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Kang W, Zhu D, Zhang S, Qiao X, Liu J, Liu C, Lu H. Role of NF-κB in cardiac changes of obstructive sleep apnoea rabbits treated by mandibular advancement device. J Oral Rehabil 2024; 51:962-969. [PMID: 38379384 DOI: 10.1111/joor.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/28/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an independent risk factor for cardiovascular diseases. We aimed to investigate the role of nuclear factor-kappa B (NF-κB) in the changes of cardiac structures in OSA rabbits treated by mandibular advancement device (MAD). METHODS Eighteen male New Zealand white rabbits aged 6 months were randomly divided into three groups: control group, group OSA and group MAD. Hyaluronate gel was injected into the soft palate of the rabbits in group OSA and group MAD to induce OSA. The cone beam computer tomography (CBCT) of the upper airway and polysomnography (PSG) was performed to ensure successful modelling. CBCT and PSG were applied again to detect the effects of MAD treatment. All animals were induced to sleep in a supine position for 4-6 h a day for 8 weeks. Then the levels of NF-κB, Interleukin 6 (IL-6), Interleukin 10 (IL-10) and the proportion of myocardial fibrosis (MF) were detected. RESULTS The higher activation of NF-κB, IL-6 and IL-10 were found in the OSA group than in the control group, leading to the increase of collagen fibres compared with the control group. Furthermore, the apnoea-hypopnea index (AHI) was positively correlated with the above factors. There were no significant differences between group MAD and the control group. CONCLUSION The NF-κB pathway was activated in the myocardium of OSA rabbits, which accelerated the development of MF. Early application of MAD could reduce the activation of NF-κB in the myocardium and prevent the development of MF.
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Affiliation(s)
- Wenjing Kang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Dechao Zhu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Shilong Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Xing Qiao
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Jie Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Chunyan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, PR China
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Hui X, Cao W, Xu Z, Guo J, Luo J, Xiao Y. Hypoxic indices for obstructive sleep apnoea severity and cardiovascular disease risk prediction: A comparison and application in a community population. Respirology 2024. [PMID: 38773880 DOI: 10.1111/resp.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND AND OBJECTIVE The apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) encounter challenges in capturing the intricate relationship between obstructive sleep apnoea (OSA) and cardiovascular disease (CVD) risks. Although novel hypoxic indices have been proposed to tackle these limitations, there remains a gap in comprehensive validation and comparisons across a unified dataset. METHODS Samples were derived from the Sleep Heart Health Study (SHHS), involving 4485 participants aged over 40 years after data quality screening. The study compared several key indices, including AHI, ODI, the reconstructed hypoxic burden (rHB), the percentage of sleep time with the duration of respiratory events causing desaturation (pRED_3p) and the sleep breathing impairment index (SBII), in relation to CVD mortality and morbidity risks. Adjusted Cox proportional models were employed to calculate hazard ratios (HRs) for each index, and comparisons were performed. RESULTS SBII and pRED_3p exhibited significant correlations with both CVD mortality and morbidity, with SBII showing the highest adjusted HR (95% confidence interval) for mortality (2.04 [1.25, 3.34]) and pRED_3p for morbidity (1.43 [1.09-1.88]). In contrast, rHB was only significant in predicting CVD mortality (1.63 [1.05-2.53]), while AHI and ODI did not show significant correlations with CVD outcomes. The adjusted models based on SBII and pRED_3p exhibited optimal performance in the CVD mortality and morbidity datasets, respectively. CONCLUSION This study identified the optimal indices for OSA-related CVD risks prediction, SBII for mortality and pRED_3p for morbidity. The open-source online platform provides the computation of the indices.
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Affiliation(s)
- Xinjie Hui
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenhao Cao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zeyu Xu
- State Key Laboratory of Information Photonics and Optical Communications, Beijing University of Posts and Telecommunications, Beijing, China
| | - Junwei Guo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinmei Luo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Hein M, Wacquier B, Conenna M, Lanquart JP, Point C. Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA. Life (Basel) 2024; 14:644. [PMID: 38792664 PMCID: PMC11123427 DOI: 10.3390/life14050644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/06/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
In this study, the 10-year cardiovascular risk associated with comorbid sleep disorders (insomnia disorder, obstructive sleep apnea syndrome, and COMISA [comorbid insomnia and sleep apnea]) was investigated for patients with major depression. To enable our analysis, 607 patients with major depression were selected from the data register of the Sleep Unit. High 10-year cardiovascular risk was considered present when the Framingham Risk Score was ≥10%. The 10-year cardiovascular risk associated with comorbid sleep disorders has been assessed using logistic regression analyzes. High 10-year cardiovascular risk is significant (40.4%) in patients with major depression. After successive introduction of the different confounders, multivariate logistic regressions showed that for patients with major depression high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with insomnia disorder or obstructive sleep apnea syndrome alone. Thus, these results highlight the existence of a negative synergistic action between insomnia disorder and obstructive sleep apnea syndrome on the 10-year cardiovascular risk in patients with major depression, which demonstrates the importance of researching and treating COMISA to improve the prognosis of this specific population subgroup characterized by higher cardiovascular morbidity and mortality.
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Affiliation(s)
- Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Brussels, Belgium
- Route de Lennik, 1070 Anderlecht, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Matteo Conenna
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Brussels, Belgium; (B.W.); (M.C.); (J.-P.L.); (C.P.)
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Liu L, Zhen J, Liu S, Ren L, Zhao G, Liang J, Xu A, Li C, Wu J, Cheung BMY. Association between sleep patterns and galectin-3 in a Chinese community population. BMC Public Health 2024; 24:1323. [PMID: 38755574 PMCID: PMC11097462 DOI: 10.1186/s12889-024-18811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Irregular sleep patterns have been associated with inflammation. Galectin-3, a novel biomarker, plays an important role in inflammation. We investigated the relationship between sleep patterns and galectin-3 in a Chinese population. METHODS A total of 1,058 participants from the Shenzhen-Hong Kong United Network on Cardiovascular Disease study were included in the analysis. Age and sex-adjusted linear regression models were employed to investigate the relationship between galectin-3 level and traditional metabolic biomarkers. Logistic regression models were used to estimate the association among sleep disturbance, nighttime sleep duration, and daytime napping duration and elevated galectin-3, with elevated galectin-3 defined as galectin-3 level > 65.1 ng/ml. RESULTS Of study participants, the mean age was 45.3 years and 54.3% were women. Waist circumference, natural logarithm (ln)-transformed triglyceride, and ln-transformed high sensitivity C-reactive protein were positively associated with galectin-3 level (age and sex-adjusted standardized β [95% confidence interval (CI)], 0.12 [0.04, 0.21], 0.11 [0.05, 0.17], and 0.08 [0.02, 0.14], respectively). Sleep disturbance was associated with elevated galectin-3 (odds ratio [95% CI], 1.68 [1.05, 2.68], compared to those without sleep disturbance) after adjusting for traditional metabolic biomarkers. No interaction was observed between galectin-3 and age, sex, obesity, hypertension, and diabetes on sleep disturbance. No association was found between nighttime sleep duration or daytime napping duration and elevated galectin-3. CONCLUSIONS Our study provides evidence of a significant association between sleep disturbance and elevated galectin-3 level, independent of traditional metabolic biomarkers. Screening and interventions on galectin-3 could assist in preventing sleep disturbance-induced inflammatory disease.
