1
|
Liguori C, Fernandes M, Spanetta M, Zanovello M, Giambrone MP, Lupo C, Placidi F, Izzi F, Mercuri NB, Pierantozzi M. Brainstem impairment in obstructive sleep apnoea and the effect of CPAP treatment: an electrophysiological blink reflex study. Sleep Breath 2023:10.1007/s11325-023-02944-8. [PMID: 37923871 DOI: 10.1007/s11325-023-02944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE This study aimed to evaluate the functionality of the brainstem structures through the blink reflex (BR) test in patients with obstructive sleep apnoea (OSA) and to assess the effects of continuous positive airway pressure (CPAP) treatment on BR responses. METHODS Patients with moderate-severe OSA and controls underwent BR testing. Patients with OSA who were adherent to CPAP therapy repeated BR testing at 6 months follow-up. CPAP adherence was defined as CPAP use for ≥ 4 hour per night on > 5 nights per week with residual apnoea-hypopnea index less than 5 events per hour. RESULTS A total of 22 patients with OSA (86% male, mean age 57.8 ± 10.6 years) and 20 controls (60% male, mean age 55.3 ± 9.3 years) were included. Patients with OSA showed longer right and left R1 latency, as well as delayed right ipsilateral and contralateral R2 latencies compared to controls. Patients with OSA who were compliant with CPAP treatment (n = 16; 88% men, mean age 58.8 ± 9.7 years) showed a significant decrease in latency of the right ipsilateral and contralateral R2 responses at 6 months. CONCLUSION This study showed an abnormal pattern of BR responses in patients with OSA, consistent with a significant impairment of brainstem functionality in OSA. CPAP treatment partially improved the BR responses, suggesting the importance of treating OSA.
Collapse
Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy.
- Neurology Unit, University Hospital of Rome 'Tor Vergata', Rome, Italy.
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Martina Zanovello
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy
| | - Maria Pia Giambrone
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy
| | - Clementina Lupo
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Neurology Unit, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Neurology Unit, University Hospital of Rome 'Tor Vergata', Rome, Italy
| | - Nicola Biagio Mercuri
- Sleep Medicine Centre, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Neurology Unit, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, University Hospital of Rome 'Tor Vergata', Rome, Italy
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| |
Collapse
|
2
|
Azahar NM, Ganbaatar G, Kitaoka K, Sawayama Y, Yano Y. Nocturnal hypoxia and the difference in morning and evening blood pressure measured at home. Hypertens Res 2023; 46:781-783. [PMID: 36642752 DOI: 10.1038/s41440-022-01164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Nazar Mohd Azahar
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan.,Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Pulau Pinang, Malaysia
| | - Gantsetseg Ganbaatar
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan.,Department of Public Health and Traditional Medicine, Darkhan-Uul Medical School of Mongolian National University of Medical Sciences, Darkhan-Uul, Mongolia
| | - Kaori Kitaoka
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yuichiro Yano
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan.
