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Mann DL, Staykov E, Georgeson T, Azarbarzin A, Kainulainen S, Redline S, Sands SA, Terrill PI. Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea. Ann Am Thorac Soc 2024; 21:1186-1193. [PMID: 38530665 PMCID: PMC11298983 DOI: 10.1513/annalsats.202308-710oc] [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: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
Rationale: Moderate-severe obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI], >15 events/h) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI <15 events/h) also report sleepiness. Objectives: To test the hypothesis that sleepiness in the AHI <15 events/h group is a consequence of substantial flow limitation in the absence of overt reductions in airflow (i.e., apnea/hypopnea). Methods: A total of 1,886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram-recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by an Epworth Sleepiness Scale score ⩾11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI <15 events/h. Results: A total of 772 individuals with an AHI <15 events/h were included in the primary analysis. Flow limitation was associated with EDS (odds ratio, 2.04; 95% confidence interval, 1.17-3.54; per 2-standard deviation increase in flow limitation frequency) after adjusting for age, sex, body mass index, race/ethnicity, and sleep duration. This effect size did not appreciably change after also adjusting for AHI. Conclusions: In individuals with an AHI <15 events/h, increasing flow limitation frequency by 2 standard deviations is associated with a twofold increase in the risk of EDS. Future studies should investigate addressing flow limitation in low-AHI individuals as a potential mechanism for ameliorating sleepiness.
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Affiliation(s)
- Dwayne L. Mann
- School of Electrical Engineering and Computer Science
- Institute for Social Science Research, and
| | - Eric Staykov
- School of Electrical Engineering and Computer Science
| | - Thomas Georgeson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; and
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Shirzad M, Van Riesen J, Behboodpour N, Heath M. 10-min exposure to a 2.5% hypercapnic environment increases cerebral blood blow but does not impact executive function. LIFE SCIENCES IN SPACE RESEARCH 2024; 40:143-150. [PMID: 38245339 DOI: 10.1016/j.lssr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 01/22/2024]
Abstract
Space travel and exploration are associated with increased ambient CO2 (i.e., a hypercapnic environment). Some work reported that the physiological changes (e.g., increased cerebral blood flow [CBF]) associated with a chronic hypercapnic environment contributes to a "space fog" that adversely impacts cognition and psychomotor performance, whereas other work reported no change or a positive change. Here, we employed the antisaccade task to evaluate whether transient exposure to a hypercapnic environment influences top-down executive function (EF). Antisaccades require a goal-directed eye movement mirror-symmetrical to a target and are an ideal tool for identifying subtle EF changes. Healthy young adults (aged 19-25 years) performed blocks of antisaccade trials prior to (i.e., pre-intervention), during (i.e., concurrent) and after (i.e., post-intervention) 10-min of breathing factional inspired CO2 (FiCO2) of 2.5% (i.e., hypercapnic condition) and during a normocapnic (i.e., control) condition. In both conditions, CBF, ventilatory and cardiorespiratory responses were measured. Results showed that the hypercapnic condition increased CBF, ventilation and end-tidal CO2 and thus demonstrated an expected physiological adaptation to increased FiCO2. Notably, however, null hypothesis and equivalence tests indicated that concurrent and post-intervention antisaccade reaction times were refractory to the hypercapnic environment; that is, transient exposure to a FiCO2 of 2.5% did not produce a real-time or lingering influence on an oculomotor-based measure of EF. Accordingly, results provide a framework that - in part - establishes the FiCO2 percentage and timeline by which high-level EF can be maintained. Future work will explore CBF and EF dynamics during chronic hypercapnic exposure as more direct proxy for the challenges of space flight and exploration.
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Affiliation(s)
- Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - James Van Riesen
- Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada
| | - Nikan Behboodpour
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada; Graduate Program in Neuroscience, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada.
