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Day C, Nishino N, Tsukahara Y. Sleep in the Athlete. Clin Sports Med 2024; 43:93-106. [PMID: 37949516 DOI: 10.1016/j.csm.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Sleep is important for not only general health but also for lowering injury risk and maintaining athletic performance. Sleep disorders are prevalent in athletes, and taking a sleep history, evaluating sleep quality, and addressing other related factors including mental health are essential in diagnosing and understanding sleep disorders. Other methods such as polysomnography, actigraphy, and sheet sensors can also be used. Treatment options for sleep disorders include sleep hygiene, cognitive behavioral therapy, medication, and addressing contributing factors. For athletes, sleep can also be affected by factors such as travel fatigue and jet lag, which should be taken into consideration.
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Affiliation(s)
- Carly Day
- Department of Health and Kinesiology, Purdue University, 900 John R Wooden Drive, West Lafayette, IN 47907, USA.
| | - Naoya Nishino
- Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Yuka Tsukahara
- Department of Sports Medicine, Tokyo Women's College of Physical Education, 3-40-1 Fujimidai, Kunitachi, Tokyo 1868668, Japan
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Ciavarella D, Lorusso M, Campobasso A, Cazzolla AP, Montaruli G, Burlon G, Lo Muzio E, Laurenziello M, Tepedino M. Craniofacial morphology in Obstructive Sleep Apnea patients. J Clin Exp Dent 2023; 15:e999-e1006. [PMID: 38186919 PMCID: PMC10767735 DOI: 10.4317/jced.61104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background To evaluate the correlation between cephalometric skeletal parameters and Obstructive Sleep Apnea syndrome (OSAs) severity, in adult patients with OSAs. Material and Methods One hundred patients (94 males,6 females mean age 59,3) with diagnosis of OSAs were retrospectively enrolled. Each patient received Home Sleep Apnea Testing (HSAT) and latero-lateral radiograph. Eight cephalometric parameters (cranial deflection angle, saddle angle, articular angle, divergence angle, cranial base angle, skull base length, mandibular length, maxilla length) were analyzed and then related to Apnea/Hypopnea Index (AHI) and to the Oxygen Desaturation Index (ODI), recorded by HSAT. A Spearman's rho correlation test between cephalometric measurements and HSAT indices was performed. Statistical significance was set at p< 0.05. Results A negative statistically significant correlation was found between mandibular length (Condilion-Gnathion distance) and AHI (rho= -0,2022; p<0,05) and between maxilla length (Ans-Pns) and AHI (rho= -0,2984; p<0,01) and ODI (rho= -0,2443; p<0,05). A statistically significant correlation was also observed between the divergence angle (S-N^Go-Me) and AHI (rho=0,2263; p<0,05) and between cranial deflection angle (Fh^NBa) and AHI (rho=0,2212; p<0,05) and ODI (rho=0,1970; p<0,05). Conclusions The OSAs severity may be related to certain predisposing features in craniofacial morphology, such as maxillary and mandibular length, divergence and cranial deflection. Key words:OSAs, Home Sleep Apnea Testing, AHI, ODI, Cephalometry, Airway.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Angela-Pia Cazzolla
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Giuseppe Burlon
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Eleonora Lo Muzio
- Department of Translational Medicine and for Romagna, School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, L'Aquila, Italy
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Desai R, Mellacheruvu SP, Akella SA, Mohammed AS, Saketha P, Mohammed AA, Hussain M, Bavanasi A, Gummadi J, Sunkara P. Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis. Med Sci (Basel) 2023; 11:69. [PMID: 37987324 PMCID: PMC10660682 DOI: 10.3390/medsci11040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. METHODS Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. RESULTS Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31-1.66), coagulopathy (OR 1.43, 95% CI 1.35-1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28-1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11-1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22-1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20-1.29), male sex (OR 1.22, 95% CI-1.18-1.26), hyperlipidemia (OR 1.20, 95% CI 1.16-1.24), low household income (OR 1.19, CI 1.13-1.26), renal failure (OR 1.15, 95% CI 1.12-1.19), diabetes (OR 1.14, 95% CI 1.10-1.17), metastatic cancer (OR 1.14, 95% CI 1.03-1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07-1.17) (All p value < 0.05). CONCLUSIONS This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. CLINICAL IMPLICATIONS Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.
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Affiliation(s)
- Rupak Desai
- Independent Researcher, Atlanta, GA 30033, USA;
| | | | - Sai Anusha Akella
- Department of Internal Medicine, Kakatiya Medical College, Warangal 506007, India;
| | - Adil Sarvar Mohammed
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, USA
| | - Pakhal Saketha
- Department of Internal Medicine, Bhaskar Medical College, Hyderabad 500075, India;
| | - Abdul Aziz Mohammed
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Mushfequa Hussain
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Aamani Bavanasi
- Department of Internal Medicine, Captain James A Lovell FHCC/Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Jyotsna Gummadi
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD 21237, USA;
| | - Praveena Sunkara
- Department of Internal Medicine, Medstar Medical Group, Charlotte Hall, MD 20622, USA;
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Kalkanis A, Testelmans D, Papadopoulos D, Van den Driessche A, Buyse B. Insights into the Use of Point-of-Care Ultrasound for Diagnosing Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2262. [PMID: 37443656 DOI: 10.3390/diagnostics13132262] [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: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a sleeping disorder caused by complete or partial disturbance of breathing during the night. Existing screening methods include questionnaire-based evaluations which are time-consuming, vary in specificity, and are not globally adopted. Point-of-care ultrasound (PoCUS), on the other hand, is a painless, inexpensive, portable, and useful tool that has already been introduced for the evaluation of upper airways by anesthetists. PoCUS could also serve as a potential screening tool for the diagnosis of OSA by measuring different airway parameters, including retropalatal pharynx transverse diameter, tongue base thickness, distance between lingual arteries, lateral parapharyngeal wall thickness, palatine tonsil volume, and some non-airway parameters like carotid intima-media thickness, mesenteric fat thickness, and diaphragm characteristics. This study reviewed previously reported studies to highlight the importance of PoCUS as a potential screening tool for OSA.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | | | - Bertien Buyse
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
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Teni MT, Loux T, Sebert Kuhlmann A. Racial disparity in gestational diabetes mellitus and the association with sleep-disordered breathing and smoking cigarettes: a cross-sectional study. J Matern Fetal Neonatal Med 2022; 35:10601-10607. [PMID: 36273849 DOI: 10.1080/14767058.2022.2139175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) prevalence has risen in the U.S. and worldwide over the past decade. Minority groups, especially Asian and Hispanic women, are often disproportionately affected by GDM. Identifying modifiable risk factors such as sleep-disordered breathing and smoking and their interaction with race/ethnicity could play a pivotal role in preventing GDM. METHODS Data from the 2017-2018 National Health and Nutrition Examination Surveys (NHANES) were used to run a survey-weighted multivariable logistic regression assessing the association between sleep-disordered breathing and smoking with GDM among women aged 15-60 (n = 1326). The interaction term of the two predictors and race/ethnicity was introduced to the model to assess the interaction effect. The analyses were adjusted for age, marital status, education level, and BMI. RESULTS Approximately 13% of the participants reported having GDM. The lowest prevalence was observed among Non-Hispanic Blacks (7.8%) and the highest was among Other (15.5%). Sleep-disordered breathing was significantly associated with GDM (OR = 1.69, 95% CI 1.05, 2.73). No statistically significant association was observed between smoking and GDM (OR = 1.03, 95% CI 0.47, 2.27), and neither was the association between race/ethnicity and GDM. Furthermore, none of the interaction effects were statistically significant. CONCLUSION Preventive strategies targeting GDM should focus on improving modifiable risk factors, such as sleep-disordered breathing. It is important to screen women with sleep-disordered breathing and monitor their blood sugar before becoming pregnant to prevent the development of GDM. Future studies are recommended to understand the lower prevalence of GDM among Black women and the higher prevalence among "Other" race group which mostly includes Asian women.
