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Wei Z, Shen H, Wang F, Huang W, Li X, Xu H, Zhu H, Guan J. Melatonin mediates intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients. Ann Med 2024; 56:2361825. [PMID: 38973375 PMCID: PMC11232642 DOI: 10.1080/07853890.2024.2361825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/21/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Intestinal barrier dysfunction and systemic inflammation are common in obstructive sleep apnoea (OSA). We aimed to investigate the role of melatonin, an anti-inflammatory mediator, in mediating the relationships between OSA, intestinal barrier dysfunction and systemic inflammation. METHODS Two hundred and thirty-five male participants who complained with sleep problems and underwent whole night polysomnography at our sleep centre between 2017 and 2018 were enrolled. Polysomnographic data, anthropometric measurements and biochemical indicators were collected. Serum melatonin, intestinal barrier function biomarker zonula occludens-1 (ZO-1) and inflammatory biomarkers C-reactive protein (CRP) with lipopolysaccharide (LPS) were detected. Spearman's correlation analysis assessed the correlations between sleep parameters, melatonin and biomarkers (ZO-1, LPS and CRP). Mediation analysis explored the effect of OSA on intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients. RESULTS As OSA severity increased, serum melatonin decreased, whereas ZO-1, LPS and CRP increased. Spearman's correlation analysis showed that serum melatonin was significantly negatively correlated with ZO-1 (r = -0.19, p < .05) and LPS (r = -0.20, p < .05) in the moderate-OSA group; serum melatonin was significantly negatively correlated with ZO-1 (r = -0.46, p < .01), LPS (r = -0.35, p < .01) and CPR (r = -0.30, p < .05) in the severe-OSA group. Mediation analyses showed melatonin explain 36.12% and 35.38% of the effect of apnoea-hypopnea index (AHI) on ZO-1 and LPS in moderate to severe OSA patients. CONCLUSIONS Our study revealed that melatonin may be involved in mediating intestinal barrier dysfunction and systemic inflammation in moderate-to-severe OSA patients.
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Affiliation(s)
- Zhicheng Wei
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hangdong Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Fan Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Weijun Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huajun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huaming Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Schiza S, Bouloukaki I, Kaditis A, Lombardi C, Bonsignore MR. Vitamin D deficiency: A forgotten aspect in sleep disorders? A critical update. Sleep Med 2024; 121:77-84. [PMID: 38941960 DOI: 10.1016/j.sleep.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
Over the past few years, there has been a surge in interest regarding the connection between sleep duration and quality, sleep disorders, mainly Obstructive sleep apnoea (OSA) and Vitamin D. There is growing evidence to support a new role of Vitamin D in the maintenance and regulation of optimal sleep. Furthermore, a notable link has been identified between OSA and a decrease in serum Vitamin D levels, which appears to intensify as the severity of sleep apnea worsens. Vitamin D status could also potentially serve as a mediator or provide an explanation for the association between OSA and cardiometabolic morbidity, but the current state of research in this area is inadequate. Studies have indicated that the supplementation of Vitamin D can optimize sleep quality, presenting more proof of the connection between insufficient vitamin D levels and sleep disorders. However, it is unclear whether low serum Vitamin D levels are a contributing factor to OSA development or if OSA predisposes individuals to Vitamin D deficiency. As a result, various studies have endeavored to examine the complex relationship between OSA and Vitamin D deficiency. In children and adolescents, while data is limited, there seems also to be a link between sleep disorders and Vitamin D levels. Therefore, the objective of this review is to provide a comprehensive overview of the current evidence on the association between Vitamin D and sleep disorders in both adults and children.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athanasios Kaditis
- Division of Pediatric Pulmonology and Cystic Fibrosis Center, Department of Child Health, University of Missouri School of Medicine, MUHC Children's Hospital, Columbia, MO, USA; Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Dept, University of Palermo, Palermo, Italy; IBIM CNR, Palermo, Italy
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Kwon Y, Gami AS, Javaheri S, Pressman GS, Scammell TE, Surkin LA, Zee PC. Cardiovascular Risks in People With Narcolepsy: Expert Panel Consensus Recommendations. J Am Heart Assoc 2024; 13:e035168. [PMID: 39119988 DOI: 10.1161/jaha.124.035168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Observational and retrospective studies suggest that people with narcolepsy may have an increased prevalence of cardiovascular and cardiometabolic comorbidities and may be at greater risk for future cardiovascular events. An expert consensus panel was formed to establish agreement on the risk of hypertension and cardiovascular/cardiometabolic disease in people with narcolepsy and to develop strategies to mitigate these risks. METHODS AND RESULTS Experts in sleep medicine and cardiology were selected to participate in the panel. After reviewing the relevant literature, the experts identified key elements, drafted recommendation statements, and developed discussion points to provide supporting evidence for the recommendations. The draft and final recommendations were rated on a scale from 0 (not at all agree) to 4 (very much agree). All experts had an agreement rating of 4.0 for all 14 revised recommendation statements for patients with narcolepsy. These statements comprised 3 themes: (1) recognize the risk of hypertension and cardiovascular/cardiometabolic disease, (2) reduce the risk of hypertension and cardiovascular/cardiometabolic disease, and (3) reduce sodium intake to lower the risk of hypertension and cardiovascular disease. CONCLUSIONS These consensus recommendations are intended to increase awareness of potential cardiovascular/cardiometabolic risks in patients with narcolepsy for all clinicians. Early monitoring for, and prevention of, cardiovascular risks in this population are of great importance, especially as narcolepsy usually develops in adolescents and young adults, who will be exposed to adverse effects of the disease for decades. Prospective systematic studies are needed to determine association and causation of narcolepsy with cardiovascular/cardiometabolic disorders.
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Affiliation(s)
| | | | | | - Gregg S Pressman
- Cardiovascular Diseases Fellowship Training Program Jefferson Einstein Hospital Philadelphia PA
| | | | - Lee A Surkin
- Empire Sleep Medicine and VirtuOx, Inc. New York NY
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine Northwestern University Chicago IL
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Wu S, Yang YM, Zhu J, Wang LL, Xu W, Lyu SQ, Wang J, Shao XH, Zhang H. Association between adherence to life's simple 7 metrics and risk of obstructive sleep apnea among adults in the United States. BMC Psychiatry 2024; 24:560. [PMID: 39138439 PMCID: PMC11323594 DOI: 10.1186/s12888-024-05990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/26/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND We aimed to explore the impact of adherence to Life's Simple 7 (LS7) metrics on risk of obstructive sleep apnea (OSA), and the impact of inflammation on the association, in adults in the United States. METHODS Data from 13,825 community-dwelling adults aged ≥ 20 years recruited in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008, 2015-2018 was analyzed. The LS7 score was calculated based on the AHA definition of LS7 metrics. The diagnosis of OSA was based on self-reported symptoms of sleep disturbance using a standard questionnaire. The Multivariable Apnea Prediction (MAP) Index score was also calculated to assess the risk of OSA. Log-binominal regression and negative binomial regression were performed to estimate the associations between LS7 and OSA and MAP index, with odds ratios (ORs) and prevalence ratios (PRs) and their 95% confidence intervals (CIs) calculated. Mediation analysis was performed to estimate the mediating effects of inflammatory indicators on the associations. RESULTS A total of 4473 participants (32.4%) had OSA, and the mean MAP index was 0.39. In fully adjusted log-binominal regression models, with total score < 6 as the reference, the ORs (95% CIs) for risk of OSA were 0.90 (0.73, 1.10), 0.76 (0.65, 0.89), 0.78 (0.64, 0.95), and 0.45 (0.38, 0.54) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). When LS7 score was analyzed as a continuous variable, each 1-point increase in LS7 score was associated with a 15% decrease in OSA risk (P < 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for the MAP index were 0.93 (0.90, 0.97), 0.87 (0.84, 0.91), 0.80 (0.77, 0.84), and 0.55 (0.53, 0.57) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). For each 1-point increase in LS7 score, the risk of OSA decreased by 13% (P < 0.001). Consistent results were observed in subgroup analysis. Mediation analysis indicated that inflammatory factors, including blood cell count, neutrophil count, and C-reactive protein, positively mediated the association of LS7 with OSA, with a mediation proportion of 0.022 (P = 0.04), 0.02 (P = 0.04), and 0.02 (P = 0.02), respectively. CONCLUSIONS In a nationally representative sample of US adults, adherence to LS7 metrics was independently associated with reduced OSA risk. Inflammation plays a mediating role in the association between LS7 and OSA.
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Affiliation(s)
- Shuang Wu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Min Yang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jun Zhu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu-Lu Wang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Xu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Qi Lyu
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Wang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing-Hui Shao
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Zhang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
- National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Deshmukh AJ, Somers VK. Obstructive Sleep Apnea and Atrial Fibrillation: From Boolean Logic to Fuzzy Inference! JACC Clin Electrophysiol 2024:S2405-500X(24)00638-8. [PMID: 39152967 DOI: 10.1016/j.jacep.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Stenberg E, Ottosson J, Näslund E. Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events after Metabolic and Bariatric Surgery: A Propensity-Matched Cohort Study. J Am Coll Surg 2024; 239:77-84. [PMID: 38372341 DOI: 10.1097/xcs.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although obstructive sleep apnea (OSA) is common among patients with obesity and linked to cardiovascular disease, there is a lack of studies evaluating the effects of reaching remission from OSA after metabolic and bariatric surgery. STUDY DESIGN A registry-based nationwide study including patients operated with sleeve gastrectomy or Roux-en-Y gastric bypass from 2007 until 2019 in Sweden. Patients who reached remission of OSA were compared with those who did not reach remission and a propensity score-matched control group of patients without OSA at the time of operation. The main outcome was overall mortality, and secondary outcome was major cardiovascular events (MACEs). RESULTS In total, 5,892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4,334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% vs 9.1%; p < 0.001) and MACE (cumulative incidence 3.4% vs 5.8%; p < 0.001) at 10 years after operation compared with those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6%, p = 0.493, for MACE 3.7%, p = 0.251). CONCLUSIONS The remission rate of OSA was high after metabolic and bariatric surgery. This was in turn associated with reduced risk for death and MACE compared with patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline. A diligent follow-up of patients who do not reach remission remains important.
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Affiliation(s)
- Erik Stenberg
- From the Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Stenberg, Ottosson)
| | - Johan Ottosson
- From the Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Stenberg, Ottosson)
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden (Näslund)
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Shen FJ, Zhou RK, Qiu DQ, Li L. The effect of PAP on UACR and metabolic indexes in patients with MS and OSAHS. Sleep Breath 2024; 28:1635-1644. [PMID: 38720150 PMCID: PMC11303581 DOI: 10.1007/s11325-024-03044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/13/2024] [Accepted: 04/26/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To investigate the effects of positive airway pressure (PAP) device on urinary albumin to creatinine ratio (UACR) and metabolic indexes in patients with metabolic syndrome (MS) and obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS This study is a retrospective cohort study. Grouped according to whether to use PAP treatment, there were 25 cases in the PAP group and 44 cases in the no OSAHS treatment group. The PAP group received positive airway pressure device and routine treatment of MS. The no OSAHS treatment group received routine treatment of OSAHS and MS. The treatment period is 3 months. RESULTS 1. The PAP group demonstrated significant reductions in Body Mass Index (BMI), Waist circumference (WC), Neck circumference (NC), Visceral fat area (VFA), Fasting C peptide (FCP), high-sensitivity C-reactive protein (hs-CRP), and UACR compared to the no OSAHS treatment group, with significant differences (P all <0.05). Among them, the UACR in the PAP group decreased significantly (from 86.05(52.55,131.61)mg/g to 16.76(8.70,25.12)mg/g, P<0.001). 2. Linear regression analysis using the decrease in UACR values as the dependent variable demonstrated a positive linear relationship with the decrease in BMI, VFA, fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR). Furthermore, multiple linear regression analysis indicated that the decrease in VFA (B=0.537 [95% confidence interval, 0.084 to 0.989]; P = 0.021) and HOMA-IR (B=1.000 [95% confidence interval, 0.082 to 1.917]; P = 0.033) values independently correlated with decrease in UACR values. CONCLUSIONS PAP treatment can reduce UACR in patients with MS and OSAHS, and has the effect of improving metabolic disorders. The decrease of UACR in patients may be related to the decrease of visceral fat and the improvement of insulin resistance.