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Wu HM, Wang ZJ, Cheng CH, Su T, Wang J, Li YZ, Wang QJ, Han F, Chen R. Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Nat Sci Sleep 2023; 15:363-373. [PMID: 37220426 PMCID: PMC10200120 DOI: 10.2147/nss.s398440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Obstructive sleep apnea hypopnea syndrome (OSAHS) can lead to cognitive impairment, though few studies have so far examined hypercapnia as its causal mechanism, due to the invasive nature of conventional arterial CO2 measurement. The study aims to investigate the effects of daytime hypercapnia on working memory in young and middle-aged patients with OSAHS. Patients and Methods This prospective study screened 218 patients and eventually recruited 131 patients (aged 25-60 years) with polysomnography (PSG)-diagnosed OSAHS. Using a cut-off of 45mmHg daytime transcutaneous partial pressure of carbon dioxide (PtcCO2), 86 patients were assigned into the normocapnic group and 45 patients into the hypercapnic group. Working memory was evaluated using the Digit Span Backward Test (DSB) and the Cambridge Neuropsychological Test Automated Battery. Results Compared with the normocapnic group, the hypercapnic group performed worse in verbal, visual, and spatial working memory tasks. PtcCO2≥45mmHg was an independent predictor for lower DSB scores (OR=4.057), lower accuracy in the immediate Pattern Recognition Memory (OR=2.600), delayed Pattern Recognition Memory (OR=2.766) and Spatial Recognition Memory (OR=2.722) tasks, lower Spatial Span scores (OR=4.795), and more between errors in the Spatial Working Memory task (OR=2.734 and 2.558, respectively). Notably, PSG indicators of hypoxia and sleep fragmentation did not predict task performance. Conclusion Hypercapnia may be plays an important role in working memory impairment in patients with OSAHS, perhaps more so than hypoxia and sleep fragmentation. Routine CO2 monitoring in these patients could prove of utility in clinical practices.
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Affiliation(s)
- Hua-Man Wu
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China
| | - Zhi-Jun Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao-Hong Cheng
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tong Su
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ye-Zhou Li
- School of Medicine, the University of Manchester, Manchester, UK
| | - Qiao-Jun Wang
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Fei Han
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Rui Chen
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Beaudin AE, Raneri JK, Ayas NT, Skomro RP, Smith EE, Hanly PJ. Contribution of hypercapnia to cognitive impairment in severe sleep-disordered breathing. J Clin Sleep Med 2022; 18:245-254. [PMID: 34286691 PMCID: PMC8807902 DOI: 10.5664/jcsm.9558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Although cognitive impairment in obstructive sleep apnea (OSA) is primarily attributed to intermittent hypoxemia and sleep fragmentation, hypercapnia may also play a role in patients whose OSA is complicated by hypoventilation. This study investigated the impact of hypercapnia on cognitive function in severe sleep-disordered breathing (OSA accompanied by hypoventilation). METHODS Patients with severe OSA (apnea-hypopnea index >30 events/h; n = 246) underwent evaluation for accompanying hypoventilation with polysomnography that included continuous transcutaneous carbon dioxide (TcCO2) monitoring and awake arterial blood gas analysis. Patients were categorized as having no hypoventilation (n = 84), isolated sleep hypoventilation (n = 40), or awake hypoventilation (n = 122). Global cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), memory with the Rey Auditory Verbal Learning Test (RAVLT), and processing speed with the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), Digit Symbol Coding subtest (DSC). RESULTS Apnea-hypopnea index was similar across groups (P = .15), but the sleep and awake hypoventilation groups had greater nocturnal hypoxemia compared with the no-hypoventilation group (P < .01). Within all groups, mean MoCA scores were < 26, which is the validated threshold to indicate mild cognitive impairment; RAVLT scores were lower than age-matched norms only in the awake-hypoventilation group (P ≤ .01); and DSC scores were lower than age-matched norms within all groups (P < .01). In multivariable regression analyses, higher arterial partial pressure of carbon dioxide (PaCO2) and TcCO2 during wakefulness were associated with lower MoCA and DSC scores (P ≤ .03), independent of confounders including overlap syndrome (OSA + chronic obstructive pulmonary disease). CONCLUSIONS Awake hypoventilation is associated with greater deficits in cognitive function in patients with severe sleep-disordered breathing. CITATION Beaudin AE, Raneri JK, Ayas NT, Skomro RP, Smith EE, Hanly PJ; on behalf of Canadian Sleep and Circadian Network. Contribution of hypercapnia to cognitive impairment in severe sleep-disordered breathing. J Clin Sleep Med. 2022;18(1):245-254.