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Affiliation(s)
- Mintesnot Tenkir Teni
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Travis Loux
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Anne Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
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Limberg JK, Baker SE, Petersen-Jones HG, Guo W, Huang A, Jensen MD, Singh P. Endothelin-1 as a novel target for the prevention of metabolic dysfunction with intermittent hypoxia in male participants. Am J Physiol Regul Integr Comp Physiol 2022; 323:R351-R362. [PMID: 35816718 PMCID: PMC9423726 DOI: 10.1152/ajpregu.00301.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
We examined the effect of intermittent hypoxia (IH, a hallmark feature of sleep apnea) on adipose tissue lipolysis and the role of endothelin-1 (ET-1) in this response. We hypothesized that IH can increase ET-1 secretion and plasma free fatty acid (FFA) concentrations. We further hypothesized that inhibition of ET-1 receptor activation with bosentan could prevent any IH-mediated increase in FFA. To test this hypothesis, 16 healthy male participants (32 ± 5 yr, 26 ± 2 kg/m2) were exposed to 30 min of IH in the absence (control) and presence of bosentan (62.5 mg oral twice daily for 3 days prior). Arterial blood samples for ET-1, epinephrine, and FFA concentrations, as well as abdominal subcutaneous adipose tissue biopsies (to assess transcription of cellular receptors/proteins involved in lipolysis), were collected. Additional proof-of-concept studies were conducted in vitro using primary differentiated human white preadipocytes (HWPs). We show that IH increased circulating ET-1, epinephrine, and FFA (P < 0.05). Bosentan treatment reduced plasma epinephrine concentrations and blunted IH-mediated increases in FFA (P < 0.01). In adipose tissue, bosentan had no effect on cellular receptors and proteins involved in lipolysis (P > 0.05). ET-1 treatment did not directly induce lipolysis in differentiated HWP. In conclusion, IH increases plasma ET-1 and FFA concentrations. Inhibition of ET-1 receptors with bosentan attenuates the FFA increase in response to IH. Based on a lack of a direct effect of ET-1 in HWP, we speculate the effect of bosentan on circulating FFA in vivo may be secondary to its ability to reduce sympathoadrenal tone.
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Affiliation(s)
- Jacqueline K Limberg
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Winston Guo
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - An Huang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Prachi Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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Moser M, Baty F, Brutsche MH, Schoch OD. In-hospital survival paradox in patients with sleep apnea-A nation-wide nested case-control study. PLoS One 2022; 17:e0271004. [PMID: 35862391 PMCID: PMC9302736 DOI: 10.1371/journal.pone.0271004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea originating from obstructive and/or central mechanisms. SA disrupts normal sleep and can lead to a series of complications when left untreated. SA results in intermittent hypoxia which has an impact on the cardio- and cerebrovascular system. Hospitalized patients with SA typically have a greater burden of comorbidity, a longer length of hospital stay, but may show an improvement of in-hospital mortality compared to patients without diagnosed SA. The reason for this survival benefit is controversial and we aimed to clarify this protective effect in the light of predictive factors including SA-associated comorbidities using a nation-wide hospitalization database. METHODS AND FINDINGS Data were extracted from a nation-wide hospitalization database provided by the Swiss Federal Office for Statistics. Hospitalized patients with a SA co-diagnosis were extracted from the database together with a 1:1-matched control population without SA. Overall, 212'581 patients with SA were hospitalized in Switzerland between 2002 and 2018. Compared to the controls, SA cases had a longer median length of hospital stay (7 days; 95% CI: 3 to 15 vs. 4 days; 95% CI: 2 to 10) (p < 0.001) and a higher median number of comorbidities (8 comorbidities; IQR: 5 to 11 vs. 3 comorbidities; IQR: 1 to 6) (p < 0.001). The risk of in-hospital mortality was lower in the SA cases compared to the controls (OR: 0.73; 95% CI: 0.7 to 0.76; p < 0.001). SA was associated with a survival benefit in hospitalizations related to 28 of 47 conditions with the highest rate of in-hospital death. Sixty-three comorbidities were significantly over-represented in SA cases among which obesity, hypertension and anatomic nasal deviations were associated with a significant decrease of in-hospital mortality. CONCLUSIONS Compared to matched controls, SA was associated with significant and relevant inpatient survival benefit in a number of most deadly conditions. Within SA-patients, associated comorbidities mostly correlated with a poorer prognosis, whereas obesity and hypertension were associated with an improved in-hospital mortality.
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Affiliation(s)
- Maurice Moser
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Otto D. Schoch
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Durante BG, Ferreira-Silva R, Goya TT, Lima MF, Rodrigues ACT, Drager LF, Jordão CP, Rodrigues AG, Alves MJDNN, Lorenzi-Filho G, Negrão CE, Ueno-Pardi LM. Effects of Exercise Training on Left Ventricular Diastolic Function Markers in Patients with Obstructive Sleep Apnea: A Randomized Study. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210146] [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] Open
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Gourishetti SC, Taylor R, Isaiah A. Stratifying the Risk of Cardiovascular Disease in Obstructive Sleep Apnea Using Machine Learning. Laryngoscope 2022; 132:234-241. [PMID: 34487556 PMCID: PMC8671206 DOI: 10.1002/lary.29852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Obstructive sleep apnea (OSA) is associated with higher risk of morbidity and mortality related to cardiovascular disease (CVD). Due to overlapping clinical risk factors, identifying high-risk patients with OSA who are likely to develop CVD remains challenging. We aimed to identify baseline clinical factors associated with the future development of CVD in patients with OSA. STUDY DESIGN Retrospective analysis of prospectively collected data. METHODS We performed a retrospective analysis of 967 adults aged 45 to 84 years and enrolled in the Multi-Ethnic Study of Atherosclerosis. Six machine learning models were created using baseline clinical factors initially identified by stepwise variable selection. The performance of these models for the prediction of additional risk of CVD in OSA was calculated. Additionally, these models were evaluated for interpretability using locally interpretable model-agnostic explanations. RESULTS Of the 967 adults without baseline OSA or CVD, 116 were diagnosed with OSA and CVD and 851 with OSA alone 10 years after enrollment. The best performing models included random forest (sensitivity 84%, specificity 99%, balanced accuracy 91%) and bootstrap aggregation (sensitivity 84%, specificity 100%, balanced accuracy 92%). The strongest predictors of OSA and CVD versus OSA alone were fasting glucose >91 mg/dL, diastolic pressure >73 mm Hg, and age >59 years. CONCLUSION In the selected study population of adults without OSA or CVD at baseline, the strongest predictors of CVD in patients with OSA include fasting glucose, diastolic pressure, and age. These results may shape a strategy for cardiovascular risk stratification in patients with OSA and early intervention to mitigate CVD-related morbidity. LEVEL OF EVIDENCE 3 Laryngoscope, 132:234-241, 2022.
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Affiliation(s)
- Saikrishna C. Gourishetti
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine Baltimore, MD
| | - Rodney Taylor
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine Baltimore, MD
| | - Amal Isaiah
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine Baltimore, MD,Department of Pediatrics, University of Maryland School of Medicine Baltimore, MD,Corresponding author: Amal Isaiah, MD, PhD, Department of Otorhinolaryngology—Head and Neck Surgery, 16 S Eutaw St Ste 500, Baltimore, MD 21201, , Phone: 410-328-5837, Fax: 410-328-5827
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Serino M, Cardoso C, Carneiro RJ, Ferra J, Aguiar F, Rodrigues D, Redondo M, van Zeller M, Drummond M. OSA patients not treated with PAP - Evolution over 5 years according to the Baveno classification and cardiovascular outcomes. Sleep Med 2021; 88:1-6. [PMID: 34710706 DOI: 10.1016/j.sleep.2021.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-therapy at diagnosis is unknown. Currently, the severity of OSA is based on the apnea-hypopnea index (AHI), but its prognostic relevance has raised concerns. The Baveno classification may allow a better stratification of severity and therapeutic guidance in OSA. METHODS Patients with AHI≥5/h in 2015, classified into Baveno groups A and B and non-eligible for PAP therapy at diagnosis and over 5 years, were analyzed. Patients were reclassified into Baveno groups (A-D) and changes in groups over 5 years were explored. Patients in Baveno groups C and D, who developed major cardiovascular comorbidities (CVC) or end-organ damage (EOD group), were compared with patients in Baveno groups A and B (non-EOD group). To identify predictors of the development of major CVC or EOD, a logistic regression analysis was performed. RESULTS There were 76 patients, 58% male, mean age 51.9 ± 10.1 years, mean body mass index (BMI) of 30.3 ± 5.0 kg/m2 and median AHI of 8.9 (5.9-12.0) events/h. At diagnosis, 46% and 54% of patients were classified into Baveno group A and group B, respectively. In total, 21% of patients developed major CVC or EOD (Baveno group C or D); higher age (p = 0.011) and BMI (p = 0.004) and a higher percentage of central apneas (p = 0.012) at diagnosis significantly predicted it, while sex, sleepiness, insomnia, AHI, ODI and T90 were not. CONCLUSIONS A significant percentage of patients non-eligible for PAP-therapy at diagnosis of OSA developed CVC or EOD; higher age and BMI and a higher percentage of central apneas were significant predictors.