| |
Collapse
|
3
|
Tan NKW, Yap DWT, Tan BKJ, Teo YH, Tan EKH, Chan JY, Lee HY, See A, Toh ST. The association of obstructive sleep apnea with melanoma incidence and mortality: a meta-analysis of 5,276,451 patients. Sleep Med 2021; 88:213-220. [PMID: 34794048 DOI: 10.1016/j.sleep.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/21/2021] [Accepted: 10/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Melanoma is the most aggressive and lethal form of skin cancer. While emerging in-vivo evidence suggests that intermittent hypoxia, a hallmark feature of obstructive sleep apnea (OSA), may induce melanoma tumorigenesis, the epidemiological association between OSA and melanoma has been inconsistent. METHODS We performed a literature search of PubMed, Embase, Scopus and Cochrane Library from inception until 6 June 2021. Two reviewers independently selected randomized trials or observational studies that reported the association of OSA with melanoma incidence or mortality in adults, in comparison to participants with no OSA. Two reviewers independently extracted relevant data and assessed the quality of evidence using the GRADE framework and the Newcastle-Ottawa Scale (NOS). We pooled data using an inverse variance-weighted meta-analysis and ran pre-specified subgrourp analyses. RESULTS The meta-analysis included six studies out of 1897 records, comprising a combined cohort of 5,276,451 patients. All studies were adjusted for covariates, with majority of studies adjusting for age (N=5) and sex (N = 4). Compared to those without OSA, patients with OSA had 71% higher pooled hazards of melanoma (HR = 1.71; 95% CI: 1.08-2.69, I2 = 99%). Subgroup analyses for studies with (1) median follow-up duration of at least five years, (2) prospective study design, (3) adjustment for obesity yielded HRs of 1.88 (95%CI:1.32-2.67, N = 5), 1.11 (95%CI:0.77-1.60, N = 2) and 1.52 (95%CI:0.75-3.08, N = 3) respectively. One study investigating the relationship between OSA and melanoma mortality detected no association. There were insufficient studies to assess publication bias. CONCLUSIONS Meta-analysis of mainly retrospective observational studies, with significant heterogeneity, suggests increased melanoma incidence in OSA patients. Future studies should prospectively explore the differential risk of melanoma for varying OSA severity, and whether timely OSA treatment may mitigate this risk.
Collapse
Affiliation(s)
- Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Dominic Wei Ting Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | | | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital (SGH), Singapore
| | - Song Tar Toh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore; Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital (SGH), Singapore; SingHealth Duke-NUS Sleep Centre, SingHealth, Singapore; Duke-NUS Medical School, Singapore.
| |
Collapse
|
4
|
Borowiec BG, Scott GR. Rapid and reversible modulation of blood haemoglobin content during diel cycles of hypoxia in killifish (Fundulus heteroclitus). Comp Biochem Physiol A Mol Integr Physiol 2021; 261:111054. [PMID: 34384878 DOI: 10.1016/j.cbpa.2021.111054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
We investigated whether fish can make dynamic haematological adjustments to support aerobic metabolism during repeated cycles of hypoxia-reoxygenation. Killifish were acclimated to normoxia, constant hypoxia (2 kPa O2), or intermittent cycles of nocturnal hypoxia (12 h of normoxia: 12 h of 2 kPa O2 hypoxia) for 28 days. Normoxia-acclimated fish were sampled in the daytime in normoxia and after exposure to a single bout of nocturnal hypoxia. Each hypoxia acclimation group were sampled at the PO2 experienced during acclimation during both the day and night. All acclimation groups had increased blood haemoglobin content and haematocrit and reduced spleen mass during nocturnal hypoxia compared to normoxic controls. Blood haemoglobin content was negatively correlated with spleen mass at both the individual and group level. Fish acclimated to intermittent hypoxia rapidly reversed these changes during diurnal reoxygenation. The concentrations of haemoglobin, ATP, and GTP within erythrocytes did not vary substantially between groups. We also measured resting O2 consumption rate (MO2) and maximum MO2 (induced by an exhaustive chase) in hypoxia in each acclimation group. Fish acclimated to intermittent hypoxia maintained higher resting MO2 than other groups in hypoxia, comparable to the resting MO2 of normoxia-acclimated controls measured in normoxia. Differences in resting MO2 in hypoxia did not result from variation in O2 transport capacity, because maximal MO2 in hypoxia always exceeded resting MO2. Therefore, reversible modulation of blood haemoglobin content along with metabolic adjustments help killifish cope with intermittent cycles of hypoxia in the estuarine environment.