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Affiliation(s)
- Fang-Jing Shen
- Ningbo University Health Science Center, Ningbo, Zhejiang, China
| | - Ren-Ke Zhou
- Ningbo University Health Science Center, Ningbo, Zhejiang, China
| | - Dan-Qi Qiu
- Ningbo University Health Science Center, Ningbo, Zhejiang, China
| | - Li Li
- Department of Endocrinology, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
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Wan J, Wang P, Liu S, Wang X, Zhou P, Yang J. Risk factors and a predictive model for left ventricular hypertrophy in young adults with salt-sensitive hypertension. J Clin Hypertens (Greenwich) 2024; 26:933-944. [PMID: 38940286 PMCID: PMC11301447 DOI: 10.1111/jch.14863] [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: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Salt-sensitive hypertension is common among individuals with essential hypertension, and the prevalence of left ventricular hypertrophy (LVH) has increased. However, data from early identification of the risk of developing LVH in young adults with salt-sensitive hypertension are lacking. Thus, the present study aimed to design a nomogram for predicting the risk of developing LVH in young adults with salt-sensitive hypertension. A retrospective analysis of 580 patients with salt-sensitive hypertension was conducted. The training set consisted of 70% (n = 406) of the patients, while the validation set consisted of the remaining 30% (n = 174). Based on multivariate analysis of the training set, predictors for LVH were extracted to develop a nomogram. Discrimination curves, calibration curves, and clinical utility were employed to assess the predictive performance of the nomogram. The final simplified nomogram model included age, sex, office systolic blood pressure, duration of hypertension, abdominal obesity, triglyceride-glucose index, and estimated glomerular filtration rate (eGFR). In the training set, the model demonstrated moderate discrimination, as indicated by an area under the receiver operating characteristic (ROC) curve of 0.863 (95% confidence interval: 0.831-0.894). The calibration curve exhibited good agreement between the predicted and actual probabilities of LVH in the training set. Additionally, the validation set further confirmed the reliability of the prediction nomogram. In conclusions, the simplified nomogram, which consists of seven routine clinical variables, has shown good performance and clinical utility in identifying young adults with salt-sensitive hypertension who are at high risk of LVH at an early stage.
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Affiliation(s)
- Jindong Wan
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peijian Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Sen Liu
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Xinquan Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Peng Zhou
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Jian Yang
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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9
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Ko J, Lim JH, Kim DB, Joo MJ, Jang YS, Park EC, Shin J. Association between alcohol use disorder and risk of obstructive sleep apnea. J Sleep Res 2024; 33:e14128. [PMID: 38112217 DOI: 10.1111/jsr.14128] [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: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder characterised by recurrent upper airway collapse during sleep. Alcohol consumption has been linked to an increased risk of OSA due to its effects on the upper airway and body mass index (BMI). We aimed to investigate the correlation between alcohol use disorders and OSA. We used 11,859 participants data from Korean National Health and Nutrition Examination Surveys. The variable of interest was alcohol use disorder, measured using the Alcohol Use Disorders Identification Test, and the dependent variable was the risk of OSA, measured using the Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, age, neck circumference, and male gender questionnaires. Multiple logistic regression was used to assess the association between alcohol use disorder and OSA risk after adjusted analysis. A significant association was found between alcohol use disorder and OSA (adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.93-2.37). In the unemployed group, those with alcohol use disorder had the highest odds of being at risk of OSA compared with those who did not have this disorder (aOR 2.45, 95% CI 2.04-2.95). The OSA risk increased as the snoring frequency, amount of alcohol consumed, and frequency of binge drinking increased. This study suggests an association between alcohol use disorders and the risk of OSA. The frequency of alcohol consumption, quantity of alcohol consumed, and snoring frequency were associated with the risk of OSA. Therefore, ceasing alcohol consumption is recommended as an effective approach to enhancing sleep quality.
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Affiliation(s)
- Jisu Ko
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jae Hyeok Lim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Dan Bi Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Min Jeong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, New York, USA
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Talukder A, Li Y, Yeung D, Shi M, Umbach DM, Fan Z, Li L. OSApredictor: A tool for prediction of moderate to severe obstructive sleep apnea-hypopnea using readily available patient characteristics. Comput Biol Med 2024; 178:108777. [PMID: 38901189 PMCID: PMC11265974 DOI: 10.1016/j.compbiomed.2024.108777] [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: 02/06/2024] [Revised: 05/25/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
Sleep apnea is a common sleep disorder. The availability of an easy-to-use sleep apnea predictor would provide a public health benefit by promoting early diagnosis and treatment. Our goal was to develop a prediction tool that used commonly available variables and was accessible to the public through a web site. Using data from polysomnography (PSG) studies that measured the apnea-hypopnea index (AHI), we built a machine learning tool to predict the presence of moderate to severe obstructive sleep apnea (OSA) (defined as AHI ≥15). Our tool employs only seven widely available predictor variables: age, sex, weight, height, pulse oxygen saturation, heart rate and respiratory rate. As a preliminary step, we used 16,958 PSG studies to examine eight machine learning algorithms via five-fold cross validation and determined that XGBoost exhibited superior predictive performance. We then refined the XGBoost predictor by randomly partitioning the data into a training and a test set (13,566 and 3392 PSGs, respectively) and repeatedly subsampling from the training set to construct 1000 training subsets. We evaluated each of the resulting 1000 XGBoost models on the single set-aside test set. The resulting classification tool correctly identified 72.5 % of those with moderate to severe OSA as having the condition (sensitivity) and 62.8 % of those without moderate to-severe OSA as not having it (specificity); overall accuracy was 66 %. We developed a user-friendly publicly available website (https://manticore.niehs.nih.gov/OSApredictor). We hope that our easy-to-use tool will serve as a screening vehicle that enables more patients to be clinically diagnosed and treated for OSA.
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Affiliation(s)
- Amlan Talukder
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Yuanyuan Li
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Deryck Yeung
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Min Shi
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - David M Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Zheng Fan
- Division of Sleep Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leping Li
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.
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Liu X, Li S, Wang X, Fan J, Gong W, Yan Y, Ai H, Que B, Zheng W, Nie S. Impact of obstructive sleep apnea on prognosis of patients with cardiometabolic multimorbidity. Diabetol Metab Syndr 2024; 16:178. [PMID: 39060937 PMCID: PMC11282628 DOI: 10.1186/s13098-024-01403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Cardiometabolic multimorbidity (CMM) is a growing global health problem, and obstructive sleep apnea (OSA) is recognized as an important risk factor for cardiovascular disease. However, the impact of OSA on the prognosis of CMM patients remains unclear. METHODS This study was a sub-study of OSA-acute coronary syndrome (ACS) and included 1, 927 hospitalized ACS patients. Patients were divided into the CMM group and the non-CMM group. OSA was diagnosed using the apnea-hypopnea index (AHI). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). The secondary endpoint included cardiac events, all-cause death and all repeat revascularizations. RESULTS This study enrolled 1, 927 patients hospitalized for ACS, with a median follow-up of 3 years. Among them, 723 patients (37.5%) had CMM, while 1, 204 patients (62.5%) did not have CMM. Over half of the patients in each group had OSA. OSA patients exhibited worse cardiometabolic profiles than their non-OSA counterparts, including higher body mass index (BMI), glycemic indices, lipids and inflammation. In the CMM group, OSA patients had a significantly higher incidence of MACCE than non-OSA patients (34.7% vs. 23.7%, p = 0.004). These results remained significant after adjustment, indicating that OSA substantially increased the risk of MACCE in the CMM group (adjusted hazard ratio [HR]: 1.432; 95% confidence interval [CI]: 1.017-2.016; p = 0.040). Conversely, the incidence of MACCE was similar between OSA and non-OSA subgroups within the non-CMM cohort. Subgroup analyses showed that OSA increased the risk of MACCE in CMM patients aged ≥ 60 years (adjusted HR: 1.642; 95% CI: 1.031-2.615; p = 0.037) and in those with specific clinical characteristics. CONCLUSION OSA significantly impacts the prognosis of CMM patients, highlighting the need for targeted OSA screening and management strategies to improve outcomes in this population potentially.
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Grants
- 2020YFC2004800 National Key Research and Development Program of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- QLM20230608 Beijing Hospitals Authority Youth Programme
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Affiliation(s)
- Xiaogang Liu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China
| | - Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wen Zheng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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Yan W, Zhou J, Jiang M, Kong Y, Qin H, Qi Y, Wang S, Tai J. Obstructive sleep apnea and 19 gastrointestinal diseases: a Mendelian randomization study. Front Psychiatry 2024; 15:1256116. [PMID: 39132315 PMCID: PMC11310136 DOI: 10.3389/fpsyt.2024.1256116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Background Alterations gastrointestinal diseases (GDs) were reported in individuals with obstructive sleep apnea (OSA), however, the genetic background between OSA and GDs is still unclear. Methods This investigation employed Mendelian randomization (MR) analyses to evaluate the causal effect between OSA and 19 types of GDs (gastroesophageal reflux disease (GERD), ulcerative colitis, celiac disease, Crohn's disease, chronic gastritis, irritable bowel syndrome, primary biliary cholangitis, diverticular disease, gastroduodenal ulcer, acute pancreatitis, non-alcoholic fatty liver disease, primary sclerosing cholangitis, cirrhosis, calculus of bile duct, calculus of gallbladder, pancreatic cancer, gastric cancer, colorectal cancer, and esophageal cancer). The inverse-variance weighted (IVW) method was used to evaluate the main effects model of causality. Results This MR study suggests that OSA may play a causal role inflammation-related GDs (GERD, PIVW=5.94×10-9; gastroduodenal ulcer, PIVW=1×10-4; chronic gastritis, PIVW=0.0214; ulcerative colitis, PIVW=0.0296), and gallstones (calculi of the gallbladder, PIVW=0.0429; calculi of the bile duct, PIVW=0.0068). After accounting for obesity, type 2 diabetes, smoking, and alcohol consumption, the multivariate MR (MVMR) analysis identified that OSA is an independent risk factor for GERD, gastroduodenal ulcer, and calculus of the bile duct. The reverse MVMR analysis showed a causal effect of GERD on OSA. Besides, we did not find that the predisposition to OSA was associated with 4 cancers. Conclusion This MR analysis provides compelling evidence of an independent causal relationship between genetically predicted OSA and an elevated risk of inflammation-related GDs. Besides, no causal association was observed between OSA and cancers. Further studies should be carried out to verify our findings.
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Affiliation(s)
- Weiheng Yan
- Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiayi Zhou
- Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Miaomiao Jiang
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
| | - Yaru Kong
- Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Han Qin
- Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuwei Qi
- Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital Capital Institute of Pediatrics, Beijing, China
| | - Shan Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Hou S, Zhu G, Liu X, Wang C, Liang J, Hao W, Kong L. Screening of preoperative obstructive sleep apnea by cardiopulmonary coupling and its risk factors in patients with plans to receive surgery under general anesthesia: a cross-sectional study. Front Neurol 2024; 15:1370609. [PMID: 39114535 PMCID: PMC11303281 DOI: 10.3389/fneur.2024.1370609] [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: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024] Open
Abstract
Objective Preoperative obstructive sleep apnea (OSA) is supposed to be the abnormally high occurrence of OSA the night before surgery under general anesthesia. This study aimed to evaluate the prevalence preoperative OSA using cardiopulmonary coupling (CPC) and its correlation with imbalance of sympathetic/parasympathetic nervous system. Methods A total of 550 patients with plans to receive surgery under general anesthesia were enrolled. All patients were assigned to wear CPC on the night before surgery until the next day. Sleep quality characteristics, heart rate variation parameters, and apnea-hypopnea index were acquired. The diagnosis of pre-existing OSA was not considered in the current study. Results According to apnea-hypopnea index, 28.4%, 32.2%, 26.2%, and 13.3% patients were assessed as no, mild, moderate, and severe operative OSA, respectively. Multivariate logistic regression model revealed that higher age [p < 0.001, odds ratio (OR) = 1.043] was independently and positively associated with preoperative OSA; heart rate variation parameters representing the imbalance of sympathetic/parasympathetic nervous system, such as higher low-frequency (p < 0.001, OR = 1.004), higher low-frequency/high-frequency ratio (p = 0.028, OR = 1.738), lower NN20 count divided by the total number of all NN intervals (pNN20; p < 0.001, OR = 0.950), and lower high-frequency (p < 0.001, OR = 0.998), showed independent relationships with a higher probability of preoperative OSA. Higher age (p = 0.005, OR = 1.024), higher very-low-frequency (p < 0.001, OR = 1.001), and higher low-frequency/high-frequency ratio (p = 0.003, OR = 1.655) were associated with a higher probability of moderate-to-severe preoperative OSA, but higher pNN10 (p < 0.001, OR = 0.951) was associated with a lower probability of moderate-to-severe preoperative OSA. Conclusion Preoperative OSA is prevalent. Higher age and imbalance of sympathetic/parasympathetic nervous system are independently and positively associated with a higher occurrence of preoperative OSA. CPC screening may promote the management of preoperative OSA.