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Affiliation(s)
- Lin Liu
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Juanying Zhen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuyun Liu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Guoru Zhao
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Research Center for Neural Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianguo Liang
- Precision Health Research Center Company Limited, Hong Kong SAR, China
| | - Aimin Xu
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chao Li
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jun Wu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Wang M, Wen W, Chen Y, Yishajiang S, Li Y, Li Z, Zhang X. TRPC5 channel participates in myocardial injury in chronic intermittent hypoxia. Clinics (Sao Paulo) 2024; 79:100368. [PMID: 38703717 PMCID: PMC11087918 DOI: 10.1016/j.clinsp.2024.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE The purpose of this study is to develop an animal model of Chronic Intermittent Hypoxia (CIH) and investigate the role of the TRPC5 channel in cardiac damage in OSAHS rats. METHODS Twelve male Sprague Dawley rats were randomly divided into the CIH group and the Normoxic Control (NC) group. Changes in structure, function, and pathology of heart tissue were observed through echocardiography, transmission electron microscopy, HE-staining, and TUNEL staining. RESULTS The Interventricular Septum thickness at diastole (IVSd) and End-Diastolic Volume (EDV) of rats in the CIH group significantly increased, whereas the LV ejection fraction and LV fraction shortening significantly decreased. TEM showed that the myofilaments in the CIH group were loosely arranged, the sarcomere length varied, the cell matrix dissolved, the mitochondrial cristae were partly flocculent, the mitochondrial outer membrane dissolved and disappeared, and some mitochondria were swollen and vacuolated. The histopathological examination showed that the cardiomyocytes in the CIH group were swollen with granular degeneration, some of the myocardial fibers were broken and disorganized, and most of the nuclei were vacuolar and hypochromic. CONCLUSION CIH promoted oxidative stress, the influx of Ca2+, and the activation of the CaN/NFATc signaling pathway, which led to pathological changes in the morphology and ultrastructure of cardiomyocytes, the increase of myocardial apoptosis, and the decrease of myocardial contractility. These changes may be associated with the upregulation of TRPC5.
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Affiliation(s)
- Mengmeng Wang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, China
| | - Wen Wen
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, China
| | - Yulan Chen
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, China.
| | - Sharezati Yishajiang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, China
| | - Yu Li
- Second Department of General Internal Medicine, The First Affiliated Hospital of Xinjiang Medical University, China
| | - Zhiqiang Li
- Laboratory Animal Center, Xinjiang Medical University, China
| | - Xiangyang Zhang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, China
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Huang J, Zhuang J, Zheng H, Yao L, Chen Q, Wang J, Fan C. A Machine Learning Prediction Model of Adult Obstructive Sleep Apnea Based on Systematically Evaluated Common Clinical Biochemical Indicators. Nat Sci Sleep 2024; 16:413-428. [PMID: 38699466 PMCID: PMC11063111 DOI: 10.2147/nss.s453794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a common and potentially fatal sleep disorder. The purpose of this study was to construct an objective and easy-to-promote model based on common clinical biochemical indicators and demographic data for OSA screening. Methods The study collected the clinical data of patients who were referred to the Sleep Medicine Center of the Second Affiliated Hospital of Fujian Medical University from December 1, 2020, to July 31, 2023, including data for demographics, polysomnography (PSG), and 30 biochemical indicators. Univariate and multivariate analyses were performed to compare the differences between groups, and the Boruta method was used to analyze the importance of the predictors. We selected and compared 10 predictors using 4 machine learning algorithms which were "Gaussian Naive Bayes (GNB)", "Support Vector Machine (SVM)", "K Neighbors Classifier (KNN)", and "Logistic Regression (LR)". Finally, the optimal algorithm was selected to construct the final prediction model. Results Among all the predictors of OSA, body mass index (BMI) showed the best predictive efficacy with an area under the receiver operating characteristic curve (AUC) = 0.699; among the predictors of biochemical indicators, triglyceride-glucose (TyG) index represented the best predictive performance (AUC = 0.656). The LR algorithm outperformed the 4 established machine learning (ML) algorithms, with an AUC (F1 score) of 0.794 (0.841), 0.777 (0.827), and 0.732 (0.788) in the training, validation, and testing cohorts, respectively. Conclusion We have constructed an efficient OSA screening tool. The introduction of biochemical indicators in ML-based prediction models can provide a reference for clinicians in determining whether patients with suspected OSA need PSG.
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Affiliation(s)
- Jiewei Huang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiajing Zhuang
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Huaxian Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Ling Yao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000, People’s Republic of China
- Department of Nephrology, Rheumatology and Immunology, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350014, People’s Republic of China
| | - Qingquan Chen
- The Sleep Disorder Medicine Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiaqi Wang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Chunmei Fan
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
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Lee Y, Park D, Kim S, Shin C, Suh S. Association of nightmares with cardio-cerebrovascular disease, hypertension and hyperlipidemia in older adults: A population-based cross-sectional study. J Psychosom Res 2024; 182:111669. [PMID: 38788282 DOI: 10.1016/j.jpsychores.2024.111669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE This cross-sectional study investigated the relationship of nightmares with cardio-cerebrovascular disease (CVD), hypertension and hyperlipidemia which are major preceding diseases of CVD in older adults. METHODS Participants (n = 2824; mean age 63.6 ± 6.6 years, females 49.3%) completed the Disturbing Dream and Nightmare Severity Index (DDNSI), which was used to divide the sample into either the Nightmare or Non-Nightmare group (cut-off score ≥ 10). Demographic information, history of CVD (cerebrovascular disease, myocardial infarction, congestive heart failure, coronary artery disease, and arrhythmia), hypertension, hyperlipidemia, and self-report questionnaires about stress (Perceived Stress Scale), depression (Beck Depression Inventory), sleep quality (Pittsburgh Sleep Quality Index), and insomnia symptoms were also collected. RESULTS Among the sample, 379 participants (13.4%) reported experiencing nightmares more than once a year, and 73 participants (2.6%) were classified as having nightmare disorder based on DDNSI scores (≥10). 11.3% of participants (n = 319) reported having more than one CVD. Approximately half of the participants reported a history of hypertension (52.1%, n = 1471) and hyperlipidemia (47.7%, n = 1346). Logistic regression analysis indicated the Nightmare group was 2.04 times at higher risk for hyperlipidemia (OR = 2.04, 95% CI 1.22-3.40, p = .006) after controlling for covariates compared to the Non-Nightmare group. Although non-significant, there was a trend toward a higher risk of hypertension in the Nightmare group (OR = 1.67, 95% CI 0.99-2.84, p = .056). CONCLUSIONS Results of this study indicate frequent nightmares in older adults may be associated with hyperlipidemia, which are risk factors for CVD. Further studies are needed to explore nightmares' directionality and health consequences in an aging population.
