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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [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: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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Yatsu S, Kasai T, Naito R, Matsumoto H, Murata A, Shitara J, Shiroshita N, Kato M, Kawana F, Sato A, Ishiwata S, Shimizu M, Kato T, Suda S, Hiki M, Minamino T. Impact of sleep-disordered breathing on overnight changes in arterial stiffness in patients with acute heart failure. Hypertens Res 2024; 47:342-351. [PMID: 37783770 DOI: 10.1038/s41440-023-01448-y] [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: 05/31/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
Overnight increases in arterial stiffness associated with sleep-disordered breathing may adversely affect patients with acute heart failure. Thus, we investigated overnight changes in arterial stiffness and their association with sleep-disordered breathing in patients hospitalized for acute heart failure. Consecutive patients with acute heart failure were enrolled. All participants underwent overnight full polysomnography following the initial improvement of acute signs and symptoms of acute heart failure. The arterial stiffness parameter, cardio-ankle vascular index (CAVI), was assessed before and after polysomnography. Overall, 60 patients (86.7% men) were analyzed. CAVI significantly increased overnight (from 8.4 ± 1.6 at night to 9.1 ± 1.7 in the morning, P < 0.001) in addition to systolic and diastolic blood pressure (from 114.1 mmHg to 121.6 mmHg, P < 0.001; and from 70.1 mmHg to 78.2 mmHg, P < 0.001, respectively). Overnight increase in CAVI (ΔCAVI ≥ 0) was observed in 42 patients (70%). The ΔCAVI ≥ 0 group was likely to have moderate-to-severe sleep-disordered breathing (i.e., apnea-hypopnea index ≥15, 55.6% vs 80.9%, P = 0.047) and greater obstructive respiratory events (29.4% vs 58.5%, P = 0.041). In multivariable analysis, moderate-to-severe sleep-disordered breathing and greater obstructive respiratory events were independently correlated with an overnight increase in CAVI (P = 0.033 and P = 0.042, respectively). In patients hospitalized for acute heart failure, arterial stiffness, as assessed by CAVI, significantly increased overnight. Moderate-to-severe sleep-disordered breathing and obstructive respiratory events may play an important role in the overnight increase in cardio-ankle vascular index.
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Affiliation(s)
- Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan.
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
| | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nanako Shiroshita
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsue Kato
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiro Sato
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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Hsiao YW, Lin WL, Chou YH, Liu SH, Liao TWE, Chen SA, Lo LW. Renal sympathetic denervation ameliorates the activated inflammatory response through JAK-STAT pathway in a chronic obstructive sleep apnea animal model. Sleep Med 2024; 113:142-151. [PMID: 38016360 DOI: 10.1016/j.sleep.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is known to increase the risk of cardiovascular disease and inflammation plays a significant role in this process. Renal denervation (RDN) is a novel approach aimed at reducing sympathetic nervous system activity. The role of RDN in the inflammatory response to chronic OSA (COSA) is currently unclear. The main objective was to study inflammatory mechanisms in the rabbit heart with COSA and the effects of RDN. METHODS Eighteen rabbits were randomized into three groups: sham control, COSA, and COSA-RDN. COSA and COSA-RDN groups received liquid silicone injections, while the sham control group received normal saline. We performed combined surgical and chemical RDN through bilateral retroperitoneal flank incisions in the COSA-RDN group after silicone injections. The inflammatory mechanisms were assessed through immunoblotting, real-time PCR, and ELISA after the experiment. RESULTS H&E staining showed immune cell infiltration in COSA, which decreased after RDN treatment. The level of α7nAChR was significantly reduced in COSA compared to the sham control but was restored to a similar level in the COSA-RDN group. Furthermore, the expressions of p-JAK2 and p-STAT3 were significantly reduced in COSA but showed an up-regulation following RDN treatment. Similarly, levels of the inflammatory markers IL-6, IL-1β and TNF-α were markedly increased in COSA but decreased after RDN therapy. We observed NF-κB activation in the COSA rabbit model, which decreased after RDN treatment, as evidenced by decreased NF-κB expression. CONCLUSIONS Our study suggests that RDN treatment may prevent COSA-associated heart inflammation via the JAK2-STAT3 signaling pathway.
