1
|
Kim JM, Choi JS. The Analysis of Neutrophil to Lymphocyte Ratio (NLR), Lymphocyte to Monocyte Ratio (LMR), and Platelet to Lymphocyte Ratio (PLR) in Patients with Adenoidectomy and Tonsillectomy. J Clin Med 2024; 13:5457. [PMID: 39336944 PMCID: PMC11432515 DOI: 10.3390/jcm13185457] [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: 08/22/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Adenoidectomy and tonsillectomy are among the most commonly performed procedures in ENT practice. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are recognized inflammatory markers. This study aims to evaluate the changes in NLR, PLR, and LMR in patients undergoing adenoidectomy and tonsillectomy. Methods: The study group consisted of 980 patients who underwent adenoidectomy and/or tonsillectomy. Preoperative and postoperative inflammatory markers were measured in all patients. The NLR, LMR, and PLR values were then calculated and analyzed. Results: In patients undergoing adenoidectomy and/or tonsillectomy, the postoperative NLR was significantly lower than the preoperative NLR. Similarly, the postoperative LMR was significantly higher, and the postoperative PLR was significantly lower compared to their preoperative values. Conclusions: The significant changes in NLR, LMR, and PLR following adenoidectomy and/or tonsillectomy suggest a reduction in systemic inflammation post-surgery. These findings indicate that these procedures may contribute to the improvement of inflammatory status in patients, highlighting the potential role of these markers in monitoring surgical outcomes.
Collapse
Affiliation(s)
- Jeong-Mi Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea;
- Research Center for Controlling Intercellular Communication (RCIC), College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology, Head and Neck Surgery, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea;
- Research Center for Controlling Intercellular Communication (RCIC), College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea
- Program in Biomedical Science & Engineering, Department of Biomedical Science, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Republic of Korea
| |
Collapse
|
2
|
Soleimani F, Donker DW, Oppersma E, Duiverman ML. Clinical evidence and technical aspects of innovative technology and monitoring of chronic NIV in COPD: a narrative review. Expert Rev Respir Med 2024; 18:513-526. [PMID: 39138642 DOI: 10.1080/17476348.2024.2384024] [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: 03/29/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Chronic nocturnal noninvasive ventilation (NIV) improves outcomes in COPD patients with chronic hypercapnic respiratory failure. The aim of chronic NIV in COPD is to control chronic hypercapnic respiratory insufficiency and reduce symptoms of nocturnal hypoventilation, thereby improving quality of life. Chronic NIV care is more and more offered exclusively at home, enabling promising outcomes in terms of patient and caregiver satisfaction, hospital care consumption and cost reduction. Yet, to achieve and maintain optimal ventilation, during adaptation and follow-up, effective feasible (home) monitoring poses a significant challenge. AREAS COVERED Comprehensive monitoring of COPD patients receiving chronic NIV requires integrating data from ventilators and assessment of the patient's status including gas exchange, sleep quality, and patient-reported outcomes. The present article describes the physiological background of monitoring during NIV and aims to provide an overview of existing methods for monitoring, assessing their reliability and clinical relevance. EXPERT OPINION Patients on chronic NIV are 'ideal' candidates for home monitoring; the advantages of transforming hospital to home care are huge for patients and caregivers and for healthcare systems facing increasing patient numbers. Despite the multitude of available monitoring methods, identifying and characterizing the most relevant parameters associated with optimal patient well-being remains unclear.
Collapse
Affiliation(s)
- F Soleimani
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - D W Donker
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Liu W, Ding F, Guo H, Li J, Guo W, Wang J, Cui Z. Risk factors analysis of noninvasive positive pressure ventilation in inpatients with overlapping syndrome of chronic obstructive pulmonary disease combined with obstructive sleep apnea. Ann Thorac Med 2024; 19:201-207. [PMID: 39144532 PMCID: PMC11321525 DOI: 10.4103/atm.atm_305_23] [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: 12/29/2023] [Revised: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE The aim of the study was to analyze the clinical data of patients with chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome (OS) during hospitalization and to evaluate the risk factors of patients treated with Non-Invasive Ventilation (NIV). METHODS Demographic and clinical data of patients with confirmed OS during hospitalization were retrospectively collected. The patients were divided into two groups according to whether noninvasive ventilator was used during hospitalization, including OS treated with NIV (244 cases) and OS without NIV (239 cases). The t-test, χ 2 test, and Kaplan-Meier curve were used to compare the two groups, and multiple logistic regression was used to analyze the risk factors of NIV in patients with OS. RESULTS Compared with the OS group without NIV, the pulmonary hypertension, lymphocyte count, and left ventricular ejection fraction% of OS patients with NIV were lower, whereas PCO2, uric acid, C-reactive protein, procalcitonin, and N-terminal pro-B-type natriuretic peptide were higher, with statistical differences (P < 0.05). During hospitalization and follow-up, OS patients with NIV had a longer hospital stay (P < 0.001), and there was no significant difference in the rate of readmission within 28 days. The logistic regression analysis showed that the history of diuretic use, previous history of noninvasive ventilator use, and ischemic heart disease were independent risk factors for NIV treatment in OS patients during hospitalization. CONCLUSION Patients with OS undergoing NIV during hospitalization exhibited more severe overall illness and had prolonged hospital stays compared to OS patients not receiving NIV. History of diuretic use, history of NIV use, and ischemic heart disease are independent risk factors for NIV treatment in OS patients during hospitalization.
Collapse
Affiliation(s)
- WenJing Liu
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - Fang Ding
- Department of Gerontology, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - JieMei Li
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - Wei Guo
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| | - ZhaoBo Cui
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei Province, China
| |
Collapse
|
4
|
Jiang Y, Lin C, Xu M, Zhu T, Li X, Wang W. Differences and Risk Factors of Peripheral Blood Immune Cells in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2024; 16:737-749. [PMID: 38882924 PMCID: PMC11178088 DOI: 10.2147/nss.s458098] [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: 01/05/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a respiratory disorder characterized by chronic intermittent hypoxia and fragmented sleep, leading to inflammatory response and oxidative stress. However, the differences in immune inflammatory response in OSA patients with different severity remain unclear. Purpose This study aims to examine the differences in peripheral blood immune cells and their risk factors in OSA patients. Patients and Methods A total of 277 snoring patients from the Sleep Respiratory Disorder Monitoring Center of Zhongnan Hospital of Wuhan University were recruited in this study. According to the diagnosis and severity criteria of OSA, the included patients were further divided into simple snoring, mild, moderate, and severe groups. Peripheral blood immune cell counts including white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cells, platelets, and polysomnography indicators were collected from the patients. Results Compared with simple snoring patients, the OSA patients had increased circular monocyte and basophil count levels. In addition, correlation analysis results indicated that monocyte count was positively associated with chronic obstructive pulmonary disease (COPD), smoking, apnea-hypopnea index (AHI), the longest apnea duration, and Oxygen desaturation index (ODI), and negatively correlated with average SpO2 in snoring patients. Finally, multiple linear regression analysis revealed that AHI, COPD, smoking, and maximum heart rate were independent predictors of monocyte count. Conclusion OSA patients had a significant increase in their peripheral blood monocyte count. AHI, COPD, smoking, and maximum heart rate were risk factors for increased peripheral blood monocyte count in OSA patients. These findings suggest that peripheral blood monocytes can be considered an inflammatory biomarker of OSA.
Collapse
Affiliation(s)
- Ying Jiang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Chuankai Lin
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Min Xu
- Medical and Nursing School, Wuhan Railway Vocational College of Technology, Wuhan, 430205, People's Republic of China
| | - Taiwen Zhu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Xuhong Li
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| |
Collapse
|
5
|
McNicholas WT. Does Obstructive Sleep Apnea Lead to Progression of Chronic Obstructive Pulmonary Disease. Sleep Med Clin 2024; 19:253-260. [PMID: 38692750 DOI: 10.1016/j.jsmc.2024.02.005] [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] [Indexed: 05/03/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have important bidirectional relationships that influence the pathophysiology of each disorder. The slim hyperinflated "pink puffer" phenotype of COPD protects against OSA, whereas the heavier "blue bloater" phenotype predisposes to OSA by fluid retention. OSA may aggravate COPD by promoting airway inflammation. COPD-OSA overlap patients have lower quality of life and are at higher risk of cardiovascular comorbidity than either disorder alone due to greater nocturnal oxygen desaturation and sympathetic activation. Management of OSA with positive airway pressure improves COPD outcomes that include lower exacerbation rates compared to untreated patients.
Collapse
Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland; School of Medicine and the Conway Research Institute, University College, Dublin, Ireland.
| |
Collapse
|
6
|
Marin-Oto M, Marin JM. Obstructive Sleep Apnea Effects on Chronic Airway Disease Exacerbations-Missed Opportunities for Improving Outcomes in Chronic Obstructive Pulmonary Disease and Asthma. Sleep Med Clin 2024; 19:275-282. [PMID: 38692752 DOI: 10.1016/j.jsmc.2024.02.007] [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] [Indexed: 05/03/2024]
Abstract
In patients with chronic obstructive pulmonary disease (COPD) and asthma, exacerbations determine the natural history of both diseases. Patients with both respiratory diseases who suffer from obstructive sleep apnea (OSA) as a comorbidity (overlap syndromes) have a higher risk of exacerbations and hospitalization. In cases of OSA/COPD and OSA/asthma, continuous positive airway pressure treatment is indicated. Adequate adherence to therapy appears to reduce exacerbations and their severity, especially in OSA/COPD overlap. However, there is a lack of randomized trials that definitively demonstrate this evidence.
Collapse
Affiliation(s)
- Marta Marin-Oto
- Respiratory Department, University of Zaragoza School of Medicine, Hospital Clínico Universitario, San Juan Bosco 15, Zaragoza 50009, Spain
| | - Jose M Marin
- Department of Medicine, University of Zaragoza School of Medicine, Hospital Universitario Miguel Servet, Domingo Miral, s/n, Zaragoza 50009, Spain.
| |
Collapse
|
7
|
De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med 2024; 20:863-870. [PMID: 38189375 PMCID: PMC11145048 DOI: 10.5664/jcsm.11000] [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: 09/22/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES This study examined in-hospital outcomes for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as COPD-OSA overlap syndrome, during hospitalizations for acute exacerbation of COPD. METHODS The National Inpatient Sample was used to examine in-hospital mortality, length of stay, costs, and utilization of supportive ventilation in patients with COPD-OSA overlap during acute exacerbation of COPD hospitalizations. A 1-to-1 matched case-control design was utilized to match patients with and without OSA. Multivariate logistic regression modeling was used to examine mortality and ventilatory support, while controlling for potentially confounding diagnoses. RESULTS COPD-OSA overlap was associated with longer median length of stay (4 days OSA, 3 days non-OSA; P < .001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P < .001), increased utilization of noninvasive positive-pressure ventilation (13.92% OSA, 6.78% non-OSA; P < .001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P = .001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P < .001). These differences in mortality (adjusted odds ratio: 0.650; 95% confidence interval: 0.624-0.678) and noninvasive positive-pressure ventilation usage (adjusted odds ratio: 1.998; 95% confidence interval: 1.970-2.026) remained when adjusted for confounders. CONCLUSIONS Patients with COPD-OSA overlap have higher utilization of supportive ventilation and longer length of stay during acute exacerbation of COPD hospitalizations, contributing to higher costs. The diagnosis of OSA is associated with reduced mortality in these hospitalizations, which may be related to greater utilization of supportive ventilation when OSA is recognized. CITATION De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med. 2024;20(6):863-870.
