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Biffi A, Quarti-Trevano F, Bonzani M, Seravalle G, Corrao G, Mancia G, Grassi G. Neuroadrenergic activation in obstructive sleep apnoea syndrome: a new selected meta-analysis - revisited. J Hypertens 2022; 40:15-23. [PMID: 34857700 PMCID: PMC10871617 DOI: 10.1097/hjh.0000000000003045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuroadrenegic overdrive occurs in obstructive sleep apnoea syndrome (OSAS). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities, represented major weaknesses not allowing to precisely define the main features of the phenomenon, particularly in nonobese patients. OBJECTIVE This meta-analysis detected 14 microneurographic studies based on muscle sympathetic nerve activity (MSNA) quantification in uncomplicated OSAS of different clinical severity. METHODS The evaluation was extended to the relationships of MSNA with heart rate, anthropometric and blood pressure values, metabolic variables, apnoea-hypopnea index and oxygen saturation. RESULTS MSNA is activated markedly and almost homogeneously between studies, showing a progressive increase from the healthy state to mild, moderate and severe OSAS (46.03, 48.32, 71.84, 69.27 bursts/100 heart beats). Of special interest are the findings that MSNA is significantly related to the apnoea-hypopnea index, a marker of OSAS severity (r = 0.55, P = 0.04) but not to BMI, as it occurs in OSAS associated with obesity, and heart rate is significantly and directly related to MSNA and apnoea-hypopnea index (r = 0.68 and r = 0.60, respectively P = 0.03 and P = 0.02), thus representing a surrogate marker of the sympathetic overdrive. CONCLUSION OSAS, even when uncomplicated by other cardiometabolic disease, displays a marked sympathetic activation, reflected by the MSNA and heart rate behaviour, becoming a target of therapeutic interventions aimed at exerting sympathomoderating effects, such as continuous positive airway pressure.
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Affiliation(s)
- Annalisa Biffi
- Department of Statistics and Quantitative Methods, University Milano-Bicocca
- National Centre for Healthcare Research and Pharmacoepidemiology
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca
| | - Matilde Bonzani
- National Centre for Healthcare Research and Pharmacoepidemiology
| | - Gino Seravalle
- Department of Statistics and Quantitative Methods, University Milano-Bicocca
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca
| | - Giuseppe Mancia
- Policlinico di Monza, Monza and University Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Statistics and Quantitative Methods, University Milano-Bicocca
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Hao W, Wang X, Fan J, Zeng Y, Ai H, Nie S, Wei Y. Association between apnea-hypopnea index and coronary artery calcification: a systematic review and meta-analysis. Ann Med 2021; 53:302-317. [PMID: 33522282 PMCID: PMC7877988 DOI: 10.1080/07853890.2021.1875137] [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: 09/06/2020] [Accepted: 01/06/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the association between presence and severity of obstructive sleep apnoea (OSA) and the presence of subclinical coronary artery disease (CAD) as assessed by coronary calcium score. METHODS Medline, Cochrane, and Google Scholar databases were searched. The presence of coronary artery calcification (CAC) and CAC score were assessed. RESULTS Irrespective of the cut-off value of apnoea-hypopnea index (AHI) (5 or 15 events/h), patients in the OSA group had higher rate of CAC presence and mean CAC score than those in the control group. Subgroup analyses of patients monitored with home sleep apnoea testing (HSAT) or in-hospital/laboratory polysomnography showed that the OSA group had higher rate of CAC presence and mean CAC score than the control group, except in the comparison of mean CAC score between AHI ≥5 vs. <5 events/h for patients using HSAT, which was not significant. Pair-wise comparison showed that CAC score may increase with increased OSA severity. CONCLUSIONS In participants without symptomatic coronary disease, the presence of OSA was associated with the presence and extent of CAC. However, potential confounders such as age, gender, and BMI and the diversity of CAC scores may affect the association.
