1
|
Szeto B, Kesser B. Daytime Somnolence and Sleep Apnea Are Associated With Dizziness in the Elderly. Otol Neurotol 2024:00129492-990000000-00626. [PMID: 39234856 DOI: 10.1097/mao.0000000000004325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
OBJECTIVE Dizziness is a debilitating multifactorial disorder commonly affecting the elderly. Daytime somnolence and sleep apnea have been linked to dizziness, but previous studies were limited by small sample sizes. The purpose of this study was to examine the relationship between dizziness and daytime somnolence and sleep-disordered breathing, in a nationally representative sample of elderly adults, while adjusting for possible confounders and mediators. STUDY DESIGN Data from the National Health and Nutrition Examination Study (NHANES; 2017-2020 prepandemic data) were analyzed in a cross-sectional manner using survey methods. SETTING Community-based setting in the United States. PARTICIPANTS A total of 1,490 nationally representative participants aged ≥70 years. MAIN OUTCOMES Multivariable logistic regression was used to examine the relationship between dizziness and daytime somnolence, snoring, and apnea, while adjusting for covariates (gender, age, body mass index, and various medical conditions that may confound this relationship). RESULTS Frequent daytime somnolence five or more times monthly (odds ratio, 2.13; 95% confidence interval, 1.49-3.06) and presence of apnea (odds ratio, 1.65; 95% confidence interval, 1.20-2.27) were found to be associated with greater odds of dizziness when adjusting for medical comorbidities. A significant association was not found between snoring and dizziness. CONCLUSIONS AND RELEVANCE In the elderly, daytime somnolence and apnea were independently associated with increased odds of dizziness, even after adjusting for medical comorbidities. Daytime somnolence and sleep apnea should be added to the differential diagnosis in this patient population. Optimizing sleep may help reduce symptoms of dizziness in this population, but prospective studies would be required to confirm these findings.Level of evidence: 4.
Collapse
Affiliation(s)
- Betsy Szeto
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | | |
Collapse
|
2
|
Nielsen S, Nyvad J, Christensen KL, Poulsen PL, Laugesen E, Grove EL, Buus NH. Obstructive sleep apnea, coronary calcification and arterial stiffness in patients with diabetic kidney disease. Atherosclerosis 2024; 394:117170. [PMID: 37558603 DOI: 10.1016/j.atherosclerosis.2023.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnea (OSA) may accelerate arterial calcification, but the relation remains unexplored in diabetic kidney disease (DKD). We examined the associations between OSA, coronary calcification and large artery stiffness in patients with DKD and reduced renal function. METHODS Patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and urine albumin-creatinine ratio (UACR) > 30 mg/g were tested for OSA quantified by the apnea-hypopnea index (AHI, events/hour). Patients without OSA (AHI< 5) were compared to patients with moderate (AHI 15-29) or severe (AHI ≥30) OSA and underwent computed tomography angiography with coronary Agatston scoring (CAS) to quantify coronary calcification. Arterial stiffness was determined as carotid-femoral pulse wave velocity (PWV). RESULTS Among 114 patients with acceptable AHI recordings had 43 no OSA, 33 mild OSA and 38 moderate-severe OSA. Mean age of the 74 patients completing the study was 71.5 ± 9.4 years (73% males), eGFR 32.2 ± 12.3 ml/min/1.73 m2 and UACR 533 (192-1707) mg/g. CAS (ln-transformed) was significantly higher in patients with OSA compared to patients without (6.6 ± 1.7 vs. 5.6 ± 2.4, p = 0.04), and the same was observed for PWV (11.9 ± 2.7 vs. 10.5 ± 2.2 m/s, p = 0.02). In multivariable linear regression analyses adjusted for sex, age, body mass index, UACR, and mean arterial pressure, moderate-severe OSA remained significantly associated with PWV but not with CAS. Dominance analysis revealed OSA as the third and second most important factor relative to CAS and PWV respectively. CONCLUSIONS In DKD patients, moderate-severe OSA is a significant predictor of arterial stiffness but is not independently associated with coronary calcification.
Collapse
Affiliation(s)
- Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Løgstrup Poulsen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Esben Laugesen
- Steno Diabetes Center, Aarhus University Hospital, Denmark; Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Sheu JY, Chang LY, Chen JY, Chuang MH, Wu VC, Chueh JS. The Prevalence of Obstructive Sleep Apnea in Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2024:dgae415. [PMID: 38941133 DOI: 10.1210/clinem/dgae415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Indexed: 06/29/2024]
Abstract
CONTEXT Investigating the co-occurrence of obstructive sleep apnea (OSA) and primary aldosteronism (PA) is crucial for understanding their interrelation. OBJECTIVE This work aimed to evaluate the prevalence of OSA in individuals diagnosed with PA and to assess the prevalence of PA within the OSA population, with a specific focus on hypertensive individuals. METHODS An exhaustive search was performed across PubMed, Embase, CINAHL, Scopus, and Web of Science up to September 2023, without restrictions on language or publication date. Studies were selected based on their focus on the prevalence of OSA in PA patients and vice versa, specifically in hypertensive individuals. Data were extracted using standard guidelines, focusing on patient characteristics, prevalence rates, and other relevant clinical parameters. RESULTS Proportional meta-analysis using a random-effects model revealed a 59.8% prevalence of OSA in hypertensive PA patients, with 45.4% exhibiting moderate-to-severe OSA. Meta-regression showed no significant effect of age, sex, body mass index, antihypertensive medication, systolic blood pressure, diastolic blood pressure, or serum potassium on OSA prevalence. However, a significant positive association was found with the glomerular filtration rate (GFR) (P < .001). Subgroup analysis also revealed that a hyperfiltration rate (GFR ≥ 100 mL/min per 1.73 m2) may be associated with a higher prevalence of OSA (71%, P value for interaction < .01). Among hypertensive OSA patients, 11.2% had PA. CONCLUSION A substantial prevalence of OSA in individuals with PA was identified, demonstrating a complex interplay between these conditions in hypertensive patients. Notably, the prevalence of OSA was significantly associated with kidney hyperfiltration.
Collapse
Affiliation(s)
- Jia-Yuh Sheu
- Department of Urology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Li-Yang Chang
- College of Medicine, National Taiwan University, Taipei 106319, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Min-Hsiang Chuang
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Primary Aldosteronism Center of National Taiwan University Hospital, Taipei 100225, Taiwan
- Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital, Taipei 100225, Taiwan
- Primary Aldosteronism Center of National Taiwan University Hospital, Taipei 100225, Taiwan
- Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| |
Collapse
|
4
|
O'Brien JM, Dinh D, Roberts L, Teh A, Brennan A, Duffy SJ, Clark D, Ajani A, Oqueli E, Sebastian M, Reid C, Econ CH, Freeman M, Chandrasekhar J. Associations Between Metabolic Syndrome and Long-Term Mortality in Patients who underwent Percutaneous Coronary Intervention: An Australian Cohort Analysis. Am J Cardiol 2024; 219:25-34. [PMID: 38447892 DOI: 10.1016/j.amjcard.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 02/06/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
Metabolic syndrome (MetS) provides significant risk for coronary disease, however long-term prognosis after percutaneous coronary intervention (PCI) has been understudied. We assessed the prevalence and outcomes of patients with MetS from an Australian PCI cohort. We retrospectively examined data from the Melbourne Interventional Group multicenter PCI registry using a modified definition for MetS including ≥3 of the following: hypertension, diabetes mellitus, dyslipidemia, and body mass index ≥30 kg/m2. Thirty-day outcomes and long-term mortality were compared with patients without MetS. Cox regression methods were used to assess the multivariable effect of MetS on long-term mortality. Of 41,146 patients, 12,228 (34%) had MetS. Patients with MetS experienced greater 30-day myocardial infarction (2.2% vs 1.8%, p = 0.013), whereas patients without MetS had a trend for greater 30-day mortality (3.0% vs 3.4%, p = 0.051) and greater in-hospital major bleeding (1.7% vs 2.4%, p <0.001). After a median follow-up of 5.62 years (Q1 2.03, Q3 8.89), patients with MetS experienced greater mortality (24% vs 19%, p <0.001). After adjustment, MetS was not an independent predictor of long-term mortality (hazard ratio 0.95 confidence interval 0.86 to 1.05, p = 0.35). In sensitivity analyses, MetS-Diabetic patients had the highest, and MetS-NonDiabetic obese patients had the lowest long-term mortality. One in 3 patients who underwent all-comer PCI presented with MetS and experienced greater long-term mortality compared with others. However, this association was lost after adjustment for baseline confounders, highlighting that MetS is a marker of risk after PCI. Our findings support the obesity paradox and confirm robust associations between diabetes mellitus and long-term mortality.
