adults. GeroScience 2024; 46:99-111. [PMID: 37814196 PMCID: PMC10828345 DOI: 10.1007/s11357-023-00958-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Numerous evidence reports direct correlation between cognitive impairment, Alzheimer's disease and sleep disorders, in particular obstructive sleep apnea. Both obstructive sleep apnea and Alzheimer's disease are highly prevalent conditions whose incidence increases with age. Several studies demonstrate how sleep-disordered breathing may lead to poor cognition, even though the underlying mechanisms of this association remain partially unclear. According to the most recent studies, obstructive sleep apnea may be considered a modifiable risk factor for cognitive dysfunction. In the present review, the authors aim to integrate recent research examining obstructive sleep apnea and Alzheimer's disease biomarkers, also focusing on the mechanisms that support this correlation, including but not limited to the role of hypoxia and cardiovascular risk. Moreover, the potential favourable effect of obstructive sleep apnea therapy on cognitive function is discussed, to evaluate the benefits deriving from appropriate treatment of sleep-disordered breathing on cognition.
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Affiliation(s)
- Erica Ercolano
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giovanni Carbone
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Francesco Scognamiglio
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri - S.P.A. - Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Scientifico Di Telese Terme, Telese, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Department of Brain Sciences, Imperial College London, London, UK.
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McCloskey LC. Mentation Tracks Severity but not Oxygenation in Obstructive Sleep Apnea. Percept Mot Skills 2023; 130:1139-1151. [PMID: 37051688 DOI: 10.1177/00315125231170025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
There is a rough consensus, after decades of research, that obstructive sleep apnea (OSA) is associated with mild cognitive impairments, especially in areas of executive functioning (EF), attention/working memory (A/WM), episodic memory (EM), and speed of speed of information processing (SIP). However, there is less consensus as to whether apnea severity matters for these impairments, which sleep variables matter most to which cognitive domains, whether common OSA comorbidities contribute to these determinations, or whether the apparent associations are really artifacts of these comorbidities. In this study, 40 participants with OSA submitted to polysomnography and to neuropsychological assessment with an expanded Halstead-Reitan Test Battery. Aggregates of tests to cover the four cognitive domains mentioned above were linearly regressed on the apnea-hypopnea index (AHI), the nadir of oxygen saturation (NOS), and hypertension and diabetes mellitus (scored present or absent). The AHI predicted both EF (p = .015; sr2 = .13) and A/WM (p = .023; sr2 = 11) in the primary analyses, and EM (p = .027; sr2 = .10) in the secondary analyses. Thus, AHI may affect EF, A/WM and perhaps EM beyond NOS and beyond two of OSA's most common comorbidities. Implications of these findings are discussed here.
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Silva MA, Lee JM, Garcia A, Dams-O'Connor K, Nakase-Richardson R. Research Letter: Impact of Obstructive Sleep Apnea Disease Duration on Neuropsychological Functioning After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. J Head Trauma Rehabil 2022; 37:E496-E501. [PMID: 35687890 PMCID: PMC10249369 DOI: 10.1097/htr.0000000000000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationship between obstructive sleep apnea (OSA) disease duration and cognitive functioning in those with a history of traumatic brain injury (TBI). We hypothesized that longer OSA duration would predict poorer cognitive performance. SETTING Inpatient brain injury units at a Veterans Affairs (VA) Polytrauma Rehabilitation Center. PARTICIPANTS Participants in the VA TBI Model Systems multicenter longitudinal study who enrolled in a modular substudy (April 15, 2018, to January 15, 2021) examining cognition following TBI. All participants had received inpatient rehabilitation for TBI and reported a diagnosis of OSA ( n = 89, mean age = 40.8 years, 97% male, 81% White). Reported duration of OSA ranged from 2 to 7 years (mean = 4.2; SD = 3.9). DESIGN Retrospective analysis of prospective cohort, cross-sectional. MAIN MEASURES Brief Test of Adult Cognition by Telephone (BTACT). RESULTS Controlling for age, education, and time to follow commands, OSA disease duration was negatively associated with delayed verbal memory ( R2Δ = 0.053, F(1,84) = 5.479, P = .022). Performance in other cognitive domains was not significantly associated with OSA disease duration. CONCLUSION This study provides preliminary evidence that longer duration of OSA (ie, time since diagnosis) has a negative impact on verbal memory in those with a history of hospitalized TBI. This finding extends the literature (which focused on the general population) on the cognitive impact of OSA and is consistent with hypothesized mechanisms such as hippocampal damage and secondary impact of fatigue. Findings suggest that early OSA identification and treatment may be prudent for persons with TBI.
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Affiliation(s)
- Marc A Silva
- Mental Health and Behavioral Sciences Section, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Silva, Lee, Garcia, and Nakase-Richardson); Departments of Internal Medicine (Drs Silva and Nakase-Richardson) and Psychiatry and Behavioral Neurosciences (Dr Silva), University of South Florida, Tampa; Traumatic Brain Injury Center of Excellence, Tampa, Florida (Dr Garcia); Departments of Rehabilitation and Human Performance and Neurology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Dams-O'Connor)
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7
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Yang C, Zhou Y, Liu H, Xu P. The Role of Inflammation in Cognitive Impairment of Obstructive Sleep Apnea Syndrome. Brain Sci 2022; 12:brainsci12101303. [PMID: 36291237 PMCID: PMC9599901 DOI: 10.3390/brainsci12101303] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) has become a major worldwide public health concern, given its global prevalence. It has clear links with multiple comorbidities and mortality. Cognitive impairment is one related comorbidity causing great pressure on individuals and society. The clinical manifestations of cognitive impairment in OSAS include decline in attention/vigilance, verbal–visual memory loss, visuospatial/structural ability impairment, and executive dysfunction. It has been proven that chronic intermittent hypoxia (CIH) may be a main cause of cognitive impairment in OSAS. Inflammation plays important roles in CIH-induced cognitive dysfunction. Furthermore, the nuclear factor kappa B and hypoxia-inducible factor 1 alpha pathways play significant roles in this inflammatory mechanism. Continuous positive airway pressure is an effective therapy for OSAS; however, its effect on cognitive impairment is suboptimal. Therefore, in this review, we address the role inflammation plays in the development of neuro-impairment in OSAS and the association between OSAS and cognitive impairment to provide an overview of its pathophysiology. We believe that furthering the understanding of the inflammatory mechanisms involved in OSAS-associated cognitive impairment could lead to the development of appropriate and effective therapy.
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8
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Song X, Roy B, Vacas S, Woo MA, Kang DW, Aysola RS, Kumar R. Brain regional homogeneity changes after short-term positive airway pressure treatment in patients with obstructive sleep apnea. Sleep Med 2022; 91:12-20. [PMID: 35245787 PMCID: PMC10498724 DOI: 10.1016/j.sleep.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
Patients with obstructive sleep apnea (OSA) reveal functional changes in brain sites involved in autonomic, cognitive, and mood regulations. However, it is unclear whether these brain changes reverse with short-term positive airway pressure (PAP) treatment. Our aim was to examine brain functional changes in response to 3-months of PAP treatment using regional homogeneity (ReHo) measures, where increased and decreased ReHo value indicates hyper- and hypo-local neural activities, respectively, and considered as functional deficits. We collected brain magnetic resonance imaging data as well as mood, cognitive, and sleep variables from 17 treatment-naïve OSA at baseline and after 3-months of PAP treatment and 25 age- and gender-matched healthy controls. Whole-brain ReHo maps were calculated and compared between OSA and controls and OSA subjects before and after PAP treatment. At baseline, treatment-naïve OSA subjects showed higher ReHo in the bilateral thalamus, putamen, postcentral gyrus, paracentral lobule, supplementary motor area, and right insula, and lower ReHo in the frontal and parietal cortices, compared to controls. After 3-months of PAP treatment, abnormal sleep and mood scores decreased significantly to normal levels. ReHo decreased in the autonomic and somatosensory control areas, including the thalamus, putamen, postcentral gyrus, and insula, and increased in the cognitive and affective regulatory parietal regions. The normalized ReHo was correlated with improved sleep quality and reduced anxiety symptoms. These findings suggest that 3-months of PAP use can improve sleep, mood issues, and partly recover brain activities, however, longer PAP treatment may be required to fully and permanently reverse brain functional deficits.
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Affiliation(s)
- Xiaopeng Song
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Bhaswati Roy
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Susana Vacas
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel W Kang
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ravi S Aysola
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA.
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9
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Kong L, Li H, Shu Y, Liu X, Li P, Li K, Xie W, Zeng Y, Peng D. Aberrant Resting-State Functional Brain Connectivity of Insular Subregions in Obstructive Sleep Apnea. Front Neurosci 2022; 15:765775. [PMID: 35126035 PMCID: PMC8813041 DOI: 10.3389/fnins.2021.765775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The insular cortex is a cortical regulatory area involved in dyspnea, cognition, emotion, and sensorimotor function. Previous studies reported that obstructive sleep apnea (OSA) shows insular tissue damage and abnormal functional connections for the whole insula. The insula can be divided into different subregions with distinct functional profiles, including the ventral anterior insula (vAI) participating in affective processing, dorsal anterior insula (dAI) involved in cognitive processing, and posterior insula (PI) involved in the processing of sensorimotor information. However, the functional connectivity (FC) of these insular subregions in OSA has yet to be established. Hence, the purpose of this study was to explore the resting-state FC of the insular subregions with other brain areas and its relationship with clinical symptoms of OSA. Resting-state functional magnetic resonance imaging data from 83 male OSA patients and 84 healthy controls were analyzed by whole-brain voxel-based FC using spherical seeds from six insular subregions, namely, the bilateral vAI, dAI, and PI, to identify abnormalities in the insular subregions network and related brain regions. Ultimately, the Pearson correlation analysis was carried out between the dysfunction results and the neuropsychological tests. Compared with the healthy control group, the OSA patients exhibited disturbed FC from the dAI to areas relevant to cognition, such as the bilateral cerebellum posterior lobe, superior frontal gyrus, right middle frontal gyrus and middle temporal gyrus; decreased FC from the vAI to areas linked with emotion, such as the bilateral fusiform gyrus, superior parietal lobule, precuneus and cerebellum posterior lobe; and abnormal FC from the PI to the brain regions involved in sensorimotor such as the bilateral precentral gyrus, right superior/middle temporal gyrus and left superior frontal gyrus. The linear regression result showed that the apnea-hypopnea index was positively correlated with the increased FC between the right PI and the right precuneus (after Bonferroni correlation, P < 0.001) In conclusion, the abnormal FC between insular subregions and other brain regions were related to cognitive, emotional and sensorimotor networks in OSA patients. These results may provide a new imaging perspective for further understanding of OSA-related cognitive and affective disorders.
