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Shi Y, Jiang Z, Jiang L, Xu J. Integrative analysis of key candidate genes and signaling pathways in acute coronary syndrome related to obstructive sleep apnea by bioinformatics. Sci Rep 2021; 11:14153. [PMID: 34239024 PMCID: PMC8266822 DOI: 10.1038/s41598-021-93789-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Although obstructive sleep apnea (OSA) has been clinically reported to be associated with acute coronary syndrome (ACS), the pathogenesis between the two is unclear. Herein, we analyzed and screened out the prospective molecular marker. To explore the candidate genes, as well as signaling cascades involved in ACS related to OSA, we extracted the integrated differentially expressed genes (DEGs) from the intersection of genes from the Gene Expression Omnibus (GEO) cohorts and text mining, followed by enrichment of the matching cell signal cascade through DAVID analysis. Moreover, the MCODE of Cytoscape software was employed to uncover the protein-protein interaction (PPI) network and the matching hub gene. A total of 17 and 56 integrated human DEGs in unstable angina (UA) and myocardial infarction (MI) group associated with OSAs that met the criteria of |log2 fold change (FC)|≥ 1, adjusted P < 0.05, respectively, were uncovered. After PPI network construction, the top five hub genes associated with UA were extracted, including APP, MAPK3, MMP9, CD40 and CD40LG, whereas those associated with MI were PPARG, MAPK1, MMP9, AGT, and TGFB1. The establishment of the aforementioned candidate key genes, as well as the enriched signaling cascades, provides promising molecular marker for OSA-related ACS, which will to provide a certain predictive value for the occurrence of ACS in OSA patients in the future.
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Affiliation(s)
- Yanxi Shi
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China
| | - Zhengye Jiang
- Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, China
| | - Liqin Jiang
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China
| | - Jianjiang Xu
- Department of Cardiology, Jiaxing Second Hospital, Jiaxing, China.
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Yang SH, Xing YS, Wang ZX, Liu YB, Chen HW, Ren YF, Chen JL, Li SB, Wang ZF. Association of Obstructive Sleep Apnea With the Risk of Repeat Adverse Cardiovascular Events in Patients With Newly Diagnosed Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2021; 100:260-270. [PMID: 33570429 DOI: 10.1177/0145561321989450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of obstructive sleep apnea (OSA) on subsequent cardiovascular events in patients with acute coronary syndrome (ACS) remains inconclusive. AIM Our aim was to systematically assess the relationship between preexisting OSA and adverse cardiovascular events in patients with newly diagnosed ACS by conducting a systematic review and meta-analysis. METHODS We systematically searched PubMed, EMBASE, and Cochrane library for studies published up to May 1, 2020, that reported any association between OSA and cardiovascular events in patients with newly diagnosed ACS. The main outcomes were a composite of all-cause or cardiovascular death, recurrent myocardial infarction, stroke, repeat revascularization, or heart failure. We conducted a pooled analysis using the random-effects model. We also performed subgroup, sensitivity, heterogeneity analysis, and the assessment of publication bias. RESULTS We identified 10 studies encompassing 3350 participants. The presence of OSA was associated with increased risk of adverse cardiovascular events in newly prognosed ACS (risk ratio [RR] 2.18, 95% confidence interval [CI]: 1.45-3.26, P < .001, I2 = 64%). Between-study heterogeneity was partially explained by a multicenter study (9 single-center studies, RR 2.33 95% CI 1.69-3.19, I2 =18%), and I2 remarkably decreased from 64% to 18%. Moreover, OSA significantly increased the incidence of repeat revascularization (8 studies) and heart failure (6 studies) in patients with newly diagnosed ACS. CONCLUSION Patients with preexisting OSA are at greater risk of subsequent cardiovascular events after onset of ACS. Further studies should investigate the treatment of OSA in patient with ACS.