Collapse
Affiliation(s)
- Joseph M O'Brien
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Andrew Teh
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - Stephen J Duffy
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine
| | - David Clark
- Department of Cardiology, Austin Health, Heidelberg, Victoria Australia; Department of Cardiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Service, Ballarat, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Barwon Health, University Hospital Geelong, Geelong, Victoria Australia
| | - Christopher Reid
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Cert Health Econ
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine; Royal Melbourne Hospital, Curtin University, Perth, Western Australia, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern Health, Box Hill, Victoria, Australia; Eastern Health Clinical School, Monash University, Victoria, Australia.
| |
Collapse
|
5
|
Peixoto de Miranda ÉJF, Mazzotti DR, Santos RB, Souza SP, Parise BK, Giatti S, Aielo AN, Cunha LF, Silva WA, Bortolotto LA, Lorenzi-Filho G, Lotufo PA, Bensenor IM, Bittencourt MS, Drager LF. Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health. Chest 2024; 165:202-212. [PMID: 37356709 DOI: 10.1016/j.chest.2023.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/06/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. RESEARCH QUESTION Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (β = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (β = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
Collapse
Affiliation(s)
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS; Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Ronaldo B Santos
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Silvana P Souza
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Barbara K Parise
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Soraya Giatti
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Aline N Aielo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Lorenna F Cunha
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Wagner A Silva
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratório do Sono, Disciplina de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Márcio S Bittencourt
- Cardiac CT Program, Heart and Vascular Institute, University of Pittsburgh., Pittsburgh, PA
| | - Luciano F Drager
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil.
| |
Collapse
|
6
|
Verma RK, Prasad V, Buddhavarapu V. The potential of clinical prediction model development from a change in cardiac repolarization and pulse oximetry data in patients with undiagnosed obstructive sleep apnea undergoing coronary artery bypass grafting. J Clin Sleep Med 2024; 20:3-5. [PMID: 37909086 PMCID: PMC10758564 DOI: 10.5664/jcsm.10904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Ram Kishun Verma
- Department of Sleep Medicine, Parkview Health, Fort Wayne, Indiana
| | - Vinita Prasad
- Department of Psychiatry, Parkview Health, Fort Wayne, Indiana
| | | |
Collapse
|
7
|
Seo MY, Lee SH, Kim HY. Obstructive sleep apnea and its association with coronary artery calcium volume in asymptomatic male subjects. Sci Rep 2023; 13:21620. [PMID: 38062084 PMCID: PMC10703816 DOI: 10.1038/s41598-023-47666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
The aim of this study was to analyze the association between various parameters related to obstructive sleep apnea (OSA) and coronary artery calcium (CAC) volume. We retrospectively reviewed the medical records of 315 male subjects who underwent standard polysomnography (PSG) and coronary artery computed tomography. In this study, we found that only the apnea index (AI) and minimal oxygen saturation (minimal SaO2) were independently associated with CAC volume after adjustment for confounders; for a 1/h increase in the AI, the CAC volume increased by 1.311 mm3, and for a 1% increase in the minimal SaO2, the CAC volume decreased by 2.187 mm3. We also found that the CAC volume was significantly different between the habitual snorer and the severe OSA group (21.27 ± 40.79 vs 71.33 ± 175.00, p = 0.042). Moreover, the CAC volume was significantly different between the first and fourth quartile groups of the AI (32.42 ± 59.54% vs. 78.74 ± 198.50, p = 0.048), but not among groups according to the hypopnea index quartile. Therefore, we concluded that among various OSA-related PSG parameters, the AI and minimal SaO2 was independently associated with the CAC volume and significantly related to upcoming cardiovascular events in middle-aged men.
Collapse
Affiliation(s)
- Min Young Seo
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| |
Collapse
|
8
|
Hao W, Wang B, Fan J, Que B, Ai H, Wang X, Nie S. Obstructive sleep apnea is associated with the long-term prognosis of patients in acute coronary syndromes with prior myocardial infarction: Insights from OSA-ACS study. Sleep Med 2023; 112:141-148. [PMID: 37862977 DOI: 10.1016/j.sleep.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/13/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to prior myocardial infarction (MI) remains unclear. We aimed to investigate the association between OSA and long-term cardiovascular outcomes in ACS patients with or without prior MI. METHODS We prospectively recruited eligible 2160 ACS patients with portable sleep monitoring in Beijing Anzhen Hospital between June 2015 and January 2020. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/hour. The primary endpoint 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. RESULTS Among 1927 patients enrolled, 1014 (52.6%) had OSA and 316 (16.4%) had prior MI. During 2.9 (1.5, 3.6) years of follow-up, multivariate analysis showed that OSA was associated with 1.7 times the risk of MACCE in patients with prior MI (50 events [28.2%] vs 24 events [17.3%]; adjusted HR = 1.74, 95%CI 1.04-2.90, P = 0.034), but not in patients without prior MI group (177 events [21.1%] vs 138 events [17.8%]; adjusted HR = 1.19, 95%CI 0.94-1.51, P = 0.15). There was no significant interaction between prior MI and OSA for MACCE (interaction P = 0.14). CONCLUSIONS OSA was independently associated with an increased risk of MACCE among ACS patients, particularly among ACS patients with prior MI. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS characterized by prior MI are warranted.
Collapse
Affiliation(s)
- Wen Hao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bin Wang
- Division of Cardiology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
| |
Collapse
|
9
|
Li X, Chen J, Du H, Zhang Y, Hua J, Cheng Y, Li X, Chen X. Association between Obstructive Sleep Apnea and Intracranial Artery Calcification Stratified by Gender and Body Mass Index: A Hospital-Based Observational Study. Neuroepidemiology 2023; 57:391-399. [PMID: 37660685 DOI: 10.1159/000533843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial arterial calcification (IAC) has been validated as a marker for subclinical cerebrovascular disease. However, the relationship between OSA with IAC was less studied compared with its established association with coronary artery calcification. In this study, we aimed to investigate the association between the severity of OSA and the degree of IAC in hospitalized patients without preexisting cardiovascular disease. METHODS This hospital-based observational study was conducted from June 1, 2017, to May 1, 2019. In total, 901 consecutive patients who underwent head computed tomography scans and portable sleep monitoring were included. On the basis of the apnea-hypopnea index (AHI), patients were divided into four OSA severity groups (normal: AHI <5/h; mild: 5≤ AHI <15/h; moderate: 15≤ AHI <30/h; severe: AHI ≥30/h). Associations of OSA with IAC scores were assessed by using multivariate logistic regression analysis. RESULTS Of the 901 patients, 484 (53.7%) were men; the mean (SD) age was 66.1 (10.0) years. The non-OSA group included 207 (23.0%) patients; mild OSA, 209 (23.2%); moderate OSA, 235 (26.1%); and severe OSA, 169 (18.8%). Mean IAC scores were higher in the severe OSA group compared with non-, mild, and moderate OSA groups (4.79 vs. 2.58; 4.79 vs. 2.94; 4.79 vs. 3.39; p < 0.001). Multivariate analysis adjusted for confounding factors revealed that only severe OSA was associated with a higher IAC score (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.43-1.91; p < 0.001). In stratified analyses by BMI, among participants with a BMI <25 kg/m2, the positive association between AHI values and IAC scores was found in the moderate OSA group (OR: 1.23; 95% CI: 1.05, 1.43; p = 0.01) and the severe OSA group (OR: 1.96; 95% CI: 1.55, 2.48; p < 0.001). When stratified by gender, in women, the positive association was found in the moderate OSA group (adjusted OR: 1.21; 95% CI: 1.02-1.51; p = 0.016) and the severe OSA group (adjusted OR: 1.76; 95% CI: 1.36-2.25; p < 0.001). For the men group, a positive association between IAC scores and AHI was only observed in the severe OSA group. DISCUSSION These findings suggest that OSA, in particular severe OSA (AHI ≥30), is independently associated with higher IAC scores. Women and no-obesity individuals appeared more susceptible to adverse OSA-related subclinical cerebrovascular disease as measured by IAC scores.
Collapse
Affiliation(s)
- Xuelong Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China,
| | - Junru Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
| | - Yujing Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiewei Hua
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangyang Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
| | - Xianliang Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China
| |
Collapse
|
10
|
Swami SS, Aye SL, Trivedi Y, Bolgarina Z, Desai HN, Senaratne M, Mohammed L. From Snoring to Soaring: Unveiling the Positive Effects of Continuous Positive Airway Pressure Ventilation on Cardiovascular Health in Patients With Obstructive Sleep Apnoea Through a Systematic Review. Cureus 2023; 15:e45076. [PMID: 37711271 PMCID: PMC10497801 DOI: 10.7759/cureus.45076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023] Open
Abstract
Increased cardiovascular (CV) morbidity and death are linked to obstructive sleep apnoea (OSA). The primary method of treating OSA is continuous positive airway pressure (CPAP). CPAP has some debatable outcomes on CV events in people suffering from OSA. The current study investigates how CPAP affects CV outcomes. The goal is to evaluate CPAP's effectiveness in lowering CV outcomes in OSA patients. We used a computer to search the PubMed, PubMed Central Library, Science Direct, and Google Scholar databases for studies comparing the effects of CPAP and a control group on CV outcomes in OSA patients. These included randomised control trials (RCT), narrative reviews, systematic reviews, case-control studies, observational studies and meta-analyses. A total of 52,937 patients were included in the final analysis of six RCTs, four observational studies, 10 meta-analyses, one case-control study, two systematic reviews and one narrative review. The weighted mean follow-up lasted for a period of between three months and nine years. The risk of major cardiovascular adverse events (MACE) was the same for both the CPAP and control groups. According to subgroup analysis, patients with lower MACE adherence rates (four hours per night) were more likely to use CPAP. The risk of all-cause mortality, CV-related complications causing mortality, acute myocardial infarction acute stroke, or hospitalisations for angina was the same in the CPAP and control groups. The primary outcome was that in patients with therapy with CPAP in addition to usual care and usual care alone did not prevent CV events in patients with moderate-to-severe OSA and existing CV illness. Patients with OSA who utilise CPAP may not experience fewer CV events. Patients who use CPAP consistently (four hours per night) could benefit from improved CV results. Future research must assess how well-adherent patients with severe OSA and low CV event rates respond to CPAP therapy. In patients who use CPAP for more than four hours each night, CPAP therapy may minimise the risk of MACE and stroke. Additional randomised trials requiring adequate CPAP time adherence are needed to support this perception. Despite the fact that there is no evidence to support the claim that CPAP therapy improves CV outcomes, bias difficulties, CPAP adherence problems, and the patient groups included in each RCT may have made it more difficult to generalise the findings to all patients. Future research is therefore needed to look at these relevant results.