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Affiliation(s)
- Andrew E. Beaudin
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill K. Raneri
- Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Najib T. Ayas
- Department of Medicine, Respiratory and Critical Care Divisions, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert P. Skomro
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J. Hanly
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Address correspondence to: Patrick J. Hanly, MD, FRCPC, DABSM, Professor, Department of Medicine, Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Rm 1421, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; Tel: +1 403-210-8743; Fax +1 403-283-6151;
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Schramm P, Das N, Schneiderman E, German Z, Hui J, Wilson D, Spence JS, Moura P, Chapman SB. Snoring Remediation with Oral Appliance Therapy Potentially Reverses Cognitive Impairment: An Intervention Controlled Pilot Study. Geriatrics (Basel) 2021; 6:geriatrics6040107. [PMID: 34842718 PMCID: PMC8628661 DOI: 10.3390/geriatrics6040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Respiration rate (RR) dynamics entrains brain neural networks. RR differences between mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in response to oral appliance therapy (OAT) are unknown. This pilot study investigated if RR during stable sleep shows a relationship to pathological severity in subjects with MCI and AD who snore and if RR is influenced following stabilization of the upper airway using OAT. The study cohort was as follows: cognitively normal (CN; n = 14), MCI (n = 14) and AD (n = 9); and a sub-population receiving intervention, CN (n = 5), MCI (n = 7), AD (n = 6) subjects. The intervention used was an oral appliance plus a mouth shield (Tx). RR maximum (max) rate (breaths/minute) and RR fluctuation during 2116 stable sleep periods were measured. The Montreal cognitive assessment (MoCA) was administered before and after 4 weeks with Tx. Baseline data showed significantly higher RR fluctuation in CN vs. AD (p < 0.001) but not between CN vs. MCI (p = 0.668). Linear mixed model analysis indicated Tx effect (p = 0.008) for RR max. Tx after 4 weeks lowered the RR-max in MCI (p = 0.022) and AD (p < 0.001). Compared with AD RR max, CN (p < 0.001) and MCI (p < 0.001) were higher with Tx after 4 weeks. Some MCI and AD subjects improved executive and memory function after 4 weeks of Tx.
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Affiliation(s)
- Preetam Schramm
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
- Correspondence:
| | - Namrata Das
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
- McLean Hospital, Harvard Medical School Affiliate, 115 Mill St, Belmont, MA 02478, USA
| | - Emet Schneiderman
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Zohre German
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Jason Hui
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, Dallas, TX 75246, USA;
| | - Duane Wilson
- College of Dental Medicine, University of New England, Portland, ME 04103, USA;
| | - Jeffrey S. Spence
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
| | - Pollyana Moura
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Sandra B. Chapman
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
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Experimental Setting for Applying Mechanical Stimuli to Study the Endothelial Response of Ex Vivo Vessels under Realistic Pathophysiological Environments. Life (Basel) 2021; 11:life11070671. [PMID: 34357043 PMCID: PMC8306098 DOI: 10.3390/life11070671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
This paper describes the design, construction and testing of an experimental setting, making it possible to study the endothelium under different pathophysiological conditions. This novel experimental approach allows the application of the following stimuli to an ex vivo vessel in a physiological bath: (a) a realistic intravascular pressure waveform defined by the user; (b) shear stress in the endothelial layer since, in addition to the pressure waveform, the flow through the vessel can be independently controlled by the user; (c) conditions of hypo/hyperoxia and hypo/hypercapnia in an intravascular circulating medium. These stimuli can be applied alone or in different combinations to study possible synergistic or antagonistic effects. The setting performance is illustrated by a proof of concept in an ex vivo rabbit aorta. The experimental setting is easy to build by using very low-cost materials widely available. Online Supplement files provide all the technical information (e.g., circuits, codes, 3D printer drivers) following an open-source hardware approach for free replication.
