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Vgontzas AN, He F, Fernandez-Mendoza J, Karagkouni E, Pejovic S, Karataraki M, Li Y, Bixler EO. Age-related differences in the association of mild-to-moderate sleep apnea with incident cardiovascular and cerebrovascular diseases. Sleep Med 2024; 113:306-312. [PMID: 38101102 DOI: 10.1016/j.sleep.2023.11.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Mild-to-moderate obstructive sleep apnea (mmOSA) is highly prevalent in the general population. However, studies on its association with incident cardiovascular and/or cerebrovascular disease (CBVD) are limited. We examined the association between mild-to-moderate OSA and incident cardiovascular and/or cerebrovascular (CBVD) in a general population sample, and whether age modifies this association. METHODS A total of 1173 adults from the Penn State Adult Cohort (20-88 years) without CBVD or severe OSA at baseline were followed-up after 9.2 (±4.1) years. Incident CBVD was defined based on a self-report of a physician diagnosis or treatment for heart disease and/or stroke. Logistic regression examined the association of mild-to-moderate OSA (AHI 5-29.9) with incident CBVD and the combined effect of mmOSA and MetS on incident CBVD after adjusting for multiple confounders. RESULTS Age significantly modified the association between mmOSA with incident CBVD (p-interaction = 0.04). Mild-to-moderate OSA was significantly associated with incident CBVD in adults aged <60 years (OR = 1.74, 95%CI = 1.06-2.88, p = 0.029), but not in adults aged ≥60 years (OR = 0.71, 95%CI = 0.39-1.27, p = 0.247). Even mild OSA (AHI 5-14.9) carried a significant risk for incident CBDV in adults aged <60 years (OR = 1.86, 95%CI = 1.05-3.28, p = 0.032). An additive effect was found between mmOSA and MetS with incident CBVD in those aged <65 years (OR = 3.84, 95%CI = 1.95-7.56, p<0.001). CONCLUSIONS The risk of incident CBVD is increased in young and middle-aged but not older adults with mmOSA, which may affect the way we currently diagnose and treat this highly prevalent sleep-related breathing disorder.
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Affiliation(s)
- Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| | - Fan He
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Efthalia Karagkouni
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Slobodanka Pejovic
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Maria Karataraki
- Department of Psychiatry and Behavioral Sciences, University of Crete, Heraklion, Crete, Greece
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Edward O Bixler
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Peixoto de Miranda ÉJF, Mazzotti DR, Santos RB, Souza SP, Parise BK, Giatti S, Aielo AN, Cunha LF, Silva WA, Bortolotto LA, Lorenzi-Filho G, Lotufo PA, Bensenor IM, Bittencourt MS, Drager LF. Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health. Chest 2024; 165:202-212. [PMID: 37356709 DOI: 10.1016/j.chest.2023.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/06/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. RESEARCH QUESTION Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (β = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (β = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
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Affiliation(s)
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS; Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Ronaldo B Santos
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Silvana P Souza
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Barbara K Parise
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Soraya Giatti
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Aline N Aielo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Lorenna F Cunha
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Wagner A Silva
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratório do Sono, Disciplina de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Márcio S Bittencourt
- Cardiac CT Program, Heart and Vascular Institute, University of Pittsburgh., Pittsburgh, PA
| | - Luciano F Drager
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil.
