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Adami LNG, Moysés-Oliveira M, Souza-Cunha LA, Vasco MB, Tufik S, Andersen ML. Lipid metabolism and neuromuscular junction as common pathways underlying the genetic basis of erectile dysfunction and obstructive sleep apnea. Int J Impot Res 2023:10.1038/s41443-023-00795-1. [PMID: 37990110 DOI: 10.1038/s41443-023-00795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
Erectile dysfunction (ED) incidence is higher in patients with obstructive sleep apnea (OSA). Studies have suggested that ED and OSA may activate similar pathways; however, few have investigated the links between their underlying genotypic profiles. Therefore, we conducted an in-silico analysis to test whether ED and OSA share genetic variants of risk and to identify any molecular, cellular and biological interactions between them. Two gene lists were manually curated through a literature review based on a PUBMED search, which resulted in one gene list associated with ED (total of 205 genes) and the other with OSA (total of 2622 genes). Between those gene sets, 35 were common for both lists (Fisher exact test, p-value = 0.027). The Protein-protein interaction (PPI) analysis using the intersect list as input showed that 3 of them had direct interactions (LPL, DGKB and PLCB1). In addition, the biological function of the genes contained in the intersect list suggested that pathways related to lipid metabolism and the neuromuscular junction were commonly found in the genetic basis of ED and OSA. From the shared genes between both conditions, the biological pathways highlighted in this study may serve as preliminary findings for future functional investigations on OSA and ED association.
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Affiliation(s)
- Luana N G Adami
- Sleep Institute, São Paulo, Brazil
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Matheus Brandão Vasco
- Departamento de Cirurgia, Disciplina de Urologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Sleep Institute, São Paulo, Brazil
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica L Andersen
- Sleep Institute, São Paulo, Brazil.
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
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del Portillo JH, Hernandez BM, Bazurto MA, Echeverri D, Cabrales J. High frequency of coronary artery ectasia in obstructive sleep apnea. J Clin Sleep Med 2022; 18:433-438. [PMID: 34398745 PMCID: PMC8804997 DOI: 10.5664/jcsm.9598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) have a greater risk of developing coronary artery disease. However, the frequency of specific coronary artery vascular phenotypes, such as coronary artery ectasia (CAE), which has a frequency of 5% in the general population, has not been studied in patients with OSA. This study aimed to estimate CAE frequency in patients with OSA who underwent coronary angiography. METHODS A retrospective cross-sectional study was performed. The results of each polysomnography were reviewed, classifying OSA severity according to the apnea-hypopnea index. Each coronary angiography was reviewed. CAE was defined and classified according to the scales described in the literature. Two groups of patients were classified and compared (OSA/CAE group vs OSA/non-CAE group). RESULTS We identified the frequency of CAE in 185 patients with OSA who underwent coronary angiography. The frequency of CAE was 18.4% in these patients. ST-elevation myocardial infarction as the indication for coronary angiography was significantly greater in the OSA/CAE group than the OSA/non-CAE group (26.5% vs 9.9%; P = .02); 62% of the patients having severe OSA (apnea-hypopnea index ≥ 30 events/h). These patients in the OSA/CAE group had a significantly higher median apnea-hypopnea index than in the OSA/non-CAE group (72.5 events/h vs 53.5 events/h, respectively; P = .039). The CAE severity was not directly related to the OSA severity. CONCLUSIONS The frequency of CAE in patients with OSA is higher than that reported for the general population. The severity of OSA is related to the presence of CAE but not to its severity. CITATION del Portillo JH, Hernandez BM, Bazurto MA, Echeverri D, Cabrales J. High frequency of coronary artery ectasia in obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):433-438.
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Affiliation(s)
- Juan Hernando del Portillo
- Department of Interventional Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogota, Colombia,Medical School, Universidad el Bosque, Bogota, Colombia,Address correspondence to: Juan Hernando del Portillo, MD, Calle 163A # 13B, 60 Bogotá, Colombia; Tel: +57 3105596728; and
| | - Boris Miguel Hernandez
- Department of Interventional Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogota, Colombia,Medical School, Universidad el Bosque, Bogota, Colombia
| | | | - Dario Echeverri
- Department of Interventional Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogota, Colombia,Medical School, Universidad el Bosque, Bogota, Colombia,School of Medicine, Universidad del Rosario, Bogota, Colombia
| | - Jaime Cabrales
- Department of Interventional Cardiology, Fundación Cardioinfantil–Instituto de Cardiología, Bogota, Colombia,Medical School, Universidad el Bosque, Bogota, Colombia,School of Medicine, Universidad del Rosario, Bogota, Colombia
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Yatsu S, Naito R, Kasai T, Matsumoto H, Shitara J, Shimizu M, Murata A, Kato T, Suda S, Hiki M, Sai E, Miyauchi K, Daida H. Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention. Clin Res Cardiol 2018; 107:711-718. [PMID: 29605831 DOI: 10.1007/s00392-018-1238-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI). METHODS We conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke. RESULTS Of 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9 years. The cumulative incidence of MACCE was significantly higher in patients with SDB (P = 0.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05-5.4, P = 0.036). CONCLUSIONS SDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.