Collapse
Affiliation(s)
- Shivling S Swami
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Soe Lwin Aye
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Yash Trivedi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zoryana Bolgarina
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Heet N Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mithum Senaratne
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
11
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
12
|
Dey S, Sun E, Frishman WH, Aronow WS. Sleep Disorders and Coronary Artery Disease. Cardiol Rev 2023; 31:219-224. [PMID: 36301202 DOI: 10.1097/crd.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A sufficient amount and quality sleep is vital components for maintaining optimal physical wellbeing, cognition, and cardiovascular health. Normal sleep provides us with a low physiological stress that promotes overall cardiovascular health. Sleep disorders are common, and often goes undiagnosed. Patients with sleep disorders, commonly suffer from poor quality of life due to the poor quality of their sleep. They are associated with adverse effects on cardiovascular health, such as coronary artery disease. Sleep disorders discussed in this review article include sleep-disordered breathing (obstructive sleep apnea and central sleep apnea), insomnia and restless leg syndrome. Sleep disorders primarily have four acute adverse cardiovascular consequences. First, intermittent hypoxemia-reoxygenation in arterial blood along with PCO 2 fluctuation; second is excessive arousals; third, decreased parasympathetic and increased sympathetic tone; fourth being the large pressure swings in the intrathoracic cavity. This review focuses on classifications, and prevalence of the three major classes of sleep disorders, and the evidence to date on the association between these sleep disorders and coronary artery disease.
Collapse
Affiliation(s)
- Subo Dey
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Eric Sun
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| |
Collapse
|
13
|
de Menezes-Júnior LAA, Fajardo VC, Neto RMDN, de Freitas SN, Oliveira FLP, Pimenta FAP, Machado-Coelho GLL, Meireles AL. Association of Hypovitaminosis D with Sleep Parameters in Rotating Shift Worker Drivers. Sleep Sci 2023; 16:84-91. [PMID: 37151772 PMCID: PMC10157830 DOI: 10.1055/s-0043-1767748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/09/2022] [Indexed: 05/09/2023] Open
Abstract
Objective To evaluate the association between sleep parameters and hypovitaminosis D in rotating shift drivers. Material and Methods We conducted a cross-sectional study on 82 male rotating shift workers (24-57 years old) with at least one cardiovascular risk factor (such as hyperglycemia, dyslipidemia, abdominal obesity, physical inactivity, hypertension, and smoking). Polysomnography was used to evaluate sleep parameters. Logistic regression was used to model the association between hypovitaminosis D and sleep parameters after adjustment for relevant covariates. Results Hypovitaminosis D (< 20 ng/mL) was seen in 30.5% of the workers. Shift workers with hypovitaminosis D had lower sleep efficiency (odds ratio [OR]: 3.68; 95% confidence interval [CI]: 1.95-5.53), lower arterial oxygen saturation (OR: 5.35; 95% CI: 3.37-6.12), and increased microarousal index (OR: 3.85; 95% CI: 1.26-5.63) after adjusting. Conclusion We suggest that hypovitaminosis D is associated with greater sleep disturbances in rotating shift workers.
Collapse
Affiliation(s)
- Luiz Antônio Alves de Menezes-Júnior
- Federal University of Ouro Preto, Postgraduate in Health and Nutrition, Ouro Preto, MG, Brazil
- Address for correspondence Luiz Antônio Alves de Menezes-Júnior
| | - Virgínia Capistrano Fajardo
- Federal University of Minas Gerais, Postgraduate in Applied Sciences in Adult Health, Belo Horizonte, MG, Brazil
| | | | | | | | | | - George Luiz Lins Machado-Coelho
- Federal University of Ouro Preto, Postgraduate in Health and Nutrition, Ouro Preto, MG, Brazil
- Federal University of Ouro Preto, School of Medicine, Ouro Preto, MG, Brazil
| | - Adriana Lúcia Meireles
- Federal University of Ouro Preto, Postgraduate in Health and Nutrition, Ouro Preto, MG, Brazil
- Federal University of Ouro Preto, School of Nutrition, Ouro Preto, MG, Brazil
| |
Collapse
|
14
|
Sahnoun I, Moussa I, Ghériani R, Smaoui R, El Gharbi LD. [Obstructive hypopnea sleep apnea syndrome in the elderly]. Pan Afr Med J 2023; 44:78. [PMID: 37159628 PMCID: PMC10162893 DOI: 10.11604/pamj.2023.44.78.36607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/14/2022] [Indexed: 05/11/2023] Open
Abstract
Introduction obstructive sleep apnea hypopnea syndrome (OSAHS) is a common but often under diagnosed disease among elderly persons. The aim of our study was to determine the clinical and polygraphic characteristics of OSAHS in elderly by comparing them to younger patients. Methods a retrospective study was performed at Pavillon D pneumology at Abderrahmen Mami Hospital in Ariana including 222 patients with OSAHS, divided into two groups: group 1 including 72 patients aged 18 to 45 years and Group 2 including 150 patients aged 65 and over. Clinical and polygraphic data was collected. Results elderly patients were more female, less exposed to tobacco but more exposed to biomass smoke. The average consultation time was significantly longer for elderly patients compared to young patients. Diurnal fatigue and memory impairment were more observed in elderly patients. Asthma, hypothyroidism, diabetes, dyslipidemia, hypertension and atrial fibrillation were most commonly observed in elderly patients. Pauses in airflow and tonsillary hypertrophy were less observed in this group. There was no significant difference in OSAHS severity between the 2 groups. Logistic regression analysis showed that elderly apneic patients were more likely to be female, to have more memory impairment and to have more comorbidities with HTA, atrial fibrillation, diabetes and hypothyroidism. Conclusion the frequency of cardiovascular, metabolic and cognitive comorbidities requires sleep investigation in apneic elderly subject, whether the clinical presentation is typical or not.
Collapse
Affiliation(s)
- Imen Sahnoun
- Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Corresponding author: Imen Sahnoun, Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie.
| | - Ines Moussa
- Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Rim Ghériani
- Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Racha Smaoui
- Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| | - Leila Douik El Gharbi
- Service de Pneumologie D, Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie
| |
Collapse
|
15
|
Titova OE, Yuan S, Baron JA, Lindberg E, Michaëlsson K, Larsson SC. Self-reported symptoms of sleep-disordered breathing and risk of cardiovascular diseases: Observational and Mendelian randomization findings. J Sleep Res 2022; 31:e13681. [PMID: 35869582 PMCID: PMC9788251 DOI: 10.1111/jsr.13681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
Sleep-disordered breathing may increase the risk of cardiovascular diseases, but observational findings are inconclusive. We investigated whether sleep-disordered breathing-related symptoms are associated with risk of several cardiovascular diseases using data from a cohort study and by performing Mendelian randomization analyses. The cohort study included 43,624 adults (56-94 years old) who completed questionnaires regarding symptoms of snoring and cessation of breathing, lifestyle habits and health characteristics. Participants were followed up for incident cardiovascular diseases and death over 8 years through linkage to the Swedish National Patient and Death Registers. The Mendelian randomization analyses were conducted using single-nucleotide polymorphisms robustly associated with sleep apnea in a recent genome-wide association study and summary-level data for major cardiovascular diseases from large-scale consortia. In the cohort study, an increased risk of atrial fibrillation was observed in participants who reported both snoring and cessation of breathing (hazard ratio [95% confidence interval] = 1.16 [1.03-1.30]) compared with those without sleep-disordered breathing symptoms. There was no association between sleep-disordered breathing symptoms and risk of myocardial infarction, heart failure, aortic valve stenosis or abdominal aortic aneurysm in multivariable analyses. Mendelian randomization analyses showed no association of genetic liability to sleep apnea with myocardial infarction, heart failure or atrial fibrillation, but revealed a suggestive association with coronary artery disease (odds ratio [95% confidence interval] = 1.24 [1.02-1.52]).
Collapse
Affiliation(s)
- Olga E. Titova
- Unit of Medical Epidemiology, Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Shuai Yuan
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - John A. Baron
- Unit of Medical Epidemiology, Department of Surgical SciencesUppsala UniversityUppsalaSweden,Department of MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA,Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep ResearchUppsala UniversityUppsalaSweden
| | - Karl Michaëlsson
- Unit of Medical Epidemiology, Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Susanna C. Larsson
- Unit of Medical Epidemiology, Department of Surgical SciencesUppsala UniversityUppsalaSweden,Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| |
Collapse
|
16
|
Liu Y, Wang M, Shi J. Influence of obstructive sleep apnoea on coronary artery disease in a Chinese population. J Int Med Res 2022; 50:3000605221115389. [PMID: 36036372 PMCID: PMC9434670 DOI: 10.1177/03000605221115389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between obstructive sleep apnoea (OSA) and the severity of coronary artery disease (CAD) assessed by angiography. METHODS This prospective study screened 273 patients diagnosed with CAD by coronary angiography. The severity of CAD was assessed by SYNTAX score. A total of 255 subjects were enrolled of whom 161 were diagnosed with OSA, with an apnoea-hypopnoea index ≥5/hour. Ninety-four CAD patients without OSA were used as controls. The relationship between OSA and CAD was analysed by multiple linear regression. RESULTS The prevalence of OSA in CAD patients was 63.1%. The prevalences of single-vessel, two-vessel, and three-vessel disease were similar in the two groups. However, CAD was significantly more severe in patients with OSA, measured by SYNTAX score, than in those without OSA. OSA was independently associated with CAD after adjusting for traditional risk factors. CONCLUSIONS OSA is relatively common among patients with CAD in China. The independent association between OSA and CAD, even after adjusting for traditional confounders, suggests that OSA should be taken into account when considering the risk factors for CAD. The present findings highlight the important adverse influence of OSA on the severity of CAD.
