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López-Cepero A, Pérez CM, González-Lorenzo K, Suárez E, Ramos AR, Teng Y, Avilés-Santa ML. The relationship between obstructive sleep apnea and haemoglobin A1c and the moderating role of glycaemic status in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Sleep Res 2023:e14092. [PMID: 38035753 PMCID: PMC11136884 DOI: 10.1111/jsr.14092] [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: 06/29/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
This study investigated the relationship between obstructive sleep apnea and haemoglobin A1c (HbA1c) among Hispanics/Latinos in the United States and assessed whether this relationship was moderated by glycaemic status. This was a cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos cohort. The sample consisted of 13,394 participants with valid measures of obstructive sleep apnea, HbA1c, and study covariates. Obstructive sleep apnea was assessed with the apnea-hypopnea index and categorised as obstructive sleep apnea if the apnea-hypopnea index was ≥5 events/h. HbA1c measures were obtained through fasting blood samples. Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG) and use of antihyperglycaemic medications were used to define glycaemic status (i.e., normoglycaemia [FPG < 5.6 mmol/L (< 100 mg/dL) and 2h-PG < 7.8 mmol/L (140 mg/dL)], prediabetes [FPG 5.6-6.9 mmol/L (100-125 mg/dL), and/or 2h-PG 7.8-11.0 mmol/L (140-199 mg/dL)], diabetes without treatment [FPG > 7.0 mmol/L (≥ 126 mg/dL) and/or 2h-PG ≥ 11.1 mmol/L (≥ 200 mg/dL)], and diabetes with treatment. Multivariable linear regression was used to calculate adjusted least square means. Overall, 25.9% of the sample had obstructive sleep apnea and 49.2% had normal glycaemic levels, 36.1% had prediabetes, 6.5% diabetes without receiving treatment, and 8.3% diabetes and undergoing treatment for it. Participants with obstructive sleep apnea had significantly higher adjusted mean HbA1c (adjusted mean [standard error] 5.85 [0.03)]) than those without (5.70 [0.02)]; p < 0.001). Models stratified by diabetes status showed that the association between obstructive sleep apnea (versus not) and higher HbA1c was only for participants with normal glycaemic status (adjusted mean [standard error] 5.27 [0.01] versus 5.30 [0.01]; p = 0.013) and prediabetes (5.59 [0.01] versus 5.66 [0.01]; p < 0.001). In conclusion, obstructive sleep apnea was associated with higher HbA1c in a diverse sample of Hispanic/Latino adults in the United States. This association was present only for participants with normal glycaemic status or with prediabetes. Studies are needed to further understand the clinical implications of the association between obstructive sleep apnea and HbA1c according to glycaemic status.
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Affiliation(s)
| | - Cynthia M. Pérez
- University of Puerto Rico School of Public Health, Medical Sciences Campus, San Juan, PR
| | - Keyla González-Lorenzo
- University of Puerto Rico School of Public Health, Medical Sciences Campus, San Juan, PR
| | - Erick Suárez
- University of Puerto Rico School of Public Health, Medical Sciences Campus, San Juan, PR
| | - Alberto R. Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Yanping Teng
- Collaborative Studies Coordinating Center, UNC Department of Biostatistics
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Karuga FF, Jaromirska J, Malicki M, Sochal M, Szmyd B, Białasiewicz P, Strzelecki D, Gabryelska A. The role of microRNAs in pathophysiology and diagnostics of metabolic complications in obstructive sleep apnea patients. Front Mol Neurosci 2023; 16:1208886. [PMID: 37547923 PMCID: PMC10403239 DOI: 10.3389/fnmol.2023.1208886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which is characterized by recurrent apneas and/or hypopneas occurring during sleep due to upper airway obstruction. Among a variety of health consequences, OSA patients are particularly susceptible to developing metabolic complications, such as metabolic syndrome and diabetes mellitus type 2. MicroRNAs (miRNAs) as epigenetic modulators are promising particles in both understanding the pathophysiology of OSA and the prediction of OSA complications. This review describes the role of miRNAs in the development of OSA-associated metabolic complications. Moreover, it summarizes the usefulness of miRNAs as biomarkers in predicting the aforementioned OSA complications.