Collapse
Affiliation(s)
| | - Patricia Greenberg
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, New Brunswick, New Jersey
| | - Jag Sunderram
- Division of Pulmonary and Critical Care, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
8
|
van Zeller M, McNicholas WT. Sleep disordered breathing: OSA-COPD overlap. Expert Rev Respir Med 2024; 18:369-379. [PMID: 38932721 DOI: 10.1080/17476348.2024.2373790] [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: 12/06/2023] [Accepted: 06/25/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Sleep has important effects on breathing and gas exchange that may have negative consequences in patients with chronic obstructive pulmonary disease (COPD). COPD and obstructive sleep apnea (OSA) are highly prevalent and may coexist, which is referred to as the overlap syndrome. AREAS COVERED The probability of OSA-COPD overlap represents the balance of protective and promoting factors such as hyperinflation and fluid retention; thus, different clinical COPD phenotypes influence the likelihood of comorbid OSA. The clinical presentation of OSA-COPD overlap is nonspecific, and the diagnosis requires clinical awareness to identify patients needing overnight studies. Both COPD and OSA are associated with a range of overlapping physiological and biological disturbances including hypoxia and inflammation that contribute to cardiovascular comorbidities. The management of OSA-COPD overlap patients differs from those with COPD alone and the survival of overlap patients treated with positive airway pressure (PAP) is superior to those untreated. EXPERT OPINION The recognition of OSA-COPD overlap has important clinical relevance because of its impact on outcomes and management. Management of the overlap should address both sleep quality and disordered gas exchange. PAP therapy has demonstrated reductions in COPD exacerbations, hospitalizations, healthcare costs and mortality in overlap patients.
Collapse
Affiliation(s)
- Mafalda van Zeller
- Respiratory Department and Sleep and Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Walter T McNicholas
- School of Medicine and The Conway Research Institute, University College Dublin, Dublin, Ireland
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| |
Collapse
|
9
|
Akyol Gurses A, Akyildiz UO. Predictive value of red cell distribution width for overlap syndrome in obstructive sleep apnea. Front Neurol 2024; 15:1415410. [PMID: 38846032 PMCID: PMC11153708 DOI: 10.3389/fneur.2024.1415410] [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: 04/10/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are prevalent disorders, and the concurrence so-called overlap syndrome (OVS) is not rare either. Early recognition of OVS is essential because this group is more prone to cardiovascular morbidities and requires effective multidisciplinary follow-up. This study aimed to evaluate RDW in patients with severe OSAS and investigate whether it can predict OVS. Patients and methods 96 patients were retrospectively analyzed, of whom 66 were found to have severe OSAS alone and 30 OVS during diagnostic workups. Demographic, polysomnographic, and laboratory results, including RDW, were compared between groups. Multivariate logistic regression was used to determine independent associates of OVS. Results Gender and body mass index (BMI) were similar, however, the mean age and RDW were higher in the OVS group (p:0.008, p:0.002). The increase in RDW remained significant after adjustment for age, BMI, and cardiovascular risk factors. An RDW value of >13.65% was shown to have a 78.3% sensitivity and 60% specificity for predicting OVS in severe OSAS (p:0.004). Conclusion The results suggest that RDW can be a reliable indicator for diagnosing OVS in OSAS. It can help in identifying the subset of patients who would benefit from proper consultations and multidisciplinary follow-up, leading to appropriate treatment of each disease component and effective monitoring to prevent adverse cardiovascular outcomes.
Collapse
Affiliation(s)
- Asli Akyol Gurses
- Division of Clinical Neurophysiology, Department of Neurology, School of Medicine, Gazi University, Ankara, Türkiye
- Neuroscience and Neurotechnology Center of Excellence (NÖROM), Gazi University, Ankara, Türkiye
| | - Utku Ogan Akyildiz
- Department of Neurology, School of Medicine, Adnan Menderes University, Aydin, Türkiye
| |
Collapse
|
10
|
Pan Z, Liao S, Sun W, Zhou H, Lin S, Chen D, Jiang S, Long H, Fan J, Deng F, Zhang W, Chen B, Wang J, Huang Y, Li J, Chen Y. Screening and early warning system for chronic obstructive pulmonary disease with obstructive sleep apnoea based on the medical Internet of Things in three levels of healthcare: protocol for a prospective, multicentre, observational cohort study. BMJ Open 2024; 14:e075257. [PMID: 38418236 PMCID: PMC10910414 DOI: 10.1136/bmjopen-2023-075257] [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: 05/02/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent respiratory diseases in China and impose significant burdens on the healthcare system. Moreover, the co-occurrence of COPD and OSA exacerbates clinical outcomes significantly. However, comprehensive epidemiological investigations in China remain scarce, and the defining characteristics of the population affected by COPD and OSA, alongside their intrinsic relationship, remain ambiguous. METHODS AND ANALYSIS We present a protocol for a prospective, multicentre, observational cohort study based on a digital health management platform across three different healthcare tiers in five sites among Chinese patients with COPD. The study aims to establish predicative models to identify OSA among patients with COPD and to predict the prognosis of overlap syndrome (OS) and acute exacerbations of COPD through the Internet of Things (IoT). Moreover, it aims to evaluate the feasibility, effectiveness and cost-effectiveness of IoT in managing chronic diseases within clinical settings. Participants will undergo baseline assessment, physical examination and nocturnal oxygen saturation measuring. Specific questionnaires screening for OSA will also be administered. Diagnostic lung function tests and polysomnography will be performed to confirm COPD and OSA, respectively. All patients will undergo scheduled follow-ups for 12 months to record the changes in symptoms, lung functions and quality of life. Primary outcomes include the prevalence and characteristics of OS, while secondary outcomes encompass OS prognosis and the feasibility of the management model in clinical contexts. A total of 682 patients with COPD will be recruited over 12-24 months. ETHICS AND DISSEMINATION The study has been approved by Peking University Third Hospital, and all study participants will provide written informed consent. Study results will be published in an appropriate journal and presented at national and international conferences, as well as relevant social media and various stakeholder engagement activities. TRIAL REGISTRATION NUMBER NCT04833725.
Collapse
Affiliation(s)
- Zihan Pan
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
- General Practice Medicine, Peking University First Hospital, Beijing, China
| | - Sha Liao
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Wanlu Sun
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Beijing, China
| | - Haoyi Zhou
- School of Software, Beihang University, Beijing, China
| | - Shuo Lin
- Air Liquide Healthcare (Beijing), Beijing, China
| | - Dian Chen
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Simin Jiang
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Huanyu Long
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Jing Fan
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Wenlou Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Baiqi Chen
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Junyi Wang
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Yongwei Huang
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
- Sleep Monitoring Center, Peking University Third Hospital, Beijing, China
| | - Jianxin Li
- School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Yahong Chen
- Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| |
Collapse
|
11
|
Shen H, Xu Y, Zhang Y, Ren L, Chen R. Correlation Between Diaphragmatic Excursion and Exercise Tolerance Improvement Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease-Obstructive Sleep Apnea Overlap Syndrome. Int J Chron Obstruct Pulmon Dis 2024; 19:63-75. [PMID: 38222322 PMCID: PMC10787556 DOI: 10.2147/copd.s437698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose We assess the predictive value of diaphragm excursion (DE) in enhancing exercise tolerance following pulmonary rehabilitation (PR) among patients with COPD-OSA overlap syndrome. Material and Methods This prospective cohort study enrolled 63 patients diagnosed with COPD-OSA overlap syndrome who actively participated in a PR program from January 2021 to May 2023. Among these, 58 patients successfully completed the 20-week PR program, with exercise tolerance assessed through the measurement of six-minute walk distance (6MWD), and DE evaluated by ultrasonography. The responder to PR in terms of exercise ability was defined as a patient who showed an increase of >30m in 6MWD. The cutoff value for predicting PR response based on DE was determined using receiver operating characteristic (ROC) curves. Results Following the PR program, significant improvements were observed in mMRC, 6MWD, DE during deep breathing, and diaphragm thickness fraction (DTF). Of the participants, 33 patients (57%) were classified as responders, while 25 patients (43%) were considered non-responders. Baseline values of FEV1% predicted, 6MWD, DE during deep breathing, DTF, and PaO2 exhibited a significant elevation in responders as compared to non-responders. The changes of 6MWD were positively associated with the baseline values of DTF and DE during deep breathing, FEV1% predicted and PaO2, while negatively correlated with baseline value of mMRC. The predictive performance in terms of the area under the ROC curve for determining responder's DTF was found to be 0.769, accompanied by a sensitivity of 85% and specificity of 68%, using a cutoff value at 17.26%. Moreover, it was observed that DE during deep breathing could predict the area under the ROC curve for responders to be 0.753, with a sensitivity of 91% and specificity of 56% at a cutoff value of 3.61cm. Conclusion Diaphragm excursion serves as a valuable predictor for determining the enhancement of exercise tolerance following PR in patients with COPD-OSA overlap syndrome. Trial Registration ChiCTR1800020257, www.chictr.org.cn/index.aspx.
Collapse
Affiliation(s)
- Honghua Shen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yiming Xu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Yin Zhang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Lei Ren
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, 200040, People’s Republic of China
| | - Rui Chen
- Department of Respiratory Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
| |
Collapse
|
12
|
Jen R, Ellis C, Kaminska M, Road J, Ayas N. Noninvasive Home Mechanical Ventilation for Stable Hypercapnic COPD: A Clinical Respiratory Review from Canadian Perspectives. Can Respir J 2023; 2023:8691539. [PMID: 37822670 PMCID: PMC10564575 DOI: 10.1155/2023/8691539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023] Open
Abstract
Acute short-term noninvasive ventilation (NIV) for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) has well-established benefits; however, the role of long-term home NIV remains controversial. In the past decade, studies utilizing aggressive NIV settings to maximally reduce carbon dioxide levels (PaCO2) have resulted in several positive clinical trials and led to updated guidelines on home NIV for stable hypercapnic COPD patients. This clinical respiratory review discusses the high-intensity NIV approach, summarizes recent key trials and guidelines pertaining to home NIV in COPD, and considers key clinical questions for future research and application in the Canadian context. With recent evidence and Canadian Thoracic Society (CTS) guidelines supporting the use of NIV in carefully selected COPD patients with persistent daytime hypercapnia, we believe it is time to reconsider our approach.
