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Peker Y, Celik Y, Behboudi A, Redline S, Lyu J, Wei Y, Gottlieb DJ, Jelic S. CPAP may promote an endothelial inflammatory milieu in sleep apnoea after coronary revascularization. EBioMedicine 2024; 101:105015. [PMID: 38403558 PMCID: PMC10944158 DOI: 10.1016/j.ebiom.2024.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/22/2024] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has failed to reduce cardiovascular risk in obstructive sleep apnoea (OSA) in randomized trials. CPAP increases angiopoietin-2, a lung distension-responsive endothelial proinflammatory marker associated with increased cardiovascular risk. We investigated whether CPAP has unanticipated proinflammatory effects in patients with OSA and cardiovascular disease. METHODS Patients with OSA (apnoea-hypopnea index [AHI] ≥15 events/h without excessive sleepiness) in the Randomized Intervention with CPAP in Coronary Artery Disease and OSA study were randomized to CPAP or usual care following coronary revascularization. Changes in plasma levels of biomarkers of endothelial (angiopoietin-2, Tie-2, E-selectin, vascular endothelial growth factor [VEGF-A]) and lung epithelial (soluble receptor of advanced glycation end-products [sRAGE]) function from baseline to 12-month follow-up were compared across groups and associations with cardiovascular morbidity and mortality assessed. FINDINGS Patients with OSA (n = 189; 84% men; age 66 ± 8 years, BMI 28 ± 3.5 kg/m2, AHI 41 ± 23 events/h) and 91 patients without OSA participated. Angiopoietin-2 remained elevated whereas VEGF-A declined significantly over 12 months in the CPAP group (n = 91). In contrast, angiopoietin-2 significantly declined whereas VEGF-A remained elevated in the usual care (n = 98) and OSA-free groups. The changes in angiopoietin-2 and VEGF-A were significantly different between CPAP and usual care, whereas Tie-2, sRAGE and E-selectin were similar. Greater 12-month levels of angiopoietin-2 were associated with greater mortality. Greater CPAP levels were associated with worse cardiovascular outcomes. INTERPRETATION Greater CPAP levels increase proinflammatory, lung distension-responsive angiopoietin-2 and reduce cardioprotective angiogenic factor VEGF-A compared to usual care, which may counteract the expected cardiovascular benefits of treating OSA. FUNDING National Institutes of Health/National Heart, Lung, and Blood Institute; Swedish Research Council; Swedish Heart-Lung Foundation; ResMed Foundation.
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Affiliation(s)
- Yuksel Peker
- Koç University School of Medicine, Istanbul, Turkey; University of Gothenburg, Gothenburg, Sweden; Brigham & Women's Hospital, Boston, MA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Lund University, Lund, Sweden
| | - Yeliz Celik
- Koç University School of Medicine, Istanbul, Turkey; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Jing Lyu
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ying Wei
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Daniel J Gottlieb
- Brigham & Women's Hospital, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA.
| | - Sanja Jelic
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Kyle Martin W, Schladweiler MC, Oshiro W, Smoot J, Fisher A, Williams W, Valdez M, Miller CN, Jackson TW, Freeborn D, Kim YH, Davies D, Ian Gilmour M, Kodavanti U, Kodavanti P, Hazari MS, Farraj AK. Wildfire-related smoke inhalation worsens cardiovascular risk in sleep disrupted rats. FRONTIERS IN ENVIRONMENTAL HEALTH 2023; 2:1166918. [PMID: 38116203 PMCID: PMC10726696 DOI: 10.3389/fenvh.2023.1166918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction As a lifestyle factor, poor sleep status is associated with increased cardiovascular morbidity and mortality and may be influenced by environmental stressors, including air pollution. Methods To determine whether exposure to air pollution modified cardiovascular effects of sleep disruption, we evaluated the effects of single or repeated (twice/wk for 4 wks) inhalation exposure to eucalyptus wood smoke (ES; 964 μg/m3 for 1 h), a key wildland fire air pollution source, on mild sleep loss in the form of gentle handling in rats. Blood pressure (BP) radiotelemetry and echocardiography were evaluated along with assessments of lung and systemic inflammation, cardiac and hypothalamic gene expression, and heart rate variability (HRV), a measure of cardiac autonomic tone. Results and Discussion GH alone disrupted sleep, as evidenced by active period-like locomotor activity, and increases in BP, heart rate (HR), and hypothalamic expression of the circadian gene Per2. A single bout of sleep disruption and ES, but neither alone, increased HR and BP as rats transitioned into their active period, a period aligned with a critical early morning window for stroke risk in humans. These responses were immediately preceded by reduced HRV, indicating increased cardiac sympathetic tone. In addition, only sleep disrupted rats exposed to ES had increased HR and BP during the final sleep disruption period. These rats also had increased cardiac output and cardiac expression of genes related to adrenergic function, and regulation of vasoconstriction and systemic blood pressure one day after final ES exposure. There was little evidence of lung or systemic inflammation, except for increases in serum LDL cholesterol and alanine aminotransferase. These results suggest that inhaled air pollution increases sleep perturbation-related cardiovascular risk, potentially in part by increased sympathetic activity.
