1
|
Nokes B, Orr JE, White S, Luu S, Chen Z, Alex R, Sands SA, Wojeck BS, Owens RL, Malhotra A, Schmickl CN. Effect of obesity on sleep apnea pathogenesis differs in women versus men: multiple mediation analyses in the retrospective SNOOzzzE cohort. J Appl Physiol (1985) 2024; 136:1516-1525. [PMID: 38660729 PMCID: PMC11368527 DOI: 10.1152/japplphysiol.00925.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
There are multiple mechanisms underlying obstructive sleep apnea (OSA) development. However, how classic OSA risk factors such as body mass index (BMI) and sex portend to OSA development has not been fully described. Thus we sought to evaluate how obesity leads to OSA and assess how these mechanisms differ between men and women. The San Diego Multi-Outcome OSA Endophenotype (SNOOzzzE) cohort includes 3,319 consecutive adults who underwent a clinical in-laboratory polysomnography at the University of California, San Diego, sleep clinic between January 2017 and December 2019. Using routine polysomnography signals, we determined OSA endotypes. We then performed mediation analyses stratified by sex to determine how BMI influenced the apnea-hypopnea index (AHI) using OSA pathophysiological traits as mediators, adjusting for age, race, and ethnicity. We included 2,146 patients of whom 919 (43%) were women and 1,227 (57%) were obese [body mass index (BMI) > 30 kg/m2]. BMI was significantly associated with AHI in both women and men. In men, the adjusted effect of BMI on AHI was partially mediated by a reduction in upper airway stiffness (βstandardized = 0.124), a reduction in circulatory delay (βstandardized = 0.063), and an increase in arousal threshold (βstandardized = 0.029; Pboot-strapped,all < 0.05). In women, the adjusted effect of BMI on AHI was partially mediated by a reduction in upper airway stiffness (βstandardized = 0.05) and circulatory delay (βstandardized = 0.037; Pboot-strapped,all < 0.05). BMI-related OSA pathogenesis differs by sex. An increase in upper airway collapsibility is consistent with prior studies. A reduction in circulatory delay may lead to shorter and thus more events per hour (higher AHI), while the relationship between arousal threshold and OSA is likely complex.NEW & NOTEWORTHY Our data provide important insights into obesity-related obstructive sleep apnea (OSA) pathogenesis, thereby validating, and extending, prior research findings. This is the largest sample size study to examine the relationships between obesity and gender on OSA pathogenesis. The influence of obesity on sleep apnea severity is mediated by different mechanistic traits (endotypes).
Collapse
Affiliation(s)
- Brandon Nokes
- Sleep Medicine Section, Veterans Affairs San Diego Healthcare System, San Diego, California, United States
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Stephanie White
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Steven Luu
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Zihan Chen
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Raichel Alex
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Brian S Wojeck
- Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Robert L Owens
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, United States
| |
Collapse
|
2
|
Karuga FF, Kaczmarski P, Białasiewicz P, Szmyd B, Jaromirska J, Grzybowski F, Gebuza P, Sochal M, Gabryelska A. REM-OSA as a Tool to Understand Both the Architecture of Sleep and Pathogenesis of Sleep Apnea-Literature Review. J Clin Med 2023; 12:5907. [PMID: 37762848 PMCID: PMC10531579 DOI: 10.3390/jcm12185907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system activity, or metabolism. Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of pauses in breathing during sleep caused by blockage of the upper airways. This common condition has multifactorial ethiopathogenesis (e.g., anatomical predisposition, sex, obesity, and age). Within this heterogenous syndrome, some distinctive phenotypes sharing similar clinical features can be recognized, one of them being REM sleep predominant OSA (REM-OSA). The aim of this review was to describe the pathomechanism of REM-OSA phenotype, its specific clinical presentation, and its consequences. Available data suggest that in this group of patients, the severity of specific cardiovascular and metabolic complications is increased. Due to the impact of apneas and hypopneas predominance during REM sleep, patients are more prone to develop hypertension or glucose metabolism impairment. Additionally, due to the specific function of REM sleep, which is predominantly fragmented in the REM-OSA, this group presents with decreased neurocognitive performance, reflected in memory deterioration, and mood changes including depression. REM-OSA clinical diagnosis and treatment can alleviate these outcomes, surpassing the traditional treatment and focusing on a more personalized approach, such as using longer therapy of continuous positive airway pressure or oral appliance use.