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Affiliation(s)
- Shujie Hou
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Guojia Zhu
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xu Liu
- School of Basic Medicine, Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Chuan Wang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Junchao Liang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Lili Kong
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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Zhao H, Sun R, Cao S, Han J. Clinical effects of twin-block combined with maxillary expansion on the upper airway in adolescents with Class II malocclusion. Clin Oral Investig 2024; 28:442. [PMID: 39046570 DOI: 10.1007/s00784-024-05837-6] [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: 02/20/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Class II malocclusion, particularly class II division 1, poses a significant orthodontic challenge with implications for both aesthetics and health. This study aimed to explore the impact of twin-block (TB) combined with maxillary expansion treatment (TB-ME) on upper airway dimensions and inflammatory profiles in adolescents with skeletal Class II Division 1 malocclusion in adolescent. METHODS Ninety-two eligible patients were randomly assigned to two groups: TB-ME treatment and traditional McLaughlin Bennett Trevisi (MBT) straight-wire orthodontic treatment (Control). Cephalometric lateral X-ray scans were conducted before and after treatment to assess skeletal changes, including SNA, ANB, and SNB angles, which are essential to assess the anteroposterior relationships of the maxilla and mandible to the cranial base. We also measured the upper airway volumes and areas. Concentrations of inflammatory factors including intercellular adhesion molecule 1 (ICAM-1), matrix metallopeptidase 2 (MMP2), and interleukin 8 (IL-8) of gingival crevicular fluid analysis (GCF) were detected by enzyme-linked immunosorbent assay. RESULTS TB-ME treatment induced significant improvement in cephalometric parameters, including a decrease in SNA and ANB angles and an increase in SNB angle. Upper airway volumes and areas increased significantly in both groups, with TB-ME showing greater improvements. GCF analysis revealed a reduction in ICAM-1, MMP2, and IL-8 concentrations in the TB-ME group compared to the Control group. CONCLUSIONS TB-ME treatment demonstrates multifaceted improvements in skeletal malocclusion, upper airway dimensions, and inflammatory profiles in adolescents with class II division 1 malocclusion, showing the promise of TB-ME in addressing the complexities associated with class II malocclusion.
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Affiliation(s)
- Huanhuan Zhao
- Dental Clinic, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou, Hebei, 061000, China.
| | - Ru Sun
- Dental Clinic, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou, Hebei, 061000, China
| | - Sumin Cao
- Dental Clinic, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou, Hebei, 061000, China
| | - Jingmei Han
- Dental Clinic, Cangzhou Central Hospital, No. 16 Xinhua West Road, Cangzhou, Hebei, 061000, China
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Yang L, Liu B, Zhao F, Zhou Z. A meta-analysis of the correlation between obstructive sleep apnea syndrome and renal injury. Int Urol Nephrol 2024:10.1007/s11255-024-04160-z. [PMID: 39048772 DOI: 10.1007/s11255-024-04160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To conduct a meta-analysis on the correlation between obstructive sleep apnea syndrome (OSAS) and renal injury. METHODS Literature search was carried out in PubMed, Embase and Ovid-Medline databases between the date of database establishment and June 30th 2024. The keywords included obstructive sleep apnea hypopnea syndrome, sleep apnea hypopnea syndrome, renal injury, and correlation. Two researchers 1st independently screened the titles and abstracts based on the eligibility criteria, then extracted the data and evaluated the quality, and used Review Manager 5.3 for data processing. All analysis methods were based on PRISMA. RESULTS Finally, 8 studies that matched the inclusion criteria were included, and the relationship between obstructive sleep apnea syndrome and serum cystatin C was analyzed. The homogeneity test showed (P < 0.01, I2 = 98%), and from the meta-analysis results, it could be known that the level of serum cystatin C in sufferers with OSAS was obviously greater than the control one (OR = 1.12, 95% CI 0.96-1.28, P < 0.01). The relationship between OSAS and serum creatinine was analyzed, and homogeneity test showed (P < 0.01, I2 = 96%). From the meta analysis result, it could be known that the serum creatinine level of obstructive sleep apnea syndrome was obviously greater than the control one (OR = 1.01, 95% CI 0.85 ~ 1.17, P < 0.01). The relationship between obstructive sleep apnea syndrome with serum urea nitrogen was analyzed, and homogeneity test showed (P < 0.01, I2 = 91%). From the meta-analysis results, it could be known that serum urea nitrogen of OSAS was obviously greater than the control one (OR = 1.38, 95% CI 01.17 ~ 1.59, P < 0.01). CONCLUSIONS Eight articles have been included to determine the correlation between obstructive sleep apnea syndrome and renal injury, and it has been found that obstructive sleep apnea syndrome is closely related to renal injury, and the two may be risk factors for each other.
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Affiliation(s)
- Linghong Yang
- Department of General Practice, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, ZheJiang, China
| | - Bo Liu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, ZheJiang, China
| | - Feimin Zhao
- Department of Geriatrics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, ZheJiang, China
| | - Zhangning Zhou
- Department of Geriatrics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, 313000, ZheJiang, China.
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Yang Z, Ma J, Kang Z, Wang L. The impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer cell activity in pediatric obstructive sleep apnea hypopnea syndrome (OSAHS). Sleep Breath 2024:10.1007/s11325-024-03115-z. [PMID: 39042240 DOI: 10.1007/s11325-024-03115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE This study aimed to investigate the impact of surgical intervention on peripheral blood T lymphocyte subsets and natural killer (NK) cell activity in pediatric patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS A total of 36 OSAHS children, 32 children with tonsillar hypertrophy, and 30 healthy children were enrolled. Clinical data and polysomnography (PSG) results were collected. Peripheral blood samples were analyzed for T lymphocyte subsets, NK cells, and cytokine levels including Th1 (IFN-γ, IL-2, TNF-α), Th2 (IL-4, IL-10), and Th17 (IL-17). RESULTS At baseline, OSAHS children exhibited lower LSaO2 levels and higher AHI values compared to healthy children. They also showed decreased percentages of CD3 + T cells, CD4 + T cells, NK cells, and elevated CD8 + T cells and CD4+/CD8 + ratio. Levels of IFN-γ, IL-2, TNF-α, IL-4, and IL-17 were significantly lower in OSAHS children. Post-surgery improvements were observed in LSaO2, AHI, and immune markers at 3 months and 6 months. Pearson's correlation analysis revealed significant associations between LSaO2, AHI, and peripheral blood immune parameters at baseline and 6 months post-surgery. CONCLUSION Surgical intervention in pediatric OSAHS influences peripheral blood T lymphocyte subsets and NK cell activity. Early intervention and monitoring of immune function are crucial for the recovery and healthy development of affected children.
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Affiliation(s)
- Zhichao Yang
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianli Ma
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhaopeng Kang
- Department of Andrology, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China.
| | - Lixin Wang
- Department of Otolaryngology Head and Neck Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China.
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Fang F, Sun Z, Gao Y, Han J, Zhao L, Zhao Z, He Z, Zhang Z, Bian H, Liu L. Effects of combined morbid insomnia and sleep apnea on long-term cardiovascular risk and all-cause mortality in elderly patients: a prospective cohort study. BMC Geriatr 2024; 24:622. [PMID: 39034410 PMCID: PMC11265059 DOI: 10.1186/s12877-024-05147-2] [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: 12/04/2022] [Accepted: 06/13/2024] [Indexed: 07/23/2024] Open
Abstract
PURPOSE It is reported that insomnia and obstructive sleep apnea (OSA) increase the incidence of adverse cardiovascular events. The aim of this study was to analyze the risk of cardiovascular disease and mortality in elderly patients with comorbid insomnia and obstructive sleep apnea (COMISA). METHODS We included 868 elderly patients with OSA who underwent sleep monitoring at a multicenter sleep room from January 2015 to October 2017. We collected demographic data, clinical features, medical history, sleep parameters, and laboratory findings. Cox proportional hazards analysis was used to identify the relationship between COMISA and adverse cardiovascular events and all-cause mortality. RESULTS There were 181 elderly patients with COMISA. The median follow-up was 43 months, during which we observed major adverse cardiac events (MACE) in 90 patients. The Kaplan-Meier survival curve indicated a significant relationship between COMISA and MACE (Plog Rank < 0.001). Multivariate Cox regression analysis showed that COMISA increased the incidence of MACE (HR = 2.328, 95% CI: 1.349-4.018, P = 0.002), hospitalization for unstable angina (HR = 2.915, 95% CI: 1.397-6.081, P = 0.004), and the combination of all events (HR = 2.301, 95% CI: 1.393-3.803, P = 0.001). However, there were no significant differences in cardiovascular death, all-cause mortality, myocardial infarction, or hospitalized heart failure in patients with COMISA (P > 0.05). Subgroup analyses showed that among COMISA patients, male sex (HR = 2.800, 95% CI: 1.458-5.377, P = 0.002), age < 70 years (HR = 4.050, 95% CI: 2.022-8.115, P < 0.001), and overweight and obesity (HR = 2.482, 95% CI: 1.383-4.453, P = 0.002) were associated with a higher risk of MACE. CONCLUSIONS Our results showed that COMISA increased the risk of MACE, unstable angina, and the compound occurrence of all events. Male, overweight or obese COMISA patients under 70 years of age have an increased risk of MACE.
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Affiliation(s)
- Fengfeng Fang
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Medical College, Yan'an University, Yan'an, China
| | - Zhihong Sun
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Jiming Han
- Medical College, Yan'an University, Yan'an, China
| | - Libo Zhao
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zhe Zhao
- Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Zijun He
- Medical College, Yan'an University, Yan'an, China
| | - Zuo Zhang
- People's Hospital of Ningxia Hui Autonomous Region, Beijing, China.
| | - Hongyan Bian
- Medical College, Yan'an University, Yan'an, China.
- Cardiovascular and Cerebrovascular Disease Hospital of the Affiliated Hospital of Yan'an University, Yan'an, China.
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Noh HE, Rha MS, Jeong Y, Kim CH, Cho HJ. Outcomes and Predictors of Success Following Multilevel Surgery in Positional and Nonpositional Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2024. [PMID: 39033351 DOI: 10.1002/ohn.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/17/2024] [Accepted: 04/06/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To assess the surgical outcomes and identify predictors of surgical success in patients with positional and non-positional obstructive sleep apnea following multilevel airway surgery. STUDY DESIGN Retrospective cohort study. SETTING Singe-tertiary medical center. METHODS This study included 158 patients with obstructive sleep apnea who underwent multilevel airway surgery. Patients were divided into 2 groups according to position dependency: "positional patients" group (n = 100), and "nonpositional patients" group (n = 58). The characteristics and surgical outcomes of the 2 groups were compared. RESULTS The nonpositional group included younger and more obese patients in comparison to the positional group. Moreover, the nonpositional group had more severe disease than the positional group. Both groups showed overall improvement after surgery, and the surgical success rate did not differ significantly between the 2 groups (nonpositional, 41.4% vs positional, 48.0%; P = .424). Notably, 69.0% of patients belonging to the non-positional group converted to positional group postoperatively. Logistic regression analysis revealed that larger tonsil size, female sex, and higher mean O2 saturation were associated with higher success rate in the positional group, whereas larger tonsil size was associated with surgical success in the nonpositional group. CONCLUSION Both nonpositional and positional groups showed improvements following multilevel airway surgery, and surgery induced a transition from nonpositional to positional group. Given that the factors related to surgical success differed between the two groups, surgeons should consider position dependency and these distinct factors during decision-making.
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Affiliation(s)
- Hae E Noh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Rha
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeonsu Jeong
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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19
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Cheng ETW, Au CT, Chan RNC, Chan JWY, Chan NY, Wing YK, Li AM, Lam E, Chan KC. Ferritin is a potential marker of cardiometabolic risk in adolescents and young adults with sleep-disordered breathing. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae048. [PMID: 39161746 PMCID: PMC11331151 DOI: 10.1093/sleepadvances/zpae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/26/2024] [Indexed: 08/21/2024]
Abstract
Objective To explore markers that reflect sleep-disordered breathing (SDB) severity and investigate their associations with cardiometabolic risk factors in adolescents and young adults. Methods Participants were recruited from our SDB epidemiological cohort. They underwent overnight polysomnography and ambulatory blood pressure (BP) monitoring. Complete blood count, ferritin, high-sensitivity C-reactive protein (hs-CRP), fasting blood glucose, and lipid profile were measured. Multiple linear regression was used to examine the association between red cell indices (RCIs), ferritin, and obstructive apnea-hypopnea index (OAHI). Subgroup analyses on participants with SDB were performed for the association of RCIs and ferritin with lipid profile, hs-CRP, and BP. Results There were 88 participants with SDB and 155 healthy controls aged 16-25 years. Hemoglobin (Hb; p < .001), hematocrit (HCT; p < .001), and ferritin (p < .001) were elevated with increasing SDB severity and were independently associated with OAHI (β=1.06, p < .001; β=40.2, p < .001; β=4.89 × 10-3, p = .024, respectively). In participants with SDB, after adjusting for age, sex, and BMI, significant associations were found between ferritin with low-density lipoprotein (LDL; β=0.936 × 10-3, p = .008) and triglyceride (TG; β =1.08 × 10-3, p < .001), as well as between Hb (β=1.40, p = .007), HCT (β=51.5, p = .010) and mean arterial pressure (MAP). Ferritin (β=0.091, p = .002), Hb (β=0.975, p = .005), and HCT (β=38.8, p = .004) were associated with hs-CRP independent of age, sex, BMI, plasma LDL, and MAP. OAHI was not associated with LDL and TG in the multivariable models. Conclusions Serum ferritin, but not OAHI, was associated with LDL and TG in participants with SDB, suggesting it is a potential marker of cardiometabolic risk in patients with SDB.