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Arnaud C, Billoir E, de Melo Junior AF, Pereira SA, O'Halloran KD, Monteiro EC. Chronic intermittent hypoxia-induced cardiovascular and renal dysfunction: from adaptation to maladaptation. J Physiol 2023; 601:5553-5577. [PMID: 37882783 DOI: 10.1113/jp284166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
Chronic intermittent hypoxia (CIH) is the dominant pathological feature of human obstructive sleep apnoea (OSA), which is highly prevalent and associated with cardiovascular and renal diseases. CIH causes hypertension, centred on sympathetic nervous overactivity, which persists following removal of the CIH stimulus. Molecular mechanisms contributing to CIH-induced hypertension have been carefully delineated. However, there is a dearth of knowledge on the efficacy of interventions to ameliorate high blood pressure in established disease. CIH causes endothelial dysfunction, aberrant structural remodelling of vessels and accelerates atherosclerotic processes. Pro-inflammatory and pro-oxidant pathways converge on disrupted nitric oxide signalling driving vascular dysfunction. In addition, CIH has adverse effects on the myocardium, manifesting atrial fibrillation, and cardiac remodelling progressing to contractile dysfunction. Sympatho-vagal imbalance, oxidative stress, inflammation, dysregulated HIF-1α transcriptional responses and resultant pro-apoptotic ER stress, calcium dysregulation, and mitochondrial dysfunction conspire to drive myocardial injury and failure. CIH elaborates direct and indirect effects in the kidney that initially contribute to the development of hypertension and later to chronic kidney disease. CIH-induced morphological damage of the kidney is dependent on TLR4/NF-κB/NLRP3/caspase-1 inflammasome activation and associated pyroptosis. Emerging potential therapies related to the gut-kidney axis and blockade of aryl hydrocarbon receptors (AhR) are promising. Cardiorenal outcomes in response to intermittent hypoxia present along a continuum from adaptation to maladaptation and are dependent on the intensity and duration of exposure to intermittent hypoxia. This heterogeneity of OSA is relevant to therapeutic treatment options and we argue the need for better stratification of OSA phenotypes.
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Affiliation(s)
- Claire Arnaud
- Université Grenoble-Alpes INSERM U1300, Laboratoire HP2, Grenoble, France
| | - Emma Billoir
- Université Grenoble-Alpes INSERM U1300, Laboratoire HP2, Grenoble, France
| | | | - Sofia A Pereira
- iNOVA4Health, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Emilia C Monteiro
- iNOVA4Health, NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Yang K, Hou R, Zhao J, Wang X, Wei J, Pan X, Zhu X. Lifestyle effects on aging and CVD: A spotlight on the nutrient-sensing network. Ageing Res Rev 2023; 92:102121. [PMID: 37944707 DOI: 10.1016/j.arr.2023.102121] [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: 05/24/2023] [Revised: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
Aging is widespread worldwide and a significant risk factor for cardiovascular disease (CVD). Mechanisms underlying aging have attracted considerable attention in recent years. Remarkably, aging and CVD overlap in numerous ways, with deregulated nutrient sensing as a common mechanism and lifestyle as a communal modifier. Interestingly, lifestyle triggers or suppresses multiple nutrient-related signaling pathways. In this review, we first present the composition of the nutrient-sensing network (NSN) and its metabolic impact on aging and CVD. Secondly, we review how risk factors closely associated with CVD, including adverse life states such as sedentary behavior, sleep disorders, high-fat diet, and psychosocial stress, contribute to aging and CVD, with a focus on the bridging role of the NSN. Finally, we focus on the positive effects of beneficial dietary interventions, specifically dietary restriction and the Mediterranean diet, on the regulation of nutrient metabolism and the delayed effects of aging and CVD that depend on the balance of the NSN. In summary, we expound on the interaction between lifestyle, NSN, aging, and CVD.
