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Narayan A, Raghuveer P. Obstructive sleep apnea risk among adults with type 2 diabetes mellitus in an urban primary care setting of Mangalore, India. J Family Med Prim Care 2024; 13:3264-3269. [PMID: 39228574 PMCID: PMC11368261 DOI: 10.4103/jfmpc.jfmpc_105_24] [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: 01/20/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 09/05/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is an under-evaluated and under-treated problem, particularly among individuals with type 2 diabetes mellitus (T2DM). Therefore, in this study, we aim to determine the risk of OSA among adults with T2DM residing in an urban area of Mangalore and to elucidate the determinants of OSA among the study participants. Materials and Methods A cross-sectional study was conducted for a period of 2 months among adult patients (≥ 18 years) with T2DM seeking health care at a primary care setting located in an urban area of Mangalore. Face-to-face interviews were conducted using a semi-structured proforma. STOP-BANG questionnaire was used to assess the risk of OSA among the study participants. The measurements, such as height, weight, and neck circumference, were conducted using standard techniques. Results The mean age of the study participants was 58.12 ± 11.60 years. The majority, (58.30%), were males, and 45.0% reported a family history of T2DM. A total of 108 (60.0%) experienced loud snoring while asleep, while 149 (82.80%) experienced tiredness during daytime. The mean body mass index (BMI) was 24.64 ± 4.9 kg/m2, while a neck circumference of >40 cms was found in 28.90%. A total of 69 (38.30%) had a high risk of OSA with a STOP-BANG score ranging from 5 to 8, while 71 (39.40%) had a score ranging from 3 to 4 (intermediate risk). The statistically significant associations were found between age >50 years, male gender, and diabetes for ≥ 7 years and high risk of OSA (P < 0.001). Conclusion More than a third of the study participants had a high risk of OSA. Age > 50 years, male gender, and diabetes for ≥7 years were the factors associated with OSA.
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Affiliation(s)
- Anusha Narayan
- Department of Anaesthesia, S Nijalingappa Medical College, Bagalkot, Karnataka, India
| | - Pracheth Raghuveer
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), An Institute of National Importance, Bengaluru, Karnataka, India
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Dedhia RC, Bliwise DL, Quyyumi AA, Thaler ER, Boon MS, Huntley CT, Seay EG, Tangutur A, Strollo PJ, Gurel N, Keenan BT. Hypoglossal Nerve Stimulation and Cardiovascular Outcomes for Patients With Obstructive Sleep Apnea: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024; 150:39-48. [PMID: 38032624 PMCID: PMC10690581 DOI: 10.1001/jamaoto.2023.3756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Importance Sham-controlled trials are needed to characterize the effect of hypoglossal nerve stimulation (HGNS) therapy on cardiovascular end points in patients with moderate-severe obstructive sleep apnea (OSA). Objective To determine the effect of therapeutic levels of HGNS, compared to sham levels, on blood pressure, sympathetic activity, and vascular function. Design, Setting, and Participants This double-blind, sham-controlled, randomized crossover therapy trial was conducted from 2018 to 2022 at 3 separate academic medical centers. Adult patients with OSA who already had an HGNS device implanted and were adherent and clinically optimized to HGNS therapy were included. Participants who had fallen asleep while driving within 1 year prior to HGNS implantation were excluded from the trial. Data analysis was performed from January to September 2022. Interventions Participants underwent a 4-week period of active HGNS therapy and a 4-week period of sham HGNS therapy in a randomized order. Each 4-week period concluded with collection of 24-hour ambulatory blood pressure monitoring (ABPM), pre-ejection period (PEP), and flow-mediated dilation (FMD) values. Main Outcomes and Measures The change in mean 24-hour systolic blood pressure was the primary outcome, with other ABPM end points exploratory, and PEP and FMD were cosecondary end points. Results Participants (n = 60) were older (mean [SD] age, 67.3 [9.9] years), overweight (mean [SD] body mass index, calculated as weight in kilograms divided by height in meters squared, 28.7 [4.6]), predominantly male (38 [63%]), and had severe OSA at baseline (mean [SD] apnea-hypopnea index, 33.1 [14.9] events/h). There were no differences observed between active and sham therapy in 24-hour systolic blood pressure (mean change on active therapy, -0.18 [95% CI, -2.21 to 1.84] mm Hg), PEP (mean change on active therapy, 0.11 [95% CI, -5.43 to 5.66] milliseconds), or FMD (mean change on active therapy, -0.17% [95% CI, -1.88% to 1.54%]). Larger differences between active and sham therapy were observed in a per-protocol analysis set (n = 20) defined as experiencing at least a 50% reduction in apnea-hypopnea index between sham and active treatment. Conclusions and Relevance In this sham-controlled HGNS randomized clinical trial, mean 24-hour systolic blood pressure and other cardiovascular measures were not significantly different between sham and active HGNS therapy. Several methodologic lessons can be gleaned to inform future HGNS randomized clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT03359096.
