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Wilensky A, Frank N, Mizraji G, Tzur D, Goldstein C, Almoznino G. Periodontitis and Metabolic Syndrome: Statistical and Machine Learning Analytics of a Nationwide Study. Bioengineering (Basel) 2023; 10:1384. [PMID: 38135975 PMCID: PMC10741025 DOI: 10.3390/bioengineering10121384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
This study aimed to analyze the associations between periodontitis and metabolic syndrome (MetS) components and related conditions while controlling for sociodemographics, health behaviors, and caries levels among young and middle-aged adults. We analyzed data from the Dental, Oral, and Medical Epidemiological (DOME) record-based cross-sectional study that combines comprehensive sociodemographic, medical, and dental databases of a nationally representative sample of military personnel. The research consisted of 57,496 records of patients, and the prevalence of periodontitis was 9.79% (5630/57,496). The following parameters retained a significant positive association with subsequent periodontitis multivariate analysis (from the highest to the lowest OR (odds ratio)): brushing teeth (OR = 2.985 (2.739-3.257)), obstructive sleep apnea (OSA) (OR = 2.188 (1.545-3.105)), cariogenic diet consumption (OR = 1.652 (1.536-1.776)), non-alcoholic fatty liver disease (NAFLD) (OR = 1.483 (1.171-1.879)), smoking (OR = 1.176 (1.047-1.322)), and age (OR = 1.040 (1.035-1.046)). The following parameters retained a significant negative association (protective effect) with periodontitis in the multivariate analysis (from the highest to the lowest OR): the mean number of decayed teeth (OR = 0.980 (0.970-0.991)); North America as the birth country compared to native Israelis (OR = 0.775 (0.608-0.988)); urban non-Jewish (OR = 0.442 (0.280-0.698)); and urban Jewish (OR = 0.395 (0.251-0.620)) compared to the rural locality of residence. Feature importance analysis using the eXtreme Gradient Boosting (XGBoost) machine learning algorithm with periodontitis as the target variable ranked obesity, OSA, and NAFLD as the most important systemic conditions in the model. We identified a profile of the "patient vulnerable to periodontitis" characterized by older age, rural residency, smoking, brushing teeth, cariogenic diet, comorbidities of obesity, OSA and NAFLD, and fewer untreated decayed teeth. North American-born individuals had a lower prevalence of periodontitis than native Israelis. This study emphasizes the holistic view of the MetS cluster and explores less-investigated MetS-related conditions in the context of periodontitis. A comprehensive assessment of disease risk factors is crucial to target high-risk populations for periodontitis and MetS.
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Affiliation(s)
- Asaf Wilensky
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Noa Frank
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Gabriel Mizraji
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Dorit Tzur
- Medical Information Department, General Surgeon Headquarter, Medical Corps, Israel Defense Forces, Tel-Hashomer 02149, Israel
| | - Chen Goldstein
- Big Biomedical Data Research Laboratory, Dean’s Office, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Galit Almoznino
- Big Biomedical Data Research Laboratory, Dean’s Office, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Vajravelu ME, Tas E, Arslanian S. Pediatric Obesity: Complications and Current Day Management. Life (Basel) 2023; 13:1591. [PMID: 37511966 PMCID: PMC10381624 DOI: 10.3390/life13071591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery.
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Affiliation(s)
- Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Emir Tas
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Umano GR, Galderisi A, Aiello F, Martino M, Camponesco O, Di Sessa A, Marzuillo P, Alfonso P, Miraglia Del Giudice E. Obstructive sleep apnea (OSA) is associated with the impairment of beta-cell response to glucose in children and adolescents with obesity. Int J Obes (Lond) 2023; 47:257-262. [PMID: 36670156 PMCID: PMC10113157 DOI: 10.1038/s41366-023-01257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The main purpose of the study is to assess the association between obstructive sleep apnea (OSA) and insulin secretion in children with obesity. METHODS We enrolled children and adolescents who attended our pediatric clinic because of obesity and OSA. Glucose homeostasis was assessed through standard 2-h oral glucose tolerance test (OGTT). Nocturnal cardio-respiratory polygraphy was performed for OSA diagnosis. Twenty-two patients underwent a 3-h OGTT to investigate insulin secretion and sensitivity through the oral-minimal model. RESULTS seventy-seven children and adolescents were included in the study. Based on OSA severity, the cohort was divided into three groups (29 mild, 29 moderate, and 19 severe OSA). The group with mild OSA showed lower levels of 30-min glucose (p = 0.01) and 60-min glucose (p = 0.03), and lower prevalence of elevated 1-h glucose (10.4% versus 44.8% in moderate and 31.6% in severe OSA, p = 0.01). The odds for elevated 1-h plasma glucose was 6.2-fold (95%CI 1.6-23.4) higher in subjects with moderate and severe OSA compared to mild OSA (p = 0.007) independent of confounders. Spearman correlation test revealed a positive correlation between 30-min plasma glucose and apnea-hypopnea index (AHI, r = 0.31, p = 0.01), oxygen desaturation index (ODI, r = 0.31, p = 0.009), and mean desaturation (r = 0.25, p = 0.04). The 3-h OGTT study included 22 participants (7 mild, 9 moderate, and 6 severe OSA). The group with mild OSA showed a higher dynamic, static, and total insulin secretion compared to those with moderate and severe OSA (p < 0.0001, p = 0.007, p = 0.007, respectively). AHI was significantly correlated to dynamic insulin secretion (r = -0.48, p = 0.02). CONCLUSIONS OSA might impair beta-cell function reducing the pool of promptly releasable insulin in children and adolescents with obesity, in the absence of an effect on insulin sensitivity.