Collapse
Affiliation(s)
- Yufei Liu
- The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, China
| | - Meitan Wang
- Harbin Children's Hospital affiliated to Harbin Medical University, Harbin, China
| | - Jinghui Shi
- The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, China
| |
Collapse
|
17
|
Li YE, Ren J. Association between obstructive sleep apnea and cardiovascular diseases. Acta Biochim Biophys Sin (Shanghai) 2022; 54:882-892. [PMID: 35838200 PMCID: PMC9828315 DOI: 10.3724/abbs.2022084] [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] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by partial obstruction of upper respiratory tract and repetitive cessation of breathing during sleep. The etiology behind OSA is associated with the occurrence of intermittent hypoxemia, recurrent arousals and intrathoracic pressure swings. These contributing factors may turn on various signaling mechanisms including elevated sympathetic tone, oxidative stress, inflammation, endothelial dysfunction, cardiovascular variability, abnormal coagulation and metabolic defect ( e.g., insulin resistance, leptin resistance and altered hepatic metabolism). Given its close tie with major cardiovascular risk factors, OSA is commonly linked to the pathogenesis of a wide array of cardiovascular diseases (CVDs) including hypertension, heart failure, arrhythmias, coronary artery disease, stroke, cerebrovascular disease and pulmonary hypertension (PH). The current standard treatment for OSA using adequate nasal continuous positive airway pressure (CPAP) confers a significant reduction in cardiovascular morbidity. Nonetheless, despite the availability of effective therapy, patients with CVDs are still deemed highly vulnerable to OSA and related adverse clinical outcomes. A better understanding of the etiology of OSA along with early diagnosis should be essential for this undertreated disorder in the clinical setting.
Collapse
Affiliation(s)
- Yiran E. Li
- Department of CardiologyZhongshan HospitalFudan University; Shanghai Institute of Cardiovascular DiseasesShanghai200032China
| | - Jun Ren
- Department of CardiologyZhongshan HospitalFudan University; Shanghai Institute of Cardiovascular DiseasesShanghai200032China,Department of Laboratory Medicine and PathologyUniversity of WashingtonSeattleWA98195USA,Correspondence address. Tel: +86-21-64041990; E-mail:
| |
Collapse
|
18
|
Naghshtabrizi N, Alizadeh S, Naghshtabrizi B, Jalali A, Salarifar M. Relationship between Severity and Complexity of Coronary Artery Involvement and Obstructive Sleep Apnea Based on STOP-BANG Questionnaire. Int J Prev Med 2022; 13:34. [PMID: 35392318 PMCID: PMC8980830 DOI: 10.4103/ijpvm.ijpvm_443_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA), which has a known correlation with cardiovascular disease, is a possible risk factor of coronary artery disease (CAD) that is preventable. Aims: We sought to put lights on the relationship between OSA based on the STOP-BANG questionnaire (SBQ) and the severity and complexity of coronary artery involvement. Methods: This cross-sectional, single-center, retrospective study was conducted among 145 patients who underwent selective coronary angiography (SCA) between October 2018 and March 2019, admitted to the Tehran Heart Center, Tehran, Iran. OSA risk was assessed in patients based on SBQ categories. Also, the severity and complexity of coronary artery involvement calculated according to SYNTAX and Gensini scores. Analysis performed by statistical software SPSS 25. Results: Based on SBQ risk assessment categories, 22 (15.2%), 64 (44.1%), and 59 (40.7%) of the patients were low, intermediate, and high-risk for OSA, respectively. By comparing the means of coronary artery involvement, there was no significant difference in SYNTAX score 17.15 ± 13.67 (10.56–23.74) in low, 15.67 ± 9.78 (13.19–18.16) in intermediate, and 16.93 ± 9.21 (14.42–19.45) in high-risk groups; P value: 0.754, and Gensini score 66.4 ± 70.75 (35.04–97.77) in low, 66.21 ± 55.05 (52.45–79.96) in intermediate, 74.61 ± 56.33 (59.93–89.3) iin high risk groups; P value: 0.697 with groups of OSA risks. Also, after adjusting confounding factors, there was still no statistically significant difference in terms of coronary involvement scores. Conclusions: There was no statistically significant difference in SYNTAX and Gensini scores of different groups of OSA risk categories based on the SBQ. However, our results can't be extended into the connection between OSA and CAD.
Collapse
Affiliation(s)
- Nima Naghshtabrizi
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | - Soroosh Alizadeh
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | | | - Arash Jalali
- Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Elfanagely Y, Atsawarungruangkit A, Scharfen J, Pavlech L, Moss SF. Association Between Obstructive Sleep Apnea and Barrett's Esophagus: A Systematic Review and Meta-Analysis. Dig Dis Sci 2021; 66:3689-3697. [PMID: 33236316 DOI: 10.1007/s10620-020-06709-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has gastrointestinal implications as it is associated with gastroesophageal reflux disease. Less certain is an independent association between OSA and Barrett's esophagus. We performed a systematic review and meta-analysis to evaluate the association between OSA and Barrett's esophagus. METHODS A systematic search of Ovid MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials was performed. Inclusion criteria were observational studies (retrospective and case-control) assessing the association between OSA and Barrett's esophagus in adult subjects. Data from the included studies were extracted and used to calculate the pooled odds ratio of OSA with 95% confidence interval (CI) between patients with Barrett's esophagus and those without, using a random-effects model. RESULTS Altogether six studies involving 2333 subjects met the inclusion criteria and were included in this meta-analysis. The pooled analysis found a significantly increased risk of OSA, high risk of OSA, and patient-reported OSA symptoms among patients with Barrett's esophagus versus those without Barrett's esophagus, with a pooled odds ratio (OR) of 2.19 (95% CI 1.53-3.15). A subgroup analysis for cases of definite OSA (formally diagnosed via polysomnography) and Barrett's esophagus (n = 2 studies) also demonstrated significant association (OR 2.59, 95% CI 1.39-4.84). CONCLUSION A significantly increased risk of OSA among patients with Barrett's esophagus was demonstrated in this meta-analysis. Further investigation is warranted to determine the pathophysiology and clinical implications of this association.
Collapse
Affiliation(s)
- Yousef Elfanagely
- Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, Jane Brown Ground, Suite 0100, Providence, RI, USA.
| | | | - James Scharfen
- Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, Jane Brown Ground, Suite 0100, Providence, RI, USA
| | - Laura Pavlech
- Brown University Library, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven F Moss
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| |
Collapse
|
21
|
ZORLU Ç. Aortic arch calcification is strongly associated with obstructive sleep apnea. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.948441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
22
|
Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:608-624. [PMID: 34353537 DOI: 10.1016/j.jacc.2021.05.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.
Collapse
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
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.
Collapse
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.
| |
Collapse
|
25
|
Zhang X, Wang S, Xu H, Yi H, Guan J, Yin S. Metabolomics and microbiome profiling as biomarkers in obstructive sleep apnoea: a comprehensive review. Eur Respir Rev 2021; 30:30/160/200220. [PMID: 33980666 PMCID: PMC9489097 DOI: 10.1183/16000617.0220-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in metabolism and the microbiome may serve as biomarkers for OSA. Herein, we review the literature on the metabolomic and microbiome changes associated with OSA, and identify the metabolites and microorganisms involved. Methods We searched the PUBMED and EMBASE electronic databases using the following terms: “obstructive sleep apnea”, “OSA”, “sleep disordered breathing”, “SDB”, “intermittent hypoxia”, “sleep fragmentation”, and either “metabolomics” or “microbiome”. In total, 273 papers were identified, of which 28 were included in our study. Results Changes in the levels of certain metabolites related to fatty acid, carbohydrate and amino acid metabolism were associated with the incidence of OSA. The diversity and abundance of microflora, particularly Firmicutes and Bacteroidetes, were altered in humans and rodents with OSA. Conclusions Certain changes in metabolism and the microbiota play an integral role in the pathophysiology of OSA and OSA-induced cardiovascular complications. Metabolomic and microbiome biomarkers shed light on the pathogenesis of OSA, and facilitate early diagnosis and treatment. Unique alterations in metabolism and the microbiome play an integral role in the pathophysiology of OSA and OSA-induced cardiovascular complicationshttps://bit.ly/3mW2rD5
Collapse
Affiliation(s)
- Xiaoman Zhang
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Both authors contributed equally
| | - Shengming Wang
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China.,Both authors contributed equally
| | - Huajun Xu
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China .,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Dept of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
26
|
Ding MC, Hsu CM, Liu SYC, Lee YC, Yang YH, Liu CY, Chang GH, Tsai YT, Lee LA, Yang PR, Li HY, Tsai MS. Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063191. [PMID: 33808734 PMCID: PMC8003369 DOI: 10.3390/ijerph18063191] [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] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Abstract
(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea–DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p < 0.001). A strong sleep apnea–DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28–2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.
Collapse
Affiliation(s)
- Meng-Chang Ding
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
| | - Cheng-Ming Hsu
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yao-Hsu Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
| | - Geng-He Chang
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Pei-Rung Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: (H.-Y.L.); (M.-S.T.); Tel.: +886-3-328-1200 (ext. 3968) (H.-Y.L.); +886-5-362-1000 (ext. 2076) (M.-S.T.); Fax: +886-3-397-9361 (H.-Y.L.); +886-5-3623002 (M.-S.T.)
| | - Ming-Shao Tsai
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (H.-Y.L.); (M.-S.T.); Tel.: +886-3-328-1200 (ext. 3968) (H.-Y.L.); +886-5-362-1000 (ext. 2076) (M.-S.T.); Fax: +886-3-397-9361 (H.-Y.L.); +886-5-3623002 (M.-S.T.)
| |
Collapse
|
27
|
Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:30-38. [PMID: 33613657 PMCID: PMC7868912 DOI: 10.11909/j.issn.1671-5411.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a potential cardiovascular risk. We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction (AMI). METHODS We prospectively enrolled 252 AMI elderly patients (mean age, 68.5 ± 6.9 years) who were undergoing revascularization and completed a sleep study during their hospitalization. All subjects were categorized into non-OSA (apnea–hypopnea index (AHI) < 15, n = 130) and OSA (AHI ≥ 15, n = 122) groups based on the AHI. The changes in the autonomic nervous system, incidence of arrhythmia during nocturnal sleep, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between the groups.
