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Wu Q, Ma X, Wang Y, Jin J, Li J, Guo S. Efficacy of continuous positive airway pressure on NT-pro-BNP in obstructive sleep apnea patients: a meta-analysis. BMC Pulm Med 2023; 23:260. [PMID: 37452327 PMCID: PMC10349511 DOI: 10.1186/s12890-023-02539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND N-terminal probrain natriuretic peptide (NT-pro-BNP) and BNP are well-known markers for the diagnosis and prognostic of heart failure. Until now, it was not clear whether BNP levels are influenced by events occurring within Obstructive sleep apnea-hypopnea syndrome (OSAHS) with continuous positive airway pressure (CPAP). METHODS A thorough search in PubMed, EMBASE, Google Scholar, and Web of Science databases up to October 24, 2022, and a meta-analysis aimed to explore further accurate estimates of the effects of BNP on OSAHS after CPAP treatment to assess the strength of the evidence. RESULTS The forest plot outcome indicated that CPAP therapy did not change the BNP level in patients with OSAHS, with a weighted mean difference (WMD) of -0.47 (95% CI: -1.67 to 2.62; P = 0.53] based on the random effect model because of high significant heterogeneity (I2 = 80%) among the studies. Subgroup analysis also explored the changes in BNP levels in patients with OSAHS. Begg's test (P = 0.835) and Egger's test (P = 0.245) suggested significant negative publication bias. CONCLUSION Our meta-analysis suggests that CPAP therapy does not change the BNP level in patients with OSAHS; therefore, it is not accurate to use BNP level as an index to evaluate heart function in patients with OSAHS, but more related research should be conducted.
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Affiliation(s)
- Qinqin Wu
- Department of Pulmonary and Critical Care Medicine, Linfen Central Hospital, Linfen, Shanxi, China
| | - Xiaojun Ma
- Department of Pulmonary and Critical Care Medicine, Linfen Central Hospital, Linfen, Shanxi, China
| | - Yanyan Wang
- Department of Pulmonary and Critical Care Medicine, Linfen Central Hospital, Linfen, Shanxi, China
| | - Jianfeng Jin
- Department of Pulmonary and Critical Care Medicine, Linfen Central Hospital, Linfen, Shanxi, China
| | - Jia Li
- Department of Pulmonary and Critical Care Medicine, Linfen Central Hospital, Linfen, Shanxi, China
| | - Shuming Guo
- Linfen Central Hospital, Linfen, Shanxi, China.
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2
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Chetan IM, Gergely-Domokos B, Beyer R, Tomoaia R, Cabau G, Vulturar D, Chis A, Lesan A, Vesa CS, Pop D, Todea DA. The role of 3D speckle tracking echocardiography in the diagnosis of obstructive sleep apnea and its severity. Sci Rep 2022; 12:22347. [PMID: 36572720 PMCID: PMC9791147 DOI: 10.1038/s41598-022-26940-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
There is a consistent relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. It is already recognized that OSA may influence the geometry and function of the right ventricle (RV). This has encouraged the development of echocardiographic evaluation for screening of OSA and its severity. Three-dimensional speckle tracking echocardiography (3D STE) is in assumption better, compared with 2D STE, because it overcomes the standard 2D echo limitations. Thus, the purpose of our study is to evaluate whether 3D STE measurements, could predict the positive diagnosis and severity of OSA. We enrolled 69 patients with OSA and 37 healthy volunteers who underwent a cardiorespiratory sleep study. 2DE was performed in all patients. RVEF and 3D RVGLS were measured by 3DSTE. NT pro BNP plasma level was also assessed in all participants. 3D RV GLS (- 13.5% vs. - 22.3%, p < 0.001) and 3D RVEF (31.9% vs. 50%, p < 0.001) were reduced in patients with OSA, compared with normal individuals. 3D Strain parameters showed better correlation to standard 2D variables, than 3D RVEF. Except for NT pro BNP (p = 0.059), all parameters served to distinguish between severe and mild-moderate cases of OSA. 3D STE may be a reliable and accurate method for predicting OSA. Consequently, 3D RV GLS is a good tool of assessing the RV global function in OSA, because it correlates well with other established measurements of RV systolic function. Furthermore, 3D RV GLS was a precise parameter in identifying severe cases of OSA, while NT pro BNP showed no association.
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Affiliation(s)
- Ioana Maria Chetan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bianca Gergely-Domokos
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Ruxandra Beyer
- Heart Institute "Nicolae Stancioiu", Cluj-Napoca, Romania
| | - Raluca Tomoaia
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Cabau
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Damiana Vulturar
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana Chis
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Lesan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Stefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Pop
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Adina Todea
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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3
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Aro MM, Anttalainen U, Polo O, Saaresranta T. Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea. Eur Clin Respir J 2021; 8:1888394. [PMID: 33643550 PMCID: PMC7894421 DOI: 10.1080/20018525.2021.1888394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy. Methods: Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP. Results: In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain. Conclusions: This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy.
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Affiliation(s)
- Miia M Aro
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Olli Polo
- Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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4
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Xu L, Keenan BT, Maislin D, Gislason T, Benediktsdóttir B, Gudmundsdóttir S, Gardarsdottir M, Staley B, Pack FM, Guo X, Feng Y, Chahwala J, Manaktala P, Hussein A, Reddy-Koppula M, Hashmath Z, Lee J, Townsend RR, Schwab RJ, Pack AI, Kuna ST, Chirinos JA. Effect of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Cardiac Remodeling as Assessed by Cardiac Biomarker and Magnetic Resonance Imaging in Nonobese and Obese Adults. Hypertension 2021; 77:980-992. [PMID: 33461313 DOI: 10.1161/hypertensionaha.120.15882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m2) and obese (n=136; body mass index ≥30 kg/m2) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP (P<0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index (P=0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01578031.
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Affiliation(s)
- Liyue Xu
- From the Sleep Center, Peking University People's Hospital, Beijing, China (L.X.).,Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - David Maislin
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Thorarinn Gislason
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Bryndís Benediktsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.G., B.B.)
| | - Sigrun Gudmundsdóttir
- Sleep Department, Landspitali (T.G., B.B., S.G.), The National University Hospital of Iceland, Reykjavik
| | | | - Bethany Staley
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Frances M Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Xiaofeng Guo
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.F.)
| | - Jugal Chahwala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Pritika Manaktala
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Anila Hussein
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Maheshwara Reddy-Koppula
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Zeba Hashmath
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Jonathan Lee
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Raymond R Townsend
- Renal-Electrolyte and Hypertension Division (R.R.T.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Richard J Schwab
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine (L.X., B.T.K., D.M., B.S., F.M.P., X.G., R.J.S., A.I.P., S.T.K.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia.,Sleep Medicine Section, Crescenz Veterans Affairs Medical Center, Philadelphia (S.T.K.)
| | - Julio A Chirinos
- Cardiovascular Division, Department of Medicine (J.C., PM., A.H., M.R.-K., Z.H., J.L., J.A.C.), Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia
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5
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Green M, Ken-Dror G, Fluck D, Sada C, Sharma P, Fry CH, Han TS. Meta-analysis of changes in the levels of catecholamines and blood pressure with continuous positive airway pressure therapy in obstructive sleep apnea. J Clin Hypertens (Greenwich) 2020; 23:12-20. [PMID: 32970922 PMCID: PMC8030100 DOI: 10.1111/jch.14061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 12/22/2022]
Abstract
Stress from obstructive sleep apnea (OSA) stimulates catecholamine release consequently exacerbating hypertension. However, different studies have shown a conflicting impact of continuous positive airway pressure (CPAP) treatment in patients with OSA on catecholamine levels and blood pressure. We aimed to examine changes to catecholamine levels and blood pressure in response to CPAP treatment. We conducted a meta‐analysis of data published up to May 2020. The quality of the studies was evaluated using standard tools for assessing the risk of bias. Meta‐analysis was conducted using RevMan (v5.3) and expressed in standardized mean difference (SMD) for catecholamines and mean difference (MD) for systolic (SBP) and diastolic blood pressure (DBP). A total of 38 studies met our search criteria; they consisted of 14 randomized control trials (RCT) totaling 576 participants and 24 prospective cohort studies (PCS) of 547 participants. Mean age ranged between 41 and 62 year and body mass index between 27.2 and 35.1 kg/m2. CPAP treatment reduced 24‐hour urinary noradrenaline levels both in RCT (SMD = −1.1; 95% confidence interval (CI): −1.63 to − 0.56) and in PCS (SMD = 0.38 (CI: 0.24 to 0.53). SBP was also reduced by CPAP treatment in RCT (4.8 mmHg; CI: 2.0‐7.7) and in PCS (7.5 mmHg; CI: 3.3‐11.7). DBP was similarly reduced (3.0 mmHg; CI: 1.4‐4.6) and in PCS (5.1 mmHg; CI: 2.3‐8.0). In conclusion, CPAP treatment in patients with OSA reduces catecholamine levels and blood pressure. This suggests that sympathetic activity plays an intermediary role in hypertension associated with OSA‐related stress.