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Affiliation(s)
- Giuseppina Rosaria Umano
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Francesca Aiello
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mariangela Martino
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Ornella Camponesco
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna Di Sessa
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pierluigi Marzuillo
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Papparella Alfonso
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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A Bidirectional Association Between Obstructive Sleep Apnea and Metabolic-Associated Fatty Liver Disease. Endocrinol Metab Clin North Am 2023. [PMID: 37495341 DOI: 10.1016/j.ecl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Obesity is considered a twentieth-century epidemic and is a growing concern among health professionals. Obesity and its complications contribute to multiple chronic illnesses, such as type 2 diabetes (T2D), metabolic syndrome, obstructive sleep apnea (OSA), malignancy, and cardiovascular and liver diseases. In the last two decades, a bidirectional association between OSA and metabolic-associated fatty liver disease (MAFLD), independent of obesity, has been established. Both conditions have similar risk factors and metabolic comorbidities that may imply a common disease pathway. This review compiles the evidence and delineates the relationship between OSA and MAFLD from a clinical and diagnostic aspect.
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Huang J, Chen L, Li X, Chen M, Lin T, Chen G. Association Between Metabolic-Associated Fatty Liver Disease and Obstructive Sleep Apnea: A Cross-Sectional Study. Nat Sci Sleep 2023; 15:49-57. [PMID: 36879664 PMCID: PMC9985450 DOI: 10.2147/nss.s398971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
AIM Emerging evidence has revealed that obstructive sleep apnea (OSA) is an independent risk factor for the development of a variety of adverse metabolic disease states. In this study, we evaluated the association between OSA severity and metabolic dysfunction-associated fatty liver disease (MAFLD) among Asian populations. MATERIALS AND METHODS This was a cross-sectional, single-center study. The study cohort consisted of patients undergoing polysomnography and abdominal ultrasonography. Logistic regression analysis was used to evaluate the independent risk factors of MAFLD in patients with OSA. RESULTS A total of 1065 patients (277 non-MAFLD and 788 MAFLD) were included in the study. The prevalence of MAFLD in non-OSA, mild-moderate OSA, and severe OSA patients was 58.16%, 72.41%, and 78.0%, respectively (p < 0.001). We identified significant differences in body mass index (BMI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and lowest O2 saturation (LaSO2) between non-MAFLD and MAFLD patients (all p < 0.001). After adjusting for confounding variables, we used multivariate regression analysis to show that BMI, ODI, and triglyceride (TG) levels independently predicted the occurrence of MAFLD (odds ratio [OR] = 1.234, p < 0.001; OR = 1.022, p = 0.013; OR = 1.384, p = 0.001, respectively). Moreover, stratified analysis according to BMI indicated that TG levels were the predominant risk factor for MAFLD in a group of patients with a BMI < 23 kg/m2, while BMI, ODI, TG levels, and total cholesterol (TC) were the major risk factors for MAFLD in a group of patients with a BMI ≥ 23 kg/m2 (all p < 0.05). CONCLUSION OSA-associated chronic intermittent hypoxia was independently associated with the risk of MAFLD, especially in OSA patients with a BMI ≥ 23 kg/m2, suggesting that oxidative stress might play an important role in the pathogenesis of MAFLD in patients with OSA.
