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Akset M, Poppe KG, Kleynen P, Bold I, Bruyneel M. Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship. Clin Endocrinol (Oxf) 2023; 98:3-13. [PMID: 35182448 DOI: 10.1111/cen.14685] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common disorder characterized by recurrent episodes of apnoea or hypopnea due to total or partial pharyngeal collapse and temporary upper airway obstruction during sleep. The prevalence of OSA is increasing and currently affects about 30% of men and 13% of women in Europe. Intermittent hypoxia, oxidative stress, systemic inflammation, and sleep fragmentation resulting from OSA can provoke subsequent cardiometabolic disorders. The relationships between endocrine disorders and OSA are complex and bidirectional. Indeed, several endocrine disorders are risk factors for OSA. Compared with the general population, the prevalence of OSA is increased in patients with obesity, hypothyroidism, acromegaly, Cushing syndrome, and type 1 and 2 diabetes. In some cases, treatment of the underlying endocrine disorder can improve, and occasionally cure, OSA. On the other hand, OSA can also induce endocrine disorders, particularly glucose metabolism abnormalities. Whether continuous positive airway pressure (CPAP) treatment for OSA can improve these endocrine disturbances remains unclear due to the presence of several confounding factors. In this review, we discuss the current state-of-the-art based on the review of the current medical literature for key articles focusing on the bidirectional relationship between endocrine disorders and OSA and the effects of treatment. Screening of OSA in endocrine patients is also discussed, as it remains a subject of debate.
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Affiliation(s)
- Maud Akset
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kris Gustave Poppe
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Kleynen
- Department of Endocrinology, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Shakoei S, Torabimirzaee A, Saffarian Z, Abedini R. Sleep disturbance in alopecia areata: A cross-sectional study. Health Sci Rep 2022; 5:e576. [PMID: 35387310 PMCID: PMC8973252 DOI: 10.1002/hsr2.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Alopecia areata (AA) is a nonscarring hair loss with autoimmune pathophysiology, which is associated with psychiatric disorders including anxiety and depression. Sleep disorders are commonly seen with anxiety and depression. Here we evaluate the sleep quality of AA patients. Methods This cross-sectional study involved 51 AA patients and 51 age- and sex-matched healthy controls. The sleep quality and day sleepiness were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. The severity of AA was evaluated with the Severity of Alopecia Tool (SALT). Results Unlike the ESS score, the mean PSQI score was significantly higher in the AA group compared with the controls (7 ± 4.13 vs. 3.53 ± 1.96, p < 0.001). The number of cases with ESS ≥ 11, indicating the excess daytime sleepiness, was significantly higher in the AA group compared with controls (15 vs. 6, p = 0.02). There was no significant correlation between PSQI score and age, age of onset of the disease, or SALT score (p > 0.05). Anxiety and depression were more common in the AA group versus controls (p = 0.9). PSQI score was higher in AA patients who had anxiety and depression compared with those who did not (9.9 ± 5.28 vs. 4.76 ± 3.08, p = 0.001). Conclusion Sleep quality is impaired in AA patients. As expected, sleep would be more disturbed in AA cases with depression or anxiety. Therefore, attention to sleep quality and concomitant psychiatric diseases is essential in AA clinical management.