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Affiliation(s)
- Youjin Lee
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Dasom Park
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea
| | - Soriul Kim
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea; Biomedical Research Center, Korea University Ansan Hospital, Ansan, Gyeonggi, Republic of Korea.
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Republic of Korea.
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Bikov A, Bailly S, Testelmans D, Fanfulla F, Pataka A, Bouloukaki I, Hein H, Dogas Z, Basoglu OK, Staats R, Parati G, Lombardi C, Grote L, Mihaicuta S. The relationship between periodic limb movement during sleep and dyslipidaemia in patients with obstructive sleep apnea. J Sleep Res 2024; 33:e14012. [PMID: 37596874 DOI: 10.1111/jsr.14012] [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: 04/09/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non- high-density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep index ≥ 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea-hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 ± 12.1 years, body mass index 31.9 ± 5.8 kg m-2 , apnea-hypopnea index 36.7 ± 25.4 per hr) had higher triglyceride (1.81 ± 1.04 versus 1.69 ± 0.90 mmol L-1 , p = 0.002) and lower high-density lipoprotein cholesterol (1.19 ± 0.34 versus 1.24 ± 0.37 mmol L-1 , p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 ± 1.10 versus 4.94 ± 1.07 mmol L-1 ), low-density lipoprotein cholesterol (3.04 ± 0.96 versus 2.98 ± 0.98 mmol L-1 ) or non- high-density lipoprotein cholesterol (3.78 ± 1.10 versus 3.70 ± 1.05 mmol L-1 ) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea.
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Affiliation(s)
- Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sebastien Bailly
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven, Belgium
| | - Francesco Fanfulla
- Sleep Medicine Unit - Istituti Clinici Scientifici Maugeri - Istituto Scientifico di Pavia e Montescano IRCCS, Pavia, Italy
| | - Athanasia Pataka
- Respiratory Failure Unit, School of Medicine, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Holger Hein
- Private practice for Sleep Medicine and Sleep Disorders Center, Reinbek, Germany
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Ozen K Basoglu
- Department of Respiratory Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Richard Staats
- Thorax Department, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal
- Instituto de Saúde Ambiental - ISAMB; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Gianfranco Parati
- Sleep Center-Department of Cardiology, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- Sleep Center-Department of Cardiology, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ludger Grote
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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Guo C, Harshfield EL, Markus HS. Sleep Characteristics and Risk of Stroke and Dementia: An Observational and Mendelian Randomization Study. Neurology 2024; 102:e209141. [PMID: 38350061 PMCID: PMC11067695 DOI: 10.1212/wnl.0000000000209141] [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: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are implicated as risk factors of both stroke and dementia. However, whether these associations are causal and whether treatment of sleep disorders could reduce stroke and dementia risk remain uncertain. We aimed to evaluate associations and ascertain causal relationships between sleep characteristics and stroke/dementia risk and MRI markers of small vessel disease (SVD). METHODS We used data sets from a multicenter population-based study and summary statistics from genome-wide association studies (GWASs) of sleep characteristics and outcomes. We analyzed 502,383 UK Biobank participants with self-reported sleep measurements, including sleep duration, insomnia, chronotype, napping, daytime dozing, and snoring. In observational analyses, the primary outcomes were incident stroke, dementia, and their subtypes, alongside SVD markers. Hazard ratios (HRs) and odds ratios (ORs) were adjusted for age, sex, and ethnicity, and additional vascular risk factors. In Mendelian randomization (MR) analyses, ORs or risk ratios are reported for the association of each genetic score with clinical or MRI end points. RESULTS Among 502,383 participants (mean [SD] age, 56.5 [8.1] years; 54.4% female), there were 7,668 cases of all-cause dementia and 10,334 strokes. In longitudinal analyses, after controlling for cardiovascular risk factors, participants with insomnia, daytime napping, and dozing were associated with increased risk of any stroke (HR 1.05, 95% CI 1.01-1.11, p = 8.53 × 10-3; HR 1.09, 95% CI 1.05-1.14, p = 3.20 × 10-5; HR 1.19, 95% CI 1.08-1.32, p = 4.89 × 10-4, respectively). Almost all sleep measures were associated with dementia risk (all p < 0.001, except insomnia). Cross-sectional analyses identified associations between napping, snoring, and MRI markers of SVD (all p < 0.001). MR analyses supported a causal link between genetically predicted insomnia and increased stroke risk (OR 1.31, 95% CI 1.13-1.51, p = 0.00072), but not with dementia or SVD markers. DISCUSSION We found that multiple sleep measures predicted future risk of stroke and dementia, but these associations were attenuated after controlling for cardiovascular risk factors and were absent in MR analyses for Alzheimer disease. This suggests possible confounding or reverse causation, implying caution before proposing sleep disorder modifications for dementia treatment.
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Affiliation(s)
- Chutian Guo
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Eric L Harshfield
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Hugh S Markus
- From the Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
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10
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Carsuzaa F, Chary E, Thariat J, Dufour X, Favier V. Obstructive sleep apnea syndrome: A frequent and difficult-to-detect complication of radiotherapy for oropharyngeal cancers. Radiother Oncol 2024; 192:110109. [PMID: 38280437 DOI: 10.1016/j.radonc.2024.110109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
This pilot study reveals a higher prevalence of obstructive sleep apnea syndrome (OSAS) in patients treated for oropharyngeal squamous cell carcinoma with radiotherapy compared to the general population. OSAS indicators such as the Epworth Sleepiness Scale seem insufficient in the diagnostic approach to OSAS in this population and systematic screenings should be considered.