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Affiliation(s)
- Raj C. Dedhia
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia
- Department of Sleep Medicine, University of Pennsylvania, Philadelphia
| | | | - Arshed A. Quyyumi
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Erica R. Thaler
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia
| | - Maurits S. Boon
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin T. Huntley
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Everett G. Seay
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia
| | - Akshay Tangutur
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia
| | - Patrick J. Strollo
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nil Gurel
- Reality Labs, Meta, Menlo Park, California
| | - Brendan T. Keenan
- Department of Sleep Medicine, University of Pennsylvania, Philadelphia
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Modi NS, Bajoria PS, Dave PA, Rohit RK, Tibrewal C, Patel P, Gandhi SK, Gutlapalli SD, Diaz K, Nfonoyim J. Effectiveness of Continuous Positive Airway Pressure in Treating Hypertension in Obstructive Sleep Apnea: A Traditional Review. Cureus 2023; 15:e42111. [PMID: 37602019 PMCID: PMC10436127 DOI: 10.7759/cureus.42111] [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: 06/18/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Almost one billion individuals worldwide suffer from obstructive sleep apnea (OSA). The most widely used treatment for OSA has been continuous positive airway pressure (CPAP), but its effect on blood pressure (BP) has been challenged. Our review aims to evaluate the effects of treating OSA with CPAP on BP and BP-related morbidities in adult hypertensive patients. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on the use of CPAP in OSA patients with hypertension. We selected various forms of academic writing, encompassing complete texts that were published in the English language. The study included a total of 21 papers. OSA is a serious health concern associated with a higher risk of cardiovascular disease, kidney disease, pulmonary hypertension, and aortic stiffness, which is brought on by the periodic hypoxia caused by nocturnal respiratory episodes. For individuals with moderate-to-severe OSA, CPAP therapy has been shown to have a considerable long-term benefit with a median drop of 11 mm Hg, and high adherence results in a decrease in diastolic BP. CPAP therapy directly lowers BP in OSA patients with a body mass index (BMI) of more than 30 kg/m2 and has also demonstrated improvement in early signs of atherosclerosis with lower nocturnal systolic BP levels. OSA patients with resistant hypertension also experienced lower BP after using CPAP for a year. Therefore, our findings suggest that obesity, hypersomnolence, high nocturnal BP, prolonged CPAP usage, and resistant hypertension may all have a major impact on the BP response to CPAP therapy in individuals with severe OSA.