Collapse
Affiliation(s)
- Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Kaczmarski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland
| | - Julia Jaromirska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Filip Grzybowski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Piotr Gebuza
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland (F.G.)
| |
Collapse
|
3
|
deAndrés-Galiana EJ, Fernández-Martínez JL, Álvarez-Machancoses Ó, Bea G, Galmarini CM, Kloczkowski A. Analysis of transcriptomic responses to SARS-CoV-2 reveals plausible defective pathways responsible for increased susceptibility to infection and complications and helps to develop fast-track repositioning of drugs against COVID-19. Comput Biol Med 2022; 149:106029. [PMID: 36067633 PMCID: PMC9423878 DOI: 10.1016/j.compbiomed.2022.106029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/08/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To understand the transcriptomic response to SARS-CoV-2 infection, is of the utmost importance to design diagnostic tools predicting the severity of the infection. METHODS We have performed a deep sampling analysis of the viral transcriptomic data oriented towards drug repositioning. Using different samplers, the basic principle of this methodology the biological invariance, which means that the pathways altered by the disease, should be independent on the algorithm used to unravel them. RESULTS The transcriptomic analysis of the altered pathways, reveals a distinctive inflammatory response and potential side effects of infection. The virus replication causes, in some cases, acute respiratory distress syndrome in the lungs, and affects other organs such as heart, brain, and kidneys. Therefore, the repositioned drugs to fight COVID-19 should, not only target the interferon signalling pathway and the control of the inflammation, but also the altered genetic pathways related to the side effects of infection. We also show via Principal Component Analysis that the transcriptome signatures are different from influenza and RSV. The gene COL1A1, which controls collagen production, seems to play a key/vital role in the regulation of the immune system. Additionally, other small-scale signature genes appear to be involved in the development of other COVID-19 comorbidities. CONCLUSIONS Transcriptome-based drug repositioning offers possible fast-track antiviral therapy for COVID-19 patients. It calls for additional clinical studies using FDA approved drugs for patients with increased susceptibility to infection and with serious medical complications.
Collapse
Affiliation(s)
- Enrique J deAndrés-Galiana
- Group of Inverse Problems, Optimization and Machine Learning. Department of Mathematics, University of Oviedo, C. Federico García Lorca, 18, 33007, Oviedo, Spain; Department of Computer Science, University of Oviedo, C. Federico García Lorca, 18, 33007, Oviedo, Spain.
| | - Juan Luis Fernández-Martínez
- Group of Inverse Problems, Optimization and Machine Learning. Department of Mathematics, University of Oviedo, C. Federico García Lorca, 18, 33007, Oviedo, Spain; DeepBioInsights, Spain.
| | - Óscar Álvarez-Machancoses
- Group of Inverse Problems, Optimization and Machine Learning. Department of Mathematics, University of Oviedo, C. Federico García Lorca, 18, 33007, Oviedo, Spain.
| | - Guillermina Bea
- Group of Inverse Problems, Optimization and Machine Learning. Department of Mathematics, University of Oviedo, C. Federico García Lorca, 18, 33007, Oviedo, Spain; DeepBioInsights, Spain.
| | - Carlos M Galmarini
- Topazium Artificial Intelligence, Paseo de la Castellana 40, 28046, Madrid, Spain.
| | - Andrzej Kloczkowski
- Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
4
|
Gentile F, Borrelli C, Sciarrone P, Buoncristiani F, Spiesshoefer J, Bramanti F, Iudice G, Vergaro G, Emdin M, Passino C, Giannoni A. Central Apneas Are More Detrimental in Female Than in Male Patients With Heart Failure. J Am Heart Assoc 2022; 11:e024103. [PMID: 35191313 PMCID: PMC9075076 DOI: 10.1161/jaha.121.024103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Central apneas (CA) are a frequent comorbidity in patients with heart failure (HF) and are associated with worse prognosis. The clinical and prognostic relevance of CA in each sex is unknown. Methods and Results Consecutive outpatients with HF with either reduced or mildly reduced left ventricular ejection fraction (n=550, age 65±12 years, left ventricular ejection fraction 32%±9%, 21% women) underwent a 24‐hour ambulatory polygraphy to evaluate CA burden and were followed up for the composite end point of cardiac death, appropriate implantable cardioverter‐defibrillator shock, or first HF hospitalization. Compared with men, women were younger, had higher left ventricular ejection fraction, had lower prevalence of ischemic etiology and of atrial fibrillation, and showed lower apnea‐hypopnea index (expressed as median [interquartile range]) at daytime (3 [0–9] versus 10 [3–20] events/hour) and nighttime (10 [3–21] versus 23 [11–36] events/hour) (all P<0.001), despite similar neurohormonal activation and HF therapy. Increased chemoreflex sensitivity to either hypoxia or hypercapnia (evaluated in 356 patients, 65%, by a rebreathing test) was less frequent in women (P<0.001), but chemoreflex sensitivity to hypercapnia was a predictor of apnea‐hypopnea index in both sexes. At adjusted survival analysis, daytime apnea‐hypopnea index ≥15 events/hour (hazard ratio [HR], 2.70; 95% CI, 1.06–7.34; P=0.037), nighttime apnea‐hypopnea index ≥15 events/hour (HR, 2.84; 95% CI, 1.28–6.32; P=0.010), and nighttime CA index ≥10 events/hour (HR, 5.01; 95% CI, 1.88–13.4; P=0.001) were independent predictors of the primary end point in women but not in men (all P>0.05), also after matching women and men for possible confounders. Conclusions In chronic HF, CA are associated with a greater risk of adverse events in women than in men.