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Affiliation(s)
- Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Julia Jaromirska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Mikołaj Malicki
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Bartosz Szmyd
- Department of Neurosurgery and Neuro-Oncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
- Department of Pediatrics, Oncology, and Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
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3
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Dutra-Marques AC, Rodrigues S, Cepeda FX, Toschi-Dias E, Rondon E, Carvalho JC, Alves MJNN, Braga AMFW, Rondon MUPB, Trombetta IC. Exaggerated Exercise Blood Pressure as a Marker of Baroreflex Dysfunction in Normotensive Metabolic Syndrome Patients. Front Neurosci 2021; 15:680195. [PMID: 34177456 PMCID: PMC8219920 DOI: 10.3389/fnins.2021.680195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Exaggerated blood pressure response to exercise (EEBP = SBP ≥ 190 mmHg for women and ≥210 mmHg for men) during cardiopulmonary exercise test (CPET) is a predictor of cardiovascular risk. Sympathetic hyperactivation and decreased baroreflex sensitivity (BRS) seem to be involved in the progression of metabolic syndrome (MetS) to cardiovascular disease. Objective To test the hypotheses: (1) MetS patients within normal clinical blood pressure (BP) may present EEBP response to maximal exercise and (2) increased muscle sympathetic nerve activity (MSNA) and reduced BRS are associated with this impairment. Methods We selected MetS (ATP III) patients with normal BP (MetS_NT, n = 27, 59.3% males, 46.1 ± 7.2 years) and a control group without MetS (C, n = 19, 48.4 ± 7.4 years). We evaluated BRS for increases (BRS+) and decreases (BRS−) in spontaneous BP and HR fluctuations, MSNA (microneurography), BP from ambulatory blood pressure monitoring (ABPM), and auscultatory BP during CPET. Results Normotensive MetS (MetS_NT) had higher body mass index and impairment in all MetS risk factors when compared to the C group. MetS_NT had higher peak systolic BP (SBP) (195 ± 17 vs. 177 ± 24 mmHg, P = 0.007) and diastolic BP (91 ± 11 vs. 79 ± 10 mmHg, P = 0.001) during CPET than C. Additionally, we found that MetS patients with normal BP had lower spontaneous BRS− (9.6 ± 3.3 vs. 12.2 ± 4.9 ms/mmHg, P = 0.044) and higher levels of MSNA (29 ± 6 vs. 18 ± 4 bursts/min, P < 0.001) compared to C. Interestingly, 10 out of 27 MetS_NT (37%) showed EEBP (MetS_NT+), whereas 2 out of 19 C (10.5%) presented (P = 0.044). The subgroup of MetS_NT with EEBP (MetS_NT+, n = 10) had similar MSNA (P = 0.437), but lower BRS+ (P = 0.039) and BRS− (P = 0.039) compared with the subgroup without EEBP (MetS_NT−, n = 17). Either office BP or BP from ABPM was similar between subgroups MetS_NT+ and MetS_NT−, regardless of EEBP response. In the MetS_NT+ subgroup, there was an association of peak SBP with BRS− (R = −0.70; P = 0.02), triglycerides with peak SBP during CPET (R = 0.66; P = 0.039), and of triglycerides with BRS− (R = 0.71; P = 0.022). Conclusion Normotensive MetS patients already presented higher peak systolic and diastolic BP during maximal exercise, in addition to sympathetic hyperactivation and decreased baroreflex sensitivity. The EEBP in MetS_NT with apparent well-controlled BP may indicate a potential depressed neural baroreflex function, predisposing these patients to increased cardiovascular risk.
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Affiliation(s)
- Akothirene C Dutra-Marques
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sara Rodrigues
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Felipe X Cepeda
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edgar Toschi-Dias
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Universidade Metodista de São Paulo, São Paulo, Brazil
| | - Eduardo Rondon
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jefferson C Carvalho
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Janieire N N Alves
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Maria F W Braga
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ivani C Trombetta
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Chen Y, Chen L, Ye L, Jin J, Sun Y, Zhang L, Zhao S, Zhang Y, Wang W, Gu W, Hong J. Association of Metabolic Syndrome With Prevalence of Obstructive Sleep Apnea and Remission After Sleeve Gastrectomy. Front Physiol 2021; 12:650260. [PMID: 33868016 PMCID: PMC8044302 DOI: 10.3389/fphys.2021.650260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 12/28/2022] Open
Abstract
Obesity is an important risk factor for metabolic syndrome and obstructive sleep apnea (OSA). Bariatric surgery has been shown to effectively reduce weight and obesity-related comorbidities. However, the prevalence and severity of OSA in obese patients with different baseline metabolic states and the improvements of OSA after bariatric surgery remain unknown. The main aims of this study were to ascertain the prevalence of OSA in young Chinese obese patients with different metabolic states and to evaluate their respective OSA remission after laparoscopic sleeve gastrectomy. We first performed a cross-sectional study involving 123 metabolically healthy obese patients and 200 metabolically unhealthy obese patients (who had the same age and BMI ranges) to estimate the prevalence of OSA at baseline. Then we performed a retrospective study, which was registered at ClinicalTrials.gov (ref. NCT02653430) of 67 patients who underwent laparoscopic sleeve gastrectomy to evaluate the remission of OSA. Metabolically healthy and unhealthy obese patients had similar apnea-hypopnea index levels (16.6 ± 22.0 vs. 16.7 ± 18.7 events/h, P = 0.512) and prevalence of OSA (66.7% vs. 69.0%, P = 0.662). Male sex, age, waist circumference and lower liver-to-spleen ratio were independent risk factors for OSA. After laparoscopic sleeve gastrectomy, no difference was found in the decrease in body mass index (BMI) change (10.8 ± 4.8 vs. 10.8 ± 3.0 kg/m2, P = 0.996) or the decrease in the apnea-hypopnea index (18.9 ± 24.6 vs. 17.0 ± 24.0 events/h, P = 0.800). The remission of moderate-to-severe OSA was observed in the MHO (36.3%; 54.5-18.2%, P = 0.125) and MUO (32.2%; 66.1-33.9%, P = 0.001) patients. These results suggest that, in patients with obesity, metabolic syndrome does not add extra risk for the prevalence or severity of OSA. Both metabolically healthy and unhealthy obese patients could benefit equally from laparoscopic sleeve gastrectomy in terms of weight loss and obstructive sleep apnea remission.