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Affiliation(s)
- Mackenzie Green
- Medical School, University of Glasgow, Glasgow, UK.,Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | - Gie Ken-Dror
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Charif Sada
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK
| | | | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK.,Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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6
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Jayaprakash TP, Ogbue OD, Malhotra P, Akku R, Khan S. Impact of Snoring on the Cardiovascular System and its Treatment: Positive and Negative Effects of Continuous Positive Airway Pressure in Sleep Apnea. Cureus 2020; 12:e9796. [PMID: 32821638 PMCID: PMC7431295 DOI: 10.7759/cureus.9796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common condition, and if not treated can be a significant risk factor for multiple comorbidities like hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The underlying pathophysiology involves coagulation and inflammatory pathways, including an overactive sympathetic nervous system. This ultimately causes hemodynamic changes and subclinical myocardial injuries. We reviewed the published literature about the impact of continuous positive airway pressure (CPAP) when used as a mode of treatment to reduce the OSA effects on cardiomyocytes. We found that the results were mixed, including both ill and good effects. The cardiac markers like N-terminal pro-brain natriuretic peptide (NT-proBNP) and atrial natriuretic peptide (ANP) were reduced, implying the decrease in the incidence of heart failure with CPAP treatment in a few of the studies. They also proved a significant decrease in harmful cardiovascular (CV) outcomes, while others concluded that CPAP therapy might be stressful on the heart, causing an elevation in cardiac troponin T levels. However, the impact on inflammatory markers is still indeterminate and needs more research in future.
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Affiliation(s)
| | - Olisaemeka D Ogbue
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Parul Malhotra
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.,Internal Medicine, Punjab Institute of Medical Sciences, Ludhiana, IND
| | - Radhika Akku
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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7
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Lee JC, Moon KH, Kwon T, Yang SK, Park S. Impact of adenotonsillectomy on urinary storage symptoms in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2018; 109:119-121. [PMID: 29728163 DOI: 10.1016/j.ijporl.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To prospectively evaluate the effectiveness of adenotonsillectomy on resolving urinary storage symptoms such as frequency, urgency, and urgency urinary incontinence (UUI) in indicated sleep disordered breathing (SDB) patients. METHODS We prospectively analyzed changes in storage symptoms and SDB score before and after surgery in 102 children (74 males, 28 females, mean age 8.4 ± 2.8 years) who underwent adenotonsillectomy between July 2011 and Feb 2012. Before and 3 months after surgery, all children and their parents were requested to answer a self-reported SDB scale-questionnaire (22 questions, 0-22 points) and a urinary storage symptoms questionnaire. RESULTS The prevalence of urgency in the overall patients was 31.2%. After adenotonsillectomy, prevalence of frequency and, urgency in addition to SDB score were significantly decreased (p ≦ 0.001). The prevalence of UUI was also significantly lower (11.6%-7.4%, p < 0.001). Patients with urgency had a significantly higher SDB score than those without (11.4 ± 4.3 vs. 7.8 ± 4.0, p < 0.001). After treatment, there was no difference between these two groups. CONCLUSION Adenotonsillectomy markedly improved both SDB score and decreased the prevalence of voiding symptoms (frequency, urgency, and UUI). There was a strong correlation between preoperative SDB score and severity of urgency in children with SDB.
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Affiliation(s)
- Jong Cheol Lee
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seong Kyeong Yang
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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8
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Poonit ND, Cai XH. The relation and mechanism of kidney injury in obstructive sleep apnea: a literature review. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0146-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Chang YS, Yee BJ, Hoyos CM, Wong KK, Sullivan DR, Grunstein RR, Phillips CL. The effects of continuous positive airway pressure therapy on Troponin-T and N-terminal pro B-type natriuretic peptide in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med 2017; 39:8-13. [DOI: 10.1016/j.sleep.2017.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/24/2017] [Accepted: 08/05/2017] [Indexed: 11/26/2022]
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10
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Hamasaki H, Katsuyama H, Sako A, Yanai H. Short sleep duration is associated with B-type natriuretic peptide levels and predicts the death of Japanese patients with type 2 diabetes. Sleep Med 2017; 36:1-5. [DOI: 10.1016/j.sleep.2017.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) and may confer significant stress to the cardiovascular system and increases the risk for future cardiovascular events. The present review will provide updates on the current understanding of the relationship of SDB and common HF biomarkers and the effect of positive airway pressure therapy on these biomarkers, with particular emphasis in patients with coexisting SDB and HF. RECENT FINDINGS Prior studies have examined the relationship between HF biomarkers and SDB, and the effect of SDB treatment on these biomarkers, with less data available in the context of coexisting SDB and HF. Overall, however, the association of SDB and circulating biomarkers has been inconsistent. Further research is needed to elucidate the relationship between biomarkers and SDB in HF, to evaluate the clinical utility of biomarkers over standard methods in large, prospective studies and also to assess the impact of treatment of SDB on these biomarkers in HF via interventional studies.
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Affiliation(s)
- Ying Y Zhao
- Sleep Care Solutions, 1835 Yonge Street, Suite 303, Toronto, Ontario, M4S 1X8, Canada.
| | - Reena Mehra
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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12
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Mentek M, Aptel F, Godin-Ribuot D, Tamisier R, Pepin JL, Chiquet C. Diseases of the retina and the optic nerve associated with obstructive sleep apnea. Sleep Med Rev 2017; 38:113-130. [PMID: 29107469 DOI: 10.1016/j.smrv.2017.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
Many associations between ocular disorders and obstructive sleep apnea (OSA) have been studied, such as nonarteritic anterior ischemic optic neuropathy, glaucoma, papilledema, retinal vein occlusion, eyelid hyperlaxity, lower-eyelid ectropion and recurrent corneal erosions. The objective of this review is to synthetize the possible vascular disorders of the retina and the optic nerve associated with sleep apnea patients and to discuss the underlying pathophysiological hypotheses. Main mechanisms involved in the ocular complications of OSA are related to intermittent hypoxia, sympathetic system activation, oxidant stress, and deleterious effects of endothelin 1. The main evidence-based medicine data suggest that OSA should be screened in patients with ischemic optic neuropathy and diabetic retinopathy. The effect of OSA treatment and emerging therapies are discussed.
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Affiliation(s)
- Marielle Mentek
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Florent Aptel
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France
| | - Diane Godin-Ribuot
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Jean-Louis Pepin
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Christophe Chiquet
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France.