Collapse
Affiliation(s)
- Francesco Gentile
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,University Hospital Pisa Italy
| | - Chiara Borrelli
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,University Hospital Pisa Italy
| | - Paolo Sciarrone
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,University Hospital Pisa Italy
| | | | | | | | - Giovanni Iudice
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy
| | - Giuseppe Vergaro
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
| | - Michele Emdin
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
| | - Claudio Passino
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
| | - Alberto Giannoni
- Fondazione Toscana G. MonasterioCNR-Regione Toscana Pisa Italy.,Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
| |
Collapse
|
5
|
Abstract
Central apnea syndrome is a disorder with protean manifestations and concomitant conditions. It can occur as a distinct clinical entity or as part of another clinical syndrome. The pathogenesis of central sleep apnea (CSA) varies depending on the clinical condition. Sleep-related withdrawal of the ventilatory drive to breathe is the common denominator among all cases of central apnea, whereas hypocapnia is the final common pathway leading to apnea in the majority of central apnea. Medical conditions most closely associated with CSA include heart failure, stroke, spinal cord injury, and opioid use, among others. Nocturnal polysomnography is the standard diagnostic method, including measurement of sleep and respiration. The latter includes detection of flow, measurement of oxyhemoglobin saturation and detection of respiratory effort. Management strategy incorporates clinical presentation, associated conditions, and the polysomnographic findings in an individualized manner. The pathophysiologic heterogeneity may explain the protean clinical manifestations and the lack of a single effective therapy for all patients. While research has enhanced our understanding of the pathogenesis of central apnea, treatment options are extrapolated from treatment of obstructive sleep apnea. Co-morbid conditions and concomitant obstructive sleep apnea influence therapeutic approach significantly. Therapeutic options include positive pressure therapy, pharmacologic therapy, and supplemental Oxygen. Continuous positive airway pressure (CPAP) is the initial standard of care, although the utility of other modes of positive pressure therapy, as well as pharmacotherapy and device-based therapies, are currently being investigated.
Collapse
Affiliation(s)
- Geoffrey Ginter
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States
| | - M Safwan Badr
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States.
| |
Collapse
|
6
|
Ye H, Huang S, Song Y, Liu H, Zhao X, Zhao D, Mi F, Wang X, Zhang X, Du J, Zhu N, Zhang L, Zhao Y. Gene co-expression analysis identifies modules related to insufficient sleep in humans. Sleep Med 2021; 86:68-74. [PMID: 34464880 DOI: 10.1016/j.sleep.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Insufficient sleep and circadian rhythm disruption may cause cancer, obesity, cardiovascular disease, and cognitive impairment. The underlying mechanisms need to be elucidated. METHOD Weighted gene co-expression network analysis (WGCNA) was used to identify co-expressed modules. Connectivity Map tool was used to identify candidate drugs based on top connected genes. R ptestg package was utilized to detected module rhythmicity alteration. A hypergeometric test was used to test the enrichment of insomnia SNP signals in modules. Google Scholar was used to validate the modules and hub genes by literature. RESULTS We identified a total of 45 co-expressed modules. These modules were stable and preserved. Eight modules were correlated with sleep restriction duration. Module rhythmicity was disrupted in sleep restriction subjects. Hub genes that involve in insufficient sleep also play important roles in sleep disorders. Insomnia GWAS signals were enriched in six modules. Finally, eight drugs associated with sleep disorders were identified. CONCLUSION Systems biology method was used to identify sleep-related modules, hub genes, and candidate drugs. Module rhythmicity was altered in sleep insufficient subjects. Thiamphenicol, lisuride, timolol, and piretanide are novel candidates for sleep disorders.