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Affiliation(s)
- Esther T W Cheng
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun T Au
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Raymond N C Chan
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey W Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun K Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert M Li
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ethan Lam
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, Chinese University of Hong Kong, Hong Kong SAR, China
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20
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Li J, Sun L, Zhao Y. Advances in non-coding RNA as a biomarker for obstructive sleep apnoea hypoventilation syndrome. Sleep Breath 2024:10.1007/s11325-024-03109-x. [PMID: 39017902 DOI: 10.1007/s11325-024-03109-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/19/2024] [Accepted: 07/12/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Obstructive sleep apnoea hypoventilation syndrome (OSAHS) is a common sleep disorder that affects multiple body systems, which in turn is closely associated with cognitive dysfunction, diabetes mellitus, oncological cardiovascular diseases and metabolic disorders. In recent years, non-coding RNA (ncRNA) has emerged as a new opportunity for biomarker discovery. We therefore discuss the research progress and potential role of ncRNAs in obstructive sleep apnea hypoventilation syndrome. METHODS This review systematically searched relevant academic literature from PubMed, Web of Science and other databases. During the retrieval process, a combination of keywords such as "OSAHS", "ncRNA", "lncRNA", "miRAN", "circRNA" was used for search. RESULTS Circulating ncRNA has good area under the ROC curve, sensitivity and specificity in the diagnosis of OSAHS, and has the potential to become a diagnostic marker for OSAHS, while several circulating ncRNAs or circulating ncRNAs in combination with other tests such as the Obstructive Sleep Apnoea Screening Scale have a higher value of application as a test for OSAHS. Further analyses revealed that many circulating ncRNAs were significantly differentially expressed in the serum of OSAHS patients with different very severities, a potential marker for predicting the severity of OSAHS, and that the ncRNA content of patients' serum also had a significant effect during CPAP therapy, suggesting that it may have potential for therapeutic monitoring. Meanwhile, serum ncRNAs from patients have been shown to be effective in the diagnosis of OSAHS complications such as hypertension, Alzheimer's disease, acute myocardial infarction and atherosclerosis. The expression of up- or down-regulated ncRNAs can regulate different signalling pathways, which in turn affects various OSAHS complications such as pulmonary hypertension, diabetes mellitus, and cognitive dysfunction, and is expected to become a new direction for the treatment of these complications. CONCLUSIONS The changes in ncRNA expression in OSAHS patients are expected to be a novel biomarker for the diagnosis and treatment of OSAHS, and can also be used as a potential biomarker for the combination of diabetes mellitus, cardiovascular disease, respiratory disease, and cognitive dysfunction in OSAHS. It is believed that the continuous progress of ncRNA-related research is expected to promote the early detection, diagnosis and treatment of OSAHS and its complications.
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Affiliation(s)
- Jingli Li
- Kunming University of Science and Technology Affiliated The First People's Hospital of Yunnan Province, Kunming, 650500, Yunnan, China
| | - Limei Sun
- Kunming University of Science and Technology Affiliated Puer City People's Hospital, Puer, 665000, Yunnan, China
| | - Yuan Zhao
- Kunming University of Science and Technology Affiliated Puer City People's Hospital, Puer, 665000, Yunnan, China.
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21
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Li A, Zhang Q, Yao Y, Zhu X, Liu C, Guo Y, Kan H, Chen R. Higher ambient temperatures may worsen obstructive sleep apnea: A nationwide smartwatch-based analysis of 6.2 million person-days. Sci Bull (Beijing) 2024; 69:2114-2121. [PMID: 38821748 DOI: 10.1016/j.scib.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 06/02/2024]
Abstract
Obstructive sleep apnea (OSA) is a serious type of sleep disorder that can lead to cardiometabolic and neurocognitive diseases. We utilized smart device-based photoplethysmography technology to collect sleep data from the Chinese population from 2019 to 2022. Distributed lag nonlinear models combined with a generalized nonlinear model or a linear mixed effects model were used to investigate the short-term associations between daily temperature and indicators of OSA severity. We included a total of 6,232,056 d of sleep monitoring data from 51,842 participants with moderate to severe risk of OSA from 313 Chinese cities. The relationships between ambient temperature and OSA exacerbation, apnea-hypopnea index (AHI), and minimum oxygen saturation (MinSpO2) were almost linear and present only on the same day. Higher temperatures were associated with a greater risk of OSA exacerbation, with an 8.4% (95% confidence interval (CI): 7.6%-9.3%) increase per 10 °C increase in temperature. A 10 °C increase in daily temperature corresponded to an AHI increase of 0.70 events/h (95% CI: 0.65-0.76) and a MinSpO2 decrease of 0.18% (95% CI: 0.16%-0.19%). Exposure to elevated temperatures during the night can also lead to adverse effects. The effects of higher temperatures on OSA severity were stronger among men, participants with a body mass index ≥ 24 kg/m2, those aged 45 years and older, individuals with a history of hypertension and diabetes, and during the cold season. This large-scale, nationwide, longitudinal study provides robust evidence suggesting that higher ambient temperatures may immediately worsen OSA.
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Affiliation(s)
- Anni Li
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Qingli Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yuan Yao
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China; Institute for Hospital Management Research, Chinese PLA General Hospital, Beijing 100048, China
| | - Xinlei Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China.
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22
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Khan AY, Curry B, Jergel A, Keesari R, Prosky J, Garcia RU. Obstructive Sleep Apnea and Short-Term Outcomes After Pediatric Cardiac Surgery. Pediatr Cardiol 2024:10.1007/s00246-024-03583-w. [PMID: 39008057 DOI: 10.1007/s00246-024-03583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
Obstructive sleep apnea (OSA) has been associated with negative cardiovascular effects and negative outcomes following cardiovascular surgery in the adult population. Our objective was to evaluate if there is a similar association in children. Single center retrospective matched cohort study, we collected data on patients aged 1-18 who were admitted to the cardiac intensive care unit (CICU) between Jan 2012 and Dec 2021. We used a 3:1 propensity score matching for cases not diagnosed with OSA. Primary outcome was a composite variable: "adverse outcome," consisting of prolonged hospital and CICU stay, prolonged duration of mechanical ventilation, need for extracorporeal membrane oxygenation, and death. The study comprised 80 patients diagnosed with OSA and 240 patients without a diagnosis of OSA before cardiac surgery. The median age was 5.3 years (IQR 2.7-11.2). There were 184 (57.5%) males, and 102 (31.9%) had chromosomal and genetic abnormalities. There was a difference in "adverse outcome" between the OSA and non-OSA groups [34 (42.50%) vs 68 (28.33%), p = 0.027]. Moreover, bivariate analysis revealed that CICU length of stay, and chromosomal anomalies were statistically different between the groups. By logistic regression the composite variable "adverse outcome" remained associated to the OSA group (p = 0.009) with an adjusted odds ratio (OR) of 4.09 (1.83-9.18), p < 0.001. Children diagnosed with OSA had a higher risk of "adverse outcome" following cardiac surgery. The risk disappeared if the patient had Tonsillectomy and Adenoidectomy before cardiac surgery. Further studies should explore a proactive treatment for OSA in pediatric patients who need cardiac surgery.
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Affiliation(s)
- Adil Y Khan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Brian Curry
- Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Jergel
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jordan Prosky
- Emory University School of Medicine, Atlanta, GA, USA
| | - Richard U Garcia
- Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine Children's Healthcare of Atlanta, 2835 Brandywine Rd, Suite 400, Atlanta, 30341, GA, USA.
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23
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Sanchez-Azofra A, Orr JE, Sanz-Rubio D, Marin-Oto M, Alarcon-Sisamon S, Vicente E, Ancochea J, Soriano JB, DeYoung P, Azarbarzin A, Malhotra A, Marin JM. Apnea-Specific Pulse-Rate Response is Associated With Early Subclinical Atherosclerosis in Obstructive Sleep Apnea. Arch Bronconeumol 2024:S0300-2896(24)00242-4. [PMID: 39084963 DOI: 10.1016/j.arbres.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION In patients with obstructive sleep apnea (OSA), novel metrics such as hypoxic burden (HB) and sleep apnea-specific pulse-rate response (ΔHR) may better correlate with cardiovascular diseases (CVD) than the apnea-hypopnea index (AHI). This manuscript aims to assess the correlation between ΔHR and HB with subclinical atherosclerosis in patients with OSA, testing the hypothesis that elevated ΔHR and HB are associated with subclinical atherosclerosis development. METHODS In a prospective study, individuals aged 20-65 years with suspected OSA without known comorbidities were consecutively recruited and defined as OSA (AHI≥5events/h) or healthy controls. Using bilateral carotid ultrasonography, common carotid intima-media thickness (CIMT) was assessed and the identification of at least one atheromatous plaque defined the presence of subclinical atherosclerosis. ΔHR, and HB were derived from pulse-oximetry. RESULTS We studied 296 patients of age 45±10 years old, of whom 28% were women, and with a BMI of 30.3±5.3kg/m2. Overall, 245 had OSA and 51 were healthy controls. After controlling for confounding variables higher ΔHR but not HB, was associated with higher CIMT (p=0.006) and higher time spent with oxygen saturation below 90% (T90) was associated with an increase in carotid atheroma plaques (p=0.032). When stratifying OSA based on HB tertiles, we observed that within tertile 2 of HB, an increase in ΔHR was associated with larger CIMT (p=0.017). CONCLUSION A higher ΔHR is associated with an increase in CIMT among adult patients with OSA. This study suggests that ΔHR could be a biomarker of risk for CVD in patients with OSA.
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Affiliation(s)
- Ana Sanchez-Azofra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain.
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David Sanz-Rubio
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Marta Marin-Oto
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain; Department of Medicine, Faculty of Medicine, University of Zaragoza, Edificio A, 50009 Zaragoza, Spain
| | - Sergio Alarcon-Sisamon
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Eugenio Vicente
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Julio Ancochea
- Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan B Soriano
- Division of Pulmonary Medicine, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Calle Diego de Leon 62, 28006 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Pamela DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Harvard University, 75 Francis St, 02115 Boston, MA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Jose M Marin
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain; Department of Medicine, Faculty of Medicine, University of Zaragoza, Edificio A, 50009 Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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24
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Wang X, Zhou T, Huang W, Zhang J, Zou J, Guan J, Yi H, Yin S. Differences in Physiologic Endotypes Between Nonpositional and Positional OSA: Results From the Shanghai Sleep Health Study Cohort. Chest 2024; 166:212-225. [PMID: 38218217 DOI: 10.1016/j.chest.2024.01.021] [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: 03/23/2023] [Revised: 12/04/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Positional OSA (POSA) is a recognized subtype of OSA that exhibits distinct endotypic characteristics when compared with nonpositional OSA (NPOSA). The basis for the disparity in endotypes between these subtypes remains poorly understood. RESEARCH QUESTION (1) Do individuals with NPOSA and POSA have different underlying OSA endotypes? (2) Which endotypic characteristics are critical in determining NPOSA and POSA severity? STUDY DESIGN AND METHODS Within the Shanghai Sleep Health Study cohort, individuals with OSA were recruited and classified as having POSA or NPOSA. Endotypes were calculated using polysomnography. RESULTS Endotype analysis was conducted in 1,036 individuals with OSA. Compared with individuals with NPOSA, those with POSA had lower loop gain calculated during all sleep stages and all sleep positions (0.55; interquartile range [IQR], 0.46-0.66 vs 0.68, IQR, 0.52-0.90; P < .001), lower arousal threshold calculated during all sleep stages and all sleep positions (ArTHAll) (138.67; IQR, 118.94-180.87 percentage of the eupneic ventilation [%Veupnea] vs 189.00; IQR, 129.71-257.76 %Veupnea; P < .001), lower pharyngeal collapsibility calculated during all sleep stages and all sleep positions (VpassiveAll) (91.85; IQR, 83.13-95.15 %Veupnea vs 76.38; IQR, 23.77-92.08 %Veupnea; P < .001), and higher muscle compensation calculated during all sleep stages and all sleep positions (6.50; IQR, -6.77 to 16.39 %Veupnea vs 3.65; IQR, -10.47 to 12.14 %Veupnea; P = .003). Logistic regression analyses indicated that higher VpassiveAll was associated with increased odds of POSA vs NPOSA. In NPOSA, fully adjusted linear regression analyses indicated that VpassiveAll (β = -0.55; 95% CI, -0.68 to -0.42; P < .001) and lower loop gain calculated during all sleep stages and all sleep positions (β = 0.19; 95% CI, 0.08-0.30; P < .001) were significant independent predictors of the apnea hypopnea index, with VpassiveAll being the most critical factor. In contrast, in POSA, collapsibility appeared to be less influential (β = -0.09; 95% CI, -0.21 to 0.03; P = .138). Nonanatomic endotypic characteristics (LGAll: β = 0.29; 95% CI, 0.18-0.41; P < .001; arousal threshold in all sleep stages and all sleep positions: β = 0.15; 95% CI, 0.01-0.28; P = .031; muscle compensation in all sleep stages and all sleep positions: β = -0.21; 95% CI, -0.29 to -0.12; P < .001) were significant in determining the severity of POSA, with loop gain being the most crucial factor. INTERPRETATION This study highlights the differences in endotypes between NPOSA and POSA. In Chinese individuals, anatomic factors were more significant in determining the severity of NPOSA, whereas nonanatomic traits were more likely to determine the severity of POSA. Future research should focus on developing personalized management strategies for individuals with NPOSA and POSA based on their endotypes. TRIAL REGISTRATION Chinese Clinical Trial Registry; No.: ChiCTR1900025714; URL: https://www.chictr.org.cn/indexEN.html.