Collapse
Affiliation(s)
- Rachel Jen
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
| | - Colin Ellis
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Marta Kaminska
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jeremy Road
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
| | - Najib Ayas
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
13
|
Howarth T, Ben Saad H, Heraganahally SS. The Impact of Lung Function Parameters on Sleep Among Aboriginal Australians - A Polysomnography and Spirometry Relationship Study. Nat Sci Sleep 2023; 15:449-464. [PMID: 37323655 PMCID: PMC10263013 DOI: 10.2147/nss.s409883] [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: 03/01/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Background Sleep disorders such as obstructive sleep apnoea (OSA) are known to overlap significantly with airway diseases in various populations. This study assessed the relationship between lung function parameters against polysomnography (PSG) and continuous positive airway pressure (CPAP) adherence data amongst an Aboriginal Australian population. Methods Patients who undertook both a diagnostic PSG and spirometry were included. Restrictive, obstructive, and mixed impairments were assessed via global lung function initiative (GLI-2012, ATS/ERS) criteria/guidelines. PSG and CPAP data were evaluated between patients with or without spirometry impairments. Results Of the total 771 patients, 248 had PSG and spirometry data available (52% female, 44% remote residents, 78% obese). The majority (89%) had OSA (51% severe), 95 (38%) were observed to have a restrictive impairment, and 31 (13%) had an obstructive or mixed impairment on spirometry. Compared to patients with no spirometric impairment, those with restrictive or obstructive/mixed impairments demonstrated significantly lower sleep efficiency (median 84% vs 79% and 78%), higher apnoea-hypopnea index (AHI) during rapid eye movement (REM) sleep (median 32 vs 52 and 55 events/hour), reduced REM oxygen saturation (SpO2) (median 94.0% vs 92.0% and 92.5%) and reduced adherence to CPAP therapy (median 39% vs 22% and 17%). Differences in sleep efficiency, REM AHI, and NREM SpO2 held for patients with obstructive/mixed impairments in multivariate modelling. Conclusion Aboriginal Australian patients with OSA have a higher concurrent lung function' impairment. Spirometric impairment appears to negatively influence sleep efficiency, nocturnal SpO2 and CPAP adherence. This may have substantial implications for OSA management among Aboriginal Australians.
Collapse
Affiliation(s)
- Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Helmi Ben Saad
- Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de recherche “Insuffisance Cardiaque” (LR12SP09), Université de Sousse, Sousse, Tunisia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
14
|
Fang Y, Su J, Zhang B, Zhao C, Ji L, Liang F, Wang Z, Hao J, Meng Y, Wei B, Huang Y, Dai L, Ouyang S. Autoantibodies of inflammatory cytokines as serum biomarkers in OSA patients. Clin Chim Acta 2023:117399. [PMID: 37217113 DOI: 10.1016/j.cca.2023.117399] [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: 11/16/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
As many as 90% of patients with obstructive sleep apnea (OSA) may be undiagnosed. It is necessary to explore the potential value of autoantibodies against CRP, IL-6, IL-8 and TNF-α in the diagnosis of OSA. ELISA was performed to detect the level of autoantibodies against CRP, IL-6, IL-8 and TNF-α in sera from 264 OSA patients and 231 normal controls (NCs). The expression level of autoantibodies against CRP, IL-6 and IL-8 in OSA were significantly higher than that in NC while the level of anti-TNF-α was lower in OSA than that in NC. The per SD increment of anti-CRP, anti-IL-6 and anti-IL-8 autoantibodies were significantly associated with a 430%, 100% and 31% higher risk for OSA, respectively. The AUC of anti-CRP was 0.808 (95% CI: 0.771-0.845) when comparing OSA with NC, while the AUC increased to 0.876 (95% CI: 0.846-0.906) combining four autoantibodies. For discrimination of severe OSA versus NC and non-severe OSA versus NC, the AUC for four autoantibodies combination was 0.885 (95% CI: 0.851-0.918) and 0.876 (95% CI: 0.842-0.913). This study revealed the association between autoantibodies against inflammatory factors and OSA, and the combination of autoantibodies against CRP, IL-6, IL-8 and TNF-α may function as novel biomarker for monitoring the presence of OSA.
Collapse
Affiliation(s)
- Yifei Fang
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jiao Su
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Binglu Zhang
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Chunling Zhao
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Longtao Ji
- Henan Institute of Medical and Pharmaceutical Sciences & Henan Key Medical Laboratory of Tumor Molecular Biomarkers, Zhengzhou University, Zhengzhou 450052, Henan, China; BGI College, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Feifei Liang
- Henan Institute of Medical and Pharmaceutical Sciences & Henan Key Medical Laboratory of Tumor Molecular Biomarkers, Zhengzhou University, Zhengzhou 450052, Henan, China; BGI College, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Zhi Wang
- Henan Institute of Medical and Pharmaceutical Sciences & Henan Key Medical Laboratory of Tumor Molecular Biomarkers, Zhengzhou University, Zhengzhou 450052, Henan, China; BGI College, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jimin Hao
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yang Meng
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Beilei Wei
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yuyang Huang
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Liping Dai
- Henan Institute of Medical and Pharmaceutical Sciences & Henan Key Medical Laboratory of Tumor Molecular Biomarkers, Zhengzhou University, Zhengzhou 450052, Henan, China; BGI College, Zhengzhou University, Zhengzhou 450052, Henan, China.
| | - Songyun Ouyang
- Department of Respiratory and Sleep Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China.
| |
Collapse
|
15
|
Zhang C, Wei S, Wang Y, Yu K, Jin Z, Zhang M, Ma X, Zhang C, Zhang Q, Sun K, Zhou P, Zhong Y, Ma J, Liao J, Wang G. Association between preserved ratio impaired spirometry and sleep apnea in a Chinese community. Curr Med Res Opin 2023; 39:621-626. [PMID: 36847254 DOI: 10.1080/03007995.2023.2182531] [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] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study investigated the association between obstructive sleep apnea (OSA) and preserved ratio impaired spirometry (PRISm) in a community population. METHODS Baseline data from a prospective cohort study, the Predictive Value of Combining Inflammatory Biomarkers and Rapid Decline of FEV1 for COPD (PIFCOPD), were used for cross-sectional analysis. Participants aged 40-75 years were recruited from the community and their demographic information and medical history were collected. The STOP-Bang questionnaire (SBQ) was used to assess the risk of OSA. Pulmonary function tests were performed using a portable spirometer (COPD-6) and forced expiratory volume in 1 s (FEV1) and 6 s (FEV6) were measured. Routine blood, biochemical, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 tests were also performed. The pH of the exhaled breath condensate was determined. RESULTS A total of 1183 participants were enrolled, of which 221 with PRISm and 962 with normal lung function. The neck circumference, waist-to-hip ratio, hs-CRP concentration, proportion of males, cigarette exposure, number of current smoker, high risk of OSA, and prevalence of nasal and ocular allergy symptoms were significantly higher in the PRISm group than in the non-PRISm group (p < .05). Logistic regression showed that the risk of OSA (odds ratio, 1.883; 95% confidence interval, 1.245-2.848), waist-to-hip ratio, current smoking, and prevalence of nasal allergy symptoms were independently associated with PRISm after correcting for age and sex. CONCLUSION These findings showed that OSA prevalence is independently associated with PRISm prevalence. Further studies should confirm the relationship between systemic inflammation in OSA, localized inflammation of the airways, and impaired lung function.
Collapse
Affiliation(s)
- Cheng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shanshan Wei
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yunxia Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyao Yu
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Jin
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Meng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyu Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Chunbo Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Qi Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyan Sun
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Peining Zhou
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yijue Zhong
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jiping Liao
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| |
Collapse
|
16
|
Kaya İ, Pekcan S, Dursunoğlu N, Şenol H. Determination and Comparison of Sleep Quality and Sleep Disorders in Patients with COPD According to GOLD Groups. JOURNAL OF TURKISH SLEEP MEDICINE 2023. [DOI: 10.4274/jtsm.galenos.2022.28190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
|
17
|
Ryabova MA, Malkova ME, Faizova AR, Volchkov EA. [Long-term stenting as an option to ensure the stability of the respiratory tract in a patient with rhonchopathy and overlap syndrome]. Vestn Otorinolaringol 2023; 88:100-106. [PMID: 38153901 DOI: 10.17116/otorino202388061100] [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] [Indexed: 12/30/2023]
Abstract
Rhonchopathy is a major problem of both a medical and social nature, it is detected in about 33% of the adult population. It should be noted that snoring is often accompanied by a more formidable disease - obstructive sleep apnea (OSA) syndrome, which, in turn, is considered a life-threatening condition. It is known that in severe forms of OSA syndrome, up to 400-500 respiratory stops per night with a total duration of up to 3-4 hours can occur, which leads to acute and chronic lack of oxygen during sleep. In turn, chronic obstructive pulmonary disease (COPD) is one of the most common diseases and one of the leading causes of death worldwide. The association of OSA syndrome and COPD, which is designated by the term overlap syndrome, is characterized by the summation of the negative effect of these pathological conditions on the parameters of blood oxygen saturation during night sleep. Diagnosis, treatment and prognosis in patients with overlap syndrome should be based on an interdisciplinary approach, including the use of modern and highly informative methods of functional diagnosis. To date, many methods of treatment (conservative, surgical, combined) of rhonchopathy and OSA syndrome are known. In most cases, preference is given to minimally invasive methods, creating constant positive pressure in the respiratory tract. Tracheostomy is an absolutely effective method of treating OSA syndrome, however, it is very traumatic, but in exceptional cases it is necessary. This paper describes a clinical case of installing a T-shaped stent not only for the treatment of chronic cicatricial stenosis, but also to compensate for OSA syndrome and restore vocal function.
Collapse
Affiliation(s)
- M A Ryabova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - M E Malkova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - A R Faizova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - E A Volchkov
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| |
Collapse
|
18
|
Mikkelsen ACD, Thomsen KL, Mookerjee RP, Hadjihambi A. The role of brain inflammation and abnormal brain oxygen homeostasis in the development of hepatic encephalopathy. Metab Brain Dis 2022; 38:1707-1716. [PMID: 36326976 DOI: 10.1007/s11011-022-01105-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Hepatic encephalopathy (HE) is a frequent complication of chronic liver disease (CLD) and has a complex pathogenesis. Several preclinical and clinical studies have reported the presence of both peripheral and brain inflammation in CLD and their potential impact in the development of HE. Altered brain vascular density and tone, as well as compromised cerebral and systemic blood flow contributing to the development of brain hypoxia, have also been reported in animal models of HE, while a decrease in cerebral metabolic rate of oxygen and cerebral blood flow has consistently been observed in patients with HE. Whilst significant strides in our understanding have been made over the years, evaluating all these mechanistic elements in vivo and showing causal association with development of HE, have been limited through the practical constraints of experimentation. Nonetheless, improvements in non-invasive assessments of different neurophysiological parameters, coupled with techniques to assess changes in inflammatory and metabolic pathways, will help provide more granular insights on these mechanisms. In this special issue we discuss some of the emerging evidence supporting the hypothesis that brain inflammation and abnormal oxygen homeostasis occur interdependently during CLD and comprise important contributors to the development of HE. This review aims at furnishing evidence for further research in brain inflammation and oxygen homeostasis as additional therapeutic targets and potentially diagnostic markers for HE.