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Affiliation(s)
- Yufei Chen
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Lijia Chen
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Lingxia Ye
- Department of Endocrinology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiabin Jin
- Department of Pancreatic Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingkai Sun
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Ling Zhang
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Shaoqian Zhao
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqiong Gu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jie Hong
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
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5
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Identifying the risk of obstructive sleep apnea in metabolic syndrome patients: Diagnostic accuracy of the Berlin Questionnaire. PLoS One 2019; 14:e0217058. [PMID: 31112558 PMCID: PMC6528986 DOI: 10.1371/journal.pone.0217058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor frequently present in patients with metabolic syndrome (MetS). Additionally, moderate and severe OSA are highly prevalent in patients with cardiac disease, as they increase the riskfor cardiovascular events by 80%. The gold standard diagnostic method for OSA is overnight polysomnography (PSG), which remains unaffordable for the overall population. The aim of the present study was to evaluate whether the Berlin Questionnaire (BQ) is anuseful tool for assessing the risk of OSA in patients with MetS. METHODS 97 patients, previously untreated and recently diagnosed with MetS (National Cholesterol Education Program, Adult Treatment Panel III, ATP-III) underwent a PSG. OSA was characterized by the apnea-hypopnea index (AHI). BQ was administered before PSG and we evaluated sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS Of the 97 patients with MetS, 81 patients had OSA, with 47 (48.5%) presenting moderate and severe OSA. For all MetS with OSA (AHI≥5 events/hour), the BQ showed good sensitivity (0.65, 95% CI 0.54 to 0.76) and fair specificity (0.38, 95% CI 0.15-0.65) with a positive predictive value of 0.84, a negative predictive value of 0.18 and an 84% accuracy. Similarly, for moderate-to-severe OSA (AHI≥15 events/hour) we found good sensitivity (0.73, 95% CI 0.58-0.85) and fair specificity (0.40, 95% CI 0.27-0.55). Interestingly, for severe OSA (AHI≥30 events/hour), there was a very good sensitivity (0.91, 95% CI 0.72-0.99) and moderate specificity (0.42, 95% CI 0.31-0.54). CONCLUSION The BQ is a valid tool for screening the risk of OSA in MetS patients in general, and it is particularly useful in predicting severe OSA.
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Tażbirek M, Potoczny J, Strójwąs K, Pierzchała W, Barczyk A. Anthropometric Factors in the Assessment of Obstructive Sleep Apnea Risk in Patients with Metabolic Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1160:35-41. [PMID: 31041698 DOI: 10.1007/5584_2019_376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are related to a higher incidence of cardio-vascular diseases and mortality in patients. The aim of the study was to define the potential use of anthropometric factors for the evaluation of OSA risk in patients with diagnosed MetS. The patient group consisted of 50 obese men with MetS (mean age 49 ± 9 years). The following anthropometric indices were assessed: body mass index (BMI), neck circumference (NC), waist circumference (WC), and waist-to-hip ratio (WHR). In addition, blood glucose and lipid profile were investigated. On the basis of polysomnography, clinical symptoms, and Epworth Sleep Scale, patients were stratified into the OSA group accompanied by MetS (n = 31) and the MetS alone group taken as control (n = 19). OSA was evaluated as severe in 26 out of the 31 patients (>30 apneic episodes per hour). We found a significantly larger NC in the OSA with MetS group then that in the MetS alone group. Further, NC associated with the increase in the apnea/hypopnea index. However, the other anthropometric indices investigated failed to differentiate the two groups. We conclude that increased neck circumference in patients suffering from metabolic syndrome is a risk factor for the development of OSA.