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Affiliation(s)
| | - Parth S Bajoria
- Department of Internal Medicine, GMERS (Gujarat Medical Education and Research Society) Medical College Gandhinagar, Gandhinagar, IND
| | | | - Ralph Kingsford Rohit
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Charu Tibrewal
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M.P. Shah Government Medical College, Jamnagar, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York City, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Keith Diaz
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
| | - Jay Nfonoyim
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York City, USA
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Kourtidou C, Ztriva E, Kostourou DT, Polychronopoulos G, Satsoglou S, Chatzopoulos G, Kontana A, Tzavelas M, Valanikas E, Veneti S, Sofogianni A, Milonas D, Papagiannis A, Savopoulos C, Tziomalos K. The Predictive Role of the Triglyceride/Glucose Index in Patients with Hypercholesterolemia and Acute Ischemic Stroke. Rev Cardiovasc Med 2022; 23:399. [PMID: 39076671 PMCID: PMC11270394 DOI: 10.31083/j.rcm2312399] [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: 07/21/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 07/31/2024] Open
Abstract
Background The triglyceride/glucose index (TyG) reflects insulin resistance and predicts the risk of acute ischemic stroke (aIS). However, it is uncertain if this index predicts the severity and outcome of aIS because studies that addressed this question are few and all were performed in Asian subjects. Moreover, there are no studies that focused on patients with hypercholesterolemia. Methods We studied 997 Caucasian patients who were hospitalized for aIS and had hypercholesterolemia. aIS severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS) and severe aIS was defined as NIHSS ≥ 21. The outcome was assessed with the functional outcome at discharge and with in-hospital mortality. An unfavorable functional outcome was defined as modified Rank in scale (mRs) at discharge between 3 and 6. Results The TyG index did not correlate with the NIHSS at admission (r = 0.032, p = NS) and was similar in patients with severe and non-severe aIS (8.7 ± 0.6 and 8.6 ± 0.6, respectively; p = NS). Risk factors for severe aIS were age, female gender, atrial fibrillation (AF) and diastolic blood pressure (DBP) at admission. The TyG index also did not correlate with the mRs(r = 0.037, p = NS) and was similar in patients who had unfavorable and favorable functional outcome (8.7 ± 0.6 and 8.6 ± 0.5, respectively; p = NS). Risk factors for unfavorable functional outcome were age, previous ischemic stroke, body mass index and the NIHSS at admission. The TyG index was similar in patients who died during hospitalization and patients who were discharged (8.7 ± 0.6 and 8.7 ± 0.6, respectively; p = NS). Risk factors for in-hospital mortality were AF and DBP and NIHSS at admission. Conclusions The TyG index does not appear to be associated with the severity or the outcome of aIS. Nevertheless, since there are few relevant data in Caucasians and the TyG index is an inexpensive and widely available biomarker, more studies in this ethnic group are required to determine the predictive role of this index in patients with aIS.
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Affiliation(s)
- Christodoula Kourtidou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Eleftheria Ztriva
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Danai-Thomais Kostourou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Georgios Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Sarantis Satsoglou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Georgios Chatzopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Anastasia Kontana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Marios Tzavelas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Evripidis Valanikas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Stavroula Veneti
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Areti Sofogianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Dimitrios Milonas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Achilleas Papagiannis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
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Li Y, Ma X, Mei S, Ji Y, Wang D, He L, Sun D, Yan J. mRNA, lncRNA, and circRNA expression profiles in a new aortic dissection murine model induced by hypoxia and Ang II. Front Cardiovasc Med 2022; 9:984087. [PMID: 36386298 PMCID: PMC9643159 DOI: 10.3389/fcvm.2022.984087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background and aims Aortic dissection (AD) is a cardiovascular emergency with degeneration of the aortic media. Mounting evidence indicates obstructive sleep apnea (OSA) as an independent risk factor for AD development with unknown mechanisms. This study aims to establish a stable murine model of OSA-related AD (OSA-AD) and uncover the potential changes in gene transcripts in OSA-AD. Materials and methods ApoE–/– mice were exposed to the chronic intermittent hypoxia (CIH) system combined with Ang II administration to establish the OSA-AD model. Pathological staining was performed to exhibit the physiological structure of the mouse aorta. The SBC mouse ceRNA microarray was used to identify significantly differentially expressed (DE) mRNAs, DE long-non-coding RNAs (DElncRNAs), and DE circular RNAs (DEcircRNAs) in OSA-AD tissues. Subsequently, bioinformatics analysis, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genome (KEGG), and protein–protein interaction (PPI) analyses, were performed to evaluate the function of the significantly differentially expressed transcripts (DETs). The hub genes were confirmed using quantitative real-time polymerase chain reaction (qRT-PCR). Results ApoE–/– mice exposed to CIH and Ang II showed a high ratio of aortic accident (73.33%) and significant aortic diameter dilatation (1.96 ± 0.175 mm). A total of 1,742 mRNAs, 2,625 lncRNAs, and 537 circRNAs were identified as DETs (LogFC ≥ 1.5 or ≤ –1.5, P < 0.05). GO and KEGG analyses demonstrated that the differentially expressed mRNAs (DEmRNAs) were most enriched in cell proliferation, migration, apoptosis, inflammation, and hypoxia-related terms, which are closely related to aortic structural homeostasis. The PPI network contained 609 nodes and 934 connections, the hub genes were highlighted with the CytoHubba plugin and confirmed by qRT-PCR in AD tissues. KEGG pathway analysis revealed that the cis-regulated genes of DElncRNAs and circRNAs-host genes were enriched in aortic structural homeostasis-related pathways. Conclusion Our findings help establish a de novo OSA-AD animal model using ApoE–/– mice. Many DEmRNAs, DElncRNAs, and DEcircRNAs were screened for the first time in OSA-AD tissues. Our findings provide useful bioinformatics data for understanding the molecular mechanism of OSA-AD and developing potential therapeutic strategies for OSA-AD.