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Affiliation(s)
- Xiaoting Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Tianjiao Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Weijun Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
| | - Jingyu Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jianyin Zou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
| | - Shankai Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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25
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Li S, Xin Q, Yan Y, Wang X, Ai H, Que B, Gong W, Nie S. Pde5 Inhibition Reduced Blood Pressure and Alleviated Target Organ Damage in Chronic Intermittent Hypoxia. J Cardiovasc Pharmacol 2024; 84:81-91. [PMID: 38030140 PMCID: PMC11230658 DOI: 10.1097/fjc.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
ABSTRACT The role of phosphodiesterase 5 (Pde5) in obstructive sleep apnea-induced damage remains unclear. Our study aimed to investigate the role of Pde5 in the chronic intermittent hypoxia (CIH) model. C57BL/6J wild-type (WT) mice (n = 48) and Pde5 knockout (Pde5 -/- ) mice (n = 24) were randomly assigned to CIH group and room air group. After 6 weeks, some WT mice (n = 24) in CIH group were given sildenafil or saline gavage for another 4 weeks. Blood pressure was regularly measured during the experiment. Echocardiography was used to estimate cardiac function. We collected organs from each group of mice and measured their physical indicators. Histochemical staining was used to explore the size of cardiomyocyte and fibrosis area of various organs. Cyclic guanosine monophosphate and malondialdehyde concentrations in serum were measured by ELISA assay. Compared with the RA-treated group, the 6-week CIH resulted in a significant increase in blood pressure, altered heart structure, and reduced serum cyclic guanosine monophosphate in WT mice. Pde5 -/- mice and sildenafil intragastric administration significantly reduced systolic blood pressure in CIH condition and attenuated the damage of target organs. In CIH model, we found that the cardiomyocyte size and fibrosis area of heart and kidney significantly reduced in Pde5 -/- groups. Besides, endogenous and exogenous inhibition of Pde5 reduced malondialdehyde level and inflammatory and oxidative stress markers expression in CIH condition. In this study, we found that Pde5 inhibition could reduce blood pressure and alleviate target organ damage in the CIH model, which may be mediated through the oxidative stress pathway.
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Affiliation(s)
- Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Qingjie Xin
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; and
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Fujita Y, Yamauchi M, Muro S. Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea. Respir Investig 2024; 62:645-650. [PMID: 38759606 DOI: 10.1016/j.resinv.2024.05.004] [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: 12/27/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.
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Affiliation(s)
- Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan; Department of Clinical Pathophysiology of Nursing, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Simon SL, Snell-Bergeon JK, Schäfer M, Barker AJ, Browne LP, Truong U, Tell SS, Vigers T, Baumgartner AD, Lyon E, Polsky S, Schauer IE, Nadeau KJ. Sleep duration and association with cardiometabolic health in adolescents and adults with type 1 diabetes: Results from the BCQR-T1D study. Diabetes Obes Metab 2024; 26:2662-2672. [PMID: 38584515 PMCID: PMC11150084 DOI: 10.1111/dom.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024]
Abstract
AIM Type 1 diabetes (T1D) increases the risk of morbidity and mortality from cardiovascular disease, and insufficient sleep is prevalent. Emerging evidence suggests a link between sleep and cardiometabolic health, but this has not been examined across the lifespan in individuals with T1D. We aimed to examine associations between sleep and cardiometabolic health in adolescents and adults with T1D in a secondary analysis of data from a 4-week double-blind, random-order, placebo-controlled crossover trial of bromocriptine quick release (BCQR) therapy with a 4-week washout in between conditions. MATERIALS AND METHODS Forty-two adults (19-60 years) and 42 adolescents (12-18 years) with T1D >9 months completed 1 week of home monitoring with wrist-worn actigraphy to estimate sleep duration and continuous glucose monitoring, anthropometrics, arterial stiffness, magnetic resonance imaging (adolescents only), and fasting laboratory testing at each treatment phase. RESULTS Sixty-two per cent of adolescents and 74% of adults obtained <7 h of sleep per night at baseline. After adjustment for age, sex and diabetes duration, baseline sleep <7 h per night was associated with a higher body mass index, a higher waist circumference, a higher systolic blood pressure, worse arterial stiffness and a lower estimated insulin sensitivity (all p < .05). When examined by age group, associations between sleep duration and cardiometabolic health outcomes remained significant, predominantly for adolescents. In adolescents only, wake time was significantly later (p = .027) and time in bed was significantly longer with BCQR versus placebo (p = .049). CONCLUSIONS Objectively measured sleep <7 h per night was prevalent in adolescents and adults with T1D and associated with poorer cardiometabolic health markers. Small changes in sleep were seen following BCQR treatment in adolescents only. Sleep may be an important and novel target for improving cardiometabolic health in individuals with T1D.
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Affiliation(s)
- Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora CO USA
| | - Michal Schäfer
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Uyen Truong
- Department of Cardiology, Children’s National Hospital, Washington, DC USA
| | - Shoshana S. Tell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Timothy Vigers
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Amy D. Baumgartner
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Ellen Lyon
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora CO USA
| | - Irene E. Schauer
- Department of Medicine, University of Colorado Anschutz Medical Campus and Endocrinology Section, Rocky Mountain Regional VA Medical Center, Aurora, CO USA
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
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Tekumalla S, Plawecki A, Kaffenberger T, Alapati R, Doghramji K, Boon M, Huntley C. The relationship between positive airway pressure tolerance and adherence: defining a new metric. J Clin Sleep Med 2024; 20:1033-1038. [PMID: 38305783 PMCID: PMC11217623 DOI: 10.5664/jcsm.11050] [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: 07/25/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVES Positive airway pressure (PAP) therapy adherence rates range from 30% to 60%, yet adherent patients may still express dissatisfaction with treatment. The identification of factors affecting PAP tolerance could provide insight into its impact on adherence. METHODS Patients with obstructive sleep apnea presenting for first follow-up visit after newly initiating PAP therapy were given a 10-question PAP tolerance survey encompassing domains of psychosocial perception, practical issues, and side effects, utilizing 10-point visual analog scales. Relationships between adherence data, tolerance scores, and patient variables (demographics, sleep-related factors, comorbidities, usage data) were explored via 2-tailed t tests, multivariable regression analysis, and recursive partitioning regression trees with a significance level of P ≤ .05. RESULTS For 105 patients, tolerance scores were higher in patients considered adherent to therapy (P = .033), as were scores for individual survey questions addressing the ability to fall asleep (P = .013) and sleep through the night (P = .020). Depression positively (P = .006) and insomnia medication use negatively (P = .010) predicted tolerance score. Data-driven tolerance score cutoffs were identified to correlate with PAP adherence, with higher tolerance scores correlating with greater adherence rates. CONCLUSIONS PAP tolerance may play an important role in therapy adherence. Tolerance can be statistically defined and categorized based on prior adherence data. Its utility as a predictive tool in assessing future adherence is warranted. CITATION Tekumalla S, Plawecki A, Kaffenberger T, et al. The relationship between positive airway pressure tolerance and adherence: defining a new metric. J Clin Sleep Med. 2024;20(7):1033-1038.
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Affiliation(s)
- Sruti Tekumalla
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrea Plawecki
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania
| | - Thomas Kaffenberger
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania
| | - Rahul Alapati
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karl Doghramji
- Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania
| | - Maurits Boon
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania
| | - Colin Huntley
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Thomas Jefferson University Sleep Disorders Center, Philadelphia, Pennsylvania
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29
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Kazmierski RH. Obstructive sleep apnea: What is an orthodontist's role? Prog Orthod 2024; 25:21. [PMID: 38945976 PMCID: PMC11214936 DOI: 10.1186/s40510-024-00524-4] [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: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The American Association of Orthodontists white paper on obstructive sleep apnea and orthodontics remains the most authoritative statement on the topic. This was produced in 2019 due to increasing orthodontic interest in obstructive sleep apnea (OSA) and the lack of formal guidelines for orthodontists. Since the white paper's release, advocacy for contrarian ideas and practices remain. Orthodontists are sometimes acting as primary care providers for OSA. Procedures appropriate only for screening are sometimes being used for diagnosis. The side effects of effective treatments such as mandibular advancement devices need further consideration. Also, research has clarified the effectiveness and ineffectiveness of treatments such as palatal expansion. RESULTS Part of an orthodontist's role is screening for OSA. The correct action when this is suspected remains referral to the appropriate physician specialist for diagnosis and treatment or coordination of treatment. Orthodontists may participate in the treatment of patients with OSA as a member of a multi-disciplinary team. Effective orthodontic treatments may include orthognathic surgery with maxillomandibular advancement and mandibular advancement devices. The negative effects of the latter make this a choice of last resort. Current research indicates that OSA alone is not sufficient indication for palatal expansion. CONCLUSIONS Orthodontists should appropriately screen for obstructive sleep apnea. This may be done as part of our health histories, our clinical examination, and review of radiographs taken for purposes other than the diagnosis and screening for OSA. Orthodontic treatment for OSA can be helpful and effective. However, this may be done only after referral to the appropriate physician specialist, as part of a multi-disciplinary team, with consideration of the likely effectiveness of treatment, and after all likely and potential negative consequences have been considered and thoroughly discussed with the patient.
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Affiliation(s)
- Robert H Kazmierski
- Solo Private Orthodontic Practice, 110 Marter Ave., Suite 404, Moorestown, NJ, 08057, USA.
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30
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Song J, Xu S, Chen Q, Gou Y, Zhao C, Jia C, Liu H, Zhang Z, Li B, Gao Y, Zhao Y, Ji E. Cardiomyocyte-specific overexpression of FPN1 diminishes cardiac hypertrophy induced by chronic intermittent hypoxia. J Cell Mol Med 2024; 28:e18543. [PMID: 39054575 PMCID: PMC11272608 DOI: 10.1111/jcmm.18543] [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: 03/24/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
The significance of iron in myocardial mitochondria function cannot be underestimated, because deviations in iron levels within cardiomyocytes may have profound detrimental effects on cardiac function. In this study, we investigated the effects of ferroportin 1 (FPN1) on cardiac iron levels and pathological alterations in mice subjected to chronic intermittent hypoxia (CIH). The cTNT-FPN1 plasmid was administered via tail vein injection to induce the mouse with FPN1 overexpression in the cardiomyocytes. CIH was established by exposing the mice to cycles of 21%-5% FiO2 for 3 min, 8 h per day. Subsequently, the introduction of hepcidin resulted in a reduction in FPN1 expression, and H9C2 cells were used to establish an IH model to further elucidate the role of FPN1. First, FPN1 overexpression ameliorated CIH-induced cardiac dysfunction, myocardial hypertrophy, mitochondrial damage and apoptosis. Second, FPN1 overexpression attenuated ROS levels during CIH. In addition, FPN1 overexpression mitigated CIH-induced cardiac iron accumulation. Moreover, the administration of hepcidin resulted in a reduction in FPN1 levels, further accelerating the CIH-induced levels of ROS, LIP and apoptosis in H9C2 cells. These findings indicate that the overexpression of FPN1 in cardiomyocytes inhibits CIH-induced cardiac iron accumulation, subsequently reducing ROS levels and mitigating mitochondrial damage. Conversely, the administration of hepcidin suppressed FPN1 expression and worsened cardiomyocyte iron toxicity injury.