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Affiliation(s)
- Jiefeng Huang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Lida Chen
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Xiangcheng, Zhangzhou, People's Republic of China
| | - Xiuling Li
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Menglan Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ting Lin
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Gongping Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
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Chen LD, Huang JF, Lin XJ, Huang YP, Xu QZ, Chen GP, Lin QC. Expression profiling and functional analysis of circular RNAs in vitro model of intermittent hypoxia-induced liver injury. Front Physiol 2022; 13:972407. [PMID: 36187780 PMCID: PMC9515621 DOI: 10.3389/fphys.2022.972407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Intermittent hypoxia (IH) is a prominent feature of obstructive sleep apnea (OSA) which is increasingly recognized as a key risk factor for liver injury. Circular RNAs (circRNAs) has been suggested to act as a regulator of multiple biological processes. However, there is no study evaluating circRNAs alterations and potential role of circRNAs in OSA-related liver injury. The present study aimed to investigate circRNA expression profiles in vitro model of IH-induced liver injury, as well as potential functional characterization of the differentially expressed circRNAs (DE circRNAs). BRL-3A cells were exposed to IH or normoxia. Cell apoptosis and cell viability were evaluated using flow cytometry and cell counting kit-8, respectively. The expression profile of circRNAs was depicted by circRNA sequencing. The selected circRNAs were verified by quantitative real-time PCR (qRT-PCR). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) analyses were employed to predict DE circRNAs functions. The circRNA-miRNA-mRNA regulatory network was constructed. IH treatment caused cell injury in BRL-3A cells. 98 circRNAs were identified as being dysregulated in IH-treated BRL-3A cells. Among them, 58 were up-regulated and 40 were down-regulated. Go and KEGG analyses suggested that the DE circRNAs were predominantly enriched in the biological process such as positive regulation of NF−kappaB transcription factor activity and pathways such as circadian entrainment, Wnt signaling pathway, MAPK signaling pathway, and protein export. 3 up-regulated circRNAs and 3 down-regulated circRNAs with high number of back-splicing sites were chosen for qRT-PCR validation and were consistent with the sequencing data. CircRNA1056 and circRNA805 were predicted to interact with microRNAs that might thereby regulate downstream genes. The study characterized a profile of dysregulated circRNAs in IH-induced BRL-3A cell injury. DE circRNAs may play vital roles in the pathophysiology of IH-induced liver injury. Our findings provide preliminary support for further research in mechanisms and a new theory for the pathogenesis of OSA-related liver injury.
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Affiliation(s)
- Li-Da Chen
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Jie-Feng Huang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, China
- Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, China
| | - Xue-Jun Lin
- Department of Laboratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Ya-Ping Huang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Qiao-Zhen Xu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Gong-Ping Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, China
- Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, China
- *Correspondence: Gong-Ping Chen, ; Qi-Chang Lin,
| | - Qi-Chang Lin
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, China
- Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, China
- *Correspondence: Gong-Ping Chen, ; Qi-Chang Lin,
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. Although environmental factors are major contributors to early onset, children have both shared and unique genetic risk alleles as compared with adults with NAFLD. Treatment relies on reducing environmental risk factors, but many children have persistent diseases. No medications are approved specifically for the treatment of NAFLD, but some anti-obesity or diabetes treatments may be beneficial. Pediatric NAFLD increases the risk of diabetes and other cardiovascular risk factors. Long-term prospective studies are needed to determine the long-term risk of hepatic and non-hepatic morbidity and mortality in adulthood.
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Affiliation(s)
- Stavra A Xanthakos
- Professor of Pediatrics, Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's, Department of Pediatrics, Director, Nonalcoholic Steatohepatitis Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Ji Y, Liang Y, Mak JC, Ip MS. Obstructive sleep apnea, intermittent hypoxia and non-alcoholic fatty liver disease. Sleep Med 2022; 95:16-28. [DOI: 10.1016/j.sleep.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
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Coté CJ. Obstructive sleep apnoea and polymorphisms: implications for anaesthesia care. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s2.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With a worldwide obesity pandemic, the incidence of obstructive sleep apnoea (OSA) is increasing; obesity is the most significant risk factor in children. Increasing evidence suggests that OSA is in part mediated through markers of inflammation. Systemic and pulmonary hypertension, right ventricular hypertrophy, prediabetes, and other conditions are common. Adenotonsillectomy improves only ~70% of children; 30% require other interventions, e.g. weight loss programs. The gold standard for diagnosis is a sleep-polysomnogram which are expensive and not readily available. The McGill oximetry score (saw-tooth desaturations during obstruction and arousal) is more cost-effective.
Repeated episodes of desaturation alter the opioid receptors such that analgesia is achieved at much lower levels of opioid than in patients undergoing the same procedure but without OSA. This response is of great concern because a standard dose of opioids may be a relative overdose.
Polymorphism variations in cytochrome CYP2D6 have major effects upon drug efficacy and side effects. Codeine, hydrocodone, oxycodone, and tramadol are all prodrugs that require CYP2D6 for conversion to the active compound. CYP2D6 is quite variable and patients can be divided into 4 classes: For codeine for example, poor metaboliser (PM) have virtually no conversion to morphine, intermediate metabolisers (IM) have some conversion to morphine, extensive metabolisers (EM) have a normal rate of conversion to morphine, and ultra-rapid metabolisers (RM) convert excessive amounts of codeine to morphine. Such variations result in some patients achieving no analgesia because there is reduced conversion to the active moiety whereas others convert an excessive amount of drug to the active compound thus resulting in relative or actual overdose despite appropriate dosing.
Thus, OSA patients may have both opioid sensitivity due to recurrent desaturations and altered drug metabolism resulting in higher than intended blood levels of opioid. OSA patients should only receive one-third to half the usual dose of opioid. In those under the age of six, an effort should be made to avoid opioids altogether and use opioid sparing techniques such as alternating acetaminophen and ibuprofen.
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