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Stellbrink C, Hansky B, Baumann P, Lawin D. [Transvenous neurostimulation in central sleep apnea associated with heart failure]. Herzschrittmacherther Elektrophysiol 2018; 29:377-382. [PMID: 30306302 DOI: 10.1007/s00399-018-0591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
Sleep-related breathing disorders can be classified as either obstructive (OSA) or central sleep apnea (CSA). Whereas there is substantial knowledge about the pathophysiology and sound recommendations for the diagnosis and treatment of OSA, the origin of CSA is still incompletely understood, patient identification is difficult and the necessity for specific treatment is under debate. CSA often accompanies heart failure and is associated with an adverse prognosis. Optimized heart failure treatment reduces CSA and is thus the cornerstone of CSA treatment. In contrast to OSA, noninvasive ventilation does not lead to prognostic improvement in CSA and ASV ventilation may even lead to an increase in mortality. Transvenous neurostimuation of the phrenic nerve is currently under clinical investigation as a new therapeutic modality for CSA. Early results demonstrate positive effects on sleep parameters and quality of life without any evidence for a negative impact on mortality. However, these results await confirmation in larger studies before this new approach can be advocated for routine clinical use.
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Affiliation(s)
- Christoph Stellbrink
- Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
| | - Bert Hansky
- Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Philipp Baumann
- Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Dennis Lawin
- Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
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2
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Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, Oto A, Potpara TS, Steffel J, Marín F, de Oliveira Figueiredo MJ, de Simone G, Tzou WS, Chiang CE, Williams B, Dan GA, Gorenek B, Fauchier L, Savelieva I, Hatala R, van Gelder I, Brguljan-Hitij J, Erdine S, Lovic D, Kim YH, Salinas-Arce J, Field M. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2018; 19:891-911. [PMID: 28881872 DOI: 10.1093/europace/eux091] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 12/23/2022] Open
Abstract
Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the available evidence to publish a joint consensus document on hypertension and cardiac arrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and the patient in light of all of the circumstances presented by that patient.
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Affiliation(s)
- Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Thomas Kahan
- Karolinska Institutet Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Heart and Health Foundation of Turkey, Ankara, Turkey
| | - Tatjana S Potpara
- School of Medicine, Cardiology Clinic, Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia
| | - Jan Steffel
- Electrophysiology and Cardiac Devices, Department of Cardiology, University Heart Center Zurich; Zurich, Switzerland
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | | | - Giovanni de Simone
- Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld # 1, Napoli 80131, Italy
| | - Wendy S Tzou
- Cardiac Electrophysiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chern-En Chiang
- Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, UK
| | | | - Gheorghe-Andrei Dan
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest Romania
| | | | | | | | - Robert Hatala
- National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Isabelle van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana Brguljan-Hitij
- University Medical Centre, Hypertension Department, Hospital Dr. Peter Drzaja, Ljubljana, Slovenia
| | - Serap Erdine
- Istanbul University Cerrahpasa Medical School, Head of Hypertension Department, Istanbul, Turkey
| | - Dragan Lovic
- Clinic for internal disease Intermedica, Cardiology department-Hypertension centere, Serbia
| | | | | | - Michael Field
- University of Wisconsin, Clinical Science Center, Madison, USA
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Mollayeva T, Cassidy JD, Shapiro CM, Mollayeva S, Colantonio A. Concussion/mild traumatic brain injury-related chronic pain in males and females: A diagnostic modelling study. Medicine (Baltimore) 2017; 96:e5917. [PMID: 28207508 PMCID: PMC5319497 DOI: 10.1097/md.0000000000005917] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
| | - J. David Cassidy
- Division of Health Care and Outcomes Research, University Health Network
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
| | - Colin M. Shapiro
- Toronto Western Hospital, University Health Network
- Youthdale Child & Adolescent Sleep Clinic
| | - Shirin Mollayeva
- Department of Biology, University of Toronto, Mississauga, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
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Won C, Guilleminault C. The use of positive airway pressure therapy for treatment of resistant hypertension. Expert Rev Cardiovasc Ther 2016; 14:505-11. [PMID: 26671301 DOI: 10.1586/14779072.2016.1132626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
It is well accepted that obstructive sleep apnea (OSA) is a risk factor for hypertension. In the subgroup of patients with resistant hypertension (rHTN), OSA appears to be particularly rampant; suggesting sleep disordered breathing may contribute to pathological mechanisms that make blood pressure difficult to control. This article explores potential mechanisms by which sleep apnea contributes to rHTN, and examines the impact of treating OSA with positive airway pressure therapy on blood pressure control. In recent years, there has been a surge of interest in randomized controlled trials of positive airway pressure therapy in patients with OSA and rHTN, because patients with rHTN respond poorly to medications. As a result, identifying novel targets for blood pressure control in this high-risk population has become paramount.