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Affiliation(s)
- Shu-Han Yang
- Department of Cardiology, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Yong-Sheng Xing
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Zeng-Xia Wang
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Yan-Bin Liu
- Department of Cardiology, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Hong-Wei Chen
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Yan-Feng Ren
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Jing-Ling Chen
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Sheng-Bo Li
- Department of Intensive Care Unit, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
| | - Zhi-Fang Wang
- Department of Cardiology, Xinxiang Central Hospital, The Fourth Clinical College of 91593Xinxiang Medical University, Henan Province, People's Republic of China
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Xie L, Zhen P, Yu F, Yu X, Qian H, Yang F, Tong J. Effects of sleep apnea hypopnea syndromes on cardiovascular events: a systematic review and meta-analysis. Sleep Breath 2021; 26:5-15. [PMID: 33772396 DOI: 10.1007/s11325-021-02294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/13/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous studies suggest that sleep apnea hypopnea syndrome (SAHS) is an independent risk factor that contributes to certain cardiovascular events. However, there are studies arguing that patients with SAHS had lower peak troponin levels when suffering cardiovascular events compared to patients without SAHS, which indicates that there may potentially be a protective effect of SAHS. This meta-analysis aimed to assess the impact of SAHS on cardiovascular events. METHODS Databases were searched for studies that examined cardiac biomarkers or reported angiographic data when patients with SAHS experienced cardiovascular events. The data about peak cardiac biomarkers and angiographic coronary lesion were extracted and then used to compute the pooled standardized mean difference (SMD) and 95% confidence interval (95% CI). RESULTS Among 26 studies included in the meta-analysis, there was not a definite difference between the SAHS group and the control group for troponins (SMD, 0.05; 95% CI, [- 0.16, 0.26]), creatine kinase (SMD, - 0.08; 95% CI, [- 0.38, 0.22]), and CK-MB (SMD, - 0.11; 95% CI, [- 0.51, 0.29]). However, patients with SAHS revealed worse coronary lesion condition grading via both Gensini score (SMD, 0.63; 95% CI, [0.31, 0.95]) and SYNTAX score (SMD, 0.99; 95% CI, [0.31-1.67]). CONCLUSIONS Ischemic preconditioning induced by the intermittent hypoxia at the early stage could generate a cardiac protection effect, which would then benefit SAHS patients encountering a major adverse cardiovascular event.
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Affiliation(s)
- Liang Xie
- School of Medicine, Southeast University, Nanjing, China.,Jinling Hospitial, School of Medicine, Nanjing University, Nanjing, China
| | - Penghao Zhen
- School of Medicine, Southeast University, Nanjing, China.,Department of Cardiology, Zhongda Hospital, Nanjing, China
| | - Fuchao Yu
- School of Medicine, Southeast University, Nanjing, China.,Department of Cardiology, Zhongda Hospital, Nanjing, China
| | - Xiaojin Yu
- School of Public Health, Southeast University, 87 Dingjiaqiao, Nanjing, China
| | - Hai Qian
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Fang Yang
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biomedical Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Jiayi Tong
- School of Medicine, Southeast University, Nanjing, China. .,Department of Cardiology, Zhongda Hospital, Nanjing, China.
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Wang H, Li X, Tang Z, Gong G. Cardiovascular Outcomes Post Percutaneous Coronary Intervention in Patients with Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Ther 2020; 11:1795-1806. [PMID: 32591980 PMCID: PMC7376814 DOI: 10.1007/s13300-020-00870-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a major risk factor for the occurrence of cardiovascular diseases. Similar to T2DM, obstructive sleep apnea (OSA) is also known to be a risk factor for cardiovascular diseases. In this analysis, we aimed to systematically compare the post-interventional cardiovascular outcomes observed in patients with T2DM with versus without OSA. METHODS Electronic databases were searched for relevant publications comparing the cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients with T2DM with OSA. Cardiovascular outcomes were considered as the relevant endpoints. The RevMan software 5.3 was used to carry out the statistical analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the results following data assessment. RESULTS A total of 1168 participants with T2DM were included in this analysis, of whom 614 had co-existing OSA. The time period of patients' enrollment varied from year 2002 to 2017. Our current analysis showed that major adverse cardiac events (MACEs) (OR 2.28, 95% CI 1.24-4.18; P = 0.008) and all-cause mortality (OR 1.95, 95% CI 1.08-3.54; P = 0.03) were significantly higher in the OSA subgroup. However, major adverse cerebrovascular and cardiovascular (MACCEs) (OR 1.38, 95% CI 0.97-1.98; P = 0.07) and cardiac death (OR 1.79, 95% CI 0.77-4.16; P = 0.18) were not significantly different post PCI. In addition, hospitalization for heart failure (OR 1.99, 95% CI 0.43-9.25; P = 0.38), re-infarction (OR 1.52, 95% CI 0.85-2.70; P = 0.16), stroke (OR 1.81, 95% CI 0.81-4.08; P = 0.15), target vessel revascularization (TVR) (OR 1.54, 95% CI 0.98-2.42; P = 0.06), and target lesion revascularization (TLR) (OR 1.32, 95% CI 0.80-2.18; P = 0.28) were also not significantly different post PCI in the patients with T2DM with versus without OSA. CONCLUSION OSA was associated with a significant increase in all-cause mortality and MACEs post PCI in these patients with T2DM. Therefore, special care and continuous follow-up might be required for patients with T2DM with associated OSA after PCI. However, as a result of the limited number of participants, further larger studies would be required to confirm these hypotheses.