Collapse
Affiliation(s)
| | - Karen Louise Thomsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- UCL Institute of Liver and Digestive Health, University College London, London, UK
| | - Rajeshwar Prosad Mookerjee
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- UCL Institute of Liver and Digestive Health, University College London, London, UK
| | - Anna Hadjihambi
- The Roger Williams Institute of Hepatology London, Foundation for Liver Research, London, SE5 9NT, UK.
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
| |
Collapse
|
19
|
O'Neill E, Ryan S, McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnoea overlap: co-existence, co-morbidity, or causality? Curr Opin Pulm Med 2022; 28:543-551. [PMID: 36124997 DOI: 10.1097/mcp.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The chronic obstructive pulmonary disease and obstructive sleep apnoea overlap syndrome is associated with higher morbidity and mortality rates than either disease alone. There is evidence of a bidirectional relationship between the two conditions, with the overlap syndrome encompassing a spectrum of clinical phenotypes. RECENT FINDINGS This review examines the evidence for the various factors that determine the overlap syndrome, the impact overlap syndrome has on co-morbidities, and implications for diagnosis and treatment. SUMMARY The accurate diagnosis of the overlap syndrome is critical given its implications for treatment optimisation and reduction in healthcare utilisation and costs.
Collapse
Affiliation(s)
- Emily O'Neill
- School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | | | | |
Collapse
|
20
|
Archontogeorgis K, Voulgaris A, Nena E, Zissimopoulos A, Bouloukaki I, Schiza SE, Steiropoulos P. Vitamin D Levels in Patients with Overlap Syndrome, Is It Associated with Disease Severity? J Pers Med 2022; 12:jpm12101693. [PMID: 36294836 PMCID: PMC9605178 DOI: 10.3390/jpm12101693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) has been defined as overlap syndrome (OVS). Recently, a link between OSA, COPD and Vitamin D (Vit D) serum concentration was reported, however, evidence regarding Vit D status in patients with OVS is scarce. The aim of the present study was to evaluate Vit D serum levels and to explore the association of those levels with anthropometric, pulmonary function and sleep parameters in patients with OVS. Methods: Vit D serum levels were measured in patients diagnosed with OVS, as confirmed by overnight polysomnography and pulmonary function testing. Results: A total of 90 patients (79 males and 11 females) were included in the analysis. The patients were divided into three groups matched for age, gender, and BMI: the control group that included 30 patients (27 males and 3 females), the OSA group that included 30 patients (26 males and 4 females), and the OVS group that included 30 patients (26 males and 4 females). Patients with OVS exhibited decreased serum 25(OH)D levels compared with OSA patients and controls (14.5 vs. 18.6 vs. 21.6 ng/mL, p < 0.001). In the OVS group, multiple linear regression analysis identified AHI and FEV1, as predictors of serum 25(OH)D levels (p = 0.041 and p = 0.038, respectively). Conclusions: Lower Vit D levels have been observed in patients with OVS compared with OSA patients and non-apneic controls, indicating an increased risk of hypovitaminosis D in this population which might be associated with disease severity.
Collapse
Affiliation(s)
- Kostas Archontogeorgis
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Athanasios Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Athanasios Zissimopoulos
- Laboratory of Nuclear Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Paschalis Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-551352096
| |
Collapse
|
21
|
Ioachimescu OC, McNicholas WT. Chronic Obstructive Pulmonary Disease-Obstructive Sleep Apnea Overlap: More Than a Casual Acquaintance. Am J Respir Crit Care Med 2022; 206:139-141. [PMID: 35549667 PMCID: PMC9887423 DOI: 10.1164/rccm.202204-0695ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Octavian C. Ioachimescu
- Sleep Medicine SectionAtlanta Veteran Affairs Health Care SystemDecatur, Georgia,Department of MedicineEmory UniversityAtlanta, Georgia
| | - Walter T. McNicholas
- School of MedicineUniversity College DublinDublin, Ireland,Department of Respiratory and Sleep MedicineSt. Vincent’s Hospital GroupDublin, Ireland
| |
Collapse
|
22
|
Ludwig K, Huppertz T, Radsak M, Gouveris H. Cellular Immune Dysfunction in Obstructive Sleep Apnea. Front Surg 2022; 9:890377. [PMID: 35874140 PMCID: PMC9299259 DOI: 10.3389/fsurg.2022.890377] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Repetitive pauses in breathing during sleep cause a brief but recurrent decrease in oxygen saturation in organs and tissues (chronic intermittent tissue hypoxia). Many studies have proven a pro-inflammatory status in OSA patients. However, few reports are available on the effects of OSA on the cellular immune system, mostly focusing on single immune cell types and their subtypes. The aim of this Mini-Review is to summarize these reports, as OSA is associated with a high prevalence and comorbidities such as atherosclerosis, which are known to involve the cellular immune system.
Collapse
Affiliation(s)
- Katharina Ludwig
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tilman Huppertz
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Markus Radsak
- IIIrd Department of Medicine, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Haralampos Gouveris
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
- Correspondence: Haralampos Gouveris
| |
Collapse
|
23
|
Abstract
This review presents the normal physiologic changes in ventilation during sleep and how they can be detrimental to chronic obstructive pulmonary disease (COPD). Sleep-related breathing disorders (SRBDs) in COPD lead to higher morbidity and mortality if left unrecognized and untreated. The diagnosis of SRBDs requires a high index of suspicion, as symptoms may overlap with other sleep disorders. Mortality risk is improved when patients with COPD with OSA (overlap syndrome) are treated with positive airway pressure and when long-term nocturnal noninvasive ventilation is started on chronic stable hypercapnic COPD. Treatment of isolated nocturnal oxygen desaturation has not been associated with improved survival.
Collapse
|
24
|
KELEŞ AO, ŞAHİN DUYAR S, AKSU F, FIRAT S. The relationship of obstructive sleep apnea risk with the disease severity and clinical parameters in COPD population. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.992192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
25
|
Zhang P, Chen B, Lou H, Zhu Y, Chen P, Dong Z, Zhu X, Li T, Lou P. Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in China. BMC Pulm Med 2022; 22:16. [PMID: 34983482 PMCID: PMC8725359 DOI: 10.1186/s12890-021-01780-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND "Overlap syndrome" refers to obstructive sleep apnea (OSA) combined with chronic obstructive pulmonary disease (COPD), and has poorer outcomes than either condition alone. We aimed to evaluate the prevalence and possible predictors of overlap syndrome and its association with clinical outcomes in patients with COPD. METHODS We assessed the modified Medical Research Council dyspnea scale (mMRC), Epworth sleepiness scale (ESS), COPD assessment test (CAT), Hospital Anxiety and Depression Scale (HADS), Charlson Comorbidity Index (CCI), and STOP-Bang questionnaire (SBQ) and performed spirometry and full overnight polysomnography in all patients. An apnea-hypopnea index (AHI) ≥ 5 events per hour was considered to indicate OSA. Risk factors for OSA in COPD patients were identified by univariate and multivariate logistic regression analyses. RESULTS A total of 556 patients (66%) had an AHI ≥ 5 events per hour. There were no significant differences in age, sex ratio, mMRC score, smoking index, number of acute exacerbations and hospitalizations in the last year, and prevalence of cor pulmonale between the two groups (all p > 0.05). Body mass index (BMI), neck circumference, CAT score, CCI, ESS, HADS, and SBQ scores, forced expiratory volume (FEV)1, FEV1% pred, FEV1/forced vital capacity ratio, and prevalence of hypertension, coronary heart disease, and diabetes were all significantly higher and the prevalence of severe COPD was significantly lower in the COPD-OSA group compared with the COPD group (p < 0.05). BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in COPD patients (p < 0.05). SBQ could be used for OSA screening in patients with COPD. Patients with severe COPD had a lower risk of OSA compared with patients with mild or moderate COPD (β = - 0.459, odds ratio = 0.632, 95% confidence interval 0.401-0.997, p = 0.048). CONCLUSION Patients with overlap syndrome had a poorer quality of life, more daytime sleepiness, and a higher prevalence of hypertension and diabetes than patients with COPD alone. BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in patients with COPD. The risk of OSA was lower in patients with severe, compared with mild or moderate COPD.
Collapse
Affiliation(s)
- Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Bi Chen
- Department of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Heqing Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Yanan Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Peipei Chen
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Zongmei Dong
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Xuan Zhu
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Ting Li
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases of Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, Jiangsu, China.
| |
Collapse
|
26
|
Liu W, Guo H, Ding F, Cui Z, Zhang J, Wang J, Yuan Y. Comparison of invasive intubation and noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and obstructive sleep apnoea syndrome. J Int Med Res 2021; 49:3000605211068312. [PMID: 34939869 PMCID: PMC8721719 DOI: 10.1177/03000605211068312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The concurrence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea syndrome (OSAS) is defined as overlap syndrome (OS), but investigations into predictors of OS in patients with COPD remain limited. Here, potential markers of OS in patients with COPD were investigated, and results of intubation were compared between patients with COPD only or OS. METHODS This retrospective study included patients with COPD who were divided according to OS diagnosis: COPD only (COPD group) or OS (OS group). RESULTS Among 206 patients with COPD, 120 were diagnosed with OS. Mean body mass index (BMI) was significantly higher in the OS versus COPD group (28.95 ± 2.96 versus 23.84 ± 4.06, respectively). Receiver operating characteristic curve analyses revealed that BMI was associated with OS (area under the curve, 0.835). The rate of invasive intubation within 48 h was lower in the OS versus COPD group (9.2% versus 20.9%, respectively), and the duration of noninvasive ventilation was longer in the OS versus COPD group. CONCLUSIONS BMI may be a predictor of OS in patients with COPD. The duration of noninvasive ventilation was longer in patients with OS than in patients with COPD alone.