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Affiliation(s)
- Christine Won
- a Department of Psychiatry, School of Medicine , Yale University, Section of Pulmonary, Critical Care, and Sleep Medicine , New Haven , USA
| | - Christian Guilleminault
- b Department of Psychiatry, School of Medicine , Stanford University , Redwood City , CA , USA
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Pan Y, Wang W, Wang KS. Associations of Alcohol Consumption and Chronic Diseases With Sleep Apnea Among US Adults. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e19088. [PMID: 25032163 PMCID: PMC4080510 DOI: 10.5812/ijhrba.19088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 03/31/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Sleep apnea (SA) is a common sleep disorder among US adults. Associations of SA with alcohol consumption and some chronic diseases have been inconsistent. OBJECTIVES This study aimed to estimate prevalence of SA and examine its associations with potential factors including alcohol consumption, asthma, diabetes, and hypertension. PATIENTS AND METHODS This was a cross-sectional study on 823 adults with SA and 38,638 controls from the 2011 National Survey on Drug Use and Health Data. Weighted univariate and multiple logistic regression analyses were used to examine the associations of SA with the potential factors. RESULTS The prevalence of SA was higher in males (4.01%) than in females (2.61%), while the prevalence increased with age (0.86%, 3.50%, and 4.47% for age groups of 18-25, 26-64, and ≥ 65, respectively). Univariate analysis revealed that all factors except for income and education were associated with SA (P < 0.05). In multivariable analyses, participants who were current and past alcohol consumers had significantly higher odds of having SA (OR = 1.52, 95% CI = 1.03-2.23; OR = 1.65, 95% CI = 1.09-2.49, respectively) than non-alcohol drinker. Furthermore, asthma (OR = 2.77, 95% CI = 2.04-3.75), diabetes (OR = 2.89, 95% CI = 2.19-3.83), and hypertension (OR = 2.42, 95% CI = 1.91-3.07) were significantly associated with SA. CONCLUSIONS Age, alcohol consumption, asthma, diabetes, and hypertension, were positively associated with SA. More efforts should be directed to promoting screening for SA and finding possible treatments for SA among these vulnerable groups.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | - Weize Wang
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
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Li J, Chen X, Sun J. Is the grading system of the severity of the OSAHS used presently rational or not?: from the view of incidence of hypertension in different severity groups. Eur Arch Otorhinolaryngol 2014; 271:2561-4. [PMID: 24756614 DOI: 10.1007/s00405-014-3036-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/25/2014] [Indexed: 11/24/2022]
Abstract
The grading system of the severity of obstructive sleep apnea hypopnea syndrome (OSAHS) used presently showed that the severe OSAHS had an extensive range of apnea hypopnea index (AHI) (≥ 30, even over 100). So this grading system is not rational. From Jan 1999 to June 2011, there were 2,618 patients complaining of snoring took the polysomnography. The patients were divided into 11 groups according to their AHI. Frequencies of OSAHS with hypertension in each group were tested using crosstabs. The incidence of hypertension was increased as the increasing of AHI. Crosstab analysis showed that there were four cutoff points of AHI (5, 30, 50, 100). There was a significant difference in the incidence of hypertension between the groups of AHI more than the cutoff point and AHI less than the cutoff point. So from the view of hypertension in each group, we recommend that the AHI <5 should be considered as normal or simple snorer, AHI = 5-30 as mild degree of OSAHS, AHI = 30-50 as moderate degree of OSAHS, AHI = 50-100 as severe degree of OSAHS, and AHI ≥ 100 as profound degree of OSAHS.