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Affiliation(s)
- Ya-Wen Hsiao
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Lun Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan; Taichung Veterans General Hospital Taichung, Taiwan
| | - Yu-Hui Chou
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taichung Veterans General Hospital Taichung, Taiwan
| | - Shin-Huei Liu
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Wei Ernie Liao
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taichung Veterans General Hospital Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan.
| | - Li-Wei Lo
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Higher Hospital Frailty Risk Score Is an Independent Predictor of In-Hospital Mortality in Hospitalized Older Adults with Obstructive Sleep Apnea. Geriatrics (Basel) 2022; 7:geriatrics7060127. [PMID: 36412616 PMCID: PMC9680342 DOI: 10.3390/geriatrics7060127] [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: 08/29/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Frailty predisposes individuals to stressors, increasing morbidity and mortality risk. Therefore, this study examined the impact of frailty defined by the Hospital Frailty Risk Score (HFRS) and other characteristics in older hospitalized patients with Obstructive Sleep Apnea (OSA). Methods: We conducted a retrospective study using the National Inpatient Sample 2016 in patients ≥65 years old with OSA. Logistic regression was used to evaluate the impact of frailty on inpatient mortality. A Kaplan-Meier curve with a log-rank test was used to estimate survival time between frailty groups. Results: 182,174 discharge records of elderly OSA were included in the study. 54% of the cohort were determined to be a medium/high frailty risk, according to HFRS. In multivariable analysis, frailty was associated with a fourfold (medium frailty, adjusted odd ratio (aOR): 4.12, 95% Confidence Interval (CI): 3.76−4.53, p-value < 0.001) and sixfold (high frailty, OR: 6.38, 95% CI: 5.60−7.27, p-value < 0.001) increased odds of mortality. Hospital survival time was significantly different between the three frailty groups (Log-rank test, p < 0.0001). Comorbidity burden defined by Charlson comorbidity Index (CCI) was associated with increased mortality (p < 0.001). Conclusion: More than half of the whole cohort was determined to be at medium and high frailty risk. Frailty was a significant predictor of in-hospital deaths in hospitalized OSA patients. Frailty assessment may be applicable for risk stratification of older hospitalized OSA patients.
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Saeed S, Romarheim A, Solheim E, Bjorvatn B, Lehmann S. Cardiovascular remodeling in obstructive sleep apnea: focus on arterial stiffness, left ventricular geometry and atrial fibrillation. Expert Rev Cardiovasc Ther 2022; 20:455-464. [PMID: 35673889 DOI: 10.1080/14779072.2022.2081547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is associated with increased risk of cardiovascular disease. The main interest of this clinical review is to discuss the cardiovascular consequences of OSA with a special focus on left ventricular (LV) function and structure, arterial stiffness and atrial fibrillation. AREA COVERED We present an overview of the definition, prevalence, and risk factors of OSA and outline the association between OSA and cardiovascular complications. We then briefly discuss echocardiographic assessment in OSA with focus on the left atrium and LV. Finally, we highlight the importance of adherence to continuous positive airway pressure (CPAP) therapy with regard to reducing the risk of cardiovascular disease. EXPERT COMMENTARY Although OSA has a strong association with cardiovascular complications, it is often underdiagnosed and undertreated. Patients with resistant hypertension and atrial fibrillation with poor therapeutic success after cardioversion or catheter ablation should be more often screened for OSA. Patients with nocturnal adverse cardiovascular events (stroke, arrhythmias, angina, coronary events) should be closely assessed with regard to OSA, and if confirmed, timely treated by lifestyle modification, CPAP, and aggressive antihypertensive treatment. Adherence to CPAP in OSA patients is essential in terms of reducing the risk of cardiovascular events.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Andrea Romarheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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6