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Affiliation(s)
- Florent Carsuzaa
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Eléonore Chary
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Juliette Thariat
- Département de radiothérapie, Centre François Baclesse, Caen, France
| | - Xavier Dufour
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Valentin Favier
- Département ORL et chirurgie cervico-faciale, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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11
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Tang R, Li C, Di D, Zhou L, Qian Y, Qiang C, Ma C, Zhou R, Wang B, Wang M. Evaluate the Relationship Between Obstructive Sleep Apnea and Metabolic Syndrome in Real-World Data. Nat Sci Sleep 2024; 16:217-231. [PMID: 38445023 PMCID: PMC10912035 DOI: 10.2147/nss.s433514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a disorder characterized by disruption in breathing and hypoventilation. In parallel, metabolic syndrome (MetS) mainly co-occur with OSA, however, their association has not been fully elucidated. Therefore, this study aimed to reveal the relationship between OSA and MetS using data from the National Health And Nutrition Examination Survey (NHANES) database and pooled data from Genome-Wide Association Studies (GWAS). Material and Methods Data from the National Health and Nutrition Examination Survey and pooled data from genome-wide association analysis (GWAS) were used univariate and multivariate logistic regression analyses were carried out to evaluate the correlation between OSA and MetS, and multivariate logistic regression models were utilized for adjusting for potential confounders. Two-sample Mendelian randomization (MR) was used to assess the causal relationship between OSA and MetS. The variance-weighted inverse method was employed as the main method of analysis. Results A positive relationship of OSA with Mets was evidenced by multivariate logistic regression analysis, and OSA was associated with higher incidence rates of all-cause and cardiovascular mortality. OSA is strongly associated with abdominal obesity, hypertension, hyperglycemia, high triglycerides, and low HDL. Furthermore, except for hypertriglyceridemia, MR analysis indicated that genetically driven OSA was causally associated with a higher risk of MetS. Conclusion The positive relationship of OSA with Mets was revealed, and higher incidence rates of all-cause mortality and cardiovascular mortality were noted to be correlated with OSA. MR analysis further confirmed the causal relationship of OSA with MetS and cardiovascular disease.
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Affiliation(s)
- Renzhe Tang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Chong Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Dongmei Di
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Lin Zhou
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Yongxiang Qian
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Chaohua Qiang
- Department of Echocardiography, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Chao Ma
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Rui Zhou
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Bin Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
| | - Min Wang
- Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, 213003, People’s Republic of China
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Olszewska E, De Vito A, Baptista P, Heiser C, O’Connor-Reina C, Kotecha B, Vanderveken O, Vicini C. Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 1 Definitions and Diagnosis. J Clin Med 2024; 13:502. [PMID: 38256636 PMCID: PMC10816926 DOI: 10.3390/jcm13020502] [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: 12/06/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Seeking consensus on definitions and diagnosis of snoring and obstructive sleep apnea (OSA) among sleep surgeons is important, particularly in this relatively new field with variability in knowledge and practices. A set of statements was developed based on the literature and circulated among eight panel members of European experts, utilizing the Delphi method. Responses in agreement and disagreement on each statement and the comments were used to assess the level of consensus and develop a revised version. The new version with the level of consensus and anonymized comments was sent to each panel member as the second round. This was repeated a total of five rounds. The total number of statements included in the initial set was 112. In the first round, of all eight panelists, the percentage of questions that had consensus among the eight, seven, and six panelists were 45%, 4.5%, and 7.1%, respectively. In the final set of statements consisting of 99, the percentage of questions that had consensus among the 8, 7, and 6 panelists went up to 66.7%, 24.2%, and 6.1%, respectively. Delphi's method demonstrated an efficient method of interaction among experts and the establishment of consensus on a specific set of statements.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Andrea De Vito
- Department of Surgery, Morgagni-Pierantoni Hospital, Health Local Agency of Romagna, 47121 Forlì, Italy;
| | - Peter Baptista
- Clinica Universidad da Navarra, Departmento de Orl, 31008 Pamplona, Spain;
| | - Clemens Heiser
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany
| | | | - Bhik Kotecha
- Nuffield Health Brentwood, Essex, Brentwood CM15 8EH, UK;
- UME Health, 17 Harley Street, London W1G 9QH, UK
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium; (C.H.); (O.V.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Claudio Vicini
- GVM Care & Research ENT Consultant, GVM Primus Medica Center, GVM San Pier Damiano Hospital, 48018 Faenza, Italy;
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Moradi MT, Fadaei R, Sharafkhaneh A, Khazaie H, Gozal D. The role of lncRNAs in intermittent hypoxia and sleep Apnea: A review of experimental and clinical evidence. Sleep Med 2024; 113:188-197. [PMID: 38043330 DOI: 10.1016/j.sleep.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023]
Abstract
In this narrative review, we present a comprehensive assessment on the putative roles of long non-coding RNAs (lncRNAs) in intermittent hypoxia (IH) and sleep apnea. Collectively, the evidence from cell culture, animal, and clinical research studies points to the functional involvement of lncRNAs in the pathogenesis, diagnosis, and potential treatment strategies for this highly prevalent disorder. Further research is clearly warranted to uncover the mechanistic pathways and to exploit the therapeutic potential of lncRNAs, thereby improving the management and outcomes of patients suffering from sleep apnea.
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Affiliation(s)
- Mohammad-Taher Moradi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Amir Sharafkhaneh
- Sleep Disorders and Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - David Gozal
- Joan C. Edwards School of Medicine, Marshall University, 1600 Medical Center Dr, Huntington, WV, 25701, USA.
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14
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Correia S, Gonzalez M, Deger M, Pitts P. The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example. OPEN RESPIRATORY ARCHIVES 2024; 6:100289. [PMID: 38225949 PMCID: PMC10788272 DOI: 10.1016/j.opresp.2023.100289] [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: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 01/17/2024] Open
Abstract
Introduction Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain. Methods A time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1-3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway. Results Compared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3 h/night and the proportion of individuals defined as adherent increased from 79% to 91%. Conclusions Implementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes.
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Affiliation(s)
| | - Monica Gonzalez
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, University of Cantabria, Santander, Spain
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Nambiema A, Lisan Q, Vaucher J, Perier MC, Boutouyrie P, Danchin N, Thomas F, Guibout C, Solelhac G, Heinzer R, Jouven X, Marques-Vidal P, Empana JP. Healthy sleep score changes and incident cardiovascular disease in European prospective community-based cohorts. Eur Heart J 2023; 44:4968-4978. [PMID: 37860848 PMCID: PMC10719494 DOI: 10.1093/eurheartj/ehad657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/20/2023] [Accepted: 07/25/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND AIMS Evidence on the link between sleep patterns and cardiovascular diseases (CVDs) in the community essentially relies on studies that investigated one single sleep pattern at one point in time. This study examined the joint effect of five sleep patterns at two time points with incident CVD events. METHODS By combining the data from two prospective studies, the Paris Prospective Study III (Paris, France) and the CoLaus|PsyCoLaus study (Lausanne, Switzerland), a healthy sleep score (HSS, range 0-5) combining five sleep patterns (early chronotype, sleep duration of 7-8 h/day, never/rarely insomnia, no sleep apnoea, and no excessive daytime sleepiness) was calculated at baseline and follow-up. RESULTS The study sample included 11 347 CVD-free participants aged 53-64 years (44.6% women). During a median follow-up of 8.9 years [interquartile range (IQR): 8.0-10.0], 499 first CVD events occurred (339 coronary heart disease (CHD) and 175 stroke). In multivariate Cox analysis, the risk of CVD decreased by 18% [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.76-0.89] per one-point increment in the HSS. After a median follow-up of 6.0 years (IQR: 4.0-8.0) after the second follow-up, 262 first CVD events occurred including 194 CHD and 72 stroke. After adjusting for baseline HSS and covariates, the risk of CVD decreased by 16% (HR 0.84, 95% CI 0.73-0.97) per unit higher in the follow-up HSS over 2-5 years. CONCLUSIONS Higher HSS and HSS improvement over time are associated with a lower risk of CHD and stroke in the community.