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Affiliation(s)
- Jinrang Li
- Department of Otorhinolaryngology Head & Neck Surgery, Navy General Hospital, Beijing, 100048, China,
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Chen YL, Su MC, Liu WH, Wang CC, Lin MC, Chen MC. Influence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure. J Clin Sleep Med 2014; 10:57-64. [PMID: 24426821 DOI: 10.5664/jcsm.3360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE Obstructive sleep apnea syndrome (OSAS) has been considered to be an important predisposing factor for cardiovascular disease. This study aims to investigate the impact of OSAS on cardiac function and remodeling in patients without congestive heart failure. METHODS A total of 79 patients with sleep disordered breathing, preserved systolic function, and normal pro-brain natriuretic peptide level were enrolled. Sixty-five patients were classified to have moderate to severe OSAS (apnea-hypopnea index [AHI] ≥ 15/h), while the other 14 patients with mild or no OSAS (AHI < 15/h) served as control subjects. Baseline clinical and polysomnographic variables as well as tissue Doppler imaging and three-dimensional echocardiographic parameters were obtained. RESULTS The body mass index, neck circumference, Epworth Sleepiness Scale, desaturation index, arousal index, and snoring index were significantly higher in patients with moderate to severe OSAS than those without (p < 0.05). The left atrial size, mitral A-wave velocity, and left ventricular end-diastolic volume were significantly larger, while E/A ratio was lower in patients with moderate to severe OSAS than those without (p < 0.05). Notably, AHI in REM sleep was significantly correlated with the aortic root size, E/A ratio, left ventricular volume, and stroke volume. In addition, the area under the receiver operator characteristic curve for AHI in REM sleep ≥ 32.3/h was 0.647 (95% CI [0.525, 0.769]) in predicting the development of left ventricular diastolic dysfunction. AHI in REM sleep ≥ 32.3/h was the only independent variant in predicting diastolic dysfunction after adjusting the variables including age, gender, hypertension, and body mass index. CONCLUSIONS Patients with moderate to severe OSAS tend to have cardiac dysfunction revealed by echocardiography. High AHI in REM sleep is significantly associated with cardiovascular remodeling and ventricular diastolic dysfunction, and may be a potential variable to predict cardiac dysfunction.
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Affiliation(s)
- Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Joukar S, Ghorbani-Shahrbabaki S, Hajali V, Sheibani V, Naghsh N. Susceptibility to life-threatening ventricular arrhythmias in an animal model of paradoxical sleep deprivation. Sleep Med 2013; 14:1277-82. [DOI: 10.1016/j.sleep.2013.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/05/2013] [Accepted: 07/02/2013] [Indexed: 01/04/2023]
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Guillot M, Sforza E, Achour-Crawford E, Maudoux D, Saint-Martin M, Barthélémy JC, Roche F. Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population. Sleep Med 2013; 14:838-42. [PMID: 23831239 DOI: 10.1016/j.sleep.2013.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 04/30/2013] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The impact of sleep-related breathing disorders on the incidence of arterial hypertension (AHT) in the older adults is not well-established. The aim of our study was to test the link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects after 3 years. METHODS 372 normotensive subjects with a mean age of 68.2 years were included in our longitudinal study. All participants had a ventilatory polygraphic recording and an ambulatory blood pressure (BP) monitoring at baseline and after 3 years. Severe OSA was defined by an apnea-hypopnea index (AHI) of ≥ P30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140mmHg for systolic BP and >85mmHg for diastolic BP or the use of antihypertensive medication. RESULTS The baseline factors significantly associated with an increased risk for new-onset hypertension were male gender, obesity, diabetes mellitus (DM), dyslipidemia, and OSA. Multiple logistic regression analyses showed that an AHI ≥30 per hour was independently associated with incident hypertension after 3 years (P=.02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8). CONCLUSIONS The presence of severe OSA is associated with new-onset AHT in normotensive elderly (mean age, 68.2 y) subjects.