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Strehmel R, Valo M, Teupe C. Natriuretic Peptide and High-Sensitive Troponin T Concentrations Correlate with Effectiveness of Short-Term CPAP in Patients with Obstructive Sleep Apnea and Coronary Artery Disease. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 10:33-39. [PMID: 27980444 PMCID: PMC5154737 DOI: 10.4137/ccrpm.s40939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/08/2016] [Accepted: 11/20/2016] [Indexed: 11/05/2022]
Abstract
The risk of cardiovascular complications is increased in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the most effective way to treat clinically significant OSA. We hypothesized that the concentrations of the cardiac risk markers N-terminal brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TropT) correlate with the effectiveness of CPAP therapy in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with severe OSA and coexisting CAD (group 1) and 20 control patients with severe OSA alone (group 2) were treated with CPAP and monitored by laboratory-based polysomnography. NT-proBNP and hs-TropT levels were measured before and after CPAP. Apnea-hypopnea index (AHI) and oxygen desaturation were similar in both groups. In group 1, hs-TropT levels correlated with AHI and oxygen desaturation upon CPAP. Elevated NT-proBNP levels in group 1 were significantly reduced by CPAP. NT-proBNP levels correlated with AHI and showed negative correlation with ST-segment depression. No such correlations were found in group 2. CPAP has the potential to normalize elevated NT-proBNP serum levels in patients with severe OSA and coexisting CAD. Levels of NT-proBNP and hs-TropT correlated with AHI and oxygen desaturation.
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Affiliation(s)
- Ralf Strehmel
- Department of Medicine, Center of Sleep Medicine, Krankenhaus Sachsenhausen, Frankfurt, Germany
| | - Misa Valo
- Department of Medicine, Center of Sleep Medicine, Krankenhaus Sachsenhausen, Frankfurt, Germany
| | - Claudius Teupe
- Department of Medicine, Center of Sleep Medicine, Krankenhaus Sachsenhausen, Frankfurt, Germany.; Department of Medicine - Cardiology, Krankenhaus Sachsenhausen, Frankfurt, Germany
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Aziz F, Chaudhary K. The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology. Cardiorenal Med 2016; 7:74-82. [PMID: 27994605 DOI: 10.1159/000450796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/05/2016] [Indexed: 01/07/2023] Open
Abstract
Obstructive sleep apnea (OSA), hypertension, and chronic kidney disease (CKD) are different entities and are generally managed individually most of the time. However, CKD, OSA, and hypertension share many common risk factors and it is not uncommon to see this complex triad together. In fact, they share similar pathophysiology and have been interlinked with each other. The common pathophysiology includes chronic volume overload, hyperaldosteronism, increased sympathetic activity, endothelial dysfunction, and increased inflammatory markers. The combination of this triad has significant negative impact on the cardiovascular health, and increases the mortality and morbidity in this complicated group of patients. On one hand, progression of CKD can lead to the worsening of OSA and hypertension; similarly, worsening sleep apnea can make the hypertension difficult to treat and enhance the progression of CKD. This review article highlights the bidirectional interlink among these apparently different disease processes which share common pathophysiological mechanisms and emphasizes the importance of treating them collectively to improve outcomes.
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Affiliation(s)
- Fahad Aziz
- Division of Nephrology, University of Missouri Health Science Center, Columbia, MO, USA
| | - Kunal Chaudhary
- Division of Nephrology, University of Missouri Health Science Center, Columbia, MO, USA; Nephrology Section, Harry S. Truman Veterans' Hospital, Columbia, MO, USA
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15
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The effect of surgical and non-surgical weight loss on N-terminal pro-B-type natriuretic peptide and its relation to obstructive sleep apnea and pulmonary function. BMC Res Notes 2016; 9:440. [PMID: 27619215 PMCID: PMC5020450 DOI: 10.1186/s13104-016-2241-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022] Open
Abstract
Background Obesity is a major risk factor for obstructive sleep apnea, impaired pulmonary function and heart failure, but obesity is also associated with paradoxically low levels of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). In subjects with severe obesity undergoing weight loss treatment, we assessed the associations between changes in severity of obstructive sleep apnea, pulmonary function and serum NT-proBNP levels. Methods One-year non-randomized controlled clinical trial. Participants, 69.6 % women, mean (SD) age 44.6 (10.8) years and body mass index (BMI) 45.1 (5.6) kg/m2, underwent gastric bypass surgery (n = 76) or intensive lifestyle intervention (n = 63), resulting in 30 (8) % and 8 (9) % weight loss, respectively. The reference group included 30 normal weight, healthy, gender and age matched controls. Sleep recordings, arterial blood gases, pulmonary function and blood tests were assessed before and 1 year after the interventions. Results NT-proBNP concentrations increased significantly more after surgery than after lifestyle intervention. The post intervention values in both groups were significantly higher than in a normal weight healthy reference group. In the whole study population changes (∆) in NT-proBNP correlated significantly with changes in both BMI (r = −0.213) and apnea hypopnea index (AHI, r = −0.354). ∆NT-proBNP was, independent of age, gender and ∆BMI, associated with ∆AHI (beta −0.216, p = 0.021). ∆AHI was, independent of ∆BMI, significantly associated with changes in pO2 (beta −0.204), pCO2 (beta 0.199), forced vital capacity (beta −0.168) and forced expiratory volume first second (beta −0.160). Conclusions Gastric bypass surgery was associated with a greater increase in NT-proBNP concentrations than non-surgical weight loss treatment. Reduced AHI was, independent of weight loss, associated with increased NT-proBNP levels and improved dynamic lung volumes and daytime blood gases. Clinical Trial Registration ClinicalTrials.gov NCT00273104, retrospectively registered Jan 5, 2006 (study start Dec 2005) Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2241-x) contains supplementary material, which is available to authorized users.
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Maeder MT, Mueller C, Schoch OD, Ammann P, Rickli H. Biomarkers of cardiovascular stress in obstructive sleep apnea. Clin Chim Acta 2016; 460:152-63. [DOI: 10.1016/j.cca.2016.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
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Msaad S, Marrakchi R, Grati M, Gargouri R, Kammoun S, Jammoussi K, Yangui I. How does serum brain natriuretic peptide level change under nasal continuous positive airway pressure in obstructive sleep apnea-hypopnea syndrome? Libyan J Med 2016; 11:31673. [PMID: 27581116 PMCID: PMC5007247 DOI: 10.3402/ljm.v11.31673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with cardiovascular morbidity and mortality, which can be improved by using continuous positive airway pressure (CPAP) therapy. However, the pathophysiological links between the two kinds of disease and the mechanism of the CPAP effect remain incompletely understood. We aimed to inquire into the myocardial involvement in this relationship. We suggested that serum brain natriuretic peptide (BNP) is sensitive enough to detect myocardial stress caused by OSAHS. DESIGN AND METHODS Sixty-four subjects without cardiovascular disease (21 controls, 24 normotensive OSAHS patients, and 19 hypertensive OSAHS patients) were analyzed for serum BNP at baseline and serially over 6 months. CPAP was applied to 23 patients with severe OSAHS. RESULTS At baseline, the serum BNP levels were significantly higher (p=0.0001) in the OSAHS group (22.3±14.79 pg/ml) than in the control group (9.2±6.75 pg/ml). Increased serum BNP levels were significantly associated with mean transcutaneous oxygen saturation (SpO2) (p<0.0001), minimal SpO2 (p=0.002), oxygen desaturation index (p=0.001), and total sleep time spent with SpO2 lower than 90% (p=0.002). All patients with elevated BNP levels (≥37 pg/ml) had moderate or severe OSAHS (11/43 OSAHS patients). The more severe the OSAHS, the higher the BNP levels were. However, only the difference between severe and mild OSAHS was statistically significant (p=0.029). Hypertensive OSAHS patients had the highest baseline BNP levels (27.7±16.74 pg/ml). They were significantly higher (p=0.001) than in normotensive OSAHS patients (18±11.72 pg/ml) (p=0.039) and the controls (9.2±6.75 pg/ml). As compared with baseline, treatment with CPAP significantly decreased BNP levels in both hypertensive and normotensive OSAHS patients (respectively, from 36±16.10 to 29.7±14.29 pg/ml, p<0.001, and from 20±10.09 to 16±8.98 pg/ml, p<0.001). In contrast, the BNP levels slightly increased in the controls (from 9.2±6.75 to 9.5±7.02 pg/ml, p=0.029), but there was no statistically significant difference in comparison with the baseline value. The effect of CPAP on BNP levels was more marked in patients with higher baseline BNP levels and those with the most prolonged nocturnal desaturation (p=0.001, r=0.65). It was also more marked in hypertensive OSHAS patients (p=0.015, r=0.72) in comparison with normotensive OSAHS patients (p=0.03, r=0.62). CONCLUSION BNP seems to be sensitive enough to detect myocardial stress caused by OSAHS. As such, it is a potential marker for screening of preclinical cardiovascular damage in patients with untreated OSAHS. Application of CPAP decreases levels significantly in normotensive and particularly in hypertensive OSAHS. These findings are consistent with previous results suggesting the potential benefits of CPAP on cardiovascular outcome in OSAHS patients.