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Affiliation(s)
- Hong Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Xinxin Li
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhangui Tang
- Department of Cardiovascular Disease, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Guoping Gong
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Le Grande MR, Beauchamp A, Driscoll A, Jackson AC. Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:147. [PMID: 32209053 PMCID: PMC7092582 DOI: 10.1186/s12872-020-01430-3] [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] [Received: 05/17/2019] [Accepted: 03/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) has been recognised as a risk factor for cardiovascular diseases such as hypertension and cardiovascular events such as acute coronary syndrome (ACS). Since it is also known to reduce exercise tolerance, it is important to establish the prevalence of OSA in ACS patients, particularly in those who are commencing cardiac rehabilitation (CR) programs. Methods Using PRISMA guidelines a systematic search was conducted in order to identify studies that objectively measured (using polysomnography or portable monitoring) the prevalence of OSA in ACS patients following hospital admission. A data extraction table was used to summarise study characteristics and the quality of studies were independently assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analysis of the selected studies was conducted in order to estimate OSA prevalence as a function of the two main methods of measurement, the severity of OSA, and timing of the OSA assessment following ACS hospital admission. Results Pooled prevalence estimates of OSA using the “gold standard” polysomnography ranged from 22% for severe OSA to 70% for mild OSA, at any time after hospital admission. Similar prevalence estimates were obtained using portable monitoring, but interpretation of these results are limited by the significant heterogeneity observed among these studies. Conclusions Prevalence of OSA following ACS is high and likely to be problematic upon patient entry into CR programs. Routine screening for OSA upon program entry may be necessary to optimise effectiveness of CR for these patients.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia. .,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia. .,Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Department of Medicine -Western Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St.Albans, VIC, 3021, Australia.,School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia.,Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
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6
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Fan J, Wang X, Ma X, Somers VK, Nie S, Wei Y. Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc 2020; 8:e010826. [PMID: 30636505 PMCID: PMC6497330 DOI: 10.1161/jaha.118.010826] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea‐hypopnea index ≥15 events·h−1. The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia‐driven revascularization, or hospitalization for unstable angina or heart failure. OSA was present in 403 of 804 (50.1%) patients. During median follow‐up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non‐OSA group (log‐rank, P=0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE (adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57; P=0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46; P=0.023), but no increased risk was found within 1‐year follow‐up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09; P=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia‐driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non‐OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05; P=0.027). Conclusions There was no independent correlation between OSA and 1‐year MACCE after ACS. The increased risk associated with OSA was only observed after 1‐year follow‐up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation.
