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Yi M, Zhao W, Tan Y, Fei Q, Liu K, Chen Z, Zhang Y. The causal relationships between obstructive sleep apnea and elevated CRP and TNF-α protein levels. Ann Med 2022; 54:1578-1589. [PMID: 35652886 PMCID: PMC9176672 DOI: 10.1080/07853890.2022.2081873] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and inflammation are closely related. This study aimed to evaluate the associations and causal effect between C-reactive protein (CRP) and tumour necrosis factor-alpha (TNF-α) levels andOSA. METHODS Pooled analysis was conducted to compare the expression differences of CRP and TNF-α between OSA patients with different severity and controls, and between continuous positive airway pressure (CPAP) and non-CPAP interventions for OSA patients. Using published GWAS summary statistics, we conducted a bidirectional two-sample Mendelian Randomization (MR) to estimate the causal relationships between CRP and TNF-α levels and OSA risk. Effect estimates were evaluated using inverse-variance weighted (IVW) as primary method, and several other MR methods as sensitivity analysis. RESULTS Both TNF-α (WMD [95%CI] = 5.86 [4.80-6.93] pg/ml, p < .00001) and CRP (WMD [95%CI] = 2.66 [2.15-3.17] mg/L, p < .00001), showed a significant increase in OSA patients compared with controls and this increasing trend was associated with OSA severity. Besides, compared to blank control (non-CPAP), CPAP treatment can reduce high TNF-α (WMD [95%CI]= -4.44 [-4.81, -4.07]pg/ml, p < .00001) and CRP (WMD [95%CI]= -0.91 [-1.65, -0.17] mg/l, p = .02) in OSA. Moreover, the primary MR analysis by IVW showed that OSA was the genetically predicted cause of elevated CRP (estimate: 0.095; 95% CI, [0.010-0.179]; p = .029) using six SNPs as the instrument variable, which were repeated by weighted median (estimate: 0.053; 95% CI, [0.007, 0.100]; p =.024) and MR RAPS (estimate: 0.109; 95% CI, [0.079, 0.140]; p = 1.98x10-12). Besides, the causal effect from elevated CRP on increased OSA risk was almost significant by IVW (OR:1.053; 95% CI, [1.000, 1.111]; p = .053). However, there were no causal associations between TNF-α and OSA from both directions. CONCLUSIONS Increased CRP and TNF-α were associated with OSA severity and sensible to CPAP treatment. Also, OSA had a suggestive causal effect on elevated CRP.
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Affiliation(s)
- Minhan Yi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,School of Life Sciences, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wangcheng Zhao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | - Yun Tan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,School of Life Sciences, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quanming Fei
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | - Kun Liu
- School of Life Sciences, Central South University, Changsha, China
| | - Ziliang Chen
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Abstract
It is generally considered that obstructive sleep apnea is a potential cause of heart failure (HF), and insomnia and central sleep apnea are results of HF. However, the number of reports describing the bidirectional relationship between sleep disorder and HF has increased. Sleep disorder may contribute to left ventricular diastolic dysfunction via left atrial overload, left ventricular remodeling, pulmonary hypertension, and atrial fibrillation, which lead to HF with preserved left ventricular ejection fraction. Overnight rostral fluid shift and lung congestion may lead to airflow obstruction in the upper pharynx and stimulate pulmonary irritant receptors, which induce hyperventilation and sleep disorder.
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Affiliation(s)
- Masahiko Kato
- Division of School of Health Science, Department of Pathobiological Science and Technology, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Japan.
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine, and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Japan
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High Plasma Cystine Levels Are Associated with Blood Pressure and Reversed by CPAP in Patients with Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10071387. [PMID: 33808409 PMCID: PMC8037115 DOI: 10.3390/jcm10071387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) independent of obesity (OBS) imposes severe cardiovascular risk. To what extent plasma cystine concentration (CySS), a novel pro-oxidative vascular risk factor, is increased in OSA with or without OBS is presently unknown. We therefore studied CySS together with the redox state and precursor amino acids of glutathione (GSH) in peripheral blood mononuclear cells (PBMC) in untreated male patients with OSA (apnea-hypopnea-index (AHI) > 15 h-1, n = 28) compared to healthy male controls (n = 25) stratifying for BMI ≥ or < 30 kg m-2. Fifteen OSA patients were reassessed after 3-5-months CPAP. CySS correlated with cumulative time at an O2-saturation <90% (Tu90%) (r = 0.34, p < 0.05) beside BMI (r = 0.58, p < 0.001) and was higher in subjects with "hypoxic stress" (59.4 ± 2.0 vs. 50.1 ± 2.7 µM, p < 0.01) defined as Tu90% ≥ 15.2 min (corresponding to AHI ≥ 15 h-1). Moreover, CySS significantly correlated with systolic (r = 0.32, p < 0.05) and diastolic (r = 0.31, p < 0.05) blood pressure. CPAP significantly lowered CySS along with blood pressure at unchanged BMI. Unexpectedly, GSH antioxidant capacity in PBMC was increased with OSA and reversed with CPAP. Plasma CySS levels are increased with OSA-related hypoxic stress and associated with higher blood pressure. CPAP decreases both CySS and blood pressure. The role of CySS in OSA-related vascular endpoints and their prevention by CPAP warrants further studies.
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Evaluation of right ventricular performance and impact of continuous positive airway pressure therapy in patients with obstructive sleep apnea living at high altitude. Sci Rep 2020; 10:20186. [PMID: 33214634 PMCID: PMC7678870 DOI: 10.1038/s41598-020-71584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 08/10/2020] [Indexed: 02/08/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) can lead to alterations in right ventricular (RV) performance and pulmonary vascular haemodynamics. Additionally, altitude-related hypoxia is associated with pulmonary vasoconstriction, and the effect of high-altitude on the pulmonary circulation in OSAS patients can be further altered. We sought to assess alterations in RV morphology and function in OSAS patients living at high altitude by way of 2-dimensional speckle tracking echocardiography (2D-STE), real-time 3- dimensional echocardiography (RT-3DE) and cardiac biomarkers. We also evaluate the impact of continuous positive airway pressure (CPAP) treatment on RV performance. Seventy-one patients with newly diagnosed OSAS and thirty-one controls were included in this study. All individuals were assessed for cardiac biomarkers as well as underwent 2D-STE and RT-3DE. Forty-five OSAS patients underwent CPAP therapy for at least 24 weeks and were studied before and after CPAP treatment. RT-3DE was used to measure RV volume, and calculate RV 3D ejection fraction (3D RVEF). Peak systolic strain was determined. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide, and cardiac troponin T were also measured. Right atrium volume index, RV volume, RV volume index, systolic pulmonary artery pressure (sPAP), pulmonary vascular resistance (PVR) and level of serum CRP were significantly higher in OSAS group, while OSAS patients showed lower 3D RVEF and RV longitudinal strains. Compared to the patients with sPAP < 40 mmHg, RV longitudinal strains in patients with sPAP ≥ 40 mmHg were lower. Both RV global longitudinal strain and sPAP were associated with apnea–hypopnea index. Patients treated with 6 months of CPAP therapy had significant improvement in RV geometry and performance. RV structural abnormalities and RV function impairments were observed in OSAS patients living at moderate high altitude compared to control highlanders. The reversibility of these changes after application of CPAP were further confirmed.
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Nocturnal Continuous Positive Airway Pressure (nCPAP) Decreases High-Sensitivity C-Reactive Protein (hs-CRP) in Obstructive Sleep Apnea-Hypopnea Syndrome. SLEEP DISORDERS 2020; 2020:8913247. [PMID: 33204538 PMCID: PMC7652622 DOI: 10.1155/2020/8913247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 01/24/2023]
Abstract
Background Systemic and airway inflammation has recently been linked to obstructive sleep apnea-hypopnea syndrome (OSAHS) and is considered to be a probable risk factor for OSAHS-induced cardiovascular damage. High-sensitivity C-reactive protein (hs-CRP), as an inflammatory mediator, may be useful for the prediction of the risk of cardiovascular disease (CVD) and assessment of nocturnal continuous positive airway pressure (nCPAP) therapy effect in OSAHS patients. Methods A prospective, controlled, cross-sectional study was conducted on 64 consecutive adult subjects with suspected sleep-disordered breathing (SDB). Results OSAHS was confirmed in 43 patients (24 normotensive and 19 hypertensive patients) and ruled out in 21 normotensive subjects (controls). The median plasma level of hs-CRP did not differ significantly between OSAHS patients and controls. It showed an unmarked rise with the severity of OSAHS (p = 0.20) and was not correlated with AHI (p = 0.067; r = 0.28). After adjusting for cervical perimeter (CP), waist-to-hip ratio (WHR), and blood sugar level, hs-CRP level of 1 mg/dL or greater was significantly more often observed in OSAHS patients compared with controls (p = 0.032; OR = 5.60) and was also significantly associated with AHI (p = 0.021). A significant decrease in the median plasma hs-CRP level was observed in CPAP compliant patients (p = 0.006). Of those, only normotensive patients showed a significant decrease in plasma hs-CRP level. In hypertensive ones, however, the hs-CRP level dropped but not significantly. Using a linear regression model, the change in hs-CRP level (Δhs-CRP) following a 6-month-nCPAP therapy was found to positively correlate with the baseline hs-CRP level for both hypertensive (p = 0.02; r = 0.68), and even more normotensive OSAHS patients (p < 0.0001; r = 0.89). Conclusion nCPAP therapy may have a cardiovascular protective effect in OSAHS patients. hs-CRP level would be useful as a valuable predictor of success in OSAHS treatment monitoring.