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Affiliation(s)
- Safoura Shakoei
- Department of Dermatology, Imam Khomeini HospitalTehran University of Medical Sciences (TUMS)TehranIran
| | - Alireza Torabimirzaee
- Department of Dermatology, Imam Khomeini HospitalTehran University of Medical Sciences (TUMS)TehranIran
| | - Zahra Saffarian
- Department of Dermatology, Imam Khomeini HospitalTehran University of Medical Sciences (TUMS)TehranIran
| | - Robabeh Abedini
- Department of Dermatology, Razi HospitalTehran University of Medical Sciences (TUMS)TehranIran
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3
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Yuan J, Qi S, Zhang X, Lai H, Li X, Xiaoheng C, Li Z, Yao S, Ding Z. Local symptoms of Hashimoto's thyroiditis: A systematic review. Front Endocrinol (Lausanne) 2022; 13:1076793. [PMID: 36743914 PMCID: PMC9892448 DOI: 10.3389/fendo.2022.1076793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Hashimoto's thyroiditis (HT) is the most common type of thyroid disease and can cause many different manifestations. The local symptoms of HT are an under-studied area of research. Therefore, the purpose of this study was to investigate the local symptoms of HT and their prevalence. METHODS A systematic review was performed to find articles in PubMed that discuss the local symptoms of HT. Relevant vocabulary terms and key terms included: autoimmune thyroid disease (AITD), hyperthyroidism, hypothyroidism, neck, throat, pharynx, airway, esophagus, breathe, swallow, globus, sleep apnea, symptoms, and quality of life. Two investigators independently screened the eligible studies. RESULTS A total of 54 articles fulfilled the inclusion criteria. Of these, 25 were clinical studies, 24 were case reports, and five were reviews. These clinical studies and case reports included a total of 2660 HT patients. There were eight local symptoms related to HT: neck pain (0.02%~16%), voice changes (7%~30%), throat discomfort (20%~43.7%), shortness of breath (28%~50%), dysphagia (29%), goiter-related symptoms (69.44%), sleep apnea, and generally defined compressive symptoms. Due to the use of different outcome measures among all the studies, a meta-analysis of the data could not be performed. CONCLUSION Goiter symptoms, which are an item on the ThyPRO scales, are the most frequent local symptoms in HT patients, and include neck pain, voice changes, throat discomfort, and dysphagia. These local symptoms should be identified in the clinic and included in the early diagnosis and management of HT, as well as evaluated further to understand their relevance in the pathogenesis of HT.
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Affiliation(s)
- Jiaojiao Yuan
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
| | - Shuo Qi
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
- *Correspondence: Shuo Qi, ; Zhiguo Ding,
| | - Xufan Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
| | - Hezheng Lai
- National Institute of Complementary Medicine, Western Sydney University, Westmead, NSW, Australia
| | - Xinyi Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Xiaoheng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhe Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Simiao Yao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- The First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiguo Ding
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
- *Correspondence: Shuo Qi, ; Zhiguo Ding,
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4
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Liu PK, Chiu TY, Wang NK, Levi SR, Tsai MJ. Ocular Complications of Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10153422. [PMID: 34362205 PMCID: PMC8348497 DOI: 10.3390/jcm10153422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Tzu-Yu Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Sarah R. Levi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5601)
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Veatch OJ, Bauer CR, Keenan BT, Josyula NS, Mazzotti DR, Bagai K, Malow BA, Robishaw JD, Pack AI, Pendergrass SA. Characterization of genetic and phenotypic heterogeneity of obstructive sleep apnea using electronic health records. BMC Med Genomics 2020; 13:105. [PMID: 32711518 PMCID: PMC7382070 DOI: 10.1186/s12920-020-00755-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is defined by frequent episodes of reduced or complete cessation of airflow during sleep and is linked to negative health outcomes. Understanding the genetic factors influencing expression of OSA may lead to new treatment strategies. Electronic health records (EHRs) can be leveraged to both validate previously reported OSA-associated genomic variation and detect novel relationships between these variants and comorbidities. Methods We identified candidate single nucleotide polymorphisms (SNPs) via systematic literature review of existing research. Using datasets available at Geisinger (n = 39,407) and Vanderbilt University Medical Center (n = 24,084), we evaluated associations between 40 previously implicated SNPs and OSA diagnosis, defined using clinical codes. We also evaluated associations between these SNPs and OSA severity measures obtained from sleep reports at Geisinger (n = 6571). Finally, we used a phenome-wide association study approach to help reveal pleiotropic genetic effects between OSA candidate SNPs and other clinical codes and laboratory values available in the EHR. Results Most previously reported OSA candidate SNPs showed minimal to no evidence for associations with OSA diagnosis or severity in the EHR-derived datasets. Three SNPs in LEPR, MMP-9, and GABBR1 validated for an association with OSA diagnosis in European Americans; the SNP in GABBR1 was associated following meta-analysis of results from both clinical populations. The GABBR1 and LEPR SNPs, and one additional SNP, were associated with OSA severity measures in European Americans from Geisinger. Three additional candidate OSA SNPs were not associated with OSA-related traits but instead with hyperlipidemia and autoimmune diseases of the thyroid. Conclusions To our knowledge, this is one of the largest candidate gene studies and one of the first phenome-wide association studies of OSA genomic variation. Results validate genetic associates with OSA in the LEPR, MMP-9 and GABBR1 genes, but suggest that the majority of previously identified genetic associations with OSA may be false positives. Phenome-wide analyses provide evidence of mediated pleiotropy. Future well-powered genome-wide association analyses of OSA risk and severity across populations with diverse ancestral backgrounds are needed. The comprehensive nature of the analyses represents a platform for informing future work focused on understanding how genetic data can be useful to informing treatment of OSA and related comorbidities.