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Affiliation(s)
- Kaiying Yang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Rongyao Hou
- Department of Neurology, The Affiliated Hiser Hospital of Qingdao University, Qingdao 266000, China
| | - Jie Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Xia Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Jin Wei
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Xudong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Xiaoyan Zhu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
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5
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Proteomic profiling for prediction of recurrent cardiovascular event in patients with acute coronary syndrome and obstructive sleep apnea: A post-hoc analysis from the ISAACC study. Biomed Pharmacother 2023; 158:114125. [PMID: 36549084 DOI: 10.1016/j.biopha.2022.114125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a recurrent cardiovascular event (CVE) risk in patients with a first acute coronary syndrome (ACS). However, the pathological pathways by which OSA promotes this deleterious role are unknown. We aim to explore the proteomic profile associated with OSA that promote the recurrent CVE risk in severe OSA patients with ACS without previous cardiovascular diseases. METHODS This post-hoc analysis from the ISAACC study (NCT01335087) included 86 patients admitted for ACS. Patients underwent respiratory polygraphy for the first 24-72 h to OSA diagnosis. We analyzed of 276 cardiovascular and inflammatory related proteins in baseline fasting plasma samples using proximity expression assay technology (Olink®, Sweden). Protein levels were compared between severe OSA patients with/without recurrent CVEs during follow-up. Random forest was conducted to select relevant proteins and generate a predictive model of recurrent CVE. RESULTS We included 86 patients (median age: 61 years, median BMI: 29.4 kg/m2 and 86 % males) admitted for ACS with severe OSA (56 without recurrent CVE/30 with recurrent CVE). The plasma levels of 38 proteins were differentially expressed between groups. Additionally, 12 proteins had a significant association with respiratory polygraphy parameters. Three proteins discriminate with an AUC of 0.81 (95 % CI of 0.71-0.9) between severe OSA patients with and without recurrent CVE. These proteins were implicated in cell proliferation, communication and apoptosis, and regulation/response to the inflammatory and immune systems. CONCLUSION In ACS patients with severe OSA, a proteomic profile was associated with recurrent CVEs. This proteomic profile was correlated with specific OSA parameters from respiratory polygraphy. Proteomic profiling may provide an new direction for patient risk stratification and clinical management.
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Cardiovascular Disease in Obstructive Sleep Apnea: Putative Contributions of Mineralocorticoid Receptors. Int J Mol Sci 2023; 24:ijms24032245. [PMID: 36768567 PMCID: PMC9916750 DOI: 10.3390/ijms24032245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and highly prevalent condition that is associated with oxidative stress, inflammation, and fibrosis, leading to endothelial dysfunction, arterial stiffness, and vascular insulin resistance, resulting in increased cardiovascular disease and overall mortality rates. To date, OSA remains vastly underdiagnosed and undertreated, with conventional treatments yielding relatively discouraging results for improving cardiovascular outcomes in OSA patients. As such, a better mechanistic understanding of OSA-associated cardiovascular disease (CVD) and the development of novel adjuvant therapeutic targets are critically needed. It is well-established that inappropriate mineralocorticoid receptor (MR) activation in cardiovascular tissues plays a causal role in a multitude of CVD states. Clinical studies and experimental models of OSA lead to increased secretion of the MR ligand aldosterone and excessive MR activation. Furthermore, MR activation has been associated with worsened OSA prognosis. Despite these documented relationships, there have been no studies exploring the causal involvement of MR signaling in OSA-associated CVD. Further, scarce clinical studies have exclusively assessed the beneficial role of MR antagonists for the treatment of systemic hypertension commonly associated with OSA. Here, we provide a comprehensive overview of overlapping mechanistic pathways recruited in the context of MR activation- and OSA-induced CVD and propose MR-targeted therapy as a potential avenue to abrogate the deleterious cardiovascular consequences of OSA.