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Jehan S, Zizi F, Pandi-Perumal SR, McFarlane SI, Jean-Louis G, Myers AK. Obstructive sleep apnea, hypertension, resistant hypertension and cardiovascular disease. SLEEP MEDICINE AND DISORDERS : INTERNATIONAL JOURNAL 2020; 4:67-76. [PMID: 33501418 PMCID: PMC7830712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common causes of hypertension (HTN) and cardiovascular disease (CVD). It is also a quite common underlying factor in resistant HTN (RHTN). The main etiological factor of OSA is obesity, which is a rapidly growing global epidemic. To control obesity, patients should be encouraged by health care professionals to lose weight and be educated about weight loss strategies such as lifestyle modifications, which include regular exercise, low-calorie diet, low sodium intake, smoking cessation, and decreased alcohol consumption. This review also emphasizes the importance of screening for OSA as the major underlying cause of essential, and RHTN, which can lead to CVD and can cause end-organ damage. It also stresses the importance of using continuous positive airway pressure (CPAP) and its beneficial effects, along with other antihypertensive regimens, in treating HTN, and RHTN. Treatment with CPAP therapy decreases sympathetic activity, high blood pressure (BP), heart rate, and CVD as well as its associated mortality.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | | | - Samy I McFarlane
- Division of Endocrinology, Department of Medicine, SUNY Downstate Medical Center, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavior Change, Division of Health and Behavior, New York University School of Medicine, USA
| | - Alyson K Myers
- Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, USA
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Mohammadkhani PG, Irandoust K, Taheri M, Mirmoezzi M, Baić M. Effects of eight weeks of aerobic exercise and taking caraway supplement on C-reactive protein and sleep quality in obese women. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2019.1587837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Khadijeh Irandoust
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Morteza Taheri
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Masoud Mirmoezzi
- Faculty of Physical Education and Sports Science, Islamic Azad University, Tehran, Iran
| | - Mario Baić
- Faculty of Kinesiology, University of Zagreb, Zagreb, croatia
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8
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Asgari A, Soltaninejad F, Farajzadegan Z, Amra B. Effect of CPAP Therapy on Serum Lipids and Blood Pressure in Patients with Obstructive Sleep Apnea Syndrome. TANAFFOS 2019; 18:126-132. [PMID: 32440300 PMCID: PMC7230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most of patients with Obstructive Sleep Apnea (OSA) are at risk of metabolic syndrome. The treatment of choice for OSA patients is the Continuous Positive Airway Pressure (CPAP). Reports about the effect of CPAP on metabolic parameters are controversial. So, we aimed to evaluate the effect of CPAP therapy on blood pressure, Fasting Blood Sugar (FBS), and serum lipids including: Triglycerides (TG), total cholesterol (Chol), High Density Lipoproteins (HDL), and Low Density Lipoproteins (LDL). MATERIALS AND METHODS This study included 35 OSA patients. Initially, their baseline demographic and clinical characteristics were recorded. Then, the patients underwent CPAP therapy on average 4-7 hours for 8 weeks. The level of FBS, TG, Cholesterol, HDL, LDL, and blood pressure were measured and recorded before and after treatment. Finally, the collected data were analyzed with SPSS version 22. RESULTS This study included 35 OSA patients [24 men (68.6%)], with mean age of 45.58±8.02 years. Results indicated that CPAP therapy led to decrease of 9.76 and 3.49 mmHg in systolic and diastolic blood pressures, respectively. Also, LDL decreased to 6.27mg/dl and HDL increased to 0.75 mg/dl (P<0.001) with treatment. The changes of other variables were not significant (P>0.05). CONCLUSION Treatment of OSA with CPAP has beneficial effects on blood pressure and some items of lipid profile. Regarding the importance of metabolic disturbances in OSA complications, choosing an appropriate treatment for OSA patients can play an important role in improvement of patients status as well as prevention of these complications.
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Affiliation(s)
- Abdolah Asgari
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Bamdad Respiratory and Sleep Research Center, Pulmonary Unit, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,,Correspondence to: Soltaninejad F, Address: Pulmonary Unit, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Email address:
| | - Ziba Farajzadegan
- Department of Community and Preventive Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Amra
- Bamdad Respiratory and Sleep Research Center, Pulmonary Unit, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Pitts KD, Arteaga AA, Hardy ET, Stevens BP, Spankovich CS, Lewis AF. The effect of continuous positive airway pressure therapy on nasal patency. Int Forum Allergy Rhinol 2018; 8:1136-1144. [PMID: 29897663 DOI: 10.1002/alr.22157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure (CPAP) users and are frequently cited as reasons for noncompliance. To our knowledge, no study has demonstrated a change in objective or subjective nasal patency in patients with obstructive sleep apnea (OSA) after a therapeutic trial of CPAP therapy. METHODS This prospective nonrandomized trial tested the hypothesis that CPAP therapy would result in both objective and subjective improvements in nasal patency in patients with OSA. Prior to initiation of CPAP, acoustic rhinometry (AR) was used to determine nasal volume and minimum cross-sectional area in the upright and reclined positions. Subjective nasal patency was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Both assessments were repeated at follow-up visits. RESULTS AR data demonstrated a statistically significant increase in total nasal volume (TV) in the reclined position (p = 0.002) and minimum cross-sectional area (MCA) in both the sitting and reclined positions (p = 0.006, p = 0.021) in OSA patients after >30 days of CPAP therapy and with >70% compliance. NOSE scores decreased significantly (p = 0.038) representing an improvement in nasal patency. CONCLUSION Objective and subjective measurements of TV and MCA increased after initiation of CPAP therapy in this prospective study.
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Affiliation(s)
- Kristen D Pitts
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Alberto A Arteaga
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Elliot T Hardy
- The Baton Rouge Clinic, A Medical Corporation, Baton Rouge, LA
| | - Ben P Stevens
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Christopher S Spankovich
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Andrea F Lewis
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS
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Perrini S, Cignarelli A, Quaranta VN, Falcone VA, Kounaki S, Porro S, Ciavarella A, Ficarella R, Barbaro M, Genchi VA, Nigro P, Carratù P, Natalicchio A, Laviola L, Resta O, Giorgino F. Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea. JCI Insight 2017; 2:94379. [PMID: 28878129 DOI: 10.1172/jci.insight.94379] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In obese subjects with obstructive sleep apnea (OSA), chronic intermittent hypoxia (CIH) may be linked to systemic and adipose tissue inflammation. METHODS We obtained abdominal subcutaneous adipose tissue biopsies from OSA and non-OSA obese (BMI > 35) subjects at baseline and after 24 weeks (T1) of weight-loss intervention plus continuous positive airway pressure (c-PAP) or weight-loss intervention alone, respectively. OSA subjects were grouped according to good (therapeutic) or poor (subtherapeutic) adherence to c-PAP. RESULTS At baseline, anthropometric and metabolic parameters, serum cytokines, and adipose tissue mRNA levels of obesity-associated chemokines and inflammatory markers were not different in OSA and non-OSA subjects. At T1, body weight was significantly reduced in all groups. Serum concentrations of IL-2, IL-4, IL-6, MCP-1, PDGFβ, and VEGFα were reduced by therapeutic c-PAP in OSA subjects and remained unaltered in non-OSA and subtherapeutic c-PAP groups. Similarly, adipose tissue mRNA levels of macrophage-specific (CD68, CD36) and ER stress (ATF4, CHOP, ERO-1) gene markers, as well as of IL-6, PDGFβ, and VEGFα, were decreased only in the therapeutic c-PAP group. CONCLUSION CIH does not represent an additional factor increasing systemic and adipose tissue inflammation in morbid obesity. However, in subjects with OSA, an effective c-PAP therapy improves systemic and obesity-associated inflammatory markers. FUNDING Ministero dell'Università e della Ricerca and Progetti di Rilevante Interesse Nazionale.