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Affiliation(s)
- Aboubakari Nambiema
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
| | - Quentin Lisan
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
- Department of Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Julien Vaucher
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Marie-Cecile Perier
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
| | - Pierre Boutouyrie
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Cellular, Molecular and Pathophysiological Mechanisms of Heart Failure, APHP, DMU CARTE, Pharmacology, Paris, France
| | - Nicolas Danchin
- Preventive and Clinical Investigation Center (IPC), Paris, France
| | | | - Catherine Guibout
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Xavier Jouven
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
| | - Pedro Marques-Vidal
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Empana
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease, 56 rue Leblanc, Paris 75015, France
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Lisik D, Pires GN, Zou D. Perspective: Systematic review and meta-analysis in obstructive sleep apnea - What is lacking? Sleep Med 2023; 111:54-61. [PMID: 37717377 DOI: 10.1016/j.sleep.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/20/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
Obstructive sleep apnea (OSA) affects nearly one billion of the global adult population. It is associated with substantial burden in terms of quality of life, cognitive function, and cardiovascular health. Positive airway pressure (PAP) therapy, commonly considered the first-line treatment, is limited by low compliance and lacking efficacy on long-term cardiovascular outcomes. A substantial body of research has been produced investigating (novel) non-PAP treatments. With increased understanding of OSA pathogenesis, promising therapeutic approaches are emerging. There is an imperative need of high-quality synthesis of evidence; however, current systematic reviews and meta-analyses (SR/MA) on the topic demonstrate important methodological limitations and are seldom based on research questions that fully reflect the complex intricacies of OSA management. Here, we discuss the current challenges in management of OSA, the need of treatable traits based OSA treatment, the methodological limitations of existing SR/MA in the field, potential remedies, as well as future perspectives.
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Affiliation(s)
- Daniil Lisik
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, São Paulo, Brazil
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Nunes HDSS, Vaz de Castro J, Favier V, Carsuzaa F, Kim MHR, Mira FA, Meccariello G, Vicini C, De Vito A, Lechien JR, Chiesa Estomba C, Maniaci A, Iannella G, Cammaroto G. Predictors of Success of Pharyngeal Surgery in the Treatment of Obstructive Sleep Apnea: A Narrative Review. J Clin Med 2023; 12:6773. [PMID: 37959237 PMCID: PMC10649816 DOI: 10.3390/jcm12216773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: This narrative review aims to explore the predictors of success for pharyngeal surgery in the treatment of obstructive sleep apnea (OSA). An extensive literature search was conducted, identifying relevant studies published up to June 2023, utilizing various databases and key search terms related to OSA, surgical interventions, and predictors of success. The review encompasses both retrospective and prospective studies, case series, and cohort studies to provide a broad understanding of the topic; (2) Methods: Review of English scientific literature on phenotypes of OSA related to predictors of success of pharyngeal surgery; (3) Results: Of 75 articles, 21 were included, in these the following were determined to be factors for surgical success: body mass index (BMI) (8 articles), apnea/hypopnea index (AHI) (8 articles), cephalometry (8 articles), palatine tonsil size (7 articles), Modified Mallampati score (2 articles), genioglossus electromyography (2 articles), Friedman score or upper airway anatomy (3 articles), nasopharyngolaryngoscopy (2 articles), drug-induced sleep endoscopy (DISE) (1 article), oral cavity anatomy (1 article) and oxygen desaturation index (ODI) (1 article); (4) Conclusions: The lack of standardized protocols for the indication of pharyngeal surgery is a reality, however identifying known predictors of surgical success may facilitate homogenizing indications.
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Affiliation(s)
- Heloisa dos Santos Sobreira Nunes
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
| | - Joana Vaz de Castro
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Armed Forces Hospital, 1649-026 Lisbon, Portugal
| | - Valentin Favier
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Montpellier, 34080 Montpellier, France
| | - Florent Carsuzaa
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Marina He Ryi Kim
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
| | - Felipe Ahumada Mira
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Hospital of Linares, Linares 3582259, Chile
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Jerome R. Lechien
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology and Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, 7000 Mons, Belgium
| | - Carlos Chiesa Estomba
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Otorhinolaryngology, Donostia University Hospital, Biodonostia Research Institute, Osakidetza, 20014 San Sebastian, Spain
| | - Antonino Maniaci
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Piazza Università 2, 95100 Catania, Italy
| | - Giannicola Iannella
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università 33, 00185 Rome, Italy
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
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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: 0] [Impact Index Per Article: 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.
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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.)
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Chen Y, Wang J, Wen S, Wang D, Gan Q, Lin Y, Lai J, Zhang H, Zhou Y, Zhao D. Obstructive Sleep Apnea with High Pulse Wave Amplitude Drops Index: A Specific Phenotype for Cardiovascular Benefit from Continuous Positive Airway Pressure? Am J Respir Crit Care Med 2023; 208:634-635. [PMID: 37321209 PMCID: PMC10492243 DOI: 10.1164/rccm.202304-0761le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/15/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Yating Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingcun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shenyu Wen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Donghao Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiming Gan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yiqi Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxiong Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haojie Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanyan Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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20
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Bushi G, Padhi BK, Shabil M, Satapathy P, Rustagi S, Pradhan KB, Al-qaim ZH, Khubchandani J, Sah R, Sah S, Anand A. Cardiovascular Disease Outcomes Associated with Obstructive Sleep Apnea in Diabetics: A Systematic Review and Meta-Analysis. Diseases 2023; 11:103. [PMID: 37606474 PMCID: PMC10443251 DOI: 10.3390/diseases11030103] [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: 06/12/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND There is significant pathogenic and epidemiological overlap between diabetes and obstructive sleep apnea (OSA). This systematic review aimed to ascertain the association between OSA and cardiovascular disease (CVD) in a diabetic population. METHODS The study protocol was registered with PROSPERO (CRD42023404126). On 15 July 2023, a comprehensive search of the literature was performed in PubMed, EBSCO, Scopus, ProQuest, and Web of Science, using keywords and synonyms of OSA, diabetes, and CVD, coupled with specific terms for different CVDs. Only observational studies that reported CVD events in diabetics (with and without OSA) were included. The quality of the studies included in the analysis was assessed using the Newcastle-Ottawa Scale. RESULTS In the primary literature search, 8795 studies were identified, of which 9 met the inclusion criteria and included 17,796 participants. Eight studies were eligible for meta-analysis, and a pooled risk ratio (RR) of 1.29 (95% CI = 0.91-1.83) was found for developing CVD in diabetics with OSA at a 95% prediction interval of 0.30-5.60. The included studies showed significant heterogeneity with an I2 value of 91%. CONCLUSION These findings show the possible association between OSA and diabetes and their impact on CVDs. Identifying and managing OSA in individuals with diabetes at an early phase could potentially reduce the risk of CVDs and its related complications.