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Affiliation(s)
- M Serino
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
| | - C Cardoso
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal
| | - R J Carneiro
- Department of Pneumology, Centro Hospitalar Oeste, Hospital Torres Vedras, Torres Vedras, Portugal
| | - J Ferra
- Department of Pneumology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, LisboaVedras, Portugal
| | - F Aguiar
- Department of Pneumology, Hospital de Braga, Braga, Portugal
| | - D Rodrigues
- Pulmonology Department, Centro Hospitalar Universitário São João, Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M Redondo
- Pulmonology Department, Centro Hospitalar Universitário São João, Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M van Zeller
- Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Drummond
- Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
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Le Grande MR, Jackson AC, Beauchamp A, Kerr D, Driscoll A. Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis. Sleep Med 2021; 86:135-160. [PMID: 33674192 DOI: 10.1016/j.sleep.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used. OBJECTIVE To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy. METHODS We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD). RESULTS Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria. CONCLUSION There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Department of Medicine - Western Health, The University of Melbourne, VIC, 3052, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, VIC, 3021, Australia; School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Debra Kerr
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
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12
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Huber FL, Furian M, Kohler M, Latshang TD, Nussbaumer-Ochsner Y, Turk A, Schoch OD, Laube I, Thurnheer R, Bloch KE. Health Preference Measures in Patients with Obstructive Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure Therapy: Data from a Randomized Trial. Respiration 2021; 100:328-338. [PMID: 33540413 DOI: 10.1159/000513306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with obstructive sleep apnea syndrome (OSAS), the preference-based, health-related quality of life in terms of utility has not been extensively studied. OBJECTIVE To address this point, we compared the performance of different instruments assessing utility in patients with OSAS undergoing continuous positive airway pressure (CPAP) therapy. MATERIALS AND METHODS Data of 208 patients with OSAS (28 women, mean ± SE age 54.4 ± 0.7 years, apnea-hypopnea index (AHI) 51.9 ± 1.8/h, Epworth sleepiness score 13.4 ± 0.2) participating in a randomized trial of different CPAP modalities over 2 years were analyzed. Evaluations included sleep studies, Epworth sleepiness scale, and several utility instruments that measure subjective health preference on a scale ranging from 1 (most preferred and perfect health) to 0 (least preferred and very poor health). RESULTS After 2 years of CPAP therapy, the mean ± SE AHI was 6.7 ± 1.5/h and Epworth score 7.9 ± 0.4, both p < 0.001 versus baseline. Baseline utilities and changes (95% confidence interval) after 2 years of CPAP therapy were EuroQol 5-dimensions 0.79 ± 0.01, 0.02 (0.00-0.05, p = 0.064); short-form 6-dimension medical outcome questionnaire 0.72 ± 0.01, 0.06 (0.04-0.08, p < 0.001); Euro-thermometer visual analog scale 0.70 ± 0.01, 0.09 (0.07-0.12, p < 0.001); time trade-off 0.82 ± 0.01, 0.03 (0.01-0.06, p = 0.002); and standard gamble 0.82 ± 0.01, -0.01 (-0.03 to 0.02, p = 0.712). CONCLUSION The short-form 6-dimensions questionnaire, the Euro-thermometer, and the time trade-off instruments reflected the major clinical improvements in OSAS, while the EuroQoL 5-dimensions and standard gamble tests were not sensitive to CPAP effects. These results indicate that the evaluation of utility of a treatment for OSAS depends critically on the instrument used, which is important from an individual and societal perspective.
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Affiliation(s)
- Fabienne L Huber
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Tsogyal D Latshang
- Department of Respiratory Medicine, Sleep Disorders Center, Cantonal Hospital Chur, Chur, Switzerland
| | | | - Alexander Turk
- Department of Internal Medicine, See-Spital, Horgen, Switzerland
| | - Otto D Schoch
- Department of Respiratory Medicine, Center for Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Irene Laube
- Department of Respiratory Medicine, Sleep Disorders Center, Triemli Hospital, Zurich, Switzerland
| | - Robert Thurnheer
- Department of Respiratory Medicine, Sleep Disorders Center, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Konrad E Bloch
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland,
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Increased risk of major depressive disorder in sleep apnea patients in Taiwan. Sci Rep 2021; 11:765. [PMID: 33436925 PMCID: PMC7803988 DOI: 10.1038/s41598-020-80759-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/28/2020] [Indexed: 12/21/2022] Open
Abstract
The association between sleep apnea (SA) and depression had been reported in a few previous studies. However, whether SA increases the risk of major depressive disorder (MDD) has not been studied comprehensively in a large-scale study. We performed this population-based cohort study to assess the association between SA and MDD. We identified adult patients having SA from the Taiwan National Health Insurance Research Database and excluded those having MDD before SA diagnosis. Thirty control subjects were randomly selected to match to each SA patient by age and sex. Totally, 10,259 SA patients were matched to 102,590 control subjects. The incidence rate and cumulative incidence of MDD were significantly higher in SA patients than in the control subjects (both p < 0.0001). Multivariable Cox regression analysis showed that SA remained an independent risk factor for incident MDD after adjusting for age, sex, residency, income level, and comorbidities (hazard ratio = 2.9 [95% CI 2.8–3.1], p < 0.0001). In summary, SA patients have an increased risk to develop MDD. Physicians caring for SA patients must pay attention to their psychosocial health status.
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Alharbi H, Ahmad M, Tian Z, Yu R, Li YL. Therapeutic value of the metabolomic active neurotransmitter isorhynchophylline in the treatment of spontaneously hypertensive rats by regulating neurotransmitters. Transl Neurosci 2021; 12:425-431. [PMID: 34760298 PMCID: PMC8562224 DOI: 10.1515/tnsci-2020-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Hypertension is one of the most reported cardiovascular and cerebrovascular diseases with significantly high morbidity and mortality rates. This condition threatens the very existence of human beings. Numerous studies conducted earlier revealed the good therapeutic effect of isorhynchophylline on hypertension since the former regulates the metabolic disorders in neurotransmitters. However, the mechanism behind this action is yet to be deciphered. The current study followed the targeted metabolomics method to investigate the changes in the neurotransmitter level in the hippocampus of spontaneously hypertensive rats (SHRs) after the rats were treated with isorhynchophylline. The authors predicted the metabolic pathways involved in extensively modified neurotransmitters. Further, the expressions of metabolism-key enzymes in mRNA and protein levels were also determined. When treated with isorhynchophylline, it induced notably varying metabolomic profiles of the hippocampus in SHRs. Isorhynchophylline perturbed a total of seven extensively modified neurotransmitters as well as the primarily related pathways such as tyrosine and glutamate metabolism. An increase in the key metabolic enzymes such as DDC, MAO, COMT, TH, and DβH was observed in the SHR group, whereas their levels decreased after treatment with isorhynchophylline. The expression of GAD67 established cross-current validity. So, isorhynchophylline has been proved to have potential therapeutic value to treat hypertension via tyrosine and glutamate metabolism in the hippocampus. Further, the current study also opened new ventures to further investigate the working mechanism of isorhynchophylline in hypertension.
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Affiliation(s)
- Homood Alharbi
- Department of Medical Surgical Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Ahmad
- Department of Medical Surgical Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Zhenhua Tian
- Department of Pharmaceutical Sciences, Traditional Chinese Medicine, Shandong University, Jinan, China
| | - Ruixue Yu
- Department of Pharmaceutical Sciences, Traditional Chinese Medicine, Shandong University, Jinan, China
| | - Yun Lun Li
- Department of Pharmaceutical Sciences, Traditional Chinese Medicine, Shandong University, Jinan, China
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15
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Starkey SY, Jonasson DR, Alexis S, Su S, Johal R, Sweeney P, Brasher PMA, Fleetham J, Ayas N, Orenstein T, Ahmed IH. Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What's the Best Test? CJC Open 2020; 3:442-449. [PMID: 34027347 PMCID: PMC8129472 DOI: 10.1016/j.cjco.2020.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Among individuals with nonvalvular atrial fibrillation (AF), the prevalence of obstructive sleep apnea (OSA) can be as high as 85%. Continuous positive airway pressure treatment for moderate or severe OSA might improve AF outcomes and quality of life, so early identification of OSA might be of value. However, screening questionnaires for OSA are suboptimal because they are weighted toward tiredness and loud snoring, which might be absent in AF patients. NoSAS (Neck, Obesity, Snoring, Age, Sex) is a new OSA questionnaire that excludes these parameters. Acoustic pharyngometry (AP) is a potential novel screening technique that measures pharyngeal cross-sectional area, which is reduced in patients with OSA. Methods We prospectively compared the accuracy of the NoSAS, the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, blood Pressure, Body mass index, Age, Neck circumference and Gender), and AP with home sleep apnea testing (HSAT) in consecutive patients with nonvalvular AF. Results Of 188 participants, 86% had OSA and 49% had moderate or severe OSA. Mean Epworth Sleepiness Scale scores were low; 5.9 (SD, 3.9), indicating that most participants were not sleepy. Receiver operating characteristic curves for comparisons of screening tests with HSAT showed suboptimal accuracy. For moderate plus severe and severe only groups respectively, the area under the curve was 0.50 (95% confidence interval [CI], 0.42-0.58) and 0.42 (95% CI, 0.34-0.52) for AP, 0.65 (95% CI, 0.58-0.73) and 0.63 (95% CI, 0.52-0.74) for the STOP-BANG questionnaire, and 0.68 (95% CI, 0.60-0.75) and 0.69 (95% CI, 0.59-0.80) for the NoSAS. Conclusions AP and NoSAS are not sufficiently accurate for screening AF patients for OSA. Because of the high rates of OSA in this cohort, the potential benefits of OSA treatment, and the suboptimal accuracy of current screening questionnaires, cardiologists should consider HSAT for AF patients.