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Affiliation(s)
- Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiryu Sai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Takama N, Matsuo Y, Arai H, Yamagishi T, Eguma H, Kurabayashi M. Integrated area of desaturation index in patients with myocardial infarction. Int J Cardiol 2010; 143:425-8. [DOI: 10.1016/j.ijcard.2008.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
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Abstract
Sleep disordered breathing, especially obstructive sleep apnea, are common in cardiovascular disease. Negative hemodynamic effects are mediated by nocturnal ischemia and intrathoracal pressure swings. Therefore "therapy resistant" arterial hypertension and congestive heart failure, as well as atrial fibrillation or sleep associated bradycardia are suggestive of sleep disordered breathing. Further on, clinical course of coronary artery disease seems to be influenced by nocturnal breathing disorders. Application of continuous positive airway pressure (CPAP) is effective in most of the patients and attenuates cardiodepressive hemodynamic effects of obstructive sleep apnea.
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Affiliation(s)
- S Steiner
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
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Peak time of acute coronary syndrome in patients with sleep disordered breathing. J Cardiol 2009; 53:164-70. [DOI: 10.1016/j.jjcc.2008.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 08/05/2008] [Accepted: 09/30/2008] [Indexed: 11/20/2022]
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Steiner S, Schueller PO, Hennersdorf MG, Behrendt D, Strauer BE. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respir Res 2008; 9:50. [PMID: 18522716 PMCID: PMC2430556 DOI: 10.1186/1465-9921-9-50] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 06/03/2008] [Indexed: 11/28/2022] Open
Abstract
Rationale There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea. Objectives To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention. Methods 78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index < 10/h (group I) and 35 pt. with obstructive sleep apnea and an AHI > 10/h (group II). Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months. Main results Angiographic restenosis (>50% luminal diameter), was present in 6 (14%) of group I and in 9 (25%) of group II (p = 0.11). Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01). Among these 35 patients, 21(60%) used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08). There was no difference in late lumen loss between treated patients and the group I (p = 0.206). Conclusion In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.
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Affiliation(s)
- Stephan Steiner
- Department of Cardiology, Pneumology and Angiology University Düsseldorf , 40225 Düsseldorf, Germany.
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Iesato K, Tatsumi K, Saibara T, Nakamura A, Terada J, Tada Y, Sakao S, Tanabe N, Takiguchi Y, Kuriyama T. Decreased lipoprotein lipase in obstructive sleep apnea syndrome. Circ J 2007; 71:1293-8. [PMID: 17652898 DOI: 10.1253/circj.71.1293] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lipoprotein lipase (LPL) might play a major role in lipid metabolism by hydrolyzing triglyceride-rich lipoproteins. Decreased LPL activity can trigger early inflammatory responses central to atherosclerosis. However, whether repeated apnea-related hypoxemia influences lipid metabolism in patients with obstructive sleep apnea syndrome (OSAS) remain undefined. This investigation determined whether circulating LPL was influenced by repeated apnea-related hypoxemia, and the effect of nasal continuous positive airway pressure (CPAP) therapy on LPL concentrations in OSAS patients. METHODS AND RESULTS The participants of the study were 155 men with OSAS and 39 men without OSAS. Circulating LPL concentrations decreased with the severity of OSAS. They correlated negatively with serum triglyceride, and the linear regression lines between LPL concentrations and triglyceride in OSAS patients were shifted downward compared with those in non-OSAS patients, suggesting that any pathophysiological factor might decrease LPL activity in OSAS patients. Some OSAS patients were subjected to CPAP therapy for 3 months. CPAP therapy increased LPL concentrations and decreased C-reactive protein (CRP) concentrations. CONCLUSIONS The present study suggests that repeated apnea-related hypoxemia might affect lipid metabolism and augment inflammatory responses, and CPAP therapy could be effective to decrease inflammatory responses and ameliorate lipid metabolism in patients with OSAS.
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Affiliation(s)
- Ken Iesato
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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Cassar A, Morgenthaler TI, Lennon RJ, Rihal CS, Lerman A. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol 2007; 50:1310-4. [PMID: 17903628 DOI: 10.1016/j.jacc.2007.06.028] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/29/2007] [Accepted: 06/18/2007] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Our purpose was to compare outcomes of patients treated for obstructive sleep apnea (OSA) versus patients with untreated OSA, all of whom had undergone percutaneous coronary intervention (PCI). BACKGROUND Obstructive sleep apnea has been associated with increases in fatal and nonfatal cardiovascular events. It is not known whether treatment of OSA in patients who have had PCI results in a better outcome. METHODS In a retrospective cohort study, a group of patients with OSA diagnosed with polysomnography between 1992 and 2004 (apnea-hypopnea index > or =15) who subsequently underwent a PCI (n = 371) were stratified according to whether they were treated for OSA (n = 175) or not (n = 196). Main outcome measures were cardiac death, general mortality, major adverse cardiac events (MACE) (severe angina, myocardial infarction, PCI, coronary artery bypass grafting, or death), and major adverse cardiac or cerebrovascular events (MACCE). RESULTS Patients treated for OSA had a statistically significant decreased number of cardiac deaths on follow-up when compared with untreated OSA patients (3% [95% confidence interval (CI) 0% to 6%] vs. 10% [95% CI 5% to 14%] after 5 years, p = 0.027), as well as a trend toward decreased all-cause mortality (p = 0.058). There was no difference in the number of MACE or MACCE between the 2 groups (p = 0.91 and 0.96, respectively). CONCLUSIONS Treatment of OSA is associated with a reduction in the number of cardiac deaths, but not in MACE or MACCE, after PCI. Screening for and treating OSA in patients with coronary artery disease who may undergo PCI may result in decreased cardiac death.
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Affiliation(s)
- Andrew Cassar
- Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota 55902, USA
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