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Theofilis P, Kalaitzidis RG. Hypertension is the crucial link between obstructive sleep apnea and arterial stiffness. J Clin Hypertens (Greenwich) 2022; 24:398-400. [PMID: 35156758 PMCID: PMC8989743 DOI: 10.1111/jch.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia - Piraeus "Agios Panteleimon", Piraeus, Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia - Piraeus "Agios Panteleimon", Piraeus, Nikaia, Greece
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7
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Saeed S, Romarheim A, Mancia G, Saxvig IW, Gulati S, Lehmann S, Bjorvatn B. Characteristics of hypertension and arterial stiffness in obstructive sleep apnea: A Scandinavian experience from a prospective study of 6408 normotensive and hypertensive patients. J Clin Hypertens (Greenwich) 2022; 24:385-394. [PMID: 35156757 PMCID: PMC8989758 DOI: 10.1111/jch.14425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The impact of obstructive sleep apnea (OSA) on arterial stiffness is less studied. We aimed to investigate the prevalence and covariates of increased pulse pressure (PP), a surrogate marker of arterial stiffness, in the entire study population as well as in separate analyses in normotensive and hypertensive patients. Further, we also explored the impact of smoking on brachial BP in hypertensive patients. Between 2012 and 2019, a total of 6408 participants with suspected OSA underwent a standard out-of-center respiratory polygraphy. OSA was defined by an apnea-hypopnea index (AHI) ≥15/h regardless of symptoms. PP ≥60 mmHg was used as a surrogate marker of increased arterial stiffness. Mean age was 49.3±13.7 years, 69.4% were male, and 34.5% had OSA. The prevalence of hypertension was 70.8% in OSA and 46.7% in No-OSA (AHI < 15/h) controls (P < .0001). Hypertension was controlled (clinic BP < 140/90 mmHg) in 45.5% and uncontrolled in 54.5% (P < .001). Mean PP was 50±12 mmHg in smokers and 52±12 mmHg in non-smokers (P = .001). Increased PP was found in 24.2% of the entire study population and was higher in patients with OSA compared to No-OSA group (27.5% vs 22.4%, P < .0001). In an unadjusted logistic regression model, OSA was associated with a 1.3-fold higher risk of having increased PP (95% CI 1.16-1.48, P < .001). In a multivariable-adjusted model, higher age, male sex, and history of hypertension, but not OSA (OR 0.89; 95% CI 0.77-1.02, P = .104) were associated with increased PP. In this large study of nearly 6500 participants who were referred with suspected OSA, one-third were diagnosed with OSA and a quarter had increased arterial stiffness by elevated brachial PP. Hypertension but not OSA per se was associated with increased arterial stiffness. Hypertension was highly prevalent and poorly controlled.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Andrea Romarheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Giuseppe Mancia
- Milano and Policlinico di Monza, University of Milano-Bicocca, Monza, Italy
| | - Ingvild West Saxvig
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Shashi Gulati
- Department of Otolaryngology/Head & Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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8
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Catalan Serra P, Soler X. Obstructive Sleep apnea and cardiovascular events in Elderly Patients. Expert Rev Respir Med 2022; 16:197-210. [PMID: 35041560 DOI: 10.1080/17476348.2022.2030225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In recent decades, life expectancy has increased considerably. The cardiovascular effects of Obstructive Sleep Apnea (OSA) in the elderly lead to patient disability and high resource consumption. Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular disease. However, chronic intermittent hypoxia may protect elderly patients from cardiovascular events (CVE) due to biological adaptation. AREAS COVERED OSA patients are at increased risk of cardiovascular events. The severity of OSA increases cardiovascular risk, and this association also exists in the elderly. This article reviews the association between OSA, CPAP treatment, and CVE, particularly stroke and coronary heart disease (CHD), in the elderly. MEDLINE and the Cochrane Collaboration databases were searched from inception to July 2021. EXPERT COMMENTARY Although a positive association between OSA and the incidence of cardiovascular disease in the elderly has been established, the role of sleep apnea in certain cardiovascular events remains controversial. Most authors agree that untreated OSA is a risk factor for stroke or worse stroke prognosis. However, the association between OSA and CHD is usually less pronounced than between OSA and stroke, especially in the elderly.