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Affiliation(s)
- Samantha Y Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Stephanie Alexis
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Su
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Ravinder Johal
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Paul Sweeney
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John Fleetham
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib Ayas
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teddi Orenstein
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Iqbal H Ahmed
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Wang H, Li X, Tang Z, Gong G. Cardiovascular Outcomes Post Percutaneous Coronary Intervention in Patients with Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Ther 2020; 11:1795-1806. [PMID: 32591980 PMCID: PMC7376814 DOI: 10.1007/s13300-020-00870-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a major risk factor for the occurrence of cardiovascular diseases. Similar to T2DM, obstructive sleep apnea (OSA) is also known to be a risk factor for cardiovascular diseases. In this analysis, we aimed to systematically compare the post-interventional cardiovascular outcomes observed in patients with T2DM with versus without OSA. METHODS Electronic databases were searched for relevant publications comparing the cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients with T2DM with OSA. Cardiovascular outcomes were considered as the relevant endpoints. The RevMan software 5.3 was used to carry out the statistical analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the results following data assessment. RESULTS A total of 1168 participants with T2DM were included in this analysis, of whom 614 had co-existing OSA. The time period of patients' enrollment varied from year 2002 to 2017. Our current analysis showed that major adverse cardiac events (MACEs) (OR 2.28, 95% CI 1.24-4.18; P = 0.008) and all-cause mortality (OR 1.95, 95% CI 1.08-3.54; P = 0.03) were significantly higher in the OSA subgroup. However, major adverse cerebrovascular and cardiovascular (MACCEs) (OR 1.38, 95% CI 0.97-1.98; P = 0.07) and cardiac death (OR 1.79, 95% CI 0.77-4.16; P = 0.18) were not significantly different post PCI. In addition, hospitalization for heart failure (OR 1.99, 95% CI 0.43-9.25; P = 0.38), re-infarction (OR 1.52, 95% CI 0.85-2.70; P = 0.16), stroke (OR 1.81, 95% CI 0.81-4.08; P = 0.15), target vessel revascularization (TVR) (OR 1.54, 95% CI 0.98-2.42; P = 0.06), and target lesion revascularization (TLR) (OR 1.32, 95% CI 0.80-2.18; P = 0.28) were also not significantly different post PCI in the patients with T2DM with versus without OSA. CONCLUSION OSA was associated with a significant increase in all-cause mortality and MACEs post PCI in these patients with T2DM. Therefore, special care and continuous follow-up might be required for patients with T2DM with associated OSA after PCI. However, as a result of the limited number of participants, further larger studies would be required to confirm these hypotheses.
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Affiliation(s)
- Hong Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
| | - Xinxin Li
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhangui Tang
- Department of Cardiovascular Disease, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Guoping Gong
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Maeder MT. Editorial Commentary: Biomarkers of cardiovascular risk in obstructive sleep apnea - innovation or illusion? Trends Cardiovasc Med 2020; 31:250-251. [PMID: 32437867 DOI: 10.1016/j.tcm.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Micha T Maeder
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen 9007, Switzerland.
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18
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Magalhães MGS, Teixeira JB, Santos AMB, Clímaco DCS, Silva TNS, de Lima AMJ. Construct validity and reproducibility of the six-minute step test in subjects with obstructive sleep apnea treated with continuous positive airway pressure. J Bras Pneumol 2020; 46:e20180422. [PMID: 32321033 PMCID: PMC7572295 DOI: 10.36416/1806-3756/e20180422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/08/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the construct validity and reproducibility of the six-minute step test (6MST) in individuals with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS We evaluated 48 volunteers diagnosed with OSA and treated with CPAP for at least two months. The volunteers underwent the six-minute walk test (6MWT) and the 6MST, in random order and on different days, with an interval of, at most, seven days between the two tests. RESULTS A moderate positive correlation was found between the distance walked on the 6MWT and the number of steps climbed on the 6MST (r = 0.520; p < 0.001). There was no significant difference between the two 6MSTs in terms of the number of steps climbed (121.7 ± 27.1 vs. 123.6 ± 26.7). Reproducibility for performance on the 6MST and for cardiovascular variables was considered excellent (intraclass correlation coefficient > 0.8). Regarding cardiovascular responses, the 6MST produced higher values than did the 6MWT for HR at six minutes, percent predicted maximum HR, and leg fatigue at six minutes, as well as for systolic blood pressure at six minutes and at one minute of recovery. CONCLUSIONS The 6MST is valid and reproducible, producing greater cardiovascular stress than does the 6MWT. However, the 6MST is also characterized as a submaximal test for the assessment of exercise tolerance in individuals with OSA treated with CPAP.
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Affiliation(s)
| | - Juliana Baptista Teixeira
- . Programa de Pós-Graduação em Fisioterapia, Universidade Federal de Pernambuco - UFPE - Recife (PE) Brasil
| | - Ana Maria Bezerra Santos
- . Graduação em Bacharelado em Ciências Biológicas, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
| | | | | | - Anna Myrna Jaguaribe de Lima
- . Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
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Münch HJ, O'Leary P, Bille J, Kjaergaard T. Oropharyngeal rhabdomyoma: the cause of severe sleep apnoea? BMJ Case Rep 2020; 13:13/2/e230949. [PMID: 32041754 DOI: 10.1136/bcr-2019-230949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report presents an elderly male patient who on diagnosis with a large oropharyngeal tumour had no specific symptomatology apart from severe obstructive sleep apnoea. Histopathology revealed the tumour to be an adult rhabdomyoma, a rare but benign tumour arising from striated muscle cells. The tumour obstructed most of the oropharyngeal space and almost occluded the patient's airway when lying in a supine position. The patient was deemed operable, and the tumour was excised in toto using a transoral robotic surgery system. On follow-up, the patient had a severe reduction of apnoeas/hypopnoeas and felt subjectively 'reborn'. This is to our knowledge the first case where an adult rhabdomyoma is removed using a robot-assisted approach, thus presenting a new and viable option when considering removal of benign tumours of the pharynx leading to a very minor degree of morbidity for the patients.
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Affiliation(s)
| | - Padraig O'Leary
- Department of Otorhinolaryngology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Jesper Bille
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Kjaergaard
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark
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Schulz S, Ritter J, Schneider G, Guntinas-Lichius O, Voss A. Risk detection in patients with obstructive sleep apnea syndrome based on cardiovascular time series analysis .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6794-6797. [PMID: 31947400 DOI: 10.1109/embc.2019.8856472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive sleep apnea represents the most common form of sleep-disordered breathing and has a high prevalence in patients with cardiovascular disease. Disturbed sleep is a potential risk factor for cardiovascular disorders such as arterial hypertension, cardiac ischemia, sudden cardiac death, and stroke. In this study we investigated polysomnographic records and analyzed the ECG, plethysmogram, respiration and SpO2 time series during wakefulness (WK), NREM, and REM sleep stages applying variability and coupling analyses methods. We enrolled 55 patients with obstructive sleep apnea syndrome (OSAS) and 29 healthy control subjects (CON: 45.9±14.9 years, 21 male) in this study. OSAS patients were subdivided into a low- and high-risk group (LR: 50.8±14.1 years, n=29, 21 male; HR: 57.2±13.4 years, n=26, 19 male) based on the Apnea-Hypopnea Index (AHI) (CON: 0-5 AHI, LR: 5-15 AHI, HR: >15 AHI). We could demonstrate the presence of an altered autonomic function in OSAS patients, differing from healthy controls. This altered autonomic function was mainly based on heart rate-, respiratory-, SpO2- and plethysmogram variability and their couplings. The discriminant analysis showed that the optimal set consisting of two autonomic indices revealed a high classification power (ACC=86.7%, AUC=90.3%, SENS=89.5% and SPEC=84.6%) when comparing low-risk and high-risk OSAS patients during WK. These results were slightly improved when analyzing REM sleep stages. Based on these results it seems to be possible to perform optimal risk stratification for OSAS patients based on autonomic indices. Based on our findings it is possible to differentiate between high-risk OSAS patient and low-risk OSAS patient at an early stage and in a promising manner allowing to set up therapy strategies for those patients in an early stage.