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Affiliation(s)
- Sameh Msaad
- Department of Respiratory and Sleep Diseases, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia;
| | - Rim Marrakchi
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Biochemistry Department, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
| | - Malek Grati
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Biochemistry Department, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
| | - Rahma Gargouri
- Department of Respiratory and Sleep Diseases, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Samy Kammoun
- Department of Respiratory and Sleep Diseases, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Kamel Jammoussi
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Biochemistry Department, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
| | - Ilhem Yangui
- Department of Respiratory and Sleep Diseases, Hedi Chaker University Hospital of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Niimi A, Suzuki M, Yamaguchi Y, Ishii M, Fujimura T, Nakagawa T, Fukuhara H, Kume H, Igawa Y, Akishita M, Homma Y. Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria. J Urol 2016; 196:1183-9. [PMID: 27105762 DOI: 10.1016/j.juro.2016.04.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We investigated the relationships among nocturnal polyuria, sleep apnea and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. MATERIALS AND METHODS We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-hour frequency-volume chart. Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. Frequency-volume chart data were analyzed in 22 patients after continuous positive airway pressure therapy. RESULTS Patients with nocturnal polyuria showed a higher apnea-hypopnea index (33.9 vs 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (0.22 vs -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in patients 65 years old or older than in those 64 years or younger. A multivariate linear regression model showed an independent relationship of nocturnal polyuria with the apnea-hypopnea index and the circadian change in extracellular fluid adjusted to lean body mass (p = 0.0012 and 0.022, respectively). Continuous positive airway pressure therapy significantly improved nocturnal polyuria and nocturia only in patients with nocturnal polyuria. CONCLUSIONS This study identified sleep apnea and the circadian change in extracellular fluid as independent factors for nocturnal polyuria.
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Affiliation(s)
- Aya Niimi
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Yasuhiro Yamaguchi
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Masaki Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Valo M, Wons A, Moeller A, Teupe C. Markers of Myocardial Ischemia in Patients With Coronary Artery Disease and Obstructive Sleep Apnea: Effect of Continuous Positive Airway Pressure Therapy. Clin Cardiol 2015; 38:462-8. [PMID: 26175232 DOI: 10.1002/clc.22419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/24/2015] [Accepted: 03/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular complications. OSA and coronary artery disease (CAD) share the same risk factors and coexist in many patients. In previous studies, repeated nocturnal cardiac ischemic events in OSA patients with CAD have been reported. HYPOTHESIS We hypothesized that OSA may precipitate myocardial ischemia, evidenced by ST-segment depression and elevated N-terminal brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TropT) levels in patients with severe OSA and concomitant CAD. We also aimed to evaluate if the effects could be reversed by continuous positive airway pressure (CPAP) therapy. METHODS Twenty-one patients with severe OSA (apnea-hypopnea index >15/h, nadir oxygen desaturation ≤ 80%), and coexisting CAD underwent in-hospital polysomnography at baseline and under CPAP. Blood samples for hs-TropT and NT-proBNP measurements were drawn prior and immediately after sleep. ST-segment depression was measured at the time of maximum oxygen desaturation during sleep. RESULTS CPAP significantly decreased elevated NT-proBNP levels from 475 ± 654 pg/mL before sleep to 353 ± 573 pg/mL after sleep and attenuated ST-segment depression during sleep. hs-TropT was not elevated and did not differ after nocturnal oxygen desaturation at baseline and after CPAP. CONCLUSIONS CPAP significantly reduced NT-proBNP in patients suffering from severe OSA and coexisting CAD. Repeated nocturnal myocardial ischemia did not cause myocyte necrosis evidenced by elevated hs-TropT or ST-segment depression.
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Affiliation(s)
- Misa Valo
- Department of Medicine, Center of Sleep Medicine, Sachsenhausen Hospital, Frankfurt, Germany
| | - Annette Wons
- Department of Medicine, Center of Sleep Medicine, Sachsenhausen Hospital, Frankfurt, Germany
| | - Albert Moeller
- Department of Medicine, Center of Sleep Medicine, Sachsenhausen Hospital, Frankfurt, Germany
| | - Claudius Teupe
- Department of Medicine, Center of Sleep Medicine, Sachsenhausen Hospital, Frankfurt, Germany
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Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease. Pulm Med 2015; 2015:621450. [PMID: 26090222 PMCID: PMC4451285 DOI: 10.1155/2015/621450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T) and B-type natriuretic peptide (NT-proBNP) in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI), oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.
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Bladder Oxidative Stress in Sleep Apnea Contributes to Detrusor Instability and Nocturia. J Urol 2015; 193:1692-9. [DOI: 10.1016/j.juro.2014.11.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/21/2022]
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Use of continuous positive airway pressure for sleep apnea in the treatment of hypertension. Curr Opin Nephrol Hypertens 2015; 23:462-7. [PMID: 24992567 DOI: 10.1097/mnh.0000000000000047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) and hypertension are highly prevalent and treatable conditions that often coexist and both contribute to an increased cardiovascular risk. The ability of continuous positive airway pressure (CPAP) to improve blood pressure in hypertensive patients with OSA is debated. This review highlights findings from recent studies that have investigated the impact of CPAP on blood pressure in patients with OSA. RECENT FINDINGS Comparing the results of various studies is complicated by important methodological differences among them. In hypertensive patients with OSA, treatment with CPAP improves blood pressure to a smaller degree than that derived from antihypertensive medication. Patients with more severe OSA and with greater adherence to CPAP are likely to gain the most benefit from the therapy. SUMMARY CPAP should be used in combination with antihypertensive medications in hypertensive patients with OSA. CPAP has the additional benefits of restoring nocturnal dipping and improving arterial stiffness, thus potentially influencing cardiovascular morbidity in these high-risk patients.
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What can blood biomarkers tell us about cardiovascular risk in obstructive sleep apnea? Sleep Breath 2015; 19:755-68. [DOI: 10.1007/s11325-015-1143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/01/2015] [Accepted: 02/08/2015] [Indexed: 12/31/2022]
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Efficacy of Positive Airway Pressure on Brain Natriuretic Peptide in Patients with Heart Failure and Sleep-Disorder Breathing: A Meta-analysis of Randomized Controlled Trials. Lung 2015; 193:255-60. [DOI: 10.1007/s00408-015-9684-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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Abstract
Nocturia is a bothersome symptom that increases with age, resulting in sleep disruption, an increased risk of falls, and a greater likelihood of rating one's health as poor. It is often a symptom of conditions that cause low volume voiding, overproduction of urine across the day or only at night and a symptom of a sleep disorder. Nocturia affects quality of life and has an impact on aging in place, thus assessment and treatment are essential. Behavioral treatments should be explored first, keeping in mind what the affected older adult defines as the desired outcomes of treatment.
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Querejeta Roca G, Redline S, Punjabi N, Claggett B, Ballantyne CM, Solomon SD, Shah AM. Sleep apnea is associated with subclinical myocardial injury in the community. The ARIC-SHHS study. Am J Respir Crit Care Med 2014; 188:1460-5. [PMID: 24156237 DOI: 10.1164/rccm.201309-1572oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality, although the underlying mechanisms are not well understood. OBJECTIVES We aimed to determine whether more severe OSA, measured by the Respiratory Disturbance Index (RDI), is associated with subclinical myocardial injury and increased myocardial wall stress. METHODS A total of 1,645 participants (62.5 ± 5.5 yr and 54% women) free of coronary heart disease and heart failure and participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies underwent overnight polysomnography and measurement of high-sensitivity troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP). MEASUREMENTS AND MAIN RESULTS OSA severity was defined using conventional clinical categories: none (RDI ≤ 5), mild (RDI 5-15), moderate (RDI 15-30), and severe (RDI > 30). Hs-TnT, but not NT-proBNP, was associated with OSA after adjusting for 17 potential confounders (P = 0.02). Over a median of 12.4 (interquartile range, 11.6-13.1) years follow-up, hs-TnT was related to risk of death or incident heart failure in all OSA categories (P ≤ 0.05 in each category). CONCLUSIONS In middle-aged to older individuals, OSA severity is independently associated with higher levels of hs-TnT, suggesting that subclinical myocardial injury may play a role in the association between OSA and risk of heart failure. OSA was not associated with NT-proBNP levels after adjusting for multiple possible confounders.