Collapse
Affiliation(s)
| | - Graham R Scott
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Voulgaris A, Marrone O, Bonsignore MR, Steiropoulos P. Chronic kidney disease in patients with obstructive sleep apnea. A narrative review. Sleep Med Rev 2019; 47:74-89. [PMID: 31376590 DOI: 10.1016/j.smrv.2019.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
Prevalence of both chronic kidney disease (CKD) and obstructive sleep apnea (OSA) is continuously increasing. Moreover, the prevalence of OSA increases as kidney function declines and is higher among patients with end-stage renal disease (ESRD). In addition, OSA is recognized as a potential nontraditional risk factor for development and progression of CKD. Continuous positive airway pressure (CPAP) plays a pivotal role in the management of OSA, eliminating patients' symptoms and improving their quality of life. Recent studies suggested that CPAP treatment may have beneficial effects on kidney function among patients with OSA. This narrative review summarizes the existing knowledge on the association between CKD and OSA, with emphasis on the epidemiology, the pathophysiology of the development of CKD in OSA and vice versa, as well as the effect of CPAP on renal function.
Collapse
Affiliation(s)
- Athanasios Voulgaris
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Oreste Marrone
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology, CNR, Palermo, Italy; Pulmonary Division, University Hospital AOUP Paolo Giaccone, PROMISE Department, University of Palermo, Palermo, Italy
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| |
Collapse
|
6
|
Narang I, McCrindle BW, Manlhiot C, Lu Z, Al-Saleh S, Birken CS, Hamilton J. Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea. Sleep Breath 2018; 22:1037-1044. [PMID: 29357088 DOI: 10.1007/s11325-018-1631-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/06/2017] [Accepted: 01/11/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE There is conflicting data regarding the independent associations of obstructive sleep apnea (OSA) with metabolic risk in obese youth. Previous studies have not consistently addressed central adiposity, specifically elevated waist to height ratio (WHtR), which is associated with metabolic risk independent of body mass index. OBJECTIVE The objective of this study was to determine the independent effects of the obstructive apnea-hypopnea index (OAHI) and associated indices of nocturnal hypoxia on metabolic function in obese youth after adjusting for WHtR. METHODS Subjects had standardized anthropometric measurements. Fasting blood included insulin, glucose, glycated hemoglobin, alanine transferase, and aspartate transaminase. Insulin resistance was quantified with the homeostatic model assessment. Overnight polysomnography determined the OAHI and nocturnal oxygenation indices. RESULTS Of the 75 recruited subjects, 23% were diagnosed with OSA. Adjusting for age, gender, and WHtR in multivariable linear regression models, a higher oxygen desaturation index was associated with a higher fasting insulin (coefficient [standard error] = 48.076 [11.255], p < 0.001), higher glycated hemoglobin (coefficient [standard error] = 0.097 [0.041], p = 0.02), higher insulin resistance (coefficient [standard error] = 1.516 [0.364], p < 0.001), elevated alanine transferase (coefficient [standard error] = 11.631 [2.770], p < 0.001), and aspartate transaminase (coefficient [standard error] = 4.880 [1.444], p = 0.001). However, there were no significant associations between OAHI, glucose metabolism, and liver enzymes. CONCLUSION Intermittent nocturnal hypoxia rather than the OAHI was associated with metabolic risk in obese youth after adjusting for WHtR. Measures of abdominal adiposity such as WHtR should be considered in future studies that evaluate the impact of OSA on metabolic health.
Collapse
Affiliation(s)
- Indra Narang
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. .,University of Toronto, Toronto, Ontario, Canada.
| | - Brian W McCrindle
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- The Cardiovascular Data Management Centre, The Hospital for Sick Children, Toronto, Canada
| | - Zihang Lu
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Abstract
BACKGROUND Sleep disorders and nocturnal hypoxia are common in patients with cerebrovascular disease. Sleep-disordered breathing is associated with a poor functional outcome in stroke patients. OBJECTIVE We investigated the relationship between nocturnal hypoxia and functional outcome in the rehabilitation phase of stroke patients. METHODS Thirty patients with stroke and 20 controls were included. Functional status was evaluated with the Functional Independence Measure (FIM). Pulse oximetry was performed overnight from 21.00 h to 07.00 h. Baseline awake oxygen saturation, nocturnal oxygen saturation, the lowest nocturnal oxygen saturation, and the >4% Oxygen Desaturation Index (ODI) were calculated. RESULTS The mean oxygen saturation measurements were not significantly different among the groups (p > 0.05). There was no significant relationship between the FIM scores and the oxygen saturation measurements of the stroke patients (p > 0.05). The baseline oxygen saturation in patients with disease duration of 3 months or less was 94.67, and it was 96.56 (p = 0.016) in those with disease duration of more than 3 months. CONCLUSION This study showed that nocturnal oxygen saturation was not associated with functional outcome in therehabilitation phase of stroke patients.