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Affiliation(s)
- Yuanyuan Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaozhu Ma
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Mei
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yueping Ji
- Department of Cardiology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Dong Wang
- Department of Cardiology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Liqun He
- Department of Cardiology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Liqun He,
| | - Dating Sun
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Cardiology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
- Dating Sun,
| | - Jiangtao Yan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Jiangtao Yan,
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Zeng Y, Shu Y, Liu X, Li P, Kong L, Li K, Xie W, Zeng L, Long T, Huang L, Li H, Peng D. Frequency-specific alterations in intrinsic low-frequency oscillations in newly diagnosed male patients with obstructive sleep apnea. Front Neurosci 2022; 16:987015. [PMID: 36248662 PMCID: PMC9561418 DOI: 10.3389/fnins.2022.987015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Previous studies found abnormal low-frequency spontaneous brain activity related to cognitive impairment in patients with obstructive sleep apnea (OSA). However, it is unclear if low-frequency spontaneous brain activity is related to specific frequency bands in OSA patients. In this study, we used the amplitude of low-frequency fluctuation (ALFF) method in patients with OSA to explore characteristics of spontaneous brain activity in the classical (0.01–0.1 Hz) and five sub-frequency bands (slow-2 to slow-6) and analyzed the relationship between spontaneous brain activity and clinical evaluation was analyzed. Patients and methods Resting-state magnetic resonance imaging data and clinical assessments were collected from 52 newly-diagnosed OSA patients and 62 healthy controls (HCs). We calculated the individual group ALFF values in the classical and five different sub-frequency bands. A two-sample t-test compared ALFF differences, and one-way analysis of variance explored interactions in frequency bands between the two groups. Results ALFF values in the OSA group were lower than those in the HC group in the bilateral precuneus/posterior cingulate cortex, bilateral angular gyrus, left inferior parietal lobule, brainstem, and right fusiform gyrus. In contrast, ALFF values in the OSA group were higher than those in the HC group in the bilateral cerebellum posterior lobe, bilateral superior frontal gyrus, bilateral middle frontal gyrus, left inferior frontal gyrus, left inferior temporal gyrus, and left fusiform gyrus. Some ALFF values in altered brain regions were associated with body mass index, apnea-hypopnea index, neck circumference, snoring history, minimum SaO2, average SaO2, arousal index, oxygen reduction index, deep sleep period naming, abstraction, and delayed recall in specific frequency bands. Conclusion Our results indicated the existence of frequency-specific differences in spontaneous brain activity in OSA patients, which were related to cognitive and other clinical symptoms. This study identified frequency-band characteristics related to brain damage, expanded the cognitive neuroimaging mechanism, and provided additional OSA neuroimaging markers.
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Affiliation(s)
- Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Haijun Li,
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Dechang Peng,
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Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel) 2022; 12:1222. [PMID: 36013401 PMCID: PMC9410036 DOI: 10.3390/life12081222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug-drug and drug-disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a "one-stop shop" for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA.