Collapse
Affiliation(s)
- Wenjing Liu
- Second Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Hong Guo
- Department of Neurosurgery, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Fang Ding
- Department of Gerontology, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Zhaobo Cui
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Juxiang Zhang
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Yadong Yuan
- Second Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
27
|
Khurana S, Soda N, Shiddiky MJA, Nayak R, Bose S. Current and future strategies for diagnostic and management of obstructive sleep apnea. Expert Rev Mol Diagn 2021; 21:1287-1301. [PMID: 34747304 DOI: 10.1080/14737159.2021.2002686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a common sleep disorder with multiple comorbidities including hypertension, diabetes, and cardiovascular disorders. Detected based on an overnight sleep study is called polysomnography (PSG); OSA still remains undiagnosed in majority of the population mainly attributed to lack of awareness. To overcome the limitations posed by PSG such as patient discomfort and overnight hospitalization, newer technologies are being explored. In addition, challenges associated with current management of OSA using continuous positive airway pressure (CPAP), etc. presents several pitfalls. AREAS COVERED Conventional and modern detection/management techniques including PSG, CPAP, smart wearable/pillows, bio-motion sensors, etc., have both pros and cons. To fulfill the limitations in OSA diagnostics, there is an imperative need for new technology for screening of symptomatic and more importantly asymptomatic OSA patients to reduce the risk of several associated life-threatening comorbidities. In this line, molecular marker-based diagnostics have shown great promises. EXPERT OPINION A detailed overview is presented on the OSA management and diagnostic approaches and recent advances in the molecular screening methods. The potentials of biomarker-based detection and its limitations are also portrayed and a comparison between the standard, current modern approaches, and promising futuristic technologies for OSA diagnostics and management is set forth.ABBREVIATIONS AHI: Apnea hypopnea index; AI: artificial intelligence; CAM: Cell adhesion molecules; CPAP: Continuous Positive Airway Pressure; COVID-19: Coronavirus Disease 2019; CVD: Cardiovascular disease; ELISA: Enzyme linked immunosorbent assay; HSAT: Home sleep apnea testing; IR-UWB: Impulse radio-ultra wideband; MMA: maxillomandibular advancement; PSG: Polysomnography; OSA: Obstructive sleep apnea; SOD: Superoxide dismutase; QD: Quantum dot.
Collapse
Affiliation(s)
- Sartaj Khurana
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India.,Amity Institute of Molecular Medicine and Stem Cell Research, Amity University Uttar Pradesh, Noida, India
| | - Narshone Soda
- Queensland Micro- and Nanotechnology Centre (Qmnc) and School of Environment and Science (ESC), Griffith University, Brisbane, Australia
| | - Muhammad J A Shiddiky
- Queensland Micro- and Nanotechnology Centre (Qmnc) and School of Environment and Science (ESC), Griffith University, Brisbane, Australia
| | - Ranu Nayak
- Amity Institute of Nanotechnology, Amity University Uttar Pradesh, Noida, India
| | - Sudeep Bose
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India.,Amity Institute of Molecular Medicine and Stem Cell Research, Amity University Uttar Pradesh, Noida, India
| |
Collapse
|
28
|
Mohammad OI, Elgazzar AG, Mahfouz SM, Elnaggar ME. Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The conjunction of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome (OS). The coexistence of these diseases has cardiovascular morbidity and mortality. The aim of this study is to assess the prevalence of OSA in COPD patients. One hundred COPD patients (obese and non-obese) performed sleep questionnaires and polysomnograms.
Results
OSA prevalence in COPD was 50% and it increases with increasing disease severity (P < 0.001). The highest prevalence of OSA was found in obese patients with severe COPD; 90.5% of these patients have OSA. In the OSA group, obese patients were found to have significantly higher STOP-Bang Questionnaire (SBQ), Epworth Sleep Scale (ESS), modified medical research council (mMRC) dyspnea scale, apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI). Both obese and non-obese COPD patients showed significant positive correlations between AHI and smoking index (SI), SBQ, ESS, mMRC, ODI, and neck circumference (NC).
Conclusions
From this study, it can be concluded that moderate and severe COPD patients had a higher diagnosis of sleep-disordered breathing. Also, obese-COPD patients are more susceptible to develop OSA.
Trial registration
Name of the registry: Benha University Protocol Record Benha U123, Obstructive Sleep Apnea Prevalence in Patients With Chronic Obstructive Pulmonary Diseases. Trial registration number:
NCT04903639. Date of registry: 5/22/2021 (retrospective study).
Collapse
|
29
|
Hirayama A, Goto T, Faridi MK, Camargo CA, Hasegawa K. Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013. J Asthma 2021; 58:1176-1185. [PMID: 32521180 PMCID: PMC7762726 DOI: 10.1080/02770903.2020.1781887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation. METHODS We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18-54 years) hospitalized for asthma exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for asthma exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission. RESULTS Among 65,731 patients hospitalized for asthma exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54-1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases-asthma (IRR 1.21; 95%CI 1.15-1.27), COPD (IRR 2.03; 95%CI 1.88-2.19), respiratory failure (IRR 3.04; 95%CI 2.76-3.34), pneumonia (IRR 1.67; 95%CI 1.49-1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36-4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50-1.62). These associations remained significant after adjustment for confounders. CONCLUSIONS The observed association of OSA with a higher risk of readmissions after hospitalization for asthma exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and asthma management.
Collapse
Affiliation(s)
- Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
30
|
Tang M, Long Y, Liu S, Yue X, Shi T. Prevalence of Cardiovascular Events and Their Risk Factors in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome. Front Cardiovasc Med 2021; 8:694806. [PMID: 34336955 PMCID: PMC8318267 DOI: 10.3389/fcvm.2021.694806] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have been identified as independent risk factors for cardiovascular diseases. However, the impact of COPD and OSA overlap syndrome (OS) on cardiovascular outcomes remains to be elucidated. Objective: To determine the prevalence of cardiovascular events and their risk factors in OS patients. Methods: Seventy-four patients who had OS between January 2015 and July 2020 were retrospectively enrolled, and 222 COPD-only patients and 222 OSA-only patients were pair-matched for age and sex from the same period and served as the OS-free control group. The prevalence rates of coronary heart disease (CHD), arrhythmia, heart failure, and pulmonary arterial hypertension (PAH) were compared among the three groups, and multivariable logistic regression models were used to screen the risk factors for specific cardiovascular events. Results: OS patients had higher prevalence rates of heart failure (10.8 vs. 0.5 and 1.4%, respectively) and PAH (31.1 vs. 4.5 and 17.1%, respectively) than those with OSA alone or COPD alone (all P < 0.01). The CHD prevalence was also significantly higher in the OS group than in the COPD-alone group (25.7 vs. 11.7%, P < 0.01). There was no significant difference in the prevalence of arrhythmia among the three groups (20.3, 22.5, and 13.1%, respectively, P > 0.05). In OS patients, risk factors for CHD included hypertension, diabetes, body mass index, lactate dehydrogenase level, and tidal volume; risk factors for heart failure included diabetes, partial pressure of oxygen, partial pressure of carbon dioxide, maximum ventilatory volume, and neutrophilic granulocyte percentage; and risk factors for PAH included minimum nocturnal oxygen saturation, partial pressure of carbon dioxide, and brain natriuretic peptide and lactate dehydrogenase levels. Conclusions: OS patients have a higher prevalence of cardiovascular events, which is associated with hypoxemia, hypercapnia, and impaired lung function in these patients.
Collapse
Affiliation(s)
- Manyun Tang
- Arrhythmia Unit, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunxiang Long
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shihong Liu
- East Unit, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin Yue
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Tao Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
31
|
Total Sleep Time in the Taiwan Obstructive Lung Disease Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137080. [PMID: 34281018 PMCID: PMC8296961 DOI: 10.3390/ijerph18137080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have been reported to have poor sleep quality. However, total sleep time has not been evaluated in detail among patients with COPD. This retrospective, observational, multicenter research study was performed across six participating hospitals in Taiwan, with a total of 421 adult patients enrolled. Pulmonary function, the Modified British Medical Research Council Dyspnea Scale, the COPD Assessment Test and basic clinical data were assessed. The Pittsburgh Sleep Quality Index was also administered to patients, and the total sleep time was extracted for further analysis. The patients whose total sleep time was between 6 and 7 h had better pulmonary function, and the patients who slept less than 5 h had worse comorbidities. There was a significant higher total sleep time in Global Initiatives for Chronic Obstructive Lung Disease (GOLD) group B compared to GOLD group A. COPD patients who sleep between 5 and 6 h used fewer oral steroids and were less likely to use triple therapy (long-acting beta-agonist, long-acting muscarinic antagonist, inhaled cortical steroid). COPD patients sleeping from 5 to 7 h had better clinical features than those sleeping less than 5 h in terms of pulmonary function, comorbidities and medication usage.
Collapse
|
32
|
Pham K, Parikh K, Heinrich EC. Hypoxia and Inflammation: Insights From High-Altitude Physiology. Front Physiol 2021; 12:676782. [PMID: 34122145 PMCID: PMC8188852 DOI: 10.3389/fphys.2021.676782] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022] Open
Abstract
The key regulators of the transcriptional response to hypoxia and inflammation (hypoxia inducible factor, HIF, and nuclear factor-kappa B, NF-κB, respectively) are evolutionarily conserved and share significant crosstalk. Tissues often experience hypoxia and inflammation concurrently at the site of infection or injury due to fluid retention and immune cell recruitment that ultimately reduces the rate of oxygen delivery to tissues. Inflammation can induce activity of HIF-pathway genes, and hypoxia may modulate inflammatory signaling. While it is clear that these molecular pathways function in concert, the physiological consequences of hypoxia-induced inflammation and how hypoxia modulates inflammatory signaling and immune function are not well established. In this review, we summarize known mechanisms of HIF and NF-κB crosstalk and highlight the physiological consequences that can arise from maladaptive hypoxia-induced inflammation. Finally, we discuss what can be learned about adaptive regulation of inflammation under chronic hypoxia by examining adaptive and maladaptive inflammatory phenotypes observed in human populations at high altitude. We aim to provide insight into the time domains of hypoxia-induced inflammation and highlight the importance of hypoxia-induced inflammatory sensitization in immune function, pathologies, and environmental adaptation.
Collapse
Affiliation(s)
| | | | - Erica C. Heinrich
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, Riverside, CA, United States
| |
Collapse
|
33
|
Han X, Lee SSY, Ingold N, McArdle N, Khawaja AP, MacGregor S, Mackey DA. Associations of sleep apnoea with glaucoma and age-related macular degeneration: an analysis in the United Kingdom Biobank and the Canadian Longitudinal Study on Aging. BMC Med 2021; 19:104. [PMID: 33971878 PMCID: PMC8111909 DOI: 10.1186/s12916-021-01973-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep apnoea, a common sleep-disordered breathing condition, is characterised by upper airway collapse during sleep resulting in transient hypoxia, hypoperfusion of the optic nerve, and spike in intracranial pressure. Previous studies have reported conflicting findings on the association of sleep apnoea with glaucoma, and there are limited reports on the link between sleep apnoea and age-related macular degeneration (AMD). METHODS Middle-aged and older participants from the longitudinal United Kingdom (UK) Biobank (n = 502,505) and the Canadian Longitudinal Study on Aging (CLSA; n = 24,073) were included in this analysis. Participants in the UK Biobank and the CLSA were followed for 8 and 3 years, respectively. Participants with diagnosed glaucoma or AMD at baseline were excluded from the analysis. In the UK Biobank, sleep apnoea and incident cases of glaucoma and AMD were identified through hospital inpatient admission, primary care records, and self-reported data. Multivariable Cox proportional hazards models were used to explore associations of sleep apnoea with incidence of glaucoma or AMD. RESULTS During the 8-year follow-up in the UK Biobank, glaucoma incidence rates per 1000 person-years were 2.46 and 1.59 for participants with and without sleep apnoea, and the AMD incidence rates per 1000 person-years were 2.27 and 1.42 for participants with and without sleep apnoea, respectively. Multivariable adjusted hazard ratios of glaucoma and AMD risk for sleep apnoea were 1.33 (95% confidence interval [CI] 1.10-1.60, P = 0.003) and 1.39 (95% CI 1.15-1.68, P < 0.001) relative to participants without sleep apnoea. In the CLSA cohort, disease information was collected through in-person interview questionnaires. During the 3-year follow-up, glaucoma incidence rates per 1000 person-years for those with and without sleep apnoea were 9.31 and 6.97, and the AMD incidence rates per 1000 person-years were 8.44 and 6.67, respectively. In the CLSA, similar associations were identified, with glaucoma and AMD odds ratios of 1.43 (95% CI 1.13-1.79) and 1.39 (95% CI 1.08-1.77), respectively, in participants with sleep apnoea compared to those without sleep apnoea (both P < 0.001). CONCLUSIONS In two large-scale prospective cohort studies, sleep apnoea is associated with a higher risk of both glaucoma and AMD. These findings indicate that patients with sleep apnoea might benefit from regular ophthalmologic examinations.