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Affiliation(s)
- M Tażbirek
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - J Potoczny
- Student Scientific Circle, Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - K Strójwąs
- Student Scientific Circle, Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - W Pierzchała
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Barczyk
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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7
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Peng CS, Cao YA, Tian YH, Zhang WL, Xia J, Yang L. Features of continuous glycemic profile and glycemic variability in patients with obstructive sleep apnea syndrome. Diabetes Res Clin Pract 2017; 134:106-112. [PMID: 29096240 DOI: 10.1016/j.diabres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022]
Abstract
AIMS To investigate glycemic variability (GV) in Obstructive Sleep Apnea Syndrome (OSAS) patients by monitoring continuous blood glucose profile. METHODS OSAS group (n=86) and normal control group (n=40) were included. Continuous blood glucose was monitored. The relationship of GV, insulin resistance index (IRI) and the respiratory disturbance index (AHI) were analyzed. RESULTS The daily average blood glucose level was significantly higher in the OSAS patients than in the control group (6.31±0.61vs. 4.94±0.78; P<0.01). The postprandial glycemic peaks in the OSAS patients were significantly higher and prolonged. The indicators of GV were all significantly higher in the OSAS patients, including blood glucose fluctuation coefficient (BGFC, 1.93±0.71vs. 1.21±0.38, P<0.05), mean amplitude of glycemic excursions (MAGE, 4.18±0.65vs. 2.18±0.48; P<0.05) and night mean amplitude of glycemic excursions (NMAGE, 2.00±0.53vs. 1.11±0.43; P<0.05). Pearson correlation analysis showed that among the OSAS patients, the severity of OSAS (AHI) was positively correlated with the IRI (r=0.310); and the GV indicators (MAGE and NMAGE) were positively correlated with IRI and AHI (r=0.318 and 0.349, respectively) (P<0.01 or 0.001). CONCLUSIONS Continuous glycemic spectrum and GV provide comprehensive glycemic profiles and may reveal important aspects of glucose metabolism abnormality beyond regular examinations, and are therefore of particular significance for glycemic management in OSAS patients.
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Affiliation(s)
- Chao-Sheng Peng
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Yue-An Cao
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Yu-Hong Tian
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Wen-Luo Zhang
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Jing Xia
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China
| | - Lu Yang
- Naval General Hospital of PLA, Special Care Medical Center, Beijing 100048, China.
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8
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Brockmann PE, Gozal D, Villarroel L, Damiani F, Nuñez F, Cajochen C. Geographic latitude and sleep duration: A population-based survey from the Tropic of Capricorn to the Antarctic Circle. Chronobiol Int 2017; 34:373-381. [DOI: 10.1080/07420528.2016.1277735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Pablo E. Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Sleep Medicine Center, Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Damiani
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Nuñez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Hui P, Zhao L, Xie Y, Wei X, Ma W, Wang J, Hou Y, Ning J, Zhou L, Guo Q, Zhou S. Nocturnal Hypoxemia Causes Hyperglycemia in Patients With Obstructive Sleep Apnea and Type 2 Diabetes Mellitus. Am J Med Sci 2016; 351:160-8. [PMID: 26897271 DOI: 10.1016/j.amjms.2015.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our purpose was to investigate the relationship between oxygen saturation (SpO2) and dynamic interstitial glucose level (IGL) in patients with obstructive sleep apnea (OSA) along with type 2 diabetes mellitus (T2DM), and to investigate the potential mechanisms thereof. MATERIALS AND METHODS A total of 130 patients with OSA and T2DM underwent polysomnography and oral glucose tolerance tests at the Sleep Medicine Center. Using the lowest (L) SpO2% tested, patients were divided into mild, moderate and severe LSpO2 groups. Polysomnography and continuous glucose monitoring systems were used to analyze the altered pattern of SpO2 and dynamic IGL in the 3 groups. RESULTS LSpO2 during sleep in patients with OSA and T2DM stimulated an increase in IGL. The moderate and severe levels were represented by IGL45 and IGL30, respectively. The average nocturnal and peak IGL after LSpO2 in the severe group were significantly higher than in the mild and moderate groups. Stepwise multiple regression analysis showed that the body mass index (β = 0.301, P < 0.001), homeostatic model assessment of insulin resistance (β = 0.260, P < 0.001), apnea-hypopnea index (β = 0.309, P < 0.001), average SpO2 (β = -0.423, P = 0.008), LSpO2 (β = -0.369, P < 0.001) and microarousal index (β = 0.335, P = 0.044) were probably related to nocturnal IGL in patients with OSA along with T2DM. CONCLUSIONS Severe and moderate OSA with T2DM is marked by a delayed IGL peak following LSpO2. Nocturnal hypoxemia causes hyperglycemia in patients with OSA along with T2DM.