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Farré R, Almendros I, Martínez-García MÁ, Gozal D. Experimental Models to Study End-Organ Morbidity in Sleep Apnea: Lessons Learned and Future Directions. Int J Mol Sci 2022; 23:ijms232214430. [PMID: 36430904 PMCID: PMC9696027 DOI: 10.3390/ijms232214430] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Sleep apnea (SA) is a very prevalent sleep breathing disorder mainly characterized by intermittent hypoxemia and sleep fragmentation, with ensuing systemic inflammation, oxidative stress, and immune deregulation. These perturbations promote the risk of end-organ morbidity, such that SA patients are at increased risk of cardiovascular, neurocognitive, metabolic and malignant disorders. Investigating the potential mechanisms underlying SA-induced end-organ dysfunction requires the use of comprehensive experimental models at the cell, animal and human levels. This review is primarily focused on the experimental models employed to date in the study of the consequences of SA and tackles 3 different approaches. First, cell culture systems whereby controlled patterns of intermittent hypoxia cycling fast enough to mimic the rates of episodic hypoxemia experienced by patients with SA. Second, animal models consisting of implementing realistic upper airway obstruction patterns, intermittent hypoxia, or sleep fragmentation such as to reproduce the noxious events characterizing SA. Finally, human SA models, which consist either in subjecting healthy volunteers to intermittent hypoxia or sleep fragmentation, or alternatively applying oxygen supplementation or temporary nasal pressure therapy withdrawal to SA patients. The advantages, limitations, and potential improvements of these models along with some of their pertinent findings are reviewed.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence: (R.F.); (D.G.)
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
| | - Miguel-Ángel Martínez-García
- CIBER de Enfermedades Respiratorias, 1964603 Madrid, Spain
- Pneumology Department, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, The University of Missouri, Columbia, MO 65201, USA
- Correspondence: (R.F.); (D.G.)
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Wei Q, Xu X, Chen L, Wang T, Xie L, Yu FC, Song SF, Sheng ZQ, Tong JY. Effects of chronic intermittent hypoxia on left cardiac function in young and aged mice. Am J Physiol Regul Integr Comp Physiol 2022; 322:R241-R252. [PMID: 35080993 DOI: 10.1152/ajpregu.00256.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular disease that is characterized by chronic intermittent hypoxia (CIH), and its impact is related to age. This study aims to assess the age-related impact of CIH on cardiac function and to further explore the mechanism. After 8 weeks of severe CIH exposure, the hearts of young mice showed slight physiological hypertrophy, decreased diastolic function, and collagen I accumulation but no obvious change in contractile function. However, the contractile function of the hearts of aged mice was severely decreased. CIH exposure promoted the fragmentation of mitochondria in the hearts of aged mice and decreased the mitochondrial membrane potential of cardiomyocytes, but these effects were not observed in young mice exposed to the same conditions. CIH induced significant decreases in basal respiration, maximum respiration and ATP production in cardiac mitochondria of aged mice compared to those of young mice. The assessment of mitochondrial-related proteins showed that young mouse hearts had upregulated adaptive nuclear respiratory factors (Nrf)1/2 sirtuin (SIRT)1/3 and transcription factor A (TFAM) expression that stabilized mitochondrial function in response to CIH exposure. Aged mouse hearts exhibited maladaptation to CIH exposure, and downregulation of SIRT1 and TFAM expression resulted in mitochondrial dysfunction.
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Affiliation(s)
- Qin Wei
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Xuan Xu
- Southeast University, Nanjing, Jiangsu, China
| | - Long Chen
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Tao Wang
- Southeast University, Nanjing, Jiangsu, China
| | - Liang Xie
- Southeast University, Nanjing, Jiangsu, China
| | - Fu-Chao Yu
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Si-Fan Song
- Southeast University, Nanjing, Jiangsu, China
| | | | - Jia-Yi Tong
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
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Weng C, Huang L, Feng H, He Q, Lin X, Jiang T, Lin J, Wang X, Liu Q. Gestational chronic intermittent hypoxia induces hypertension, proteinuria, and fetal growth restriction in mice. Sleep Breath 2021; 26:1661-1669. [PMID: 34845629 DOI: 10.1007/s11325-021-02529-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/14/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Pregnant women are predisposed to obstructive sleep apnea (OSA). Based on the fact that OSA is an independent risk factor for hypertension among the general population, we hypothesized that chronic intermittent hypoxia (CIH), as a feature of OSA, may lead to preeclampsia. METHODS Pregnant and non-pregnant C57BL/6 J mice were exposed to two conditions of chronic intermittent hypoxia: CIH1 (21-5% O2 alternations), CIH2 (21-10% O2 alternations), and room air until day 19. RESULTS In non-pregnant mice, compared with their respective baseline values, systolic blood pressure (SBP) started to rise from day 14 in the CIH1 group, and SBP rose until day 19 in the CIH2 group. Compared with the pregnant mice exposed to room air, pregnant mice exposed to CIH1 maintained elevated SBP from day 14, accompanied by proteinuria, fetal and placental growth restriction, and a reduction in the number of fetuses. An imbalance between proangiogenic and antiangiogenic factors and impairment of vascular remodeling existed in the placenta of pregnant mice exposed to CIH1. Maternal serum levels of the soluble form of vascular endothelial growth factor receptor-1 were also significantly increased. Pregnant mice exposed to CIH2 seemed to have milder changes than pregnant mice exposed to CIH1. CONCLUSION Our results demonstrated that gestational CIH may induce gestational hypertension, proteinuria, fetal and placental growth restriction as well as impairments in placental angiogenesis and vascular remodeling.