Collapse
Affiliation(s)
- Canan Celik
- Department of Physical Medicine and Rehabilitation, Giresun University Medicine Faculty, Giresun, Turkey
| | - Asli Gencay Can
- Department of Physical Medicine and Rehabilitation, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Seniz Akcay Yalbuzdag
- Department of Physical Medicine and Rehabilitation, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Mustafa Ozer
- Department of Physical Medicine and Rehabilitation, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
| |
Collapse
|
8
|
Inami T, Seino Y, Shimura T, Kurihara O, Kimata N, Murakami D, Munakata R, Takano M, Ohba T, Shimizu W. Linkage of sleep-disordered breathing and acute aortic dissection with patent false lumen. Heart Vessels 2016; 31:1069-76. [PMID: 26113456 DOI: 10.1007/s00380-015-0699-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
Sleep-disordered breathing (SDB) is known as a cardiovascular risk factor and has high prevalence in hypertension, which is a major risk factor of aortic dissection (AD). However, the impact of SDB on AD has not been fully clarified. The aim of this study is to elucidate the impact of SDB on AD, especially on the type of false lumen in AD. We enrolled twenty-three consecutive patients with acute AD (mean age: 66 ± 13 years). All subjects were evaluated by an ambulatory polygraphic sleep monitoring within 1 month from the onset. AD was evaluated by axial images of computed tomography. We comparatively analyzed SDB and AD. 35 % of the subjects presented severe OSA (apnea-hypopnea index: AHI ≥30). The patent false lumen group showed significantly higher systolic and diastolic blood pressure (BP) on arrival and AHI, and lower percutaneous oxygen saturation (SaO2) compared with those in the thrombosed false lumen group. The prevalence of severe SDB was higher in the patent false lumen group (60 vs 15 %, p = 0.039). Systolic BP on arrival was significantly correlated with AHI (r = 0.457, p = 0.033) and the minimum SaO2 (r = -0.537, p = 0.010). The present study revealed close linkage between SDB and AD, and a high prevalence of SDB among AD patients. Severe SDB was related to the development of AD, especially for the patent false lumen type through highly elevated BP which might be easily evoked in the presence of severe SDB. Repetitive occurrence of intrathoracic negative pressure also might influence the repair or closure of false lumen of AD, although the present analysis did not reach statistical significance.
Collapse
|
9
|
Troy LK, Corte TJ. Sleep disordered breathing in interstitial lung disease: A review. World J Clin Cases 2014; 2:828-834. [PMID: 25516856 PMCID: PMC4266829 DOI: 10.12998/wjcc.v2.i12.828] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/25/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with interstitial lung disease commonly exhibit abnormal sleep architecture and increased sleep fragmentation on polysomnography. Fatigue is a frequent complaint, and it is likely that poor sleep quality is a significant contributor. A number of studies have shown that sleep disordered breathing is prevalent in this population, particularly in the idiopathic pulmonary fibrosis subgroup. The factors that predispose these patients to obstructive sleep apnoea are not well understood, however it is believed that reduced caudal traction on the upper airway can enhance collapsibility. Ventilatory control system instability may also be an important factor, particularly in those with increased chemo-responsiveness, and in hypoxic conditions. Transient, repetitive nocturnal oxygen desaturation is frequently observed in interstitial lung disease, both with and without associated obstructive apnoeas. There is increasing evidence that sleep-desaturation is associated with increased mortality, and may be important in the pathogenesis of pulmonary hypertension in this population.
Collapse
|