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Affiliation(s)
- Peilin Hui
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Lijun Zhao
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuping Xie
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China.
| | - Xiaoquan Wei
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Wei Ma
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jinfeng Wang
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yiping Hou
- Department of Neuroscience, Anatomy, Histology and Embryology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Jing Ning
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Liya Zhou
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qian Guo
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Shuhong Zhou
- Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China
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10
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Tahrani AA. Obstructive sleep apnea in patients with diabetes: implications for clinical practice. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/dmt.15.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Dudzińska D, Boncler M, Watala C. The cardioprotective power of leaves. Arch Med Sci 2015; 11:819-39. [PMID: 26322095 PMCID: PMC4548035 DOI: 10.5114/aoms.2015.53303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/29/2013] [Accepted: 08/21/2013] [Indexed: 12/19/2022] Open
Abstract
Lack of physical activity, smoking and/or inappropriate diet can contribute to the increase of oxidative stress, in turn affecting the pathophysiology of cardiovascular diseases. Strong anti-oxidant properties of plant polyphenolic compounds might underlie their cardioprotective activity. This paper reviews recent findings on the anti-oxidant activity of plant leaf extracts and emphasizes their effects on blood platelets, leukocytes and endothelial cells - the targets orchestrating the development and progression of cardiovascular diseases. We also review the evidence linking supplementation with plant leaf extracts and the risk factors defining the metabolic syndrome. The data point to the importance of leaves as an alternative source of polyphenolic compounds in the human diet and their role in the prevention of cardiovascular diseases.
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Affiliation(s)
- Dominika Dudzińska
- Department of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Lodz, Poland
| | - Magdalena Boncler
- Department of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Lodz, Poland
| | - Cezary Watala
- Department of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Lodz, Poland
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12
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Tahrani AA. Diabetes and sleep apnea. INTERNATIONAL TEXTBOOK OF DIABETES MELLITUS 2015:316-336. [DOI: 10.1002/9781118387658.ch22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Altaf Q, Tahrani AA. Obstructive Sleep Apnea and Diabetic Microvascular Complications. MODULATION OF SLEEP BY OBESITY, DIABETES, AGE, AND DIET 2015:213-224. [DOI: 10.1016/b978-0-12-420168-2.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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14
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Geovanini GR, Gowdak LHW, Pereira AC, Danzi-Soares NDJ, Dourado LOC, Poppi NT, Cesar LAM, Drager LF, Lorenzi-Filho G. OSA and depression are common and independently associated with refractory angina in patients with coronary artery disease. Chest 2014; 146:73-80. [PMID: 24811214 DOI: 10.1378/chest.13-2885] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 ± 4 kg/m2 vs 28.5 ± 4 kg/m2, P = .06), and were older (61 ± 10 y vs 57 ± 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 ± 6 vs 8 ± 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 ± 8 vs 10 ± 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 ± 30 events/h vs 23 ± 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% ± 13 vs 4% ± 9, P = .04), and a higher proportion of severe OSA (AHI ≥ 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.
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Affiliation(s)
- Glaucylara R Geovanini
- Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil
| | - Luis H W Gowdak
- Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre C Pereira
- Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Luciana O C Dourado
- Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Nilson T Poppi
- Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Luciano F Drager
- Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil.
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Abstract
PURPOSE OF REVIEW The relationship between obstructive sleep apnoea (OSA) and dysglycaemia is well established. However, uncertainty remains as to the extent that obesity mediates this relationship. The impact of OSA treatment on glucose metabolism and the consequences of having OSA in patients with diabetes is unclear. This review aims to summarize the latest evidence regarding the links between OSA and dysglycaemia. RECENT FINDINGS OSA is associated with insulin resistance in lean individuals and predicts insulin resistance worsening longitudinally. Continuous positive airway pressure (CPAP) lowers insulin resistance in CPAP-compliant patients. OSA is associated with impaired β-cell function. In patients with type 2 diabetes (T2D), the association between OSA and glycosylated haemoglobin (HbA1c) is related to nocturnal hypoxaemia. Apnoea hypopnoea index (AHI) during rapid eye movement (REM) (not non-REM) sleep is associated with HbA1c. In-laboratory, supervised CPAP improves glycaemia. OSA is associated with and predicts the progression of some diabetic vascular complications. Intensive lifestyle intervention in patients with T2D improves OSA independent of weight loss. SUMMARY OSA is associated with insulin resistance and β-cell dysfunction independent of obesity. OSA is associated with HbA1c and vascular complications in patients with T2D. CPAP might improve insulin resistance and glycaemic measures. Lifestyle intervention has a significant impact on AHI in patients with T2D.
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Tahrani AA, Ali A. Obstructive Sleep Apnoea and Type 2 Diabetes. EUROPEAN ENDOCRINOLOGY 2014; 10:43-50. [PMID: 29872463 DOI: 10.17925/ee.2014.10.01.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/07/2014] [Indexed: 12/20/2022]
Abstract
With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnoea (OSA) is a very common medical condition that is associated with increased risk of cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycaemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycaemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.