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Affiliation(s)
- Jingyao Fan
- 1 Emergency & Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Xiao Wang
- 1 Emergency & Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Xinliang Ma
- 1 Emergency & Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing China.,2 Department of Emergency Medicine Thomas Jefferson University Philadelphia PA
| | - Virend K Somers
- 3 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Shaoping Nie
- 1 Emergency & Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Yongxiang Wei
- 4 Department of Otolaryngology Head & Neck Surgery Beijing Anzhen Hospital Capital Medical University Beijing China
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Singh M, Tuteja A, Wong DT, Goel A, Trivedi A, Tomlinson G, Chan V. Point-of-Care Ultrasound for Obstructive Sleep Apnea Screening: Are We There Yet? A Systematic Review and Meta-analysis. Anesth Analg 2019; 129:1673-1691. [PMID: 31743189 DOI: 10.1213/ane.0000000000004350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Perioperative diagnosis of obstructive sleep apnea (OSA) has important resource implications as screening questionnaires are overly sensitive, and sleep studies are expensive and time-consuming. Ultrasound (US) is a portable, noninvasive tool potentially useful for airway evaluation and OSA screening in the perioperative period. The objective of this systematic review was to evaluate the correlation of surface US with OSA diagnosis and to determine whether a point-of-care ultrasound (PoCUS) for OSA screening may help with improved screening in perioperative period. METHODS A search of all electronic databases including Medline, Embase, and Cochrane Database of Systematic Reviews was conducted from database inception to September 2017. Inclusion criteria were observational cohort studies and randomized controlled trials of known or suspected OSA patients undergoing surface US assessment. Article screening, data extraction, and summarization were conducted by 2 independent reviewers with ability to resolve conflict with supervising authors. Diagnostic properties and association between US parameters (index test) and OSA diagnosis using sleep study (reference standard) were evaluated. The US parameters were divided into airway and nonairway parameters. A random-effects meta-analysis was planned, wherever applicable. RESULTS Of the initial 3865 screened articles, 21 studies (7 airway and 14 nonairway) evaluating 3339 patients were included. Majority of studies were conducted in the general population (49%), respirology (23%), and sleep clinics (12%). No study evaluated the use of US for OSA in perioperative setting. Majority of included studies had low risk of bias for reference standard and flow and timing. Airway US parameters having moderate-good correlation with moderate-severe OSA were distance between lingual arteries (DLAs > 30 mm; sensitivity, 0.67; specificity, 0.59; 1 study/66 patients); mean resting tongue thickness (>60 mm; sensitivity, 0.85; specificity, 0.59; 1 study/66 patients); tongue base thickness during Muller maneuver (MM; sensitivity, 0.59; specificity, 0.78; 1 study/66 patients); and a combination of neck circumference and retropalatal (RP) diameter shortening during MM (sensitivity, 1.0; specificity, 0.65; 1 study/104 patients). Nonairway US parameters having a low-moderate correlation with moderate-severe OSA were carotid intimal thickness (pooled correlation coefficient, 0.444; 95% confidence interval [CI], 0.320-0.553; P value = .000, 8 studies/727 patients) and plaque presence (sensitivity, 0.24-0.75; specificity, 0.13-1.0; 4 studies/1183 patients). CONCLUSIONS We found that a number of airway and nonairway parameters were identified with moderate to good correlation with OSA diagnosis in the general population. In future studies, it remains to be seen whether PoCUS screening for a combination of these parameters can address the pitfalls of OSA screening questionnaires.
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Affiliation(s)
- Mandeep Singh
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Toronto Sleep and Pulmonary Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, Ontario, Canada
| | - Arvind Tuteja
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Akash Goel
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Trivedi
- Department of Chemistry, McMaster University, Hamilton, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Aurora RN, Crainiceanu C, Gottlieb DJ, Kim JS, Punjabi NM. Obstructive Sleep Apnea during REM Sleep and Cardiovascular Disease. Am J Respir Crit Care Med 2019; 197:653-660. [PMID: 29112823 DOI: 10.1164/rccm.201706-1112oc] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) during REM sleep is a common disorder. Data on whether OSA that occurs predominantly during REM sleep is associated with health outcomes are limited. OBJECTIVES The present study examined the association between OSA during REM sleep and a composite cardiovascular endpoint in a community sample with and without prevalent cardiovascular disease. METHODS Full-montage home polysomnography was conducted as part of the Sleep Heart Health Study. The study cohort was followed for an average of 9.5 years, during which time cardiovascular events were assessed. Only participants with a non-REM apnea-hypopnea index (AHI) of less than 5 events/h were included. A composite cardiovascular endpoint was determined as the occurrence of nonfatal or fatal events, including myocardial infarction, coronary artery revascularization, congestive heart failure, and stroke. Proportional hazards regression was used to derive the adjusted hazards ratios for the composite cardiovascular endpoint. MEASUREMENTS AND MAIN RESULTS The sample consisted of 3,265 subjects with a non-REM AHI of less than 5.0 events/h. Using a REM AHI of less than 5.0 events/h as the reference group (n = 1,758), the adjusted hazards ratios for the composite cardiovascular endpoint in those with severe REM OSA (≥30 events/h; n = 180) was 1.35 (95% confidence interval, 0.98-1.85). Stratified analyses demonstrated that the association was most notable in those with prevalent cardiovascular disease and severe OSA during REM sleep with an adjusted hazards ratio of 2.56 (95% confidence interval, 1.46-4.47). CONCLUSIONS Severe OSA that occurs primarily during REM sleep is associated with higher incidence of a composite cardiovascular endpoint, but in only those with prevalent cardiovascular disease.