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10
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Ulland TK, Ewald AC, Knutson AO, Marino KM, Smith SMC, Watters JJ. Alzheimer's Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link. Cells 2021; 10:2907. [PMID: 34831129 PMCID: PMC8616348 DOI: 10.3390/cells10112907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 12/14/2022] Open
Abstract
Sleep Disordered Breathing (SDB) and Alzheimer's Disease (AD) are strongly associated clinically, but it is unknown if they are mechanistically associated. Here, we review data covering both the cellular and molecular responses in SDB and AD with an emphasis on the overlapping neuroimmune responses in both diseases. We extensively discuss the use of animal models of both diseases and their relative utilities in modeling human disease. Data presented here from mice exposed to intermittent hypoxia indicate that microglia become more activated following exposure to hypoxia. This also supports the idea that intermittent hypoxia can activate the neuroimmune system in a manner like that seen in AD. Finally, we highlight similarities in the cellular and neuroimmune responses between SDB and AD and propose that these similarities may lead to a pathological synergy between SDB and AD.
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Affiliation(s)
- Tyler K. Ulland
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI 53705, USA; (T.K.U.); (K.M.M.)
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Andrea C. Ewald
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Andrew O. Knutson
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Kaitlyn M. Marino
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI 53705, USA; (T.K.U.); (K.M.M.)
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
| | - Stephanie M. C. Smith
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
| | - Jyoti J. Watters
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI 53705, USA
- Department of Comparative Biosciences, University of Wisconsin Madison, Madison, WI 53706, USA; (A.C.E.); (A.O.K.); (S.M.C.S.)
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11
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Gnoni V, Drakatos P, Higgins S, Duncan I, Wasserman D, Kabiljo R, Mutti C, Halasz P, Goadsby PJ, Leschziner GD, Rosenzweig I. Cyclic alternating pattern in obstructive sleep apnea: A preliminary study. J Sleep Res 2021; 30:e13350. [PMID: 33939202 DOI: 10.1111/jsr.13350] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea is linked to cardiovascular disease, metabolic disorders and dementia. The precise nature of the association between respiratory events in obstructive sleep apnea, cortical or subcortical arousals, and cognitive, autonomic and oxidative stress consequences remains incompletely elucidated. Previous studies have aimed to understand the relationship between obstructive sleep apnea and arousal patterns, as defined by the cyclic alternating pattern, but results have been inconsistent, in part likely due to the presence of associated comorbidities. To better define this relationship, we analysed cyclic alternating patterns in patients with obstructive sleep apnea without any additional comorbidities. We identified 18 adult male, non-obese subjects with obstructive sleep apnea and no other comorbidities or medication history, who underwent whole-night electroencephalography and polysomnography. Cyclic alternating pattern analysis was performed and verified by certified somnologists. Pairwise linear regression analysis demonstrated an inverse relationship between obstructive sleep apnea severity and cyclic alternating pattern subtype A1, and a direct correlation with cyclic alternating pattern subtype A3. Cyclic alternating pattern subtypes A1 prevail in milder obstructive sleep apnea phenotype, whilst cyclic alternating pattern subtypes A2 and A3 overcome among moderate-to-severe obstructive sleep apnea patients. The milder obstructive sleep apnea group also presented higher sleep efficiency, and increased percentages of non-rapid eye movement stage 3 and rapid eye movement sleep, as well as longer cyclic alternating pattern sequences in N3, while severe obstructive sleep apnea patients spent more time in lighter sleep stages. These results imply/suggest a balance between cyclic alternating pattern's adaptive and maladaptive arousal processes in obstructive sleep apnea of differing severities. In milder obstructive sleep apnea (apnea-hypopnea index < 20), sleep continuity may be reinforced by cyclic alternating pattern subtype A1, whereas in more severe obstructive sleep apnea, decompensation of these sleep-stabilizing mechanisms may occur and more intrusive cyclic alternating pattern fluctuations disrupt sleep circuitry.
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Affiliation(s)
- Valentina Gnoni
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sean Higgins
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Iain Duncan
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Danielle Wasserman
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Renata Kabiljo
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Carlotta Mutti
- Neurology Unit, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Peter Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Guy D Leschziner
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Sleep Disorders Centre, Guy's and St Thomas NHS Foundation Trust, London, UK
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12
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Khuu MA, Nallamothu T, Castro-Rivera CI, Arias-Cavieres A, Szujewski CC, Garcia Iii AJ. Stage-dependent effects of intermittent hypoxia influence the outcome of hippocampal adult neurogenesis. Sci Rep 2021; 11:6005. [PMID: 33727588 PMCID: PMC7966401 DOI: 10.1038/s41598-021-85357-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Over one billion adults worldwide are estimated to suffer from sleep apnea, a condition with wide-reaching effects on brain health. Sleep apnea causes cognitive decline and is a risk factor for neurodegenerative conditions such as Alzheimer’s disease. Rodents exposed to intermittent hypoxia (IH), a hallmark of sleep apnea, exhibit spatial memory deficits associated with impaired hippocampal neurophysiology and dysregulated adult neurogenesis. We demonstrate that IH creates a pro-oxidant condition that reduces the Tbr2+ neural progenitor pool early in the process, while also suppressing terminal differentiation of adult born neurons during late adult neurogenesis. We further show that IH-dependent cell-autonomous hypoxia inducible factor 1-alpha (HIF1a) signaling is activated in early neuroprogenitors and enhances the generation of adult born neurons upon termination of IH. Our findings indicate that oscillations in oxygen homeostasis, such as those found in sleep apnea, have complex stage-dependent influence over hippocampal adult neurogenesis.
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Affiliation(s)
- Maggie A Khuu
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Thara Nallamothu
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Carolina I Castro-Rivera
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.,Committee On Neurobiology, The University of Chicago, Chicago, IL, 60307, USA.,Grossman Institute for Neuroscience, Quantitative Biology and Human Behavior, The University of Chicago, Chicago, IL, 60637, USA
| | - Alejandra Arias-Cavieres
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Caroline C Szujewski
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.,Committee On Neurobiology, The University of Chicago, Chicago, IL, 60307, USA.,Grossman Institute for Neuroscience, Quantitative Biology and Human Behavior, The University of Chicago, Chicago, IL, 60637, USA
| | - Alfredo J Garcia Iii
- Institute for Integrative Physiology, Section of Emergency Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA. .,Committee On Neurobiology, The University of Chicago, Chicago, IL, 60307, USA. .,Grossman Institute for Neuroscience, Quantitative Biology and Human Behavior, The University of Chicago, Chicago, IL, 60637, USA.
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13
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André C, Rehel S, Kuhn E, Landeau B, Moulinet I, Touron E, Ourry V, Le Du G, Mézenge F, Tomadesso C, de Flores R, Bejanin A, Sherif S, Delcroix N, Manrique A, Abbas A, Marchant NL, Lutz A, Klimecki OM, Collette F, Arenaza-Urquijo EM, Poisnel G, Vivien D, Bertran F, de la Sayette V, Chételat G, Rauchs G. Association of Sleep-Disordered Breathing With Alzheimer Disease Biomarkers in Community-Dwelling Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol 2021; 77:716-724. [PMID: 32202593 DOI: 10.1001/jamaneurol.2020.0311] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Increasing evidence suggests that sleep-disordered breathing (SDB) increases the risk of developing Alzheimer clinical syndrome. However, the brain mechanisms underlying the link between SDB and Alzheimer disease are still unclear. Objective To determine which brain changes are associated with the presence of SDB in older individuals who are cognitively unimpaired, including changes in amyloid deposition, gray matter volume, perfusion, and glucose metabolism. Design, Setting, and Participants This cross-sectional study was conducted using data from the Age-Well randomized clinical trial of the Medit-Ageing European project, acquired between 2016 and 2018 at Cyceron Center in Caen, France. Community-dwelling older adults were assessed for eligibility and were enrolled in the Age-Well clinical trial if they did not meet medical or cognitive exclusion criteria and were willing to participate. Participants who completed a detailed neuropsychological assessment, polysomnography, a magnetic resonance imaging, and florbetapir and fluorodeoxyglucose positron emission tomography scans were included in the analyses. Main Outcomes and Measures Based on an apnea-hypopnea index cutoff of 15 events per hour, participants were classified as having SDB or not. Voxelwise between-group comparisons were performed for each neuroimaging modality, and secondary analyses aimed at identifying which SDB parameter (sleep fragmentation, hypoxia severity, or frequency of respiratory disturbances) best explained the observed brain changes and assessing whether SDB severity and/or SDB-associated brain changes are associated with cognitive and behavioral changes. Results Of 157 participants initially assessed, 137 were enrolled in the Age-Well clinical trial, and 127 were analyzed in this study. The mean (SD) age of the 127 participants was 69.1 (3.9) years, and 80 (63.0%) were women. Participants with SDB showed greater amyloid burden (t114 = 4.51; familywise error-corrected P = .04; Cohen d, 0.83), gray matter volume (t119 = 4.12; familywise error-corrected P = .04; Cohen d, 0.75), perfusion (t116 = 4.62; familywise error-corrected P = .001; Cohen d, 0.86), and metabolism (t79 = 4.63; familywise error-corrected P = .001; Cohen d, 1.04), overlapping mainly over the posterior cingulate cortex and precuneus. No association was found with cognition, self-reported cognitive and sleep difficulties, or excessive daytime sleepiness symptoms. Conclusions and Relevance The SDB-associated brain changes in older adults who are cognitively unimpaired include greater amyloid deposition and neuronal activity in Alzheimer disease-sensitive brain regions, notably the posterior cingulate cortex and precuneus. These results support the need to screen and treat for SDB, especially in asymptomatic older populations, to reduce Alzheimer disease risk. Trial Registration ClinicalTrials.gov Identifier: NCT02977819.