RESULTS The mean AHI value in all AMI patients was 22.8 ± 10.9. OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation (MinSaO2), as well as greater proportion of multivessel coronary artery disease (all P < 0.05). The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset (both P < 0.05) and higher incidence of arrhythmia (including sinus, atrial, and ventricular in origin). At a median follow-up of 6 months (mean 0.8–1.6 years), OSA (AHI ≥ 15) combined with hypoxia (MinSaO 2 ≤ 80%) was independently associated with the incidence of MACCEs (hazard ratio [HR]: 4.536; 95% confidence interval [CI]: 1.461−14.084,P = 0.009) after adjusting for traditional risk factors.
CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction, increase the occurrence of heart rhythm disorders in elderly subacute MI patients, and worsen their short-term poor outcomes.
Collapse
|
28
|
Kwon Y, Mariani S, Reid M, Jacobs D, Lima J, Kapur V, Punjabi N, Redline S. Lung to finger circulation time in sleep study and coronary artery calcification: the Multi-Ethnic Study of Atherosclerosis. Sleep Med 2020; 75:8-11. [PMID: 32841914 PMCID: PMC7669686 DOI: 10.1016/j.sleep.2020.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/10/2020] [Accepted: 05/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Lung to finger circulation time (LFCT) measured from sleep studies may represent a novel physiologic marker for cardiovascular risk in patients with sleep disordered breathing (SDB). We hypothesized that sleep study-derived LFCT would improve risk classification of markers of subclinical cardiovascular disease. METHODS We included participants in the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep cohort with moderate-severe SDB (apnea hypopnea index [AHI] ≥ 15/hr) (N = 598). RESULTS Those with average LFCT above the median (19.4 s) (vs. shorter LFCT) tended to be older, more obese and male. In multivariable analysis, no significant associations were found between average LFCT and subclinical cardiovascular markers including coronary artery calcium, carotid intima-media thickness or left ventricular hypertrophy. However, there was modest improvement in risk classification of coronary artery calcification as compared with AHI alone when average LFCT was added to AHI (C statistics 0.53 vs. 0.62, p = 0.0066). CONCLUSIONS In conclusion, LFCT may be a useful addition to conventional SDB metrics to improve cardiovascular risk assessment.
Collapse
Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Sara Mariani
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle Reid
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - David Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MA, USA
| | - Vishesh Kapur
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Naresh Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, MA, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
29
|
Ishiwata S, Tomita Y, Ishiwata S, Narui K, Daida H, Kasai T. Association between Obstructive Sleep Apnea and SYNTAX Score. J Clin Med 2020; 9:jcm9103314. [PMID: 33076434 PMCID: PMC7602636 DOI: 10.3390/jcm9103314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is related to an increased risk of cardiovascular diseases, including coronary artery disease (CAD). We investigated the association between OSA and the severity of CAD by assessing coronary angiography findings. We retrospectively analyzed patients who underwent their first coronary angiography to evaluate CAD and polysomnography (PSG) to investigate the severity of OSA in our hospital from March 2002 to May 2015. The severity of CAD was determined based on coronary angiography findings using the SYNTAX score. The patients were divided into two groups according to the apnea-hypopnea index (AHI): mild OSA (AHI < 15/h) and moderate-to-severe OSA (AHI ≥ 15/h). Overall, 98 patients were enrolled. The SYNTAX score was significantly different between the two groups (p = 0.001). After adjustment for other risk factors, including age, sex, obesity, hypertension, hyperlipidemia, diabetes mellitus, smoking status, and family history of CAD, moderate-to-severe OSA significantly correlated to the SYNTAX score (partial correlations = 0.24, p = 0.039). These results suggest that the severity of CAD is related to moderate-to-severe OSA.
Collapse
Affiliation(s)
- Sayaki Ishiwata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (S.I.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Yasuhiro Tomita
- Department of Cardiovascular Medicine, Toranomon Hospital, Tokyo 105-8470, Japan;
- Department of Sleep Medicine, Toranomon Hospital, Tokyo 105-8470, Japan;
- Correspondence:
| | - Sugao Ishiwata
- Department of Cardiovascular Medicine, Toranomon Hospital, Tokyo 105-8470, Japan;
| | - Koji Narui
- Department of Sleep Medicine, Toranomon Hospital, Tokyo 105-8470, Japan;
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (S.I.); (H.D.); (T.K.)
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (S.I.); (H.D.); (T.K.)
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| |
Collapse
|
30
|
Seo MY, Lee SH, Hong SD, Chung SK, Kim HY. Hypoxemia During Sleep and the Progression of Coronary Artery Calcium. Cardiovasc Toxicol 2020; 21:42-48. [PMID: 32705479 DOI: 10.1007/s12012-020-09593-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate the associations between objective sleep parameters of obstructive sleep apnea (OSA) and progression of subclinical cardiovascular disease as measured by the coronary artery calcium (CAC) score. We reviewed the medical records of 196 patients who underwent both polysomnography (PSG) and repeated coronary artery computed tomography (CT) for screening purposes. For each participant, the first coronary CT scan was conducted within 12 months of PSG. Follow-up CT was performed voluntarily. The CAC score was log-transformed to obtain normally distributed data. We evaluated potential associations between various sleep parameters by analyzing overnight-attended PSG and CAC score progression over time. ST90 (total sleep time of SaO2 < 90%), CT90 (percentage of time of SaO2 < 90%), and degree of mean oxygen desaturation were significantly correlated with CAC score progression even after adjustment for confounders (age, sex, DM, HTN, hypercholesterolemia, BMI, and smoking status) (estimate = 0.004, p = .010; estimate = 0.009, p < .001; estimate = 0.027, p = .001; respectively). We also performed subgroup analysis and found that the progression of CAC score over time showed higher tendency when CT90 value was 2.73 or more (CT90 ≥ 2.73 group; estimate = 0.336, CT90 < 2.73 group; estimate = 0.194, p < .001 each). ST90, CT90 and mean oxygen desaturation are significant predictors of cardiovascular disease progression. Coronary artery status should be monitored repetitively in patients with hypoxemia during sleep.
Collapse
Affiliation(s)
- Min Young Seo
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea.,Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
31
|
Kim S, Lee KY, Kim NH, Abbott RD, Kim C, Lee SK, Kim SH, Shin C. Relationship of obstructive sleep apnoea severity and subclinical systemic atherosclerosis. Eur Respir J 2020; 55:13993003.00959-2019. [PMID: 31672758 DOI: 10.1183/13993003.00959-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/16/2019] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnoea (OSA) is a common form of sleep disordered breathing. Untreated OSA might accelerate atherosclerosis, potentially increasing the cardiovascular disease burden in patients. The present study aimed to evaluate the association between objectively measured OSA severity and the presence of subclinical systemic atherosclerosis using noninvasive measurements, including tomographic quantification of the calcium burden.A total of 2157 participants of the Korean Genome and Epidemiology Study, who were free of structural heart disease and underwent both in-home polysomnography and chest computed tomography, were cross-sectionally analysed. Participants were divided into three groups based on the severity of OSA: no OSA (apnoea-hypopnoea index (AHI) <5 events·h-1, n=1096), mild OSA (AHI 5- <15 events·h-1, n=700) and moderate-to-severe OSA (AHI ≥15 events·h-1, n=361). Calcium deposits in the thoracic aorta and coronary arteries were measured by the Agatston score.Participants with moderate-to-severe OSA were 1.6 times (95% CI 1.18-2.15 times; p=0.002) more likely to have ascending thoracic aorta calcification (≥100 units) than those without OSA, after adjustment for cardiovascular risk factors. In addition, the association between moderate-to-severe OSA and ascending thoracic aorta calcification of subjects with higher epicardial fat volume was slightly stronger than that in patients without OSA and in the lowest epicardial fat volume tertile (OR 2.11, 95% CI 1.30-3.43).Severity of OSA in the general population was independently associated with subclinical systemic atherosclerosis. These findings highlight the potential importance of severe OSA, especially in subjects with higher epicardial fat, as a possible predictive factor for systemic atherosclerosis and cardiovascular disease.
Collapse
Affiliation(s)
- Soriul Kim
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ki Yeol Lee
- Dept of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea.,These two authors contributed equally to this work
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Dept of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Robert D Abbott
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Cherry Kim
- Dept of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Seong Hwan Kim
- Division of Cardiology, Dept of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chol Shin
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea .,Division of Pulmonary Sleep and Critical Care Medicine, Dept of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.,These two authors contributed equally to this work
| |
Collapse
|
32
|
Resano-Barrio MP, Arroyo-Espliguero R, Viana-Llamas MC, Mediano O. Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk. Eur Cardiol 2020; 15:e65. [PMID: 33042228 PMCID: PMC7539148 DOI: 10.15420/ecr.2020.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnoea (OSA) syndrome is characterised by the presence of apnoea or obstructive hypopnoea during sleep, accompanied by hypoxia. It is estimated that the syndrome affects approximately 10% of men and 15% of women. Diagnosis and treatment rates have increased in recent years, but the condition remains undiagnosed in a high percentage of patients. Recent evidence suggests that OSA may increase the risk of cardiovascular disease. The relationship between OSA and cardiovascular disease can be explained, at least in part, by the coexistence of cardiovascular risk factors in the two pathologies, such as age, overweight, smoking and sedentary lifestyle. However, OSA has been independently associated with the risk of developing hypertension, cerebrovascular disease, ischaemic heart disease, heart failure and arrhythmias. Clinical trials that have evaluated the efficacy of continuous positive airway pressure (CPAP) treatment in primary and secondary cardiovascular prevention have not demonstrated a significant reduction in the incidence or recurrence of cardiovascular events. This article analyses the relationship between OSA and cardiovascular risk and discusses recent clinical trials on the efficacy of CPAP in primary and secondary cardiovascular prevention.