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Affiliation(s)
- Wen Hao
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yaping Zeng
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shaoping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yongxiang Wei
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Neuroadrenergic activation in obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Hypertens 2021; 39:2281-2289. [PMID: 34620811 DOI: 10.1097/hjh.0000000000002934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuroadrenergic overdrive occurs in obstructive sleep apnea syndrome (OSAS). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities, represented major weaknesses not allowing to precisely define the main features of the phenomenon, particularly in nonobese patients. OBJECTIVE This meta-analysis evaluated 850 participants recruited in 26 microneurographic studies, based on muscle sympathetic nerve activity (MSNA) quantification in uncomplicated OSAS of different clinical severity. METHODS The evaluation was extended to the relationships of MSNA with heart rate (HR), anthropometric and blood pressure (BP) values, metabolic variables, apnea-hypopnea index (AHI) and oxygen saturation. RESULTS MSNA is activated markedly and almost homogeneously between studies, showing a progressive increase from the healthy state to mild, moderate and severe OSAS (41.6, 48.3, 65.5 and 70.7 bursts/100 heart beats, respectively, P < 0.01). Of special interest are the findings that first, MSNA is significantly related to the AHI, a marker of OSAS severity (r = 0.55, P < 0.02) and O2 saturation but not to body weight and BMI, as it occurs in OSAS associated with obesity; and second, HR is significantly and directly related to MSNA and AHI (r = 0.56 and 0.46, P < 0.03 for both), thus representing a surrogate marker of the sympathetic overdrive. CONCLUSION OSAS, even when uncomplicated by other cardiometabolic disease, displays a marked sympathetic activation, reflected by the MSNA and HR behavior, becoming a target of therapeutic interventions aimed at exerting sympathomoderating effects, such as continuous positive airway pressure.
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Lu M, Wang Z, Zhan X, Wei Y. Obstructive sleep apnea increases the risk of cardiovascular damage: a systematic review and meta-analysis of imaging studies. Syst Rev 2021; 10:212. [PMID: 34330323 PMCID: PMC8325188 DOI: 10.1186/s13643-021-01759-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We aimed to perform a systematic review and meta-analysis of the association between obstructive sleep apnea (OSA) and cardiac as well as coronary impairment evaluated using imaging modalities. Finding of this study will provide more robust evidence regarding OSA-induced cardiovascular damage. METHODS We systematically searched through PubMed, EMBASE, and Cochrane library databases for relevant literatures on the association between OSA and cardiovascular damage evaluated using imaging modalities, and manually searched the references of selected articles for additional relevant articles. For each clinical parameter relevant to the meta-analysis, we first evaluated the methodological heterogeneity of the relevant studies and thereafter pooled the data together using fixed effect or random effect model. The difference in the relevant indices of cardiovascular damage between OSA patients and controls was evaluated using the standardized mean difference. RESULTS Of the 82 articles included in the final systematic analysis, 20 studies explored the association between OSA and coronary atherosclerosis. OSA patients had higher rate of coronary atherosclerosis assessed by coronary artery calcification score and plaque volume. Moreover, the severity of OSA and coronary atherosclerosis displayed a positive correlation. The rest of the studies (n = 62) evaluated cardiac alterations in OSA patients. According to the inclusion and exclusion criteria, 46 studies yielding 3082 OSA patients and 1774 controls were pooled for the meta-analysis. For left cardiac structure and function, OSA patients exhibited significantly wider left atrial diameter; higher left atrium volume index; wider left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and left ventricular mass; higher left ventricular mass index; wider interventricular septum diameter and posterior wall diameter; and higher left ventricular myocardial performance index (all p < 0.05). In addition, compared with controls, left ventricular ejection fraction was significantly decreased in OSA patients (p = 0.001). For right cardiac structure and function, OSA patients displayed a significant increase in right ventricular diameter and right ventricular myocardial performance index (both p < 0.001). Finally, compared with controls, OSA patients displayed significant decrease in tricuspid annular plane systolic excursion and RV fractional area change (p = 0.001). CONCLUSION Overall, this systematic review and meta-analysis provides imaging evidence in support that OSA patients are at a higher risk of developing coronary atherosclerosis and display cardiac remodeling and dysfunction.