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Affiliation(s)
- W. Kyle Martin
- Curriculum in Toxicology and Environmental Medicine, UNC, Chapel Hill, NC, United States
| | - M. C. Schladweiler
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Oshiro
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - J. Smoot
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - A. Fisher
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Williams
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Valdez
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - C. N. Miller
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - T. W. Jackson
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Freeborn
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - Y. H. Kim
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Davies
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Ian Gilmour
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - U. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - P. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. S. Hazari
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - A. K. Farraj
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
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Liu Y, Abdul Ghafoor A, Hajipour M, Ayas N. Role of precision medicine in obstructive sleep apnoea. BMJ MEDICINE 2023; 2:e000218. [PMID: 36936264 PMCID: PMC9951383 DOI: 10.1136/bmjmed-2022-000218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. Increasingly, obstructive sleep apnoea is recognised as a heterogeneous disease, and patients have varied susceptibility to long term complications and different responses to treatment. This narrative review summarises the current knowledge of precision medicine in obstructive sleep apnoea, particularly the role of symptom clusters, polysomnogram phenotypes, physiological endotypes, and circulating biomarkers in defining subtypes. In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes.
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Affiliation(s)
- Yu Liu
- Department of Pharmacology, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Ali Abdul Ghafoor
- Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Mohammadreza Hajipour
- Division of Experimental Medicine, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Najib Ayas
- Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada
- Canadian Sleep and Circadian Network, Montréal, QC, Canada
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Allen AJH, Peres BU, Liu Y, Jen R, Shah A, Laher I, Almeida F, Taylor C, Ghafoor AA, Ayas NT. Circulating markers of oxidative stress and risk of incident cardiovascular events in obstructive sleep apnea. Sleep Biol Rhythms 2022; 20:533-540. [PMID: 38468626 PMCID: PMC10899996 DOI: 10.1007/s41105-022-00399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
The identification of which patients with obstructive sleep apnea (OSA) are more likely to develop cardiovascular disease (CVD) remains a challenge. OSA causes oxidative stress (OS) which may contribute to CVD pathogenesis. Therefore, OS markers could be useful in risk-stratifying cardiovascular (CV) risk in OSA patients. The purpose of this pilot study was to assess whether three OS marker levels could be associated with incident CVD in suspected OSA patients. Morning plasma levels of 8-isoprostane, 8-hydroxy-2'-deoxyguanosine (8-OHdG) and superoxide dismutase (SOD) were measured in patients with suspected OSA referred for a polysomnogram (PSG). A composite outcome of CV events was defined by linkage with provincial administrative health databases. Cox proportional hazards models were used to assess the relationship between the levels of OS markers and events. 352 patients were included (mean age of 51.4 years, 68% male, median apnea hypopnea index of 16/h). Thirty-one first CV events occurred over an 8-year follow-up. In univariate or fully adjusted models, none of the OS markers were significantly associated with incident CV events (hazard ratio in adjusted models of: 1.25 (95% CI 0.56-2.80, p = 0.59), 1.15 (0.52-2.57, p = 0.73), 0.77 (0.37-1.61, p = 0.48), for 8-OHdG, 8-isoprostane and SOD; however, confidence intervals were wide. In this small preliminary study, oxidative stress markers were not significantly associated with risk of CV events. However, moderate associations between these markers and risk of CV events are possible and should be the focus of future larger studies. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00399-0.