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Affiliation(s)
- Olivia J Veatch
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 125 S. 31st St, Office 2123, Philadelphia, PA, 19104, USA. .,Sleep Disorders Division/Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA. .,Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Mail-Stop 4015, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | | | - Brendan T Keenan
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 125 S. 31st St, Office 2123, Philadelphia, PA, 19104, USA
| | | | - Diego R Mazzotti
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 125 S. 31st St, Office 2123, Philadelphia, PA, 19104, USA
| | - Kanika Bagai
- Sleep Disorders Division/Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Beth A Malow
- Sleep Disorders Division/Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Janet D Robishaw
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 125 S. 31st St, Office 2123, Philadelphia, PA, 19104, USA
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Xerfan EM, Facina AS, Andersen ML, Tufik S, Tomimori J. Hashimoto Thyroiditis as a Cause or Consequence of Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:1703. [PMID: 31739867 PMCID: PMC6853408 DOI: 10.5664/jcsm.8054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022]
Abstract
Xerfan EMS, Facina AS, Andersen ML, Tufik S, Tomimori J. Hashimoto thyroiditis as a cause or consequence of obstructive sleep apnea. J Clin Sleep Med . 2019;15(11):1703.
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Affiliation(s)
- Ellen M.S. Xerfan
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP) São Paulo, Brazil
| | - Anamaria S. Facina
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP) São Paulo, Brazil
| | - Monica L. Andersen
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP) São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP) São Paulo, Brazil
| | - Jane Tomimori
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP) São Paulo, Brazil
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7
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Xerfan EMS, Andersen ML, Facina AS, Tufik S, Tomimori J. Alopecia areata and sleep quality: is there an interaction? J Eur Acad Dermatol Venereol 2019; 33:e405-e406. [PMID: 31120167 DOI: 10.1111/jdv.15705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E M S Xerfan
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - M L Andersen
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - A S Facina
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - S Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - J Tomimori
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Sriphrapradang C, Pinyopodjanard S, Suntornlohanakul O, Nimitphong H, Chirakalwasan N, Saetang S, Anothaisintawee T, Siwasaranond N, Manodpitipong A, Chailurkit LO, Reutrakul S. Lack of associations between thyroid function and obstructive sleep apnea severity in adults with prediabetes and diabetes mellitus. Sleep Breath 2018; 23:963-967. [PMID: 30456738 DOI: 10.1007/s11325-018-1756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypothyroidism is associated with a high frequency of obstructive sleep apnea (OSA). However, the prevalence of OSA in hypothyroid patients is not different from the general population in many reports. The importance of thyroid function screening in sleep-disordered breathing is still controversial. This study aimed to explore the association between thyroid dysfunction and OSA in the adults with prediabetes or diabetes mellitus type 2, who have very high prevalence of OSA. METHODS OSA was assessed using an in-home monitoring device, WatchPAT200. OSA severity was measured using apnea-hypopnea index (AHI), oxygen desaturation index (ODI), minimum oxygen saturation (minO2), and time spent under oxygen saturation < 90% (T90). Patients with pre-existing thyroid dysfunction were excluded. RESULTS Participants included 70 men and 118 women with mean age 52.8 ± 10.9 years and body mass index 28.2 ± 4.9 kg/m2. One hundred forty participants (75%) had OSA, with a median AHI of 10.1 (interquartile range 4.8, 18.3). The percentage of positive thyroid autoantibody (thyroperoxidase and thyroglobulin antibody) was similar among the subjects with and without OSA. There was no correlation between the levels of thyroid function (TSH, FT3, FT4, TSH/FT3, and TSH/FT4 ratio) and the severity indices of OSA (AHI, ODI, minO2, and T90). CONCLUSIONS These data do not support universal screening for thyroid dysfunction in OSA patients with diabetes or prediabetes.