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Affiliation(s)
- Sebastio Perrini
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Angelo Cignarelli
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Vitaliano Nicola Quaranta
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy
| | - Vito Antonio Falcone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy
| | - Stella Kounaki
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Stefania Porro
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Alessandro Ciavarella
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Romina Ficarella
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Maria Barbaro
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Valentina Annamaria Genchi
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Pasquale Nigro
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Pierluigi Carratù
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy
| | - Annalisa Natalicchio
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Luigi Laviola
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
| | - Onofrio Resta
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation - Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, and
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Effect of modern surgical treatment on the inflammatory/anti-inflammatory balance in patients with obstructive sleep apnoea. The Journal of Laryngology & Otology 2017; 131:719-727. [PMID: 28534455 DOI: 10.1017/s0022215117001116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the inflammatory/anti-inflammatory cytokine balance - T helper 1/T helper 2 ratios - in obstructive sleep apnoea patients, before and after treatment. METHODS Twenty-eight patients received continuous positive airway pressure treatment and 29 patients who could not tolerate continuous positive airway pressure were scheduled for surgery. Serum levels of interleukins 2, 4 and 10, tumour necrosis factor-alpha, and interferon gamma were analysed by enzyme-linked immunosorbent assays before and three months after treatment. RESULTS The success rate of surgical treatment was 65.5 per cent. Mean compliance for the continuous positive airway pressure group was 40.9 per cent. The apnoea/hypopnoea index significantly decreased in both groups after treatment (p < 0.001). The interferon gamma/interleukin-4 ratio decreased following surgical treatment (p = 0.014), and the interleukin-2/interleukin-4 ratio decreased after treatment in 57 patients in the overall cohort (p = 0.032). CONCLUSION After treatment for obstructive sleep apnoea, some ratios reflecting T helper 1/T helper 2 cytokine balance favoured the T helper 2 direction, suggesting a shift to an anti-inflammatory state. Successful surgery and better continuous positive airway pressure compliance can help ameliorate inflammation in obstructive sleep apnoea patients, which may reduce associated morbidities.
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Kim J, Lee SJ, Choi KM, Lee SK, Yoon DW, Lee SG, Shin C. Obstructive Sleep Apnea Is Associated with Elevated High Sensitivity C-Reactive Protein Levels Independent of Obesity: Korean Genome and Epidemiology Study. PLoS One 2016; 11:e0163017. [PMID: 27684378 PMCID: PMC5042376 DOI: 10.1371/journal.pone.0163017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 09/01/2016] [Indexed: 01/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSA) has been recognized as a common health problem, and increasing obesity rates have led to further remarkable increases in the prevalence of OSA, along with more prominent cardiovascular morbidities. Though previous studies have reported an independent relationship between elevated high sensitivity C-reactive protein (hsCRP) levels and OSA, the issue remains controversial owing to inadequate consideration of obesity and various confounding factors. So far, few population based studies of association between OSA and hsCRP levels have been published. Therefore, the purpose of the present study was to investigate whether OSA is associated with increased hsCRP levels independent of obesity in a large population-based study. A total of 1,835 subjects (968 men and 867 women) were selected from a larger cohort of the ongoing Korean Genome and Epidemiology Study (KoGES). Overnight polysomnography was performed on each participant. All participants underwent anthropometric measurements and biochemical analyses, including analysis of lipid profiles and hsCRP levels. Based on anthropometric data, body mass index (BMI) and waist hip ratio (WHR) were calculated and fat mass (FM) were measured by means of multi-frequency bioelectrical impedance analysis (BIA). Mild OSA and moderate to severe OSA were defined by an AHI >5 and ≥15, respectively. The population was sub-divided into 3 groups based on the tertile cut-points for the distribution of hsCRP levels. The percentage of participants in the highest tertile of hsCRP increased dose-dependently according to the severity of OSA. After adjustment for potential confounders and obesity-related variables (BMI, WHR, and body fat) in a multiple logistic model, participants with moderate to severe OSA had 1.73-, 2.01-, and 1.61-fold greater risks of being in the highest tertile of hsCRP levels than participants with non-OSA, respectively. Interaction between obesity (BMI ≥25kg/m2) and the presence of moderate-to-severe OSA was significant on the middle tertile levels of hsCRP (OR = 2.4), but not on the highest tertile, compared to the lowest tertile. OSA is independently associated with elevated hsCRP levels and may reflect an increased risk for cardiovascular morbidity. However, we found that OSA and obesity interactively contribute to individuals with general levels of hsCRP (<1.01 mg/dl). The short-term and long-term effects of elevated hsCRP levels on cardiovascular risk in the context of OSA remain to be defined in future studies.
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Affiliation(s)
- Jinkwan Kim
- Department of Biomedical Laboratory Science, College of Health Science, Jungwon University, Chung-Buk, Republic of Korea
| | - Seok Jun Lee
- Department of Biomedical Laboratory Science, College of Health Science, Cheong-Ju University, Chung-Buk, Republic of Korea
| | - Kyung-Mee Choi
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
| | - Dae Wui Yoon
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
| | - Seung Gwan Lee
- Department of Health and Integrative Science, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University, Ansan, Republic of Korea
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
- * E-mail:
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Binar M, Akcam T, Karakoc O, Sagkan RI, Musabak U, Gerek M. A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea? Eur Arch Otorhinolaryngol 2016; 274:829-836. [PMID: 27586389 DOI: 10.1007/s00405-016-4290-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
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Bauters F, Rietzschel ER, Hertegonne KBC, Chirinos JA. The Link Between Obstructive Sleep Apnea and Cardiovascular Disease. Curr Atheroscler Rep 2016; 18:1. [PMID: 26710793 DOI: 10.1007/s11883-015-0556-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is common in the general population and highly prevalent in patients with cardiovascular disease. In this paper, we review (1) the pathophysiological mechanisms of OSA that may causally contribute to cardiovascular disease; (2) current evidence regarding the association between OSA and hypertension, stroke, ischemic heart disease, heart failure, atrial fibrillation, and cardiovascular mortality; and (3) the impact of continuous positive airway pressure (CPAP) treatment on cardiovascular risk factors and outcomes. We emphasize the importance of obesity as a comorbidity of OSA and a confounder in the association between OSA and cardiovascular disease. We also discuss the importance of addressing obesity in patients with OSA, as a strategy to reduce the burden of cardiovascular risk factors in this population. Implications for the approach of patients' OSA in clinical practice and future research directions are discussed.
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Affiliation(s)
| | | | | | - Julio A Chirinos
- Ghent University Hospital, Ghent, Belgium.
- Hospital of the University of Pennsylvania, 3400 Spruce Street. Gates 9021, Philadelphia, PA, 19060, USA.
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Effects of Continuous Positive Airway Pressure on Lipidaemia and High-sensitivity C-reactive Protein Levels in Non-obese Patients with Coronary Artery Disease and Obstructive Sleep Apnoea. Heart Lung Circ 2016; 25:576-83. [DOI: 10.1016/j.hlc.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 11/30/2022]
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Altintas N, Mutlu LC, Akkoyun DC, Aydin M, Bilir B, Yilmaz A, Malhotra A. Effect of CPAP on New Endothelial Dysfunction Marker, Endocan, in People With Obstructive Sleep Apnea. Angiology 2016; 67:364-74. [PMID: 26076702 PMCID: PMC4846580 DOI: 10.1177/0003319715590558] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea-hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.
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Affiliation(s)
- Nejat Altintas
- Department of Pulmonary, Sleep and Critical Care Medicine, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Levent Cem Mutlu
- Department of Pulmonary, Sleep and Critical Care Medicine, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Dursun Cayan Akkoyun
- Department of Cardiology, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Murat Aydin
- Department of Biochemistry, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Bulent Bilir
- Department of Internal Medicine, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Ahsen Yilmaz
- Department of Biochemistry, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Atul Malhotra
- Department of Pulmonary, Sleep and Critical Care Medicine, San Diego, School of Medicine, University of California, San Diego, CA, USA
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Association between continuous positive airway pressure and circulating omentin levels in patients with obstructive sleep apnoea. Sleep Breath 2016; 20:939-45. [DOI: 10.1007/s11325-016-1315-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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The Impact of Obstructive Sleep Apnoea and Nasal Continuous Positive Airway Pressure on Circulating Ischaemia-Modified Albumin Concentrations. Mediators Inflamm 2016; 2016:8907314. [PMID: 26903714 PMCID: PMC4745313 DOI: 10.1155/2016/8907314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to evaluate the impact of obstructive sleep apnoea syndrome (OSAS) and the effects of nasal continuous positive airway pressure (CPAP) on circulating ischaemia-modified albumin (IMA) concentrations. The study included 97 newly diagnosed OSAS patients and 30 nonapnoeic controls. Blood samples were obtained in the morning after polysomnography. After 3 months of CPAP treatment, 31 patients with moderate-severe OSAS were reassessed for serum IMA concentrations. Significantly higher serum IMA concentrations were measured in the OSAS group than in the control group [0.518 ± 0.091 absorbance units (ABSU), 0.415 ± 0.068 ABSU, P < 0.001]. Serum IMA concentrations correlated significantly with the apnoea-hypopnoea index, mean SaO2, desaturation index, and C-reactive protein concentrations. Multiple logistic regression analyses showed that OSAS increased the serum IMA concentration independent of age, sex, body mass index, smoking habit, and cardiovascular disease. After 3 months of treatment with CPAP, OSAS patients had significantly lower serum IMA concentrations (0.555 ± 0.062 ABSU to 0.431 ± 0.063 ABSU, P < 0.001). The results showed that OSAS is associated with elevated concentrations of IMA, which can be reversed by effective CPAP treatment.