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Affiliation(s)
| | - Xavier Soler
- Department of Pulmonary, Critical Care, and Sleep Medicine. University of California, San Diego, California
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9
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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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10
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Cuspidi C, Tadic M, Gherbesi E, Sala C, Grassi G. Targeting subclinical organ damage in obstructive sleep apnea: a narrative review. J Hum Hypertens 2021; 35:26-36. [PMID: 32801297 DOI: 10.1038/s41371-020-00397-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 12/19/2022]
Abstract
Subclinical abnormalities in cardiac and vascular structure reflect the adverse effects triggered by a variety of risk factors on the cardiovascular (CV) system thereby representing an intermediate step in the cardiovascular continuum; such alterations are recognized as reliable markers of increased cardiovascular risk in different clinical settings including obstructive sleep apnea (OSA). The mechanisms underlying subclinical organ damage (OD) in the OSA setting are multifactorial. Hypoxemia and hypercapnia, induced by repeated collapses of upper airways, have been suggested to trigger a cascade of events such as activation of the sympathetic tone, renin-angiotensin-aldosterone system leading to endothelial dysfunction, vasoconstriction, myocardial and vascular remodeling, and hypertension. Furthermore, coexisting non-haemodynamic alterations such as increased oxidative stress, release of inflammatory substances, enhanced lipolysis and insulin resistance have been reported to play a role in the pathogenesis of both cardiac and extra-cardiac OD. In this article we reviewed available evidence on the association between OSA and subclinical cardiac (i.e., left and right ventricular hypertrophy, left atrial dilatation) and extra-cardiac organ damage (i.e., carotid atherosclerosis, arterial stiffness, microvascular retinal changes, and microalbuminuria). This association is apparently stronger for cardiac and carotid subclinical damage than for other markers (i.e., arterial stiffness and retinal changes) and mostly evident in the setting of severe OSA.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
- Istituto Auxologico Italiano IRCCS, Milano, Italy.
| | - Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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11
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Alansare AB, Kowalsky RJ, Jones MA, Perdomo SJ, Stoner L, Gibbs BB. The Effects of a Simulated Workday of Prolonged Sitting on Seated versus Supine Blood Pressure and Pulse Wave Velocity in Adults with Overweight/Obesity and Elevated Blood Pressure. J Vasc Res 2020; 57:355-366. [PMID: 32937620 PMCID: PMC7666078 DOI: 10.1159/000510294] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
We evaluated the effects of a simulated workday of prolonged sitting on blood pressure (BP) and pulse wave velocity (PWV) and examined whether posture (seated vs. supine) affected responses. Participants (n = 25) were adults, with overweight/obesity and elevated BP, and performed seated desk work for 7.5 h. BP and PWV were measured in seated and supine postures at baseline (7:15 a.m.), midday (12:05 p.m.), and afternoon (4:45 p.m.). Generalized linear mixed models evaluated the effects of prolonged sitting on BP and PWV within each posture and interactions by posture and sex. In the recommended postures, seated BP and supine carotid-femoral pulse wave velocity (cfPWV) and carotid-ankle pulse wave velocity (caPWV), but not carotid-radial pulse wave velocity (crPWV), significantly increased over the simulated seated workday (all p < 0.05; effect sizes [d] ranged from 0.25 to 0.44). Whilst no posture-by-time interactions were observed (p > 0.05), BP, caPWV, and crPWV were higher when seated versus supine (main effects of posture p < 0.05; d ranged from 0.30 to 1.04). Exploratory analysis revealed that females had greater seated BP responses (p for interaction <0.05); seated PWV and supine BP and PWV responses were similar by sex (p for interaction >0.05). A simulated workday of prolonged sitting increased seated BP and supine cfPWV and caPWV, and posture minimally influenced these responses. These results add to the evidence suggesting a deleterious effect of prolonged sitting on cardiovascular health.