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Affiliation(s)
- Ji‐Xian Song
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Shan Xu
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
- Hebei Key Laboratory of Turbidity Toxin SyndromeThe First Affiliated Hospital Hebei University of Chinese MedicineShijiazhuangChina
| | - Qi Chen
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Yujing Gou
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Chen‐Bing Zhao
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Cui‐Ling Jia
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Han Liu
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Zhi Zhang
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Bo‐liang Li
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Yuhui Gao
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
| | - Yashuo Zhao
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
- Hebei Key Laboratory of Turbidity Toxin SyndromeThe First Affiliated Hospital Hebei University of Chinese MedicineShijiazhuangChina
| | - En‐Sheng Ji
- Hebei Technology Innovation Center of TCM Combined Hydrogen MedicineHebei University of Chinese MedicineShijiazhuangChina
- Department of Physiology, Institute of Basic MedicineHebei University of Chinese MedicineShijiazhuangChina
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Torres G, Sánchez de la Torre M, Pinilla L, Barbé F. Obstructive sleep apnea and cardiovascular risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:234-242. [PMID: 38413245 DOI: 10.1016/j.arteri.2024.01.004] [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: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
Patients with obstructive sleep apnea (OSA) experience repetitive episodes of upper airway obstruction due to recurrent collapse during sleep. This leads to intermittent hypoxia episodes, which, through complex pathophysiological mechanisms, trigger sympathetic overactivation, endothelial dysfunction, hypercoagulation, and metabolic dysregulation. Consequently, other cardiovascular risk factors such as hypertension, metabolic syndrome, and diabetes are induced. Furthermore, this enhances target organ damage, affecting the heart, arteries, and kidneys, leading to an increased risk of cardiovascular morbidity and mortality. Among the various treatments for OSA, Continuous Positive Airway Pressure (CPAP) has been extensively studied. To date, this treatment has shown mild benefits in reducing blood pressure, particularly noticeable in patients with resistant hypertension. Furthermore, CPAP treatment appears to reduce cardiovascular events, both in primary and secondary prevention, though this benefit is limited to individuals with good compliance (CPAP use ≥4h/night). Future research perspectives in OSA seem to focus on identifying patients in whom the condition significantly influences cardiovascular risk, thus determining those who would benefit the most from treatment in the reduction of cardiovascular risk.
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Affiliation(s)
- Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, España; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Manuel Sánchez de la Torre
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, España; Precision Medicine in Chronic Diseases, Hospital Universitari de Santa Maria, IRBLleida, Lleida, España; Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, España
| | - Lucia Pinilla
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, España; Precision Medicine in Chronic Diseases, Hospital Universitari de Santa Maria, IRBLleida, Lleida, España; Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, España
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, España; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, España
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Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, Lavie CJ, Virani SS, Slipczuk L. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:249-262. [PMID: 38795275 PMCID: PMC11192677 DOI: 10.1007/s11883-024-01207-5] [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] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE OF REVIEW Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.
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Affiliation(s)
- Vita N Jaspan
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siddhant Parihar
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Shapiro
- Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA.
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33
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Mizuno H. Hypertension and blood pressure variability in patients with obstructive sleep apnea. Hypertens Res 2024; 47:1992-1993. [PMID: 38760529 DOI: 10.1038/s41440-024-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Hiroyuki Mizuno
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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34
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Das P, Wang Y, Angom RS, Dredla B, Wang E, Jansen-West K, Badi M, Ross O, Meschia JF, Mukhopadhyay D. Changes in plasma concentrations of novel vascular and inflammatory biomarkers in obstructive sleep apnea patients pre- and post-stroke. Sleep Med 2024; 119:518-525. [PMID: 38805859 DOI: 10.1016/j.sleep.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is increasingly recognized as a common condition in the general population and causes significant OSA-associated morbidities including cardiovascular and cerebrovascular events such as cerebral small vessel disease (CSVD) and stroke. METHODS In this study, using sensitive ELISA immunoassays, we measured subset of endothelial/vascular and inflammatory biomarkers as well as neurofilament light chain (NfL), a sensitive marker for neuroaxonal injury, using plasma from OSA patients post-stroke (Acute Cerebral Infarction (ACI), N = 26) to determine their usefulness as potential prognostic markers in disease progression. RESULTS Our results showed significantly increased plasma TNFα and NfL concentrations and decreased concentrations of platelet derived growth factor (PDGF-AA) in post-stroke OSA patients with more severe white matter hyperintensities (WMHs). And after separating the patients based on sex, compared to females, male post-stroke OSA patients with severe WMHs have increased circulating levels of inflammatory chemokine CXCL10 and cytokine Interleukin-10 (IL-10) and significantly decreased levels of Angiopoietin-1 (Ang-1) an important protein responsible for endothelial/vascular integrity functions. Importantly, in a subset of newly diagnosed OSA patients (without prior history of stroke), significantly increased plasma CXCL10 levels and decreased plasma Ang-1 levels were also readily observed when compared to healthy controls, indicating possible altered endothelial integrity and ongoing vascular inflammation in these newly diagnosed OSA patients. CONCLUSIONS In summary, our study has identified a novel set of plasma biomarkers including PDGF-AA, CXCL10 and Ang-1 for their potential prognostic value for disease outcomes pre- and post-stroke in OSA patients and use as surrogate markers to measure efficacy of treatment modalities.
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Affiliation(s)
- Pritam Das
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Ying Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Brynn Dredla
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Enfeng Wang
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Karen Jansen-West
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mohammed Badi
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Owen Ross
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
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Hickman W, Dada RS, Thibault D, Gibson C, Heller S, Jagadeesan V, Hayanga HK. Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis. Ann Card Anaesth 2024; 27:220-227. [PMID: 38963356 PMCID: PMC11315250 DOI: 10.4103/aca.aca_14_24] [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: 01/13/2024] [Revised: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 07/05/2024] Open
Abstract
CONTEXT Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. AIMS Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. SETTINGS AND DESIGN Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. MATERIAL AND METHODS Retrospective data analysis from 2017-2021. STATISTICAL ANALYSIS USED Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. RESULTS A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). CONCLUSIONS While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.
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Affiliation(s)
- William Hickman
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States
| | - Rachel S. Dada
- Department of Anesthesiology, West Virginia University, Morgantown, West Virginia, United States
| | - Dylan Thibault
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Christina Gibson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States
| | - Scott Heller
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Vikrant Jagadeesan
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, United States
| | - Heather K. Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States
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Cheung EC, Nilsson A, Venter I, Kowalik G, Ribeiro C, Rodriguez J, Kuraoka K, Russo R, Escobar JB, Alber BR, Mendelowitz D, Kay MW, Schunke KJ. Sex differences in cardiac transcriptomic response to neonatal sleep apnea. Physiol Rep 2024; 12:e16110. [PMID: 38981849 PMCID: PMC11233197 DOI: 10.14814/phy2.16110] [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: 03/25/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 07/11/2024] Open
Abstract
Pediatric obstructive sleep apnea poses a significant health risk, with potential long-term consequences on cardiovascular health. This study explores the dichotomous nature of neonatal cardiac response to chronic intermittent hypoxia (CIH) between males and females, aiming to fill a critical knowledge gap in the understanding of sex-specific cardiovascular consequences of sleep apnea in early life. Neonates were exposed to CIH until p28 and underwent comprehensive in vivo physiological assessments, including whole-body plethysmography, treadmill stress-tests, and echocardiography. Results indicated that male CIH rats weighed 13.7% less than age-matched control males (p = 0.0365), while females exhibited a mild yet significant increased respiratory drive during sleep (93.94 ± 0.84 vs. 95.31 ± 0.81;p = 0.02). Transcriptomic analysis of left ventricular tissue revealed a substantial sex-based difference in the cardiac response to CIH, with males demonstrating a more pronounced alteration in gene expression compared to females (5986 vs. 3174 genes). The dysregulated miRNAs in males target metabolic genes, potentially predisposing the heart to altered metabolism and substrate utilization. Furthermore, CIH in males was associated with thinner left ventricular walls and dysregulation of genes involved in the cardiac action potential, possibly predisposing males to CIH-related arrhythmia. These findings emphasize the importance of considering sex-specific responses in understanding the cardiovascular implications of pediatric sleep apnea.
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Affiliation(s)
- Emily C. Cheung
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Anna Nilsson
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Ian Venter
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Grant Kowalik
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Caitlin Ribeiro
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeannette Rodriguez
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Kiralee Kuraoka
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
| | - Rebekah Russo
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Joan B. Escobar
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Bridget R. Alber
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - David Mendelowitz
- Department of Pharmacology and PhysiologyThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Matthew W. Kay
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Kathryn J. Schunke
- Department of Biomedical EngineeringThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
- Department of Anatomy, Biochemistry & PhysiologyUniversity of HawaiiHonoluluHawaiiUSA
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Nielsen S, Nyvad J, Christensen KL, Poulsen PL, Laugesen E, Grove EL, Buus NH. Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease. Atherosclerosis 2024; 394:117170. [PMID: 37558603 DOI: 10.1016/j.atherosclerosis.2023.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnea (OSA) may accelerate arterial calcification, but the relation remains unexplored in diabetic kidney disease (DKD). We examined the associations between OSA, coronary calcification and large artery stiffness in patients with DKD and reduced renal function. METHODS Patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and urine albumin-creatinine ratio (UACR) > 30 mg/g were tested for OSA quantified by the apnea-hypopnea index (AHI, events/hour). Patients without OSA (AHI< 5) were compared to patients with moderate (AHI 15-29) or severe (AHI ≥30) OSA and underwent computed tomography angiography with coronary Agatston scoring (CAS) to quantify coronary calcification. Arterial stiffness was determined as carotid-femoral pulse wave velocity (PWV). RESULTS Among 114 patients with acceptable AHI recordings had 43 no OSA, 33 mild OSA and 38 moderate-severe OSA. Mean age of the 74 patients completing the study was 71.5 ± 9.4 years (73% males), eGFR 32.2 ± 12.3 ml/min/1.73 m2 and UACR 533 (192-1707) mg/g. CAS (ln-transformed) was significantly higher in patients with OSA compared to patients without (6.6 ± 1.7 vs. 5.6 ± 2.4, p = 0.04), and the same was observed for PWV (11.9 ± 2.7 vs. 10.5 ± 2.2 m/s, p = 0.02). In multivariable linear regression analyses adjusted for sex, age, body mass index, UACR, and mean arterial pressure, moderate-severe OSA remained significantly associated with PWV but not with CAS. Dominance analysis revealed OSA as the third and second most important factor relative to CAS and PWV respectively. CONCLUSIONS In DKD patients, moderate-severe OSA is a significant predictor of arterial stiffness but is not independently associated with coronary calcification.
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Affiliation(s)
- Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Løgstrup Poulsen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Esben Laugesen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
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Yan Z, Xu Y, Li K, Liu L. The correlation between frailty index and incidence, mortality in obstructive sleep apnea: Evidence from NHANES. Heliyon 2024; 10:e32514. [PMID: 39183837 PMCID: PMC11341328 DOI: 10.1016/j.heliyon.2024.e32514] [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: 11/03/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 08/27/2024] Open
Abstract
Background The emergence of obstructive sleep apnea (OSA) is marked by a growing trend towards younger individuals, while its developmental trajectory remains shrouded in uncertainty, accompanied by intricate prognostic implications. While frailty and sleep problems often coexist, the relationship between them remains unclear. Hence, this study aims to utilize the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2008 to analyze and explore the relationship between the level of frailty index (FI) and the risk of OSA incidence and survival outcomes. Materials and methods Specialized weighted complex survey design analysis software was employed for data analysis. Multivariate logistic regression models and restricted cubic splines (RCS) were utilized to assess the association between FI and OSA incidence in all participants. Additionally, a Cox proportional hazards model was established to estimate the association between FI and the hazard ratios (HRs) for all-cause mortality and cardiovascular disease (CVD) mortality. Results A total of 8524 participants were included in this study. Compared to the Non-frail group (FI ≤ 0.1), OSA risk increased with higher FI levels. In Model 3, adjusted for multiple covariates, the Pro-frail group (0.1 0.3) [OR = 2.32, 95 % CI (1.55, 3.48)] exhibited an average 31 %, 62 %, and 132 % increase in OSA risk, respectively. RCS results demonstrated a nonlinear dose-response relationship between OSA risk and FI levels, with an increasing trend (P = 0.004). The Cox model indicated that, except for the Pro-frail group, OSA-related mortality risk also increased with higher FI levels, with a more pronounced effect on CVD-related mortality. Conclusion This study supports the hypothesis that FI may be associated with an increased risk of OSA, with a higher emphasis on OSA-related mortality risk in Mildly frail and Moderately/Severely frail populations.