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Troester N, Palfner M, Schmidberger E, Olschewski H, Avian A. Sleep Related Breathing Disorders and Inflammation - The Missing Link? A Cohort Study Evaluating the Interaction of Inflammation and Sleep Related Breathing Disorders and Effects of Treatment. PLoS One 2015; 10:e0137594. [PMID: 26356577 PMCID: PMC4565554 DOI: 10.1371/journal.pone.0137594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/18/2015] [Indexed: 01/21/2023] Open
Abstract
Introduction Sleep related breathing disorders (SRBD) are associated with both obesity and systemic inflammation. While the relationship between obesity and SRBD is established, the causality between inflammation and SRBD remains unclear. In this study we investigated the relation between SRBD and C-reactive protein (CRP) as a parameter of inflammation and the influence of SRBD treatment on CRP with additional regard to changes in metabolic and cardiovascular parameters. Methods Polysomnography (PSG) and laboratory data of patients diagnosed with SRBD over a period of 5 years were prospectively collected in a database and retrospectively analysed regarding the association of SRBD (according to apnoea-hypopnoea- index (AHI), duration of events and extent of desaturation) to CRP, blood pressure, cholesterol, fasting plasma glucose, HbA1c, quality of life measured via a visual analogue scale (VAS 0–100%), and the effects of SRBD therapy on these parameters. Results 716 patients were included in the study, 171 with mild SRBD (AHI ≥5 to <15/h), 209 with moderate SRBD (AHI 15 to <30/h), 336 with severe SRBD (AHI ≥30/h). Results according to severity of SRBD. Severe SRBD was significantly associated with elevated levels of CRP (3.7 [1.8–7.0] mg/l, vs. moderate (p = 0.001), and mild SRBD (p<0.001), and higher prevalence of hypertension as compared to moderate and mild SRBD (p<0.001, respectively). Results in highly successful treatment. If SRBD treatment was highly successful (AHI <5/h), CRP and quality of life improved significantly (p = 0.001 and p = 0.002), as did blood pressure (p<0.001 for systolic and diastolic values), although BMI increased (p<0.001). Results in partially successful treatment. If success was defined as reduction of AHI of ≥50%, CRP also decreased (p<0.001), as did blood pressure (p<0.001). Again, BMI increased (p<0.001). Conclusion This is the first study to show an association of SRBD and CRP independently of BMI in a large cohort. The SRBD therapy-induced CRP decrease was not associated with BMI changes or metabolic changes but rather with the magnitude of AHI improvement.
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Affiliation(s)
- Natascha Troester
- Division of Pulmonology, Department of Internal Medicine, Medical University, Graz, Austria
| | - Michael Palfner
- Division of Pulmonology, Department of Internal Medicine, Medical University, Graz, Austria
| | - Erich Schmidberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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de Lima FFF, Mazzotti DR, Tufik S, Bittencourt L. The role inflammatory response genes in obstructive sleep apnea syndrome: a review. Sleep Breath 2015. [DOI: 10.1007/s11325-015-1226-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sharples L, Glover M, Clutterbuck-James A, Bennett M, Jordan J, Chadwick R, Pittman M, East C, Cameron M, Davies M, Oscroft N, Smith I, Morrell M, Fox-Rushby J, Quinnell T. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. Health Technol Assess 2015; 18:1-296. [PMID: 25359435 DOI: 10.3310/hta18670] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1. All MADs improved disease-specific QoL. Compliance was lower for SP1, which was unpopular at trial exit. At 4 weeks, all devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. META-ANALYSIS A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH patients comparing MAD with conservative management (CM), MADs with CPAP or CPAP with CM. MADs and CPAP significantly improved AHI [MAD -9.3/hour (p < 0.001); CPAP -25.4/hour (p < 0.001)]. Effect difference between CPAP and MADs was 7.0/hour (p < 0.001), favouring CPAP. No trials compared CPAP with MADs in mild OSAH. MAD and CPAP reduced the ESS score similarly [MAD 1.6 (p < 0.001); CPAP 1.6 (p < 0.001)]. LONG-TERM COST-EFFECTIVENESS An existing model assessed lifetime cost-utility of MAD and CPAP in mild to moderate OSAH, using the revised meta-analysis to update input values. The TOMADO provided utility estimates, mapping ESS score to European Quality of Life-5 Dimensions three-level version for device cost-utility. Using SP2 as the standard device, MADs produced higher mean costs and mean QALYs than CM [incremental cost-effectiveness ratio (ICER) £6687/QALY]. From a willingness to pay (WTP) of £15,367/QALY, CPAP is cost-effective, although the likelihood of MADs (p = 0.48) and CPAP (p = 0.49) being cost-effective is very similar. Both were better than CM, but there was much uncertainty in the choice between CPAP and MAD (at a WTP £20,000/QALY, the probability of being the most cost-effective was 47% for MAD and 52% for CPAP). When SP2 lifespan increased to 18 months, the ICER for CPAP compared with MAD became £44,066. The ICER for SP1 compared with CM was £1552, and for bMAD compared with CM the ICER was £13,836. The ICER for CPAP compared with SP1 was £89,182, but CPAP produced lower mean costs and higher mean QALYs than bMAD. Differential compliance rates for CPAP reduces cost-effectiveness so MADs become less costly and more clinically effective with CPAP compliance 90% of SP2. CONCLUSIONS Mandibular advancement devices are clinically effective and cost-effective in mild to moderate OSAH. A semi-bespoke MAD is the appropriate first choice in most patients in the short term. Future work should explore whether or not adjustable MADs give additional clinical and cost benefits. Further data on longer-term cardiovascular risk and its risk factors would reduce uncertainty in the health economic model and improve precision of effectiveness estimates. TRIAL REGISTRATION This trial is registered as ISRCTN02309506. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Sharples
- University of Leeds Clinical Trials Research Unit, Leeds, UK
| | - Matthew Glover
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | | | - Maxine Bennett
- Medical Research Council Biostatistics Unit, Cambridge, UK
| | - Jake Jordan
- Health Economics Research Unit, Brunel University, Uxbridge, UK
| | - Rebecca Chadwick
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Marcus Pittman
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Clare East
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Malcolm Cameron
- Maxillofacial Unit, Addenbrooke's NHS Foundation Trust, Cambridge, UK
| | - Mike Davies
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Nick Oscroft
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Ian Smith
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Mary Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Timothy Quinnell
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
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Bouloukaki I, Mermigkis C, Kallergis EM, Moniaki V, Mauroudi E, Schiza SE. Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein. World J Exp Med 2015; 5:77-83. [PMID: 25992322 PMCID: PMC4436942 DOI: 10.5493/wjem.v5.i2.77] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/28/2014] [Accepted: 03/20/2015] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.
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Yalamanchali S, Salapatas AM, Hwang MS, Pott TR, Lundgren ME, Joseph NJ, Friedman M. Impact of mandibular advancement devices on C-reactive protein levels in patients with obstructive sleep apnea. Laryngoscope 2014; 125:1733-6. [DOI: 10.1002/lary.25061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/19/2014] [Accepted: 11/06/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sreeya Yalamanchali
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Anna M. Salapatas
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Michelle S. Hwang
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Thomas R. Pott
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Mary E. Lundgren
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Ninos J. Joseph
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Michael Friedman
- Rush University Medical Center; Chicago Illinois U.S.A
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
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Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, Foster GD, Maislin G, Saif H, Broderick P, Chittams J, Hanlon AL, Pack AI. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 2014; 370:2265-75. [PMID: 24918371 PMCID: PMC4138510 DOI: 10.1056/nejmoa1306187] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear. METHODS We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks. We assessed the incremental effect of the combined interventions over each one alone on the CRP level (the primary end point), insulin sensitivity, lipid levels, and blood pressure. RESULTS Among the 146 participants for whom there were follow-up data, those assigned to weight loss only and those assigned to the combined interventions had reductions in CRP levels, insulin resistance, and serum triglyceride levels. None of these changes were observed in the group receiving CPAP alone. Blood pressure was reduced in all three groups. No significant incremental effect on CRP levels was found for the combined interventions as compared with either weight loss or CPAP alone. Reductions in insulin resistance and serum triglyceride levels were greater in the combined-intervention group than in the group receiving CPAP only, but there were no significant differences in these values between the combined-intervention group and the weight-loss group. In per-protocol analyses, which included 90 participants who met prespecified criteria for adherence, the combined interventions resulted in a larger reduction in systolic blood pressure and mean arterial pressure than did either CPAP or weight loss alone. CONCLUSIONS In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT0371293 .).