Collapse
Affiliation(s)
- Xikun Han
- Statistical Genetics, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, Queensland, 4006, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia.
| | - Samantha Sze-Yee Lee
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Nathan Ingold
- Statistical Genetics, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, Queensland, 4006, Australia.,School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Anthony P Khawaja
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, Queensland, 4006, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Nedlands, Western Australia, Australia
| |
Collapse
|
34
|
Zhang C, Cheng Y, Liu F, Ma J, Wang G. A community study of the risk for obstructive sleep apnea and respiratory inflammation in an adult Chinese population. Postgrad Med 2021; 133:531-540. [PMID: 33851902 DOI: 10.1080/00325481.2021.1914466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: We aimed to investigate the relationship between obstructive sleep apnea (OSA) risk and respiratory inflammation evaluated by the exhaled breath condensate (EBC) interleukin-6 (IL-6) and plasma surfactant protein-D (SP-D), based on the Berlin questionnaire (BQ) screening values in an adult, urban community in Beijing, China.Methods: Volunteers aged >40 years were recruited from the Shichahai community of central Beijing (Registration number: NCT04832711). Their general information and disease history were recorded. OSA risk was assessed using the BQ. IL-6 in EBC and plasma SP-D were d etected by enzyme-linked immunoassay through specimens collected while fasting. The differences in IL-6 and SP-D values between high-risk and low-risk groups for OSA were compared, and the factors affecting their values were analyzed.Results: Among 1,239 participants, 18.8% of participants were in the high-risk group. There were more participants with higher body mass index, chronic hypertension, coronary heart disease, and diabetes in the high-risk group than in the low-risk group (P < 0.05). There were no significant differences in EBC IL-6 and plasma SP-D between the high- and low-OSA risk groups (p > 0.05). After adjustment for age, sex and chronic comorbidities, multivariate logistic regression showed that there was no correlation between risk of OSA and IL-6 in EBC. However, the risk of OSA (odds ratio [OR] [95% CI]: 1.69 [1.15,2.48]; β = 0.522) and BMI (OR [95%CI]: 0.94 [0.91,0.98]; β = -0.061) were independently associated with plasma SP-D level (p < 0.05 for both). Stratification analysis showed that OSA risk were independently associated with plasma SP-D levels in participants <65 years, or men, or participants with BMI<25.Conclusion: This study showed that plasma SP-D, an inflammation biomarker, was associated with risk of OSA and BMI in a Chinese central urban community.The relationship between the risk of OSA and respiratory inflammation in community populations needs to be further evaluated.
Collapse
Affiliation(s)
- Cheng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yuan Cheng
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Feng Liu
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| |
Collapse
|
35
|
Akinnusi M, El-Masri AR, Lawson Y, El-Solh AA. Association of overlap syndrome with incident atrial fibrillation. Intern Emerg Med 2021; 16:633-642. [PMID: 32803632 DOI: 10.1007/s11739-020-02469-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19-29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3-2.0], percentage of time spent with O2 saturation below 90% (CT90) (OR 3.72, 95% CI 1.18-11.71), and CPAP adherence (OR 0.32, 95% CI 0.13-0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03-2.37) and worse mortality rates (OR 1.92, 95% CI 1.04-3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.
Collapse
Affiliation(s)
- Morohunfolu Akinnusi
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Abdul Rahman El-Masri
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Ali Albert El-Solh
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
- Department of Medicine, Jacob's School of Medicine, Buffalo, NY, USA.
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
36
|
Wu G, Lee YY, Gulla EM, Potter A, Kitzmiller J, Ruben MD, Salomonis N, Whitsett JA, Francey LJ, Hogenesch JB, Smith DF. Short-term exposure to intermittent hypoxia leads to changes in gene expression seen in chronic pulmonary disease. eLife 2021; 10:63003. [PMID: 33599610 PMCID: PMC7909952 DOI: 10.7554/elife.63003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) results from episodes of airway collapse and intermittent hypoxia (IH) and is associated with a host of health complications. Although the lung is the first organ to sense changes in oxygen levels, little is known about the consequences of IH to the lung hypoxia-inducible factor-responsive pathways. We hypothesized that exposure to IH would lead to cell-specific up- and downregulation of diverse expression pathways. We identified changes in circadian and immune pathways in lungs from mice exposed to IH. Among all cell types, endothelial cells showed the most prominent transcriptional changes. Upregulated genes in myofibroblast cells were enriched for genes associated with pulmonary hypertension and included targets of several drugs currently used to treat chronic pulmonary diseases. A better understanding of the pathophysiologic mechanisms underlying diseases associated with OSA could improve our therapeutic approaches, directing therapies to the most relevant cells and molecular pathways.
Collapse
Affiliation(s)
- Gang Wu
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Yin Yeng Lee
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Evelyn M Gulla
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Andrew Potter
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Joseph Kitzmiller
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Marc D Ruben
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Nathan Salomonis
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, United States.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Jeffery A Whitsett
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Lauren J Francey
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - John B Hogenesch
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - David F Smith
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,The Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States
| |
Collapse
|
37
|
Boof ML, Dingemanse J, Brunke M, Esselmann A, Heymer P, Kestermann O, Lederer K, Fietze I, Ufer M. Effect of the novel dual orexin receptor antagonist daridorexant on night-time respiratory function and sleep in patients with moderate chronic obstructive pulmonary disease. J Sleep Res 2021; 30:e13248. [PMID: 33417730 DOI: 10.1111/jsr.13248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/29/2023]
Abstract
In patients with chronic obstructive pulmonary disease (COPD), sleep is often fragmented while, conversely, the use of sleep medications is of concern in these patients due to potential impairment of nocturnal breathing. This randomised, double-blind, placebo-controlled, two-period crossover study was conducted to evaluate the effect of the new dual orexin receptor antagonist daridorexant on night-time respiratory function and sleep in patients with moderate COPD. In each period, the highest Phase-III dose of 50 mg daridorexant or placebo was administered once daily in the evening for 5 consecutive days. The primary endpoint was peripheral oxygen saturation (SpO2 ) during total sleep time (TST) after last dosing. Night-time respiratory function and sleep were further evaluated based on the apnea-hypopnea index (AHI), sleep duration, and objective sleep parameters. Pharmacokinetics, safety, and tolerability were also assessed. Primary endpoint analysis revealed no significant mean treatment difference (i.e. daridorexant - placebo) for SpO2 during TST as it was 0.18% (90% confidence interval: -0.21 to 0.57). There was also no difference from placebo for SpO2 during non-rapid eye movement (REM) and REM sleep at Night 5 and after first dosing. The AHI was slightly increased compared to placebo, but not to a clinically meaningful extent. In addition, daridorexant improved objective sleep parameters (i.e. prolonged TST, increased sleep efficiency, and decreased wake after sleep onset), reached expected plasma concentrations, and was safe and well tolerated. In conclusion, single and multiple doses of 50 mg daridorexant do not impair night-time respiratory function and improves sleep in patients with moderate COPD.
Collapse
Affiliation(s)
- Marie-Laure Boof
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Jasper Dingemanse
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Mareile Brunke
- Klinische Forschung Hannover-Mitte GmbH, Hannover, Germany
| | | | - Peter Heymer
- Klinische Forschung Dresden GmbH, Dresden, Germany
| | | | | | | | - Mike Ufer
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| |
Collapse
|
38
|
Kerget B, Kerget F, Kahraman ÇY, Aksakal A, Araz Ö. The relationship between NLRP3 rs10159239 and Vaspin rs2236242 gene variants and obstructive sleep apnea. Ups J Med Sci 2021; 126:7603. [PMID: 34349888 PMCID: PMC8276347 DOI: 10.48101/ujms.v126.7603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In obstructive sleep apnea (OSA), recurrent upper airway obstruction and apnea/hypopnea episodes result in endothelial dysfunction, which leads to the release of many proinflammatory cytokines and reactive oxygen species (ROS). ROS induces NLRP3, a protein involved in the synthesis of interleukin (IL)-1 and IL-18; vaspin is a serine protease inhibitor that has an important role in suppressing the activation of NLRP3 inflammasome. In this study, we aimed to investigate the effect of NLRP3 rs10159239 (rs9239) and vaspin rs2236242 (rs6242) single nucleotide polymorphisms (SNPs) on OSA development. METHODS This study included 220 individuals who underwent polysomnography (118 patients with OSA and 102 healthy controls). NLRP3 rs9239 and vaspin rs6242 mutation frequencies were analyzed. RESULTS The NLRP3 rs9239 SNP genotype analysis revealed no statistically significant differences between the OSA and control groups. In the vaspin gene analysis, the rs6242 AA genotype was significantly more frequent in the OSA group compared with the control group, while the AT genotype was more frequent in controls (P = 0.004, P = 0.02). Comparison of rs6242 allele levels showed that the A allele was significantly more frequent in OSA patients than in controls (P = 0.03). The AA genotype was significantly more frequent in patients with severe OSA than in patients with mild or moderate OSA and the control group (P = 0.001 for all). Serum vaspin levels were significantly lower in carriers of the AA genotype than those with AT and TT genotypes (P = 0.001). CONCLUSION The vaspin rs6242 SNP AA genotype increased susceptibility to OSA, while the AT genotype appeared to be protective. The lower plasma vaspin levels in OSA compared with the control group and in patients with the AA genotype suggest that vaspin may be a protective biomarker for OSA.