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Affiliation(s)
- Mi Lu
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China
| | - Zhenjia Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Road of Art Gallery, Beijing, 100010, China
| | - Xiaojun Zhan
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China. .,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China. .,Department of Otorhinolaryngology Head and Neck Surgery, Capital Institute of Pediatrics, No.2 Yabao Road, Beijing, 100020, China.
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Lu M, Fang F, Wang Z, Xu L, Sanderson JE, Zhan X, He L, Wu C, Wei Y. Association Between OSA and Quantitative Atherosclerotic Plaque Burden: A Coronary CT Angiography Study. Chest 2021; 160:1864-1874. [PMID: 34331905 DOI: 10.1016/j.chest.2021.07.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Limited evidence is available regarding the association between OSA and coronary plaque assessed by using quantitative coronary CT angiography. RESEARCH QUESTION Are there any associations between OSA severity-related indexes and the presence and burden of coronary plaque? STUDY DESIGN AND METHODS Cross-sectional data from 692 patients who underwent sleep monitoring and coronary CT angiography were used for this study. Of these patients, 120 (17.3%) underwent polysomnography, and 572 (82.7%) underwent respiratory polygraphy. Multivariable logistic and linear regression analyses were used to investigate the associations of OSA severity-related indexes with the presence, volume, and composition of plaque. RESULTS In multivariable analyses, patients with moderate to severe OSA were more likely to have coronary plaques (P = .037), and plaques were more likely to contain a noncalcified plaque (NCP) component (P = .032) and a low-density NCP (LD NCP) component (P = .030). Furthermore, the apnea-hypopnea index and oxygen desaturation index as continuous variables were both associated with the presence of plaque, NCP, and LD NCP (all, P < .05). Multivariable linear regression models showed that moderate to severe OSA was associated with NCP volume (β = 50.328; P = .042) and LD NCP volume (β = 15.707; P = .011). Moreover, the apnea-hypopnea index (P = .015), oxygen desaturation index (P = .005), and percentage of nighttime with oxygen saturation < 90% (P = .017) were all significant predictors of LD NCP volume. Compared with those with no or mild OSA, patients with severe OSA had a significantly higher total plaque volume (P = .036), NCP volume (P = .036), and LD NCP volume (P = .013). INTERPRETATION OSA was independently associated with the presence and burden of coronary plaque, which suggests an increased risk of coronary events. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry; No. ChiCTR-ROC-17011027; http://chictr.org.cn.
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Affiliation(s)
- Mi Lu
- Department of Otolaryngology Head and Neck Surgery-Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fang Fang
- The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Zhenjia Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - John E Sanderson
- The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaojun Zhan
- Department of Otolaryngology Head and Neck Surgery-Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianping He
- School of Medicine, Taizhou University, Taizhou, Zhejiang, China
| | - Chan Wu
- Department of Otolaryngology Head and Neck Surgery-Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head and Neck Surgery-Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Department of Otolaryngology Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, China.
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Dissanayake HU, Bin YS, Ucak S, de Chazal P, Sutherland K, Cistulli PA. Association between autonomic function and obstructive sleep apnea: A systematic review. Sleep Med Rev 2021; 57:101470. [PMID: 33839505 DOI: 10.1016/j.smrv.2021.101470] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor for hypertension and cardiovascular disease. Effects of OSA on the autonomic nervous system may mediate this association. We performed a systematic literature review to determine the profile of autonomic function associated with OSA. Three electronic databases were searched for studies of OSA patients aged ≥18 years in which autonomic function was assessed. Studies comparing patients with and without OSA, or examining the association of OSA severity with changes in autonomic function were included. Seventy-one studies met the inclusion criteria and autonomic function has been assessed using a range of techniques. The profile of autonomic function found in OSA include increased sympathetic activity, reduced parasympathetic activity and less consistently found low heart rate variability. Altered autonomic function in OSA may explain the pathophysiology of increased cardiovascular risk. Evidence from intervention studies is required to determine if treatment improves autonomic function associated with OSA.
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Affiliation(s)
- Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Yu S Bin
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Seren Ucak
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia
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