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Affiliation(s)
| | | | - Daniel J Gottlieb
- 3 Veterans Affairs Boston Healthcare System, Boston, Massachusetts; and.,4 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Naresh M Punjabi
- 1 Department of Medicine.,5 Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Lin MT, Lai CL, Lee PL, Shen MH, Yu CJ, Fang CT, Chen CL. Timely diagnosis and treatment of sleep apnea reduce cardiovascular sequelae in patients with myocardial infarction. PLoS One 2018; 13:e0201493. [PMID: 30059554 PMCID: PMC6066237 DOI: 10.1371/journal.pone.0201493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 02/04/2023] Open
Abstract
Background The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. Methods We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. Results The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). Conclusion The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events.
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Affiliation(s)
- Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Lun Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
| | - Min-Huei Shen
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ling Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
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Kim J, Mohler ER, Keenan BT, Maislin D, Arnardottir ES, Gislason T, Benediktsdottir B, Gudmundsdottir S, Sifferman A, Staley B, Pack FM, Maislin G, Chirinos JA, Townsend RR, Pack AI, Kuna ST. Carotid Artery Wall Thickness in Obese and Nonobese Adults With Obstructive Sleep Apnea Before and Following Positive Airway Pressure Treatment. Sleep 2018; 40:4037435. [PMID: 28934533 DOI: 10.1093/sleep/zsx126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Study objectives Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. The purpose of this study was to compare carotid intima-media thickness (IMT), an early sign of atherosclerosis, in obese and nonobese adults with OSA before and following positive airway pressure (PAP) treatment. Methods A total of 206 adults newly diagnosed with OSA with an apnea-hypopnea index (AHI) of 15-75 events/hour and 53 controls with AHI <10 were studied. Waist circumference was used to classify participants as obese and nonobese. Bilateral common carotid artery B-mode ultrasound was performed at baseline to assess IMT, arterial diameter, arterial-wall mass, and circumferential wall stress. Measurements were repeated in 118 participants with OSA who completed a 4-month PAP treatment and had an average daily use over that period of ≥4 hours/day. Results No significant differences in carotid IMT, diameter, or arterial-wall mass were present at baseline between participants with OSA and controls stratified by waist circumference, after adjusting for other cardiovascular risk factors. In participants with OSA, who had adequate PAP adherence over the 4-month treatment, carotid artery diameter significantly increased (mean change [95% confidence interval] = 0.13 [0.06, 0.20] mm; p = .0004), but no significant changes in carotid IMT, arterial-wall mass, and circumferential stress were observed in obese and nonobese participants. Conclusions Regardless of obesity status, carotid IMT is not increased in adults with moderate to severe OSA versus controls and does not change following 4 months of PAP treatment.
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Affiliation(s)
- Jinyoung Kim
- School of Nursing, University of Pennsylvania, Philadelphia, PA.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Emile R Mohler
- Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - David Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Erna Sif Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigrun Gudmundsdottir
- Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andrea Sifferman
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Bethany Staley
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Frances M Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julio A Chirinos
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel T Kuna
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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11
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Zhang J, Song Y, Ji Y, Song Y, Cai S, Yu Y, Liu S, Zhang W. Correlation between coronary artery disease and obstructive sleep apnea syndrome and analysis of risk factors. Exp Ther Med 2018; 15:4771-4776. [PMID: 29805494 PMCID: PMC5958735 DOI: 10.3892/etm.2018.6070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/09/2018] [Indexed: 12/20/2022] Open
Abstract
The correlation between coronary artery disease (CAD) and obstructive sleep apnea syndrome (OSAS) was investigated to analyze its risk factors. A total of 84 patients with suspected CAD due to chest tightness and pain or nocturnal angina, were selected. They were admitted and received coronary angiography in The Affiliated Hospital of Medical College Qingdao University from March, 2016 to June, 2017. The vital signs were monitored, and the sleep monitoring was performed before and after coronary angiography. Before angiography, the fasting blood was drawn for blood biochemical detection, followed by routine electrocardiogram and echocardiographic examination. In addition, the body mass index was calculated and whether patients suffered from hypertension and diabetes mellitus was observed. The patients were divided into the control group (patients with a negative coronary angiography) and the CAD group (patients with a positive coronary angiography). There were 34 cases in the control group, including 21 cases of OSAS (61.76%), and 50 in the CAD group, including 40 cases of OSAS (80.00%). Statistical analysis revealed that there were statistically significant differences in the apnea hypopnea index (AHI), lowest oxygen saturation, degree of coronary stenosis (Gensini score) and triglyceride level between the two groups (P<0.05). There were no statistically significant differences in the cholesterol level and prevalence rates of hypertension and diabetes mellitus between the two groups. Logistic regression analysis revealed that smoking and AHI >20 were the risk factors of CAD (OR=7.036 and 5.377). Thus, CAD is closely correlated with OSAS and AHI >20 is one of the risk factors of CAD.
