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Kario K, Hettrick DA, Prejbisz A, Januszewicz A. Obstructive Sleep Apnea-Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension 2021; 77:1047-1060. [PMID: 33641363 DOI: 10.1161/hypertensionaha.120.16378] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a bidirectional, causal relationship between obstructive sleep apnea (OSA) and hypertension. OSA-related hypertension is characterized by high rates of masked hypertension, elevated nighttime blood pressure, a nondipper pattern of nocturnal hypertension, and abnormal blood pressure variability. Hypoxia/hypercapnia-related sympathetic activation is a key pathophysiological mechanism linking the 2 conditions. Intermittent hypoxia also stimulates the renin-angiotensin-aldosterone system to promote hypertension development. The negative and additive cardiovascular effects of OSA and hypertension highlight the importance of effectively managing these conditions, especially when they coexist in the same patient. Continuous positive airway pressure is the gold standard therapy for OSA but its effects on blood pressure are relatively modest. Furthermore, this treatment did not reduce the cardiovascular event rate in nonsleepy patients with OSA in randomized controlled trials. Antihypertensive agents targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in comorbid hypertension and OSA, but current evidence is limited and combination strategies are often required in drug resistant or refractory patients. The key role of sympathetic nervous system activation in the development of hypertension in OSA suggests potential for catheter-based renal sympathetic denervation. Although long-term, randomized controlled trials are needed, available data indicate sustained and relevant reductions in blood pressure in patients with hypertension and OSA after renal denervation, with the potential to also improve respiratory parameters. The combination of lifestyle interventions, optimal pharmacological therapy, continuous positive airway pressure therapy, and perhaps also renal denervation might improve cardiovascular risk in patients with OSA.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | | | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., A.J.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., A.J.)
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Linz D, Hendriks J. Central sleep apnea in atrial fibrillation: Risk factor or marker of untreated underlying disease? IJC HEART & VASCULATURE 2020; 30:100650. [PMID: 33104086 PMCID: PMC7573638 DOI: 10.1016/j.ijcha.2020.100650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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3
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Khalyfa A, Castro-Grattoni AL, Gozal D. Cardiovascular morbidities of obstructive sleep apnea and the role of circulating extracellular vesicles. Ther Adv Respir Dis 2020; 13:1753466619895229. [PMID: 31852426 PMCID: PMC6923690 DOI: 10.1177/1753466619895229] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse
during sleep resulting in impaired blood gas exchange, namely intermittent
hypoxia (IH) and hypercapnia, fragmented sleep (SF), increased oxidative stress
and systemic inflammation. Among a myriad of potential associated morbidities,
OSA has been particularly implicated as mechanistically contributing to the
prevalence and severity of cardiovascular diseases (CVD). However, the benefits
of continuous positive airway pressure (CPAP), which is generally employed in
OSA treatment, to either prevent or improve CVD outcomes remain unconvincing,
suggesting that the pathophysiological mechanisms underlying the incremental CVD
risk associated with OSA are not clearly understood. One of the challenges in
development of non-invasive diagnostic assays is the ability to identify
clinically and mechanistically relevant biomarkers. Circulating extracellular
vesicles (EVs) and their cargos reflect underlying changes in cellular
homeostasis and can provide insights into how cells and systems cope with
physiological perturbations by virtue of the identity and abundance of miRNAs,
mRNAs, proteins, and lipids that are packaged in the EVs under normal as well as
diseased states, such as OSA. EVs can not only provide unique insights into
coordinated cellular responses at the organ or systemic level, but can also
serve as reporters of the effects of OSA in CVD, either by their properties
enabling regeneration and repair of injured vascular cells or by damaging them.
Here, we highlight recent progress in the pathological CVD consequences of OSA,
and explore the putative roles of EVs in OSA-associated CVD, along with emerging
diagnostic and therapeutic opportunities. The reviews of this paper are available via the supplemental material
section.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Anabel L Castro-Grattoni
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Department of Child Health and MU Women's and Children's Hospital, University of Missouri School of Medicine, 400 N. Keene Street, Suite 010, Columbia, MO 65201, USA
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Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med 2019; 6:158. [PMID: 31750317 PMCID: PMC6848060 DOI: 10.3389/fcvm.2019.00158] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022] Open
Abstract
Ventricular arrhythmia and subsequent sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is one of the most frequent causes of death in humans. Lethal ventricular arrhythmias like ventricular fibrillation (VF) prior to hospitalization have been reported to occur in more than 10% of all AMI cases and survival in these patients is poor. Identification of risk factors and mechanisms for VF following AMI as well as implementing new risk stratification models and therapeutic approaches is therefore an important step to reduce mortality in people with high cardiovascular risk. Studying spontaneous VF following AMI in humans is challenging as it often occurs unexpectedly in a low risk subgroup. Large animal models of AMI can help to bridge this knowledge gap and are utilized to investigate occurrence of arrhythmias, involved mechanisms and therapeutic options. Comparable anatomy and physiology allow for this translational approach. Through experimental focus, using state-of-the-art technologies, including refined electrical mapping equipment and novel pharmacological investigations, valuable insights into arrhythmia mechanisms and possible interventions for arrhythmia-induced SCD during the early phase of AMI are now beginning to emerge. This review describes large experimental animal models of AMI with focus on first AMI-associated ventricular arrhythmias. In this context, epidemiology of first AMI, arrhythmogenic mechanisms and various potential therapeutic pharmacological targets will be discussed.