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Affiliation(s)
- Chutintorn Sriphrapradang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.
| | - Sittichai Pinyopodjanard
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Onnicha Suntornlohanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sunee Saetang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nantaporn Siwasaranond
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Areesa Manodpitipong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - La-Or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.,Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
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Gonçalves DR, Braga A, Braga J, Marinho A. Recurrent pregnancy loss and vitamin D: A review of the literature. Am J Reprod Immunol 2018; 80:e13022. [PMID: 30051540 DOI: 10.1111/aji.13022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects approximately 1%-2% of reproductive women. Auto- and cellular immune responses seem to be associated with RPL. Vitamin D (VD) has been shown to play a role in the modulation of the immune system. Effects of VD deficiency (VDD) in pregnancy have been associated with preeclampsia, gestational diabetes, fetal growth restriction, preterm labor, and sporadic spontaneous abortion (SA). We systematically reviewed articles that studied women with 2 or more SA and its association with VD. Eleven studies were included. Studies reported a high prevalence of VD insufficiency (VDI) or VDD in women with RPL and suggested that this could be associated with immunological dysregulation and consequently with RPL. Immunological benefits were reported in the peripheral blood of women with RPL after VD exposure. Thus, it is possible to speculate a beneficial role for VD supplementation in RPL. It seems that there are not differences in the vitamin D receptor (VDR) and CYP27B1 expression in endometrium of women with RPL but, in villous and decidual tissues, RPL women seem to have a decreased expression of VDR and, perhaps, a decreased expression of CYP27B1. Further randomized controlled studies are required to investigate the association between VDD or VDI and RPL.
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Affiliation(s)
| | - António Braga
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Braga
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - António Marinho
- UMIB, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Clinical Immunology Unit, Centro Hospitalar do Porto, Porto, Portugal
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Tepebaşı MY, Şahin Calapoğlu N, Öztürk Ö, Sancer O, Gonca T. HLA-DRB1 allele frequency and immunological response in obstructive sleep apnea syndrome in Turkish population. CLINICAL RESPIRATORY JOURNAL 2018; 12:2505-2512. [PMID: 30015400 DOI: 10.1111/crj.12945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/29/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a complex, polygenic and multifactorial disease. The relationship between Human Leukocyte Antigen (HLA) polymorphisms and sleep disturbances has been established, but the relationship with HLA alleles has not been fully clarified. In addition, sleep deprivation in OSAS patients can cause changes that affect the components and responses of the immune system. OBJECTIVE The aim of this study has assessed the effect of HLA-DRB1 alleles on OSAS disease and the changes occurring in immune response cells in Turkish population. METHOD OSAS was diagnosed by polysomnography and severity was determined. PCR SSP and flow cytometry methods were used. RESULTS We found that DRB1*07 and DRB1*11 were significantly increased in the control group and DRB1*03 and DRB1*08 alleles in the patient group in our study (P = 0.048, P = 0.005, P = 0.012 and P = 0.030, respectively). DRB1*08 was significantly increased in patients with severe OSAS (P = 0.002). When the immunological response was examined in OSAS patients, there was a decrease in CD4, an increase in HLA DR, CD8 and NK cells (P = 0.002, P = 0.00, P = 0.020, P = 0.040, respectively). We also found that CD19 was reduced in severe OSAS (P = 0.048). CONCLUSION These results suggest that the DRB1*03 allele may play a predisposing role in OSAS disease and that the DRB1*08 allele may be related to the severity of the disease. In addition, the decrease in CD4, CD8, NK and HLA DR increase in this disease suggests that the disease causes impairment of the immunological system and may be associated with autoimmunity.