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Female rats are more susceptible to the deleterious effects of paradoxical sleep deprivation on cognitive performance. Behav Brain Res 2011; 228:311-8. [PMID: 22192378 DOI: 10.1016/j.bbr.2011.12.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/01/2011] [Accepted: 12/05/2011] [Indexed: 12/25/2022]
Abstract
Paradoxical sleep deprivation (PSD) may alter subsequent learning and memory capacity. There are differences in both the intensity and direction of responses of the male and female species to the same environmental stimuli and experimental conditions. In the present study, we examined the extent of the effects of PSD for 72h on spatial learning and memory, anxiety-like behavior, corticosterone levels, and the body weight in male as well as in intact and ovariectomized (OVX) female Wistar rats. Multiple platform method was used for PSD induction. Spatial learning and memory and anxiety-like behavior were determined using Morris water maze (MWM) task and open field test, respectively. The data showed that PSD could not significantly affect subsequent spatial learning and short-term memory in male rats, while it significantly impaired the performance of the intact and OVX female rats. The PSD-intact and -OVX female rats showed more memory impairment than the PSD-male animals. Those impairments do not appear to be due to elevated stress level, since the plasma corticosterone did not significantly change following PSD induction. The open field data showed that PSD significantly reduced anxiety-like behavior in all experimental groups. In addition, PSD had a reducing effect on the mean body weight of female groups. Such results suggest that the female rats are more vulnerable to the deleterious effects of sleep loss on cognitive performance.
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Abstract
Obstructive sleep apnea (OSA) is a condition in which the upper airway becomes constricted or occluded during sleep, leading to decreased or absent airflow, hypoxia, and sympathetic activation. This chain of events, occurring dozens of times an hour, can contribute to the development of hypertension, coronary artery disease, heart failure, and stroke. This article discusses the epidemiology of comorbid OSA and cardiovascular disease, the pathophysiology of OSA, how it acts as a risk factor for cardiovascular problems, and how appropriate treatment of OSA ameliorates the consequences. The importance of having a high suspicion for OSA in people with risk factors (including obesity, middle age, male or postmenopausal female) or symptoms (snoring, excessive daytime sleepiness, difficulty concentrating) is pointed out. The article concludes with clinical and research implications.
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Affiliation(s)
- Judith L Reishtein
- College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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12
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Lim YG, Hong KH, Kim KK, Shin JH, Lee SM, Chung GS, Baek HJ, Jeong DU, Park KS. Monitoring physiological signals using nonintrusive sensors installed in daily life equipment. Biomed Eng Lett 2011. [DOI: 10.1007/s13534-011-0012-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Shin JH, Chee YJ, Jeong DU, Park KS. Nonconstrained sleep monitoring system and algorithms using air-mattress with balancing tube method. ACTA ACUST UNITED AC 2009; 14:147-56. [PMID: 19846378 DOI: 10.1109/titb.2009.2034011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We evaluated the performance of a bed-type sensor system using the air-mattress with balancing tube (AMBT) method to noninvasively monitor the signals of heartbeat, respiration, and events of snoring, sleep apnea and body movement of subject on the system. The proposed system consists of multiple cylindrical air cells, two sensor cells and 18 support cells, and the small physiological signals were measured by the changes in pressure difference between the sensor cells, and the dc component was removed by balancing tube that is connecting the sensor cells. Using newly developed AMBT method, heartbeat, respiration, snoring, and body movement signals were clearly measured. For the concept of a home healthcare system, two automatic processing algorithms were developed: one is to estimate the mean heart and respiration rates for every 30 s, and another one is to detect the snoring, sleep apnea, and body movement events from the measured signals. In the beat-to-beat heart rate and breath-by-breath respiration rate analyses, the correlation coefficients of the heart and respiration rates from the proposed AMBT method compared with reference methods, electrocardiogram, and respiration effort signal from piezoelectric belt, were 0.98 ( p << 0.01) and 0.96 ( p << 0.01), respectively. Sensitivity and positive predictive value (PPV) of the detection algorithm for snoring event were 93%, 96%, for sleep apnea event were 93%, 88%, and for body movement event were 86%, 100%, respectively. These findings support that ABMT method provides an accurate and reliable means to monitor heartbeat, respiration activities and the sleep events during sleep.
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Affiliation(s)
- Jae Hyuk Shin
- Interdisciplinary Program on Biomedical Engineering, Seoul National University, Graduate School, Chongno-Ku, Seoul 110-799, Korea.
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14
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Affiliation(s)
- Atul Malhotra
- Pulmonary & Critical Care and Sleep Medicine Divisions, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA.
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Norman D, Loredo JS, Nelesen RA, Ancoli-Israel S, Mills PJ, Ziegler MG, Dimsdale JE. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension 2006; 47:840-5. [PMID: 16585412 DOI: 10.1161/01.hyp.0000217128.41284.78] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension. Prior studies have been limited, however, in their ability to show reduction in blood pressure after continuous positive airway pressure (CPAP) therapy, and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated. We performed a randomized, double-blind, placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA. We found that 2 weeks of CPAP therapy resulted in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic, mean, and diastolic blood pressure (all Ps <0.05). Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation, it did not affect blood pressure. We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA, perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation.