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Affiliation(s)
- Claire André
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Stéphane Rehel
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Elizabeth Kuhn
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Brigitte Landeau
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Inès Moulinet
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Edelweiss Touron
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Valentin Ourry
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Gwendoline Le Du
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Florence Mézenge
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Clémence Tomadesso
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Robin de Flores
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Alexandre Bejanin
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Siya Sherif
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Nicolas Delcroix
- Centre National de la Recherche Scientifique, Unité Mixte de Service 3048, GIP Cyceron, Caen, France
| | - Alain Manrique
- Normandie Université, Université de Caen, EA 4650 "Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique", GIP Cyceron, Caen, France
| | - Ahmed Abbas
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom
| | - Antoine Lutz
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale Unité 1028, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5292, Lyon University, Lyon, France
| | - Olga M Klimecki
- Swiss Center for Affective Sciences, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Collette
- GIGA-Cyclotron Research Centre, In Vivo Imaging and Psychology and Cognitive Neuroscience Unit, Liège University, Liège, Belgium
| | - Eider M Arenaza-Urquijo
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Géraldine Poisnel
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Denis Vivien
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France.,Département de Recherche Clinique, Centre Hospitalier Universitaire de Caen-Normandie, Caen, France
| | - Françoise Bertran
- Unité d'Exploration et de Traitement des Troubles du Sommeil, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Vincent de la Sayette
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France.,Service de Neurologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Gaël Chételat
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237 "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, GIP Cyceron, Caen, France
| | - Géraldine Rauchs
- Normandie Université, Université de Caen, Paris Sciences & Lettres Université, École Pratique des Hautes Études, Institut National de la Santé et de la Recherche Médicale, Unité 1077 "Neuropsychologie et Imagerie de la Mémoire Humaine," Centre Hospitalier Universitaire de Caen, GIP Cyceron, Caen, France
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14
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Li H, Li L, Kong L, Li P, Zeng Y, Li K, Xie W, Shu Y, Liu X, Peng D. Frequency‑Specific Regional Homogeneity Alterations and Cognitive Function in Obstructive Sleep Apnea Before and After Short-Term Continuous Positive Airway Pressure Treatment. Nat Sci Sleep 2021; 13:2221-2238. [PMID: 34992481 PMCID: PMC8714019 DOI: 10.2147/nss.s344842] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Previous studies have demonstrated abnormal local spontaneous brain activity in the conventional frequency bands (0.01-0.08 Hz) in obstructive sleep apnea (OSA). However, it is not clear whether these abnormalities are associated with the specific frequency band of low-frequency oscillations or whether it can be improved with a continuous positive airway pressure (CPAP) treatment. This study aimed to investigate the regional homogeneity (ReHo) in specific frequency at baseline (pre-CPAP) and after one month of CPAP adherence treatment (post-CPAP) in OSA patients. METHODS Twenty-one patients with moderate-to-severe OSA and 21 age- and sex-matched healthy controls (HCs) were included in the final analysis. ReHo was calculated in three different frequency bands (typical frequency band: 0.01-0.1 Hz; slow-5 band: 0.01-0.027 Hz; slow-4 band: 0.027-0.073 Hz), respectively. A partial correlational analysis was performed to assess the relationship between altered ReHo and clinical evaluation. RESULTS OSA patients revealed increased ReHo in the brainstem, bilateral inferior temporal gyrus (ITG)/fusiform, and right-cerebellum posterior lobe (CPL), and decreased ReHo in the bilateral inferior parietal lobule (IPL), right superior temporal gyrus (STG), and left precentral gyrus (PG) compared to HC groups in different frequency bands. Significantly changed ReHo in the bilateral middle temporal gyrus (MTG), PG, medial frontal gyrus (MFG), supplementary motor area (SMA), CPL, IPL, left superior frontal gyrus (SFG), ITG, MTG, and right STG were observed between post-CPAP and pre-CPAP OSA patients, which was associated with specific frequency bands. The altered ReHo in specific frequency bands was correlated with Montreal cognitive assessment score, Epworth sleepiness scale, and apnea hypopnea index in pre-CPAP OSA patients. CONCLUSION These findings indicate that OSA has frequency-related abnormalities of spontaneous neural activity before and after short-term CPAP treatment, which might contribute to a better understanding of local neural psychopathology and may serve as potential biomarkers for clinical CPAP treatment.
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Affiliation(s)
- Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Lan Li
- Jiangxi Provincial Institute of Parasitic Diseases Control, Nanchang City, Jiangxi Province, People's Republic of China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
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15
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Villasana-Salazar B, Hernández-Soto R, Guerrero-Gómez ME, Ordaz B, Manrique-Maldonado G, Salgado-Puga K, Peña-Ortega F. Chronic intermittent hypoxia transiently increases hippocampal network activity in the gamma frequency band and 4-Aminopyridine-induced hyperexcitability in vitro. Epilepsy Res 2020; 166:106375. [PMID: 32745888 DOI: 10.1016/j.eplepsyres.2020.106375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/21/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
Chronic intermittent hypoxia (CIH) is the most distinct feature of obstructive sleep apnea (OSA), a common breathing and sleep disorder that leads to several neuropathological consequences, including alterations in the hippocampal network and in seizure susceptibility. However, it is currently unknown whether these alterations are permanent or remit upon normal oxygenation. Here, we investigated the effects of CIH on hippocampal spontaneous network activity and hyperexcitability in vitro and explored whether these alterations endure or fade after normal oxygenation. Results showed that applying CIH for 21 days to adult rats increases gamma-band hippocampal network activity and aggravates 4-Aminopyridine-induced epileptiform activity in vitro. Interestingly, these CIH-induced alterations remit after 30 days of normal oxygenation. Our findings indicate that hippocampal network alterations and increased seizure susceptibility induced by CIH are not permanent and can be spontaneously reverted, suggesting that therapeutic interventions against OSA in patients with epilepsy, such as surgery or continuous positive airway pressure (CPAP), could be favorable for seizure control.
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Affiliation(s)
- Benjamín Villasana-Salazar
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - Rebeca Hernández-Soto
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - María Estefanía Guerrero-Gómez
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - Benito Ordaz
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - Guadalupe Manrique-Maldonado
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - Karla Salgado-Puga
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México
| | - Fernando Peña-Ortega
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México.
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16
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Post-Concussion Syndrome and Sleep Apnea: A Retrospective Study. J Clin Med 2020; 9:jcm9030691. [PMID: 32143445 PMCID: PMC7141351 DOI: 10.3390/jcm9030691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Concussion symptoms typically resolve within 7–10 days, but 10–25% of patients do not fully recover. They can develop post-concussion syndrome (PCS), which includes sleep abnormalities such as obstructive sleep apnea. It is unclear how specific sleep problems manifest in PCS and how it relates to cognition and symptomology. Methods: A retrospective chart review was conducted on PCS patients seen at the University Health Network (UHN) Concussion Clinic and sent for sleep study. Neuropsychology tests, concussion features, PCS symptoms, and demographics were abstracted from clinical charts. Sleep measures were abstracted from the overnight sleep study. Data were analyzed using chi-squared tests and linear regression. Results: Fifty-one patients completed the sleep study; 78% of these were diagnosed with sleep apnea. Patients with sleep apnea reported significantly more memory symptoms. A trend existed for higher total symptom number. Age was significantly different between the two groups. Women and men were equally at risk of being diagnosed with sleep apnea. Conclusions: Sleep apnea is common in PCS patients complaining of non-restorative sleep and/or waking up with headaches. Sleep apnea was associated with more memory symptoms. PCS patients are at higher risk for sleep apnea and sleep study should be considered if complaining of non-restorative sleep and/or waking up with headaches, regardless of sex and other known risk factors.
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17
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Tang L, Liu W, Yang Y, Han W, Li K. Relationship between sleep and cognitive function in patients with heart failure: A systematic review. J Psychosom Res 2020; 130:109913. [PMID: 31918359 DOI: 10.1016/j.jpsychores.2019.109913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/09/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this systematic review is to synthesize relevant evidence and illustrate the relationship between sleep and cognitive function in patients with heart failure. METHODS A literature search was conducted on Embase, PubMed, Web of Science, CINAHL, PsychINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wan Fang to identify relevant studies. RESULTS Seven studies, which enrolled a total of 1218 heart failure patients, were included in this review. These articles investigating the relationship between sleep and cognitive performance in patients with heart failure had inconsistent results. Five studies confirmed that sleep quality and insomnia were significantly associated with cognitive function, including global cognition, attention, and executive function, whereas the other two studies indicated no statistically significant relationship between sleep and cognitive function. CONCLUSION Although limited evidence restricts the overall conclusions, this review might provide new opportunities to identify patients with heart failure that are at high risk for cognitive decline. Further studies across a longer period are needed to confirm the relationship between sleep and cognitive function in patients with heart failure.