Collapse
Affiliation(s)
- Buğra Kerget
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
- CONTACT Buğra Kerget
| | - Ferhan Kerget
- Department of Infection Diseases and Clinical Microbiology, Health Sciences University Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Çiğdem Yüce Kahraman
- Department of Medical Genetics, Ataturk University School of Medicine, Erzurum, Turkey
| | - Alperen Aksakal
- Department of Pulmonary Diseases, Health Sciences University Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Ömer Araz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
39
|
D'Cruz RF, Murphy PB, Kaltsakas G. Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes. J Thorac Dis 2020; 12:S202-S216. [PMID: 33214924 PMCID: PMC7642631 DOI: 10.21037/jtd-cus-2020-006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) causes load-capacity-drive imbalance in both wakefulness and sleep, principally driven by expiratory flow limitation and hyperinflation. Sleep imposes additional burdens to the respiratory muscle pump, driven by changes in respiratory muscle tone, neural respiratory drive and consequences of the supine position. COPD patients are therefore at higher risk of decompensation during sleep, which may manifest as altered sleep architecture, isolated nocturnal desaturation, sleep hypoventilation and restless legs. Each form of sleep disordered breathing in COPD is associated with adverse clinical and patient-reported outcomes, including increased risk of exacerbations, hospitalisation, cardiovascular events, reduced survival and poorer quality of life. COPD-obstructive sleep apnoea (OSA) overlap syndrome represents a distinct clinical diagnosis, in which clinical outcomes are significantly worse than in either disease alone, including increased mortality, risk of cardiovascular events, hospitalisation and exacerbation frequency. Sleep disordered breathing is under-recognised by COPD patients and their clinicians, however early diagnosis and management is crucial to reduce the risk of adverse clinical outcomes. In this narrative review, we describe the pathophysiology of COPD and physiological changes that occur during sleep, manifestations and diagnosis of sleep disordered breathing in COPD and associated clinical outcomes.
Collapse
Affiliation(s)
- Rebecca F D'Cruz
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
| |
Collapse
|
40
|
Metabolic Syndrome and Abnormal Peri-Organ or Intra-Organ Fat (APIFat) Deposition in Chronic Obstructive Pulmonary Disease: An Overview. Metabolites 2020; 10:metabo10110465. [PMID: 33203192 PMCID: PMC7696438 DOI: 10.3390/metabo10110465] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disorder with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Systemic inflammation is involved in the pathogenesis of COPD and can also predispose to metabolic disorders (e.g., metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD)). Such comorbidities can negatively affect COPD outcomes, cardiovascular risk, and quality of life. Apart from NAFLD, abnormal peri-organ or intra-organ fat (APIFat) could be considered as markers for cardiometabolic diseases and even for COPD. The present narrative review considers the associations of COPD with MetS, NAFLD, and other APIFat, including epicardial, perirenal, peripancreatic, and intramuscular adipose tissue. Further research is needed to define these relationships and identify any potential clinical implications.
Collapse
|
41
|
The systolic pulmonary artery pressure and the E/e' ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation. Braz J Otorhinolaryngol 2020; 87:497-504. [PMID: 33248927 PMCID: PMC9422701 DOI: 10.1016/j.bjorl.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/13/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. OBJECTIVE To investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. METHODS The prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. RESULTS Mean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e' ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e' ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). CONCLUSION The decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e's ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.
Collapse
|
42
|
Zhuang Y, Yan Y, Yang X, Cao J. Osteoporosis in a Rat Model Co-Exposed to Cigarette Smoke and Intermittent Hypoxia. Int J Chron Obstruct Pulmon Dis 2020; 15:2817-2825. [PMID: 33177819 PMCID: PMC7652222 DOI: 10.2147/copd.s276913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose There are few studies on osteoporosis in chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome, and the results obtained are inconsistent. The purpose of our study is to observe the occurrence of osteoporosis and its possible mechanism in rat model co-exposed to cigarette smoke and intermittent hypoxia. Materials and Methods The rats were randomly divided into four groups: air exposed group, cigarette smoke (CS) exposed group, 10% concentration of intermittent hypoxia exposed group, CS combined with 10% concentration of intermittent hypoxia exposed group. All animals completed lung function and lung tissue morphology assessment. The femurs were examined by microcomputer tomography (microCT). Tartrate-resistant acidic phosphatase (TRAP) staining was used to evaluate the osteoclasts. We also assessed the interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in peripheral blood. Results There was no difference in the femoral length between each group, but the quantitative analyses of microCT showed that compared with the air exposed group, the percent bone volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), cortical thickness (Ct.Th) and bone mineral density (BMD) decreased, and the trabecular separation (Tb.Sp) and the proportion of trap-positive cells increased significantly in the overlapping exposed group. There were higher levels of BV/TV in the overlapping group than CS exposed group. Compared with the intermittent hypoxia exposed group, there were lower levels of Tb.Th and Ct.Th and higher levels of Tb.Sp in the overlapping exposed group. However, there was no statistical difference of trap-positive cell between the overlapping exposed group and the CS exposed single group or the intermittent hypoxia exposed group. There were higher levels of IL-6 and TNF-α in the overlapping exposed group than those in the air-exposed group. Conclusion Bone destruction increased in the overlapping exposed rat model compared with the rat exposed to air, which may be related to the upregulation of inflammation.
Collapse
Affiliation(s)
- Yan Zhuang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yuxia Yan
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Xia Yang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jie Cao
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| |
Collapse
|
43
|
Hu W, Zhao Z, Wu B, Shi Z, Dong M, Xiong M, Jiang Y, Liu D, Li H, Hu K. Obstructive Sleep Apnea Increases the Prevalence of Hypertension in Patients with Chronic Obstructive Disease. COPD 2020; 17:523-532. [PMID: 32901534 DOI: 10.1080/15412555.2020.1815688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Whether there are increased rates of chronic diseases associated with the combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlap syndrome (OVS) has not been determined. The purpose of this study was to assess the prevalence of five comorbidities in COPD and OVS patients. A total of 968 patients with confirmed COPD were included in this study. Participants were requested to fill out a questionnaire involving their basic information and medical history. All subjects underwent one overnight polysomnography and were then divided into an OVS group or a COPD only group according to their apnea-hypopnea index. The prevalence of hypertension, diabetes, cardiovascular disease, arrhythmia and cerebrovascular disease were compared and risk factors for comorbidities in COPD patients were identified. Compared with the COPD only group, the prevalence of hypertension was significantly higher in the OVS group, however, the prevalence rates of the other four kinds of diseases were not statistically different between the two groups. In COPD patients, the prevalence of hypertension increased with the severity of OSA and the prevalence of arrhythmia increased with airflow limitation severity. Risk factors for OSA in patients with COPD included BMI, FEV1%, Epworth Sleepiness Scale score and the Sleep Apnea Clinical Score. OSA was an independent risk factor for hypertension. The other risk factors for hypertension in COPD patients included age, BMI, CAT score and alcohol consumption. Age, lower FEV1% may be risk factors for arrhythmia. OVS patients were associated with a high prevalence rate of hypertension, while OSA was an independent risk factor for hypertension.
Collapse
Affiliation(s)
- Weihua Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiling Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bin Wu
- Institute of Respiratory Diseases, Department of Respiratory, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhihong Shi
- Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xian, Shanxi, China
| | - Minglin Dong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Jiang
- Division of Respiratory Disease, the Fifth Hospital of Wuhan City, Wuhan, China
| | - Dan Liu
- Division of Respiratory Disease, the Fifth Hospital of Wuhan City, Wuhan, China
| | - Huimin Li
- Division of Respiratory Disease, the Fifth Hospital of Wuhan City, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
44
|
Xie J, Fan Z, Yisilamu P, Sun D, Wang J, Li F, Chahal CAA. Hypoxemia and pulmonary hypertension in patients with concomitant restrictive ventilatory defect and sleep apnea: the overlap syndrome. Sleep Breath 2020; 25:1173-1179. [PMID: 32804376 DOI: 10.1007/s11325-020-02164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To investigate the severity of hypoxemia and prevalence of pulmonary hypertension (PHTN) in patients with the overlap syndrome (OS) of restrictive ventilatory defect (RVD) and sleep apnea (SA). METHODS Patients referred for both sleep test and spirometry for suspected SA and ventilatory disorders were recruited prospectively from January 2019 to January 2020. SA was determined by an apnea-hypopnea index ≥ 5/h; average oxygen saturation during sleep (meanSaO2) and percentage of total sleep time with saturation < 90% (T90) were calculated. RVD was diagnosed in the presence of forced expiratory volume in the first second/forced vital capacity (FVC) > 0.7 and FVC < 80% predicted value. PHTN was defined by tricuspid regurgitation peak velocity ≥ 3.4 m/s, documented by noninvasive transthoracic echocardiography. RESULTS Patients with OS had significantly lower meanSaO2 but higher T90 than subjects with isolated SA and isolated RVD. Patients with OS vs. those with isolated SA had higher odds of PHTN in multivariable analysis with age, sex, and body mass index adjusted for (OR 2.96, 95%CI 1.05-8.91, p = 0.040). Patients with meanSaO2 < 92% vs. meanSaO2 ≥ 92% had significantly higher odds of being diagnosed with PHTN (OR 5.40, 95%CI 2.01-15.7, p < 0.001). Similarly, T90 (≥ 4.5% versus < 4.5%) was also independently associated with the prevalence of PHTN (OR 7.21, 95%CI 2.54-23.67, p < 0.001). CONCLUSION Patients with OS of RVD and SA had severe hypoxemia, which is associated with the prevalence of PHTN. Further investigation is needed to discern whether therapeutic strategies toward OS might mitigate PHTN in this cohort. TRIAL REGISTRATION Clinical Trial Registration No. ChiCTR1900027294 on 1 October 2019.
Collapse
Affiliation(s)
- Jiang Xie
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China.
| | - Zhengyang Fan
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China
| | - Patiguli Yisilamu
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China
| | - Dance Sun
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China
| | - Jingting Wang
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China
| | - Fei Li
- Department of Respiratory and Critical Medicine of Beijing An Zhen Hospital, Capital Medical University, 2# An Zhen Road, Beijing, 100023, China
| | - C Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
45
|
Shahrbaf MA, Akbarzadeh MA, Tabary M, Khaheshi I. Air Pollution and Cardiac Arrhythmias: A Comprehensive Review. Curr Probl Cardiol 2020; 46:100649. [PMID: 32839041 DOI: 10.1016/j.cpcardiol.2020.100649] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/26/2022]
Abstract
Air pollution is the mixture of some chemical and environmental agents including dust, fumes, gases, particulate matters, and biological materials which can be harmful for the environment and the human body. The increasing trend of the air pollution, especially in developing countries, may exert its detrimental effects on human health. The potentially harmful effects of air pollution on the human health have been recognized and many epidemiological studies have clearly suggested the strong association between air pollution exposure and increased morbidities and mortalities. Air pollutants are classified into gaseous pollutants including carbon mono oxide, nitrogen oxides, ozone and sulfur dioxide, and particulate matters (PMs). All air pollutants have destructive effects on the health systems including cardiovascular system. Many studies have demonstrated the effect of air pollutant on the occurrence of ST elevation myocardial infarction, sudden cardiac death, cardiac arrythmias, and peripheral arterial disease. Recently, some studies suggested that air pollution may be associated with cardiac arrhythmias. In this study, we aimed to comprehensively review the last evidences related to the association of air pollutant and cardiac arrythmias. We found that particulate matters (PM10, PM2.5, and UFP) and gaseous air pollutants can exert undesirable effects on cardiac rhythms. Short-term and long-term exposure to the air pollutants can interact with the cardiac rhythms through oxidative stress, autonomic dysfunction, coagulation dysfunction, and inflammation. It seems that particulate matters, especially PM2.5 have stronger association with cardiac arrhythmias among all air pollutants. However, future studies are needed to confirm these results.