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Affiliation(s)
- Abdullah Bandar Alansare
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia,
| | - Robert J Kowalsky
- Department of Health and Kinesiology, College of Education and Human Performance, Texas A&M University-Kingsville, Kingsville, Texas, USA
| | - Melissa A Jones
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sophy J Perdomo
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee Stoner
- Department of Sport and Exercise, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, College of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Liu X, Ma Y, Ouyang R, Zeng Z, Zhan Z, Lu H, Cui Y, Dai Z, Luo L, He C, Li H, Zong D, Chen Y. The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome. J Neuroinflammation 2020; 17:229. [PMID: 32738920 PMCID: PMC7395983 DOI: 10.1186/s12974-020-01905-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS), a state of sleep disorder, is characterized by repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Previous studies have revealed that intermittent hypoxia (IH) conditions in OSAS patients elicited neuron injury (especially in the hippocampus and cortex), leading to cognitive dysfunction, a significant and extraordinary complication of OSAS patients. The repeated courses of airway collapse and obstruction in OSAS patients resulted in apnea and arousal during sleep, leading to IH and excessive daytime sleepiness (EDS) and subsequently contributing to the development of inflammation. IH-mediated inflammation could further trigger various types of cognitive dysfunction. Many researchers have found that, besides continuous positive airway pressure (CPAP) treatment and surgery, anti-inflammatory substances might alleviate IH-induced neurocognitive dysfunction. Clarifying the role of inflammation in IH-mediated cognitive impairment is crucial for potentially valuable therapies and future research in the related domain. The objective of this article was to critically review the relationship between inflammation and cognitive deficits in OSAS.
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Affiliation(s)
- Xiangming Liu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yiming Ma
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zihang Zeng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zijie Zhan
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Huanhuan Lu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yanan Cui
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zhongshang Dai
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Lijuan Luo
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Chenjie He
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Herui Li
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Dandan Zong
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
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13
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Ato D. Evaluation of the calculation formulas of the cardio-ankle vascular index used in the Japanese apparatus. Vasc Health Risk Manag 2019; 15:395-398. [PMID: 31686831 PMCID: PMC6752165 DOI: 10.2147/vhrm.s215709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/01/2019] [Indexed: 12/14/2022] Open
Abstract
Background Recently, coefficients in the equation of cardio-ankle vascular index (CAVI) used in VaSera® device were disclosed. This study aimed to simulate the influence of adjusting the coefficients in the equation of CAVI and also aimed to validate the equation. Methods The CAVI displayed by VaSera (CAVIvs) and the CAVI estimated (CAVIes) with fixing the coefficients of the middle range of the heart-ankle stiffness parameter β (haβ) in the equation were compared. Moreover, the heart-ankle pulse wave velocity (haPWV) which corresponds to the low cutoff haβ of 7.348 was estimated in various blood pressure patterns to validate the formula. Results The CAVIvs was clearly lower than CAVIes in the low and the high range of CAVIvs. Moreover, it was virtually impossible to obtain the low cutoff haβ of 7.348 by using typical values of haPWV. Conclusion The CAVIvs in the high-range of VaSera underestimates the original property of stiffness parameter β. Moreover, there will be also a missing information in the equations introduced in the corresponding article, especially in the calculation formula of CAVIvs from haβ. Therefore, in order to make the best use of the nature of the stiffness parameter β to be used in VaSera, fixing the coefficients or termination of its use should be considered.