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Affiliation(s)
- Abd A Tahrani
- NIHR Clinician Scientist, Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham and Honorary Consultant Physician, Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Asad Ali
- Consultant Respiratory Physician, Department of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry, UK
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17
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Tahrani AA, Ali A. Oxidative Stress, Inflammation and Endothelial Dysfunction: The Link Between Obstructive Sleep Apnoea and Vascular Disease in Type 2 Diabetes. OXIDATIVE STRESS IN APPLIED BASIC RESEARCH AND CLINICAL PRACTICE 2014:149-171. [DOI: 10.1007/978-1-4899-8035-9_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Goodson BL, Wung SF, Archbold KH. Obstructive sleep apnea hypopnea syndrome and metabolic syndrome: a synergistic cardiovascular risk factor. ACTA ACUST UNITED AC 2012. [PMID: 23190127 DOI: 10.1111/j.1745-7599.2012.00771.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for adults in the United States. One risk factor for CVD is metabolic syndrome, which encompasses obesity, hypertension, insulin resistance, proinflammatory state, and prothrombotic state. A lesser-understood risk factor is obstructive sleep apnea hypopnea syndrome (OSAHS). This article explores the physiological consequences of the interaction between OSAHS and metabolic syndrome on the cardiovascular system. DATA SOURCES Search terms "metabolic syndrome,""obstructive sleep apnea,""cardiovascular disease,""diabetes,""obesity," and "atherosclerosis," were used. Studies involving children were excluded. CONCLUSIONS Both metabolic syndrome and OSAHS have significant impact on the cardiovascular system; however, when both conditions are present together, the impact is synergistic and CVD risk is multiplied. Treatment with continuous positive airway pressure (CPAP) reduces the global burden of CVD risk. IMPLICATIONS FOR PRACTICE Providers need to screen patients routinely for both metabolic syndrome and OSAHS. Treatment should include CPAP, weight reduction, oral appliances, and/or upper airway surgeries with concurrent management for metabolic syndrome. Future research should further elucidate the mechanisms of action by which OSAHA and metabolic syndrome contribute to CVD. This understanding can lead to more stringent guidelines on the management of metabolic syndrome and OSAHS.
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Abstract
OSA is increasingly recognized as a major health problem in developed countries. Obesity is the most common risk factor in OSA and hence, the prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is highly associated with the metabolic syndrome, and it is postulated that OSA contributes to cardiometabolic dysfunction, and subsequently vasculopathy. Current evidence regarding the magnitude of impact on ultimate cardiovascular morbidity or mortality attributable to OSA-induced metabolic dysregulation is scarce. Given the known pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA, the potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. There is accumulating evidence from human and animal/cell models of intermittent hypoxia to map out these mechanistic pathways. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, a healthy diet and appropriate lifestyle modifications towards better control of metabolic function are equally important as CPAP treatment in the holistic management of OSA.
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Affiliation(s)
- Jamie Chung Mei Lam
- Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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20
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Lorenzi Filho G, Genta PR, Pedrosa RP, Drager LF, Martinez D. [Cardiovascular consequences of obstructive sleep apnea syndrome]. J Bras Pneumol 2011; 36 Suppl 2:38-42. [PMID: 20944980 DOI: 10.1590/s1806-37132010001400011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common condition associated with various cardiovascular diseases, including systemic arterial hypertension, atrial fibrillation, and atherosclerosis. The association between OSAS and cardiovascular disease has been related to the overlapping of risk factors, including obesity, having a sedentary lifestyle, being male, and being older. However, there is mounting evidence that OSAS can also independently contribute to the development and progression of various cardiovascular diseases. The mechanisms by which OSAS can affect the cardiovascular system are multiple, including the activation of the sympathetic nervous system, systemic inflammation, insulin resistance, and oxidative stress. There is also evidence that the treatment of OSAS with CPAP can reduce arterial blood pressure, early signs of atherosclerosis, the risk of atrial fibrillation recurrence, and mortality (principally mortality due to stroke or acute myocardial infarction) in patients with severe OSAS.
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Affiliation(s)
- Geraldo Lorenzi Filho
- Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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21
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Trombetta IC, Somers VK, Maki-Nunes C, Drager LF, Toschi-Dias E, Alves MJNN, Fraga RF, Rondon MUPB, Bechara MG, Lorenzi-Filho G, Negrão CE. Consequences of comorbid sleep apnea in the metabolic syndrome--implications for cardiovascular risk. Sleep 2010; 33:1193-9. [PMID: 20857866 DOI: 10.1093/sleep/33.9.1193] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined how the presence of OSA in patients with MetSyn affected hemodynamic and autonomic variables associated with poor cardiovascular outcome. DESIGN Prospective clinical study. PARTICIPANTS We studied 36 patients with MetSyn (ATP-III) divided into 2 groups matched for age and sex: (1) MetSyn+OSA (n = 18) and (2) MetSyn-OSA (n = 18). MEASUREMENTS OSA was defined by an apnea-hypopnea index (AHI) > 15 events/hour by polysomnography. We recorded muscle sympathetic nerve activity (MSNA - microneurography), heart rate (HR), and blood pressure (BP - Finapres). Baroreflex sensitivity (BRS) was analyzed by spontaneous BP and HR fluctuations. RESULTS MSNA (34 +/- 2 vs 28 +/- 1 bursts/min, P = 0.02) and mean BP (111 +/- 3 vs. 99 +/- 2 mm Hg, P = 0.003) were higher in patients with MetSyn+OSA versus patients with MetSyn-OSA. Patients with MetSyn+OSA had lower spontaneous BRS for increases (7.6 +/- 0.6 vs 12.2 +/- 1.2 msec/mm Hg, P = 0.003) and decreases (7.2 +/- 0.6 vs 11.9 +/- 1.6 msec/mm Hg, P = 0.01) in BP. MSNAwas correlated with AHI (r = 0.48; P = 0.009) and minimum nocturnal oxygen saturation (r = -0.38, P = 0.04). CONCLUSION Patients with MetSyn and comorbid OSA have higher BP, higher sympathetic drive, and diminished BRS, compared with patients with MetSyn without OSA. These adverse cardiovascular and autonomic consequences of OSA may be associated with poorer outcomes in these patients. Moreover, increased BP and sympathetic drive in patients with MetSyn+OSA may be linked, in part, to impairment of baroreflex gain.