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Affiliation(s)
- Julio A Chirinos
- From the Philadelphia Veterans Affairs Medical Center (J.A.C., I.G.), Perelman School of Medicine, University of Pennsylvania-Hospital of the University of Pennsylvania (J.A.C., I.G., D.J.R., T.A.W., R.T., G.M., H.S., P.B., A.I.P.), Monell Chemical Senses Center (K.T.), Temple University School of Medicine (G.D.F.), and University of Pennsylvania School of Nursing (J.C., A.L.H.) - all in Philadelphia
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TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 2014; 271:2745-50. [PMID: 24737056 DOI: 10.1007/s00405-014-3044-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/31/2014] [Indexed: 02/08/2023]
Abstract
The polysomnography (PSG) index of the apnea hypopnea index (AHI) is considered the 'gold standard' for stratifying the severity of obstructive sleep apnea (OSA). However, AHI cannot reflect the true characteristic of chronic intermittent hypoxia (CIH), which may trigger systemic inflammation in some OSA patients. High-sensitivity C-reactive protein (hsCRP) is considered a biomarker of systemic inflammation in OSA patients. The aim of the present study was to evaluate the relationship between PSG variables and hsCRP in men with severe OSA. Men with severe OSA (AHI ≥ 30 events/h) diagnosed by PSG were enrolled. AHI and body mass index were matched between a high hsCRP group (hsCRP ≥ 3.0 mg/L) and a low hsCRP group. A blood sample was taken for serum hsCRP analysis. Multiple regression analysis was performed to assess independent predictors of high hsCRP. One hundred and fifty-two subjects were enrolled in the study (76 in each group). Mean serum hsCRP was 3.76 ± 2.13 mg/L. The mean percentage of total sleep time spent with SaO2 <90% (TST) in the high hsCRP group was significantly higher than in the low hsCRP group (20.99 ± 18.52 vs. 5.84 ± 7.30, p < 0.001). Multivariate analysis showed that TST was the strongest predictor, contributing to 27.7% of hsCRP variability (β = 0.496, p < 0.01). TST may be superior to AHI for evaluating CIH among OSA patients. The severity of OSA should be stratified by a combination of AHI and other hypoxia variables.
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Leggett CL, Gorospe EC, Calvin AD, Harmsen WS, Zinsmeister AR, Caples S, Somers VK, Dunagan K, Lutzke L, Wang KK, Iyer PG. Obstructive sleep apnea is a risk factor for Barrett's esophagus. Clin Gastroenterol Hepatol 2014; 12:583-8.e1. [PMID: 24035775 PMCID: PMC3952037 DOI: 10.1016/j.cgh.2013.08.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/01/2013] [Accepted: 08/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Common risk factors for obstructive sleep apnea (OSA) and Barrett's esophagus (BE) include obesity and gastroesophageal reflux disease (GERD). The aims of this study were to assess the association between OSA and BE and to determine whether the association is independent of GERD and body mass index (BMI). METHODS Patients who had undergone a diagnostic polysomnogram and esophagogastroduodenoscopy were identified by using Mayo Clinic (Rochester, Minnesota) databases from January 2000-November 2011. They were randomly matched for age, sex, and BMI at time of polysomnogram into the following groups: BE but no OSA (n = 36), OSA but no BE (n = 78), both (n = 74), or neither (n = 74). Clinical and demographic variables were abstracted from medical records. The association between OSA and BE was assessed by using a multiple variable logistic model that incorporated age, sex, BMI, clinical diagnosis of GERD, and smoking history. RESULTS Subjects with OSA had an 80% increased risk for BE compared with subjects without OSA (odds ratio, 1.8; 95% confidence interval, 1.1-3.2; P = .03). These findings were independent of age, sex, BMI, GERD, and smoking history. Increasing severity of OSA, measured by using the apnea-hypopnea index, was associated with an increased risk of BE (odds ratio, 1.2 per 10-unit increase in apnea-hypopnea index; 95% confidence interval, 1.0-1.3; P = .03). CONCLUSIONS In this case-control study, OSA was associated with an increased risk of BE, potentially through BMI and GERD independent mechanisms. Patients with OSA may benefit from evaluation for BE.
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Affiliation(s)
- Cadman L. Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | | | | | - William S. Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester MN
| | | | - Sean Caples
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester MN
| | | | | | - Lori Lutzke
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
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Liu R, Liu X, Zee PC, Hou L, Zheng Z, Wei Y, Du J. Association between sleep quality and C-reactive protein: results from national health and nutrition examination survey, 2005-2008. PLoS One 2014; 9:e92607. [PMID: 24663098 PMCID: PMC3963926 DOI: 10.1371/journal.pone.0092607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/24/2014] [Indexed: 12/03/2022] Open
Abstract
Objective Our objective was to explore the association between poor sleep quality and hs_CRP in an adult U.S. population. Methods This study focused on 9,317 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005–2008 who were aged 20–85 years, completed a sleep disorder questionnaire, and had available information on serum hs_CRP. Sleep quality was classified into three categories (good, moderate, poor) based on the responses of participants to the NHANES sleep disorder questionnaire. High CRP was defined as hs-CRP >1 md/dL. Linear regression model was applied to investigate the association between poor sleep quality and log-transformed hs_CRP. And logistic regression model was fitted to evaluate the association between sleep quality and the risk of high CRP. Results Females were more likely to report poor sleep quality than males (26% vs. 19%, p<0.0001). Each sleep disorder was significantly associated with increased hs_CRP and correlative to other sleep disorders. In fully-adjusted linear regression model, poor sleep quality was significantly associated with elevated hs_CRP (log transformed) among the overall sample and in females only (β = 0.10, se = 0.03, p<0.01 and β = 0.13, se = 0.04, p<0.01, respectively). In fully-adjusted logistics regression model, poor sleep quality was linked with risk of high CRP(OR: 1.42, 95%CI: 1.15–1.76 in overall sample and OR: 1.59, 95%CI: 1.18–2.14 in females, respectively). Conclusion We found that poor sleep quality was independently associated with elevated hs_CRP in females but not in males in a U.S. adult population.
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Affiliation(s)
- Rong Liu
- Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and Children's Hospital of Chicago Research Center, Chicago, Illinois, United States of America
- * E-mail: (RL); (JD)
| | - Xin Liu
- Mary Ann and J. Milburn Smith Child Health Research Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and Children's Hospital of Chicago Research Center, Chicago, Illinois, United States of America
| | - Phyllis C. Zee
- Department of Neurology and Sleep Medicine Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Zheng Zheng
- Department of Neurobiology, Beijing Institute of Geriatrics, Beijing Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otorhinolaryngology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Jie Du
- Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- * E-mail: (RL); (JD)
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Wilczynska M, Rice S, Davies G, Lewis KE. Endothelial injury markers before and after nasal continuous positive airway pressure treatment for obstructive sleep apnoea hypopnoea syndrome. Sleep Breath 2013; 18:599-607. [DOI: 10.1007/s11325-013-0923-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/23/2013] [Accepted: 11/27/2013] [Indexed: 01/29/2023]
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) occurs in 4% of middle-aged men and 2% of middle-aged women in the general population, and the prevalence is even higher in specific patient groups. OSA is an independent risk factor for a variety of cardiovascular diseases. Endothelial injury could be the pivotal determinant in the development of cardiovascular pathology in OSA. Endothelial damage ultimately represents a dynamic balance between the magnitude of injury and the capacity for repair. Bone marrow-derived endothelial progenitor cells (EPCs) within adult peripheral blood present a possible means of vascular maintenance that could home to sites of injury and restore endothelial integrity and normal function. METHODS We summarized pathogenetic mechanisms of OSA and searched for available studies on numbers and functions of EPCs in patients with OSA to explore the potential links between the numbers and functions of EPCs and OSA. In particular, we tried to elucidate the molecular mechanisms of the effects of OSA on EPCs. CONCLUSION Intermittent hypoxia cycles and sleep fragmentation are major pathophysiologic characters of OSA. Intermittent hypoxia acts as a trigger of oxidative stress, systemic inflammation, and sympathetic activation. Sleep fragmentation is associated with a burst of sympathetic activation and systemic inflammation. In most studies, a reduction in circulating EPCs has emerged. The possible mechanisms underlying the decrease in the number or function of EPCs include prolonged inflammation response, oxidative stress, increased sympathetic activation, physiological adaptive responses of tissue to hypoxia, reduced EPC mobilization, EPC apoptosis, and functional impairment in untreated OSA. Continuous positive airway pressure (CPAP) therapy for OSA affects the mobilization, apoptosis, and function of EPCs through preventing intermittent hypoxia episodes, improving sleep quality, and reducing systemic inflammation, oxidative stress levels, and sympathetic overactivation. To improve CPAP adherence, the medical staff should pay attention to making the titration trial a comfortable first CPAP experience for the patients; for example, using the most appropriate ventilators or proper humidification. It is also important to give the patients education and support about CPAP use in the follow-up, especially in the early stage of the treatment.