Collapse
Affiliation(s)
- Hua Ye
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Shiliang Huang
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Yufei Song
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Huiwei Liu
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Xiaosu Zhao
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Dan Zhao
- Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Fangxia Mi
- Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Xinxue Wang
- Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Xuesong Zhang
- Department of Gastroenterology, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Jinman Du
- Physical Examination Center, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Na Zhu
- Physical Examination Center, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Liangshun Zhang
- Physical Examination Center, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China
| | - Yibin Zhao
- Department of Anus & Intestine Surgery, Ningbo Medical Treatment Center Lihuili Hospital, Medical School of Ningbo University, Ningbo, Zhejiang 315040, PR China.
| |
Collapse
|
7
|
Migueis DP, Lopes MC, Ignacio PSD, Thuler LCS, Araujo-Melo MH, Spruyt K, Lacerda GCB. A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan. Sleep Med 2021; 85:25-37. [PMID: 34271180 DOI: 10.1016/j.sleep.2021.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.
Collapse
Affiliation(s)
- D P Migueis
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Antonio Pedro University Hospital / Fluminense Federal University, Niterói, Brazil.
| | - M C Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - P S D Ignacio
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C S Thuler
- National Cancer Institute, Rio de Janeiro, Brazil
| | - M H Araujo-Melo
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K Spruyt
- INSERM, Université de Paris, NeuroDiderot, France
| | - G C B Lacerda
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Orr JE, Ayappa I, Eckert DJ, Feldman JL, Jackson CL, Javaheri S, Khayat RN, Martin JL, Mehra R, Naughton MT, Randerath WJ, Sands SA, Somers VK, Badr MS. Research Priorities for Patients with Heart Failure and Central Sleep Apnea. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 203:e11-e24. [PMID: 33719931 PMCID: PMC7958519 DOI: 10.1164/rccm.202101-0190st] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Central sleep apnea (CSA) is common among patients with heart failure and has been strongly linked to adverse outcomes. However, progress toward improving outcomes for such patients has been limited. The purpose of this official statement from the American Thoracic Society is to identify key areas to prioritize for future research regarding CSA in heart failure. Methods: An international multidisciplinary group with expertise in sleep medicine, pulmonary medicine, heart failure, clinical research, and health outcomes was convened. The group met at the American Thoracic Society 2019 International Conference to determine research priority areas. A statement summarizing the findings of the group was subsequently authored using input from all members. Results: The workgroup identified 11 specific research priorities in several key areas: 1) control of breathing and pathophysiology leading to CSA, 2) variability across individuals and over time, 3) techniques to examine CSA pathogenesis and outcomes, 4) impact of device and pharmacological treatment, and 5) implementing CSA treatment for all individuals Conclusions: Advancing care for patients with CSA in the context of heart failure will require progress in the arenas of translational (basic through clinical), epidemiological, and patient-centered outcome research. Given the increasing prevalence of heart failure and its associated substantial burden to individuals, society, and the healthcare system, targeted research to improve knowledge of CSA pathogenesis and treatment is a priority.
Collapse
|
9
|
Zeineddine S, Badr MS. Treatment-Emergent Central Apnea: Physiologic Mechanisms Informing Clinical Practice. Chest 2021; 159:2449-2457. [PMID: 33497650 DOI: 10.1016/j.chest.2021.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
The purpose of this review was to describe our management approach to patients with treatment-emergent central sleep apnea (TECSA). The emergence of central sleep apnea during positive airway pressure therapy occurs in approximately 8% of titration studies for OSA, and it has been associated with several demographic, clinical, and polysomnographic factors, as well as factors related to the titration study itself. TECSA shares similar pathophysiology with central sleep apnea. In fact, central and OSA pathophysiologic mechanisms are inextricably intertwined, with ventilatory instability and upper airway narrowing occurring in both entities. TECSA is a "dynamic" process, with spontaneous resolution with ongoing positive airway pressure therapy in most patients, persistence in some, or appearing de novo in a minority of patients. Management strategy for TECSA aims to eliminate abnormal respiratory events, stabilize sleep architecture, and improve the underlying contributing medical comorbidities. CPAP therapy remains a standard therapy for TECSA. Expectant management is appropriate given its transient nature in most cases, whereas select patients would benefit from an early switch to an alternative positive airway pressure modality. Other treatment options include supplemental oxygen and pharmacologic therapy.