Collapse
Affiliation(s)
| | | | | | - Olga Mediano
- Department of Respiratory Medicine, University HospitalGuadalajara, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)Madrid, Spain
- Department of Medicine, University of AlcaláAlcalá de Henares, Madrid, Spain
| |
Collapse
|
33
|
Kwon Y, Logan J, Pusalavidyasagar S, Kasai T, Cheong CS, Lee CH. Sleep Apnea and Heart. SLEEP MEDICINE RESEARCH 2019; 10:67-74. [PMID: 32699652 DOI: 10.17241/smr.2019.00493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Scientific investigations in the past few decades have supported the important role of sleep in various domains of health. Sleep apnea is a highly prevalent yet underdiagnosed sleep disorder representing a valid cardiovascular risk factor, particularly for hypertension. While several studies have demonstrated the benefits of sleep apnea treatment on subclinical cardiovascular measures, there is a paucity of studies proving reduction of cardiovascular events and mortality. Sufficient and high-quality sleep is also important in the maintenance of cardiovascular health. Future investigations should focus on improving identification of patients at greatest risk of adverse cardiovascular s sequalae of sleep apnea and testing the therapeutic benefit of sleep apnea treatment in this vulnerable group.
Collapse
Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Virginia, Charlottesville, VA 22908 USA
| | - Jeongok Logan
- University of Virginia School of Nursing, Charlottesville, VA 22908 USA
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo, 113-8421, Japan
| | - Crystal Sj Cheong
- Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore
| |
Collapse
|
34
|
Obstructive Sleep Apnea as a Predictor of Abnormal Heart Rate Turbulence. J Clin Med 2019; 9:jcm9010001. [PMID: 31861257 PMCID: PMC7019662 DOI: 10.3390/jcm9010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy one patients with clinical suspicion of OSA were qualified to participate in the study. All participants took part in a survey and were subjected to laboratory tests, 24-hour electrocardiogram (ECG) Holter monitoring with HRT analysis and polysomnography. The group with OSA manifested significantly higher turbulence onset (TO) and lower turbulence slope (TS) as compared to the group without OSA. Older age, diabetes, hypertension and higher apnea/hypopnea index (AHI) were found to be independent risk factors for increased TO, whereas older age, higher body mass index (BMI), higher blood glucose levels, hypertension and higher AHI were independent risk factors for TS reduction. The AHI ≥65 criterion indicates abnormal HRT in patients with OSA with 94.9% sensitivity and 50.0% specificity, which gives a prediction accuracy of 85.7%. In summary, OSA should be considered as a predictor of abnormal HRT.
Collapse
|
35
|
Maroja F, Caixeta A, Poyares D, Tufik S, de Paola A, Castro L, Storti L, Burke P, Cintra F. Impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction patients. Sleep Breath 2019; 24:1357-1363. [PMID: 31792908 DOI: 10.1007/s11325-019-01975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The negative association between obstructive sleep apnea (OSA) and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is well documented. However, little is known about the influence of OSA on fibrinolytic therapy. The aim of this study was to evaluate the impact of severe OSA on pharmacoinvasive treatment in ST elevation myocardial infarction (STEMI) patients. METHODS We enrolled consecutive STEMI patients without previous vascular disease, heart failure, or OSA diagnosis. All patients underwent either a pharmacoinvasive therapy or primary PCI. Syntax score (SS) was calculated for all patients, and a full bedside polysomnography was performed in the first 72 h of admission. In-hospital events and 30 days readmissions were analyzed. RESULTS The sample included 116 patients, 87 men. Patients with severe OSA were older (p = 0.01), had higher neck and abdominal circumferences (p < 0.01), and had higher BMI (p < 0.01). They also had lower reperfusion rates post-fibrinolysis (20 vs. 65%; p = 0.001), higher SS (20.2 ± 11.2 vs. 14.6 ± 10.6; p = 0.03), lower left ventricle ejection fraction (45 ± 8 vs. 51 ± 10%; p = 0.02), and a higher incidence of atrial arrhythmias (4 vs. 21%; p = 0.02). STEMI patients with severe OSA presented with threefold increase in the risk for at least one adverse outcome. Regression analysis showed that both severe OSA and hypertension were independent predictors of higher SS. CONCLUSION Severe OSA was associated with a poor outcome after pharmacoinvasive treatment in STEMI patients.
Collapse
Affiliation(s)
- Fabrizio Maroja
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Adriano Caixeta
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Dalva Poyares
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Sergio Tufik
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Angelo de Paola
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Laura Castro
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Luciana Storti
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Patrick Burke
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil
| | - Fatima Cintra
- Medicine Department, Universidade Federal de São Paulo, Rua Botucatu, 740, Vila Clementino, São Paulo, SP, Brazil.
| |
Collapse
|
36
|
Deol R, Lee KA, Kanaya AM, Kandula NR. Obstructive sleep apnea risk and subclinical atherosclerosis in South Asians living in the United States. Sleep Health 2019; 6:124-130. [PMID: 31699634 DOI: 10.1016/j.sleh.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this study was to examine the association between high risk of obstructive sleep apnea (OSA) and subclinical atherosclerosis among South Asians in the United States. DESIGN A secondary analysis of cross-sectional data. SETTING/PARTICIPANTS A community-based cohort of 906 men and women participating in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. MEASUREMENTS The Berlin Questionnaire was used to screen for OSA risk. Coronary artery calcium (CAC), common carotid artery intima-media thickness (IMT), and internal carotid artery IMT were used as measures of subclinical atherosclerosis. RESULTS The majority of participants (59%) with high OSA risk had CAC scores >0 compared with only 41% of participants with low OSA risk (P <.001). The high OSA risk group was older (P =.005), male (P =.04), had higher body mass index (P <.001) and had greater common carotid artery IMT (0.96 ± 0.27 mm) and internal carotid artery IMT (1.33 ± 0.42 mm) measurements. Snoring, sleep-disordered breathing (SDB), and high OSA risk were associated with subclinical atherosclerosis. However, only high OSA risk remained significant in multivariable models after controlling for demographic and clinical factors that included hypertension (HTN), obesity, diabetes, and dyslipidemia. CONCLUSIONS High OSA risk, which includes overlapping comorbidities of HTN and obesity, was not associated with the time living in the US but was associated with subclinical atherosclerosis markers. These cardiovascular disease risk factors should include evaluation of the spectrum of SDB among all adults, including South Asian men and women.
Collapse
Affiliation(s)
- Rupinder Deol
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143.
| | - Alka M Kanaya
- Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94115
| | - Namratha R Kandula
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| |
Collapse
|
37
|
Mo L, Gupta V, Modi R, Munnur K, Cameron JD, Seneviratne S, Edwards BA, Landry SA, Joosten SA, Hamilton GS, Wong DTL. Severe obstructive sleep apnea is associated with significant coronary artery plaque burden independent of traditional cardiovascular risk factors. Int J Cardiovasc Imaging 2019; 36:347-355. [PMID: 31637622 DOI: 10.1007/s10554-019-01710-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 01/27/2023]
Abstract
Obstructive Sleep Apnea (OSA) is strongly associated with adverse cardiovascular events. In these patients, increased oxidative stress has been associated with accelerated coronary atherosclerosis. However, it is unclear if OSA is associated with significant coronary artery plaque burden. Our aim is to determine whether OSA and/or markers of hypoxemia are associated with coronary plaque burden (CPB). Patients who had coronary computed tomography angiography (CCTA) and a polysomnogram within 1 year of each other between 2011 and 2016 were analyzed. Apnea-Hypopnea Index (AHI) and hypoxemic burden (ODI3%, ODI4%, nadir SpO2, average spO2 and time of spO2 < 88%) were obtained from the polysomnogram. Total CPB was assessed using the prognostically validated CT-Leaman score (CT-LeSc). Significant CPB was defined as CT-LeSc ≥ 8.3. There were 119 patients with mean (± SD) age of 59 ± 12 years. Using logistical regression analysis; AHI, ODI4% and ODI3% were the only parameters associated with significant CPB. Severe OSA (AHI ≥ 30 events/h) was associated with significant CPB with adjusted OR of 3.21 (p = 0.010) independent of traditional cardiovascular risk factors. Mechanisms associated with apnea and hypopnea events (as measured by AHI, ODI3% and ODI4%), but not the severity of arterial desaturation (nadir SpO2, burden of SpO2 < 88%) were associated with significant CPB.