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Ozkok A, Kanbay A, Odabas AR, Covic A, Kanbay M. Obstructive sleep apnea syndrome and chronic kidney disease: a new cardiorenal risk factor. Clin Exp Hypertens 2014; 36:211-6. [DOI: 10.3109/10641963.2013.804546] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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28
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Li AM, Au CT, Zhu JY, Chan KCC, Chan MHM, Lee DLY, Wing YK. Plasma natriuretic peptides in children and adolescents with obstructive sleep apnea and their changes following intervention. Front Pediatr 2014; 2:22. [PMID: 24716190 PMCID: PMC3970031 DOI: 10.3389/fped.2014.00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/10/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate circulating natriuretic peptides (NP) concentration in obese and non-obese children and adolescents with and without obstructive sleep apnea (OSA), and their levels following OSA treatment. METHODS Subjects with habitual snoring and symptoms suggestive of OSA were recruited. They underwent physical examination and overnight polysomnography (PSG). OSA was diagnosed if obstructive apnea-hypopnea index (OAHI) was ≥1/h. Fasting serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were taken after overnight PSG. The subjects were divided into obese, non-obese, with and without OSA groups for comparisons. RESULTS One hundred fourteen children (77 were boys) with a median [interquartile range (IQR)] age of 10.8 (8.3-12.7) years (range: 2.4-11.8 years) were recruited. Sixty-eight subjects were found to have OSA. NP levels did not differ between subjects with and without OSA in both obese and non-obese groups. Stepwise multiple linear regressions revealed that body mass index (BMI) z-score was the only independent factor associated with NP concentrations. Fifteen children with moderate-to-severe OSA (OAHI >5/h) underwent treatment and there were no significant changes in both ANP and BNP levels after intervention. CONCLUSION Body mass index rather than OSA was the main determinant of NP levels in school-aged children and adolescents.
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Affiliation(s)
- Albert Martin Li
- Department of Paediatrics, The Chinese University of Hong Kong , Hong Kong , China
| | - Chun Ting Au
- Department of Paediatrics, The Chinese University of Hong Kong , Hong Kong , China
| | - Jodie Y Zhu
- Department of Paediatrics, The Chinese University of Hong Kong , Hong Kong , China
| | | | - Michael Ho Ming Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong , Hong Kong , China
| | - Dennis Lip Yen Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong , Hong Kong , China
| | - Yun Kwok Wing
- Department of Psychiatry, Shatin Hospital, The Chinese University of Hong Kong , Hong Kong , China
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White LH, Bradley TD. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol 2013; 591:1179-93. [PMID: 23230237 PMCID: PMC3607865 DOI: 10.1113/jphysiol.2012.245159] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/06/2012] [Indexed: 12/25/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is common in the general population and increases the risk of motor vehicle accidents due to hypersomnolence from sleep disruption, and risk of cardiovascular diseases owing to repetitive hypoxia, sympathetic nervous system activation, and systemic inflammation. In contrast, central sleep apnoea (CSA) is rare in the general population. Although their pathogenesis is multifactorial, the prevalence of both OSA and CSA is increased in patients with fluid retaining states, especially heart failure, where they are associated with increased mortality risk. This observation suggests that fluid retention may contribute to the pathogenesis of both OSA and CSA. According to this hypothesis, during the day fluid accumulates in the intravascular and interstitial spaces of the legs due to gravity, and upon lying down at night redistributes rostrally, again owing to gravity. Some of this fluid may accumulate in the neck, increasing tissue pressure and causing the upper airway to narrow, thereby increasing its collapsibility and predisposing to OSA. In heart failure patients, with increased rostral fluid shift, fluid may additionally accumulate in the lungs, provoking hyperventilation and hypocapnia, driving below the apnoea threshold, leading to CSA. This review article will explore mechanisms by which overnight rostral fluid shift, and its prevention, can contribute to the pathogenesis and therapy of sleep apnoea.
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Affiliation(s)
- Laura H White
- Department of Medicine, University Health Network Toronto General Hospital, Rehabilitation Institute, University of Toronto, Ontario, Canada
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Ljunggren M, Lindahl B, Theorell-Haglöw J, Lindberg E. Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women. Sleep 2012; 35:1521-7. [PMID: 23115401 DOI: 10.5665/sleep.2202] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. One contributory factor may be hemodynamic stress due to the negative intrathoracic pressure during each episode of apnea. Type B natriuretic peptide (BNP) is secreted by the cardiac ventricles in response to volume expansion and pressure load and the authors hypothesized that there would be an association between indices of OSA during the night and levels of BNP in the morning. SETTING Community-based in Uppsala, Sweden. PARTICIPANTS There were 349 women who participated. MEASUREMENTS AND RESULTS Participants underwent full-night polysomnography and anthropometric measurements, and answered questionnaires about medical conditions and current medication. The morning after the polysomnography, blood samples were drawn for analysis of plasma BNP, C-reactive protein, creatinine, and hemoglobin. There was an increase in mean BNP as the severity of sleep apnea increased, increasing from a mean value of 8.5 ng/L among women with an apnea-hypopnea index (AHI) < 5 to 18.0 ng/L in women with an AHI ≥ 30. Elevated BNP levels (≥ 20 ng/L) were found in 29.8% of the women, whereas 70.2% had normal levels. The odds ratio was 2.2 for elevated BNP levels for women with an AHI of 5-14.9 in relation to women with an AHI < 5, 3.1 for women with an AHI of 15-29.9, and 4.6 for women with an AHI ≥ 30 after adjustment for age, body mass index, systolic blood pressure, antihypertensive drugs, and creatinine. CONCLUSIONS There is a dose-response relationship in women between the severity of sleep apnea during the night and the levels of BNP in the morning.
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Affiliation(s)
- Mirjam Ljunggren
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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Abstract
The majority of patients with obstructive sleep apnea (OSA) suffer from hypertension as a complication of both the metabolic syndrome and OSA. In animal studies, intermittent hypoxia that simulates changes seen in OSA leads to chemoreceptor and chromaffin cell stimulation of sympathetic nerve activity, endothelial damage and impaired blood pressure modulation. Human studies reveal activation of sympathetic nerves, endothelial damage and exaggerated pressor responses to sympathetic neurotransmitters and endothelin. Although treatment of the OSA normalizes sympathetic nerve responses, it only lowers blood pressure modestly. Agents that block the consequences of sympathetic over activity, such as β1 blockers and angiotensin antagonists have effectively lowered blood pressure. Diuretics have been less successful. Treatment of hypertensive patients with OSA usually requires consideration of both increased sympathetic nerve activity and the metabolic syndrome.
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Affiliation(s)
- Michael G Ziegler
- University of California, San Diego, Medical Center, Department of Medicine, 200 West Arbor Drive, San Diego, CA 92103-8341, USA
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Waters P, Hack MA, Richards J, Penney MD. Quantitating nocturia: a study into the recording of solute and water excretion to determine causation. Ann Clin Biochem 2011; 48:321-6. [PMID: 21670093 DOI: 10.1258/acb.2011.010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nocturia is common but the clinical assessment of its severity and cause rarely involves any biochemical analysis. Investigating the cause of nocturia needs to be informed by the overall 24 h fluid and solute excretion patterns. The aim of this study was to establish a practical method of monitoring the renal excretion of water and solutes over a complete 24 h cycle. METHODS The excretion patterns of sodium, volume and osmoles were assessed in 89 healthy control subjects over a 24 h period by sampling each voiding from the 24 h collection and then using the total urine creatinine as the denominator. A group of 21 patients under investigation for sleep-disordered breathing (SDB: a group of disorders known to increase the risk of nocturia) were also studied to determine comparative excretion patterns. RESULTS Reference excretion patterns of sodium, volume and osmoles were described. Patients under investigation for SDB had overall a significant (P < 0.001) increase in urine sodium excretion at night (nocturnal natriuresis) matched by an increased osmotic excretion and accompanied by a significantly increased nocturnal urine volume (P < 0.001). CONCLUSION Breaking down a 24 h urine collection into voided aliquots provides practical information on the pattern of water and solute excretion. Such patterns may assist in identifying the underlying mechanism of significant nocturia in individual patients presenting with this symptom, and could be used as a method of monitoring treatment.