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Correia FJ, Martins LEB, Barreto DM, Pithon KR. Repercussion of medium and long treatment period with continuous positive airways pressure therapy in heart rate variability of obstructive sleep apnea. ACTA ACUST UNITED AC 2019; 12:110-115. [PMID: 31879544 PMCID: PMC6922548 DOI: 10.5935/1984-0063.20190068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Obstructive sleep apnea (OSA) is a respiratory sleep disorder. Many of these patients also exhibit autonomic alterations which can be observed through heart rate variability (HRV). Currently, one of the treatments for apnea is continuous positive airway pressure (CPAP). Objective To observe OSA patients treated with CPAP exhibit HRV changes at medium and long treatment period. Methods This is an integrative literature review conducted in May of 2018. The databases used for this research were PubMed, Scopus, Scielo and Pedro, the keywords used were “heart rate variability”, “obstructive sleep apnea” and “CPAP”. In this review was included original, published, randomized and non-randomized articles, released in the English language, before and up to April 2018, which specified the effects of CPAP therapy in autonomic dysfunction through the analysis of the HRV of patients diagnosed with OSA after at least one month of therapy. Results The research of the literature produced 113 articles. After excluding duplicates and applying the inclusion and exclusion criteria, 8 articles were selected for this review. Conclusion It was concluded that CPAP therapy is related to change in heart rate variability in patients with obstructive sleep apnea.
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Affiliation(s)
- Fernanda Jesus Correia
- Universidade Estadual do Sudoeste da Bahia, Departamento de Saúde I - Jequié - Bahia - Brazil
| | | | - Daniel Matos Barreto
- Universidade Estadual do Sudoeste da Bahia, Departamento de Ciências Naturais - Vitória da Conquista - Bahia - Brazil
| | - Karla Rocha Pithon
- Universidade Estadual do Sudoeste da Bahia, Departamento de Saúde I - Jequié - Bahia - Brazil
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Liu Y, Huang Z, Huang K, Li G, Luo J, Xu Y, Chen P, Chen J, Wang L. The Clinical Value of N-Terminal Pro B-Type Natriuretic Peptide in Evaluating Obstructive Sleep Apnea in Patients With Coronary Artery Disease. J Clin Sleep Med 2019; 15:1403-1409. [PMID: 31596204 PMCID: PMC6778357 DOI: 10.5664/jcsm.7962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES Natriuretic peptides have been identified as biomarkers of increased myocardial wall stress in the context of obstructive sleep apnea (OSA) in the general population. However, the relationship between N-terminal pro B-type natriuretic peptide (NT-proBNP) and OSA remains unclear in patients with coronary artery disease (CAD). Hence, we aimed to investigate the clinical value of NT-proBNP in evaluating OSA in a large population of patients with CAD. METHODS Consecutive patients with CAD were prospectively enrolled between February 2015 and March 2018. Portable respiratory monitoring was applied to facilitate the diagnosis of sleep apnea. Patients were as assigned to the non-OSA (when the respiratory events index [REI] or 3% oxygen desaturation index [ODI] < 15 events/h) and OSA (when the REI or 3% ODI ≥ 15 events/h) groups. Multivariate analyses were used to explore the independent association between NT-proBNP levels and OSA. RESULTS A total of 1,292 consecutive patients were included with a mean NT-proBNP value of 826.57 μg/L. Patients with high levels of NT-proBNP experienced increasing severity of OSA in those with CAD (P = .0004). Univariate analysis demonstrated that NT-proBNP was a risk factor for OSA (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.03-1.18, P = .005). In addition, multivariate analysis revealed that NT-proBNP was independently associated with the presence of OSA (OR 1.11, 95% CI 1.02-1.20, P = .012) even after adjusting for other cofounding factors. CONCLUSIONS Elevated levels of NT-proBNP were independently associated with a higher likelihood of OSA in patients with CAD. Periodically screening for NT-proBNP levels may provide early identification of OSA.
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Affiliation(s)
- Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Co-first authors
| | - Zhihua Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Kaizhuang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Xu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ling Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Krasińska B, Cofta S, Szczepaniak-Chicheł L, Rzymski P, Trafas T, Paluszkiewicz L, Tykarski A, Krasiński Z. The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension-A Randomized, Controlled Trial. J Clin Med 2019; 8:jcm8101671. [PMID: 31614891 PMCID: PMC6832448 DOI: 10.3390/jcm8101671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022] Open
Abstract
The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (n = 51) and the control group, remaining on their standard antihypertensive therapy (n = 51). After that period, a significant reduction in the night-time BP parameters in the treatment group including an increased night blood pressure fall from 4.6 to 8.9% was noted. Additionally, the number of non-dipper patients was reduced by 45.1%. The treatment group also revealed a decrease in left ventricular hypertrophy and in the apnea-hypopnea index (AHI) with a positive correlation being observed between these two parameters. This study is the first to report the improvement of the circadian BP profile and the improvement of the left ventricle geometry in patients with OSA and RAH following the addition of selective mineralocorticoid receptor antagonists to antihypertensive therapy.
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Affiliation(s)
- Beata Krasińska
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Szczepan Cofta
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Ludwina Szczepaniak-Chicheł
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland.
| | - Tomasz Trafas
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Lech Paluszkiewicz
- Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany.
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Zbigniew Krasiński
- Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
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Cetin E, Casim H. The association between aortic knob width on chest x-ray and obstructive sleep apnoea syndrome in patients referred for sleep testing. CLINICAL RESPIRATORY JOURNAL 2019; 13:716-721. [PMID: 31433909 DOI: 10.1111/crj.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea (OSA) has been linked with many forms of cardiovascular diseases. Aortic knob width (AKW) has increasingly been presented as a marker of diagnosis and prognosis of atherosclerotic coronary artery disease. We sought to determine whether AKW has an association with sleep apnoea syndrome in patients referred to sleep testing in order to provide baseline information for future studies on general population. METHODS A total of 363 patients were included in this retrospective study. The capacity of AKW indexed by patients' height in predicting the presence of severe OSA was analysed using receiver operating characteristics curve analysis. The association of OSA severity with AKW indexed by height was tested with two separate models of ANCOVA (analysis of variance). RESULTS Area under the curve for estimating severe OSA with AKW was 0.67 (95% CI, 0.60 to 0.73, P < 0.001). A cut-off value of 21.42 mm/m provided a sensitivity of 62.6% and a specificity of 70.7% for severe OSA. In both ANCOVA models, the association of OSA severity on AKW indexed by height was significant and the effect size was moderate (P < 0.001, partial eta squared: 0.09 and 0.05). CONCLUSIONS Aortic knob width indexed by height has a significant association with the severity of OSA; however, the association is significantly influenced by gender and age.
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Affiliation(s)
- Erdem Cetin
- Department of Cardiovascular Surgery, Karabuk University Education and Research Hospital, Karabuk, Turkey
| | - Hasan Casim
- Department of Pulmonary Medicine, Karabuk University Education and Research Hospital, Karabuk, Turkey
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25
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Liu Y, Gao L, Lv W, Lın L, Wang Y, Fıang F, Feng F. Pathologic and hemodynamic changes of common carotid artery in obstructive sleep apnea hypopnea syndrome in a porcine model. Turk J Med Sci 2019; 49:939-944. [PMID: 31195789 PMCID: PMC7018377 DOI: 10.3906/sag-1807-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/aim To prepare a porcine model of obstructive sleep apnea-hypopnea syndrome (OSAHS) and observe the pathological and hemodynamic changes in the common carotid artery. Materials and methods Twelve male miniature pigs were randomly divided into the model and control group (n = 6). Pigs in the model group were kept in an air-flow negative pressure chamber at 0.96 ± 0.01 kPa, and the air oxygen content, temperature, and humidity were kept at normal culture conditions in both groups. After pigs in the model group presented symptoms of OSAHS, changes in the hemodynamics and morphology of the carotid artery were analyzed using color Doppler, and light and electron microscopy. Results An animal model of OSAHS was successfully created. The internal diameter of the carotid artery of pigs in the model group was decreased, while the intima thickness, peak-systolic mean velocity, and resistance index were increased when compared to the control group (P < 0.05). The results of the light and electron microscopy revealed an incomplete elastic plate, increased media thickness, irregular morphology of the smooth muscle cells, increased collagen fiber bundles, partially disordered elastic fibers, and smooth muscle layers. The quantitative analysis showed significantly increased elastic fibers in the media of the carotid artery in the model group (P < 0.01). Conclusion Pathological changes in the tissue structure and hemodynamics in the negative pressure-induced pig OSAHS model were observed. We suggest that alterations in the upper airway pressure during OSAHS may lead to cardiovascular conditions through its pathological effects on the carotid artery.