Collapse
Affiliation(s)
- Lin Mo
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Vivek Gupta
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Rohan Modi
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - Kiran Munnur
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Sujith Seneviratne
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Shane A Landry
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Simon A Joosten
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Garun S Hamilton
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia. .,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia. .,South Australian Health & Medical Research Institute, Adelaide, Australia.
| |
Collapse
|
38
|
Kim JB, Seo BS, Kim JH. Effect of arousal on sympathetic overactivity in patients with obstructive sleep apnea. Sleep Med 2019; 62:86-91. [DOI: 10.1016/j.sleep.2019.01.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
|
39
|
Kimura H, Ota H, Kimura Y, Takasawa S. Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173101. [PMID: 31455007 PMCID: PMC6747246 DOI: 10.3390/ijerph16173101] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea (OSA) causes many systemic disorders via mechanisms related to sympathetic nerve activation, systemic inflammation, and oxidative stress. OSA typically shows repeated sleep apnea followed by hyperventilation, which results in intermittent hypoxia (IH). IH is associated with an increase in sympathetic activity, which is a well-known pathophysiological mechanism in hypertension and insulin resistance. In this review, we show the basic and clinical significance of IH from the viewpoint of not only systemic regulatory mechanisms focusing on pulmonary circulation, but also cellular mechanisms causing lifestyle-related diseases. First, we demonstrate how IH influences pulmonary circulation to cause pulmonary hypertension during sleep in association with sleep state-specific change in OSA. We also clarify how nocturnal IH activates circulating monocytes to accelerate the infiltration ability to vascular wall in OSA. Finally, the effects of IH on insulin secretion and insulin resistance are elucidated by using an in vitro chamber system that can mimic and manipulate IH. The obtained data implies that glucose-induced insulin secretion (GIS) in pancreatic β cells is significantly attenuated by IH, and that IH increases selenoprotein P, which is one of the hepatokines, as well as TNF-α, CCL-2, and resistin, members of adipokines, to induce insulin resistance via direct cellular mechanisms. Clinical and experimental findings concerning IH give us productive new knowledge of how lifestyle-related diseases and pulmonary hypertension develop during sleep.
Collapse
Affiliation(s)
- Hiroshi Kimura
- Department of Advanced Medicine for Pulmonary Circulation and Respiratory Failure, Graduate School of Medicine, Nippon Medical School, Bunkyo, Tokyo 113-8603, Japan.
| | - Hiroyo Ota
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yuya Kimura
- Center for Pulmonary Diseases, NHO Tokyo National Hospital, Kiyose, Tokyo 204-0023, Japan
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, Kashihara, Nara 634-8521, Japan
| |
Collapse
|
40
|
Cho KH, Lee DH, Kim KM, Choi YH, Nam HS, Heo JH, Heo K, Kim YD. Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke. Front Neurol 2019; 10:819. [PMID: 31417490 PMCID: PMC6684953 DOI: 10.3389/fneur.2019.00819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke. Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score. Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02). Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.
Collapse
Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Choi
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
41
|
Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus. SLEEP DISORDERS 2019; 2019:3184382. [PMID: 31355009 PMCID: PMC6633920 DOI: 10.1155/2019/3184382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/07/2019] [Indexed: 01/03/2023]
Abstract
Aims Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA. Methods Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing. Results Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity. Conclusions This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.
Collapse
|
42
|
Kyotani Y, Takasawa S, Yoshizumi M. Proliferative Pathways of Vascular Smooth Muscle Cells in Response to Intermittent Hypoxia. Int J Mol Sci 2019; 20:ijms20112706. [PMID: 31159449 PMCID: PMC6600262 DOI: 10.3390/ijms20112706] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia (IH) and is a risk factor for cardiovascular diseases (e.g., atherosclerosis) and chronic inflammatory diseases (CID). The excessive proliferation of vascular smooth muscle cells (VSMCs) plays a pivotal role in the progression of atherosclerosis. Hypoxia-inducible factor-1 and nuclear factor-κB are thought to be the main factors involved in responses to IH and in regulating adaptations or inflammation pathways, however, further evidence is needed to demonstrate the underlying mechanisms of this process in VSMCs. Furthermore, few studies of IH have examined smooth muscle cell responses. Our previous studies demonstrated that increased interleukin (IL)-6, epidermal growth factor family ligands, and erbB2 receptor, some of which amplify inflammation and, consequently, induce CID, were induced by IH and were involved in the proliferation of VSMCs. Since IH increased IL-6 and epiregulin expression in VSMCs, the same phenomenon may also occur in other smooth muscle cells, and, consequently, may be related to the incidence or progression of several diseases. In the present review, we describe how IH can induce the excessive proliferation of VSMCs and we develop the suggestion that other CID may be related to the effects of IH on other smooth muscle cells.
Collapse
Affiliation(s)
- Yoji Kyotani
- Department of Pharmacology, Nara Medical University School of Medicine, Kashihara 634-8521, Japan.
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University School of Medicine, Kashihara 634-8521, Japan.
| | - Masanori Yoshizumi
- Department of Pharmacology, Nara Medical University School of Medicine, Kashihara 634-8521, Japan.
| |
Collapse
|
43
|
Coexistence of obstructive sleep apnea and telomerase activity, concentration of selected adipose tissue hormones and vascular endothelial function in patients with arterial hypertension. Respir Med 2019; 153:20-25. [PMID: 31136928 DOI: 10.1016/j.rmed.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/12/2019] [Accepted: 05/16/2019] [Indexed: 01/21/2023]
Abstract
AIM The aim of the present study was to determine the effect of obstructive sleep apnea (OSA) with hypertension on telomerase activity, visfatin and adipsine concentration in the blood and vascular endothelial function assessed by ultrasound measured flow-mediated dilatation of the brachial artery (FMD). MATERIAL AND METHODS The study involved a group of 106 people (average age: 54.79 years). The determination of telomerase activity and blood visfatin and adipsine concentrations, brachial artery ultrasound examination with endothelium-dependent dilatation evaluation (FMD) and polysomnography were carried out. RESULTS Patients with hypertension without OSA were characterized by significantly greater FMD in comparison to patients with arterial hypertension and OSA (8.13 ± 5.12 %vs. 6.82 ± 5.36%; p < 0.05). Negative linear relationship between apnea-hypopnea index (AHI) and FMD (r = -0.22, p < 0.05) has been demonstrated. Negative linear relationship between adipsine concentration in the blood and length of REM (Rapid Eye Movement) sleep (r = -0.21, p < 0.05) was found. Positive linear relationship between the concentration of visfatin in the blood and the length of REM sleep (r = 0.22, p < 0.05) was also observed. Higher body mass index, higher total cholesterol, triglyceride and glucose levels have been shown to be independent predictors of higher AHI values, while greater telomerase activity, greater FMD and use of angiotensin converting enzyme inhibitors are independent predicators for lower AHI values. CONCLUSION Higher values of AHI index in polysomnography in hypertensive patients can be related to lower telomerase activity in the blood and impaired function of vascular endothelial function assessed using ultrasound.
Collapse
|
44
|
Jarrah MI, Yassin AM, Ibdah RK, Ibnian AM, Eyadeh AA, Khassawneh BY. Screening for obstructive sleep apnea among patients undergoing coronary catheterization in Jordan. Vasc Health Risk Manag 2019; 15:109-113. [PMID: 31118652 PMCID: PMC6501777 DOI: 10.2147/vhrm.s203307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/11/2019] [Indexed: 11/25/2022] Open
Abstract
Aims: This study aimed to utilize a validated sleep questionnaire as a screening tool for symptoms and risk of obstructive sleep apnea in patients undergoing coronary catheterization in Jordan. Materials and methods: A cross-sectional design was used to screen adult patients undergoing coronary catheterization for obstructive sleep apnea (OSA). The Berlin sleep questionnaire was used to record nocturnal and daytime symptoms of OSA and to stratify patients into “low-risk” or “high-risk” for OSA. Coronary artery disease was defined as ≥50% intraluminal stenosis in at least one coronary vessel. Results: A total of 398 patients were studied, mean age was 58.7 years (SD=10.70), ranging from 21–92 years, and 68.6% were males. Based on the Berlin sleep questionnaire’s definition, 176 patients (44.2%) were at high-risk for obstructive sleep apnea. Snoring was reported by 61%; loud in 42.1%, and frequent in 62%. Daytime sleepiness was reported by 36%, and 18.9% had fallen asleep while driving. Witnessed apnea during sleep was less reported (7.8%). Prevalence of symptoms and risk of OSA were not different between patients with and without coronary artery disease, P>0.05. In addition, logistic regression indicated that there was no significant association between risk of OSA and coronary artery disease, adjusted (odds ratio=0.93, 95% Confidence Interval=0.60–1.44, P=0.752). Conclusions: Symptoms and risk of obstructive sleep apnea were common among adult Jordanians undergoing coronary catheterization. There was no association between risk of obstructive sleep apnea and coronary artery disease. Larger studies are needed to assess the role of screening for obstructive sleep apnea in this patient population.
Collapse
Affiliation(s)
- Mohamad I Jarrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmed M Yassin
- Department of Neuro sciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rasheed K Ibdah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali M Ibnian
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad A Eyadeh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Y Khassawneh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
45
|
Mano Y, Kohno T, Hayashida K, Fukuoka R, Yanagisawa R, Tanaka M, Yashima F, Tsuruta H, Itabashi Y, Murata M, Fukuda K. Prevalence, Clinical Profile, and In-Hospital Outcomes of Sleep-Disordered Breathing in Patients Undergoing Transcatheter Aortic Valve Implantation in Japan. Circ Rep 2019; 1:235-239. [PMID: 33693143 PMCID: PMC7889486 DOI: 10.1253/circrep.cr-19-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
The prevalence, patient profile, and outcomes of sleep-disordered breathing (SDB) in aortic stenosis (AS) remain unknown, especially in East Asia. Methods and Results:
One hundred and eighty-one AS patients undergoing transcatheter aortic valve implantation (TAVI) were enrolled. Sixty-one patients (33.7%) had SDB, and lower stroke volume index was an independent determinant of SDB. Incidence of in-hospital stroke after TAVI was higher in the SDB group. Conclusions:
SDB is associated with left ventricular systolic dysfunction in Japanese AS patients referred for TAVI. SDB was highly associated with the incidence of stroke as a procedural complication.