Collapse
|
46
|
Archontogeorgis K, Voulgaris A, Papanas N, Nena E, Xanthoudaki M, Pataka A, Schiza S, Rizzo M, Froudarakis ME, Steiropoulos P. Metabolic Syndrome in Patients with Coexistent Obstructive Sleep Apnea Syndrome and Chronic Obstructive Pulmonary Disease (Overlap Syndrome). Metab Syndr Relat Disord 2020; 18:296-301. [PMID: 32379990 DOI: 10.1089/met.2019.0126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Evidence suggests that metabolic syndrome (MetS) is highly prevalent in patients with obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD). However, data on the prevalence of MetS in patients having both OSAS and COPD, or overlap syndrome (OS), are scarce. The aim of this study was to evaluate the prevalence and identify predictors of MetS in patients with OS. Methods: MetS was evaluated in consecutive patients who were diagnosed with OS by polysomnography and pulmonary function testing. Results: A total of 163 subjects (138 males and 25 females) were included. MetS was present in 38% of OS patients. Patients were divided into group A (OS without MetS group: 101 patients) and group B (OS with MetS group: 62 patients). Groups were similar in terms of pulmonary function and sleep parameters. In group B, abdominal obesity was the most prevalent component of MetS (100%), followed by hypertension (82.3%), hypertriglyceridemia (72.6%), and hyperglycemia (51.6%). Age (P = 0.009) and body mass index (P = 0.029) were independent predictors of MetS in patients with OS. Conclusions: An increased prevalence of MetS was observed in a group of patients with OS. Early identification and treatment of MetS may play a significant role in prevention of complications related to OS.
Collapse
Affiliation(s)
- Kostas Archontogeorgis
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Voulgaris
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, and Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Xanthoudaki
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties School of Medicine, University of Palermo, Palermo, Italy.,Division of Endocrinology, Diabetes and Metabolism, University of South Carolina, School of Medicine Columbia, Columbia, South Carolina, USA
| | - Marios E Froudarakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
47
|
Cardiovascular Outcomes and All-Cause Mortality in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease (Overlap Syndrome). Ann Am Thorac Soc 2020; 16:71-81. [PMID: 30372124 DOI: 10.1513/annalsats.201802-136oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The combined impact of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) on cardiovascular outcomes remains controversial. OBJECTIVES We determined whether the combined presence of COPD and severe OSA defined by the apnea-hypopnea index (AHI) or degree of nocturnal hypoxemia is associated with increased hazards of cardiovascular events and mortality. METHODS Prospectively collected data from adults with suspected OSA who underwent sleep study between 1994 and 2010 were linked to provincial administrative data to determine a presence of COPD and composite outcome. Exposures of interest were: 1) AHI greater than 30, and 2) 10 or more minutes of sleep time spent with oxygen saturation (SaO2) less than 90%. The primary outcome was a composite of hospitalization due to myocardial infarction, stroke, congestive heart failure, cardiac revascularization procedures, or death from any cause. Using Cox regression and controlling for confounders, hazards were compared between four groups: AHI greater than 30 with COPD, AHI greater than 30 without COPD, AHI less than or equal to 30 with COPD, and AHI less than or equal to 30 without COPD (reference). A similar approach was used for the degree of nocturnal hypoxemia. Relative excess risk due to interaction (RERI) was calculated. To adjust for the effect of positive airway pressure treatment, given that information on its acceptance, but not adherence, was available, a separate analysis was conducted only on untreated individuals who never claimed a positive airway pressure device. RESULTS Among 10,149 participants, 30% had AHI greater than 30, 25% spent at least 10 minutes of sleep with SaO2 less than 90%, and 12% had COPD. Over a median of 9.4 years, 16.4% developed an outcome. In the total sample, a greater hazard of outcome was observed in individuals with COPD who spent at least 10 minutes of sleep with SaO2 less than 90% (hazard ratio, 1.91; 95% confidence interval [CI], 1.60 to 2.28) but not with AHI greater than 30; a synergistic effect was found in women (RERI, 1.18; 95% CI, 0.05 to 2.30), but not men (RERI, -0.08; 95% CI, -0.47 to 0.32). The highest hazard of outcome was associated with the co-occurrence of AHI greater than 30 and COPD in untreated individuals (hazard ratio, 2.01; 95% CI, 1.55 to 2.62); a synergistic effect was not found. CONCLUSIONS In adults with suspected OSA, the co-occurrence of nocturnal hypoxemia and COPD was associated with an increased hazard of cardiovascular events and mortality with a synergistic effect found only in women.
Collapse
|
48
|
Snow JB, Norton CE, Sands MA, Weise-Cross L, Yan S, Herbert LM, Sheak JR, Gonzalez Bosc LV, Walker BR, Kanagy NL, Jernigan NL, Resta TC. Intermittent Hypoxia Augments Pulmonary Vasoconstrictor Reactivity through PKCβ/Mitochondrial Oxidant Signaling. Am J Respir Cell Mol Biol 2020; 62:732-746. [PMID: 32048876 DOI: 10.1165/rcmb.2019-0351oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Pulmonary vasoconstriction resulting from intermittent hypoxia (IH) contributes to pulmonary hypertension (pHTN) in patients with sleep apnea (SA), although the mechanisms involved remain poorly understood. Based on prior studies in patients with SA and animal models of SA, the objective of this study was to evaluate the role of PKCβ and mitochondrial reactive oxygen species (mitoROS) in mediating enhanced pulmonary vasoconstrictor reactivity after IH. We hypothesized that PKCβ mediates vasoconstriction through interaction with the scaffolding protein PICK1 (protein interacting with C kinase 1), activation of mitochondrial ATP-sensitive potassium channels (mitoKATP), and stimulated production of mitoROS. We further hypothesized that this signaling axis mediates enhanced vasoconstriction and pHTN after IH. Rats were exposed to IH or sham conditions (7 h/d, 4 wk). Chronic oral administration of the antioxidant Tempol or the PKCβ inhibitor LY-333531 abolished IH-induced increases in right ventricular systolic pressure and right ventricular hypertrophy. Furthermore, scavengers of O2- or mitoROS prevented enhanced PKCβ-dependent vasoconstrictor reactivity to endothelin-1 in pulmonary arteries from IH rats. In addition, this PKCβ/mitoROS signaling pathway could be stimulated by the PKC activator PMA in pulmonary arteries from control rats, and in both rat and human pulmonary arterial smooth muscle cells. These responses to PMA were attenuated by inhibition of mitoKATP or PICK1. Subcellular fractionation and proximity ligation assays further demonstrated that PKCβ acutely translocates to mitochondria upon stimulation and associates with PICK1. We conclude that a PKCβ/mitoROS signaling axis contributes to enhanced vasoconstriction and pHTN after IH. Furthermore, PKCβ mediates pulmonary vasoconstriction through interaction with PICK1, activation of mitoKATP, and subsequent mitoROS generation.
Collapse
Affiliation(s)
- Jessica B Snow
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Charles E Norton
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Michelle A Sands
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Laura Weise-Cross
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Simin Yan
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Lindsay M Herbert
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Joshua R Sheak
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Laura V Gonzalez Bosc
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Benjimen R Walker
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Nancy L Kanagy
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Nikki L Jernigan
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Thomas C Resta
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| |
Collapse
|
49
|
Risk of obstructive sleep apnea in patients with Sjögren syndrome and Behçet's disease: a nationwide, population-based cohort study. Sleep Breath 2020; 24:1199-1205. [PMID: 31900884 DOI: 10.1007/s11325-019-01953-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients with obstructive sleep apnea (OSA) have a higher risk of Behçet's disease (BD) and Sjögren syndrome (SS). However, the bidirectional relationship between these autoimmune diseases and OSA is unclear. We investigated the relationship between autoimmune diseases (SS and BD) and OSA. METHODS SS and BD patients were identified through the Taiwan National Health Insurance Research Database from 2002 to 2012. Patients with SS or BD were matched according to age and sex with a control group in a ratio of 1:4. The study included 12,926 patients with SS and 51,704 non-SS controls. Similarly, 1221 patients with BD were matched with 4884 non-BD controls. We used a Cox regression model, stratified by age, gender, and comorbidities, to assess the risk of OSA. RESULTS OSA was diagnosed in 0.61% of the SS cohort and 1.23% of the BD cohort. The higher overall risk for OSA was observed significantly in patients with SS than in controls (adjusted hazard ratio [HR] = 2.48, 95% confidence interval [CI] = 1.89-3.24). The higher risk was also observed significantly in BD patients than in controls (HR = 1.99, 95% CI = 1.06-3.72). Furthermore, men with SS or BD exhibited HR of 2.62 (95% CI 1.89 to 3.62) and 6.40 (95% CI 2.96 to 13.84) for developing OSA, respectively. CONCLUSION Risk of OSA was significantly elevated in SS or BD patients compared with controls. Further study is warranted to elucidate underlying mechanisms.
Collapse
|
50
|
Abstract
COPD and Type 2 diabetes are two highly prevalent global health conditions associated
with high mortality and morbidity. The connection between these two common diseases is complex,
and more research is required for further understanding of these conditions. COPD is being
increasingly recognized as a risk factor for the development of type2 diabetes through different
mechanisms including systemic inflammation, obesity, hypoxia and use of corticosteroids. Also,
hyperglycemia in diabetes patients is linked to the adverse impact on lung physiology, and a possible
increase in the risk of COPD. In this review article, we discuss the studies demonstrating the
associations between COPD and Type 2 Diabetes, underlying pathophysiology and recommended
therapeutic approach in the management of patients with coexisting COPD and diabetes.
Collapse
Affiliation(s)
- Chaitanya Mamillapalli
- Springfield Clinic, Endocrinology, 1025 South 6th Street, Springfield, IL, 62702, United States
| | - Ramesh Tentu
- St. Davids Health care, Team health Hospitalist Service, Georgetown, TX 78626, United States
| | - Nitesh Kumar Jain
- Mercy Medical Centre, Pulmonology and Critical Care, Sioux City, IA 51104, United States
| | - Ramanath Bhandari
- Springfield Clinic, Endocrinology, 1025 South 6th Street, Springfield, IL, 62702, United States
| |
Collapse
|