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Affiliation(s)
| | | | - Önder Öztürk
- Department of Chest Diseases, University of Süleyman Demirel, Isparta, Turkey
| | - Okan Sancer
- Department of Medical Biology, University of Süleyman Demirel, Isparta, Turkey
| | - Taner Gonca
- Department of Chest Diseases, Isparta City Hospital, Isparta, Turkey
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11
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Jullian-Desayes I, Revol B, Chareyre E, Camus P, Villier C, Borel JC, Pepin JL, Joyeux-Faure M. Impact of concomitant medications on obstructive sleep apnoea. Br J Clin Pharmacol 2016; 83:688-708. [PMID: 27735059 DOI: 10.1111/bcp.13153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 01/11/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is characterized by repeated episodes of apnoea and hypopnoea during sleep. Little is known about the potential impact of therapy drugs on the underlying respiratory disorder. Any influence should be taken into account and appropriate action taken, including drug withdrawal if necessary. Here, we review drugs in terms of their possible impact on OSA; drugs which (1) may worsen OSA; (2) are unlikely to have an impact on OSA; (3) those for which data are scarce or contradictory; and (4) drugs with a potentially improving effect. The level of evidence is ranked according to three grades: A - randomized controlled trials (RCTs) with high statistical power; B - RCTs with lower power, non-randomized comparative studies and observational studies; C - retrospective studies and case reports. Our review enabled us to propose clinical recommendations. Briefly, agents worsening OSA or inducing weight gain, that must be avoided, are clearly identified. Drugs such as 'Z drugs' and sodium oxybate should be used with caution as the literature contains conflicting results. Finally, larger trials are needed to clarify the potential positive impact of certain drugs on OSA. In the meantime, some, such as diuretics or other antihypertensive medications, are helpful in reducing OSA-associated cardiovascular morbidity.
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Affiliation(s)
- Ingrid Jullian-Desayes
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Bruno Revol
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Elisa Chareyre
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Philippe Camus
- Pneumology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Céline Villier
- Pharmacovigilance Department, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
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Li N, Heizhati M, Sun C, Abulikemu S, Shao L, Yao X, Wang Y, Hong J, Zhou L, Wang L, Zhang Y, Zhang W. Thyroid Stimulating Hormone Is Increased in Hypertensive Patients with Obstructive Sleep Apnea. Int J Endocrinol 2016; 2016:4802720. [PMID: 27882050 PMCID: PMC5110875 DOI: 10.1155/2016/4802720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/07/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate alteration in serum TSH in hypertensives with OSA and its relation with cardiometabolic risk factors. Methods. 517 hypertensives were cross-sectionally studied. OSA was determined by polysomnography and thyroid function by standard methods. Results. OSA was diagnosed in 373 hypertensives (72.15%). Prevalence of subclinical hypothyroidism was significantly higher in OSA hypertensives than in non-OSA ones (15.0% versus 6.9%, P = 0.014). Serum LnTSH in hypertensives with severe OSA was significantly higher (0.99 ± 0.81 versus 0.74 ± 0.77 μIU/mL, P < 0.05) than in those without OSA. AHI, LSaO2, ODI3, and ODI4 were independently associated with serum TSH for those aged 30-65 years. Dividing subjects into four groups as TSH < 1.0 μIU/mL, 1.0 ≤ THS ≤ 1.9 μIU/mL, 1.91 ≤ TSH < 4.5 μIU/mL, and TSH ≥ 4.5 μIU/mL, only 26.3% of OSA subjects exhibited TSH between 1.0 and 1.9 μIU/mL, significantly less than non-OSA subjects (26.3% versus 38.2%, P = 0.01). DBP and serum LDL-c elevated with TSH increasing and were only significantly higher in TSH ≥ 4.5 μIU/mL group than in 1.0 ≤ TSH ≤ 1.9 μIU/mL group (96.32 ± 14.19 versus 92.31 ± 12.86 mmHg; P = 0.040; 0.99 ± 0.60 versus 0.87 ± 0.34 mmol/L, P = 0.023). Conclusion. OSA might be a risk factor for increased TSH even within reference range in hypertensive population.