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Affiliation(s)
- Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yu Song
- Department of Orthodontics, Qingdao Stomatological Hospital, Qingdao, Shandong 266001, P.R. China
| | - Yang Ji
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yiying Song
- Department of Invasive Technology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Shanglang Cai
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Yanling Yu
- Department of Orthodontics, Qingdao Stomatological Hospital, Qingdao, Shandong 266001, P.R. China
| | - Song Liu
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
| | - Wenzhong Zhang
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong 266001, P.R. China
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12
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Wang X, Fan JY, Zhang Y, Nie SP, Wei YX. Association of obstructive sleep apnea with cardiovascular outcomes after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0621. [PMID: 29703065 PMCID: PMC5944507 DOI: 10.1097/md.0000000000010621] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The relationship between obstructive sleep apnea (OSA) and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) remains unclear. We performed a systematic review and meta-analysis to assess the impact of OSA on subsequent cardiovascular events after PCI.We searched the PubMed, EMBASE, and Cochrane library from their inceptions to August 5, 2017. We included cohort studies that described the association between OSA (based on apnea-hypopnea index) and cardiovascular outcomes after PCI with stenting. The primary endpoint was major adverse cardiovascular event (MACE), including all-cause or cardiovascular death, myocardial infarction, stroke, repeat revascularization, or heart failure. Outcomes data were pooled using random effects models and heterogeneity was assessed with the I statistic.We identified 9 studies with 2755 participants. The prevalence of OSA in patients treated with PCI ranged from 35.3% to 61.8%. OSA was associated with increased risk of MACE after PCI (pooled risk ratio [RR] 1.96, 95% confidence interval [CI]: 1.36-2.81, P < .001, I = 54%). Between-study heterogeneity was partially explained by sample size (2 studies with ≤100 participants; RR 9.12, 95% CI: 2.69-31.00, I = 0% vs 7 studies with >100 participants; RR 1.64, 95% CI: 1.23-2.18, I = 35%). Moreover, the presence of OSA significantly increased the incidence of all-cause death (4 studies), cardiovascular death (4 studies), and repeat revascularization (7 studies) in patients undergoing PCI.Patients with OSA are at greater risk of subsequent cardiovascular events after PCI. Whether treatment of OSA prevents such events warrants further investigation.
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Affiliation(s)
- Xiao Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Jing-Yao Fan
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Ying Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University
| | - Shao-Ping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Yong-Xiang Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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13
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Meta-Analysis of the Effect of Obstructive Sleep Apnea on Cardiovascular Events After Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:1026-1030. [PMID: 28739036 DOI: 10.1016/j.amjcard.2017.06.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/26/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
Abstract
Increasing evidence proved that obstructive sleep apnea (OSA) is associated with a variety of diseases, especially cardiovascular diseases. This study systematically reviewed the existing publications to assess the influence of OSA on cardiovascular survival among patients who underwent percutaneous coronary intervention. Eleven eligible publications, including 3,008 participants, were finally evaluated. Eight studies conducted adjustment of risk ratio for potential cardiovascular risk factors, 5 studies defined OSA groups as AHI (apnea hypopnea index) ≥15/hour, whereas the remaining eligible studies used AHI ≥5/hour, AHI ≥10/hour, or AHI ≥30/hour as the criteria. According to the result from 5 studies that use AHI ≥15/hour as OSA group, the existence of OSA could, to some extent, increase the risk of cardiovascular events (risk ratio 1.59, 95% confidence interval 1.22 to 2.06). Meanwhile, hazard ratio was also observed in separate co-morbidities, such as cardiac death, all-cause mortality, stroke, target lesion revascularization, non-fatal myocardial infarction, hospitalization for heart failure, and recurrence of acute coronary syndrome, regardless if the estimates are varied among studies. In conclusion, OSA can independently increase the risk of cardiovascular events, even after adjustment for confounders. Sleep health should be given utmost importance due to its extensive influence on cardiovascular disorders.