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Affiliation(s)
- Qing Wang
- The Second Respiratory Department of the First People’s Hospital of Kunming, Yunnan, People’s Republic of China
| | - Qi Wu
- Tianjin Haihe Hospital, Tianjin, People’s Republic of China
| | - Jing Feng
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
- Correspondence: Jing Feng, Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, People’s Republic of China, Email
| | - Xin Sun
- Respiratory Department of Tianjin Haihe Hospital, Tianjin, People’s Republic of China
- Xin Sun, Respiratory Department of Tianjin Haihe Hospital, Tianjin 300350, People’s Republic of China, Email
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Lin QC, Chen LD, Yu YH, Liu KX, Gao SY. Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation. Eur Arch Otorhinolaryngol 2013; 271:825-31. [PMID: 23995706 DOI: 10.1007/s00405-013-2669-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/16/2013] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and mortality. However, the underlying mechanism is unclear. In this cross-sectional study, we investigated the influence of OSA on metabolic syndrome (MetS) and inflammation, which were considered as cardiovascular risks. A total of 144 consecutive male patients who underwent standard polysomnography were enrolled. Fasting blood samples were obtained from all patients for glucose, high-sensitivity C-reactive protein (hs-CRP) and lipids measurement. A metabolic score was established as the total number of the positive diagnostic criteria of metabolic syndrome for each patient. Systolic blood pressure, diastolic blood pressure, fasting glucose, hs-CRP and metabolic score significantly increased with the aggravation of OSA severity. Metabolic score increased from 1.74 ± 1.20 to 2.89 ± 0.99 with OSA severity (p = 0.000). hs-CRP increased from 0.68 (0.43-1.10) to 1.44 (0.62-4.02) mg/L with OSA severity (p = 0.002). After adjustment for confounders, apnea-hypopnea index and body mass index (BMI) were the major contributing factors for metabolic score (β = 0.257, p = 0.003 and β = 0.344, p = 0.000, respectively), lowest O2 saturation and BMI were the independent predictors of hs-CRP (β = -0.255, p = 0.003 and β = 0.295, p = 0.001, respectively). OSA is independently associated with sum of metabolic components and hs-CRP.
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Affiliation(s)
- Qi-Chang Lin
- Fujian Provincial Sleep-Disordered Breathing Clinic Center, Fuzhou, Fujian Province, People's Republic of China,
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Xie X, Pan L, Ren D, Du C, Guo Y. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med 2013; 14:1139-50. [PMID: 24054505 DOI: 10.1016/j.sleep.2013.07.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 06/03/2013] [Accepted: 07/03/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Our meta-analysis was performed to estimate the effect of continuous positive airway pressure (CPAP) therapy on systemic inflammation in patients with obstructive sleep apnea (OSA). METHODS A comprehensive literature search of PubMed and EMBASE was performed for literature published up to January 2013. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-CPAP therapy. RESULTS A total of 35 studies involving 1985 OSA patients were included in the meta-analysis. Each study investigated one or more inflammatory markers: 24 studies on C-reactive protein (CRP), 16 studies on IL-6, 3 studies on IL-8, and 12 studies on tumor necrosis factor α (TNF-α). The results showed that the SMD (95% confidence interval [CI]) for CRP, IL-6, IL-8, and TNF-α were 0.452 (95% CI, 0.252-0.651), 0.299 (95% CI, 0.001-0.596), 0.645 (95% CI, 0.362-0.929), and 0.478 (95% CI, 0.219-0.736) in pre- and post-CPAP therapy, respectively. The subgroup analyses seemed to support better benefits with therapy duration of ≥3 months and more adequate compliance (≥4 h/night). CONCLUSIONS CPAP therapy could partially suppress systemic inflammation in OSA patients, and substantial differences were present among the various inflammatory markers.
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Affiliation(s)
- XiaoMei Xie
- Department of Radiotherapy, Xuzhou Central Hospital, Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
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Panoutsopoulos A, Kallianos A, Kostopoulos K, Seretis C, Koufogiorga E, Protogerou A, Trakada G, Kostopoulos C, Zakopoulos N, Nikolopoulos I. Effect of CPAP treatment on endothelial function and plasma CRP levels in patients with sleep apnea. Med Sci Monit 2013. [PMID: 23197238 PMCID: PMC3560790 DOI: 10.12659/msm.883603] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the most effective method for treating obstructive sleep apnea syndrome (OSAS) and alleviating symptoms. Improved sleep quality with effective CPAP therapy might also contribute to attenuated systemic inflammation and improved endothelial function, with subsequent reduction of cardiovascular risk. The aim of this study was to assess the effect of 3-month CPAP therapy on brachial artery flow-mediated dilation (FMD) and plasma C-reactive protein (CRP) levels in patients with OSAS. MATERIAL/METHODS Our study group consisted of 38 male patients with no prior history of cardiovascular disease. Twenty patients with an Apnea-Hypopnea Index (AHI) ≥15 were assigned to receive CPAP treatment and 18 subjects with an AHI<5 were included in the control group. Six patients failed to comply with the CPAP treatment. Measurement of FMD and blood analysis was performed at baseline and 3 months after CPAP therapy. RESULTS Baseline FMD values were negatively correlated with age, BMI, AHI, DSI,% of time <90% Sa02, and CRP (p<0.05). Plasma CRP values were positively correlated with BMI, AHI, DSI and% of time <90% Sa02 (p<0.05). In the group of patients who complied with the CPAP treatment, there was a significant increase in the FMD values (9.18 ± 0.55 vs. 6.27 ± 0.50) and a decrease in the levels of CRP (0.67 ± 0.15 vs. 0.84 ± 0.18) (p<0.05). CONCLUSIONS Appropriate CPAP therapy improved both CRP and FMD values, suggesting its potentially beneficial role in reducing cardiovascular risk in OSAS patients.
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Baessler A, Nadeem R, Harvey M, Madbouly E, Younus A, Sajid H, Naseem J, Asif A, Bawaadam H. Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers - a meta-analysis. JOURNAL OF INFLAMMATION-LONDON 2013; 10:13. [PMID: 23518041 PMCID: PMC3637233 DOI: 10.1186/1476-9255-10-13] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/05/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with coronary artery disease (CAD). Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to CAD in patients with OSA. Treatment with continuous positive airway pressure (CPAP) has been shown to change levels of inflammatory markers. We analyzed data from published studies by a systematic meta-analysis. OBJECTIVE To asses if treatment for sleep apnea by CPAP will affect levels of inflammatory markers. DATA RESOURCES PubMed, Embase and Cochrane library. METHODS Study eligibility criteria full text English studies of adult, human subjects, addressing values of at least one of the inflammatory markers before and after CPAP treatment. We used the definition of OSA as an apnea-hypopnea index (AHI) of ≥ 5/h, reported values in mean and standard deviation or median with range. PARTICIPANTS Adult, human. INTERVENTIONS CPAP treatment for OSA. STUDY APPRAISAL AND SYNTHESIS METHOD A total of 3835 studies were reviewed for inclusion, while 23 studies pooled for analysis. A total of 14 studies with 771 patients were pooled for C-reactive protein (CRP); 9 studies with 209 patients were pooled for tumor necrosis factor-alpha (TNF-α); and 8 studies with 165 patients were pooled for interleukin-6 (IL-6). ENDPOINT DEFINITIONS THE FOLLOWING INFLAMMATORY MARKERS WERE CHOSEN: CRP, TNF-α, and IL-6. RESULTS C-reactive protein: Study level means ranged from 0.18 to 0.85 mg/dl before CPAP treatment and 0.10 to 0.72 mg/dl after CPAP treatment. Mean differences, at a study level, ranged from -0.05 to 0.50. The pooled mean difference was 0.14 [95% confidence interval 0.08 to 0.20, p < 0.00001]. There was heterogeneity in this endpoint (df = 13, p < 0.00001, I(2) = 95%). Tumor necrosis factor-α: Study level means ranged from 1.40 to 50.24 pg/ml before CPAP treatment and 1.80 to 28.63 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from -1.23 to 21.61. The pooled mean difference was 1.14 [95% confidence interval 0.12 to 2.15, p = 0.03]. There was heterogeneity in this endpoint (df = 8, p < 0.00001, I2 = 89%). Interleukin-6: Study level means ranged from 1.2 to 131.66 pg/ml before CPAP treatment and 0.45 to 66.04 pg/ml after CPAP treatment. Mean differences, at a study level, ranged from -0.40 to 65.62. The pooled mean difference was 1.01 [95% confidence interval -0.00 to 2.03, p = 0.05]. There was heterogeneity in this endpoint (df = 7, p < 0.00001, I(2) = 95%). LIMITATIONS Only published data. Studies pooled were mainly small, non-randomized trials. CONCLUSION Sleep apnea treatment with CPAP improves levels of inflammatory markers.
