Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography

Association of Sleep Pattern and Genetic Susceptibility with Obstructive Sleep Apnea: A Prospective Analysis of the UK Biobank

Purpose

The prevalence of obstructive sleep apnea (OSA) is high worldwide. This study aimed to quantify the relationship between the incidence of OSA and sleep patterns and genetic susceptibility.

Methods

A total of 355,133 white British participants enrolled in the UK Biobank between 2006 and 2010 with follow-up data until September 2021 were recruited. We evaluated sleep patterns using a customized sleep scoring method based on the low-risk sleep phenotype, defined as follows: morning chronotype, 7-8 hours of sleep per day, never/rarely experience insomnia, no snoring, no frequent daytime sleepiness, never/rarely nap, and easily getting up early. The polygenic risk score was calculated to assess genetic susceptibility to OSA. Cox proportional hazard models were used to evaluate the associations between OSA and sleep patterns and genetic susceptibility.

Results

During a mean follow-up of 12.57 years, 4618 participants were diagnosed with OSA (age: 56.83 ± 7.69 years, women: 31.3%). Compared with those with a poor sleep pattern, participants with a normal (HR: 0.42, 95% CI: 0.38-0.46), ideal (HR: 0.21, 95% CI: 0.19-0.24), or optimal (HR: 0.15, 95% CI: 0.12-0.18) sleep pattern were significantly more likely to have OSA. The genetic susceptibility of 173,239 participants was calculated, and the results showed that poor (HR: 3.67, 95% CI: 2.95-4.57) and normal (HR: 1.89, 95% CI: 1.66-2.16) sleep patterns with high genetic susceptibility can increase the risk for OSA.

Conclusion

This large-scale prospective study provides evidence suggesting that sleep patterns across seven low-risk sleep phenotypes may protect against OSA in individuals with varying degrees of genetic susceptibility.

Sleep Apnea and Heart Failure-Current State-of-The-Art

Sleep-disordered breathing (SDB), including obstructive and central sleep apnea, significantly exacerbates heart failure (HF) through adverse cardiovascular mechanisms. This review aims to synthesize existing literature to clarify the relationship between SDB and HF, focusing on the pathophysiological mechanisms, diagnostic challenges, and the effectiveness of treatment modalities like continuous positive airway pressure (CPAP) and adaptive servo-ventilation ASV. We analyzed peer-reviewed articles from 2003 to 2024 sourced from PubMed, EMBASE, Scopus, and Web of Science databases. The prevalence of SDB in HF patients is high, often underdiagnosed, and underappreciated. Management strategies, including CPAP and ASV, have been shown to mitigate symptoms and improve cardiac function. However, despite the availability of effective treatments, significant challenges in screening and diagnosis persist, affecting patient management and outcomes. DB significantly impacts HF prognosis. Enhanced screening strategies and broader utilization of therapeutic interventions like CPAP and ASV are essential to improve the management and outcomes of HF patients with concomitant SDB. Future research should focus on refining diagnostic and treatment protocols to optimize care for HF patients with SDB.

Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring

Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.

Coexistence of Cardiovascular Risk Factors and Blood Renalase Concentration

Cardiovascular diseases (CVDs) are one of the biggest health challenges facing health systems around the world. There are certain risk factors (CVRFs) that contribute to CVD. Risk factors associated with lifestyle such as tobacco consumption are particularly essential. Renalase is a recently discovered flavoprotein that may be involved in the progression of cardiometabolic diseases. The aim of the study was to investigate the relation between CVRFs and blood renalase concentration (BRC). The study group consisted of 96 people (51% women) who were hospitalized in the internal medicine department. CVRFs were measured using the AHA Life 7 scale. The E3109Hu ELISA kit was used to assess BRC. We found higher BRC in groups with a lower number of CVRFs (p < 0.05). We found a negative correlation between BRC and the number of CVRFs (r = -0.41). With the regression analysis, obesity, smoking, and a lack of physical activity (LoPE) were independently associated with lower blood renalase concentration. ROC analysis indicated the highest accuracy of BRC < 38.98 ng/mL in patients with ≥5 CVRFs. In conclusion, patients with a higher number of CVRFs had lower BRCs. The CVRFs particularly associated with a lower BRC were obesity, smoking, and LoPE.