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Affiliation(s)
- Ganesh Bushi
- Global Center for Evidence Synthesis, Chandigarh 160036, India; (G.B.); (B.K.P.); (M.S.); (P.S.)
| | - Bijaya Kumar Padhi
- Global Center for Evidence Synthesis, Chandigarh 160036, India; (G.B.); (B.K.P.); (M.S.); (P.S.)
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Muhammed Shabil
- Global Center for Evidence Synthesis, Chandigarh 160036, India; (G.B.); (B.K.P.); (M.S.); (P.S.)
| | - Prakasini Satapathy
- Global Center for Evidence Synthesis, Chandigarh 160036, India; (G.B.); (B.K.P.); (M.S.); (P.S.)
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India;
| | - Keerti Bhusan Pradhan
- Department of Healthcare Management, Chitkara Business School, Chitkara University Punjab, Patiala 140401, India;
| | - Zahraa Haleem Al-qaim
- Department of Anesthesia Techniques, Al-Mustaqbal University College, Hillah 51001, Iraq;
| | - Jagdish Khubchandani
- Global Center for Evidence Synthesis, Chandigarh 160036, India; (G.B.); (B.K.P.); (M.S.); (P.S.)
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM 88003, USA
| | - Ranjit Sah
- Department of General Practice and Emergency Medicine, Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal;
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India;
| | - Ayush Anand
- Department of Medicine, B.P Koirala Institute of Health Sciences, Dharan 56700, Nepal;
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Karuga FF, Jaromirska J, Malicki M, Sochal M, Szmyd B, Białasiewicz P, Strzelecki D, Gabryelska A. The role of microRNAs in pathophysiology and diagnostics of metabolic complications in obstructive sleep apnea patients. Front Mol Neurosci 2023; 16:1208886. [PMID: 37547923 PMCID: PMC10403239 DOI: 10.3389/fnmol.2023.1208886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which is characterized by recurrent apneas and/or hypopneas occurring during sleep due to upper airway obstruction. Among a variety of health consequences, OSA patients are particularly susceptible to developing metabolic complications, such as metabolic syndrome and diabetes mellitus type 2. MicroRNAs (miRNAs) as epigenetic modulators are promising particles in both understanding the pathophysiology of OSA and the prediction of OSA complications. This review describes the role of miRNAs in the development of OSA-associated metabolic complications. Moreover, it summarizes the usefulness of miRNAs as biomarkers in predicting the aforementioned OSA complications.
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Affiliation(s)
- Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Julia Jaromirska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Mikołaj Malicki
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Bartosz Szmyd
- Department of Neurosurgery and Neuro-Oncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
- Department of Pediatrics, Oncology, and Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
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Zhou Y, Jin Y, Zhu Y, Fang W, Dai X, Lim C, Mishra SR, Song P, Xu X. Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis. Public Health Rev 2023; 44:1605469. [PMID: 37383367 PMCID: PMC10293634 DOI: 10.3389/phrs.2023.1605469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 06/04/2023] [Indexed: 06/30/2023] Open
Abstract
Objectives: To summarize the evidence on the association between sleep problems and multimorbidity. Methods: Six electronic databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, and Wan fang) were searched to identify observational studies on the association between sleep problems and multimorbidity. A random-effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals for multimorbidity. Results: A total of 17 observational studies of 133,575 participants were included. Sleep problems included abnormal sleep duration, insomnia, snoring, poor sleep quality, obstructive sleep apnea (OSA) and restless legs syndrome (RLS). The pooled ORs (95% CIs) for multimorbidity were 1.49 (1.24-1.80) of short sleep duration, 1.21 (1.11-1.44) of long sleep duration and 2.53 (1.85-3.46) for insomnia. The association of other sleep problems with multimorbidity was narratively summarized due to limited number of comparable studies. Conclusion: Abnormal sleep duration and insomnia are associated with higher odds of multimorbidity, while the evidence on association of snoring, poor sleep quality, obstructive sleep apnea and restless legs syndrome with multimorbidity remains inconclusive. Interventions targeting sleep problems should be delivered for better management of multimorbidity.
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Affiliation(s)
- Yaguan Zhou
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yichen Jin
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Zhu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Carmen Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolin Xu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Ytzhaik N, Zur D, Goldstein C, Almoznino G. Obstructive Sleep Apnea, Metabolic Dysfunction, and Periodontitis-Machine Learning and Statistical Analyses of the Dental, Oral, Medical Epidemiological (DOME) Big Data Study. Metabolites 2023; 13:metabo13050595. [PMID: 37233636 DOI: 10.3390/metabo13050595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
This study aimed to analyze the associations of obstructive sleep apnea (OSA) with dental parameters while controlling for socio-demographics, health-related habits, and each of the diseases comprising metabolic syndrome (MetS), its consequences, and related conditions. We analyzed data from the dental, oral, and medical epidemiological (DOME) cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel for one year. Analysis included statistical and machine learning models. The study included 132,529 subjects; of these, 318 (0.2%) were diagnosed with OSA. The following parameters maintained a statistically significant positive association with OSA in the multivariate binary logistic regression analysis (descending order from highest to lowest OR): obesity (OR = 3.104 (2.178-4.422)), male sex (OR = 2.41 (1.25-4.63)), periodontal disease (OR = 2.01 (1.38-2.91)), smoking (OR = 1.45 (1.05-1.99)), and age (OR = 1.143 (1.119-1.168)). Features importance generated by the XGBoost machine learning algorithm were age, obesity, and male sex (located on places 1-3), which are well-known risk factors of OSA, as well as periodontal disease (fourth place) and delivered dental fillings (fifth place). The Area Under Curve (AUC) of the model was 0.868 and the accuracy was 0.92. Altogether, the findings supported the main hypothesis of the study, which was that OSA is linked to dental morbidity, in particular to periodontitis. The findings highlight the need for dental evaluation as part of the workup of OSA patients and emphasizes the need for dental and general medical authorities to collaborate by exchanging knowledge about dental and systemic morbidities and their associations. The study also highlights the necessity for a comprehensive holistic risk management strategy that takes systemic and dental diseases into account.