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Affiliation(s)
- Yongyi Liu
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lu Gao
- Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Weinong Lv
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lin Lın
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Yi Wang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Fıang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Feng
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China,Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China,The Huishan District Second People’s Hospital of Wuxi City, Wuxi, China
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26
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Saraç S, Afsar GC. Effect of mean apnea-hypopnea duration in patients with obstructive sleep apnea on clinical and polysomnography parameter. Sleep Breath 2019; 24:77-81. [PMID: 31197639 DOI: 10.1007/s11325-019-01870-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Apnea-hypopnea index is the number of apnea-hypopnea events observed during polysomnography within an hour. Mean apnea-hypopnea duration is the mean duration of all apneas and hypopneas. In this study, we aimed to investigate the association of mean apnea-hypopnea duration in patients with obstructive sleep apnea with clinical and polysomnographic parameters. METHODS In our hospital, a total of 764 patients were diagnosed with OSA by polysomnography in 2017. Age, body mass index, and the current diseases were recorded. Sleep structures obtained from polysomnography readings, blood oxygen levels, apnea-hypopnea index, and mean average duration were recorded. Patients with mean average duration of 20 s or more were assigned to the long average duration group and those with less than 20 s were assigned to the short average duration group. Groups were compared in terms of clinical and polysomnographic parameters. RESULTS Snoring, witnessed apnea, morning tiredness, and hypertension were significantly higher in the long average duration group. There was statistically significantly more male patients and higher neck circumference in the MAD group. Total wake duration, percentage of sleep, stage 3, stage 1, and mean oxygen saturation percentage of the long average duration group were significantly reduced. CONCLUSION In present study, the patients with obstructive sleep apnea with long average duration were found to have more negative effects of sleep apnea than the patients with short average duration. We think that the use of mean apnea-hypopnea duration as an indicator with apnea-hypopnea index will be beneficial for the follow-up and treatment of the disease.
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Affiliation(s)
- Sema Saraç
- Department of Pulmonary Medicine, Sureyyapasa Teaching and Research Hospital, University of Medical Sciences Istanbul, Istanbul, Turkey.
- Department of pulmonary medicine, Istanbul Sureyyapasa Chest Diseases and Chest Surgery, Hospital Maltepe, Istanbul, Turkey.
| | - Gulgun Cetintaş Afsar
- Department of Pulmonary Medicine, Sureyyapasa Teaching and Research Hospital, University of Medical Sciences Istanbul, Istanbul, Turkey
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Van Ryswyk E, Anderson CS, Barbe F, Loffler KA, Lorenzi-Filho G, Luo Y, Quan W, Wang J, Zheng D, McEvoy RD. Effect of Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea with Cardiovascular Disease. Am J Respir Crit Care Med 2019; 199:1433-1435. [DOI: 10.1164/rccm.201811-2200le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Craig S. Anderson
- University of New South WalesSydney, New South Wales, Australia
- Royal Prince Alfred HospitalSydney, New South Wales, Australia
| | - Ferran Barbe
- Hospital Universitari Arnau de Vilanova-Santa MaríaMadrid, Spain
| | | | | | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou, China
| | - Weiwei Quan
- University of New South WalesSydney, New South Wales, Australia
| | - Jiguang Wang
- Shanghai Jiaotong University School of MedicineShanghai, Chinaand
| | - Danni Zheng
- University of New South WalesSydney, New South Wales, Australia
- Royal Prince Alfred HospitalSydney, New South Wales, Australia
| | - R. Doug McEvoy
- Flinders UniversityAdelaide, South Australia, Australia
- Southern Adelaide Local Health NetworkAdelaide, South Australia, Australia
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Monneret D. N-terminal pro-brain natriuretic peptide: a potential follow-up biomarker of mandibular advancement device efficacy on cardiac function in obstructive sleep apnea. F1000Res 2019; 7:1818. [PMID: 30906526 PMCID: PMC6415324 DOI: 10.12688/f1000research.17081.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 12/26/2022] Open
Abstract
Interrelationships between obstructive sleep apnea (OSA) and cardiovascular diseases are now recognized, but some underlying pathophysiological mechanisms remain controversial. Circulating cardiac biomarkers are diagnostic tools that can help understand them, in particular the N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of myocardial stretch, and a potential indicator of subclinical cardiac stress in OSA. Continuous positive airway pressure (CPAP), the first-line treatment of moderate to severe OSA, may be considered as uncomfortable, resulting in poor adherence, and reduced effectiveness. In this case, mandibular advancement devices (MAD) are an effective alternative therapy, more comfortable, and generally well accepted, with higher compliance. To date, few studies have compared the cardiovascular effects of CPAP and MAD. From recent literature reviews, it emerges that both therapies are effective in blood pressure reduction. However, the effects of MAD on other cardiovascular outcomes are conflicting, in particular as regards to its impact on circulating cardiac biomarkers. In a recent ancillary study from a randomized controlled trial, Recoquillon
et al concluded that two months of MAD treatment had no effect on NT-proBNP plasma levels in patients with severe OSA. The present discussion analyses this result from a biological, statistical, and analytical standpoint, in light of results from other studies evaluating natriuretic peptides in MAD-treated OSA, with the aim to support further longitudinal studies designed with a high methodological quality.
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Affiliation(s)
- Denis Monneret
- Department of Biochemistry and Molecular Biology, South Lyon Hospital Group, Hospices Civils de Lyon, Pierre-Bénite, 69495, France
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29
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Lee JH, Kang EJ, Bae WY, Kim JK, Choi JH, Kim CH, Kim SJ, Jo KS, Kim MS, Koh TK. Carotid Arterial Calcium Scoring Using Upper Airway Computed Tomography in Patients with Obstructive Sleep Apnea: Efficacy as a Clinical Predictor of Cerebrocardiovascular Disease. Korean J Radiol 2019; 20:631-640. [PMID: 30887745 PMCID: PMC6424829 DOI: 10.3348/kjr.2018.0550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/16/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jae Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Eun Ju Kang
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Woo Yong Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea.
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jae Hyung Choi
- Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
| | - Chul Hoon Kim
- Department of Oral and Maxillofacial Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Sang Joon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Kyoo Sang Jo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Moon Sung Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Tae Kyung Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Mary's Medical Center, Busan, Korea
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30
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Abstract
Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
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Affiliation(s)
- Milena K Pavlova
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass.
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32
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Cuspidi C, Sala C, Tadic M, Grassi G. When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension. Am J Hypertens 2019; 32:225-233. [PMID: 30508171 DOI: 10.1093/ajh/hpy183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/04/2023] Open
Abstract
An increasing attention has been devoted in the last two decades to masked hypertension (MH), a condition characterized by the fact that classification of a normal blood pressure (BP) status by office measurements is not confirmed by home and/or ambulatory BP monitoring (ABPM). MH definition (i.e., normal office BP, but high out-of-office BP) should be restricted to untreated subjects (true MH) whereas masked uncontrolled hypertension (MUCH) reserved to treated patients previously classified as hypertensives, presenting normal office BP and high ABPM or home values. Both MH and MUCH are associated with metabolic alterations, comorbidities, and hypertension-mediated organ damage (HMOD). Furthermore, the risk of cardiovascular events related to these conditions has been shown to be close or greater than that of sustained hypertension. This review discusses available evidence about MH and MUCH by focusing on its prevalence, clinical correlates, association with HMOD, prognostic significance, and their therapeutic implications.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
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Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan. Can Respir J 2019; 2019:1683124. [PMID: 30733845 PMCID: PMC6348862 DOI: 10.1155/2019/1683124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms in the absence of a sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care and (2) assess whether any distance-related patterns were attributable to differences in the frequency of diagnosis among adults who likely required this specialist medical care. We used a cross-sectional epidemiologic study design, augmented by analysis of follow-up survey data. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study. Follow-up occurred until 2015. 6525 adults from 3731 households constituted our sample. Statistical models used log-binomial regression. Rural adults who reported the largest travel distances (≥250 km) to specialist medical care were 1.17 (95% CI: 1.07, 1.29) times more likely to report OSA symptoms in the absence of a sleep apnea diagnosis than those who reported the smallest (<100 km; referent) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who likely required this specialist medical care. Our findings suggest factors other than travel distance may be contributing to the low sleep apnea diagnostic rate. This remains important as undiagnosed and untreated OSA has serious implications on the health of people and populations, but effective treatments are available. Health care access barriers to the diagnosis and treatment of OSA require evaluation to inform health care planning and delivery.