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Affiliation(s)
- Aaron Baessler
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
| | - Rashid Nadeem
- Pulmonary and Sleep Medicine, James A Lovell Federal Health Care Center, North Chicago, IL, USA ; James A. Lovell Federal Health Care Centre, 3001 Green Bay Road, North Chicago, IL, 60064, USA
| | - Michael Harvey
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
| | - Essam Madbouly
- Pulmonary and Sleep Medicine, James A Lovell Federal Health Care Center, North Chicago, IL, USA
| | - Amna Younus
- Bahria University medical and dental college, Karachi, Pakistan
| | | | | | - Asma Asif
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
| | - Hasnain Bawaadam
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA
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Quantity and Quality of Nocturnal Sleep Affect Morning Glucose Measurement in Acutely Burned Children. J Burn Care Res 2013; 34:483-91. [DOI: 10.1097/bcr.0b013e3182a2a89c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity⁄mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity). OBJECTIVE To provide a comprehensive review of the current evidence associating OSA with increased coagulability, and to highlight areas for future research. METHODS Keyword searches in Ovid Medline were used to identify relevant articles; all references in the articles were searched for relevant titles. The Web of Science was used to identify articles citing the relevant articles found using the Ovid Medline search. All original peer-reviewed articles, meta-analyses and systematic reviews regarding the pertinent topics between 1990 and present were selected for review. RESULTS Hematocrit, blood viscosity, certain clotting factors, tissue factor, platelet activity and whole blood coagulability are increased in patients with OSA, while fibrinolysis is impaired. CONCLUSION There is considerable evidence that OSA is associated with a procoagulant state. Several factors are involved in the procoagulant state associated with OSA. There is a need for adequately powered clinical studies involving well-matched control groups to address potential confounding variables, and to accurately delineate the individual factors involved in the procoagulant state associated with OSA and their response to treatment.
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Arnardottir ES, Maislin G, Schwab RJ, Staley B, Benediktsdottir B, Olafsson I, Juliusson S, Romer M, Gislason T, Pack AI. The interaction of obstructive sleep apnea and obesity on the inflammatory markers C-reactive protein and interleukin-6: the Icelandic Sleep Apnea Cohort. Sleep 2012; 35:921-32. [PMID: 22754038 DOI: 10.5665/sleep.1952] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels. DESIGN Cross-sectional cohort. SETTING The Icelandic Sleep Apnea Cohort. PARTICIPANTS 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO₂) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m²). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO₂ only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women. CONCLUSIONS OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients.
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Affiliation(s)
- Erna S Arnardottir
- Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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Friedman M, Samuelson CG, Hamilton C, Fisher M, Kelley K, Joseph NJ, Wang PC, Lin HC. Effect of continuous positive airway pressure on C-reactive protein levels in sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg 2012; 147:423-33. [PMID: 22714423 DOI: 10.1177/0194599812451840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evaluate the effects of continuous positive airway pressure (CPAP) on C-reactive protein (CRP) levels, reported either as a primary or secondary end point among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) based on a meta-analysis of published studies. DATA SOURCES English-language searches of PubMed, Ovid, and the Cochrane databases were completed. Reference sections of identified studies were also examined for additional relevant articles to review. REVIEW METHODS Studies of adult patients with OSAHS who reported pre- and post-CPAP treatment CRP were reviewed and analyzed. Two independent reviewers extracted data from 10 peer-reviewed studies, which were combined using a random effects meta-analysis model. RESULTS The CPAP treatment was found to lead to a significant reduction in CRP levels (17.8%, P = .002). This corresponds to an effect size of -0.485 (-0.731, -0.240). Sensitivity analysis was done to determine the impact of study design. Both case-control studies and case-series studies yielded a significant effect. Sensitivity analysis also yielded a significant effect for studies with average body mass index <30, studies where CPAP was employed over automatic positive airway pressure, and studies treating patients ≤ 3 months. Analysis of publication bias, however, revealed a likelihood of "missing" studies. CONCLUSION Although there is a significant lack of high-quality studies addressing this question, this analysis suggests that treatment with CPAP leads to a statistically significant reduction in CRP levels. However, the mean pre- and posttreatment CRP levels observed are considered "high risk" for cardiovascular morbidity. The clinical significance of this finding as it relates to cardiovascular risk reduction and the relationship between CRP and OSAHS requires further study.
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Abstract
OSA is increasingly recognized as a major health problem in developed countries. Obesity is the most common risk factor in OSA and hence, the prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is highly associated with the metabolic syndrome, and it is postulated that OSA contributes to cardiometabolic dysfunction, and subsequently vasculopathy. Current evidence regarding the magnitude of impact on ultimate cardiovascular morbidity or mortality attributable to OSA-induced metabolic dysregulation is scarce. Given the known pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA, the potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. There is accumulating evidence from human and animal/cell models of intermittent hypoxia to map out these mechanistic pathways. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, a healthy diet and appropriate lifestyle modifications towards better control of metabolic function are equally important as CPAP treatment in the holistic management of OSA.
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Affiliation(s)
- Jamie Chung Mei Lam
- Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Guo Y, Pan L, Ren D, Xie X. Impact of continuous positive airway pressure on C-reactive protein in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 2012; 17:495-503. [PMID: 22664769 DOI: 10.1007/s11325-012-0722-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/16/2012] [Accepted: 05/21/2012] [Indexed: 12/23/2022]
Abstract
PURPOSE C-reactive protein (CRP) is associated with the development of obstructive sleep apnea (OSA) and cardiovascular diseases. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, but the impact of CPAP therapy on CRP levels in patients with OSA remains unclear. To obtain this information, we performed a meta-analysis to determine whether effective CPAP therapy could reduce serum CRP levels. METHODS A comprehensive literature search was performed to identify studies that examined the impact of CPAP on serum CRP levels in OSA patients who were treated with CPAP for at least 4 weeks. Standardized mean difference (SMD) was used to analyze the summary estimates for CPAP therapy. RESULTS Fourteen self-control design studies involving 1199 patients with OSA met the inclusion criteria. Meta-analysis indicated that the overall SMD for the CRP levels was 0.64 units (95 % confidence interval (CI) 0.40 to 0.88) before and after CPAP therapy; test for overall effect z = 5.27 (P = 0.000). Subgroup analysis showed that evolution of CRP decreased non-significantly in less than 3 months (SMD, 0.26, 95 % CI -0.08 to 0.60, P = 0.138), significantly decreased after 3 months (SMD, 0.68, 95 % CI 0.34 to 1.02, P = 0.000), and further declined after 6 months (SMD, 0.74, 95 % CI 0.43 to 1.05, P = 0.000). CONCLUSIONS The systemic inflammation, as measured by CRP, was present and significantly reduced by effective CPAP therapy in patients with OSA. The use of CRP levels may be clinically recognized as a valuable predictor for OSA treatment monitoring.
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Affiliation(s)
- Yongzhong Guo
- Guangzhou Institute of Respiratory Diseases, State Key Lab of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical College, 151 Yanjiang Road, Guangzhou, Guangdong 510120, China.
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Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens 2012; 26:281-7. [PMID: 21654850 PMCID: PMC3748801 DOI: 10.1038/jhh.2011.47] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnoea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is strongly associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure (BP). Determining why OSA is so strongly linked to having hypertension in cross-sectional studies, but yet CPAP therapy has limited BP benefit needs further exploration. The CPAP studies do, however, indicate a wide variation in the BP effects of CPAP, with some patients manifesting a large antihypertensive benefit such that a meaningful BP effect can be anticipated in some individuals. OSA is particularly common in patients with resistant hypertension (RHTN). The reason for this high prevalence of OSA is not fully explained, but data suggest that it may be related to the high occurrence of hyperaldosteronism in patients with RHTN. In patients with RHTN, it has been shown that aldosterone levels correlate with severity of OSA and that blockade of aldosterone reduces the severity of OSA. Overall, these findings are consistent with aldosterone excess contributing to worsening of underlying OSA. We hypothesize that aldosterone excess worsens OSA by promoting accumulation of fluid within the neck, which then contributes to increased upper airway resistance.
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Affiliation(s)
- T Dudenbostel
- Vascular Biology and Hypertension Program, Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294,USA.
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Mermigkis C, Bouloukaki I, Mermigkis D, Kallergis E, Mavroudi E, Varouchakis G, Tzortzaki E, Siafakas N, Schiza SE. CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role? Sleep Breath 2011; 16:813-9. [PMID: 21881894 DOI: 10.1007/s11325-011-0580-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/25/2011] [Accepted: 08/19/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND-AIM C-reactive protein (CRP) is directly implicated in atherogenesis and associated cardiovascular morbidity in patients with obstructive sleep apnea (OSA). Effective continuous positive airway pressure (CPAP) treatment has been shown to gradually decrease CRP levels and thus consequently improve disease-related cardiovascular morbidity. However, the influence of gender on the CRP evolution pattern has never been assessed before. The aim of our study was to investigate possible gender differences in CRP evolution in OSA patients 3 and 6 months after the start of effective CPAP treatment. METHODS The study population consisted of 436 patients (252 males/184 females) with newly diagnosed moderate to severe OSA and good CPAP compliance assessed by a thorough follow up. High-sensitivity C-reactive protein (hs-CRP) was assessed before CPAP initiation and at the third and sixth month of the follow-up period. RESULTS C-reactive protein values showed a statistically significant decrease at the third and sixth month of CPAP therapy [initial values 0.79 ± 0.65 mg/dL versus 0.70 ± 0.52 mg/dL (p < 0.05) after 3 months and 0.30 ± 0.33 mg/dL (p < 0.001) after 6 months of CPAP therapy]. When patients were divided into males and females, the above evolution pattern was changed. At the third month time point, the CRP values showed a statistically significant decrease only in males (from 0.74 ± 0.53 mg/dL to 0.61 ± 0.5 mg/dL, p < 0.01) while females showed only minimal and insignificant changes (from 0.87 ± 0.79 mg/dL to 0.83 ± 0.51 mg/dL, p > 0.05). After 6 months' treatment, CRP decreased significantly in both genders (males from 0.74 ± 0.53 mg/dL to 0.28 ± 0.32 mg/dL, p < 0.001 and females from 0.87 ± 0.79 mg/dL to 0.34 ± 0.36 mg/dL, p < 0.001). CONCLUSION Our results suggest a delay in the normalization of CRP levels in females despite effective CPAP treatment. A time period of at least 6 months appeared to be required in women in order to reduce CRP levels and consequent cardiovascular risk. In contrast, CPAP's protective role in males is achieved at an earlier time point. Gender-related hormonal and genetic factors may influence the above CRP evolution pattern.