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Affiliation(s)
- Noya Ytzhaik
- In Partial Fulfillment DMD Thesis, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Dorit Zur
- Medical Information Department, General Surgeon Headquarter, Medical Corps, 02149, Israel Defense Forces, Tel-Hashomer, Israel
| | - Chen Goldstein
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory; Dean's Office, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Galit Almoznino
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Big Biomedical Data Research Laboratory; Dean's Office, Hadassah Medical Center, Jerusalem 91120, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Department of Endodontics, Hadassah Medical Center, Jerusalem 91120, Israel
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel; Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem 91120, Israel
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Šmon J, Kočar E, Pintar T, Dolenc-Grošelj L, Rozman D. Is obstructive sleep apnea a circadian rhythm disorder? J Sleep Res 2023:e13875. [PMID: 36922163 DOI: 10.1111/jsr.13875] [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: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
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Affiliation(s)
- Julija Šmon
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Kočar
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc-Grošelj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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25
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Relationship between severity of obstructive sleep apnea and benign prostatic hyperplasia. Sleep Breath 2023; 27:363-369. [PMID: 35460050 DOI: 10.1007/s11325-022-02617-y] [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: 11/14/2021] [Revised: 03/11/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The cause of benign prostatic hyperplasia (BPH) is controversial, local hypoxia and inflammation being the main two possibilities proposed. The aim of this study was to evaluate the relationship between obstructive sleep apnea (OSA) and BPH. METHODS The study cohort comprised men from January 2016 to December 2020 in our Sleep Center. These patients were classified into four groups (no, mild, moderate, severe OSA) by apnea-hypopnea indexes (AHI). Logistic regression was used to identify independent risk factors for BPH, after which participants were stratified into younger (age ≤ 40 years) and older groups (age > 40 years) for further analysis. RESULTS The study cohort comprised 467 patients including 135 younger subjects and 332 older subjects. The prevalence of BPH in the above listed AHI categories was 37.5%, 55.0%, 62.9%, and 52.3%, respectively (p = 0.075). Logistic regression analysis of all patients identified age as a risk factor for BPH (p < 0.001). Stratified analysis according to AHI category found a prevalence of BPH of 0.0%, 13.0%, 33.3%, and 43.9%, respectively, in younger group (p = 0.006), and 52.2%, 71.9%, 71.1%, and 56.3%, respectively, in older group (p = 0.038). Logistic regression analysis found age and AHI were independent risk factors for BPH in younger group (both p < 0.05), whereas only age was identified as a risk factor for BPH in older group (p < 0.001). CONCLUSIONS Age is an independent risk factor for BPH in men with OSA. AHI is also an independent risk factor for BPH in younger men, suggesting that OSA may affect development of BPH in younger men.
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Chaszczewska-Markowska M, Górna K, Bogunia-Kubik K, Brzecka A, Kosacka M. The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results. J Clin Med 2023; 12:jcm12030801. [PMID: 36769452 PMCID: PMC9918226 DOI: 10.3390/jcm12030801] [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: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. MATERIAL AND METHODS This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex® platform was used. RESULTS In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO2, low mean nocturnal SaO2, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). CONCLUSIONS In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO2 are factors contributing to the chronic inflammatory state in OSA patients.
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Affiliation(s)
- Monika Chaszczewska-Markowska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Katarzyna Górna
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
- Correspondence:
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
| | - Monika Kosacka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
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Czerwaty K, Dżaman K, Sobczyk KM, Sikorska KI. The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review. Biomedicines 2022; 11:biomedicines11010016. [PMID: 36672523 PMCID: PMC9856172 DOI: 10.3390/biomedicines11010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases that strongly impact the quality and length of life. Their coexistence is determined by overlap syndrome (OS). This systematic review aims to define the significance of these comorbidities according to the current state of knowledge. For this systematic review, we searched PubMed, Scopus, and Cochrane for studies published between 2018 and 26 October 2022, to find original, observational, human studies published in English, where the diagnosis of COPD was according to the Global Initiative for Obstructive Lung Disease guidelines and the diagnosis of OSA was based on polysomnography. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool for cohort and case-control studies, as well as its modification for cross-sectional studies. Of the 1548 records identified, 38 were eligible and included in this systematic review. The included studies covered a total population of 27,064 participants. This paper summarizes the most important, up-to-date information regarding OS, including the prevalence, meaning of age/gender/body mass index, polysomnography findings, pulmonary function, comorbidities, predicting OSA among COPD patients, and treatment of this syndrome.
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Paschou SA, Bletsa E, Saltiki K, Kazakou P, Kantreva K, Katsaounou P, Rovina N, Trakada G, Bakakos P, Vlachopoulos CV, Psaltopoulou T. Sleep Apnea and Cardiovascular Risk in Patients with Prediabetes and Type 2 Diabetes. Nutrients 2022; 14:nu14234989. [PMID: 36501019 PMCID: PMC9741445 DOI: 10.3390/nu14234989] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common but largely undiagnosed clinical condition, which is turning into a serious public health issue. Of note is that its prevalence is gradually increasing in parallel with the obesity and type 2 diabetes mellitus (T2DM) epidemics. The aim of this article is to comprehensively review the literature in order to evaluate the cardiovascular (CV) risk among patients with OSA and prediabetes or T2DM. OSA seems to be an independent risk factor for the development as well as the progression of T2DM, whereas it is associated with T2DM-related macrovascular and microvascular complications. OSA may also act as a potential risk factor for the presentation and development of CV disease, such as hypertension, coronary artery disease, heart failure, pulmonary hypertension, atrial fibrillation and other cardiac arrythmias, as well as stroke. OSA and T2DM also share common pathophysiological mechanisms leading to atherosclerosis. Considering that the coexistence of OSA and T2DM is an independent and cumulative risk factor for CV mortality, more so than the two diseases separately, clinicians and healthcare professionals should be aware of and screen for OSA in patients with T2DM. Notably, targeted therapy for both conditions seems to substantially improve CV prognosis.
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Affiliation(s)
- Stavroula A. Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence:
| | - Evanthia Bletsa
- 3rd Department of Cardiology, Sotiria Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Katerina Saltiki
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Paraskevi Kazakou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Kanella Kantreva
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Paraskevi Katsaounou
- 1st Department of Critical Care Medicine, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Sotiria Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgia Trakada
- Respiratory Medicine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, Sotiria Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Charalambos V. Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Bordoni B, Escher AR, Toccafondi A, Mapelli L, Banfi P. Obstructive Sleep Apnea and Role of the Diaphragm. Cureus 2022; 14:e29004. [PMID: 36159353 PMCID: PMC9495286 DOI: 10.7759/cureus.29004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/07/2022] Open
Abstract
Obstructive sleep apnea (OSA) causes multiple local and systemic pathophysiological consequences, which lead to an increase in morbidity and mortality in patients suffering from this disorder. OSA presents with various nocturnal events of apnoeas or hypopneas and with sub-clinical airflow limitations during wakefulness. OSA involves a large percentage of the population, particularly men, but the estimate of OSA patients could be much broader than data from the literature. Most of the research carried out in the muscle field is to understand the causes of the presence of chronic nocturnal desaturation and focus on the genioglossus muscle and other muscles related to dilating the upper airways. Sparse research has been published regarding the diaphragm muscle, which is the main muscle structure to insufflate air into the airways. The article reviews the functional anatomy of the muscles used to open the upper respiratory tract and the non-physiological adaptation that follows in the presence of OSA, as well as the functional anatomy and pathological adaptive aspects of the diaphragm muscle. The intent of the text is to highlight the disparity of clinical interest between the dilator muscles and the diaphragm, trying to stimulate a broader approach to patient evaluation.