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Affiliation(s)
- Liya Tang
- School of Nursing, Jilin University, Changchun, China
| | - Wenping Liu
- Department of Neurology, The Second Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Wenwen Han
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China.
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18
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Lajoie AC, Lafontaine AL, Kimoff RJ, Kaminska M. Obstructive Sleep Apnea in Neurodegenerative Disorders: Current Evidence in Support of Benefit from Sleep Apnea Treatment. J Clin Med 2020; 9:E297. [PMID: 31973065 PMCID: PMC7073991 DOI: 10.3390/jcm9020297] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent upper airway obstruction during sleep resulting in intermittent hypoxemia and sleep fragmentation. Research has recently increasingly focused on the impact of OSA on the brain's structure and function, in particular as this relates to neurodegenerative diseases. This article reviews the links between OSA and neurodegenerative disease, focusing on Parkinson's disease, including proposed pathogenic mechanisms and current knowledge on the effects of treatment.
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Affiliation(s)
- Annie C. Lajoie
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.C.L.); (R.J.K.)
| | - Anne-Louise Lafontaine
- Montreal Neurological Institute, McGill University Health Centre, Montreal, QC H3A 2B4, Canada;
| | - R. John Kimoff
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.C.L.); (R.J.K.)
- Respiratory Division & Sleep Laboratory, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.C.L.); (R.J.K.)
- Respiratory Division & Sleep Laboratory, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis G G, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2019; 50:101250. [PMID: 31881487 DOI: 10.1016/j.smrv.2019.101250] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence links cognitive-decline and Alzheimer's disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA's prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA's heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.
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Affiliation(s)
- Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Arlener D Turner
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Human Services and Psychology, National Louis University, Chicago, IL, USA
| | - Mony J de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girardin Jean-Louis G
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA.
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20
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Gosselin N, Baril AA, Osorio RS, Kaminska M, Carrier J. Obstructive Sleep Apnea and the Risk of Cognitive Decline in Older Adults. Am J Respir Crit Care Med 2019; 199:142-148. [PMID: 30113864 DOI: 10.1164/rccm.201801-0204pp] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Nadia Gosselin
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
| | - Andrée-Ann Baril
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
| | - Ricardo S Osorio
- 4 Center for Brain Health, New York University Langone Medical Center, Manhattan, New York.,5 Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York; and
| | - Marta Kaminska
- 3 Canadian Sleep and Circadian Network, Canada.,6 Respiratory Epidemiology and Clinical Research Unit, Respiratory Division and Sleep Laboratory, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Julie Carrier
- 1 Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,2 Université de Montréal, Montreal, Canada.,3 Canadian Sleep and Circadian Network, Canada
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21
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Zielinski MR, Systrom DM, Rose NR. Fatigue, Sleep, and Autoimmune and Related Disorders. Front Immunol 2019; 10:1827. [PMID: 31447842 PMCID: PMC6691096 DOI: 10.3389/fimmu.2019.01827] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022] Open
Abstract
Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness-all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system-a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.
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Affiliation(s)
- Mark R Zielinski
- Veterans Affairs Boston Healthcare System, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - David M Systrom
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Noel R Rose
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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22
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Chen YJ, Liu YC, Liu YW, Lee YB, Huang HC, Chen YY, Shih YH, Lee YC, Cheng CF, Meng TC. Nitrite Protects Neurons Against Hypoxic Damage Through S-nitrosylation of Caspase-6. Antioxid Redox Signal 2019; 31:109-126. [PMID: 30417658 DOI: 10.1089/ars.2018.7522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims: The coordination of neurons to execute brain functions requires plenty of oxygen. Thus, it is not surprising that the chronic hypoxia resulting from chronic obstructive pulmonary diseases (COPD) can cause neuronal damage. Injury in the cortex can give rise to anxiety and cognitive dysfunction. This study investigated what causes hypoxia-induced neuronal injury and what strategies might be used to protect neurons against such damage. Results: This study found that hypoxia in primary cortical neurons caused neurite retraction, a caspase-6-dependent process. The hypoxic stress activated caspase-6 within the neurite, leading to microtubule disassembly and neurite retraction. The effect of hypoxia on caspase-6 activation, microtubule disassembly, and neurite retraction was alleviated by nitrite treatment. The protective role of nitrite was further supported by the observation that the active-site Cys146 of caspase-6 was S-nitrosylated in hypoxic neuro-2a cells treated with nitrite. We further validated the beneficial effect of nitrite on neuronal function against hypoxic stress in vivo. Using the wild-type or Apo E-/- mice exposed to chronic hypoxia as a model, we demonstrated that supplementing drinking water with nitrite suppressed active caspase-6 in the cortex of the brain, concomitant with the prevention of hypoxia-induced anxiety in the animals. Innovation: These results are the first evidence of a new pathway for the activation of caspase-6 and the first to indicate that nitrite can protect neurons against chronic hypoxic insult. Conclusion: Our findings suggest that nitrite holds great potential for the treatment of diseases such as COPD associated with hypoxia-induced neuronal injury.
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Affiliation(s)
- Yen-Jung Chen
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yun-Chung Liu
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Wen Liu
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Bin Lee
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Hsin-Chieh Huang
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yi-Yun Chen
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | | | - Ying-Chu Lee
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Ching-Feng Cheng
- 4 Department of Medical Research, Tzu Chi University, Hualien, Taiwan.,5 Department of Pediatrics, Tzu Chi General Hospital, Hualien, Taiwan.,6 Institutes of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Tzu-Ching Meng
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
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23
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Barletta P, Abreu AR, Ramos AR, Dib SI, Torre C, Chediak AD. Role of Obstructive Sleep Apnea in Cognitive Impairment. INTERNATIONAL JOURNAL OF HEAD AND NECK SURGERY 2019; 10:57-61. [PMID: 34305353 PMCID: PMC8302067 DOI: 10.5005/jp-journals-10001-1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer’s disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.
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Affiliation(s)
- Pamela Barletta
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexandre R Abreu
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto R Ramos
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Salim I Dib
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Carlos Torre
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alejandro D Chediak
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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24
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Ko CY, Fan JM, Hu AK, Su HZ, Yang JH, Huang LM, Yan FR, Zhang HP, Zeng YM. Disruption of sleep architecture in Prevotella enterotype of patients with obstructive sleep apnea-hypopnea syndrome. Brain Behav 2019; 9:e01287. [PMID: 30957979 PMCID: PMC6520469 DOI: 10.1002/brb3.1287] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Intermittent hypoxia and sleep fragmentation are critical pathophysiological processes involved in obstructive sleep apnea-hypopnea syndrome (OSAHS). Those manifestations independently affect similar brain regions and contribute to OSAHS-related comorbidities that are known to be related to the host gut alteration microbiota. We hypothesized that gut microbiota disruption may cross talk the brain function via the microbiota-gut-brain axis. Thus, we aim to survey enterotypes and polysomnographic data of patients with OSAHS. METHODS Subjects were diagnosed by polysomnography, from whom fecal samples were obtained and analyzed for the microbiome composition by variable regions 3-4 of 16S rRNA pyrosequencing and bioinformatic analyses. We examined the fasting levels of interleukin-6 and tumor necrosis factor-alpha of all subjects. RESULTS Three enterotypes Bacteroides, Ruminococcus, and Prevotella were identified in patients with OSAHS. Arousal-related parameters or sleep stages are significantly disrupted in apnea-hypopnea index (AHI) ≥15 patients with Prevotella enterotype; further analysis this enterotype subjects, obstructive, central, and mixed apnea indices, and mean heart rate are also significantly elevated in AHI ≥15 patients. However, blood cytokines levels of all subjects were not significantly different. CONCLUSIONS This study indicates the possibility of pathophysiological interplay between enterotypes and sleeps structure disruption in sleep apnea through a microbiota-gut-brain axis and offers some new insight toward the pathogenesis of OSAHS.
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Affiliation(s)
- Chih-Yuan Ko
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China.,Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ji-Mim Fan
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - An-Ke Hu
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - Huan-Zhang Su
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - Jiao-Hong Yang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - Li-Mei Huang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - Fu-Rong Yan
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China.,Center for Molecular Diagnosis and Therapy, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hua-Ping Zhang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,Key Laboratory of Fujian Medical University, Fujian Province University, Quanzhou, China
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25
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Parekh A, Mullins AE, Kam K, Varga AW, Rapoport DM, Ayappa I. Slow-wave activity surrounding stage N2 K-complexes and daytime function measured by psychomotor vigilance test in obstructive sleep apnea. Sleep 2019; 42:zsy256. [PMID: 30561750 PMCID: PMC6424089 DOI: 10.1093/sleep/zsy256] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/20/2018] [Accepted: 12/14/2018] [Indexed: 01/12/2023] Open
Abstract
STUDY OBJECTIVE To better understand the inter-individual differences in neurobehavioral impairment in obstructive sleep apnea (OSA) and its treatment with continuous positive airway pressure (CPAP), we examined how changes in sleep electroencephalography (EEG) slow waves were associated with next-day psychomotor vigilance test (PVT) performance. METHODS Data from 28 OSA subjects (Apnea-Hypopnea Index with 3% desaturation and/or with an associated arousal [AHI3A] > 15/hour; AHI3A = sum of all apneas and hypopneas with 3% O2 desaturation and/or an EEG arousal, divided by total sleep time [TST]), who underwent three full in-lab nocturnal polysomnographies (NPSGs: chronic OSA, CPAP-treated OSA, and acute OSA), and 19 healthy sleepers were assessed. Four 20-minute PVTs were performed after each NPSG along with subjective and objective assessment of sleepiness. Three EEG metrics were calculated: K-complex (KC) Density (#/minute of N2 sleep), change in slow-wave activity in 1-second envelopes surrounding KCs (ΔSWAK), and relative frontal slow-wave activity during non-rapid eye movement (NREM) (%SWA). RESULTS CPAP treatment of OSA resulted in a decrease in KC Density (chronic: 3.9 ± 2.2 vs. treated: 2.7 ± 1.1; p < 0.01; mean ± SD) and an increase in ΔSWAK (chronic: 2.6 ± 2.3 vs. treated: 4.1 ± 2.4; p < 0.01) and %SWA (chronic: 20.9 ± 8.8 vs. treated: 26.6 ± 8.6; p < 0.001). Cross-sectionally, lower ΔSWAK values were associated with higher PVT Lapses (chronic: rho = -0.55, p < 0.01; acute: rho = -0.46, p = 0.03). Longitudinally, improvement in PVT Lapses with CPAP was associated with an increase in ΔSWAK (chronic to treated: rho = -0.48, p = 0.02; acute to treated: rho = -0.5, p = 0.03). In contrast, OSA severity or global sleep quality metrics such as arousal index, NREM, REM, or TST were inconsistently associated with PVT Lapses. CONCLUSION Changes in EEG slow waves, in particular ∆SWAK, explain inter-individual differences in PVT performance better than conventional NPSG metrics, suggesting that ΔSWAK is a night-time correlate of next-day vigilance in OSA.