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Xue J, Allaband C, Zhou D, Poulsen O, Martino C, Jiang L, Tripathi A, Elijah E, Dorrestein PC, Knight R, Zarrinpar A, Haddad GG. Influence of Intermittent Hypoxia/Hypercapnia on Atherosclerosis, Gut Microbiome, and Metabolome. Front Physiol 2021; 12:663950. [PMID: 33897472 PMCID: PMC8060652 DOI: 10.3389/fphys.2021.663950] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 01/05/2023] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by intermittent hypoxia and hypercapnia (IHC), increases atherosclerosis risk. However, the contribution of intermittent hypoxia (IH) or intermittent hypercapnia (IC) in promoting atherosclerosis remains unclear. Since gut microbiota and metabolites have been implicated in atherosclerosis, we examined whether IH or IC alters the microbiome and metabolome to induce a pro-atherosclerotic state. Apolipoprotein E deficient mice (ApoE-/- ), treated with IH or IC on a high-fat diet (HFD) for 10 weeks, were compared to Air controls. Atherosclerotic lesions were examined, gut microbiome was profiled using 16S rRNA gene amplicon sequencing and metabolome was assessed by untargeted mass spectrometry. In the aorta, IC-induced atherosclerosis was significantly greater than IH and Air controls (aorta, IC 11.1 ± 0.7% vs. IH 7.6 ± 0.4%, p < 0.05 vs. Air 8.1 ± 0.8%, p < 0.05). In the pulmonary artery (PA), however, IH, IC, and Air were significantly different from each other in atherosclerotic formation with the largest lesion observed under IH (PA, IH 40.9 ± 2.0% vs. IC 20.1 ± 2.6% vs. Air 12.2 ± 1.5%, p < 0.05). The most differentially abundant microbial families (p < 0.001) were Peptostreptococcaceae, Ruminococcaceae, and Erysipelotrichaceae. The most differentially abundant metabolites (p < 0.001) were tauro-β-muricholic acid, ursodeoxycholic acid, and lysophosphoethanolamine (18:0). We conclude that IH and IC (a) modulate atherosclerosis progression differently in distinct vascular beds with IC, unlike IH, facilitating atherosclerosis in both aorta and PA and (b) promote an atherosclerotic luminal gut environment that is more evident in IH than IC. We speculate that the resulting changes in the gut metabolome and microbiome interact differently with distinct vascular beds.
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Affiliation(s)
- Jin Xue
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Celeste Allaband
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Biomedical Sciences Program, University of California, San Diego, San Diego, CA, United States
- Division of Gastroenterology, University of California, San Diego, San Diego, CA, United States
| | - Dan Zhou
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Orit Poulsen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Cameron Martino
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Bioinformatics and Systems Biology Program, University of California, San Diego, San Diego, CA, United States
- Center for Microbiome Innovation, University of California, San Diego, San Diego, CA, United States
| | - Lingjing Jiang
- Division of Biostatistics, University of California, San Diego, San Diego, CA, United States
| | - Anupriya Tripathi
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Division of Biological Sciences, University of California, San Diego, San Diego, CA, United States
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
| | - Emmanuel Elijah
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
- Collaborative Mass Spectrometry Innovation Center, University of California, San Diego, San Diego, CA, United States
| | - Pieter C. Dorrestein
- Center for Microbiome Innovation, University of California, San Diego, San Diego, CA, United States
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, San Diego, CA, United States
- Collaborative Mass Spectrometry Innovation Center, University of California, San Diego, San Diego, CA, United States
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Center for Microbiome Innovation, University of California, San Diego, San Diego, CA, United States
- Department of Computer Science and Engineering, University of California, San Diego, San Diego, CA, United States
| | - Amir Zarrinpar
- Division of Gastroenterology, University of California, San Diego, San Diego, CA, United States
- Center for Microbiome Innovation, University of California, San Diego, San Diego, CA, United States
- Division of Gastroenterology, VA San Diego, La Jolla, CA, United States
- Institute of Diabetes and Metabolic Health, University of California, San Diego, San Diego, CA, United States
| | - Gabriel G. Haddad
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Department of Neuroscience, University of California, San Diego, San Diego, CA, United States
- Rady Children’s Hospital, San Diego, CA, United States
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Mishra P, Jaseja H, Goyal M. A critical analysis of the purported role of hypoxaemia in the comorbidity of obstructive sleep apnoea and epilepsy. Clin Physiol Funct Imaging 2021; 41:4-9. [PMID: 33068455 DOI: 10.1111/cpf.12672] [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: 08/13/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Abstract
Obstructive sleep apnoea (OSA) is a globally prevalent sleep disorder of significant health concern and confounded with several comorbidities resulting in adverse effect(s) on quality of life in patients afflicted with it. Of particular interest is the enigmatic high comorbidity of OSA with epilepsy, the exact underlying pathophysiology of which remains elusive despite a multitude of research performed in the last four decades. Hypoxaemia, which is an important characteristic feature found in OSA during apnoeic spells, has been implicated in the high comorbidity of OSA with epilepsy, the basis of which rests upon hypoxaemia-mediated brain damage, subcortical release phenomenon, oxidative stress and neuroinflammatory reactions. However, several studies present contradictory evidences that potentially refute the hypoxaemia-based mechanism. Additionally, the role of hypercapnia thatgenerally accompanies hypoxaemia during apnoeic spells, cannot be overlooked and is known to be potentially protective against neuronal hyperexcitability. Thus, hypoxaemia theory implicated in the high comorbidity of OSA and epilepsy appears weak and refutable. This brief paper studies and critically analyses the role of hypoxaemia in conjunction with hypercapnia in the underlying pathophysiology of the comorbidity.