The U-Shaped Association between Sleep Duration, All-Cause Mortality and Cardiovascular Risk in a Hispanic/Latino Clinically Based Cohort

Sleep is essential for life, and inappropriate sleep duration patterns may lead to chronic consequences regarding human health. Several studies have confirmed the presence of a U-shaped association between sleep duration and mortality. Moreover, many consequences related to cardiometabolic aspects have been suggested in patients with abnormal sleep durations. In this study, we analyzed the associations between sleep duration, total sleep time (TST), the risk of all-cause mortality, and 10-year cardiovascular risk in a cohort of patients at a sleep medicine center in Santiago, Chile. We conducted a prospective cohort study of patients (SantOSA). A short TST was defined as ≤6 h, a normal TST as 6 to 9 h, and a long TST as ≥9 h. Adjusted hazard ratios (aHRs) for all-cause mortality were calculated. A cross-sectional analysis between TST and 10-year cardiovascular risk (calculated using the Framingham 2008 formula) was determined using logistic regression models. A total of 1385 subjects were included in the results (78% male; median age: 53, interquartile range (IQR): 42-64 years; median BMI: 29.5, IQR: 16.7-33.1). A total of 333 subjects (24%) reported short TSTs, 938 (67.7%) reported normal TSTs, and 114 (8.3%) reported long TSTs. In the fully adjusted model, the association remained significant for short (aHR: 2.51 (1.48-4.25); p-value = 0.01) and long TSTs (aHR: 3.97 (1.53-10.29); p-value = 0.04). Finally, a U-shaped association was found between short and long TSTs, with an increase in cardiovascular risk at 10 years. Compared with normal TSTs, short (≤6 h) and long (≥9 h) TSTs were significantly associated with all-cause mortality and increased 10-year cardiovascular risk.

Current Smoking Determines the Levels of Circulating MPO and MMP-9 in Adults with Coronary Artery Disease and Obstructive Sleep Apnea

(1) Background: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which a rupture of atherosclerotic plaques and oxidative stress play a role in the initiation and progression of the disorder. Circulating levels of myeloperoxidase (MPO), as an oxidative stress marker, as well as matrix metalloproteinase-9 (MMP-9), as a destabilizer of plaques, are known to be elevated in patients with CAD and are associated with worse prognosis. Some studies have suggested that OSA is associated with MPO and MMP-9, but the effect of OSA on these biomarkers in cardiac cohorts is unknown. (2) Aims: We addressed the determinants of high MPO and MMP-9 in a CAD cohort with concomitant OSA. (3) Materials and Methods: The current study was a secondary analysis of the RICCADSA trial that was conducted in Sweden between 2005 and 2013. A total of 502 revascularized CAD patients with OSA (apnea-hypopnea index [AHI] ≥ 15 events/h; n = 391) or no-OSA (AHI < 5 events/h; n = 101), based on a home sleep apnea test, and who had blood samples at baseline were included in the analysis. The patients were dichotomized into a high or low MPO and MMP-9 groups, based on the median cut-off values. (4) Results: The mean age of the participants was 63.9 (±8.6), and 84% of the study cohort were men. Median values of MPO and MMP-9 levels were 116 ng/mL and 269 ng/mL, respectively. In different multivariate linear and logistic regression models, neither OSA nor OSA severity in terms of AHI and oxygenation indices were associated with the high MPO and MMP-9 levels. Current smoking was significantly associated with both high MPO (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.06-2.84; p = 0.030) and high MMP-9 levels (OR 2.41, 95% CI 1.44-4.03; p < 0.001), respectively. Other significant determinants were revealed as beta blocker use (OR 1.81, 95% CI 1.04-3.16; p = 0.036) for high MPO as well as male sex (OR 2.07, 95% CI 1.23-3.50; p = 0.006) and calcium antagonist use (OR 1.91, 95% CI 1.18-3.09; p = 0.008) for high MMP-9 levels. (5) Conclusions: Current smoking, but not OSA, was significantly associated with high MPO and MMP-9 levels in this revascularized CAD cohort. Smoking status should be seriously taken into consideration while evaluating the effects of OSA and its treatment on long-term adverse cardiovascular outcomes in adults with CAD.

Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients

Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four groups: 33 patients had mild OSA (5 ≤ AHI < 15), 33 patients had moderate OSA (15 ≤ AHI < 30), 31 patients had severe OSA (AHI ≥ 30), and 41 individuals had AHI < 5, which were a part of the control group. SCORE-2 increased in line with OSA severity and was higher in OSA groups compared to the control group (H = 29.913; DF = 3; p < 0.001). Charlson Index was significantly higher in OSA patients compared to controls (p = 0.001), with a higher prevalence of total comorbidities in the OSA group of patients. Furthermore, CCI 10-year survival score was significantly lower in the OSA group, suggesting a shorter survival of those patients with a more severe form of OSA. We also examined the prediction model for OSA severity. Conclusions: Determining the comorbidity profile and estimation of the 10-year risk score of OSA patients could be used to classify these patients into various mortality risk categories and, according to that, provide them with adequate treatment.

Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS)

Background and Aim: Sleep-disordered breathing (SDB) is an extremely common disorder with a high impact on morbidity and mortality. The purpose of this study was to compare overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) and to highlight and understand the differences between them. Material and Methods: The study was conducted retrospectively on 132 subjects selected by consecutive sampling from those attending our unit for suspected SDB. After clinical evaluation as well as functional and sleep investigations, the population was divided according to diagnosis in OS and OHS; then, the clinical parameters of two groups were compared with different statistical analysis. Results: The subjects with OHS were younger and reported higher rated daytime sleepiness (p = 0.005). In addition, they presented more nocturnal respiratory events (apnea-hypopnea index (AHI) 63.61 ± 22.79 events·h−1 vs. AHIOS 42.21 ± 22.91 events·h−1, p < 0.0001) at the sleep investigation as worse gas exchange during sleep leading to a higher percentage of nocturnal hypoxemia (p < 0.0001). In contrast, subjects with OS had more an impaired respiratory function. With regard to night-time ventilatory therapy, more subjects with OS were effectively treated with continuous positive airway pressure (CPAP) (p = 0.011), while more OHS were treated with auto-adjusting PAP (APAP) (14% vs. 1%, p = 0.008). Conclusions: The present study tried to establish a framework for OS and OHS because proper management of the two disorders would reduce their burden on healthcare.

Effects of Exercise on Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

With exercise being more frequently utilized in treatment for obstructive sleep apnea (OSA), a systematic review of the intervention efficacy of exercise on OSA is necessary. PubMed, EBSCO, Web of Science, VIP, and CNKI databases were searched to collect randomized controlled trials (RCTs) of exercise applied to OSA from January 2000 to January 2022. The literature screening, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was then performed using Rev Man 5.4 software. A total of 9 RCTs were included, including 444 patients. Compared with the control group, exercise made an improvement in apnea-hypopnea index (AHI) [MD = -6.65, 95% CI (-7.77, -5.53), p < 0.00001], minimum oxygen saturation (SaO_2min%) [MD = 1.67, 95% CI (0.82, 2.52), p = 0.0001], peak oxygen uptake (VO_2peak) [SMD = 0.54, 95% CI (0.31, 0.78), p < 0.00001], Pittsburgh sleep quality index (PSQI) [MD = -2.08, 95% CI (-3.95, -0.21), p = 0.03], and Epworth Sleepiness Scale (ESS) values [MD = -1.64, 95% CI, (-3.07, -0.22), p = 0.02]. However, there were no significant changes in body mass index (BMI). As for the results of subgroup analysis, aerobic exercise combined with resistance exercise [MD = -7.36, 95% CI (-8.64, -6.08), p < 0.00001] had a better effect on AHI reduction than aerobic exercise alone [MD = -4.36, 95% CI (-6.67, -2.06), p = 0.0002]. This systematic review demonstrates that exercise reduces the severity of OSA with no changes in BMI, and the effect of aerobic exercise combined with resistance training is better than aerobic exercise alone in AHI reduction. Exercise also improves cardiopulmonary fitness, sleep quality, and excessive daytime sleepiness.

Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial

This study investigated the effects of an eight-week interdisciplinary weight loss and lifestyle intervention on dietary behavior in men who were overweight/had obesity and moderate-to-severe obstructive sleep apnea (OSA). It was based on data from INTERAPNEA (ClinicalTrials.gov ID: NCT03851653); a randomized clinical trial conducted from April 2019 to April 2020. Men aged 18–65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an eight-week interdisciplinary weight loss and lifestyle intervention combined with usual-care. Dietary behavior was assessed through the Food Behavior Checklist (FBC) and the Mediterranean Diet Adherence Screener (MEDAS). Of the 89 participants who underwent randomization, 75 completed the intervention endpoint assessment, 89 participants being therefore included in the intention-to-treat analyses, and 75 in the per-protocol approach. As compared with usual-care, the intervention group had greater improvements at intervention endpoint in dietary behavior, as measured by the FBC total score (20% increase in FBC total score, mean between-group difference, 8.7; 95% confidence interval, 5.7 to 11.7), and MEDAS total score (33% increase in MEDAS total score, mean between-group difference, 2.1; 95% CI 1.3 to 2.9). At 6 months after intervention, the intervention group also had greater improvements in both the FBC total score (15% increase) and MEDAS total score (25% increase), with mean between-group differences of 7.7 (CI 95%, 4.4 to 10.9) and 1.7 (CI 95%, 0.9 to 2.6), respectively. An eight-week interdisciplinary weight loss and lifestyle intervention resulted in meaningful and sustainable improvements in dietary behavior, including adherence to the Mediterranean diet in men who were overweight/ had obesity and CPAP-treated moderate-to-severe OSA.