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Affiliation(s)
- Dai Ato
- Gakujutsu Shien Co., Ltd., Tokyo, Japan
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14
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Abstract
Background Brachial–ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are indices of arterial stiffness, and several studies have used these indices. However, there is no comprehensive review of these parameters in the prognostic significance. Methods The aim of this study was to review the articles exploring the prognostic significance of these parameters. Articles demonstrating independent significance after multivariate analysis on the Cox proportional hazards model were defined as “successful.” The success rate was compared using Fisher’s exact test. In addition, multivariate logistic regression analysis was performed to explore the independent determinants of the success of prognostic prediction. Results The success rate of the baPWV articles (65.7% [46/70]) tended to be higher than that of the CAVI articles (40.0% [6/15]; P=0.083). Multivariate analysis demonstrated that log (number of patients) (OR 11.20, 95% CI 2.45–51.70, P=0.002) and dialysis population (OR 0.28, 95% CI 0.08–0.94, P=0.039) were positive and negative independent determinants of the success of prognostic prediction, respectively. In addition, after redefining two studies as the absence of arteriosclerosis obliterans (ASO) exclusion, baPWV (OR 3.36, 95% CI 0.86–13.20, P=0.083) and the existence of exclusion criteria of ASO (OR 3.08, 95% CI 0.96–9.93, P=0.060) exhibited statistical tendency in the multivariate analysis. Conclusion This study demonstrated that the number of study participants and dialysis population were the independent determinants of the success of prognostic prediction. This study also showed the importance of exclusion criteria of ASO when using these indices. In addition, a prospective large-scale study to confirm the superiority in the prognostic prediction of these indices is warranted.
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Affiliation(s)
- Dai Ato
- Gakujutsu Shien Co., Ltd, Tokyo, Japan,
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15
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Hvelplund Kristiansen M, Banghøj AM, Laugesen E, Tarnow L. Arterial stiffness in people with Type 2 diabetes and obstructive sleep apnoea. Diabet Med 2018; 35:1391-1398. [PMID: 29763980 DOI: 10.1111/dme.13666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/26/2022]
Abstract
AIMS To examine whether people with Type 2 diabetes with concurrent obstructive sleep apnoea have increased arterial stiffness as compared with people with Type 2 diabetes without obstructive sleep apnoea. METHODS In a study with a case-control design, 40 people with Type 2 diabetes and treatment-naïve moderate to severe obstructive sleep apnoea (Apnoea-Hypopnoea Index ≥15) and a control group of 31 people with Type 2 diabetes without obstructive sleep apnoea (Apnoea-Hypopnoea Index <5) were examined. Obstructive sleep apnoea status was evaluated using the ApneaLink® + home-monitoring device (Resmed Inc., San Diego, CA, USA), providing the Apnoea-Hypopnoea Index scores. Arterial stiffness was assessed according to carotid-femoral pulse wave velocity using the Sphygmocor device and the oscillometric Mobil-O-Graph® (I.E.M. GmbH, Stolberg, Germany). RESULTS Carotid-femoral pulse wave velocity was not significantly different between participants with Type 2 diabetes with obstructive sleep apnoea and those without obstructive sleep apnoea (10.7±2.2 m/s vs 10.3±2.1 m/s; P=0.513), whereas oscillometric pulse wave velocity was significantly higher in participants with Type 2 diabetes with obstructive sleep apnoea than in those without obstructive sleep apnoea (9.5±1.0 m/s vs 8.6±1.4 m/s; P=0.002). In multiple regression analysis, age (P=0.002), gender (men; P=0.018) and HbA1c (P=0.027) were associated with carotid-femoral pulse wave velocity, and systolic blood pressure (P=0.004) and age (P<0.001) were associated with oscillometric pulse wave velocity. After adjustment, presence of obstructive sleep apnoea was not independently associated with pulse wave velocity whether assessed by tonometry or oscillometry. CONCLUSION In conclusion, the present study did not find an age- and blood pressure-independent association between moderate to severe obstructive sleep apnoea and arterial stiffness in non-sleepy people with Type 2 diabetes. (Clinical trial registration number: NCT02482584).
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Affiliation(s)
| | - A M Banghøj
- Nordsjaellands University Hospital, Hilleroed, Denmark
| | - E Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - L Tarnow
- Nordsjaellands University Hospital, Hilleroed, Denmark
- Steno Diabetes Centre Sjaelland, Holbaek Sygehus, Holbaek, Denmark
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16
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Joyeux-Faure M, Tamisier R, Borel JC, Millasseau S, Galerneau LM, Destors M, Bailly S, Pepin JL. Contribution of obstructive sleep apnoea to arterial stiffness: a meta-analysis using individual patient data. Thorax 2018; 73:1146-1151. [PMID: 30032122 DOI: 10.1136/thoraxjnl-2018-211513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness? METHODS Individual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid-femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis. RESULTS 893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m2 (30±7 kg/m2). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all p<0.01) as well as to dyslipidaemia (p=0.03) and an Epworth Sleepiness Scale score ≥9 (p=0.04), whereas it was not related to obesity (p=0.54), a severe Apnoea-Hypopnoea Index (p=0.14), mean nocturnal saturation (p=0.33) or sleep time with oxygen saturation below 90% (p=0.47). In multivariable analysis, PWV was independently associated with age, systolic blood pressure and diabetes (all p<0.01), whereas severe OSA was not significantly associated with PWV. CONCLUSION Our individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters.