Collapse
Affiliation(s)
- Yoshinori Mano
- Department of Cardiology, Tokyo Dental College, Ichikawa General Hospital Chiba Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Ryoma Fukuoka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Ryo Yanagisawa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Makoto Tanaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Fumiaki Yashima
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Hikaru Tsuruta
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Yuji Itabashi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Mitsushige Murata
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine Tokyo Japan
| |
Collapse
|
46
|
Zeng Y, Yang S, Wang X, Fan J, Nie S, Wei Y. Prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome: a prospective cohort study. Respir Res 2019; 20:43. [PMID: 30819182 PMCID: PMC6393988 DOI: 10.1186/s12931-019-1008-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/18/2019] [Indexed: 12/25/2022] Open
Abstract
Background There is a paucity of data from large prospective study evaluating the prognostic significance of the residual Synergy between percutaneous intervention with Taxus drug-eluting stents and cardiac surgery (SYNTAX) Score (rSS) in patients with obstructive sleep apnea (OSA) and Acute Coronary Syndrome (ACS). Methods ACS patients who undergoing percutaneous coronary angiography and completing a sleep study during hospitalization were prospectively enrolled. The baseline SYNTAX Score (bSS) and the rSS after revascularization were assessed. Complete revascularization (CR, rSS = 0) and incomplete revascularization (ICR, rSS > 0) were categorized. OSA (apnea hypopnea index, AHI ≥ 15) and non-OSA (AHI < 15) were grouped according to AHI. The primary endpoint of the study was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for UAP or heart failure. Results Overall, 752 patients were prospectively enrolled. At a median follow-up of 1 year, the incidence of MACCEs was significantly higher in the OSA than in the non-OSA group (hazard ratio [HR]:1.68; 95% confidence interval [CI]:1.04–2.72; P = .034). ICR was associated with a higher risk of MACCEs in the non-OSA group (HR:3.34;95% CI:1.0–11.12; P = .05). The OSA patients with ICR had a 5.1 higher risk of MACCEs compared with the non-OSA with CR group, P = .007. The OSA patients with CR had a similar 1-year MACCEs as all the non-OSA patients (HR:1.10; 95% CI:0.515–2.349; P = 0.806). Conclusions ACS patients with OSA and ICR have a high rate of MACCEs at 1 year. In contrast, the prognosis of ACS patients with OSA but CR is favorable and similar to patients without OSA. Adequate level of revascularization is recommended to optimize clinical outcomes in ACS patients with OSA. Trial registration Clinicaltrials.gov identifier NCT03362385.
Collapse
Affiliation(s)
- Yaping Zeng
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shuhan Yang
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China.,Department of Cardiology, Xinxiang Central Hospital, Xinxiang, Henan Province, People's Republic of China
| | - Xiao Wang
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jingyao Fan
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shaoping Nie
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
47
|
Obstructive sleep apnea is associated with increased coronary plaque instability: an optical frequency domain imaging study. Heart Vessels 2019; 34:1266-1279. [PMID: 30790035 PMCID: PMC6620247 DOI: 10.1007/s00380-019-01363-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/15/2019] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD) and with an increased risk for myocardial infarction, stroke or death due to cardiovascular disease. Optical frequency-domain imaging (OFDI) is a useful modality for evaluating the characteristics of atherosclerotic plaque. The purpose of the study was to use OFDI to investigate the association of OSA with coronary plaque characteristics in patients undergoing percutaneous coronary intervention (PCI). We retrospectively analyzed OFDI data for coronary artery plaques from 15 patients with OSA and 35 non–OSA patients treated between October 2015 and October 2018. Plaque morphology was evaluated for 70 lesions, including 21 from patients with OSA and 49 from non–OSA patients. Compared with the non–OSA group, patients with OSA had significantly higher prevalences of thinned cap fibroatheroma (TCFA) (67% vs. 35%, P = 0.014) and microchannels (86% vs. 55%, P = 0.014); a significantly higher mean lipid index (1392 ± 982 vs. 817 ± 699, P = 0.021), macrophage grade (8.4 ± 6.4 vs. 4.8 ± 4.5, P = 0.030), and maximum number of microchannels (1.5 ± 1.0 vs. 0.7 ± 0.7, P = 0.001); and a significantly lower mean minimum fibrous cap thickness (69.4 ± 28.7 vs. 96.1 ± 51.8 μm, P = 0.008). This OFDI analysis suggests that OSA is associated with unstable plaque characteristics in patients with CAD. More intensive medical management for stabilization of coronary atherosclerotic plaque is required in patients with OSA.
Collapse
|
48
|
Bikov A, Kolossváry M, Jermendy AL, Drobni ZD, Tarnoki AD, Tarnoki DL, Forgó B, Kovacs DT, Losonczy G, Kunos L, Voros S, Merkely B, Maurovich-Horvat P. Comprehensive coronary plaque assessment in patients with obstructive sleep apnea. J Sleep Res 2019; 28:e12828. [PMID: 30724416 DOI: 10.1111/jsr.12828] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/20/2018] [Accepted: 12/27/2018] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. Previous studies have assessed the relationship between OSA and coronary artery disease (CAD) using coronary artery calcium score (CAC) measurements. However, limited data are available regarding the association of OSA with non-calcified plaque burden. We therefore aimed to assess the relationship between CAD severity as assessed by coronary computed tomography angiography (CTA) and OSA. Forty-one adult subjects (59 ± 9 years, 15 men) underwent a 256-slice coronary CTA, which was followed by a diagnostic attended cardiorespiratory polygraphy (n = 13) or polysomnography (n = 28). Segment involvement score (SIS), segment stenosis score (SSS) and CAC were used to quantify total CAD burden. Correlation analysis was used to assess potential associations between CAD and OSA. Twenty-two patients were diagnosed with OSA. SIS and SSS were elevated in OSA (2.90 ± 2.78 versus 1.79 ± 2.39 and 4.91 ± 5.94 versus 1.79 ± 4.54, OSA versus controls, SIS and SSS respectively, both p < 0.01) and correlated with OSA severity as measured by the apnea-hypopnea index (AHI, r = 0.41 and 0.43, p < 0.01) and oxygen desaturation index (ODI, r = 0.45 and 0.46, p < 0.01). However, no significant correlation was observed between CAC and OSA. Compared to CAC, SIS and SSS provide additional information on coronary plaque burden in OSA, which shows a significant association with OSA.
Collapse
Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adam L Jermendy
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsofia D Drobni
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adam D Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - David L Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Bianka Forgó
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Daniel T Kovacs
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Gyorgy Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Bela Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
49
|
López-Cano C, Rius F, Sánchez E, Gaeta AM, Betriu À, Fernández E, Yeramian A, Hernández M, Bueno M, Gutiérrez-Carrasquilla L, Dalmases M, Lecube A. The influence of sleep apnea syndrome and intermittent hypoxia in carotid adventitial vasa vasorum. PLoS One 2019; 14:e0211742. [PMID: 30721271 PMCID: PMC6363284 DOI: 10.1371/journal.pone.0211742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022] Open
Abstract
Subjects with sleep apnea-hypopnea syndrome (SAHS) show an increased carotid intima-media thickness. However, no data exist about earlier markers of atheromatous disease, such as the proliferation and expansion of the adventitial vasa vasorum (VV) to the avascular intima in this setting. Our aim was to assess carotid VV density and its relationship with sleep parameters in a cohort of obese patients without prior vascular events. A total of 55 subjects evaluated for bariatric surgery were prospectively recruited. A non-attended respiratory polygraphy was performed. The apnea-hypopnea index (AHI) and the cumulative percentage of time spent with oxygen saturation below 90% (CT90) were assessed. Serum concentrations of soluble intercellular adhesion molecule 1, P-selectin, lipocalin-2 and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. Contrast-enhanced carotid ultrasound was used to assess the VV density. Patients with SAHS (80%) showed a higher adventitial VV density (0.801±0.125 vs. 0.697±0.082, p = 0.005) and higher levels of sVCAM-1 (745.2±137.8 vs. 643.3±122.7 ng/ml, p = 0.035) than subjects with an AHI lower than 10 events/hour. In addition, a positive association exist between mean VV density and AHI (r = 0.445, p = 0.001) and CT90 (r = 0.399, p = 0.005). Finally, in the multiple linear regression analysis, female sex, fasting plasma glucose and AHI (but not CT90) were the only variables independently associated with the mean adventitial VV density (R2 = 0.327). In conclusion, a high VV density is present in obese subjects with SAHS, and chronic intermittent hypoxia is pointed as an independent risk factor for the development of this early step of atheromatous disease.
Collapse
Affiliation(s)
- Carolina López-Cano
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Ferran Rius
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Anna Michela Gaeta
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Àngels Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R), University Hospital Arnau de Vilanova, Vascular and Renal Translational Research Group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Elvira Fernández
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R), University Hospital Arnau de Vilanova, Vascular and Renal Translational Research Group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Andree Yeramian
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Marta Bueno
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Mireia Dalmases
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
- Centro de Investigación en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- * E-mail:
| |
Collapse
|
50
|
Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent disorder, which causes significant nocturnal and daytime symptoms, reduced quality of life, and impaired functional capacity. Importantly, however, OSA also appears to predispose to the development of a number of cardiovascular and metabolic diseases, including diabetes, hypertension, and stroke. In this review we explore its relationship with coronary artery disease (CAD), discussing mechanisms whereby it may promote the development of atherosclerosis, evidence of its effect on CAD incidence and outcomes, and coronary imaging studies in subjects with OSA. Finally, we shall evaluate the current evidence regarding the impact of continuous positive airway pressure therapy on CAD outcomes in OSA patients.
Collapse
Affiliation(s)
- Swapna Mandal
- Department of Respiratory and Sleep Medicine, Royal Free Hospital, London, UK.,University College London, UK
| | - Brian D Kent
- Sleep Disorders Centre, Guy's & St. Thomas' Hospitals, London, UK.,King's College London, London, UK
| |
Collapse
|