Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Chronic intermittent hypoxia-induced oxidative stress activates TRB3 and phosphorylated JNK to mediate insulin resistance and cell apoptosis in the pancreas

This study explores the potential mechanisms of obstructive sleep apnoea (OSA) complicates type 2 diabetes mellitus (T2DM) by which chronic intermittent hypoxia (CIH) induces insulin resistance and cell apoptosis in the pancreas through oxidative stress. Four- and eight-week CIH rat models were established, and Tempol (100 mg/kg/d), was used as an oxidative stress inhibitor. This study included five groups: 4-week CIH, 4-week CIH-Tempol, 8-week CIH, 8-week CIH-Tempol and normal control (NC) groups. Fasting blood glucose and insulin levels were measured in the serum. The expression levels of 8-hidroxy-2-deoxyguanosine (8-OHdG), tribbles homologue 3 (TRB3), c-Jun N-terminal kinase (JNK), phosphorylated JNK (p-JNK), insulin receptor substrate-1 (IRS-1), phosphorylated IRS-1 (Ser307) (p-IRS-1ser307 ), protein kinase B (AKT), phosphorylated AKT (Ser473) (p-AKTser473 ), B cell lymphoma protein-2 (Bcl-2), cleaved-caspase-3 (Cl-caspase-3), and the islet cell apoptosis were detected in the pancreas. CIH induced oxidative stress in the pancreas. Compared with that in the NC group and CIH-Tempol groups individually, the homeostasis model assessment of insulin resistance (HOMA-IR) and apoptosis of islet cells was increased in the CIH groups. CIH-induced oxidative stress increased the expression of p-IRS-1Ser307 and decreased the expression of p-AKTSer473 . The expression levels of TRB3 and p-JNK were higher in the CIH groups than in both the CIH-Tempol and NC groups. Meanwhile, the expressions of Cl-caspase-3 and Bcl-2 were upregulated and downregulated, respectively, in the CIH groups. Hence, the present study demonstrated that CIH-induced oxidative stress might not only induce insulin resistance but also islet cell apoptosis in the pancreas through TRB3 and p-JNK.

Exploring the Impact of Positional Sleep Apnea in a Turkish Population: Unveiling the Untold Story

BACKGROUND The present study aimed to investigate the risk factors associated with demographical, clinical and polysomnographic features of positional sleep apnea through different criterion of positional sleep apnea (POSA vs e-POSA) in a large patient cohort from a tertiary referral center MATERIAL AND METHODS A total of 782 OSA patients who were further diagnosed with POSA (total: n=470, e-POSA: n=204) or non-POSA (n=312) based on apnea-hypopnea index (AHI) events by overnight polysomnography were included. Demographical, clinical, and polysomnographic characteristics were recorded, while independent predictors of POSA and e-POSA were determined via linear regression analysis. RESULTS Severe OSA (AHI ≥30/h) was less common in the POSA (33.4% vs 71.5%, P<0.001) and e-POSA (9.8% vs 62.3%, P<0.001) groups than in the non-POSA and non-e-POSA groups, respectively. For POSA and e-POSA, male sex (OR 2.195, P<0.001 and OR 2.021, P=0.004, respectively), low body mass index (BMI; OR 0.932, P<0.001 and OR 0.948, P=0.006), low AHI (OR 0.954 and OR 0.902, P<0.001 for each), and less desaturation (T90%, OR 0.972 and OR 0.968, P<0.001 for each) were the common statistically significant predictors. Younger age was an independent predictor of POSA (OR 0.97, P=0.003). POSA (median 20.4 s) and e-POSA (20.5 s) groups demonstrated similar apnea-hypopnea durations (min) as the non-POSA (median 21.1 s) group. CONCLUSIONS Our findings revealed that male sex and lower values of BMI, AHI, and desaturation were common determinants of POSA and e-POSA, while younger age independently predicted POSA. POSA and e-POSA had similar clinical and polysomnographic characteristics and shared the unvaried hypoxic burden.

[Compliance with CPAP treatment in patients with obstructive sleep apneas during the COVID-19 pandemic in two hospitals in the Federal Capital]

Introduction

CPAP therapy is the first line treatment for sleep apnea and its effectiveness depends on adherence. Face to face control and follow-up was limited due to the fact that our country was immersed in social isolation due to the COVID-19 pandemic as of March 2020. In order to assess whether CPAP adherence was maintained in patients with obstructive sleep apnea (OSA), in two hospitals during the COVID-19 pandemic and compare it with the pre-pandemic situation on a historical control basis in the city of Buenos Aires.

Methods

Observational and retrospective study based on systematic data collection of adherence to CPAP and residual apnea-hypopnea index (AHI). For comparison, a historical control corresponding to the specular period (May to December of each year between 2016 and 2019) was used as a reference. Patients over 18 years ago with OSA on CPAP therapy more than 30 days of treatment were included. Patients with other chronic respiratory diseases requiring ventilation therapy (Bi-level, servo ventilation, volume-assured ventilation) were excluded.

Results

151 pre-pandemic patients and 127 from the pandemic period, respectively, were evaluated. Men 98 (65%) vs. 50 (60.3%) p: 0.9, age: 65.4 ± 11.9 vs. 63.6 ± 12.6 p: 0.22, body mass index 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectively. In both centers, the most used treatment was fixed CPAP; 90 (59.6%) vs. 96 (75.6%) p: 0.005. There was an increase in compliance with it compared to the pre-pandemic period in minutes/night [341.4 95% CI 292.4 - 340.6 vs. 274.3 95% CI 208.5 - 267.4, p: 0.001] and residual AHI reduction [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006].

Conclusions

In the period of the COVID-19 pandemic, greater adherence to CPAP treatment was observed in patients with sleep apnea.