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Affiliation(s)
- Marie Joyeux-Faure
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Christian Borel
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Louis-Marie Galerneau
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Destors
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Louis Pepin
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
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17
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Different effects of apnea during rapid eye movement period on peripheral arterial stiffness in obstructive sleep apnea. Atherosclerosis 2018; 269:166-171. [DOI: 10.1016/j.atherosclerosis.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/09/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
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18
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Jeon HJ, Bang YR, Jeon S, Lee TY, Park HY, Yoon IY. Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly. Psychiatry Investig 2017; 14:662-668. [PMID: 29042892 PMCID: PMC5639135 DOI: 10.4306/pi.2017.14.5.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/18/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. METHODS Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. RESULTS At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). CONCLUSION Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.
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Affiliation(s)
- Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Rong Bang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - Soyeon Jeon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - Tae Young Lee
- Medical Research Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seungnam, Republic of Korea
- Department of Psychiatry, School of Medicine, Seoul National University, Seoul, Republic of Korea
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19
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Jerrentrup L, Canisius S, Wilhelm S, Kesper K, Ploch T, Vogelmeier C, Greulich T, Becker HF. Work of Breathing in Fixed and Pressure Relief Continuous Positive Airway Pressure (C-Flex™): A post hoc Analysis. Respiration 2016; 93:23-31. [PMID: 27871083 DOI: 10.1159/000452423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expiratory pressure relief continuous positive airway pressure (pressure relief CPAP; C-Flex™) causes increases in inspiratory duty cycle and shortening of expiratory time. It has been suggested that these changes are caused by an increase in work of breathing. OBJECTIVES We studied the effects of C-Flex on work of breathing and intrinsic positive end-expiratory pressure as compared to fixed CPAP. METHODS Work of breathing was analyzed in 24 patients with obstructive sleep apnea during treatment with fixed CPAP and C-Flex with 3 different pressure relief settings in a randomized order during rapid-eye-movement (REM) and non-REM sleep. Work of breathing was assessed on a breath-by-breath basis using a piezoelectric esophageal pressure catheter and a pneumotachograph for measuring airflow. RESULTS We found there was no increase in inspiratory work of breathing observed using C-Flex compared to fixed CPAP. Instead, we found a linear decrease in inspiratory work of breathing with increasing pressure relief, with a mean difference of 1.22 J/min between CPAP and maximum pressure release (C-Flex 3; 90% of the value with nasal CPAP); however, the decrease was not statistically significant. The decrease in inspiratory work of breathing associated with C-Flex has a significant inverse correlation with BMI. CONCLUSIONS The C-Flex technology does not change work of breathing but shows a tendency towards a reduction of inspiratory work of breathing in patients with a lower BMI using higher C-Flex. The effect is probably caused by diminishing airway resistance generated by the positive end-expiratory pressure. Our findings may lead to additional fields of application of the C-Flex technology, such as chronic obstructive pulmonary disease or muscular dystrophy.