Collapse
Affiliation(s)
- Salam Zeineddine
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI; Department of Medicine, Wayne State University, Detroit, MI.
| |
Collapse
|
10
|
Rastogi R, Badr MS, Ahmed A, Chowdhuri S. Amelioration of sleep-disordered breathing with supplemental oxygen in older adults. J Appl Physiol (1985) 2020; 129:1441-1450. [PMID: 32969781 DOI: 10.1152/japplphysiol.00253.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Elderly adults demonstrate increased propensity for breathing instability during sleep compared with younger adults, and this may contribute to increased prevalence of sleep-disordered breathing (SDB) in this population. Hence, in older adults with SDB, we examined whether addition of supplemental oxygen (O2) will stabilize breathing during sleep and alleviate SDB. We hypothesized that exposure to supplemental O2 during non-rapid eye movement (NREM) sleep will stabilize breathing and will alleviate SDB by reducing ventilatory chemoresponsiveness and by widening the carbon dioxide (CO2) reserve. We studied 10 older adults with mild-to-moderate SDB who were randomized to undergo noninvasive bilevel mechanical ventilation with exposure to room air or supplemental O2 (Oxy) to determine the CO2 reserve, apneic threshold (AT), and controller and plant gains. Supplemental O2 was introduced during sleep to achieve a steady-state O2 saturation ≥95% and fraction of inspired O2 at 40%-50%. The CO2 reserve increased significantly during Oxy versus room air (-4.2 ± 0.5 mmHg vs. -3.2 ± 0.5 mmHg, P = 0.03). Compared with room air, Oxy was associated with a significant decline in the controller gain (1.9 ± 0.4 L/min/mmHg vs. 2.5 ± 0.5 L/min/mmHg, P = 0.04), with reductions in the apnea-hypopnea index (11.8 ± 2.0/h vs. 24.4 ± 5.6/h, P = 0.006) and central apnea-hypopnea index (1.7 ± 0.6/h vs. 6.9 ± 3.9/h, P = 0.03). The AT and plant gain were unchanged. Thus, a reduced slope of CO2 response resulted in an increased CO2 reserve. In conclusion, supplemental O2 reduced SDB in older adults during NREM sleep via reduction in chemoresponsiveness and central respiratory events.NEW & NOTEWORTHY This study demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB in this vulnerable population.
Collapse
Affiliation(s)
- Ruchi Rastogi
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - M S Badr
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - A Ahmed
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - S Chowdhuri
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
11
|
Billakota S, Odom N, Westwood AJ, Hanna E, Pack AM, Bateman LM. Sleep-disordered breathing, neuroendocrine function, and clinical SUDEP risk in patients with epilepsy. Epilepsy Behav 2018; 87:78-82. [PMID: 30176573 DOI: 10.1016/j.yebeh.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Sudden unexpected death in epilepsy (SUDEP) is a major contributor to epilepsy-related mortality. It is associated with nocturnal seizures and centrally mediated postictal cardiorespiratory dysfunction (CRD), but mechanisms and contributors remain poorly understood. METHODS We performed a prospective, cross-sectional, observational pilot study in the Columbia University Medical Center (CUMC) adult epilepsy monitoring unit (EMU) to explore relationships between periictal CRD, sleep-disordered breathing (SDB), neuroendocrine function, and clinical SUDEP risk. Thirty patients (twenty women, ten men) underwent video-electroencephalogram (EEG) with electrocardiogram (EKG) and digital pulse oximetry, inpatient or outpatient polysomnography (PSG), and comprehensive laboratory evaluation of sex steroid hormones. Sudden unexpected death in epilepsy risk was defined as Low (0-2) or High (≥3) using the revised SUDEP-7 Inventory. Sleep-disordered breathing was defined using standard criteria. Neuroendocrine dysfunction was defined as ≥1 laboratory abnormality. RESULTS Cardiorespiratory dysfunction occurred more frequently in high-risk patients (60% vs. 27%, p = 0.018). Endocrine dysfunction was seen in 35% of patients, more in men (p = 0.018). Sleep-disordered breathing was found in 88% of fully scoreable PSGs. CONCLUSIONS There was no significant relationship between CRD, SDB, and neuroendocrine status, though all PSGs in those with high SUDEP risk or neuroendocrine dysfunction revealed SDB. Larger studies are needed to further elucidate relationships between CRD, SDB, neuroendocrine factors, and SUDEP.