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Koh TK, Kang EJ, Bae WY, Kim SW, Kim CH, Koo SK, Kim SJ, Kim MS, Lee JH. Quantitative analysis of carotid arterial calcification using airway CT in obstructive sleep apnea. Auris Nasus Larynx 2018; 46:559-564. [PMID: 30528535 DOI: 10.1016/j.anl.2018.11.015] [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: 06/14/2018] [Revised: 10/06/2018] [Accepted: 11/25/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT). METHODS This study included a total of 180 consecutive OSA patients aged 45-80years underwent polysomnography and airway CT between March 2014 and October 2016. The subjects were divided into three groups based on the results of the respiratory disturbance index (RDI): mild (RDI 5-14, n=29), moderate (RDI 15-29, n=50), and severe (RDI≥30, n=101). The extent of carotid arterial calcification on each airway CT scan was quantified according to the modified Agatston scoring method. Differences among the three groups in clinical characteristics including age, gender, body mass index (BMI), comorbid disease, blood pressure, total cholesterol, and carotid arterial calcification score (CarACS) were analyzed. RESULTS The severe OSA group showed significantly stronger predominance for male and smoker, higher prevalence of diabetes, and larger BMI than those of mild and moderate OSA groups. The mean CarACS was significantly different among the three groups (mild RDI: 4.3±13.4, moderate RDI: 7.4±28.8, severe RDI: 48.6±121.6, P=0.011). Univariate linear regression showed that RDI, age, hypertension, male sex and diabetes significantly influenced on the CarACS. In a multivariate linear regression model, the CarACS was related to age, male sex, and diabetes. CONCLUSIONS The patients with severe OSA showed larger CarACS and a higher prevalence of atherosclerotic risk factors. The CarACS was correlated with severity of OSA, which might be more dependent on the conventional risk factors of atherosclerosis.
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Affiliation(s)
- Tae Kyung Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea.
| | - Woo Yong Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sung Wan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chul Hoon Kim
- Department of Oral and Maxillofacial Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Soo Kweon Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Mary's medical Center, Busan, Republic of Korea
| | - Sang Jun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Moon Sung Kim
- Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
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Chua AP, Koo CY, Kristanto W, Parot MVJM, Tan ESJ, Koh EHT, Abd Gani MB, Kojodjojo P, Han TO, Chan SP, Chong JPC, Frampton C, Richards AM, Lee CH. Sleep study-guided multidisciplinary therapy (SGMT) for patients with acute coronary syndrome: Trial rationale and design. Clin Cardiol 2018; 41:721-728. [PMID: 29582447 DOI: 10.1002/clc.22950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial aims to determine the effects of sleep study-guided multidisciplinary therapy (SGMT) comprising overnight sleep study, continuous positive airway pressure, and behavioral therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT will reduce (1) the plasma levels of N-terminal pro brain natriuretic peptide and suppression of tumorigenicity 2; (2) the estimated 10-year risk of cardiovascular mortality as measured by the European Systematic Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular event rate during a 3-year follow-up, compared with standard therapy. In the SGMT trial, 180 patients presenting with ACS will be randomly assigned to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will receive guideline-mandated treatment for ACS. Those assigned to SGMT will additionally undergo a sleep study and, if OSA is diagnosed, attend a multidisciplinary OSA clinic where they will receive personalized treatment including continuous positive airway pressure and behavioral/lifestyle counseling. The primary endpoint is the plasma N-terminal pro brain natriuretic peptide concentration at 7-month follow-up. This report presents the baseline characteristics of 117 patients (SGMT group: n =54; standard therapy group: n =63) who had been enrolled into the study as of August 31, 2017. The results of this trial will help us to understand whether active OSA diagnosis and treatment will improve the physiologic and clinical cardiovascular outcomes of this group of patients.
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Affiliation(s)
- Ai-Ping Chua
- Division of Respiratory Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - William Kristanto
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | | | | | | | | | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Tun-Oo Han
- Clinical Research Unit, Ng Teng Fong General Hospital, Singapore
| | - Siew-Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Jenny Pek-Ching Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | | | - Arthur Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
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Abumuamar AM, Dorian P, Newman D, Shapiro CM. The STOP-BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation. J Sleep Res 2018; 27:e12702. [DOI: 10.1111/jsr.12702] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Asmaa M. Abumuamar
- Institute of Medical Science; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Paul Dorian
- Department of Cardiology; St. Michael's Hospital; University of Toronto; Toronto ON Canada
| | - David Newman
- Department of Cardiology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Colin M. Shapiro
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
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Wang JW, Li AY, Guo QH, Guo YJ, Weiss JW, Ji ES. Endothelin-1 and ET receptors impair left ventricular function by mediated coronary arteries dysfunction in chronic intermittent hypoxia rats. Physiol Rep 2017; 5:5/1/e13050. [PMID: 28057852 PMCID: PMC5256153 DOI: 10.14814/phy2.13050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA) results in cardiac dysfunction and vascular endothelium injury. Chronic intermittent hypoxia (CIH), the main characteristic of OSAS, is considered to be mainly responsible for cardiovascular system impairment. This study is aimed to evaluate the role of endothelin‐1(ET‐1) system in coronary injury and cardiac dysfunction in CIH rats. In our study, Sprague–Dawley rats were exposed to CIH (FiO2 9% for 1.5 min, repeated every 3 min for 8 h/d, 7 days/week for 3 weeks). After 3 weeks, the left ventricular developed pressure (LVDP) and coronary resistance (CR) were measured with the langendorff mode in isolated hearts. Meanwhile, expressions of ET‐1 and ET receptors were detected by immunohistochemical and western blot, histological changes were also observed to determine effects of CIH on coronary endothelial cells. Results suggested that decreased LVDP level combined with augmented coronary resistance was exist in CIH rats. CIH could induce endothelial injury and endothelium‐dependent vasodilatation dysfunction in the coronary arteries. Furthermore, ET‐1 and ETA receptor expressions in coronary vessels were increased after CIH exposure, whereas ETB receptors expression was decreased. Coronary contractile response to ET‐1 in both normoxia and CIH rats was inhibited by ETA receptor antagonist BQ123. However, ETB receptor antagonist BQ788 enhanced ET‐1‐induced contractile in normoxia group, but had no significant effects on CIH group. These results indicate that CIH‐induced cardiac dysfunction may be associated with coronary injury. ET‐1 plays an important role in coronary pathogenesis of CIH through ETA receptor by mediating a potent vasoconstrictor response. Moreover, decreased ETB receptor expression that leads to endothelium‐dependent vasodilatation decline, might be also participated in coronary and cardiac dysfunction.
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Affiliation(s)
- Jin-Wei Wang
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Ai-Ying Li
- Department of Biochemistry, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Qiu-Hong Guo
- Department of Pharmacology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Ya-Jing Guo
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - James W Weiss
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - En-Sheng Ji
- Department of Physiology, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
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Yazgan S, Erboy F, Celik HU, Ornek T, Ugurbas SH, Kokturk F, Ayar O, Akdemir MO, Celik E. Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study. Curr Eye Res 2017; 42:1552-1560. [PMID: 28910165 DOI: 10.1080/02713683.2016.1266661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. RESULTS The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). CONCLUSIONS In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.
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Affiliation(s)
- Serpil Yazgan
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Fatma Erboy
- b Medical Faculty, Department of Ophthalmology , Medeniyet University , Istanbul , Turkey
| | - Haci Ugur Celik
- c Medical Faculty, Department of Thoracic Medicine , Bulent Ecevit University , Zonguldak , Turkey
| | - Tacettin Ornek
- b Medical Faculty, Department of Ophthalmology , Medeniyet University , Istanbul , Turkey
| | - Suat Hayri Ugurbas
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Firuzan Kokturk
- d Medical Faculty, Department of Biostastics , Bülent Ecevit University , Zonguldak , Turkey
| | - Orhan Ayar
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Mehmet Orcun Akdemir
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Erkan Celik
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
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Patients with symptoms and characteristics consistent with obstructive sleep apnea are at a higher risk for acute and subacute stent thrombosis after percutaneous coronary stent implantation: a single-center case-control study. BMC Cardiovasc Disord 2017; 17:226. [PMID: 28821224 PMCID: PMC5562978 DOI: 10.1186/s12872-017-0658-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/07/2017] [Indexed: 01/12/2023] Open
Abstract
Background To determine if obstructive sleep apnea (OSA) is a risk factor for early stent thrombosis (EST; within 30 days) after percutaneous coronary intervention (PCI). Methods This case–control study involved 23 patients with angiographically confirmed EST after PCI (case group) and 92 PCI patients (control group) who did not develop stent thrombosis during a 2-year follow-up. Patients with symptoms and characteristics consistent with OSA (hereinafter referred to as OSA) were identified using the Berlin questionnaire, and the general characteristics of the patients and their treatments as well as outcomes were recorded. The odds ratios (ORs) for OSA were calculated. Additionally, the association between OSA and EST in patients with different conventional cardiovascular risk factors was analyzed. Results The crude OR for OSA was 4.17 (95% confidence interval [CI]: 1.60–10.84, P = 0.003). After adjusting for other risk factors of EST, the OR for OSA remained significant. In participants with no or one conventional cardiovascular disease risk factor, we found a significant association between OSA and EST (OR: 17.00, 95% CI: 2.33–124.19, P = 0.005). Conclusion OSA is an independent risk factor for EST. This conclusion was further supported by the finding that in patients with few conventional cardiovascular risk factors, the contribution of OSA to EST was more obvious.