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Affiliation(s)
- Lukas Jerrentrup
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany
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20
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Lui MMS, Mak JCW, Lai AYK, Hui CKM, Lam JCM, Lam DCL, Ip MSM. The Impact of Obstructive Sleep Apnea and Tobacco Smoking on Endothelial Function. Respiration 2016; 91:124-31. [PMID: 26784019 DOI: 10.1159/000443527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endothelial dysfunction has been recognized to occur in the context of obstructive sleep apnea (OSA) or tobacco smoking. However, the deleterious effect on vascular function with concurrence of both conditions is largely unknown. OBJECTIVE To investigate whether the concurrence of OSA and smoking poses an additive detriment to endothelial dysfunction. METHODS Chinese men without a history of chronic medical illness were invited to complete a questionnaire including smoking pack-year exposure, polysomnography and peripheral arterial tonometry (PAT) for endothelial function. Serum 8-isoprostane, advanced oxidation protein products (AOPP) and monocyte chemo-attractant protein-1 (MCP-1) were measured. RESULTS 114 men were successfully enrolled. PAT ratio, adjusted for age and body mass index, correlated inversely with overall severity of OSA: apnea-hypopnea index (AHI), r = -0.160 (p = 0.092); oxygen desaturation index, r = -0.214 (p = 0.024); duration of oxygen saturation <90%, r = -0.219 (p = 0.020); and minimum oxygen saturation, r = 0.250 (p = 0.008). The PAT ratio decreased with increasing pack-year group (p = 0.018). It was lower with concurrent smoking history and moderate-severe OSA (AHI ≥15/h) compared to having one or neither factor (p = 0.011). Serum levels of 8-isoprostane and AOPP were positively related to severity of OSA, while MCP-1 correlated with smoking quantity. Multiple linear regression analyses showed that severity of intermittent hypoxia, MCP-1 and pack-year exposure were independent predictors of PAT ratio. CONCLUSION While OSA, in particular intermittent hypoxemia, and tobacco smoking were independent risk factors, the concurrence of moderate-severe OSA and smoking was associated with the most severe impairment in endothelial function.
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Affiliation(s)
- Macy Mei Sze Lui
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
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21
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Bonanno A, Riccobono L, Bonsignore MR, Lo Bue A, Salvaggio A, Insalaco G, Marrone O. Relaxin in Obstructive Sleep Apnea: Relationship with Blood Pressure and Inflammatory Mediators. Respiration 2016; 91:56-62. [PMID: 26731435 DOI: 10.1159/000443182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with nocturnal intermittent hypoxia, which may be responsible for increased circulating levels of vascular endothelial growth factor (VEGF) and inflammatory mediators, such as metalloproteinases (MMPs), and which contributes to the pathogenesis of systemic hypertension. Why some OSA patients remain normotensive is poorly understood. Relaxin-2, a pregnancy hormone, may sometimes circulate in men and could increase in hypoxic conditions. It exerts a vasodilatory activity and can modulate the release of molecules, such as MMPs and VEGF. OBJECTIVES The objective of this study was to explore if circulating relaxin-2 in male OSA subjects may be related to OSA severity, to circulating levels of MMPs, of their inhibitors (tissue inhibitors of metalloproteinases; TIMPs), and of VEGF, and if it may protect from hypertension. PATIENTS AND METHODS Fifty untreated male subjects with suspected OSA were recruited. After nocturnal polysomnography, a morning venous blood sample was withdrawn. Then, 24-hour ambulatory blood pressure (BP) monitoring was performed. RESULTS The respiratory disturbance index in the sample was 30.4 [interquartile range (IQR) 15.6-55.2]. Relaxin-2 was detectable in 20 subjects. These subjects did not differ in OSA severity or diurnal and nocturnal BP from subjects with undetectable relaxin-2, but they showed lower TIMP-1 (126.8 ± 29.1 vs. 156.9 ± 41.7 pg/ml, respectively; p = 0.007) and a marginally higher MMP-9/TIMP-1 molar ratio [0.58 (IQR 0.23-1.35) vs. 0.25 (IQR 0.15-0.56); p = 0.052]. CONCLUSIONS Relaxin-2 in male subjects was not related to OSA severity, but it was associated with lower TIMP-1. As it was often undetectable, even when BP values were normal, it is unlikely that it plays a role as a major factor protecting from hypertension in OSA.
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Affiliation(s)
- Anna Bonanno
- National Research Council, Institute of Biomedicine and Molecular Immunology x2018;A. Monroy', Palermo, Italy
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