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Affiliation(s)
- Charalampos Mermigkis
- Sleep Disorders Center, Pulmonary Department, 401 General Army Hospital, Athens, Greece.
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Abstract
Obstructive sleep apnea (OSA) is a form of sleep disordered breathing in which pharyngeal muscle relaxation leads to recurrent nighttime apneas and hypopneas that, through increased afterload, intermittent hypoxia, and excess sympathetic activity, weaken the already failing heart. This review presents the current evidence regarding the complex relationship between OSA and heart failure (HF), including support for OSA as both a cause and consequence of HF. The impact of OSA on other cardiovascular diseases, such as hypertension, ischemic heart disease and arrhythmias, as they relate to HF development or exacerbation, also are reviewed.
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Affiliation(s)
- Meredith A Brisco
- Cardiovascular Medicine, Heart Failure and Cardiac Transplant Program, University of Pennsylvania, 2 East Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Kent BD, Ryan S, McNicholas WT. Obstructive sleep apnea and inflammation: relationship to cardiovascular co-morbidity. Respir Physiol Neurobiol 2011; 178:475-81. [PMID: 21439407 DOI: 10.1016/j.resp.2011.03.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 02/24/2011] [Accepted: 03/15/2011] [Indexed: 01/17/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease and associated with cardiovascular morbidity and mortality. The pathogenesis of cardiovascular complications in OSAS is incompletely understood but a multifactorial etiology is likely. There is emerging evidence that inflammatory processes leading to endothelial dysfunction play a pivotal role. Various studies have demonstrated elevated inflammatory markers in OSAS patients in comparison to matched control subjects with a significant fall after effective treatment with continuous positive airway pressure. Cell culture and animal studies have significantly enhanced our understanding of the mechanisms of inflammation in OSAS. Intermittent hypoxia, the hallmark feature of OSAS, leads to a preferential activation of inflammatory pathways with the downstream consequence of expression of pro-inflammatory cytokines, chemokines and adhesion molecules that may contribute to endothelial dysfunction. Further studies are required to determine the precise role of inflammation in the cardiovascular pathogenesis of OSAS, particularly its interaction with oxidative stress, obesity and metabolic dysfunction.
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Affiliation(s)
- Brian D Kent
- Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland
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Lee LA, Huang CG, Chen NH, Wang CL, Fang TJ, Li HY. Severity of obstructive sleep apnea syndrome and high-sensitivity C-reactive protein reduced after relocation pharyngoplasty. Otolaryngol Head Neck Surg 2011; 144:632-8. [PMID: 21493247 DOI: 10.1177/0194599810395104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report improvement of obstructive sleep apnea syndrome (OSAS) and changes of high-sensitivity C-reactive protein (hs-CRP) concentrations after relocation pharyngoplasty (RP), a high variant of uvulopalatopharyngoplasty. STUDY DESIGN Prospective comparative study. SETTING Tertiary referral center. SUBJECTS AND METHODS Thirty consecutive OSAS patients without a preexisting diagnosis of cardiovascular disease who underwent RP were assessed for body mass index (BMI), Epworth Sleepiness Scale (ESS), sleep apnea-hypopnea index (AHI), and serum levels of hs-CRP at baseline and 6 months postoperatively. RESULTS Of the subjects, the mean values of age, BMI, ESS, AHI, and hs-CRP were 39.5 ± 7.0 years, 27.5 ± 4.5 kg/m(2), 10.8 ± 4.2, 46.2 ± 22.9 events/hour, and 2.06 ± 1.78 mg/L, respectively. After 6 months postoperatively, RP reduced the ESS (Δ = -4.3 ± 4.5, P < .001) and AHI (Δ = -28.3 ± 21.1, P < .001) and levels of hs-CRP (Δ = -0.67 ± 1.36, P = .012) significantly, whereas BMI measurements were indifferent (Δ = -0.42 ± 1.28, P = .073). Moreover, the changes of AHI and hs-CRP were particularly remarkable in patients with very severe OSAS (AHI ≥60). CONCLUSION Although many OSAS patients remain in the mild-moderate category, equivalent improvements in excessive daytime sleepiness and reductions of hs-CRP concentrations indicate that reduction of AHI is not all that matters after RP.
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Affiliation(s)
- Li-Ang Lee
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Schiza SE, Mermigkis C, Panagiotis P, Bouloukaki I, Kallergis E, Tzanakis N, Tzortzaki E, Vlachaki E, Siafakas NM. C-reactive protein evolution in obstructive sleep apnoea patients under CPAP therapy. Eur J Clin Invest 2010; 40:968-75. [PMID: 20629709 DOI: 10.1111/j.1365-2362.2010.02348.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND C-reactive protein (CRP) is recognized as a potential factor implicated in atherogenesis and associated cardiovascular morbidity. The aim of our study was to assess the CRP evolution during 1-year follow-up period in obstructive sleep apnoea (OSA) patients under CPAP treatment. METHODS Five hundred and twenty-eight patients with newly diagnosed moderate to severe OSA were included. CRP was assessed before CPAP initiation and at the 3rd, 6th and 12th month of the follow-up period. Patients were divided into good and poor CPAP compliance groups. RESULTS A significant reduction in CRP levels was observed after CPAP therapy (0·74±0·62mgdL(-1) vs. 0·31±0·29mgdL(-1) , P<0·001) in the whole patient group. The evolution of CRP values showed a gradual decrease at 3months with a steep decline at 6months, reaching a plateau after this time point. When the patients were divided into those with good and poor compliance with CPAP therapy, the above CRP evolution pattern was observed only in the former group. CONCLUSION Good CPAP compliance results in a significant CRP reduction. To achieve the best positive impact on cardiovascular morbidity and mortality, a time period of at least 6months of CPAP use is required.
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Affiliation(s)
- Sophia E Schiza
- Sleep Disorders Unit, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Voutes, Greece.
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CPAP Effect on Cardiovascular Disease. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kee K, Sands SA, Edwards BA, Berger PJ, Naughton MT. Positive Airway Pressure in Congestive Heart Failure. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kezirian EJ, Malhotra A, Goldberg AN, White DP. Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. Laryngoscope 2010; 120:1481-8. [PMID: 20564750 DOI: 10.1002/lary.20946] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of multilevel obstructive sleep apnea surgical treatment on sleep-disordered breathing severity, health-related measures, and quality of life, and to examine the association between changes in sleep-disordered breathing severity and these other outcomes. STUDY DESIGN Prospective cohort study. METHODS Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy and with evidence of multilevel (palate and hypopharynx) obstruction underwent uvulopalatopharyngoplasty, tonsillectomy, and genioglossus advancement, with or without hyoid suspension. All subjects had preoperative and postoperative study assessments, including blood draw for C-reactive protein, interleukin-6, homocysteine, homeostasis model of insulin resistance, and leptin, and evaluation with the Functional Outcomes of Sleep Questionnaire. RESULTS Thirty subjects underwent multilevel surgical treatment. The mean apnea-hypopnea index decreased from 44.9 +/- 28.1 to 27.8 +/- 26.4 events/hour (P = .008). Thirteen (43%) subjects in this heterogeneous sample achieved a response to surgery (defined as an apnea-hypopnea index reduction of >or=50% to an absolute level <15 events/hour), and body mass index <or=32 kg/m(2) was associated with a higher likelihood (55%, 12/22) of response (P = .04). There was no overall change in C-reactive protein levels, but responders demonstrated a decrease (-1.02 +/- 0.98 mg/L, P = .003) that was independent of changes in body weight. There were no significant changes in other health-related measures. Responders and nonresponders both demonstrated improvements in sleep-related quality of life. CONCLUSIONS This multilevel surgery was associated with a low likelihood of response in subjects with body mass index >32 kg/m(2). Responders had decreased C-reactive protein levels that were independent of changes in body weight.
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Affiliation(s)
- Eric J Kezirian
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
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