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Affiliation(s)
- Cuilian Weng
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Long Huang
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hangwei Feng
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Quanying He
- Department of Respirology, Peking University People's Hospital, Beijing, China
| | - Xingsheng Lin
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Tingting Jiang
- Department of Pharmacy, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian Lin
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xincai Wang
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qinghua Liu
- Department of Otorhinolaryngology, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, 134 Dongjie Street, Fuzhou, Fujian Province, China.
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[Correlation of obstructive sleep apnea with components of metabolic syndrome and implications for long-term adverse cardiovascular risk in elderly patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1592-1599. [PMID: 34916183 PMCID: PMC8685693 DOI: 10.12122/j.issn.1673-4254.2021.11.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the relationship between obstructive sleep apnea (OSA) and components of metabolic syndrome (MetS) in the elderly and the implications for long-term risk for major adverse cardiovascular events (MACE). METHODS This multicenter prospective cohort study was conducted among 1157 consecutive patients with OSA [defined as an apnea-hypopnea index (AHI) ≥5 times/h recorded by overnight polysomnography] aged ≥60 years enrolled from January, 2015 to October, 2017. All the patients did not have a history of MACE at baseline and had complete documentations of MetS indicators. The baseline demographic data, clinical characteristics, biochemical markers, and sleep parameters were collected from all the patients, who were divided into 4 groups according to the quartile level of AHI and followed up for a median of 42 months for MACE and its component events (cardiovascular death, myocardial infarction, and hospitalization for unstable angina or heart failure). Multivariate linear regression and Cox proportional risk regression models were used to analyze the correlation of MetS components with major objective predictors of OSA, AHI and LSpO2 and the long- term risk of MACE. RESULTS AHI and LSpO2 quartiles group showed a positive dose-response relationship with MetS components [fasting blood glucose, waist circumference, systolic blood pressure, and triglycerides] and a negative dose-response relationship with high-density lipoprotein level. MACE occurred in 119 (10.3%) patients with OSA during the follow-up. Multivariate Cox regression analysis showed that a high triglycerides, a high systolic blood pressure, and an increased waist circumference were independent risk factors for MACE and its component events (P < 0.05 or 0.01); a high HDL was a protective factor against MACE and myocardial infarction (P < 0.05 or 0.01) independent of the AHI. MetS components independent of LSpO2 showed no significant correlations with the risk of MACE or its component events. CONCLUSION The major diagnostic indexes AHI and LSPO2 in elderly patients with OSA have a dose-response relationship with MetS components, and the interaction between the components of MetS and AHI can increase the risk of MACE and its component events.