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Affiliation(s)
- Ankit Parekh
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna E Mullins
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Korey Kam
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew W Varga
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David M Rapoport
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Indu Ayappa
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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26
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A Human Neuroimaging Perspective on Sleep in Normative and Pathological Ageing. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-0133-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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28
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Snyder B, Duong P, Tenkorang M, Wilson EN, Cunningham RL. Rat Strain and Housing Conditions Alter Oxidative Stress and Hormone Responses to Chronic Intermittent Hypoxia. Front Physiol 2018; 9:1554. [PMID: 30459637 PMCID: PMC6232418 DOI: 10.3389/fphys.2018.01554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022] Open
Abstract
Sleep apnea has been associated with elevated risk for metabolic, cognitive, and cardiovascular disorders. Further, the role of hypothalamic–pituitary–adrenal (HPA) activation in sleep apnea has been controversial in human studies. Chronic intermittent hypoxia (CIH) is a rodent model, which mimics the hypoxemia experienced by patients with sleep apnea. Most studies of CIH in rats have been conducted in the Sprague Dawley rat strain. Previously published literature suggests different strains of rats exhibit various responses to disease models, and these effects can be further modulated by the housing conditions experienced by each strain. This variability in response is similar to what has been observed in clinical populations, especially with respect to the HPA system. To investigate if strain or housing (individual or pair-housed) can affect the results of CIH (AHI 8 or 10) treatment, we exposed individual and pair-housed Sprague Dawley and Long-Evans male rats to 7 days of CIH treatment. This was followed by biochemical analysis of circulating hormones, oxidative stress, and neurodegenerative markers. Both strain and housing conditions altered oxidative stress generation, hyperphosphorylated tau protein (tau tangles), circulating corticosterone and adrenocorticotropic hormone (ACTH), and weight metrics. Specifically, pair-housed Long-Evans rats were the most sensitive to CIH, which showed a significant association between oxidative stress generation and HPA activation under conditions of AHI of 8. These results suggest both strain and housing conditions can affect the outcomes of CIH.
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Affiliation(s)
- Brina Snyder
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Phong Duong
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Mavis Tenkorang
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - E Nicole Wilson
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Rebecca L Cunningham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
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29
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Snyder B, Duong P, Trieu J, Cunningham RL. Androgens modulate chronic intermittent hypoxia effects on brain and behavior. Horm Behav 2018; 106:62-73. [PMID: 30268884 PMCID: PMC6486829 DOI: 10.1016/j.yhbeh.2018.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022]
Abstract
Sleep apnea is associated with testosterone dysregulation as well as increased risk of developing neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). A rodent model of the hypoxemic events of sleep apnea, chronic intermittent hypoxia (CIH), has been previously documented to impair cognitive function and elevate oxidative stress in male rats, while simultaneously decreasing testosterone. Therefore, androgens may modulate neuronal function under CIH. To investigate the role of androgens during CIH, male rats were assigned to one of four hormone groups: 1) gonadally intact, 2) gonadectomized (GDX), 3) GDX + testosterone (T) supplemented, or 4) GDX + dihydrotestosterone (DHT) supplemented. Each group was exposed to either normal room air or CIH exposure for one week, followed by memory and motor task assessments. Brain regions associated with AD and PD (entorhinal cortex, dorsal hippocampus, and substantia nigra) were examined for oxidative stress and inflammatory markers, key characteristics of AD and PD. Gonadally intact rats exhibited elevated oxidative stress due to CIH, but no significant memory and motor impairments. GDX increased memory impairments, regardless of CIH exposure. T preserved memory function and prevented detrimental CIH-induced changes. In contrast, DHT was not protective, as evidenced by exacerbated oxidative stress under CIH. Further, CIH induced significant spatial memory impairment in rats administered DHT. These results indicate androgens can have both neuroprotective and detrimental effects under CIH, which may have clinical relevance for men with untreated sleep apnea.
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Affiliation(s)
- Brina Snyder
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Phong Duong
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Jenny Trieu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Rebecca L Cunningham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America.
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30
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Walter FA, Ede D, Hawkins MAW, Dolansky MA, Gunstad J, Josephson R, Moore SM, Hughes JW. Sleep quality and daytime sleepiness are not associated with cognition in heart failure. J Psychosom Res 2018; 113:100-106. [PMID: 30190041 DOI: 10.1016/j.jpsychores.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with heart failure (HF) exhibit comorbid impairments in both sleep and cognitive performance. Sleep quality has been associated with impaired cognitive performance in HF patients, but reports are inconsistent. In this study, we examined associations between sleep quality, daytime sleepiness, and cognitive function in HF. METHODS AND RESULTS Participants were 267 (age = 69.1 ± 9.3) mostly Caucasian (74.9%), male (59.6%) stable HF patients recruited from outpatient settings. This cross-sectional study was a secondary analysis of a prospective observational study. Cognitive function domains assessed included: global cognitive function, attention, memory, and executive function. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Separate multiple hierarchical linear regressions were conducted to determine associations between cognitive function and sleep quality and daytime sleepiness, after controlling for sex, New York Heart Association (NYHA) class, education, depressive symptoms, and medical comorbidities. Cognitive function was not associated with sleep quality or daytime sleepiness after alpha inflation corrections were applied. CONCLUSIONS Cognitive function in HF is not associated with sleep quality or daytime sleepiness; other factors may exert greater influence on cognitive performance.
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Affiliation(s)
- Fawn A Walter
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - David Ede
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - Misty A W Hawkins
- Oklahoma State University, Department of Psychology, 116 N. Murray, Stillwater, OK 74078, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - John Gunstad
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - Richard Josephson
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA; College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joel W Hughes
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA.
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Autonomic regulation during sleep and wakefulness: a review with implications for defining the pathophysiology of neurological disorders. Clin Auton Res 2018; 28:509-518. [PMID: 30155794 DOI: 10.1007/s10286-018-0560-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular and respiratory parameters change during sleep and wakefulness. This observation underscores an important, albeit incompletely understood, role for the central nervous system in the differential regulation of autonomic functions. Understanding sleep/wake-dependent sympathetic modulations provides insights into diseases involving autonomic dysfunction. The purpose of this review was to define the central nervous system nuclei regulating sleep and cardiovascular function and to identify reciprocal networks that may underlie autonomic symptoms of disorders such as insomnia, sleep apnea, restless leg syndrome, rapid eye movement sleep behavior disorder, and narcolepsy/cataplexy. In this review, we examine the functional and anatomical significance of hypothalamic, pontine, and medullary networks on sleep, cardiovascular function, and breathing.
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32
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Song X, Roy B, Kang DW, Aysola RS, Macey PM, Woo MA, Yan-Go FL, Harper RM, Kumar R. Altered resting-state hippocampal and caudate functional networks in patients with obstructive sleep apnea. Brain Behav 2018; 8:e00994. [PMID: 29749715 PMCID: PMC5991585 DOI: 10.1002/brb3.994] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/29/2018] [Accepted: 04/06/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Brain structural injury and metabolic deficits in the hippocampus and caudate nuclei may contribute to cognitive and emotional deficits found in obstructive sleep apnea (OSA) patients. If such contributions exist, resting-state interactions of these subcortical sites with cortical areas mediating affective symptoms and cognition should be disturbed. Our aim was to examine resting-state functional connectivity (FC) of the hippocampus and caudate to other brain areas in OSA relative to control subjects, and to relate these changes to mood and neuropsychological scores. METHODS We acquired resting-state functional magnetic resonance imaging (fMRI) data from 70 OSA and 89 healthy controls using a 3.0-Tesla magnetic resonance imaging scanner, and assessed psychological and behavioral functions, as well as sleep issues. After standard fMRI data preprocessing, FC maps were generated for bilateral hippocampi and caudate nuclei, and compared between groups (ANCOVA; covariates, age and gender). RESULTS Obstructive sleep apnea subjects showed significantly higher levels of anxiety and depressive symptoms over healthy controls. In OSA subjects, the hippocampus showed disrupted FC with the thalamus, para-hippocampal gyrus, medial and superior temporal gyrus, insula, and posterior cingulate cortex. Left and right caudate nuclei showed impaired FC with the bilateral inferior frontal gyrus and right angular gyrus. In addition, altered limbic-striatal-cortical FC in OSA showed relationships with behavioral and neuropsychological variables. CONCLUSIONS The compromised hippocampal-cortical FC in OSA may underlie depression and anxious mood levels in OSA, while impaired caudate-cortical FC may indicate deficits in reward processing and cognition. These findings provide insights into the neural mechanisms underlying the comorbidity of mood and cognitive deficits in OSA.