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Affiliation(s)
- Nanfang Li
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
- *Nanfang Li:
| | - Mulalibieke Heizhati
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Chao Sun
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Suofeiya Abulikemu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Liang Shao
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Xiaoguang Yao
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Yingchun Wang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Jing Hong
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Ling Zhou
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Lei Wang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Yu Zhang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Weiwei Zhang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
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14
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Mete T, Yalcin Y, Ciftci B. Lack of association between OSAS and hypothyroidism. Endocrine 2013; 44:822. [PMID: 23801195 DOI: 10.1007/s12020-013-9999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Turkan Mete
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Training and Research Hospital, Ankara, Turkey,
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15
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Mete T, Yalcin Y, Berker D, Ciftci B, Guven Firat S, Topaloglu O, Cinar Yavuz H, Guler S. Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine 2013; 44:723-8. [PMID: 23564558 DOI: 10.1007/s12020-013-9927-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a widespread disorder characterized by recurrent, partial, or complete episodes of apnea due to upper airway tract obstruction during sleep. OSAS frequency is likely to increase in hypothyroidism because of obesity, macroglossia, dysfunctional upper respiratory tractus (URT) musculature, deposition of mucopolysaccharides in URT tissues, and decreased ventilatory control. This study examines the relationship between OSAS and thyroid disease in OSAS subjects. This study includes 150 polysomnographically diagnosed OSAS patients (50 mild, 50 moderate, 50 severe OSAS cases) treated at Endocrinology and Metabolism Department of Ankara Numune Training and Research Hospital between January 2010 and May 2011 and 32 non-OSAS control subjects. All patients were given serum TSH, free T3 (fT3), free T4 (fT4), anti thyroid peroxidase (Anti-TPO), and anti-thyroglobulin (anti-TG) tests, as well as thyroid ultrasounds. We did not find any difference in prevalence of hypothyroidism, numbers of nodules and parenchyma heterogenicity determined by ultrasound, between OSAS subgroups and controls (p > 0,05). In this study, functional and ultrasonographic examination of the thyroid gland did not reveal any relationship between OSAS and thyroid disease. We believe hence that long-term follow-up studies can establish the possible significance of routine evaluation of OSAS patients for thyroid disease.