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Affiliation(s)
- Rizwana Sultana
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Fatoumatta Sissoho
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Vinod P. Kaushik
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Mukaila A. Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
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Silva FSL, Furlanetto KC, Neves LMT, Cipriano GFB, Accioly MF, Viana-Júnior AB, Alves TB, Moraes WRA, Lima ACGB, Ribeiro KB, Sobreira-Neto MA, Leite CF. Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire. Sleep Breath 2022; 27:1195-1201. [DOI: 10.1007/s11325-022-02661-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/05/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
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9
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Maniaci A, Ferlito S, Lechien JR, Di Luca M, Iannella G, Cammaroto G, Cannavicci A, Pollicina I, Stilo G, Di Mauro P, Magliulo G, Pace A, Vicini C. Anxiety, depression and sleepiness in OSA patients treated with barbed reposition pharyngoplasty: a prospective study. Eur Arch Otorhinolaryngol 2022; 279:4189-4198. [PMID: 35396954 DOI: 10.1007/s00405-022-07369-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy of barbed reposition pharyngoplasty (BRP) on sleepiness, anxiety, and depression o adult patients with obstructive sleep apnea (OSA). METHODS We performed a prospective multicentric study to assess functional outcomes in 20 OSA patients treated with BRP and compare the results with an observational group of 20 subjects. All recruited subjects performed at baseline and 6-months postoperative follow-up Polysomnography (PSG), daytime sleepiness scoring using the Epworth Sleepiness Scale (ESS), and anxiety and depression evaluation via the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) questionnaires. RESULTS At follow-up the BRP demonstrated greater improvements in AHI (8.92 ± 2.29 vs. 30.66 ± 2.56; p < 0.001) and ODI (7.65 ± 2.39 vs. 24.55 ± 3.20; p < 0.001) than control at intergroup analysis. Surgical group reported significant data in daytime sleepiness (5.15 ± 1.19 vs. 13.15 ± 1.35; p < 0.001), anxiety (12.65 ± 3.11 vs. 24.2 ± 2.37; p < 0.001), and depression domains (5.85 ± 1.19 vs. 17.55 ± 3.24; p < 0.001). AHI, ODI, and advanced age have been shown to multiple regression as independent predictors of treatment response for mood domains (p < 0.001; p = 0.02; p = 0.041, respectively). CONCLUSIONS Patients with OSA may benefit from palate surgery, reducing not only the apnea and hypopnea index, daytime sleepiness but also associated mood comorbidities. However, further studies are needed to confirm our preliminary results to validate the evidence to date reported.
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Affiliation(s)
- Antonino Maniaci
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy.
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
| | - Salvatore Ferlito
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Jerome Rene Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Milena Di Luca
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giannicola Iannella
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Giovanni Cammaroto
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
| | - Angelo Cannavicci
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
| | - Isabella Pollicina
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giovanna Stilo
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Paola Di Mauro
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giuseppe Magliulo
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Annalisa Pace
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
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10
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Peracaula M, Torres D, Poyatos P, Luque N, Rojas E, Obrador A, Orriols R, Tura-Ceide O. Endothelial Dysfunction and Cardiovascular Risk in Obstructive Sleep Apnea: A Review Article. Life (Basel) 2022; 12:537. [PMID: 35455027 PMCID: PMC9025914 DOI: 10.3390/life12040537] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a respiratory condition during sleep caused by repeated pauses in breathing due to upper airway obstruction. It is estimated that OSA affects 30% of the population, but only 10% are well diagnosed due to the absence of a well-defined symptomatology and poor screening tools for early diagnosis. OSA is associated to an endothelial dysfunction inducing several biological responses such as hypoxia, hypercapnia and oxidative stress, among others. OSA also triggers respiratory, nervous, metabolic, humoral and immunity system activations that increase the possibility of suffering a cardiovascular (CV) disease. In this review, we expose different studies that show the relationship between OSA and endothelial dysfunction and its association with CV pathologies like hypertension, and we define the most well-known treatments and their limitations. Additionally, we describe the potential future directions in OSA research, and we report clinical features such as endothelial progenitor cell alterations that could act as biomarkers for the development of new diagnostic tools and target therapies.