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Affiliation(s)
- Xiaopeng Song
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Bhaswati Roy
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel W Kang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ravi S Aysola
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Frisca L Yan-Go
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ronald M Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA, USA
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33
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Snyder B, Cunningham RL. Sex differences in sleep apnea and comorbid neurodegenerative diseases. Steroids 2018; 133:28-33. [PMID: 29258810 PMCID: PMC5864541 DOI: 10.1016/j.steroids.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]
Abstract
Sleep apnea is a disorder, which increasingly affects people worldwide. Whether the associated hypoxic events during sleep are central or obstructive in origin, the end result is excessive daytime sleepiness and an increased risk for several comorbidities, such as cardiovascular and neurodegenerative disorders. Sleep apnea is diagnosed more frequently in men than women, suggesting a role of sex hormones in the pathology of the disease. Furthermore, there are sex differences in the development and progression of comorbid diseases associated with sleep apnea. Therefore, treatment of sleep apnea may be clinically relevant for prevention of subsequent sex-specific comorbid disorders. While the impact sleep apnea has on cardiovascular events has been the subject of many research studies, the role of sleep apnea in neurodegeneration is less established. Here we review known risk factors for sleep apnea and the implications of the observed sex differences in this disease. We also summarize the evidence and mechanisms for how sleep apnea may contribute to the onset of neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease.
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Affiliation(s)
- Brina Snyder
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Rebecca L Cunningham
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States.
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34
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Sleep apnea: Altered brain connectivity underlying a working-memory challenge. NEUROIMAGE-CLINICAL 2018; 19:56-65. [PMID: 30035002 PMCID: PMC6051941 DOI: 10.1016/j.nicl.2018.03.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by the frequent presence of neuro-cognitive impairment. Recent studies associate cognitive dysfunction with altered resting-state brain connectivity between key nodes of the executive and default-mode networks, two anti-correlated functional networks whose strength of activation increases or decreases with cognitive activity, respectively. To date no study has investigated a relationship between cognitive impairment in OSA and brain connectivity during an active working-memory challenge. We thus investigated the effect of OSA on working-memory performance and underlying brain connectivity. OSA patients and matched healthy controls underwent functional magnetic resonance imaging (fMRI) scanning while performing a 2-back working-memory task. Standard fMRI analyses highlighted the brain regions activated at increasing levels of working-memory load, which were used as seeds in connectivity analyses. The latter were based on a multiregional Psycho-Physiological-Interaction (PPI) approach, to unveil group differences in effective connectivity underlying working-memory performance. Compared with controls, in OSA patients normal working-memory performance reflected in: a) reduced interhemispheric effective connectivity between the frontal “executive” nodes of the working-memory network, and b) increased right-hemispheric connectivity among regions mediating the “salience-based” switch from the default resting-state mode to the effortful cognitive activity associated with the executive network. The strength of such connections was correlated, at increasing task-demands, with executive (Stroop test) and memory (Digit Span test) performance in neuro-cognitive evaluations. The analysis of effective connectivity changes during a working-memory challenge provides a complementary window, compared with resting-state studies, on the mechanisms supporting preserved performance despite functional and structural brain modifications in OSA. Sleep apnea (OSA) is frequently characterized by neuro-cognitive impairment. We addressed brain connectivity underlying working-memory (WM) in OSA. Normal WM reflected in reduced interhemispheric connectivity in the executive network. Normal WM reflected in increased connectivity between salience and default networks. Brain connectivity highlights compensatory mechanisms supporting performance in OSA.
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35
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Snyder B, Shell B, Cunningham JT, Cunningham RL. Chronic intermittent hypoxia induces oxidative stress and inflammation in brain regions associated with early-stage neurodegeneration. Physiol Rep 2018; 5:5/9/e13258. [PMID: 28473320 PMCID: PMC5430123 DOI: 10.14814/phy2.13258] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/18/2023] Open
Abstract
Sleep apnea is a common comorbidity of neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). Previous studies have shown an association between elevated oxidative stress and inflammation with severe sleep apnea. Elevated oxidative stress and inflammation are also hallmarks of neurodegenerative diseases. We show increased oxidative stress and inflammation in a manner consistent with early stages of neurodegenerative disease in an animal model of mild sleep apnea. Male rats were exposed to 7 days chronic intermittent hypoxia (CIH) for 8 h/day during the light period. Following CIH, plasma was collected and tested for circulating oxidative stress and inflammatory markers associated with proinflammatory M1 or anti-inflammatory M2 profiles. Tissue punches from brain regions associated with different stages of neurodegenerative diseases (early stage: substantia nigra and entorhinal cortex; intermediate: hippocampus; late stage: rostral ventrolateral medulla and solitary tract nucleus) were also assayed for inflammatory markers. A subset of the samples was examined for 8-hydroxydeoxyguanosine (8-OHdG) expression, a marker of oxidative stress-induced DNA damage. Our results showed increased circulating oxidative stress and inflammation. Furthermore, brain regions associated with early-stage (but not late-stage) AD and PD expressed oxidative stress and inflammatory profiles consistent with reported observations in preclinical neurodegenerative disease populations. These results suggest mild CIH induces key features that are characteristic of early-stage neurodegenerative diseases and may be an effective model to investigate mechanisms contributing to oxidative stress and inflammation in those brain regions.
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Affiliation(s)
- Brina Snyder
- Institute for Health Aging, University of North Texas Health Science Center, Fort Worth, Texas
| | - Brent Shell
- Institute for Cardiovascular and Metabolic Disease, University of North Texas Health Science Center, Fort Worth, Texas
| | - J Thomas Cunningham
- Institute for Cardiovascular and Metabolic Disease, University of North Texas Health Science Center, Fort Worth, Texas
| | - Rebecca L Cunningham
- Institute for Health Aging, University of North Texas Health Science Center, Fort Worth, Texas
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36
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Polsek D, Gildeh N, Cash D, Winsky-Sommerer R, Williams SCR, Turkheimer F, Leschziner GD, Morrell MJ, Rosenzweig I. Obstructive sleep apnoea and Alzheimer's disease: In search of shared pathomechanisms. Neurosci Biobehav Rev 2018; 86:142-149. [PMID: 29223769 PMCID: PMC6562163 DOI: 10.1016/j.neubiorev.2017.12.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/29/2017] [Accepted: 12/04/2017] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a significant public health concern. The incidence continues to rise, and it is set to be over one million in the UK by 2025. The processes involved in the pathogenesis of AD have been shown to overlap with those found in cognitive decline in patients with Obstructive Sleep Apnoea (OSA). Currently, the standard treatment for OSA is Continuous Positive Airway Pressure. Adherence to treatment can, however, be an issue, especially in patients with dementia. Also, not all patients respond adequately, necessitating the use of additional treatments. Based on the body of data, we here suggest that excessive and prolonged neuronal activity might contribute to genesis and acceleration of both AD and OSA in the absence of appropriately structured sleep. Further, we argue that external factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain, and further promote disease progression. If this hypothesis is proven in future studies, it could have far-reaching clinical translational implications, as well as implications for future treatment strategies in OSA.
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Affiliation(s)
- D Polsek
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
| | - N Gildeh
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - D Cash
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Department of Neuroimaging, IoPPN, King's College London, UK
| | - R Winsky-Sommerer
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - S C R Williams
- Department of Neuroimaging, IoPPN, King's College London, UK
| | - F Turkheimer
- Department of Neuroimaging, IoPPN, King's College London, UK
| | - G D Leschziner
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK; Department of Neurology, Guy's and St Thomas' Hospital, London, UK
| | - M J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - I Rosenzweig
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK.
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37
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Polsek D, Gildeh N, Cash D, Winsky-Sommerer R, Williams SCR, Turkheimer F, Leschziner GD, Morrell MJ, Rosenzweig I. Obstructive sleep apnoea and Alzheimer's disease: In search of shared pathomechanisms. Neurosci Biobehav Rev 2017. [PMID: 29223769 DOI: 10.1016/j.neubiorev.2017.12.004.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Alzheimer's disease (AD) is a significant public health concern. The incidence continues to rise, and it is set to be over one million in the UK by 2025. The processes involved in the pathogenesis of AD have been shown to overlap with those found in cognitive decline in patients with Obstructive Sleep Apnoea (OSA). Currently, the standard treatment for OSA is Continuous Positive Airway Pressure. Adherence to treatment can, however, be an issue, especially in patients with dementia. Also, not all patients respond adequately, necessitating the use of additional treatments. Based on the body of data, we here suggest that excessive and prolonged neuronal activity might contribute to genesis and acceleration of both AD and OSA in the absence of appropriately structured sleep. Further, we argue that external factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain, and further promote disease progression. If this hypothesis is proven in future studies, it could have far-reaching clinical translational implications, as well as implications for future treatment strategies in OSA.
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Affiliation(s)
- D Polsek
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Croatian Institute for Brain Research, Medical School, University of Zagreb, Croatia
| | - N Gildeh
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - D Cash
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Department of Neuroimaging, IoPPN, King's College London, UK
| | - R Winsky-Sommerer
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - S C R Williams
- Department of Neuroimaging, IoPPN, King's College London, UK
| | - F Turkheimer
- Department of Neuroimaging, IoPPN, King's College London, UK
| | - G D Leschziner
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK; Department of Neurology, Guy's and St Thomas' Hospital, London, UK
| | - M J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - I Rosenzweig
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK.