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14
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Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies. Sleep Breath 2017; 22:33-40. [DOI: 10.1007/s11325-017-1503-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
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15
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Huang Z, Zheng Z, Luo Y, Li S, Zhu J, Liu J. Prevalence of sleep-disordered breathing in acute coronary syndrome: a systemic review and meta-analysis. Sleep Breath 2017; 21:217-226. [PMID: 27549104 DOI: 10.1007/s11325-016-1398-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/23/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed to review the literature on the prevalence of sleep-disordered breathing (SDB) in patients with acute coronary syndrome (ACS). METHODS Relevant studies were searched on PubMed, EMBASE, and Cochrane Library through December 2014. Data were extracted using standardized forms. Pooled prevalence of all SDB (apnea-hypopnea index (AHI) > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30) in ACS patients was calculated using DerSimonian-Laird random-effects model. Sensitivity analysis was performed based on races and diagnostic methods of SDB. RESULTS A total of 32 studies were included in the present meta-analysis, examining 3360 patients. The meta-analysis indicated that pooled prevalence of all SDB (AHI > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30) in ACS patients were 69 % (95 % confidence interval (CI) = 61, 77 %), 43 % (95 % CI = 36, 49 %), and 25 % (95 % CI = 17, 33 %), respectively. Sensitivity analysis indicated that the pooled prevalence of SDB in Western population was similar to that in Asian population. However, diagnostic methods of SDB seemed to have various impacts on the prevalence of all SDB (AHI > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30). CONCLUSIONS High prevalence of all SDB, moderate-to-severe SDB, and severe SDB was found in ACS patients. It is clinically important to screen for SDB in patients with ACS.
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Affiliation(s)
- Zhuoshan Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengda Zheng
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Suhua Li
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Jieming Zhu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Jinlai Liu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China.
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16
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Nadeem R, Molnar J, Madbouly EM, Nida M, Aggarwal S, Sajid H, Naseem J, Loomba R. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 2013; 9:1003-12. [PMID: 24127144 DOI: 10.5664/jcsm.3070] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been linked to and is associated with increased cardiovascular and cerebrovascular morbidity. Ongoing inflammatory responses play an important role in this association. Multiple small size studies addressing the profile of the inflammatory markers in OSA are available therefore we performed a meta-analysis. METHODS Systematic review of medical literature was conducted using PubMed, Cochrane, and EMBASE databases from 1968 to 2011 by utilizing the key words obstructive sleep apnea, C-Reactive protein, tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) and Selectins. Inclusion criteria were: full text English articles; studies with adult population; reported values for at least one of the markers of interest; with at least two separate groups (subjects with OSA and control group); OSA was defined as AHI of ≥ 5/h. RESULTS Five hundred and twelve studies were reviewed for inclusion with 51 studies pooled for analysis (30 studies for CRP, 19 studies for TNF-α, 8 studies for ICAM, 18 studies for IL-6, six studies for VCAM and 5 studies for Selectins). The levels of inflammatory markers were higher in patients with OSA compared to control group. Standardized pooled Mean differences were calculated to be 1.77 for CRP, 1.03 for TNF-α, 2.16 for IL-6, 4.22 for IL-8, 2.93 for ICAM, 1.45 for Selectins and 2.08 for VCAM. CONCLUSIONS In this meta-analysis, the levels of systemic inflammatory markers were found to be higher in OSA patients compared to control subjects.
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Affiliation(s)
- Rashid Nadeem
- Captain James A. Lovell Federal Health Care Centre, North Chicago, IL ; Rosalind Franklin University of Medicine and Science/ Chicago Medical School, North Chicago, IL
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Patients with obstructive sleep apnea display increased carotid intima media: a meta-analysis. Int J Vasc Med 2013; 2013:839582. [PMID: 24066233 PMCID: PMC3771445 DOI: 10.1155/2013/839582] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/13/2013] [Accepted: 07/19/2013] [Indexed: 12/17/2022] Open
Abstract
Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from -0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P < 0.0001). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process.
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