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Affiliation(s)
- Philip Waters
- Department of Clinical Biochemistry, Royal Gwent Hospital, Newport NP20 2UB, UK
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Kaditis AG, Alexopoulos EI, Evangelopoulos K, Kostadima E, Varlami V, Boultadakis E, Liakos N, Zakynthinos E, Zintzaras E, Gourgoulianis K. Correlation of urinary excretion of sodium with severity of sleep-disordered breathing in children: a preliminary study. Pediatr Pulmonol 2010; 45:999-1004. [PMID: 20648668 DOI: 10.1002/ppul.21285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nocturnal urinary sodium excretion is related to blood pressure (BP) levels. Elevated BP and increased nocturnal natriuresis have been demonstrated in adults with sleep apnea. Although evidence indicates increased BP in children with obstructive sleep-disordered breathing (SDB), it is unknown whether these children have also enhanced urinary sodium excretion. OBJECTIVE To evaluate the effects of SDB and morning BP on urinary sodium excretion. METHODS Consecutive children with snoring (n = 95) underwent polysomnography and morning BP measurement. Fractional excretion of sodium (FE(Na)) was the primary outcome measure and was calculated using sodium and creatinine concentrations in early morning serum and urine specimens. RESULTS Subjects with moderate-to-severe SDB had similar log-transformed FE(Na) to that of children with mild SDB and higher than children with primary snoring: -0.13 ± 0.53 versus -0.28 ± 0.41 versus -0.61 ± 0.65 (P = 0.657 and P = 0.003). Obstructive apnea-hypopnea index was significantly related to FE(Na) after adjustment for age, gender and body mass index z-score (P = 0.002). Children with moderate-to-severe SDB had similar systolic BP z-scores to those of subjects with mild SDB and higher than participants with primary snoring: 0.7 ± 1.2 versus 0.1 ± 1.0 versus -0.02 ± 1.0 (P = 0.074 and P = 0.046). In addition, participants with diastolic BP z-scores in the upper quartile of measured values had higher FE(Na) than subjects with z-scores in the lower quartiles: -0.08 ± 0.39 versus -0.41 ± 0.57 (P = 0.007). CONCLUSIONS Morning natriuresis is related to severity of SDB in children and this association may be mediated in part by elevated BP.
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Affiliation(s)
- Athanasios G Kaditis
- Sleep Disorders Laboratory, University of Thessaly School of Medicine, Larissa, Greece.
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Gottlieb JD, Schwartz AR, Marshall J, Ouyang P, Kern L, Shetty V, Trois M, Punjabi NM, Brown C, Najjar SS, Gottlieb SS. Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure. J Am Coll Cardiol 2009; 54:1706-12. [PMID: 19850211 DOI: 10.1016/j.jacc.2009.08.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/26/2009] [Accepted: 08/30/2009] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study was conducted to evaluate whether brain (B-type) natriuretic peptide (BNP) changes during sleep are associated with the frequency and severity of apneic/hypopneic episodes, intermittent arousals, and hypoxia. BACKGROUND Sleep apnea is strongly associated with heart failure (HF) and could conceivably worsen HF through increased sympathetic activity, hemodynamic stress, hypoxemia, and oxidative stress. If apneic activity does cause acute stress in HF, it should increase BNP. METHODS Sixty-four HF patients with New York Heart Association functional class II and III HF and ejection fraction <40% underwent a baseline sleep study. Five patients with no sleep apnea and 12 with severe sleep apnea underwent repeat sleep studies, during which blood was collected every 20 min for the measurement of BNP. Patients with severe sleep apnea also underwent a third sleep study with frequent BNP measurements while they were administered oxygen. This provided 643 observations with which to relate apnea to BNP. The association of log BNP with each of 6 markers of apnea severity was evaluated with repeated measures regression models. RESULTS There was no relationship between BNP and the number of apneic/hypopneic episodes or the number of arousals. However, the burden of hypoxemia (the time spent with oxygen saturation <90%) significantly predicted BNP concentrations; each 10% increase in duration of hypoxemia increased BNP by 9.6% (95% confidence interval: 1.5% to 17.7%, p = 0.02). CONCLUSIONS Hypoxemia appears to be an important factor that underlies the impact of sleep abnormalities on hemodynamic stress in patients with HF. Prevention of hypoxia might be especially important for these patients.
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Cifçi N, Uyar M, Elbek O, Süyür H, Ekinci E. Impact of CPAP treatment on cardiac biomarkers and pro-BNP in obstructive sleep apnea syndrome. Sleep Breath 2009; 14:241-4. [PMID: 19813037 DOI: 10.1007/s11325-009-0306-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/22/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of continuous positive airway pressure (CPAP) therapy on pro-brain natriuretic peptide (BNP) and cardiac markers in patients with obstructive sleep apnea syndrome and normal cardiac function. METHODS Thirty-three consecutive patients with sleep apnea syndrome were analysed for serum pro-BNP and cardiac markers prior to and after 6 months of CPAP therapy. RESULTS Twenty five patients had normal (83.3%) while remaining five (16.7%) revealed high pro-BNP values. We did not detect any significant difference between severity of obstructive sleep apnea syndrome and serum pro-BNP levels (p = 0.534). A statistically significant difference was not observed between basal and sixth-month creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I, pro-BNP, aspartate transaminase (AST), and CK levels in patients with sleep apnea syndrome (p > 0.05). CONCLUSION Obstructive sleep apnea syndrome does not induce myocardial damage enough to increase serum pro-BNP, CK, CK-MB, troponin I, and AST levels. Markers sensitive to ischemia could be preferred to evaluate effect of obstructive sleep apnea syndrome.
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Affiliation(s)
- Nilüfer Cifçi
- Department of Pulmonary Diseases, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
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Gjørup PH, Sadauskiene L, Wessels J, Nyvad O, Strunge B, Pedersen EB. Increased nocturnal sodium excretion in obstructive sleep apnoea. Relation to nocturnal change in diastolic blood pressure. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 68:11-21. [DOI: 10.1080/00365510701352020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sinha AM, Bauer A, Skobel EC, Markus KU, Ritscher G, Noelker G, Breithardt OA, Brachmann J, Stellbrink C. Long-term effects of dynamic atrial overdrive pacing on sleep-related breathing disorders in pacemaker or cardioverter defibrillator recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S219-22. [PMID: 19250100 DOI: 10.1111/j.1540-8159.2008.02289.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Sleep-related breathing disorders occur in 20-30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS. METHODS Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON-OFF (group A) or OFF-ON (group B) and the apnea-hypopnea index (AHI) was measured. RESULTS Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 +/- 10 years, body mass index 28.9 +/- 6.5 kg/m(2), left ventricular ejection fraction = 38.3 +/- 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule. CONCLUSIONS The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.