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38
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Kim H, Thomas RJ, Yun CH, Au R, Lee SK, Lee S, Shin C. Association of Mild Obstructive Sleep Apnea With Cognitive Performance, Excessive Daytime Sleepiness, and Quality of Life in the General Population: The Korean Genome and Epidemiology Study (KoGES). Sleep 2017; 40:2962428. [PMID: 28329071 DOI: 10.1093/sleep/zsx012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Study Objectives Research points to impaired cognitive performance in sleep clinic patients with obstructive sleep apnea (OSA). However, inconsistent findings from various epidemiologic studies make this relationship less generalizable. The current study investigated the association between OSA and functional outcome measures, such as cognition, daytime sleepiness, and quality of life, in a Korean general population sample. Methods A total of 1492 participants from the Korean Genome and Epidemiology Study (KoGES) were included in the analyses. The presence of OSA measured by overnight polysomnography (PSG) was defined by apnea-hypopnea index (AHI) >5. Cognitive performance was determined with scores from a comprehensive neuropsychological battery. Excessive daytime sleepiness and quality of life were additionally measured through subjective reports. Results After adjusting for various demographic and medical characteristics, OSA was independently associated with lower performance in the Digit Symbol Test (52.73 ± 17.08 vs. 58.72 ± 18.03, OSA vs. not, p = .02). Hypoxia measures were not related to cognitive performance. OSA was associated with higher odds of displaying excessive daytime sleepiness (odds ratio = 1.72, 95% CI: 1.05-2.80), but there was no significant relationship between OSA and quality of life. Conclusions Cognition was unexpectedly unaffected overall. However, OSA was associated with impairment in a multidomain test that taps skills generally associated with frontal lobe function. The results suggest that research on protective and adaptive brain mechanisms to OSA stress can provide unique insights into the brain-sleep interface. As the study runs longitudinally, it will enable future studies on the impact of OSA on cognitive decline.
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Affiliation(s)
- Hyun Kim
- Department of Psychological and Brain Sciences, Boston University.,Institute of Human Genomic Study, Korea University Ansan Hospital.,Framingham Heart Study, Boston University School of Medicine
| | - Robert J Thomas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital
| | - Sunghee Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital.,Department of Respiratory Internal Medicine, Korea University Ansan Hospital
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Farr OM, Rifas-Shiman SL, Oken E, Taveras EM, Mantzoros CS. Current child, but not maternal, snoring is bi-directionally related to adiposity and cardiometabolic risk markers: A cross-sectional and a prospective cohort analysis. Metabolism 2017; 76:70-80. [PMID: 28774733 PMCID: PMC5733777 DOI: 10.1016/j.metabol.2017.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA), typically manifested as snoring, is closely associated with obesity. However, the directionality of associations of OSA with cardiometabolic risk markers is unclear, as obesity increases risk for OSA, and OSA results in excess weight gain and its metabolic consequences. Less is known about how obesity and OSA may relate in children and adolescents and whether maternal OSA may influence the development of obesity and cardiometabolic dysfunction in offspring. BASIC PROCEDURES Among 1078 children from the Project Viva cohort, we examined cross-sectionally and prospectively associations of parent-reported child or maternal snoring with cardiometabolic outcomes, including adiposity, adipokines, and insulin resistance. MAIN FINDINGS Cross-sectionally, child snoring was related to adiposity and metabolic risk, particularly body mass index (BMI; β 0.61kg/m2, 95% CI 0.33, 0.89; p<0.001), trunk fat mass index (β 0.23kg/m2, CI 0.12, 0.34; p<0.001), high-density lipoprotein cholesterol (β -1.47mg/dL, CI -2.69, -0.25; p=0.02), and metabolic risk z-score (β 0.08, CI 0.02, 0.14; p=0.01) after correction for covariates. Prospectively, adiposity (BMI, trunk fat, fat mass, and waist circumference) and cardiometabolic (leptin, HOMA-IR, CRP, and global metabolic risk) measures at mid-childhood (~7y) were associated with child snoring at the early teen visit (~12y) after correction for covariates. Child snoring at ~9y was related to changes in adiposity between mid-childhood and early teen visits. CONCLUSIONS Child but not maternal snoring, was related to child adiposity and cardiometabolic outcomes. Adiposity and child snoring are associated with each other cross-sectionally and are each predictive of the other among children/adolescents prospectively. These results suggest similar mechanisms in pediatric/adolescent populations as in adults for the development of sleep-disordered breathing and sleep apnea that will need to be confirmed in randomized clinical trials. Importantly, this research points to the need to target both sleep and obesity in order to break this vicious cycle.
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Affiliation(s)
- Olivia M Farr
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, United States; Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Christos S Mantzoros
- Division of Endocrinology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States; Section of Endocrinology, VA Boston Healthcare System, Boston, MA, United States
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40
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Nakamura T, Goverdovsky V, Morrell MJ, Mandic DP. Automatic Sleep Monitoring Using Ear-EEG. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:2800108. [PMID: 29018638 PMCID: PMC5515509 DOI: 10.1109/jtehm.2017.2702558] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/03/2017] [Accepted: 04/24/2017] [Indexed: 11/08/2022]
Abstract
The monitoring of sleep patterns without patient's inconvenience or involvement of a medical specialist is a clinical question of significant importance. To this end, we propose an automatic sleep stage monitoring system based on an affordable, unobtrusive, discreet, and long-term wearable in-ear sensor for recording the electroencephalogram (ear-EEG). The selected features for sleep pattern classification from a single ear-EEG channel include the spectral edge frequency and multi-scale fuzzy entropy, a structural complexity feature. In this preliminary study, the manually scored hypnograms from simultaneous scalp-EEG and ear-EEG recordings of four subjects are used as labels for two analysis scenarios: 1) classification of ear-EEG hypnogram labels from ear-EEG recordings; and 2) prediction of scalp-EEG hypnogram labels from ear-EEG recordings. We consider both 2-class and 4-class sleep scoring, with the achieved accuracies ranging from 78.5% to 95.2% for ear-EEG labels predicted from ear-EEG, and 76.8% to 91.8% for scalp-EEG labels predicted from ear-EEG. The corresponding Kappa coefficients range from 0.64 to 0.83 for Scenario 1, and indicate substantial to almost perfect agreement, while for Scenario 2 the range of 0.65-0.80 indicates substantial agreement, thus further supporting the feasibility of in-ear sensing for sleep monitoring in the community.
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Affiliation(s)
- Takashi Nakamura
- Department of Electrical and Electronic EngineeringImperial College London
| | | | - Mary J Morrell
- Sleep and Ventilation UnitNational Heart and Lung Institute, Imperial College London.,NIHR Respiratory Disease Biomedical Research UnitRoyal Brompton and Harefield NHS Foundation Trust, Imperial College London.,Imperial College London
| | - Danilo P Mandic
- Department of Electrical and Electronic EngineeringImperial College London
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41
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Polšek D, Bago M, Živaljić M, Rosenzweig I, Lacza Z, Gajović S. A novel adjustable automated system for inducing chronic intermittent hypoxia in mice. PLoS One 2017; 12:e0174896. [PMID: 28362813 PMCID: PMC5376321 DOI: 10.1371/journal.pone.0174896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/16/2017] [Indexed: 11/19/2022] Open
Abstract
Background Sleep apnea is a chronic, widely underdiagnosed condition characterized by disruption of sleep architecture and intermittent hypoxia due to short cessations of breathing. It is a major independent risk factor for myocardial infarction, congestive heart failure and stroke as well as one of the rare modifiable risk factors for Alzheimer’s Dementia. Reliable animal disease models are needed to understand the link between sleep apnea and the various clinically linked disorders. New method An automated system for inducing hypoxia was developed, in which the major improvement was the possibility to efficiently adjust the length and intensity of hypoxia in two different periods. The chamber used a small volume of gas allowing for fast exchanges of different oxygen levels. The mice were kept in their cages adapted with the system on the cage lid. As a proof of principle, they were exposed to a three week period of intermittent hypoxia for 8 hours a day, with 90 s intervals of 5, 7% and 21% oxygen to validate the model. Treated (n = 8) and control mice (no hypoxia, n = 7) were handled in the same manner and their hippocampal brain regions compared by histology. Results The chamber provided a fast, reliable and precise intermittent hypoxia, without inducing noticeable side effects to the animals. The validation experiment showed that apoptotic neurons in the hippocampus were more numerous in the mice exposed to intermittent hypoxia than in the control group, in all tested hippocampal regions (cornu ammonis 1 (CA1) P <0.001; cornu ammonis 3 (CA3) P <0.001; and dentate gyrus (DG) P = 0.023). In both, control and hypoxic conditions, there was a significantly higher number of apoptotic neurons in the DG compared to the CA1 and CA3 subfields (P <0.001). Conclusion The new design of a hypoxic chamber provides a fast, adjustable and reliable model of obstructive sleep apnea, which was validated by apoptosis of hippocampal neurons.