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Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
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Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Abstract
Rationale: Evidence suggests that the physiopathologic consequences of obstructive sleep apnea (OSA) resemble those induced by aging. Some studies report that the deleterious effects associated with OSA might be age dependent. Objectives: To evaluate the association of OSA with the aging process and to determine whether this association is maintained across different age groups. Methods: This was an observational, prospective study including 599 patients with suspected OSA. Five hallmarks of aging were evaluated: alteration of cellular communication (serum CRP [C-reactive protein] concentration), deregulation of nutrient sensing (insulin resistance), telomere attrition (leukocyte telomeric length), mitochondrial dysfunction (leukocyte mitochondrial DNA copy number), and genomic instability (urinary 8-hydroxy-2-deoxyguanosine concentration). For age-stratified analyses, subjects were divided into four groups according to the apnea-hypopnea index (AHI) and the median age (50 yr): young patients without OSA (age < 50 yr old, AHI < 15 events/h), young patients with OSA (age < 50 yr old, AHI ⩾ 15 events/h), older patients without OSA (age ⩾ 50 yr old, AHI < 15 events/h), and older patients with OSA (age ⩾ 50 yr old, AHI ⩾ 15 events/h). Results: A dose-response relationship was found between the AHI, arousal index, and time during the night spent with an oxygen saturation less than 90% and the following hallmarks: alteration of cellular communication, deregulation of nutrient sensing, mitochondrial dysfunction, and genomic instability. Considering age-stratified analyses, OSA was associated with an increase in several hallmarks of aging in young patients, but no significant association of OSA was identified in older patients. Conclusions: In subjects under 50 years of age, OSA is associated with an increase in specific hallmarks of aging, independent of several known confounding factors.
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14
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OSA and Ischemic Heart Disease in the Elderly. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Hao S, Jiang P, Xie L, Xiang G, Liu Z, Hu W, Wu Q, Jiang L, Xiao Y, Li S. Essential Genes and MiRNA-mRNA Network Contributing to the Pathogenesis of Idiopathic Pulmonary Arterial Hypertension. Front Cardiovasc Med 2021; 8:627873. [PMID: 34026864 PMCID: PMC8133434 DOI: 10.3389/fcvm.2021.627873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Idiopathic pulmonary arterial hypertension (IPAH) is a life-threatening disease. Owing to its high fatality rate and narrow therapeutic options, identification of the pathogenic mechanisms of IPAH is becoming increasingly important. Methods: In our research, we utilized the robust rank aggregation (RRA) method to integrate four eligible pulmonary arterial hypertension (PAH) microarray datasets and identified the significant differentially expressed genes (DEGs) between IPAH and normal samples. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were performed to analyze their functions. The interaction network of protein-protein interaction (PPI) was constructed to explore the correlation between these DEGs. The functional modules and hub genes were further identified by the weighted gene coexpression network analysis (WGCNA). Moreover, a miRNA microarray dataset was involved and analyzed to filter differentially expressed miRNAs (DE-miRNAs). Potential target genes of screened DE-miRNAs were predicted and merged with DEGs to explore a miRNA-mRNA network in IPAH. Some hub genes were selected and validated by RT-PCR in lung tissues from the PAH animal model. Results: A total of 260 DEGs, consisting of 183 upregulated and 77 downregulated significant DEGs, were identified, and some of those genes were novel. Their molecular roles in the etiology of IPAH remained vague. The most crucial functional module involved in IPAH is mainly enriched in biological processes, including leukocyte migration, cell chemotaxis, and myeloid leukocyte migration. Construction and analysis of the PPI network showed that CXCL10, CXCL9, CCR1, CX3CR1, CX3CL1, CXCR2, CXCR1, PF4, CCL4L1, and ADORA3 were recognized as top 10 hub genes with high connectivity degrees. WGCNA further identified five main functional modules involved in the pathogenesis of IPAH. Twelve upregulated DE-miRNAs and nine downregulated DE-miRNAs were identified. Among them, four downregulated DEGs and eight upregulated DEGs were supposed to be negatively regulated by three upregulated DE-miRNAs and three downregulated DE-miRNAs, respectively. Conclusions: This study identifies some key and functional coexpression modules involved in IPAH, as well as a potential IPAH-related miRNA-mRNA regulated network. It provides deepening insights into the molecular mechanisms and provides vital clues in seeking novel therapeutic targets for IPAH.