Collapse
Affiliation(s)
- Santoshi Billakota
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States.
| | - Nicole Odom
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States; Pinehurst Neurology, P.A., Pinehurst, NC, United States
| | - Andrew J Westwood
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States
| | - Eric Hanna
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States
| | - Alison M Pack
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States
| | - Lisa M Bateman
- Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States
| |
Collapse
|
12
|
Shamim-Uzzaman QA, Singh S, Chowdhuri S. Hypopnea definitions, determinants and dilemmas: a focused review. SLEEP SCIENCE AND PRACTICE 2018. [DOI: 10.1186/s41606-018-0023-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
13
|
Morselli LL, Temple KA, Leproult R, Ehrmann DA, Van Cauter E, Mokhlesi B. Determinants of Slow-Wave Activity in Overweight and Obese Adults: Roles of Sex, Obstructive Sleep Apnea and Testosterone Levels. Front Endocrinol (Lausanne) 2018; 9:377. [PMID: 30050500 PMCID: PMC6052085 DOI: 10.3389/fendo.2018.00377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/22/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Slow-wave activity (SWA) in non-rapid eye movement (NREM) sleep, obtained by spectral analysis of the electroencephalogram, is a marker of the depth or intensity of NREM sleep. Higher levels of SWA are associated with lower arousability during NREM sleep and protect against sleep fragmentation. Multiple studies have documented that SWA levels are higher in lean women, compared to age-matched lean men, but whether these differences persist in obese subjects is unclear. Obstructive sleep apnea (OSA), a condition associated with obesity, is more prevalent in men than in women. Sex differences in SWA could therefore be one of the factors predisposing men to OSA. Furthermore, we hypothesized that higher levels of testosterone may be associated with lower levels of SWA. Objective: The aim of the current study was to identify sex differences in the determinants of SWA in young and middle-aged overweight and obese adults. Methods: We enrolled 101 overweight and obese but otherwise healthy participants from the community (44 men, 57 women) in this cross-sectional study. Participants underwent an overnight in-laboratory polysomnogram. The recordings were submitted to sleep staging and spectral analysis. Sex differences and the potential contribution of testosterone levels were evaluated after adjusting for age, body mass index and race/ethnicity. Results: OSA was present in 66% of men and in 44% of women. After adjustment for differences in age, race/ethnicity and BMI, the odds ratio for OSA in men vs. women was 3.17 (95% CI 1.14-9.43, p = 0.027). There was a graded inverse relationship between the apnea-hypopnea index (AHI) and SWA in men (β = -0.21, p = 0.018) but not in women (β = 0.10, p = 0.207). In a multivariate regression model, higher testosterone levels were independently associated with lower SWA in men after controlling for age, race/ethnicity and apnea-hypopnea index (β = -0.56, p = 0.025). Conclusion: Increasing severity of OSA was associated with significant decrease in sleep intensity in men but not in women. Higher testosterone levels were associated with lower sleep intensity in men. Men with higher testosterone levels may therefore have lower arousal thresholds and higher ventilatory instability in NREM sleep, and be at greater risk of OSA.
Collapse
Affiliation(s)
- Lisa L. Morselli
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Karla A. Temple
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Rachel Leproult
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
| | - David A. Ehrmann
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Eve Van Cauter
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Babak Mokhlesi
- Sleep, Metabolism and Health Center, University of Chicago, Chicago, IL, United States
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, United States
- *Correspondence: Babak Mokhlesi
| |
Collapse
|
14
|
Chowdhuri S, Pranathiageswaran S, Loomis-King H, Salloum A, Badr MS. Aging is associated with increased propensity for central apnea during NREM sleep. J Appl Physiol (1985) 2017; 124:83-90. [PMID: 29025898 DOI: 10.1152/japplphysiol.00125.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The reason for increased sleep-disordered breathing with predominance of central apneas in the elderly is unknown. We hypothesized that the propensity to central apneas is increased in older adults, manifested by a reduced carbon-dioxide (CO2) reserve in older compared with young adults during non-rapid eye movement sleep. Ten elderly and 15 young healthy adults underwent multiple brief trials of nasal noninvasive positive pressure ventilation during stable NREM sleep. Cessation of mechanical ventilation (MV) resulted in hypocapnic central apnea or hypopnea. The CO2 reserve was defined as the difference in end-tidal CO2 ([Formula: see text]) between eupnea and the apneic threshold, where the apneic threshold was [Formula: see text] that demarcated the central apnea closest to the eupneic [Formula: see text]. For each MV trial, the hypocapnic ventilatory response (controller gain) was measured as the change in minute ventilation (V̇e) during the MV trial for a corresponding change in [Formula: see text]. The eupneic [Formula: see text] was significantly lower in elderly vs. young adults. Compared with young adults, the elderly had a significantly reduced CO2 reserve (-2.6 ± 0.4 vs. -4.1 ± 0.4 mmHg, P = 0.01) and a higher controller gain (2.3 ± 0.2 vs. 1.4 ± 0.2 l·min-1·mmHg-1, P = 0.007), indicating increased chemoresponsiveness in the elderly. Thus elderly adults are more prone to hypocapnic central apneas owing to increased hypocapnic chemoresponsiveness during NREM sleep. NEW & NOTEWORTHY The study describes an original finding where healthy older adults compared with healthy young adults demonstrated increased breathing instability during non-rapid eye movement sleep, as suggested by a smaller carbon dioxide reserve and a higher controller gain. The findings may explain the increased propensity for central apneas in elderly adults during sleep and potentially guide the development of pathophysiology-defined personalized therapies for sleep apnea in the elderly.