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Affiliation(s)
- Dora Polšek
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Marcel Bago
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
- University of Physical Education, Budapest, Hungary
| | - Marija Živaljić
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, King's College London, London, United Kingdom
- Sleep Disorders Centre, Guy's and St Thomas's Hospitals NHS Trust, London, United Kingdom
| | - Zsombor Lacza
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Srećko Gajović
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
- * E-mail:
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Um YH, Hong SC, Jeong JH. Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:9-18. [PMID: 28138105 PMCID: PMC5290714 DOI: 10.9758/cpn.2017.15.1.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/06/2016] [Accepted: 09/11/2016] [Indexed: 01/11/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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He Y, Chen R, Wang J, Pan W, Sun Y, Han F, Wang Q, Liu C. Neurocognitive impairment is correlated with oxidative stress in patients with moderate-to-severe obstructive sleep apnea hypopnea syndrome. Respir Med 2016; 120:25-30. [PMID: 27817812 DOI: 10.1016/j.rmed.2016.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) are associated with increased risk of neurocognitive impairment, which are largely recognized as mild cognitive impairment (MCI), and oxidative stress is postulated as one of the underlying mechanisms. This study aimed to investigate the relationship between MCI and oxidative stress biomarkers in OSAHS. METHODS A total of 119 middle-aged patients with moderate-to-severe OSAHS were included. Based on the baseline Montreal Cognitive Assessment (MoCA, validated Chinese version), 86 and 33 patients presented with normal cognitive function (NC, MoCA ≥26) and mild cognitive impairment (MCI, MoCA <26), respectively. Overnight PSG, MoCA and serum levels of ischemia-modified albumin (IMA), malondialdehyde (MDA) and advanced oxidation protein products (AOPP) were collected and analyzed. RESULTS Compared to NC group, patients with MCI were characterized with significantly greater waist-to-height ratio, AHI, ODI and time ratio of SpO2<90%, and lower average SpO2 and time ratio of rapid eye movement (REM). All three oxidative stress biomarkers were markedly elevated in MCI group. Binary logistic regression analysis demonstrated that MCI is significantly correlated with serum levels of IMA, REM ratio and the age of patients. CONCLUSIONS The neurocognitive impairment in moderate-to-severe OSAHS patients is associated with significantly elevated oxidative stress. IMA might be a new useful biomarker correlated with mild cognitive impairment of the patients.
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Affiliation(s)
- Yanyu He
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Rui Chen
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China.
| | - Jing Wang
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Wenying Pan
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yanqiu Sun
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Fei Han
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Neurology, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Qiaojun Wang
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Neurology, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Chunfeng Liu
- Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Neurology, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Laboratory of Aging and Nervous Diseases, Institute of Neuroscience, Soochow University, Suzhou, China
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Gildeh N, Drakatos P, Higgins S, Rosenzweig I, Kent BD. Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer. J Thorac Dis 2016; 8:E901-E917. [PMID: 27747026 DOI: 10.21037/jtd.2016.09.23] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.
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Affiliation(s)
- Nadia Gildeh
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK;; Danish Epilepsy Centre, Dianalund, Denmark
| | - Brian D Kent
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Increase of p25 associated with cortical neuronal death induced by hypoxia. Biochem Biophys Res Commun 2016; 477:932-936. [DOI: 10.1016/j.bbrc.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
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Alimehmeti R, Cecia A, Seferi A, Roci E. Sleep-disordered breathing and stroke: A relation to be considered. World J Clin Cases 2016; 4:124-126. [PMID: 27182526 PMCID: PMC4857007 DOI: 10.12998/wjcc.v4.i5.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/08/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
Stroke is a leading cause of death and disability. Despite expensive and elaborative research in finding out mechanisms of interrelation between sleep-disordered breathing (SDB) and stroke, there is yet much attention to be given in stroke units worldwide to the prompt diagnosis and treatment of SDB in order to improve morbidity and mortality rates related with stroke. The preventive diagnosis and treatment of SDB reduce stroke rate and improves penumbra area in case of ischemic stroke. Stroke itself predispose to SDB, making the interrelationship more complicated. The review by Parra O and Arboix A reflects the results from carefully selected reviews reported in the literature so far. This review of the literature and presentation of the original study of the Authors based on their patients’ data, enhances the conviction that there exists a direct relation between SDB and stroke. Diagnosis of SDB in new stroke cases should be sought and treated carefully whenever present.
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Emamian F, Khazaie H, Tahmasian M, Leschziner GD, Morrell MJ, Hsiung GYR, Rosenzweig I, Sepehry AA. The Association Between Obstructive Sleep Apnea and Alzheimer's Disease: A Meta-Analysis Perspective. Front Aging Neurosci 2016. [PMID: 27148046 DOI: 10.3389/fnagi.2016.00078.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area.
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Affiliation(s)
- Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS)Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation SciencesTehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Guy D Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Mary J Morrell
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial CollegeLondon, UK
| | - Ging-Yuek R Hsiung
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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Emamian F, Khazaie H, Tahmasian M, Leschziner GD, Morrell MJ, Hsiung GYR, Rosenzweig I, Sepehry AA. The Association Between Obstructive Sleep Apnea and Alzheimer's Disease: A Meta-Analysis Perspective. Front Aging Neurosci 2016; 8:78. [PMID: 27148046 PMCID: PMC4828426 DOI: 10.3389/fnagi.2016.00078] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area.
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Affiliation(s)
- Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS)Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation SciencesTehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Guy D Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Mary J Morrell
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial CollegeLondon, UK
| | - Ging-Yuek R Hsiung
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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Tahmasian M, Rosenzweig I, Eickhoff SB, Sepehry AA, Laird AR, Fox PT, Morrell MJ, Khazaie H, Eickhoff CR. Structural and functional neural adaptations in obstructive sleep apnea: An activation likelihood estimation meta-analysis. Neurosci Biobehav Rev 2016; 65:142-56. [PMID: 27039344 PMCID: PMC5103027 DOI: 10.1016/j.neubiorev.2016.03.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
Abstract
The right basolateral amygdala, the hippocampus and the right insular cortex are important nodes in obstructive sleep apnea (OSA). Functional characterization of these regions suggested associated dysfunction of emotional, sensory, and limbic processes in OSA. Connectivity analysis demonstrated that these regions are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus.
Obstructive sleep apnea (OSA) is a common multisystem chronic disorder. Functional and structural neuroimaging has been widely applied in patients with OSA, but these studies have often yielded diverse results. The present quantitative meta-analysis aims to identify consistent patterns of abnormal activation and grey matter loss in OSA across studies. We used PubMed to retrieve task/resting-state functional magnetic resonance imaging and voxel-based morphometry studies. Stereotactic data were extracted from fifteen studies, and subsequently tested for convergence using activation likelihood estimation. We found convergent evidence for structural atrophy and functional disturbances in the right basolateral amygdala/hippocampus and the right central insula. Functional characterization of these regions using the BrainMap database suggested associated dysfunction of emotional, sensory, and limbic processes. Assessment of task-based co-activation patterns furthermore indicated that the two regions obtained from the meta-analysis are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus. Taken together, our findings highlight the role of right amygdala, hippocampus and insula in the abnormal emotional and sensory processing in OSA.
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Affiliation(s)
- Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; National Brain Mapping Center, Shahid Beheshti University (General & Medical campus), Tehran, Iran
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK
| | - Simon B Eickhoff
- Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA; South Texas Veterans Health Care System,San Antonio, TX 78229, USA
| | - Mary J Morrell
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK; NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
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Changes in Neurocognitive Architecture in Patients with Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure. EBioMedicine 2016; 7:221-9. [PMID: 27322475 PMCID: PMC4909326 DOI: 10.1016/j.ebiom.2016.03.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/07/2016] [Accepted: 03/12/2016] [Indexed: 12/30/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a chronic, multisystem disorder that has a bidirectional relationship with several major neurological disorders, including Alzheimer's dementia. Treatment with Continuous Positive Airway Pressure (CPAP) offers some protection from the effects of OSA, although it is still unclear which populations should be targeted, for how long, and what the effects of treatment are on different organ systems. We investigated whether cognitive improvements can be achieved as early as one month into CPAP treatment in patients with OSA. Methods 55 patients (mean (SD) age: 47.6 (11.1) years) with newly diagnosed moderate–severe OSA (Oxygen Desaturation Index: 36.6 (25.2) events/hour; Epworth sleepiness score (ESS): 12.8 (4.9)) and 35 matched healthy volunteers were studied. All participants underwent neurocognitive testing, neuroimaging and polysomnography. Patients were randomized into parallel groups: CPAP with best supportive care (BSC), or BSC alone for one month, after which they were re-tested. Findings One month of CPAP with BSC resulted in a hypertrophic trend in the right thalamus [mean difference (%): 4.04, 95% CI: 1.47 to 6.61], which was absent in the BSC group [− 2.29, 95% CI: − 4.34 to − 0.24]. Significant improvement was also recorded in ESS, in the CPAP plus BSC group, following treatment [mean difference (%): − 27.97, 95% CI: − 36.75 to − 19.19 vs 2.46, 95% CI: − 5.23 to 10.15; P = 0.012], correlated to neuroplastic changes in brainstem (r = − 0.37; P = 0.05), and improvements in delayed logical memory scores [57.20, 95% CI: 42.94 to 71.46 vs 23.41, 95% CI: 17.17 to 29.65; P = 0.037]. Interpretation One month of CPAP treatment can lead to adaptive alterations in the neurocognitive architecture that underlies the reduced sleepiness, and improved verbal episodic memory in patients with OSA. We propose that partial neural recovery occurs during short periods of treatment with CPAP. One month of CPAP treatment leads to adaptive alterations in the neuroanatomy and neurocognition in patients with OSA. Improvements in sleepiness and verbal episodic memory were demonstrable following only one month of treatment with CPAP. Our findings support the clinical rationale for the use of CPAP treatment to relieve sleepiness, even for a short duration.
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that has been linked with dementia, stroke and increased risks of cardiovascular disease. Continuous positive airway pressure (CPAP) treatment has been shown to be effective in reducing sleepiness in moderate to severe OSA. However, the evidence for its use to reverse or slow the rate of cognitive decline is unclear. Our findings show that one month of CPAP treatment in patients with moderate to severe OSA leads to adaptive alterations in the brain networks associated with reduced sleepiness and improved memory.
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