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Affiliation(s)
- Ivani C Trombetta
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Lam DCL, Lui MMS, Lam JCM, Ong LHY, Lam KSL, Ip MSM. Prevalence and recognition of obstructive sleep apnea in Chinese patients with type 2 diabetes mellitus. Chest 2010; 138:1101-7. [PMID: 20705796 DOI: 10.1378/chest.10-0596] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with disorders of glucose metabolism. Previous studies revealed a high prevalence of OSA among subjects with type 2 diabetes mellitus (DM). The aims of this study were to determine the prevalence of OSA and associated clinical factors in Chinese patients with DM. METHODS All records of the DM clinic at a teaching hospital in Hong Kong were screened between January 2007 and June 2008. Inclusion criteria for patients were Chinese, aged 18 to 75 years, with type 2 DM. Patients with unstable medical illnesses, gestational diabetes, or on renal replacement therapy were excluded. RESULTS Of 3,489 records screened, 1,859 subjects were eligible. A random sample of 663 (mean age, 58.2 ± 10.8; mean BMI, 26.0 ± 4.6), except six with known OSA, were invited for polysomnography (PSG). Of 165 subjects on which PSG was performed, OSA was diagnosed (apnea-hypopnea index [AHI] ≥ 5.0/h) in 89 subjects (53.9%, median Epworth Sleepiness Scale, 6 [interquartile range 3, 10]). Fifty-four (32.7%) had moderate/severe OSA (AHI ≥ 15/h). The estimated OSA prevalence in this diabetic cohort was 17.5% (24.7% in men, 10.3% in women). Regression analysis identified that AHI was associated independently with higher BMI, advanced age, male sex, and higher diastolic BP (R(2) = 29.6%). The adjusted OR of requiring three or more antihypertensive drugs in moderate/severe OSA was 2.48 (95% CI, 1.05-5.87). No association between glycemic control (HbA1c) and sleep was identified. CONCLUSIONS In conclusion, OSA is more prevalent in Chinese adults with DM than in the general population. A high index of suspicion for OSA in patients with DM is warranted, because they may not have overt daytime sleepiness.
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Affiliation(s)
- David C L Lam
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Rd, Hong Kong, ROC
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23
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Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJNN, Fraga RF, Jun JC, Negrão CE, Krieger EM, Polotsky VY, Lorenzi-Filho G. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One 2010; 5:e12065. [PMID: 20711453 PMCID: PMC2920316 DOI: 10.1371/journal.pone.0012065] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 07/14/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obstructive Sleep Apnea (OSA) is tightly linked to some components of Metabolic Syndrome (MetS). However, most of the evidence evaluated individual components of the MetS or patients with a diagnosis of OSA that were referred for sleep studies due to sleep complaints. Therefore, it is not clear whether OSA exacerbates the metabolic abnormalities in a representative sample of patients with MetS. METHODOLOGY/PRINCIPAL FINDINGS We studied 152 consecutive patients (age 48+/-9 years, body mass index 32.3+/-3.4 Kg/m2) newly diagnosed with MetS (Adult Treatment Panel III). All participants underwent standard polysomnography irrespective of sleep complaints, and laboratory measurements (glucose, lipid profile, uric acid and C-reactive protein). The prevalence of OSA (apnea-hypopnea index>or=15 events per hour of sleep) was 60.5%. Patients with OSA exhibited significantly higher levels of blood pressure, glucose, triglycerides, cholesterol, LDL, cholesterol/HDL ratio, triglycerides/HDL ratio, uric acid and C-reactive protein than patients without OSA. OSA was independently associated with 2 MetS criteria: triglycerides: OR: 3.26 (1.47-7.21) and glucose: OR: 2.31 (1.12-4.80). OSA was also independently associated with increased cholesterol/HDL ratio: OR: 2.38 (1.08-5.24), uric acid: OR: 4.19 (1.70-10.35) and C-reactive protein: OR: 6.10 (2.64-14.11). Indices of sleep apnea severity, apnea-hypopnea index and minimum oxygen saturation, were independently associated with increased levels of triglycerides, glucose as well as cholesterol/HDL ratio, uric acid and C-reactive protein. Excessive daytime sleepiness had no effect on the metabolic and inflammatory parameters. CONCLUSIONS/SIGNIFICANCE Unrecognized OSA is common in consecutive patients with MetS. OSA may contribute to metabolic dysregulation and systemic inflammation in patients with MetS, regardless of symptoms of daytime sleepiness.