Collapse
Affiliation(s)
- Susmita Chowdhuri
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center , Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine , Detroit, Michigan
| | - Sukanya Pranathiageswaran
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine , Detroit, Michigan
| | - Hillary Loomis-King
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine , Detroit, Michigan
| | - Anan Salloum
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center , Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine , Detroit, Michigan
| | - M Safwan Badr
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center , Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine , Detroit, Michigan
| |
Collapse
|
15
|
Chowdhuri S, Badr MS. Control of Ventilation in Health and Disease. Chest 2016; 151:917-929. [PMID: 28007622 DOI: 10.1016/j.chest.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022] Open
Abstract
Control of ventilation occurs at different levels of the respiratory system through a negative feedback system that allows precise regulation of levels of arterial carbon dioxide and oxygen. Mechanisms for ventilatory instability leading to sleep-disordered breathing include changes in the genesis of respiratory rhythm and chemoresponsiveness to hypoxia and hypercapnia, cerebrovascular reactivity, abnormal chest wall and airway reflexes, and sleep state oscillations. One can potentially stabilize breathing during sleep and treat sleep-disordered breathing by identifying one or more of these pathophysiological mechanisms. This review describes the current concepts in ventilatory control that pertain to breathing instability during wakefulness and sleep, delineates potential avenues for alternative therapies to stabilize breathing during sleep, and proposes recommendations for future research.
Collapse
Affiliation(s)
- Susmita Chowdhuri
- John D. Dingell VA Medical Center, Wayne State University, Detroit MI; Department of Medicine, Wayne State University, Detroit MI.
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Wayne State University, Detroit MI; Department of Medicine, Wayne State University, Detroit MI
| |
Collapse
|
16
|
Chen YC, Chen TW, Su MC, Chen CJ, Chen KD, Liou CW, Tang P, Wang TY, Chang JC, Wang CC, Lin HC, Chin CH, Huang KT, Lin MC, Hsiao CC. Whole Genome DNA Methylation Analysis of Obstructive Sleep Apnea: IL1R2, NPR2, AR, SP140 Methylation and Clinical Phenotype. Sleep 2016; 39:743-55. [PMID: 26888452 DOI: 10.5665/sleep.5620] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES We hypothesized that DNA methylation patterns may contribute to disease severity or the development of hypertension and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA). METHODS Illumina's (San Diego, CA, USA) DNA methylation 27-K assay was used to identify differentially methylated loci (DML). DNA methylation levels were validated by pyrosequencing. A discovery cohort of 15 patients with OSA and 6 healthy subjects, and a validation cohort of 72 patients with sleep disordered breathing (SDB). RESULTS Microarray analysis identified 636 DMLs in patients with OSA versus healthy subjects, and 327 DMLs in patients with OSA and hypertension versus those without hypertension. In the validation cohort, no significant difference in DNA methylation levels of six selected genes was found between the primary snoring subjects and OSA patients (primary outcome). However, a secondary outcome analysis showed that interleukin-1 receptor 2 (IL1R2) promoter methylation (-114 cytosine followed by guanine dinucleotide sequence [CpG] site) was decreased and IL1R2 protein levels were increased in the patients with SDB with an oxygen desaturation index > 30. Androgen receptor (AR) promoter methylation (-531 CpG site) and AR protein levels were both increased in the patients with SDB with an oxygen desaturation index > 30. Natriuretic peptide receptor 2 (NPR2) promoter methylation (-608/-618 CpG sites) were decreased, whereas levels of both NPR2 and serum C type natriuretic peptide protein were increased in the SDB patients with EDS. Speckled protein 140 (SP140) promoter methylation (-194 CpG site) was increased, and SP140 protein levels were decreased in the patients with SDB and EDS. CONCLUSIONS IL1R2 hypomethylation and AR hypermethylation may constitute an important determinant of disease severity, whereas NPR2 hypomethylation and SP140 hypermethylation may provide a biomarker for vulnerability to EDS in OSA. COMMENTARY A commentary on this article appears in this issue on page 723.