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Fernández Fabrellas E, Almenar Bonet L, Ponce Pérez S, Moro López JA, Blanquer Olivas R, Salvador Sanz A. [Usefulness of the N-terminal fraction of brain natriuretic peptide for deciding when to refer patients with sleep apnea-hypopnea syndrome to the cardiologist]. Arch Bronconeumol 2009; 45:173-80. [PMID: 19304363 DOI: 10.1016/j.arbres.2008.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 09/21/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE When sleep apnea-hypopnea syndrome (SAHS) and cardiovascular disease occur concurrently, prognosis is affected. Echocardiography can detect structural cardiac abnormalities but using this technique in all patients would place a heavy burden on resources. The objective of this study was to investigate whether the N-terminal fraction of brain natriuretic peptide (NT-proBNP) can be used as a marker for silent heart disease. PATIENTS AND METHODS NT-proBNP concentration was measured in the 114 consecutive patients with SAHS who underwent echocardiography before starting treatment. Left and right ventricular systolic and diastolic function, as well as structural abnormalities, were studied. Correlations between NT-proBNP concentration and the abnormalities detected were investigated. A receiver operating characteristics (ROC) curve was plotted for NT-proBNP concentration and cardiac abnormalities. RESULTS Data for 98 patients were finally analyzed. NT-proBNP concentration was significantly correlated with ventricular septal thickness (r=0.63), posterior wall thickness (r=0.45), and left ventricular end-diastolic diameter (r=0.51) (P<.0001 for all correlations). The area under the ROC curve was significant (0.870; 95% confidence interval, 0.801-0.939; P<.0001). Assuming that specificity would be more useful for clinical practice, we calculated that NT-proBNP concentrations below 100 and 200 pg/mL could rule out structural abnormalities with a reliability of 90% and 100%, respectively. CONCLUSIONS NT-proBNP concentration was strongly correlated with echocardiographic abnormalities and so could be a useful tool for identifying patients who should be referred to the cardiologist.
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Hyperviscosity as a possible cause of positive acoustic evoked potential findings in patients with sleep apnea: A dual electrophysiological and hemorheological study. Sleep Med 2009; 10:361-7. [DOI: 10.1016/j.sleep.2008.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 01/30/2008] [Accepted: 03/16/2008] [Indexed: 11/19/2022]
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Zakynthinos E, Kiropoulos T, Gourgoulianis K, Filippatos G. Diagnostic and prognostic impact of brain natriuretic peptide in cardiac and noncardiac diseases. Heart Lung 2008; 37:275-85. [PMID: 18620103 DOI: 10.1016/j.hrtlng.2007.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 05/14/2007] [Accepted: 05/14/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cardiac secretion of brain natriuretic peptide (BNP) increases with the progression of congestive heart failure (CHF). The plasma measurement of BNP emerged recently as a useful, cost-effective biomarker for the diagnosis and prognosis of CHF. METHODS BNP assay is useful for evaluating patients with acute dyspnea, because a low level can help rule out CHF in primary care settings and reduce the demand for echocardiography. Equally, BNP level can be particularly useful in recognizing heart failure in a patient with acute dyspnea and a history of chronic obstructive pulmonary disease. RESULTS However, although the clinical use of BNP as a biomarker in CHF is increasing, the specificity of BNP in CHF is not strong, suggesting that other mechanisms beyond simple ventricular stretch stimulate BNP release. Multiple disorders in the intensive care unit, apart from CHF, cause elevated BNP levels, including cardiovascular disease states such as ischemia, arrhythmias, cardiac hypertrophy, and coronary endothelial dysfunction, as well as disorders of no cardiac origin, such as sepsis, septic shock, and acute respiratory distress syndrome. Moreover, the impact of increased BNP in patients with sepsis is not clear. The relationship between BNP and both left ventricular ejection fraction and left-sided filling pressures is weak, and data on the prognostic impact of high BNP levels in patients with sepsis are conflicting. CONCLUSION Nevertheless, this review highlights the potential benefits of BNP in the recognition and management of heart failure, and defines the gray zones of BNP levels; it also identifies conditions influencing BNP levels in relation to a certain heart failure and describes conditions of no cardiac origin with increased BNP.
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Affiliation(s)
- Epaminondas Zakynthinos
- Critical Care Department, School of Medicine, University Hospital of Thessaly, Thessaly, Greece
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Hoekema A, Voors AA, Wijkstra PJ, Stegenga B, van der Hoeven JH, Tol CG, de Bont LGM. Effects of oral appliances and CPAP on the left ventricle and natriuretic peptides. Int J Cardiol 2008; 128:232-9. [PMID: 17727981 DOI: 10.1016/j.ijcard.2007.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 06/15/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients without cardiac disease, obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with systolic and diastolic dysfunction and left ventricular hypertrophy. Although continuous positive airway pressure (CPAP) therapy has been demonstrated to improve left ventricular structure and function in these patients, the effects of oral-appliance therapy on cardiac function are largely unknown. The aims of this study were to determine the left ventricular structure and function and natriuretic peptides in untreated OSAHS patients without cardiovascular disease, and to compare the effects of oral-appliance with CPAP therapy. METHODS In 28 moderate to severe OSAHS patients echocardiography and measurements of concentrations of the amino-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) were performed. Fifteen patients were randomized to oral-appliance and 13 to CPAP therapy. After 2 to 3 months of treatment echocardiography and NT-pro-BNP measurements were repeated. RESULTS Of the 28 patients, 7 had left ventricular hypertrophy, 6 had left ventricular dilatation, and 3 had elevated NT-pro-BNP values. No significant improvements in echocardiographic outcomes were observed following treatment. The median NT-pro-BNP values improved significantly following oral-appliance therapy (52 pg/ml to 22 pg/ml) whereas not following CPAP therapy (31 pg/ml to 37 pg/ml). CONCLUSIONS This study demonstrates that 50% of patients with moderate to severe OSASH, without cardiovascular disease, have left ventricular hypertrophy, left ventricular dilatation or elevated natriuretic peptides. Significant changes in NT-pro-BNP values indicate an improvement of cardiac function following effective oral-appliance therapy.
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Affiliation(s)
- Aarnoud Hoekema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Koga S, Ikeda S, Urata J, Kohno S. Effect of nasal continuous positive airway pressure in men on global left ventricular myocardial performance in patients with obstructive sleep apnea syndrome. Am J Cardiol 2008; 101:1796-800. [PMID: 18549862 DOI: 10.1016/j.amjcard.2008.02.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/02/2008] [Accepted: 02/02/2008] [Indexed: 10/22/2022]
Abstract
The influence of obstructive sleep apnea syndrome (OSAS) on left ventricular function remains controversial. We examined the influence of OSAS on global left ventricular function using the myocardial performance index (Tei index) and plasma brain natriuretic peptide (BNP) level and investigated the effect of nasal continuous positive airway pressure (nCPAP) on these parameters. We obtained echocardiographic indexes including the Tei index and BNP concentrations from 27 patients with OSAS whose mean apnea-hypopnea index was 42.2+/-21.5 events/hour and who were undergoing nCPAP and from 22 control subjects. We defined global left ventricular dysfunction (GLVD) as a Tei index >or=0.50 and high BNP as >or=20 pg/ml. Compared with controls, the Tei index of patients with OSAS was significantly increased (p <0.01) and prevalence of GLVD was high (19%, p<0.05). The correlation between the Tei index and apnea-hypopnea index was significant (r=0.447, p<0.05). Although BNP levels were higher in patients with OSAS than in controls, the difference did not reach significance. BNP level was high in 37% of patients with OSAS and in only 9% of controls (p<0.05). The Tei index of patients with OSAS was significantly decreased after 1 month and 3 months of nCPAP (p<0.01), and prevalence of GLVD significantly decreased from 19% to 4% (p<0.05). In contrast, BNP significantly decreased at 3 months after nCPAP (p<0.05). In conclusion, patients with moderate to severe OSAS frequently have impaired global left ventricular myocardial performance, which can be reversed at the early stage after starting nCPAP.