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Is myocardial strain an early marker of systolic dysfunction in obstructive sleep apnoea? Findings from a meta-analysis of echocardiographic studies. J Hypertens 2022; 40:1461-1468. [PMID: 35881447 DOI: 10.1097/hjh.0000000000003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We investigated the association between obstructive sleep apnoea (OSA) and subclinical systolic dysfunction through a meta-analysis of echocardiographic studies that provided data on left ventricular (LV) mechanics as assessed by global longitudinal strain (GLS). DESIGN The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search English-language articles published from inception to 31 December 2021. Studies were detected by using the following terms: 'obstructive sleep apnea', 'sleep quality', 'sleep disordered breathing', 'cardiac damage', 'left ventricular hypertrophy', 'systolic dysfunction', 'global longitudinal strain', 'left ventricular mechanics', 'echocardiography' and 'speckle tracking echocardiography'. RESULTS The meta-analysis included 889 patients with OSA and 364 non-OSA controls from 12 studies. Compared with controls, GLS was significantly reduced in the pooled OSA group (SMD -1.24 ± 0.17, CI: -1.58 to -0.90, P < 0.0001), as well as in the normotensive OSA subgroup (SMD: -1.17 ± 0.12 CI:-1.40 to -0.95, P < 0.0001). Similar findings were obtained in sub-analyses performed separately in mild, moderate and severe OSA. This was not the case for LV ejection fraction (LVEF) (i.e. comparisons between controls vs. mild OSA, mild vs. moderate OSA, moderate vs. severe OSA). CONCLUSION GLS is impaired in patients with OSA (independently from hypertension), worsening progressively from mild to moderate and severe forms, thus allowing to identify subclinical alterations of the systolic function not captured by LVEF. Therefore, myocardial strain assessment should be implemented systematically in the OSA setting to timely detect systolic dysfunction.
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Murta MS, Duarte RLM, Waetge D, Gozal D, Cardoso AP, Mello FCQ. Sleep-Disordered Breathing in Adults with Precapillary Pulmonary Hypertension: Prevalence and Predictors of Nocturnal Hypoxemia. Lung 2022; 200:523-530. [PMID: 35717489 DOI: 10.1007/s00408-022-00547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the frequency of sleep-disordered breathing (SDB) and predictors of the presence of nocturnal desaturation in adults with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. METHODS Outpatients with a hemodynamic diagnosis of precapillary pulmonary hypertension who underwent portable polysomnography were evaluated. Diagnosis and severity of SDB were assessed using three well-established respiratory disturbance index (RDI) thresholds: 5.0/h, 15.0/h, and 30.0/h, while nocturnal hypoxemia was defined by the average oxygen saturation (SpO2) < 90%. Multiple linear regression analysis evaluated the potential relationships among explanatory variables with the dependent variable (average SpO2 values), with comparisons based on the standardized regression coefficient (β). The R-squared (R2; coefficient of determination) was used to evaluate the goodness-of-fit measure for the linear regression model. RESULTS Thirty-six adults were evaluated (69.4% females). The majority of the participants (75.0%) had SDB (26 with obstructive sleep apnea [OSA] and one with central sleep apnea [CSA]); while 50% of them had nocturnal hypoxemia. In the linear regression model (R2 = 0.391), the mean pulmonary artery pressure [mPAP] (β - 0.668; p = 0.030) emerged as the only independent parameter of the average SpO2. CONCLUSION Our study found that the majority of the participants had some type of SDB with a marked predominance of OSA over CSA, while half of them had nocturnal desaturation. Neither clinical and hemodynamic parameters nor the RDI was a predictor of nocturnal desaturation, except for mPAP measured during a right heart catheterization, which emerged as the only independent and significant predictor of average SpO2.
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Affiliation(s)
- Marcia S Murta
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - Ricardo L M Duarte
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil.
| | - Daniel Waetge
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Alexandre P Cardoso
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - Fernanda C Q Mello
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
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Tadic M, Gherbesi E, Faggiano A, Sala C, Carugo S, Cuspidi C. The impact of continuous positive airway pressure on cardiac mechanics: Findings from a meta-analysis of echocardiographic studies. J Clin Hypertens (Greenwich) 2022; 24:795-803. [PMID: 35695237 PMCID: PMC9278581 DOI: 10.1111/jch.14488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 01/02/2023]
Abstract
Current evidence on the effects of continuous positive airway pressure (CPAP) on cardiac mechanics in patients with obstructive sleep apnea (OSA) is based on a few single studies. The authors investigated this topic through a meta‐analysis of speckle tracking echocardiography (STE) studies that provided data on left ventricular (LV) and right ventricular (RV) mechanics as assessed by global longitudinal strain (GLS). The PubMed, OVID‐MEDLINE, and Cochrane library databases were systematically analyzed to search English‐language review papers published from inception to January 31, 2022. Studies were identified by crossing the following terms: “obstructive sleep apnea”, “sleep quality”, “sleep disordered breathing”, “continuous positive airway pressure therapy”, “noninvasive ventilation”, “left ventricular hypertrophy”, “systolic dysfunction”, “global longitudinal strain”, “left ventricular mechanics”, “right ventricular mechanics”, “echocardiography” and “STE echocardiography”. The meta‐analysis, including a total of 337 patients with OSA from nine studies (follow‐up 2–24 months) showed a significant GLS improvement in both LV and RV after CPAP, standard mean difference (SMD) being 0.51±0.08, CI:0.36–0.66, p = .0001 and 0.28±0.07, CI:0.15–0.42, p = .0001), respectively. Corresponding SMD values for LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) were 0.20±0.06, CI:0.08–0.33, p = .001 and 0.08±0.06, CI: ‐0.04/0.20, p = .21. Our meta‐analysis suggests that: I) CPAP treatment exerts beneficial effects on biventricular function in patients with OSA; II) the assessment of cardiac mechanics by STE should be routinely recommended for monitoring cardiac function in this setting, due to limitations of conventional echocardiography in evaluating biventricular performance.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy
| | - Stefano Carugo
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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