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Affiliation(s)
- Luciano F Drager
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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Drager LF, Genta PR, Pedrosa RP, Nerbass FB, Gonzaga CC, Krieger EM, Lorenzi-Filho G. Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension. Am J Cardiol 2010; 105:1135-9. [PMID: 20381666 DOI: 10.1016/j.amjcard.2009.12.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/01/2009] [Accepted: 12/01/2009] [Indexed: 11/28/2022]
Abstract
Obstructive sleep apnea (OSA) is a secondary cause of hypertension and independently associated with target-organ damage in hypertensive patients. However, OSA remains largely underdiagnosed and undertreated. The aim of the present study was to evaluate the characteristics and clinical predictors of OSA in a consecutive series of patients followed up in a hypertension unit. A total of 99 patients (age 46 + or - 11 years, body mass index 28.8 kg/m(2), range 25.1 to 32.9) underwent polysomnography. The clinical parameters included age, gender, obesity, daytime sleepiness, snoring, Berlin Questionnaire, resistant hypertension, and metabolic syndrome. Of the 99 patients, 55 (56%) had OSA (apnea-hypopnea index >5 events/hour). Patients with OSA were older and more obese, had greater levels of blood pressure, and presented with more diabetes, dyslipidemia, resistant hypertension, and metabolic syndrome than the patients without OSA. Of the patients with OSA, 51% had no excessive daytime sleepiness. The Berlin Questionnaire and patient age revealed a high sensitivity (0.93 and 0.91, respectively) but low specificity (0.59 and 0.48, respectively), and obesity and resistant hypertension revealed a low sensitivity (0.58 and 0.44, respectively) but high specificity (0.75 and 0.91, respectively) for OSA. Metabolic syndrome was associated with high sensitivity and specificity for OSA (0.86 and 0.85, respectively). Multiple regression analysis showed that age of 40 to 70 years (odds ratio 1.09, 95% confidence interval 1.03 to 1.16), a high risk of OSA on the Berlin Questionnaire (odds ratio 8.36, 95% confidence interval 1.67 to 41.85), and metabolic syndrome (odds ratio 19.04, 95% confidence interval 5.25 to 69.03) were independent variables associated with OSA. In conclusion, more important than the typical clinical features that characterize OSA, including snoring and excessive daytime sleepiness, the presence of the metabolic syndrome is as an important marker of OSA among patients with hypertension.
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Affiliation(s)
- Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
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Pedrosa RP, Drager LF, Genta PR, Amaro ACS, Antunes MO, Matsumoto AY, Arteaga E, Mady C, Lorenzi-Filho G. Obstructive sleep apnea is common and independently associated with atrial fibrillation in patients with hypertrophic cardiomyopathy. Chest 2010; 137:1078-84. [PMID: 20154076 DOI: 10.1378/chest.09-2335] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is associated with arrhythmias and cardiovascular death. Left atrial enlargement and atrial fibrillation (AF) are considered markers for death due to heart failure in patients with HCM. Obstructive sleep apnea (OSA) is independently associated with heart remodeling and arrhythmias in other populations. We hypothesized that OSA is common and is associated with heart remodeling and AF in patients with HCM. METHODS We evaluated 80 consecutive stable patients with a confirmed diagnosis of HCM by sleep questionnaire, blood tests, echocardiography, and sleep study (overnight respiratory monitoring). RESULTS OSA (apnea-hypopnea index [AHI] > 15 events/h) was present in 32 patients (40%). Patients with OSA were significantly older (56 [41-64] vs 38.5 [30-53] years, P < .001) and presented higher BMI (28.2 +/- 3.5 vs 25.2 +/- 5.2 kg/m(2), P < .01) and increased left atrial diameter (45 [42-52.8] vs 41 [39-47] mm, P = .01) and aorta diameter (34 [30-37] vs 29 [28-32] mm, P < .001), compared with patients without OSA. Stepwise multiple linear regression showed that the AHI (P = .05) and BMI (P = .06) were associated with left atrial diameter. The AHI was the only variable associated with aorta diameter (P = .01). AF was present in 31% vs 6% of patients with and without OSA, respectively (P < .01). OSA (P = .03) and left atrial diameter (P = .03) were the only factors independently associated with AF. CONCLUSIONS OSA is highly prevalent in patients with HCM and it is associated with left atrial and aortic enlargement. OSA is independently associated with AF, a risk factor for cardiovascular death in this population.
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Affiliation(s)
- Rodrigo P Pedrosa
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar, 44, São Paulo, Brazil
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