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Ferrier KA, Neill AM, O'Meeghan T, Richards M, Campbell AJ. Continuous positive airway pressure in heart failure patients with obstructive sleep apnoea. Intern Med J 2008; 38:829-36. [PMID: 18284461 DOI: 10.1111/j.1445-5994.2007.01585.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The aim of the study was to study the effect of 6 months of continuous positive airway pressure (CPAP) in community heart failure (HF) patients with obstructive sleep apnoea (OSA). METHODS Clinically stable outpatients with HF and OSA (left ventricular ejection fraction (LVEF) <45%, apnoea/hypopnoea index >15/h, n = 19) treated with CPAP and a control group (LVEF <45%, apnoea/hypopnoea index <10/h, n = 7) were compared at baseline and at 6 months by Minnesota heart failure score, Epworth sleepiness score, shuttle walk distance, brain natriuretic peptide, urinary catecholamines and echocardiographic indices using paired t-test, McNemar's tests and effect sizes. RESULTS In HF patients with OSA, CPAP improved LVEF (35.9 +/- 6.1% to 40.6 +/- 8.0%, P = 0.015), decreased LV end-systolic volume (152 +/- 74 to 135 +/- 62 cm(3), P = 0.03), systolic blood pressure (P = 0.04) and sleepiness (Epworth sleepiness score 8.8 +/- 4.8 to 6.3 +/- 3.2, P = 0.01), whereas walk distance, catecholamines, brain natriuretic peptide levels and symptoms were unchanged. These outcomes did not change in the HF control group. CONCLUSION In community HF patients with OSA, CPAP therapy over 6 months improved LVEF, systolic blood pressure and sleepiness, but not sympathetic activation, brain natriuretic peptide or exercise levels. Acceptance was relatively low, potentially limiting therapeutic effectiveness.
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Affiliation(s)
- K A Ferrier
- Department of Cardiology, Hutt Valley District Health Board, Wellington, New Zealand
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Hübner RH, El Mokhtari NE, Freitag S, Rausche T, Göder R, Tiroke A, Lins M, Simon R, Bewig B. NT-proBNP is not elevated in patients with obstructive sleep apnoea. Respir Med 2008; 102:134-42. [PMID: 17892929 DOI: 10.1016/j.rmed.2007.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 07/13/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND N-terminal pro-brain natriuretic peptide (NT-ProBNP) has emerged as an important marker of cardiac stress and may reflect the severity of underlying cardiac dysfunction, which is thought to be associated with obstructive sleep apnoea syndrome (OSAS). METHODS This study evaluated the plasma concentration of NT-ProBNP in 60 consecutive patients (median age 55.7 years, median body mass index (BMI) 31.8) who were referred to a sleep laboratory with a suspicion of OSAS. Each subject underwent measurement of morning NT-ProBNP plasma levels, polysomnography and echocardiography. Patients were treated with nasal continuous or bilevel positive airway pressure ventilation (nCPAP/BIPAP) or without mechanical respiratory support, depending on clinical symptoms and results of polysomnography. Three months after treatment of OSAS 28 of the patients were reassessed for re-evaluation of NT-ProBNP and polysomnography. RESULTS Low or high levels of NT-proBNP were not associated with AHI and other sleep related indices (p>0.3). There was no correlation between NT-proBNP and AHI or other sleep related indices. In multiple regression analysis, NT-proBNP was significantly correlated with left ventricular ejection fraction, creatinine clearance and the presence of systemic arterial hypertension but not with AHI. CONCLUSIONS Our results show by a robust multiple regression analysis, that NT-pro BNP is not associated with OSAS and NT-pro BNP cannot be used as a sensitive marker for underlying cardiovascular abnormalities in patients with OSAS.
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Affiliation(s)
- Ralf-Harto Hübner
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 12, 24105 Kiel, Germany
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Maeder MT, Ammann P, Rickli H, Schoch OD, Korte W, Hürny C, Myers J, Münzer T. N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea. Sleep Breath 2007; 12:7-16. [PMID: 17906885 DOI: 10.1007/s11325-007-0143-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular abnormalities including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction. The present study evaluated whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and peak oxygen consumption (peak VO(2)), both integral markers of cardiovascular function, are related to OSAS severity. In addition, we tested whether NT-proBNP levels depend on body composition in OSAS patients, similar to what has been reported in patients without OSAS. Eighty-nine patients with untreated OSAS underwent NT-proBNP measurement, dual X-ray absorptiometry, and cardiopulmonary exercise testing. In a representative subgroup (n = 32), transthoracic echocardiography was performed. The severity of OSAS was classified based on apnea-hypopnea index (AHI) values as mild (AHI 5-15 h(-1)), moderate (AHI 15-30 h(-1)), and severe (AHI >30 h(-1)). OSAS was mild in 19 (21%), moderate in 21 (24%), and severe in 49 (55%) patients. NT-proBNP levels did not differ among patients with mild [30 (10-57)], moderate [37 (14-55)], and severe [24 (13-49) pg/ml; p = 0.8] OSAS and were not related to body mass index (r = 0.07; p = 0.5), percent lean body mass (r = -0.17; p = 0.1), and percent fat mass (r = 0.18; p = 0.1). Percent predicted peak VO(2) was on average normal and did not differ among patients with mild (115 +/- 26), moderate (112 +/- 23), and severe OSAS (106 +/- 29%; p = 0.4). Body weight-indexed peak VO(2) did not differ among patients with mild (31.9 +/- 10.3), moderate (32.1 +/- 7.9), and severe OSAS (30.0 +/- 9.9 ml kg(-1) min(-1); p = 0.6) either. Lower NT-proBNP (beta = -0.2; p = 0.02) was independently but weakly associated with higher body weight-indexed peak VO(2). In the echocardiography subgroup, NT-proBNP was not significantly related to left ventricular mass index (r = 0.26; p = 0.2). In conclusion, NT-proBNP and peak VO(2) are not related to OSAS severity, and NT-proBNP poorly reflects left ventricular hypertrophy in OSAS. The lack of a relationship between NT-proBNP and OSAS severity is not due to a significant influence of body composition on NT-proBNP. There is an association between higher NT-proBNP and lower peak VO(2), indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too weak to be clinically useful.
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Affiliation(s)
- Micha T Maeder
- Division of Cardiology, Kantonsspital, St. Gallen, Switzerland.
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Vartany E, Imevbore M, O'Malley M, Manfredi C, Pasquarella C, Scinto L, Fine J. N-terminal pro-brain natriuretic peptide for detection of cardiovascular stress in patients with obstructive sleep apnea syndrome. J Sleep Res 2006; 15:424-9. [PMID: 17118099 DOI: 10.1111/j.1365-2869.2006.00551.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patients with obstructive sleep apnea syndrome (OSAS) have an elevated incidence of cardiovascular events that may be related to an increased ventricular load and hypoxemia caused by apneas and hypopneas. N-terminal pro-brain natriuretic peptide (NTproBNP) appears to be an excellent marker of myocardial stretch and could serve as an indicator of subclinical cardiac stress, thereby identifying a patient population at risk for cardiac effects from OSAS. Adult patients presenting with suspected OSAS and scheduled for nocturnal polysomnography were recruited. Patients with heart or renal failure or severe lung disease were excluded. NTproBNP was measured the evening before and the morning after sleep. Blood pressure (BP) was monitored intermittently throughout the night. Fifteen male and 15 female subjects with a mean +/- SD body mass index of 38.2 +/- 9.8 were studied. Mean Apnea-Hypopnea Index (AHI) was 38.4 +/- 26, with 17 subjects having severe OSAS (AHI > 30). No subject had a significant rise in BP. NTproBNP values overnight decreased in 19 patients and rose in 11 (mean change 3.8 +/- 33 pg mL(-1)), but only one patient had an abnormal morning value. Three patients had an abnormal NTproBNP value prior to sleep, but their levels decreased with sleep. No correlations were detected between the evening baseline or postsleep NTproBNP levels and OSAS. Monitoring pre- and postsleep NTproBNP levels revealed no association with the occurrence or degree of OSAS, making it unlikely that NTproBNP could serve as a marker of cardiac stress in OSAS patients with stable BP and without overt heart failure.
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Affiliation(s)
- Edmond Vartany
- Section of Pulmonary, Sleep and Critical Care Medicine, Norwalk Hospital, Norwalk, CT 06856, USA
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Pepperell J, Stradling J, Davies R. Brain natriuretic peptide is unchanged after 4 weeks of continuous positive airway pressure therapy. J Sleep Res 2006; 15:463-4. [PMID: 17118104 DOI: 10.1111/j.1365-2869.2006.00549.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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