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Kovbasyuk Z, Ramos-Cejudo J, Parekh A, Bubu OM, Ayappa IA, Varga AW, Chen MH, Johnson AD, Gutierrez-Jimenez E, Rapoport DM, Osorio RS. Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk. J Am Heart Assoc 2024:e034079. [PMID: 39056328 DOI: 10.1161/jaha.123.034079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/31/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Although related, the precise mechanisms linking obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are unclear. Platelets are mediators of CVD risk and thrombosis and prior studies suggested associations of OSA and platelet activity. The aim of this study is to assess the link between OSA, platelet activity, and CVD-related risk factors. METHODS AND RESULTS We studied the association of OSA-measures and platelet aggregation in participants dually enrolled in the SHHS (Sleep Heart and Health Study) and FHS (Framingham Heart Study). We applied linear regression models with adjustment for demographic and clinical covariates and explored interactions with OSA and CVD-related factors, including age, sex, body mass index, hypertension, OSA diagnosis (apnea-hypopnea index 4%≥5), and aspirin use. Our final sample was of 482 participants (60 years [14.00], 50.4% female). No associations were observed between apnea-hypopnea index 4% and platelet aggregation in the main sample. Stratified analysis revealed an association in aspirin users (n=65) for our primary exposure (apnea-hypopnea index 4%, β=0.523; P<0.001; n=65), and secondary exposures: hypoxic burden (β=0.358; P<0.001), minimum saturation (β=-0.519; P=0.026), and oxygen desaturation index 3% (β=74.672; P=0.002). No associations were detected in nonaspirin users (n=417). CONCLUSIONS No associations were detected between OSA and platelet aggregation in a community sample. Our finding that OSA associates with increased platelet aggregation in the aspirin group, most of whom use it for primary prevention of CVD, suggests that platelet aggregation may mediate the adverse impact of OSA on vascular health in individuals with existing CVD risk, supporting further investigation.
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Affiliation(s)
- Zanetta Kovbasyuk
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Jaime Ramos-Cejudo
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ankit Parekh
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Omonigho M Bubu
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Indu A Ayappa
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Andrew W Varga
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Ming-Huei Chen
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | - Andrew D Johnson
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | | | - David M Rapoport
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ricardo S Osorio
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
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Balkin TJ, Simonelli G, Riedy S. Negative health outcomes in long sleepers: The societal sleep restriction hypothesis. Sleep Med Rev 2024; 77:101968. [PMID: 38936221 DOI: 10.1016/j.smrv.2024.101968] [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: 01/23/2024] [Revised: 05/15/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Society imposes work and school schedules, as well as social expectations, that militate against consistently obtaining more than 7-9 h of sleep every 24 h. For most but not all adults this sleep duration is adequate. But among those who consistently obtain more than 9 h of sleep per day ("long sleepers"), there likely exists a subpopulation of individuals who are nevertheless failing to obtain enough sleep to satisfy their physiological sleep needs - a consequence of "restricting" their daily sleep durations to whatever extent they can tolerate so as to conform as closely as possible to society's norms and expectations. It is hypothesized that the 'long sleep arm' of the seemingly paradoxical U-shaped relationship between sleep duration and negative health outcomes can be explained, at least in part, by the existence of a subpopulation of such 'sleep-restricted long sleepers.'