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Affiliation(s)
- Shengyu Hao
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Pan Jiang
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Liang Xie
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Guiling Xiang
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Weiping Hu
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qinhan Wu
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Xiao
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Shanqun Li
- Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
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Ryan S, Cummins EP, Farre R, Gileles-Hillel A, Jun JC, Oster H, Pepin JL, Ray DW, Reutrakul S, Sanchez-de-la-Torre M, Tamisier R, Almendros I. Understanding the pathophysiological mechanisms of cardiometabolic complications in obstructive sleep apnoea: towards personalised treatment approaches. Eur Respir J 2020; 56:13993003.02295-2019. [PMID: 32265303 DOI: 10.1183/13993003.02295-2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/15/2020] [Indexed: 12/19/2022]
Abstract
In January 2019, a European Respiratory Society research seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide, which occur frequently in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the detailed mechanisms of these processes is of major importance to the field and this seminar offered an ideal platform to exchange knowledge, and to discuss pitfalls of current models and the design of future collaborative studies. In addition, we debated the limitations of current treatment strategies for cardiometabolic complications in OSA and discussed potentially valuable alternative approaches.
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Affiliation(s)
- Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin P Cummins
- School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramon Farre
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Dept of Pediatrics, and The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan C Jun
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | | | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Manuel Sanchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Renaud Tamisier
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
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17
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Khalyfa A, Castro-Grattoni AL, Gozal D. Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles. Ther Adv Respir Dis 2020; 13:1753466619895229. [PMID: 31852426 PMCID: PMC6923690 DOI: 10.1177/1753466619895229] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse
during sleep resulting in impaired blood gas exchange, namely intermittent
hypoxia (IH) and hypercapnia, fragmented sleep (SF), increased oxidative stress
and systemic inflammation. Among a myriad of potential associated morbidities,
OSA has been particularly implicated as mechanistically contributing to the
prevalence and severity of cardiovascular diseases (CVD). However, the benefits
of continuous positive airway pressure (CPAP), which is generally employed in
OSA treatment, to either prevent or improve CVD outcomes remain unconvincing,
suggesting that the pathophysiological mechanisms underlying the incremental CVD
risk associated with OSA are not clearly understood. One of the challenges in
development of non-invasive diagnostic assays is the ability to identify
clinically and mechanistically relevant biomarkers. Circulating extracellular
vesicles (EVs) and their cargos reflect underlying changes in cellular
homeostasis and can provide insights into how cells and systems cope with
physiological perturbations by virtue of the identity and abundance of miRNAs,
mRNAs, proteins, and lipids that are packaged in the EVs under normal as well as
diseased states, such as OSA. EVs can not only provide unique insights into
coordinated cellular responses at the organ or systemic level, but can also
serve as reporters of the effects of OSA in CVD, either by their properties
enabling regeneration and repair of injured vascular cells or by damaging them.
Here, we highlight recent progress in the pathological CVD consequences of OSA,
and explore the putative roles of EVs in OSA-associated CVD, along with emerging
diagnostic and therapeutic opportunities. The reviews of this paper are available via the supplemental material
section.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Anabel L Castro-Grattoni
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Department of Child Health and MU Women's and Children's Hospital, University of Missouri School of Medicine, 400 N. Keene Street, Suite 010, Columbia, MO 65201, USA
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18
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Jun JC, Polotsky VY. Obstructive sleep apnoea and susceptibility to cardiovascular disease: A blessing or curse of old age? Respirology 2019; 25:242-243. [PMID: 31411783 DOI: 10.1111/resp.13679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan C Jun
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA
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