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Affiliation(s)
- Zhaoqi Yan
- Jiangxi University of Traditional Chinese Medicine, Clinical Medical College, Nanchang, Jiangxi, China
| | - Yifeng Xu
- Jiangxi University of Traditional Chinese Medicine, Clinical Medical College, Nanchang, Jiangxi, China
| | - Keke Li
- Jiangxi University of Traditional Chinese Medicine, Clinical Medical College, Nanchang, Jiangxi, China
| | - Liangji Liu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Department of Respiratory and Critical Care Medicine, Nanchang, Jiangxi, China
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Tian H, Wang A, Wu H, Zhou C, Zhang Z, Wang J. The causality between leisure sedentary behaviors, physical activity and obstructive sleep apnea: a bidirectional Mendelian randomization study. Front Public Health 2024; 12:1425060. [PMID: 38975351 PMCID: PMC11224541 DOI: 10.3389/fpubh.2024.1425060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Background Previous observational studies have shown a correlation between leisure sedentary behaviors (LSB) and physical activity (PA) with the incidence of obstructive sleep apnea (OSA). However, the causal associations remain unknown. Therefore, our study used bidirectional two-sample Mendelian randomization (MR) to identify potential causal relationships between LSB/PA and OSA. Methods We sourced genetic variation data for LSB and PA from the UK Biobank, while data on OSA were collected from the FinnGen study. The primary analysis method employed was the inverse variance weighted (IVW) approach, complemented by the weighted median and MR-Egger methods. For sensitivity analyses, we conducted Cochran's Q test, the MR-Egger intercept test, the MR-PRESSO global test, and the leave-one-out analysis. Results IVW analyses showed that genetically predicted leisure television watching (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.09-1.75, p = 0.007) and computer use (OR = 1.48, 95% CI = 1.15-1.92, p = 0.002) significantly increased the risk of OSA. Conversely, self-reported vigorous physical activity (VPA) (OR = 0.33, 95% CI = 0.11-0.98, p = 0.046) may reduce the risk of OSA. No causal effects on OSA risk were observed for driving or self-reported moderate-to-vigorous physical activity. Furthermore, the reverse MR analysis indicated no significant causal relationship between OSA and any LSB/PA phenotype. Sensitivity tests showed no significant heterogeneity or horizontal pleiotropy. Conclusion This study suggests that leisurely television watching and computer use are risk factors for OSA, while VPA may be a protective factor. Additionally, OSA does not affect PA or LSB levels. We recommend reducing sedentary activities, particularly television watching and computer use, and prioritizing VPA to reduce the risk of OSA. Further research in diverse populations and settings is needed to validate these findings.
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Affiliation(s)
- Haonan Tian
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Aozhe Wang
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Han Wu
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Cailiang Zhou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
| | - Zhenglong Zhang
- Department of Graduate School, Harbin Sport University, Harbin, China
| | - Jun Wang
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
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Aminian A, Wang L, Al Jabri A, Wilson R, Bena J, Milinovich A, Jin J, Heinzinger C, Pena-Orbea C, Foldvary-Schaefer N, Nissen SE, Mehra R. Adverse Cardiovascular Outcomes in Patients With Obstructive Sleep Apnea and Obesity: Metabolic Surgery vs Usual Care. J Am Coll Cardiol 2024:S0735-1097(24)07559-4. [PMID: 38909919 DOI: 10.1016/j.jacc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA). OBJECTIVES The authors sought to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity. METHODS Adult patients with a body mass index 35 to 70 kg/m2 and moderate-to-severe OSA at a U.S. health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap-weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022. RESULTS A total of 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m2 [Q1-Q3: 37.6-46.2 kg/m2]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (Q1-Q3: 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6-27.6 kg) or 19.3% (95% CI: 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI: 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI: 33.8%-37.4%) in the nonsurgical group (adjusted HR: 0.58 [95% CI: 0.48-0.71]; P < 0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%-12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%-13.8%) in the nonsurgical group (adjusted HR: 0.63 [95% CI: 0.45-0.89]; P = 0.009). CONCLUSIONS Among patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Lu Wang
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdullah Al Jabri
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James Bena
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alex Milinovich
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jian Jin
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Nancy Foldvary-Schaefer
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven E Nissen
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Reena Mehra
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Dunn JP, Chakladar S, Bunck MC, Bednarik J. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024. [PMID: 38912654 DOI: 10.1056/nejmoa2404881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Obstructive sleep apnea is characterized by disordered breathing during sleep and is associated with major cardiovascular complications; excess adiposity is an etiologic risk factor. Tirzepatide may be a potential treatment. METHODS We conducted two phase 3, double-blind, randomized, controlled trials involving adults with moderate-to-severe obstructive sleep apnea and obesity. Participants who were not receiving treatment with positive airway pressure (PAP) at baseline were enrolled in trial 1, and those who were receiving PAP therapy at baseline were enrolled in trial 2. The participants were assigned in a 1:1 ratio to receive either the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or placebo for 52 weeks. The primary end point was the change in the apnea-hypopnea index (AHI, the number of apneas and hypopneas during an hour of sleep) from baseline. Key multiplicity-controlled secondary end points included the percent change in AHI and body weight and changes in hypoxic burden, patient-reported sleep impairment and disturbance, high-sensitivity C-reactive protein (hsCRP) concentration, and systolic blood pressure. RESULTS At baseline, the mean AHI was 51.5 events per hour in trial 1 and 49.5 events per hour in trial 2, and the mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 39.1 and 38.7, respectively. In trial 1, the mean change in AHI at week 52 was -25.3 events per hour (95% confidence interval [CI], -29.3 to -21.2) with tirzepatide and -5.3 events per hour (95% CI, -9.4 to -1.1) with placebo, for an estimated treatment difference of -20.0 events per hour (95% CI, -25.8 to -14.2) (P<0.001). In trial 2, the mean change in AHI at week 52 was -29.3 events per hour (95% CI, -33.2 to -25.4) with tirzepatide and -5.5 events per hour (95% CI, -9.9 to -1.2) with placebo, for an estimated treatment difference of -23.8 events per hour (95% CI, -29.6 to -17.9) (P<0.001). Significant improvements in the measurements for all prespecified key secondary end points were observed with tirzepatide as compared with placebo. The most frequently reported adverse events with tirzepatide were gastrointestinal in nature and mostly mild to moderate in severity. CONCLUSIONS Among persons with moderate-to-severe obstructive sleep apnea and obesity, tirzepatide reduced the AHI, body weight, hypoxic burden, hsCRP concentration, and systolic blood pressure and improved sleep-related patient-reported outcomes. (Funded by Eli Lilly; SURMOUNT-OSA ClinicalTrials.gov number, NCT05412004.).
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Affiliation(s)
- Atul Malhotra
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ronald R Grunstein
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ingo Fietze
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Terri E Weaver
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Susan Redline
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ali Azarbarzin
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Scott A Sands
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Richard J Schwab
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Julia P Dunn
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Sujatro Chakladar
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Mathijs C Bunck
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Josef Bednarik
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
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Juhl CB, Bladbjerg EM, Gram B, Knudsen T, Lauridsen MM, Nygaard NPB, Drøjdahl Ryg N, Skadhauge L, Münster AMB. Prevalence of Obesity-Related Disease in a Danish Population - The Results of an Algorithm-Based Screening Program. Diabetes Metab Syndr Obes 2024; 17:2505-2517. [PMID: 38910914 PMCID: PMC11193984 DOI: 10.2147/dmso.s456028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/13/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose The prevalence of obesity continues to rise. People with obesity are at increased risk of several diseases. We tested an algorithm-based screening program for people with a BMI above 30 kg/m2 and present data on the prevalence of previously undiagnosed obesity-related diseases. Patients and Methods Seven hundred and sixty-nine persons with BMI > 30 kg/m2 and age 18-60 years were screened for diabetes (assessed by glycosylated hemoglobin and oral glucose tolerance test at HbA1c 43-48 mmol/mol), sleep apnea (screened by questionnaires and assessed by cardiorespiratory monitoring at indication of sleep disorder), liver steatosis or liver fibrosis (assessed by biochemistry and fibroscan) and arterial hypertension (assessed by both office and 24-hour blood pressure measurement). A reference group of people with a BMI of 18.5-29.9 kg/m2 was established. Results Of those referred, 73.0% were women. We identified new diabetes in 4.2%, prediabetes in 9.1%, moderate-to-severe sleep apnea in 25.1%, increased liver fat and increased liver stiffness in 68.1% and 17.4%, respectively, and hypertension or masked hypertension in 19.0%. The prevalence of diseases was much higher among men and increased with BMI. Except for hypertension, we found few participants with undiagnosed disease in the reference group. Conclusion An algorithm-based screening program is feasible and reveals undiagnosed obesity-related disease in a large proportion of the participants. The disproportional referral pattern calls for a tailored approach aiming to include more men with obesity. Trial Registration Inclusion of the non-obese group was approved by the Scientific Ethics Committee of The Region of Southern Denmark (project identification number: S-20210091), and the study was reported at clinicaltrials.gov (NCT05176132).
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Affiliation(s)
- Claus B Juhl
- Department of Endocrinology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Steno Diabetes Center Odense, University Hospital of Southern Denmark, Odense, Denmark
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- OPEN, Open Patient Data Explorative, Odense University Hospital, Odense, Denmark
| | - Else Marie Bladbjerg
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Bibi Gram
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
| | - Torben Knudsen
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Mette Munk Lauridsen
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Gastroenterology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Niels-Peter Brøchner Nygaard
- Department of Endocrinology, University Hospital of Southern Denmark, Esbjerg, Denmark
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Nina Drøjdahl Ryg
- Department of Endocrinology, University Hospital of Southern Denmark, Esbjerg, Denmark
- Steno Diabetes Center Odense, University Hospital of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative, Odense University Hospital, Odense, Denmark
| | - Lars Skadhauge
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Occupational Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Anna-Marie Bloch Münster
- University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
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Koss KR, Kumar D, Friedland DR, Adams JA, Lauer KK, Tong L, Luo J, Woodson BT. Disparities in polysomnography referral in a high-risk cardiac population. Sleep Breath 2024:10.1007/s11325-024-03051-y. [PMID: 38890269 DOI: 10.1007/s11325-024-03051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with metabolic, cardiovascular, and cerebrovascular comorbidities. Appropriate diagnosis and treatment of OSA might mitigate these comorbidities. This retrospective review sought to assess the impact of sex, age, race, ethnicity, and insurance status on polysomnography (PSG) referral rates. METHODS An institutional STOP-Bang database of 299,320 patients was filtered for patients admitted to the hospital with an acute cardiac diagnosis between 2015-2020. A cohort of 4,735 patients were risk stratified by STOP-Bang (SB) score and correlations were made between PSG referrals and demographic and clinical variables (sex, age, race, ethnicity, and insurance status). RESULTS Of the 25.3% of the cohort with high SB scores (5-8) only 21.3% were referred for PSG. Age and female sex were negatively associated with sleep study referrals (p < 0.001). No correlation was found between sleep study referral rates and race or ethnicity. No correlation was found between sleep study referrals and insurance provider. Admitting cardiac diagnosis significantly influenced sleep study referrals with diagnoses of arrhythmias and myocardial infarction being associated with an increased rate of PSG referrals compared to heart failure patients (p < 0.002). CONCLUSIONS Our study found no significant correlation between PSG referral rates and race, ethnicity, or insurance provider. However, we found low overall rates of PSG referral, with negative correlations between older age and female sex and a high-risk cardiac population. This represents a substantial missed opportunity to identify patients at risk for OSA, obtain a diagnosis, and provider adequate treatment.
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Affiliation(s)
- Kevin R Koss
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, US
| | - Devesh Kumar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, US
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, US
| | - Jazzmyne A Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, US
| | - Kathryn K Lauer
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, US
| | - Ling Tong
- Department of Health Informatics and Administration, University of Wisconsin, Milwaukee, US
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin, Milwaukee, US
| | - B Tucker Woodson
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, US.