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Affiliation(s)
- Turkan Mete
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Training and Research Hospital, Ankara, Turkey,
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Carratù P, Dragonieri S, Resta O. Lack of association between OSAS and hypothyroidism. Endocrine 2013; 44:821. [PMID: 23673866 DOI: 10.1007/s12020-013-9977-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Pierluigi Carratù
- Institute of Pulmonary Disease, University of Bari, Piazza G. Cesare 12, 70124, Bari, Italy,
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Ota K, Dambaeva S, Han AR, Beaman K, Gilman-Sachs A, Kwak-Kim J. Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity. Hum Reprod 2013; 29:208-19. [PMID: 24277747 DOI: 10.1093/humrep/det424] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Do women with recurrent pregnancy losses (RPL) and low vitamin D have increased prevalence of auto- and cellular immune abnormalities when compared with women with RPL who have normal vitamin D, and does vitamin D have any effect on cellular immunity in vitro? SUMMARY ANSWER A high proportion of women with RPL have vitamin D deficiency and the risk of auto- and cellular immune abnormalities is increased in women with RPL and vitamin D deficiency. WHAT IS KNOWN ALREADY Vitamin D deficiency in pregnant women is associated with increased risk of obstetrical complications such as pre-eclampsia, bacterial vaginosis associated preterm delivery, gestational diabetes mellitus and small-for-gestational age births. STUDY DESIGN, SIZE, DURATION A retrospective cross-sectional study of 133 women with RPL who were enrolled in a 2-year period, together with laboratory experiments. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with three or more consecutive spontaneous abortions prior to 20 weeks of gestation who were enrolled at the University clinic. Serum vitamin D level, cellular activity and autoimmune parameters in vivo and in vitro were measured. MAIN RESULTS AND THE ROLE OF CHANCE Sixty-three out of 133 women (47.4%) had low vitamin D (<30 ng/ml). The prevalence of antiphospholipid antibody (APA) was significantly higher in low vitamin D group (VDlow) (39.7%) than in the normal vitamin D group (VDnl) (22.9%) (P< 0.05) and the adjusted odds ratio (OR) for APA in VDlow was 2.22 with the 95% confidence interval (CI) of 1.0-4.7. The prevalence of antinuclear antigen antibody (VDlow versus VDnl; 23.8% versus 10.0%, OR 2.81, 95% CI 1.1-7.4), anti-ssDNA (19.0% versus 5.7%, OR 3.76, 95% CI 1.1-12.4) and thyroperoxidase antibody (33.3% versus 15.7%, OR 2.68, 95% CI 1.2-6.1) was significantly higher in VDlow than those of VDnl (P < 0.05 each). Peripheral blood CD19(+) B and CD56(+) NK cell levels and NK cytotoxicity at effector to target cell (E:T) ratio of 25:1 were significantly higher in VDlow when compared with those of VDnl (P < 0.05 each). Reduction (%) of NK cytotoxicity (at E:T ratio of 50:1 and 25:1) by IgG (12.5 mg/dl) was significantly lower in VDlow than those of VDnl (P < 0.05, P < 0.01, respectively). There were no differences in Th1/Th2 ratios between VDlow and VDnl. When vitamin D3 was added in NK cytotoxicity assay in vitro, NK cytotoxicity at E:T ratio of 50:1 was significantly suppressed with 10 nMol/L (nM) (11.9 ± 3.3%) and 100 nM (10.9 ± 3.7%) of vitamin D3 when compared with controls (15.3 ± 4.7%) (P < 0.01 each). TNF-α/IL-10 expressing CD3(+)/4(+) cell ratios were significantly decreased with 100 nM of vitamin D3 (31.3 ± 9.4, P < 0.05) when compared with controls (40.4 ± 11.3) in vitro. Additionally, INF-γ/IL-10 expressing CD3(+)/4(+) cell ratio was significantly decreased with 100 nM of vitamin D3 (12.1 ± 4.0, P < 0.05) when compared with controls (14.8 ± 4.6). IFN-γ and TNF-α secretion from NK cells were significantly decreased (P < 0.01 each), and IL-10, IL-1β, vascular endothelial growth factor and granulocyte colony stimulating factor levels were significantly increased (P < 0.01 each) with vitamin D3 100 nM when compared with those of controls. LIMITATIONS, REASONS FOR CAUTION The prevalence of vitamin D deficiency in women with RPL in this study is open to a possible type I error since women with vitamin D supplementation were excluded from this study. WIDER IMPLICATIONS OF THE FINDINGS Assessment of vitamin D level is recommended in women with RPL. Vitamin D supplementation should be explored further as a possible therapeutic option for RPL. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the intramural funding from Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Kuniaki Ota
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL 60061, USA
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