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Affiliation(s)
- A. J. Hirsch Allen
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
| | - Bernardo U. Peres
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Yu Liu
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
- Department of Pharmacology, Shanxi Medical University, Taiyuan, China
| | - Rachel Jen
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Canada
| | - Aditi Shah
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Canada
| | - Ismail Laher
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
| | - Fernanda Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
| | - Carolyn Taylor
- Division of Cardiology, Department of Medicine, University of British Columbia and Providence Health Care, Vancouver, Canada
| | - Ali Abdul Ghafoor
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
| | - Najib T. Ayas
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 7th Floor, Vancouver, BC V5Z 1M9 Canada
- Leon Judah Blackmore Sleep Disorders Program, UBC Hospital, Vancouver, Canada
- Canadian Sleep and Circadian Network, Montréal, Canada
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Yu J, Liu Y, Peng W, Xu Z. Serum VCAM-1 and ICAM-1 measurement assists for MACE risk estimation in ST-segment elevation myocardial infarction patients. J Clin Lab Anal 2022; 36:e24685. [PMID: 36045604 PMCID: PMC9550957 DOI: 10.1002/jcla.24685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Vascular cell adhesion molecule‐1 (VCAM‐1) and intercellular adhesion molecule‐1 (ICAM‐1) modulate atherosclerosis by promoting leukocyte infiltration, neutrophil recruitment, endothelial cell proliferation, etc., which may directly or indirectly facilitate the occurrence of major adverse cardiac events (MACE). This study intended to investigate the value of VCAM‐1 and ICAM‐1 for predicting MACE in ST‐segment elevation myocardial infarction (STEMI) patients. Methods Totally, 373 STEMI patients receiving the percutaneous coronary intervention and 50 health controls (HCs) were included. Serum VCAM‐1 and ICAM‐1 were detected by ELISA. Meanwhile, MACE was recorded during a median follow‐up of 18 (range: 1–46) months in STEMI patients. Results Vascular cell adhesion molecule‐1 and ICAM‐1 were raised in STEMI patients compared with HCs (both p < 0.001). VCAM‐1 (p = 0.002) and ICAM‐1 (p = 0.012) high were linked with raised accumulating MACE rate in STEMI patients. Notably, VCAM‐1 high (hazard ratio [HR] = 2.339, p = 0.031), age ≥ 65 years (HR = 2.019, p = 0.039), history of diabetes mellitus (DM) (HR = 2.395, p = 0.011), C‐reactive protein (CRP) ≥ 5 mg/L (HR = 2.550, p = 0.012), multivessel disease (HR = 2.561, p = 0.007) independently predicted MACE risk in STEMI patients. Furthermore, a nomogram‐based prediction model combining these factors was established, exhibiting an acceptable value for estimating 1, 2, and 3‐year MACE risk, with AUC of 0.764, 0.716, and 0.778, respectively, in STEMI patients. Conclusion This study confirms the value of VCAM‐1 and ICAM‐1 measurement in predicting MACE risk in STEMI patients. Moreover, VCAM‐1 plus other traditional prognostic factors (such as age, history of DM, CRP, and multivessel disease) cloud further improve the predictive accuracy of MACE risk in STEMI patients.
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Affiliation(s)
- Jiancai Yu
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, Cangzhou Central Hospital of Tianjin Medical University, Cangzhou, China
| | | | | | - Zesheng Xu
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, Cangzhou Central Hospital of Tianjin Medical University, Cangzhou, China
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The rs579459 ABO gene polymorphism and risk of incident cardiovascular events in obstructive sleep apnea: a pilot study. Sleep Breath 2022; 27:721-725. [DOI: 10.1007/s11325-022-02638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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The Association of Oxidative and Antioxidant Potential with Cardiometabolic Risk Profile in the Group of 60- to 65-Year-Old Seniors from Central Poland. Antioxidants (Basel) 2022; 11:antiox11061065. [PMID: 35739962 PMCID: PMC9220010 DOI: 10.3390/antiox11061065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Pathogenesis of cardiovascular diseases is caused by, inter alia, oxidative stress. On the other hand, cardiovascular risk factors may cause redox imbalance. The pathological pathways between those components are to be determined. In the group comprised of 300 sex-matched subjects, we evaluated a number of cardiovascular risk factors: blood pressure, body mass, lipids, glucose, homocysteine, uric acid, von Willebrand factor (vWF), VCAM-1 and ICAM-1. The presence of cardiovascular diseases and drugs for their treatment were examined. Secondly, we assessed total antioxidative status (TAS), total oxidative status (TOS) and other markers of oxidative stress. TAS was inversely related to LDL cholesterol. TOS was positively associated with BMI and female sex, but negatively associated with the use of angiotensin II receptor antagonists. Plasma lipid peroxides concentration was positively related to ICAM-1 and presence of stroke, whereas platelet lipid peroxides were positively associated with vWF. Platelets proteins thiol groups were in a positive relationship with vWF, but in a negative relationship with uric acid and diagnosed lipid disorders. Both free thiol and amino groups were positively associated with plasma glucose. Platelets free amino groups were related to platelets count. Superoxide generation by blood platelets (both with and without homocysteine) was positively connected to glucose level. Among women, oxidative markers appear to be more related to glucose level, whereas among men they are related to body mass indices. TAS, TOS and oxidative markers are largely related to modifiable cardiovascular risk factors such as body mass, and intake of drugs such as angiotensin II receptor blockers. Plasma and platelet oxidation markers appear to be especially associated with glucose concentration. The presented analyses unanimously indicate strong connections between cardiovascular risk factors and redox potential and specify how cardiometabolic interventions may counter-balance oxidative stress.
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