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Affiliation(s)
- Daniel Norman
- Department of Medicine, School of Medicine, University of California, San Diego, CA, USA.
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Andersen ML, Martins PJF, D'Almeida V, Santos RF, Bignotto M, Tufik S. Effects of paradoxical sleep deprivation on blood parameters associated with cardiovascular risk in aged rats. Exp Gerontol 2004; 39:817-24. [PMID: 15130676 DOI: 10.1016/j.exger.2004.02.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Revised: 02/04/2004] [Accepted: 02/18/2004] [Indexed: 01/12/2023]
Abstract
The effects of 96 h of paradoxical sleep deprivation (PSD) on blood parameters associated with cardiovascular risk were studied in young (3-month old) and aged (22-month old) rats. In general, aging was associated with an overall increase in most measures, irrespective of sleep deprivation condition. The latter manipulation also had significant effects on blood variables, but not in a consistent pattern. Thus, PSD significantly reduced triglyceride levels in both young and aged rats; it reduced blood viscosity in aged but not in young rats, and had no effect on the increased cholesterol levels observed in aged controls. Examinations of cholesterol fractions revealed significant increases in low density lipoprotein and high density lipoprotein in aged PSD rats compared to respective controls, whereas very low density lipoprotein was significant decreased after PSD in both young and aged animals. PSD increased vitamin B(12) levels in aged rats, and significantly decreased homocysteine levels in young but not in aged rats which in turn were already reduced. Folate levels were the only variable that was unaffected by aging and/or PSD. These results indicate that PSD has significant but heterogeneous physiological effects in aged rats and may intensify certain aging-related effects which contribute to cardiovascular disease risk while attenuating others.
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Affiliation(s)
- M L Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, Escola Paulista de Medicina, R. Napoleão de Barros, 925, V. Clementino 04024-002, Sao Paulo, SP, Brazil.
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Malhotra A, Trinder J, Fogel R, Stanchina M, Patel SR, Schory K, Kleverlaan D, White DP. Postural effects on pharyngeal protective reflex mechanisms. Sleep 2004; 27:1105-12. [PMID: 15532204 PMCID: PMC3504469 DOI: 10.1093/sleep/27.6.1105] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Pharyngeal muscle dilators are important in obstructive sleep apnea pathogenesis because the failure of protective reflexes involving these muscles yields pharyngeal collapse. Conflicting results exist in the literature regarding the responsiveness of these muscles during stable non-rapid eye movement sleep. However, variations in posture in previous studies may have influenced these findings. We hypothesized that tongue protruder muscles are maximally responsive to negative pressure pulses during supine sleep, when posterior tongue displacement yields pharyngeal occlusion. DESIGN We studied all subjects in the supine and lateral postures during wakefulness and stable non-rapid eye movement sleep by measuring genioglossus and tensor palatini electromyograms during basal breathing and following negative pressure pulses. SETTING Upper-airway physiology laboratory of Sleep Medicine Division, Brigham and Women's Hospital. SUBJECTS/PARTICIPANTS 17 normal subjects. MEASUREMENTS AND RESULTS We observed an increase in genioglossal responsiveness to negative pressure pulses in sleep as compared to wakefulness in supine subjects (3.9 percentage of maximum [%max] +/- 1.1 vs 4.4 %max +/- 1.0) but a decrease in the lateral decubitus position (4.1 %max +/- 1.0 vs 1.5 %max +/- 0.4), the interaction effect being significant. Despite this augmented reflex, collapsibility, as measured during negative pressure pulses, increased more while subjects were in the supine position as compared with the lateral decubitus position. While the interaction between wake-sleep state and position was also significant for the tensor palatini, the effect was weaker than for genioglossus, although, for tensor palatini, baseline activity was markedly reduced during non-rapid eye movement sleep as compared with wakefulness. CONCLUSION We conclude that body posture does have an important impact on genioglossal responsiveness to negative pressure pulses during non-rapid eye movement sleep. We speculate that this mechanism works to prevent pharyngeal occlusion when the upper airway is most vulnerable to collapse eg, during supine sleep.