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Affiliation(s)
- Priyadarshini Mishra
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Punjabi NM, Lim D. Pro - Sleep fragmentation causes hypersomnolence in sleep apnea: The convergence of rationalism and empiricism. Sleep Med Rev 2020; 55:101397. [PMID: 33271460 DOI: 10.1016/j.smrv.2020.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Naresh M Punjabi
- Department of Medicine University of Miami, Miller School of Medicine, United States.
| | - Diane Lim
- Department of Medicine University of Miami, Miller School of Medicine, United States
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Chokesuwattanaskul A, Chirakalwasan N, Jaimchariyatam N, Pitakvej N, Sarutikriangkri Y, Chunharas C, Phanthumchinda K, Likitjaroen Y. Associations between hypoxia parameters in obstructive sleep apnea and cognition, cortical thickness, and white matter integrity in middle-aged and older adults. Sleep Breath 2020; 25:1559-1570. [PMID: 33057925 DOI: 10.1007/s11325-020-02215-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between each parameter of intermittent hypoxia in obstructive sleep apnea (OSA) and the cognitive profile, cortical thickness, and white matter integrity in middle-aged and older adults. METHODOLOGY Participants were newly diagnosed with moderate or severe OSA from the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Respiratory parameters from polysomnography were extracted. Each participant was tested on a battery of neuropsychological tests and underwent an MRI scan of the brain. Cortical thickness analysis and diffusion tensor imaging analysis were performed. Participants were classified as having either severe or mild hypoxia based on parameters of hypoxia, i.e., oxygen desaturation index, lowest oxygen saturation, and the percentage of total sleep time spent below 90% oxygen saturation. RESULTS Of 17 patients with OSA, there were 8 men (47%). Median age was 57 years and median AHI was 60.6. Comparison of cortical thickness between the severe and the mild group of each hypoxic parameter revealed two clusters of cortical thinning at the right inferior frontal gyrus (p-value = 0.008) and right inferior parietal gyrus (p-value = 0.006) in the severe desaturation group and a cluster of cortical thinning at the superior parietal gyrus (p-value = 0.008) in the high oxygen desaturation index group. There was no difference in cognitive function or white matter integrity between groups. CONCLUSIONS The magnitude of the degree and frequency of desaturations in OSA are associated with a decrease in cortical thickness at the frontal and parietal regions.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. .,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. .,Chulalongkorn Cognitive Clinical and Computational Research Group, Chulalongkorn University, Bangkok, Thailand.
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nattapong Jaimchariyatam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nantaporn Pitakvej
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yuttachai Sarutikriangkri
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chaipat Chunharas
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Chulalongkorn Cognitive Clinical and Computational Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Kammant Phanthumchinda
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yuttachai Likitjaroen
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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11
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Goodman JR, Iliff JJ. Vasomotor influences on glymphatic-lymphatic coupling and solute trafficking in the central nervous system. J Cereb Blood Flow Metab 2020; 40:1724-1734. [PMID: 31506012 PMCID: PMC7370362 DOI: 10.1177/0271678x19874134] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite the recent description of meningeal lymphatic vessels draining solutes from the brain interstitium and cerebrospinal fluid (CSF), the physiological factors governing cranial lymphatic efflux remain largely unexplored. In agreement with recent findings, cervical lymphatic drainage of 70 kD and 2000 kD fluorescent tracers injected into the adult mouse cortex was significantly impaired in the anesthetized compared to waking animals (tracer distribution across 2.1 ± 4.5% and 23.7 ± 15.8% of deep cervical lymph nodes, respectively); however, free-breathing anesthetized mice were markedly hypercapnic and acidemic (paCO2 = 64 ± 8 mmHg; pH = 7.22 ± 0.05). Mechanical ventilation normalized arterial blood gases in anesthetized animals, and rescued lymphatic efflux of interstitial solutes in anesthetized mice. Experimental hypercapnia blocked cervical lymphatic efflux of intraparenchymal tracers. When tracers were injected into the subarachnoid CSF compartment, glymphatic influx into brain tissue was virtually abolished by hypercapnia, while lymphatic drainage was not appreciably altered. These findings demonstrate that cervical lymphatic drainage of interstitial solutes is, in part, regulated by upstream changes in glymphatic CSF-interstitial fluid exchange. Further, they suggest that maintaining physiological blood gas values in studies of glymphatic exchange and meningeal lymphatic drainage may be critical to defining the physiological regulation of these processes.