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Affiliation(s)
- Miriam Peracaula
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Daniela Torres
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Paula Poyatos
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Neus Luque
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Eric Rojas
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Anton Obrador
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Ramon Orriols
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
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11
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Al Saeed AA, AlShabib NS, Al Taisan AA, Kreary YA. Association of Retinal Vascular Manifestation and Obstructive Sleep Apnea (OSA): A Narrative Review. Clin Ophthalmol 2021; 15:3315-3320. [PMID: 34393479 PMCID: PMC8360361 DOI: 10.2147/opth.s305968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by frequent episodes of partial or complete obstruction of the airway during sleep causing repeated episodes of apnea. OSA is more prevalent in middle-aged and older adults. OSA is associated with numerous ocular manifestations, including retinal manifestations. Literature highlighted the clear association between OSA and numerous ocular conditions including glaucoma and papilledema. This comprehensive and narrative review aims to summarize up-to-date clinical research concerning the association of OSA and vascular conditions that affect the retina. OSA is associated with the central serous chorioretinopathy (CSC), retinal vein occlusion (RVO), hypertensive retinopathy (HTRP) and development of diabetic retinopathy (DR). Sympathetic activation, hypoxia, and hormonal dysregulation all lead to serious retinal vascular conditions that will worsen OSA patients’ quality of life. It is important to refer patients with newly diagnosed OSA to an ophthalmology clinic for the appropriate test.
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Affiliation(s)
- Ali A Al Saeed
- College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | | | - Abdulaziz A Al Taisan
- Department of Ophthalmology, College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | - Yahya A Kreary
- Department of Vitreoretinal Surgery, Dhahran Eye Specialist Hospital, Dhahran, Eastern Province, Saudi Arabia
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12
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Sanders CB, Knisely K, Edrissi C, Rathfoot C, Poupore N, Wormack L, Nathaniel T. Obstructive sleep apnea and stroke severity: Impact of clinical risk factors. Brain Circ 2021; 7:92-103. [PMID: 34189352 PMCID: PMC8191529 DOI: 10.4103/bc.bc_57_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA. METHODS This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer-Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve. RESULTS A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289-8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123-7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06-0.767, P = 0.018) was associated with NIHSS score ≤7. CONCLUSION In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.
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Affiliation(s)
- Carolyn Breauna Sanders
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Krista Knisely
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Camron Edrissi
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Chase Rathfoot
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Nicolas Poupore
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Leah Wormack
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Thomas Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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13
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Transcriptomic Changes of Murine Visceral Fat Exposed to Intermittent Hypoxia at Single Cell Resolution. Int J Mol Sci 2020; 22:ijms22010261. [PMID: 33383883 PMCID: PMC7795619 DOI: 10.3390/ijms22010261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/22/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
Intermittent hypoxia (IH) is a hallmark of obstructive sleep apnea (OSA) and induces metabolic dysfunction manifesting as inflammation, increased lipolysis and insulin resistance in visceral white adipose tissues (vWAT). However, the cell types and their corresponding transcriptional pathways underlying these functional perturbations are unknown. Here, we applied single nucleus RNA sequencing (snRNA-seq) coupled with aggregate RNA-seq methods to evaluate the cellular heterogeneity in vWAT following IH exposures mimicking OSA. C57BL/6 male mice were exposed to IH and room air (RA) for 6 weeks, and nuclei from vWAT were isolated and processed for snRNA-seq followed by differential expressed gene (DEGs) analyses by cell type, along with gene ontology and canonical pathways enrichment tests of significance. IH induced significant transcriptional changes compared to RA across 14 different cell types identified in vWAT. We identified cell-specific signature markers, transcriptional networks, metabolic signaling pathways, and cellular subpopulation enrichment in vWAT. Globally, we also identify 298 common regulated genes across multiple cellular types that are associated with metabolic pathways. Deconvolution of cell types in vWAT using global RNA-seq revealed that distinct adipocytes appear to be differentially implicated in key aspects of metabolic dysfunction. Thus, the heterogeneity of vWAT and its response to IH at the cellular level provides important insights into the metabolic morbidity of OSA and may possibly translate into therapeutic targets.
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