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Affiliation(s)
- Atul Malhotra
- Sleep Medicine and Pulmonary/Critical Care Divisions, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Geyer O, Cohen N, Segev E, Rath EZ, Melamud L, Peled R, Lavie P. The prevalence of glaucoma in patients with sleep apnea syndrome: same as in the general population. Am J Ophthalmol 2003; 136:1093-6. [PMID: 14644220 DOI: 10.1016/s0002-9394(03)00709-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An association of glaucoma and sleep apnea syndrome (SAS) has been widely reported. We investigated the largest group of patients with SAS thus far to determine the prevalence of glaucoma among these patients. DESIGN Cross-sectional study. METHODS An institutional study. STUDY POPULATION A total of 228 patients with SAS. OBSERVATION PROCEDURES Sleep studies determined the respiratory disturbance index (RDI) during night sleep. Ocular examination included intraocular pressure (IOP) measurement, optic disk evaluation, and Humphrey visual field examination. MAIN OUTCOME MEASURES The SAS was diagnosed as an RDI > 10. The RDI was graded to determine the severity of SAS: mild (RDI, 10-19), moderate (RDI, 20-39), and severe (RDI > 40). Open-angle glaucoma was diagnosed when a glaucomatous visual field defect matched the optic disk changes, irrespective of IOP levels. RESULTS Nineteen participants had mild SAS (mean +/- standard deviation, RDI = 15 +/- 3), 129 had moderate SAS (RDI = 28 +/- 5), and 80 had severe SAS (RDI = 54 +/- 11). Open-angle glaucoma was found in five SAS subjects, a prevalence of 2% (95% confidence interval, 0.7% to 5%). There was no correlation between RDI and the presence of glaucoma (chi-square = 1.18; degrees of freedom = 2; P =.6) or between the RDI and the IOP (r = -0.067; P =.316). CONCLUSION The prevalence of glaucoma in SAS patients was similar to that in the general Caucasian population.
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Affiliation(s)
- Orna Geyer
- Department of Ophthalmology, Carmel Medical Center, Haifa, Israel.
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Berlowitz DR, Ash AS, Hickey EC, Glickman M, Friedman R, Kader B. Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care 2003; 26:355-9. [PMID: 12547862 DOI: 10.2337/diacare.26.2.355] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Clinical trials have demonstrated the importance of tight blood pressure control among patients with diabetes. However, little is known regarding the management of hypertension in patients with coexisting diabetes. To examine this issue, we addressed 1) whether hypertensive patients with coexisting diabetes are achieving lower levels of blood pressure than patients without diabetes, 2) whether there are differences in the intensity of antihypertensive medication therapy provided to patients with and without diabetes, and 3) whether diabetes management affects decisions to increase antihypertensive medication therapy. RESEARCH DESIGN AND METHODS We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted. RESULTS Of the 274 hypertensive patients with diabetes, 73% had a blood pressure > or =140/90 mmHg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes. CONCLUSIONS There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes.
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Affiliation(s)
- Dan R Berlowitz
- Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
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Anderson DE, Chesney MA. Gender-specific association of perceived stress and inhibited breathing pattern. Int J Behav Med 2002; 9:216-27. [PMID: 12360838 DOI: 10.1207/s15327558ijbm0903_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Stress can potentiate the development of hypertension via inhibition of renal excretory function. One potential mediating mechanism is an inhibited breathing pattern, because hypoventilation can decrease renal sodium excretion acutely via effects on pCO2 and acid-base balance. Large individual differences in resting breathing patterns have been well-documented, with some individuals maintaining slow frequency and high pCO2. Whether this breathing pattern is related to chronic stress has not been investigated. This study reports that high perceived stress over the past month was associated with significantly lower frequency breathing at rest, independently of age, race, or body mass index. This finding was more marked in women than in men. In addition, slow breathing frequency was independently associated with higher resting end tidal CO2 in both men and women. This is the first known report of an association of sustained stress with an inhibited breathing pattern in humans, and points to a pathway by which chronic stress might contribute to the development of hypertension, especially in women.
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Affiliation(s)
- David E Anderson
- National Institute on Aging, National Institutes of Health, Laboratory of Cardiovascular Science, 5600 Nathan Shock Drive, Baltimore, MD 21224, USA
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