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Affiliation(s)
- James R Goodman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.,Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey J Iliff
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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12
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Appleton SL, Vakulin A, D’Rozario A, Vincent AD, Teare A, Martin SA, Wittert GA, McEvoy RD, Catcheside PG, Adams RJ. Quantitative electroencephalography measures in rapid eye movement and nonrapid eye movement sleep are associated with apnea–hypopnea index and nocturnal hypoxemia in men. Sleep 2019; 42:5475510. [DOI: 10.1093/sleep/zsz092] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
AbstractStudy ObjectivesQuantitative electroencephalography (EEG) measures of sleep may identify vulnerability to obstructive sleep apnea (OSA) sequelae, however, small clinical studies of sleep microarchitecture in OSA show inconsistent alterations. We examined relationships between quantitative EEG measures during rapid eye movement (REM) and non-REM (NREM) sleep and OSA severity among a large population-based sample of men while accounting for insomnia.MethodsAll-night EEG (F4-M1) recordings from full in-home polysomnography (Embletta X100) in 664 men with no prior OSA diagnosis (age ≥ 40) were processed following exclusion of artifacts. Power spectral analysis included non-REM and REM sleep computed absolute EEG power for delta, theta, alpha, sigma, and beta frequency ranges, total power (0.5–32 Hz) and EEG slowing ratio.ResultsApnea–hypopnea index (AHI) ≥10/h was present in 51.2% (severe OSA [AHI ≥ 30/h] 11.6%). In mixed effects regressions, AHI was positively associated with EEG slowing ratio and EEG power across all frequency bands in REM sleep (all p < 0.05); and with beta power during NREM sleep (p = 0.06). Similar associations were observed with oxygen desaturation index (3%). Percentage total sleep time with oxygen saturation <90% was only significantly associated with increased delta, theta, and alpha EEG power in REM sleep. No associations with subjective sleepiness were observed.ConclusionsIn a large sample of community-dwelling men, OSA was significantly associated with increased EEG power and EEG slowing predominantly in REM sleep, independent of insomnia. Further study is required to assess if REM EEG slowing related to nocturnal hypoxemia is more sensitive than standard PSG indices or sleepiness in predicting cognitive decline.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- NeuroSleep—NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Angela D’Rozario
- NeuroSleep—NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew D Vincent
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alison Teare
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Sean A Martin
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gary A Wittert
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- Freemasons Foundation Centre for Men’s Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Robert J Adams
- The Health Observatory, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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13
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Farré R, Almendros I, Montserrat JM, Gozal D, Navajas D. Gas Partial Pressure in Cultured Cells: Patho-Physiological Importance and Methodological Approaches. Front Physiol 2018; 9:1803. [PMID: 30618815 PMCID: PMC6300470 DOI: 10.3389/fphys.2018.01803] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022] Open
Abstract
Gas partial pressures within the cell microenvironment are one of the key modulators of cell pathophysiology. Indeed, respiratory gases (O2 and CO2) are usually altered in respiratory diseases and gasotransmitters (CO, NO, H2S) have been proposed as potential therapeutic agents. Investigating the pathophysiology of respiratory diseases in vitro mandates that cultured cells are subjected to gas partial pressures similar to those experienced by each cell type in its native microenvironment. For instance, O2 partial pressures range from ∼13% in the arterial endothelium to values as low as 2-5% in cells of other healthy tissues and to less than 1% in solid tumor cells, clearly much lower values than those used in conventional cell culture research settings (∼19%). Moreover, actual cell O2 partial pressure in vivo changes with time, at considerably different timescales as illustrated by tumors, sleep apnea, or mechanical ventilation. Unfortunately, the conventional approach to modify gas concentrations at the above culture medium precludes the tight and exact control of intra-cellular gas levels to realistically mimic the natural cell microenvironment. Interestingly, well-controlled cellular application of gas partial pressures is currently possible through commercially available silicone-like material (PDMS) membranes, which are biocompatible and have a high permeability to gases. Cells are seeded on one side of the membrane and tailored gas concentrations are circulated on the other side of the membrane. Using thin membranes (50-100 μm) the value of gas concentration is instantaneously (<0.5 s) transmitted to the cell microenvironment. As PDMS is transparent, cells can be concurrently observed by conventional or advanced microscopy. This procedure can be implemented in specific-purpose microfluidic devices and in settings that do not require expensive or complex technologies, thus making the procedure readily implementable in any cell biology laboratory. This review describes the gas composition requirements for a cell culture in respiratory research, the limitations of current experimental settings, and also suggests new approaches to better control gas partial pressures in a cell culture.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Josep M. Montserrat