Collapse
Affiliation(s)
- Yung-Che Chen
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Ting-Wen Chen
- Molecular Medicine Research Center, Chang Gung University, Taiwan.,Bioinformatics Center, Chang Gung University, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Chung-Jen Chen
- Division of Rheumatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Den Chen
- Center of Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Petrus Tang
- Molecular Medicine Research Center, Chang Gung University, Taiwan.,Bioinformatics Center, Chang Gung University, Taiwan
| | - Ting-Ya Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chieh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Chang Gung University of Science and Technology, Chia-yi, Taiwan
| | - Hsin-Ching Lin
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taiwan
| |
Collapse
|
17
|
de Carvalho D, Marques D, Bernuci M, Leite C, Araújo-Lopes R, Anselmo-Franci J, Bícego K, Szawka R, Gargaglioni L. Role of sex hormones in hypercapnia-induced activation of the locus coeruleus in female and male rats. Neuroscience 2016; 313:36-45. [DOI: 10.1016/j.neuroscience.2015.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/21/2015] [Accepted: 11/12/2015] [Indexed: 12/27/2022]
|
18
|
Chowdhuri S, Pranathiageswaran S, Franco-Elizondo R, Jayakar A, Hosni A, Nair A, Badr MS. Effect of age on long-term facilitation and chemosensitivity during NREM sleep. J Appl Physiol (1985) 2015; 119:1088-96. [PMID: 26316510 DOI: 10.1152/japplphysiol.00030.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/04/2015] [Indexed: 12/31/2022] Open
Abstract
The reason for increased sleep-disordered breathing with a predominance of central apneas in the elderly is unknown. We speculate that ventilatory control instability may provide a link between aging and the onset of unstable breathing during sleep. We sought to investigate potential underlying mechanisms in healthy, elderly adults during sleep. We hypothesized that there is 1) a decline in respiratory plasticity or long-term facilitation (LTF) of ventilation and/or 2) increased ventilatory chemosensitivity in older adults during non-, this should be hyphenated, non-rapid rapid eye movement (NREM) sleep. Fourteen elderly adults underwent 15, 1-min episodes of isocapnic hypoxia (EH), nadir O2 saturation: 87.0 ± 0.8%. Measurements were obtained during control, hypoxia, and up to 20 min of recovery following the EH protocol, respectively, for minute ventilation (VI), timing, and inspiratory upper-airway resistances (RUA). The results showed the following. 1) Compared with baseline, there was a significant increase in VI (158 ± 11%, P < 0.05) during EH, but this was not accompanied by augmentation of VI during the successive hypoxia trials nor in VI during the recovery period (94.4 ± 3.5%, P = not significant), indicating an absence of LTF. There was no change in inspiratory RUA during the trials. This is in contrast to our previous findings of respiratory plasticity in young adults during sleep. Sham studies did not show a change in any of the measured parameters. 2) We observed increased chemosensitivity with increased isocapnic hypoxic ventilatory response and hyperoxic suppression of VI in older vs. young adults during NREM sleep. Thus increased chemosensitivity, unconstrained by respiratory plasticity, may explain increased periodic breathing and central apneas in elderly adults during NREM sleep.
Collapse
Affiliation(s)
- Susmita Chowdhuri
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Sukanya Pranathiageswaran
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Rene Franco-Elizondo
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Arunima Jayakar
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Arwa Hosni
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Ajin Nair
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and
| | - M Safwan Badr
- Medical Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan; and Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
19
|
Won C, Guilleminault C. Gender differences in sleep disordered breathing: implications for therapy. Expert Rev Respir Med 2015; 9:221-31. [PMID: 25739831 DOI: 10.1586/17476348.2015.1019478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are gender differences in the upper airway function and respiratory stability in obstructive sleep apnea (OSA). Hormones are implicated in some gender-related differences, and these differences between men and women appear to mitigate as age increases. In addition, changes in the airway and lung function during pregnancy can contribute to snoring and OSA that might have an adverse effect on the mother and fetus. The limited data available suggest that although the prevalence and severity of OSA may be lower in women, the consequences of the disease are similar, if not worse. Women with OSA may have greater risk for hypertension and endothelial dysfunction, be more likely to develop comorbid conditions such as anxiety and depression and have increased mortality. Therefore, treatment options specifically targeting female presentations and pathophysiology of sleep-disordered breathing (SDB) are expected to result in improved outcomes in women.
Collapse
Affiliation(s)
- Christine Won
- Yale University School of Medicine, New Haven, CT, USA
| | | |
Collapse
|