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Affiliation(s)
- Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Guido Simonelli
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Center for Advanced Research in Sleep Medicine, Centre Integre Universitaire de Sante et de Services Sociaux Du Nord-de-l'île-de-Montreal, Montreal, QC, Canada
| | - Samantha Riedy
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Hein M, Wacquier B, Conenna M, Lanquart JP, Point C. Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk. Life (Basel) 2024; 14:592. [PMID: 38792613 PMCID: PMC11122566 DOI: 10.3390/life14050592] [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: 04/05/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
There is evidence for a particular relationship between low-grade inflammation (LGI) and intermittent hypoxia (IH) related to obstructive sleep apnoea syndrome (OSAS). However, despite the potential deleterious cardiovascular consequences associated with this LGI in hypertensive patients, few studies have investigated the impact of IH related to OSAS on CRP levels in this subpopulation. In total, 1404 hypertensive patients were selected retrospectively from the Sleep Laboratory database. CRP levels ≥3 mg/L but <10 mg/L were used as cut-offs to identify hypertensive patients with LGI. Logistic regressions were conducted to examine the risk of LGI associated with IH related to OSAS in hypertensive patients. LGI was frequent (33.8%) in hypertensive patients. After adjustment for confounders, multivariate logistic regressions revealed that only moderate to severe OSAS (apnoea-hypopnoea index ≥ 15/h) with high IH (oxygen desaturation index ≥ 15/h) [OR 1.51 (95% CI 1.06-2.14)] was significantly associated with LGI in hypertensive patients (p-value = 0.045). Consistent with our hypothesis, our results demonstrated the existence of a particular subtype of hypertensive patients at high cardiovascular risk characterised by the presence of LGI induced by IH hypoxia related to moderate to severe OSAS, which justifies the establishment of adequate management of this pathology to allow better cardiovascular prevention in this subpopulation.
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Affiliation(s)
- Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Brussels, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Matteo Conenna
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
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Meyer EJ, Wittert GA. Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab 2024; 109:e1267-e1279. [PMID: 37758218 PMCID: PMC10876414 DOI: 10.1210/clinem/dgad572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.
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Affiliation(s)
- Emily Jane Meyer
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gary Allen Wittert
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Gao J, Tan P, Liu Y, Chen S, Liu J. Association Between Sleep Apnea and Tinnitus: A Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2024:1455613241226853. [PMID: 38321723 DOI: 10.1177/01455613241226853] [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: 02/08/2024] Open
Abstract
Objective: It remains unclear whether sleep apnea (SA) is associated with tinnitus in adults. Based on a systematic review and meta-analysis of observational studies, we investigated the association between SA and tinnitus in adult population. Methods: Observational studies relevant to our research were identified by searching PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure databases. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Results: Eight case-control or cross-sectional studies, including 132,292 adults were included, and 1556 of them had SA. It was shown that SA was related to a higher prevalence of tinnitus (odds ratio [OR]: 1.65, 95% confidence interval: 1.14-2.39, P < .001) with moderate heterogeneity (P for Cochrane Q test = 0.04, I2 = 53%). Seven studies reported the association between obstructive SA and tinnitus, while the other one study reported the association between overall SA and tinnitus. Subgroup analyses showed that the association was not significant for mild (OR: 1.80, P = .17) or moderate (OR: 1.25, P = .53), but significant for severe SA (OR: 2.25, P = .008). In addition, the association between SA and tinnitus seemed to be stronger in studies from Italy or United States as compared to those from China (OR: 2.91 vs 1.35, P for subgroup difference = .02). The association was not significantly affected by study design, mean age, proportion of men, methods for diagnosis of SA, and controlling of age and sex (P for subgroup difference all > .05). Conclusion: Severe SA may be related to tinnitus in adults.