- CIBER de Enfermedades Respiratorias, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Sleep Lab, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States
| | - Daniel Navajas
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
- Institute for Bioengineering of Catalonia, Barcelona Institute of Science and Technology, Barcelona, Spain
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Kung SC, Shen YC, Chang ET, Hong YL, Wang LY. Hypercapnia impaired cognitive and memory functions in obese patients with obstructive sleep apnoea. Sci Rep 2018; 8:17551. [PMID: 30510244 PMCID: PMC6277381 DOI: 10.1038/s41598-018-35797-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 11/10/2018] [Indexed: 01/06/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a sleep disorder involving repeated nocturnal desaturation and sleep fragmentation. OSA can result in decreased daytime alertness and neurocognitive dysfunction. Hypercapnia status is also related to neurocognitive dysfunction in patients with pulmonary diseases. We evaluated the effects of hypercapnia on cognitive performance and memory function in a prospective case-controlled study. We enrolled thirty-nine obese patients with OSA and collected their arterial blood samples. All the participants provided arterial blood samples, and completed two questionnaires (the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale) and six cognitive tasks (the psychomotor vigilance task [PVT], the Stroop task, the Eriksen flanker task, processing speed [DSST], and verbal and visual memory [LM&FM]), which were used to evaluate daytime sleepiness, cognitive function, and memory function within one week of a polysomnographic study. When compared to the OSA without diurnal hypoventilation, the patients with stable hypercapnia (OHS) had increased reaction times in the PVT, Stroop task, and flanker task. Hypercapnic obese patients with OSA also had comparatively significantly lower scores in the processing speed and logical memory tests. OHS had increased reaction times in the attention and cognitive function assessments, and deficits in the logical memory, when compared to those with OSA without diurnal hypoventilation.
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Affiliation(s)
- Shu-Chin Kung
- Department of Human Development and Psychology, Tzu Chi University, Hualien, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - En-Ting Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Department of Chest Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
| | - Ya-Ling Hong
- Department of Human Development and Psychology, Tzu Chi University, Hualien, Taiwan
| | - Ling-Yi Wang
- Epidemiology and Biostatistics Consulting Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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15
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Rowsell L, Wong KKH, Yee BJ, Eckert DJ, Somogyi AA, Duffin J, Grunstein RR, Wang D. The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial. Thorax 2018; 74:177-184. [DOI: 10.1136/thoraxjnl-2018-211675] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/26/2018] [Accepted: 07/23/2018] [Indexed: 01/18/2023]
Abstract
ObjectiveAnaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common clinical dose of morphine on OSA, and to identify clinical phenotype and genotype vulnerability to opioid-respiratory depression.MethodsUnder a double-blind, randomised, crossover design, 60 male patients with OSA attended two visits to the hospital sleep laboratory, at least 1 week apart. Either 40 mg controlled-release oral morphine or placebo was administered. Awake ventilatory chemoreflex tests were performed post dose and prior to overnight polysomnography monitoring. Blood was sampled before sleep and the next morning for toxicology and genotype analyses. Sleep time with oxygen saturation (SpO2) <90% (T90) was the primary outcome.ResultsDespite a large inter-individual variability, 40 mg morphine did not worsen T90 and apnoea–hypopnoea index, and only decreased the SpO2 nadir by 1.3%. In patients with severe OSA, a lower baseline CO2ventilatory response threshold correlated with the worsening of T90, apnoea–hypopnoea index and oxygen desaturation index with morphine use. Patients with OSA and the A118G OPRM1 polymorphism of A/A and A/G had a significantly different morphine effect on awake ventilatory chemosensitivity and T90 during sleep.Conclusions40 mg oral controlled-release morphine did not worsen OSA in men, challenging traditional thinking that OSA will be worsened by opioids. Individual opioid response in patients with OSA may relate to baseline CO2 response threshold and OPRM1 genotype. Our study findings may pave the way for a precision medicine approach to avoid opioid-related risks.Trial registration numberThe Australian and New Zealand Clinical Trial Registry, ACTRN12613000858796.