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Wilton KM, Matteson EL, Crowson CS. Risk of Obstructive Sleep Apnea and Its Association with Cardiovascular and Noncardiac Vascular Risk in Patients with Rheumatoid Arthritis: A Population-based Study. J Rheumatol 2017; 45:45-52. [PMID: 28765254 DOI: 10.3899/jrheum.170460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To define the incidence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA) and determine whether OSA diagnosis predicts future cardiovascular disease (CVD) and noncardiac vascular events. METHODS Medical information pertaining to RA, OSA, CVD, and vascular diagnoses was extracted from a comprehensive medical record system for a geographically defined population of 813 patients previously diagnosed with RA and 813 age- and sex-matched comparator subjects. RESULTS The risk for OSA in persons with RA versus comparators was elevated, although not reaching statistical significance (HR 1.32, 95% CI 0.98-1.77; p = 0.07). Patients with RA were more likely to be diagnosed with OSA if they had traditional risk factors for OSA, including male sex, current smoking status, hypertension, diabetes, dyslipidemia, and increased body mass index. Features of RA disease associated with OSA included large joint swelling and joint surgery. Patients with RA with decreased renal function were also at higher risk of OSA. The increased risk of overall CVD among patients with RA who have OSA was similar to the increased CVD risk associated with OSA in the comparator cohort (interaction p = 0.86). OSA diagnosis was associated with an increased risk of both CVD (HR 1.9, 95% CI 1.08-3.27), and cerebrovascular disease (HR 2.4, 95% CI 1.14-5.26) in patients with RA. CONCLUSION Patients with RA may be at increased risk of OSA secondary to both traditional and RA-related risk factors. Diagnosis with OSA predicts future CVD in RA and may provide an opportunity for CVD intervention.
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Affiliation(s)
- Katelynn M Wilton
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Eric L Matteson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic
| | - Cynthia S Crowson
- From the Mayo Clinic School of Medicine; Mayo Clinic Graduate School of Biomedical Sciences; Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA. .,K.M. Wilton, BS, MD/PhD Student, Mayo Clinic School of Medicine, and Mayo Clinic Graduate School of Biomedical Sciences; E.L. Matteson, MD, MPH, Professor of Medicine, Department of Health Sciences Research, and Division of Rheumatology, Mayo Clinic; C.S. Crowson, MS, Associate Professor of Medicine, Department of Health Sciences Research, Mayo Clinic.
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Pietrock C, von Haehling S. Sleep-disordered breathing in heart failure: facts and numbers. ESC Heart Fail 2017; 4:198-202. [PMID: 28772039 PMCID: PMC5542721 DOI: 10.1002/ehf2.12193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/12/2022] Open
Abstract
Sleep‐disordered breathing has a high prevalence in the general population, but is especially prominent in patients with heart failure (HF). HF and sleep‐disordered breathing share a bidirectional relationship, with sleep‐disordered breathing being both cause and effect of poor cardiac functioning. The high inter‐individual variability of symptom presentation can impede the clinical diagnostic process. Polysomnography is the gold‐standard method of diagnosing sleep‐disordered breathing. Therapy of sleep‐disordered breathing should always consist of optimizing the treatment of the underlying disorder of HF. Additional therapeutic measures include continuous positive airway pressure ventilation therapy. New therapeutic options using neurostimulation are yielding promising results; however, long‐term benefits still need to be confirmed.
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Affiliation(s)
- Charlotte Pietrock
- Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Charité Medical School, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
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Eichhorn L, Dolscheid-Pommerich R, Erdfelder F, Ayub MA, Schmitz T, Werner N, Jansen F. Sustained apnea induces endothelial activation. Clin Cardiol 2017; 40:704-709. [PMID: 28464406 DOI: 10.1002/clc.22720] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Apnea diving has gained worldwide popularity, even though the pathophysiological consequences of this challenging sport on the human body are poorly investigated and understood. This study aims to assess the influence of sustained apnea in healthy volunteers on circulating microparticles (MPs) and microRNAs (miRs), which are established biomarkers reflecting vascular function. HYPOTHESIS Short intermittent hypoxia due to voluntary breath-holding affects circulating levels of endothelial cell-derived MPs (EMPs) and endothelial cell-derived miRs. METHODS Under dry laboratory conditions, 10 trained apneic divers performed maximal breath-hold. Venous blood samples were taken, once before and at 4 defined points in time after apnea. Samples were analyzed for circulating EMPs and endothelial miRs. RESULTS Average apnea time was 329 seconds (±103), and SpO2 at the end of apnea was 79% (±12). Apnea was associated with a time-dependent increase of circulating endothelial cell-derived EMPs and endothelial miRs. Levels of circulating EMPs in the bloodstream reached a peak 4 hours after the apnea period and returned to baseline levels after 24 hours. Circulating miR-126 levels were elevated at all time points after a single voluntary maximal apnea, whereas miR-26 levels were elevated significantly only after 30 minutes and 4 hours. Also miR-21 and miR-92 levels increased, but did not reach the level of significance. CONCLUSIONS Even a single maximal breath-hold induces acute endothelial activation and should be performed with great caution by subjects with preexisting vascular diseases. Voluntary apnea might be used as a model to simulate changes in endothelial function caused by hypoxia in humans.
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Affiliation(s)
- Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | | | - Felix Erdfelder
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | | | - Theresa Schmitz
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
| | - Felix Jansen
- Department of Medicine II, Heart Center Bonn, University Hospital of Bonn, Bonn, Germany
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Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disease, distinguished by recurrent episodes of upper airway obstruction during sleep, with an inflammatory component. C-reactive protein (CRP) and high-sensitivity C-reactive protein (hs-CRP) are markers of systemic inflammation and may serve as biomarkers of OSA. METHODS Scientific studies published from January 1, 2006, to January 1, 2016 were obtained via searches of PubMed, Embase, SCI, and China National Knowledge Internet (CNKI) using relevant terms. Studies concerning serum CRP level/ hs-CRP in OSA patients were reviewed by 2 independent reviewers. Studies were included if they conform with our specific criteria of inclusion. Eligible studies were subjected to quality review, data extraction, and meta-analysis by using RevMan (version 5.2) and STATA (version 12.0). RESULTS There were 15 studies that met inclusion criteria that included a total of 1297 subjects. Meta-analysis revealed that serum CRP levels in the OSA group were 1.98 mmol/L higher than those in control group (95% confidence interval: 1.39-2.58, P < .01). Similarly, serum hs-CRP levels in the OSA group were 1.57 mmol/L higher than that in the control group (95% confidence interval: 0.96-2.18, P < .01). Subgroup analysis showed greater differences between OSA patients and controls in the setting of obesity (body mass index)> = 30. The total weighted mean difference (WMD) between OSA and controls within the subgroup of subjects who had a CRP was 2.10; for hs-CRP, the WMD was 2.49. Comparing OSA patients of mean apnea hypopnea index> = 15 and controls, the total WMD for the CRP subgroup was 2.19; for the hs-CRP subgroup, the WMD was 1.70. CONCLUSION In our meta-analysis, serum CRP/hs-CRP levels were discovered to be higher in OSA patients compared with control subjects. Those with higher body mass index and apnea hyponea index demonstrated larger differences in CRP/hs-CRP levels. These data are consistent with an inflammatory component of OSA pathophysiology and support the role of CRP/hs-CRP as a biomarker in this disease.
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Piovezan RD, Kase C, Moizinho R, Tufik S, Poyares D. Gabapentin acutely increases the apnea-hypopnea index in older men: data from a randomized, double-blind, placebo-controlled study. J Sleep Res 2017; 26:166-170. [DOI: 10.1111/jsr.12495] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ronaldo D. Piovezan
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Camila Kase
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Renato Moizinho
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Sergio Tufik
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Dalva Poyares
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
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Liguori C, Izzi F, Mercuri NB, Romigi A, Cordella A, Tarantino U, Placidi F. Vitamin D status of male OSAS patients improved after long-term CPAP treatment mainly in obese subjects. Sleep Med 2017; 29:81-85. [DOI: 10.1016/j.sleep.2016.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 02/07/2023]
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46
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Maeder MT, Mueller C, Schoch OD, Ammann P, Rickli H. Biomarkers of cardiovascular stress in obstructive sleep apnea. Clin Chim Acta 2016; 460:152-63. [DOI: 10.1016/j.cca.2016.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
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Kales SN, Czeisler CA. Obstructive Sleep Apnea and Work Accidents: Time for Action. Sleep 2016; 39:1171-3. [PMID: 27166231 DOI: 10.5665/sleep.5822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Stefanos N Kales
- Department of Environmental & Occupational Medicine & Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.,Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Division of Sleep Medicine and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA
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