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Affiliation(s)
- Jing Gao
- Health Medicine Department, The 900th Hospital of the Chinese PLA Joint Logistics Support Force, Fuzhou, Fujian Province, P.R. China
| | - Ping Tan
- Health Medicine Department, The 900th Hospital of the Chinese PLA Joint Logistics Support Force, Fuzhou, Fujian Province, P.R. China
| | - Yunliang Liu
- Department of Otolaryngology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, P.R. China
| | - Shoujian Chen
- Health Medicine Department, The 900th Hospital of the Chinese PLA Joint Logistics Support Force, Fuzhou, Fujian Province, P.R. China
| | - Jianqing Liu
- Health Medicine Department, The 900th Hospital of the Chinese PLA Joint Logistics Support Force, Fuzhou, Fujian Province, P.R. China
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Tani S, Atsumi W, Yagi T, Imatake K, Suzuki Y, Takahashi A, Monden M, Matsumoto N, Okumura Y. Higher frequency of fish intake and healthy lifestyle behaviors may be associated with a lower platelet count in Japan: Implication for the anti-atherosclerotic effect of fish intake. Prev Med 2023; 175:107682. [PMID: 37625651 DOI: 10.1016/j.ypmed.2023.107682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Habitual fish intake and healthier lifestyles are associated with a lower risk of atherosclerotic cardiovascular disease (ASCVD). Higher platelet counts (PLCs) are reportedly associated with higher ASCVD events. We aimed to investigate the association between fish intake and lifestyle with PLCs. METHODS We conducted a cross-sectional study in a cohort of 9329 participants (average age: 46.9 ± 12.9 years; 58.9% men) with no history of ASCVD registered at the Health Planning Center of Nihon University Hospital in 2019. RESULTS The average fish intake frequency was 2.15 ± 1.28 days/week. As fish intake frequency increased (0, 1, 2, 3, 4, 5, 6, and 7 days), PLC decreased significantly (p < 0.0001). Multivariable logistic regression analysis showed that higher fish intake frequency tended to be a determinant of lower PLC. Aerobic exercise habits and sleep duration were independent negative determinants of PLC. Cigarette smoking habits were a positive independent determinant of PLC. Furthermore, with increasing fish intake frequency, the proportion of participants with habitual aerobic exercise, non-smoking habits, and longer sleep duration increased (p < 0.0001 for all). Higher n-3 polyunsaturated fatty acid (n-3 PUFA), calculated based on data from the Japanese National Health and Nutrition Survey, intake was associated with a lower PLC. CONCLUSION Higher fish intake and healthier lifestyle behaviors may be comprehensively associated with lower PLCs. The intake of N-3 PUFA with anti-inflammatory effects, rich in fish, may also be related to the lower PLC. This association may explain the preventive effects of fish intake on ASCVD risk.
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Affiliation(s)
- Shigemasa Tani
- Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan.
| | - Wataru Atsumi
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Tsukasa Yagi
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Kazuhiro Imatake
- Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Yasuyuki Suzuki
- Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Atsuhiko Takahashi
- Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Masaki Monden
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan; Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicines, 30-1 Oyaguchi-kamimachi, Itabashi-ku, 173-8610 Tokyo, Japan
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Ciarambino T, Crispino P, Guarisco G, Giordano M. Gender Differences in Insulin Resistance: New Knowledge and Perspectives. Curr Issues Mol Biol 2023; 45:7845-7861. [PMID: 37886939 PMCID: PMC10605445 DOI: 10.3390/cimb45100496] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Insulin resistance is the main mechanism in a whole series of pathological conditions, which are not only of metabolic interest but also of a systemic type. This phenomenon means that the body's cells become less sensitive to the hormone insulin, leading to higher levels of insulin in the blood. Insulin resistance is a phenomenon that can be found in both men and women and in particular, in the latter, it is found mainly after menopause. Premenopause, hormonal fluctuations during the menstrual cycle, and the presence of estrogen can affect insulin sensitivity. Androgens, such as testosterone, are typically higher in men and can contribute to insulin resistance. In both sexes, different human body types affect the distribution and location of body fat, also influencing the development of diabetes and cardiovascular disease. Insulin resistance is also associated with some neurological and neurogenerative disorders, polycystic ovary syndrome, atherosclerosis, and some of the main neoplastic pathologies. A healthy lifestyle, including regular physical activity, a balanced diet, and self-maintenance, can help to prevent the onset of insulin resistance, regardless of gender, although the different habits between men and women greatly affect the implementation of preventative guidelines that help in fighting the manifestations of this metabolic disorder. This review may help to shed light on gender differences in metabolic diseases by placing a necessary focus on personalized medical management and by inspiring differentiated therapeutic approaches.
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Affiliation(s)
- Tiziana Ciarambino
- Internal Medicine Department, Hospital of Marcianise, 81100 Caserta, Italy
| | - Pietro Crispino
- Internal Medicine Department, Hospital of Latina, 04100 Latina, Italy;
| | - Gloria Guarisco
- Diabetology, University Sapienza of Rome, Hospital of Latina, 04100 Latina, Italy;
| | - Mauro Giordano
- Internal Medicine Department, University of Campania, L. Vanvitelli, 81100 Naples, Italy;
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