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16
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Wang D, Thomas RJ, Yee BJ, Grunstein RR. Last Word on Viewpoint: Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2018; 120:1489. [PMID: 27306843 DOI: 10.1152/japplphysiol.00354.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- David Wang
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia; NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Australia; Central Clinical School, The University of Sydney, Sydney, Australia;
| | - Robert J Thomas
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brendon J Yee
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia; NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Australia; Central Clinical School, The University of Sydney, Sydney, Australia
| | - Ronald R Grunstein
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia; NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Australia; Central Clinical School, The University of Sydney, Sydney, Australia
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17
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Hypoxic dose, intensity distribution, and fatigue monitoring are paramount for "live high-train low" effectiveness. Eur J Appl Physiol 2017; 117:2119-2120. [PMID: 28664344 DOI: 10.1007/s00421-017-3664-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
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18
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Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev 2017; 38:39-49. [PMID: 28760549 DOI: 10.1016/j.smrv.2017.03.005] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) is a nocturnal breathing disorder that is associated with cognitive impairment. The primary determinants of cognitive deficits in OSA are thought to be sleep disruption and blood gas abnormalities. Cognitive impairment is also seen in other disorders that are characterised primarily by sleep disturbance (e.g., sleep restriction/deprivation, insomnia) or hypoxia/hypercarbia (e.g., chronic obstructive pulmonary disease (COPD)). Assessment of the cognitive deficits observed in these other disorders could help better define the mechanisms underlying cognitive deficits in OSA. This study utilised meta-review methodology to examine the findings from systematic reviews and meta-analyses of the effects of untreated OSA, COPD, insomnia, and sleep deprivation on cognitive function in adults, compared with norms or controls. Eighteen papers met inclusion criteria: seven in OSA, two in insomnia, five in COPD, and four in sleep deprivation. OSA and COPD were both accompanied by deficits in attention, memory, executive function, psychomotor function, and language abilities, suggesting that hypoxia/hypercarbia may be an important determinant of deficits in these domains in OSA. Both OSA and sleep deprivation studies were accompanied by deficits in attention and memory, suggesting that short-term sleep disturbance in OSA may contribute to deficits in these domains. Visuospatial deficits were unique to OSA, suggesting the contribution of a mechanism other than sleep disturbance and hypoxia/hypercarbia to this problem. Our findings suggest that the cognitive deficits associated with untreated OSA are multidimensional, with different physiological disturbances responsible for differing cognitive problems.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Australia; Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia.
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia
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19
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D'Rozario AL, Cross NE, Vakulin A, Bartlett DJ, Wong KKH, Wang D, Grunstein RR. Quantitative electroencephalogram measures in adult obstructive sleep apnea - Potential biomarkers of neurobehavioural functioning. Sleep Med Rev 2016; 36:29-42. [PMID: 28385478 DOI: 10.1016/j.smrv.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/15/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) results in significantly impaired cognitive functioning and increased daytime sleepiness in some patients leading to increased risk of motor vehicle and workplace accidents and reduced productivity. Clinicians often face difficulty in identifying which patients are at risk of neurobehavioural dysfunction due to wide inter-individual variability, and disparity between symptoms and conventional metrics of disease severity such as the apnea hypopnea index. Quantitative electroencephalogram (EEG) measures are determinants of awake neurobehavioural function in healthy subjects. However, the potential value of quantitative EEG (qEEG) measurements as biomarkers of neurobehavioural function in patients with OSA has not been examined. This review summarises the existing literature examining qEEG in OSA patients including changes in brain activity during wake and sleep states, in relation to daytime sleepiness, cognitive impairment and OSA treatment. It will speculate on the mechanisms which may underlie changes in EEG activity and discuss the potential utility of qEEG as a clinically useful predictor of neurobehavioural function in OSA.
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Affiliation(s)
- Angela L D'Rozario
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia.
| | - Nathan E Cross
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Vakulin
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Delwyn J Bartlett
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Keith K H Wong
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David Wang
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital & Sydney Local Health District, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
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20
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Olaithe M, Eastwood PR, Bucks RS, Deacon NL, Malhotra A, Kumar VHS, Zuo L, Chuang CC, Schotland H. Commentaries on Viewpoint: Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2016; 120:1487-8. [PMID: 27306842 DOI: 10.1152/japplphysiol.00327.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Olaithe
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - P R Eastwood
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - R S Bucks
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Naomi L Deacon
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Atul Malhotra
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Vasantha H S Kumar
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Li Zuo
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Chia-Chen Chuang
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Helena Schotland
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
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