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Wang PP, Cheng XQ, Dou ZJ, Fan YQ, Chen J, Zhao L, Han JX, Lin XW, Wang B. Inhibiting the CB1 receptor in CIH-induced animal model alleviates colon injury. Appl Microbiol Biotechnol 2024; 108:380. [PMID: 38888634 PMCID: PMC11189354 DOI: 10.1007/s00253-024-13216-0] [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: 01/21/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
Obstructive sleep apnea (OSA) can lead to intestinal injury, endotoxemia, and disturbance of intestinal flora. Additionally, as a crucial component of the endocannabinoid system, some studies have demonstrated that cannabinoid 1 (CB1) receptors are closely linked to the multiple organ dysfunction triggered by OSA. However, the role of the CB1 receptor in alleviating OSA-induced colon injury remains unclear. Here, through the construction of the OSA classic model, we found that the colon tissue of chronic intermittent hypoxia (CIH)-induced mice exhibited an overexpression of the CB1 receptor. The results of hematoxylin-eosin staining and transmission electron microscopy revealed that inhibition of the CB1 receptor could decrease the gap between the mucosa and muscularis mucosae, alleviate mitochondrial swelling, reduce microvilli shedding, and promote the recovery of tight junctions of CIH-induced mice. Furthermore, CB1 receptor inhibition reduced the levels of metabolic endotoxemia and inflammatory responses, exhibiting significant protective effects on the colon injury caused by CIH. At the molecular level, through western blotting and real-time polymerase chain reaction techniques, we found that inhibiting the CB1 receptor can significantly increase the expression of ZO-1 and Occludin proteins, which are closely related to the maintenance of intestinal mucosal barrier function. Through 16S rRNA high-throughput sequencing and short-chain fatty acid (SCFA) determination, we found that inhibition of the CB1 receptor increased the diversity of the microbial flora and controlled the makeup of intestinal flora. Moreover, butyric acid concentration and the amount of SCFA-producing bacteria, such as Ruminococcaceae and Lachnospiraceae, were both markedly elevated by CB1 receptor inhibition. The results of the spearman correlation study indicated that Lachnospiraceae showed a positive association with both ZO-1 and Occludin but was negatively correlated with the colon CB1 receptor, IL-1β, and TNF-α. According to this study, we found that inhibiting CB1 receptor can improve CIH-induced colon injury by regulating gut microbiota, reducing mucosal damage and promoting tight junction recovery. KEY POINTS: •CIH leads to overexpression of CB1 receptor in colon tissue. •CIH causes intestinal flora disorder, intestinal mucosal damage, and disruption of tight junctions. •Inhibition of CB1 receptor can alleviate the colon injury caused by CIH through regulating the gut microbiota, reducing mucosal injury, and promoting tight junction recovery.
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Affiliation(s)
- Pei-Pei Wang
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Qian Cheng
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhan-Jun Dou
- Department of Respiratory, Shanxi Cancer Hospital, Taiyuan, China
| | - Yong-Qiang Fan
- Department of General Surgery, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Chen
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Li Zhao
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Xing Han
- Department of Stomatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xian-Wang Lin
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bei Wang
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China.
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Liu F, Wang H, Bai B, Yin H, Liu Y, Wang Y, Liu Q, Wang S, Ma H, Geng Q. Obstructive Sleep Apnea as a Key Contributor to Mental Stress-Induced Myocardial Ischemia in Female Angina Patients with No Obstructive Coronary Artery Disease. Nat Sci Sleep 2024; 16:823-832. [PMID: 38911317 PMCID: PMC11192149 DOI: 10.2147/nss.s445219] [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: 10/17/2023] [Accepted: 06/05/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Mental stress induced myocardial ischemia (MSIMI) is regarded as the primary cause of the angina with no obstructive coronary artery disease (ANOCA). Obstructive sleep apnea (OSA) is autonomously linked to obstructive coronary heart disease, hypertension, and sudden cardiac death. Similar to the impact of psychological stress on the cardiovascular system, individuals with OSA experience periodic nocturnal hypoxia, resulting in the activation of systemic inflammation, oxidative stress, endothelial dysfunction, and sympathetic hyperactivity. The contribution of OSA to MSIMI in ANOCA patients is unclear. To explore the prevalence of OSA in ANOCA patients and the correlation between OSA and MSIMI, a prospective cohort of female ANOCA patients was recruited. Patients and Methods We recruited female patients aged 18 to 75 years old with ANOCA and evaluated MSIMI using positron emission tomography-computed tomography. Subsequently, Level III portable monitors was performed to compare the relationship between OSA and MSIMI. Results There is higher REI (7.8 vs 2.6, P=0.019), ODI (4.7 vs 9.2, P=0.028) and percentage of OSA (67.74% vs 33.33%, P=0.004) in MSIMI patients. The patients diagnosed with OSA demonstrated higher myocardial perfusion imaging scores (SSS: 1.5 vs 3, P = 0.005, SDS: 1 vs 3, P = 0.007). Adjusted covariates, the risk of developing MSIMI remained 3.6 times higher in OSA patients (β=1.226, OR = 3.408 (1.200-9.681), P = 0.021). Conclusion Patients with MSIMI exhibit a greater prevalence of OSA. Furthermore, the myocardial blood flow perfusion in patients with OSA is reduced during mental stress.
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Affiliation(s)
- Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Haochen Wang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Bingqing Bai
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, People’s Republic of China
| | - Han Yin
- Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, People’s Republic of China
| | - Yuting Liu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Yu Wang
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Quanjun Liu
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Shuxia Wang
- Department of Nuclear Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
| | - Qingshan Geng
- School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
- Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China
- Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, People’s Republic of China
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Peng Y, Shen H, Li C, Zhu X, Gao Y, Yi H, Xu H, Guan J, Li X, Yin S. Genetic variations of low-density lipoprotein cholesterol on metabolic disorders in obstructive sleep apnea. Nutr Metab (Lond) 2024; 21:31. [PMID: 38858772 PMCID: PMC11163771 DOI: 10.1186/s12986-024-00805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The study aimed to explore the relationship between low-density lipoprotein cholesterol (LDL-C) genetic variants and obstructive sleep apnea (OSA) and its complications, including cardiovascular diseases (CVD), insulin resistance (IR), and metabolic syndrome (MS). METHOD 4329 individuals with suspected OSA who underwent a comprehensive assessment of anthropometric, biochemical, and polysomnography (PSG) data, along with 30 LDL-C single nucleotide polymorphisms (SNPs) were enrolled. The 10-year Framingham CVD risk score (FRS), IR and MS were evaluated for each subject. Linear regression and logistic regression were utilized to examine the correlations among these variables. RESULTS After the Benjamini-Hochberg correction, linear regression results indicated positive correlations between variants rs3741297 and rs629301 with FRS (β = 0.031, PBH=0.002; β = 0.026, PBH=0.015). Logistic regression revealed that rs3741297 increased MS risk among total subjects [OR = 1.67 (95% CI:1.369-2.038), PBH=1.32 × 10- 5] and increased IR risk in females [OR = 3.475 (95% CI:1.653-7.307), PBH=0.03]. In males, rs2642438 decreased MS risk [OR = 0.81 (95% CI:0.703-0.933), PBH=0.045]. CONCLUSIONS The rs3741297 variant correlated with susceptibility to CVD, IR, and MS in the OSA population. OSA, CVD, IR and MS share a potentially common genetic background, which may promote precision medicine. CINICAL TRIAL REGISTRATION The study protocol was registered with the Chinese Clinical Trial Registry (ChiCTR1900025714).
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Affiliation(s)
- Yu Peng
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hangdong Shen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Chenyang Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyue Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yiqing Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huajun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China.
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China.
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
| | - Xinyi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China.
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
| | - Shankai Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine&, 600 Yishan Road, Shanghai, 200233, P. R. China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Michas G, Alexanian I, Ntali G, Tzanela M, Trikas A. Establishing a cardiometabolic outpatient department in Greece: a roadmap for multidisciplinary care. Hellenic J Cardiol 2024:S1109-9666(24)00123-4. [PMID: 38851429 DOI: 10.1016/j.hjc.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Affiliation(s)
- George Michas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Ioannis Alexanian
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Georgia Ntali
- Department of Endocrinology "D. IKKOS", Diabetes Center, Center of Excellence for Rare Endocrine Diseases, Evangelismos General Hospital of Athens, Athens, Greece
| | - Marinella Tzanela
- Department of Endocrinology "D. IKKOS", Diabetes Center, Center of Excellence for Rare Endocrine Diseases, Evangelismos General Hospital of Athens, Athens, Greece
| | - Athanasios Trikas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
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Wang Q, Stone KL, Lu Z, Tian S, Zheng Y, Zhao B, Bao Y, Shi L, Lu L. Associations between Longitudinal Changes in Sleep Stages and Risk of Cognitive Decline in Older Men. Sleep 2024:zsae125. [PMID: 38829819 DOI: 10.1093/sleep/zsae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 06/05/2024] Open
Abstract
STUDY OBJECTIVES To investigate the relationships between longitudinal changes in sleep stages and the risk of cognitive decline in older men. METHODS This study included 978 community-dwelling older men who participated in the first (2003-2005) and second (2009-2012) sleep ancillary study visits of the Osteoporotic Fractures in Men Study. We examined the longitudinal changes in sleep stages at the initial and follow-up visits, and the association with concurrent clinically relevant cognitive decline during the 6.5-year follow-up. RESULTS Men with low to moderate (quartile 2, Q2) and moderate increase (Q3) in N1 sleep percentage had a reduced risk of cognitive decline on the Modified Mini-Mental State Examination compared to those with a substantial increase (Q4) in N1 sleep percentage. Additionally, men who experienced a low to moderate (Q2) increase in N1 sleep percentage had a lower risk of cognitive decline on the Trails B compared with men in the reference group (Q4). Furthermore, men with the most pronounced reduction (Q1) in N2 sleep percentage had a significantly higher risk of cognitive decline on the Trails B compared to those in the reference group (Q4). No significant association was found between changes in N3 and rapid eye movement sleep and the risk of cognitive decline. CONCLUSIONS Our results suggested that a relatively lower increase in N1 sleep showed a reduced risk of cognitive decline. However, a pronounced decrease in N2 sleep was associated with concurrent cognitive decline. These findings may help identify older men at risk of clinically relevant cognitive decline.
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Affiliation(s)
- Qianwen Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Katie L Stone
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, United States
| | - Zhengan Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shanshan Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yongbo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Bingxin Zhao
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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Zhou Z, Zhao Q, Huang Y, Meng S, Chen X, Zhang G, Chi Y, Xu D, Yin Z, Jiang H, Yu L, Wang H. Berberine ameliorates chronic intermittent hypoxia-induced cardiac remodelling by preserving mitochondrial function, role of SIRT6 signalling. J Cell Mol Med 2024; 28:e18407. [PMID: 38894630 PMCID: PMC11187832 DOI: 10.1111/jcmm.18407] [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: 01/07/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Chronic intermittent hypoxia (CIH) is associated with an increased risk of cardiovascular diseases. Previously, we have shown that berberine (BBR) is a potential cardioprotective agent. However, its effect and mechanism on CIH-induced cardiomyopathy remain uncovered. This study was designed to determine the effects of BBR against CIH-induced cardiac damage and to explore the molecular mechanisms. Mice were exposed to 5 weeks of CIH with or without the treatment of BBR and adeno-associated virus 9 (AAV9) carrying SIRT6 or SIRT6-specific short hairpin RNA. The effect of BBR was evaluated by echocardiography, histological analysis and western blot analysis. CIH caused the inactivation of myocardial SIRT6 and AMPK-FOXO3a signalling. BBR dose-dependently ameliorated cardiac injury in CIH-induced mice, as evidenced by increased cardiac function and decreased fibrosis. Notably, SIRT6 overexpression mimicked these beneficial effects, whereas infection with recombinant AAV9 carrying SIRT6-specific short hairpin RNA abrogated them. Mechanistically, BBR reduced oxidative stress damage and preserved mitochondrial function via activating SIRT6-AMPK-FOXO3a signalling, enhancing mitochondrial biogenesis as well as PINK1-Parkin-mediated mitophagy. Taken together, these data demonstrate that SIRT6 activation protects against the pathogenesis of CIH-induced cardiac dysfunction. BBR attenuates CIH-induced myocardial injury by improving mitochondrial biogenesis and PINK1-Parkin-dependent mitophagy via the SIRT6-AMPK-FOXO3a signalling pathway.
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Affiliation(s)
- Zijun Zhou
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Qiusheng Zhao
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Shenyang Joint Logistics Support CenterPharmaceutical Instruments Supervision and Inspection StationShenyangChina
| | - Yuting Huang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Shan Meng
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Jinzhou Medical UniversityJinzhouLiaoningChina
| | - Xin Chen
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Jinzhou Medical UniversityJinzhouLiaoningChina
| | - Guoxin Zhang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Yanbang Chi
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Dengyue Xu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- School of Biomedical Engineering, Faculty of MedicineDalian University of TechnologyDalianLiaoningChina
| | - Zongtao Yin
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Hui Jiang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Liming Yu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Huishan Wang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
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Verbakel I, Bou Kheir G, de Rijk M, Dhondt K, Bliwise D, Pauwaert K, Monaghan T, Hervé F, Vogelaers D, Mariman A, Everaert K. Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review. Neurourol Urodyn 2024; 43:1134-1146. [PMID: 38289321 DOI: 10.1002/nau.25372] [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: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
AIMS As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan. METHODS An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations. RESULTS Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment. CONCLUSIONS A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.
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Affiliation(s)
- Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Karlien Dhondt
- Department of Child and Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Don Bliwise
- Sleep Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim Pauwaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Department of General Internal Medicine, AZ Delta, Roeselare, Belgium
| | - An Mariman
- Center for Integrative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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