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Affiliation(s)
- Stefan Michael Sattler
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Department I, University Hospital Grosshadern, LMU Munich, Munich, Germany
| | - Lasse Skibsbye
- Department of Exploratory Toxicology, H. Lundbeck A/S, Copenhagen, Denmark
| | - Dominik Linz
- Medical Department III, Universitätsklinikum des Saarlandes, Homburg, Germany.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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Spiesshoefer J, Aries J, Giannoni A, Emdin M, Fox H, Boentert M, Bitter T, Oldenburg O. APAP therapy does not improve impaired sleep quality and sympatho-vagal balance: a randomized trial in patients with obstructive sleep apnea and systolic heart failure. Sleep Breath 2019; 24:211-219. [DOI: 10.1007/s11325-019-01868-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022]
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Liu Y, Gao L, Lv W, Lın L, Wang Y, Fıang F, Feng F. Pathologic and hemodynamic changes of common carotid artery in obstructive sleep apnea hypopnea syndrome in a porcine model. Turk J Med Sci 2019; 49:939-944. [PMID: 31195789 PMCID: PMC7018377 DOI: 10.3906/sag-1807-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/aim To prepare a porcine model of obstructive sleep apnea-hypopnea syndrome (OSAHS) and observe the pathological and hemodynamic changes in the common carotid artery. Materials and methods Twelve male miniature pigs were randomly divided into the model and control group (n = 6). Pigs in the model group were kept in an air-flow negative pressure chamber at 0.96 ± 0.01 kPa, and the air oxygen content, temperature, and humidity were kept at normal culture conditions in both groups. After pigs in the model group presented symptoms of OSAHS, changes in the hemodynamics and morphology of the carotid artery were analyzed using color Doppler, and light and electron microscopy. Results An animal model of OSAHS was successfully created. The internal diameter of the carotid artery of pigs in the model group was decreased, while the intima thickness, peak-systolic mean velocity, and resistance index were increased when compared to the control group (P < 0.05). The results of the light and electron microscopy revealed an incomplete elastic plate, increased media thickness, irregular morphology of the smooth muscle cells, increased collagen fiber bundles, partially disordered elastic fibers, and smooth muscle layers. The quantitative analysis showed significantly increased elastic fibers in the media of the carotid artery in the model group (P < 0.01). Conclusion Pathological changes in the tissue structure and hemodynamics in the negative pressure-induced pig OSAHS model were observed. We suggest that alterations in the upper airway pressure during OSAHS may lead to cardiovascular conditions through its pathological effects on the carotid artery.
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Affiliation(s)
- Yongyi Liu
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lu Gao
- Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Weinong Lv
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lin Lın
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Yi Wang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Fıang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Feng
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China,Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China,The Huishan District Second People’s Hospital of Wuxi City, Wuxi, China
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8
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Validity of transit time–based blood pressure measurements in patients with and without heart failure or pulmonary arterial hypertension across different breathing maneuvers. Sleep Breath 2019; 24:221-230. [DOI: 10.1007/s11325-019-01848-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/19/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Singh RR, McArdle ZM, Iudica M, Easton LK, Booth LC, May CN, Parkington HC, Lombardo P, Head GA, Lambert G, Moritz KM, Schlaich MP, Denton KM. Sustained Decrease in Blood Pressure and Reduced Anatomical and Functional Reinnervation of Renal Nerves in Hypertensive Sheep 30 Months After Catheter-Based Renal Denervation. Hypertension 2019; 73:718-727. [DOI: 10.1161/hypertensionaha.118.12250] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Reetu R. Singh
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Zoe M. McArdle
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Michael Iudica
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Lawrence K. Easton
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Lindsea C. Booth
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (L.C.B., C.N.M.)
| | - Clive N. May
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (L.C.B., C.N.M.)
| | - Helena C. Parkington
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences (P.L.), Monash University, Melbourne, Australia
| | - Geoff A. Head
- Baker Heart and Diabetes Institute, Melbourne, Australia (G.A.H., M.P.S.)
| | - Gavin Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia (G.L.)
| | - Karen M. Moritz
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia (K.M.M.)
| | - Markus P. Schlaich
- Baker Heart and Diabetes Institute, Melbourne, Australia (G.A.H., M.P.S.)
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - Kate M. Denton
- From the Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology (R.R.S., Z.M.M., M.I., L.K.E., H.C.P., K.M.D.), Monash University, Melbourne, Australia
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Li X, Liu C, Zhang H, Zhang J, Zhao M, Sun D, Xia M, Han M. Effect of 12-month nasal continuous positive airway pressure therapy for obstructive sleep apnea on progression of chronic kidney disease. Medicine (Baltimore) 2019; 98:e14545. [PMID: 30813163 PMCID: PMC6407975 DOI: 10.1097/md.0000000000014545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is common among patients with chronic kidney disease (CKD). CKD may increase the risk of OSA, and OSA may increase the risk of renal injury. Nasal continuous positive airway pressure (nCPAP) is the standard treatment for OSA. However, the effect of nCPAP on the progression of CKD is unclear. METHODS A total of 395 patients with stage 3/4 CKD were initially examined, and 269 patients (148 non-OSA cases; 79 mild OSA cases; 42 moderate/severe OSA cases) were analyzed after implementation of the exclusion criteria. The severity of OSA was determined by polysomnography (PSG). Fifty-two OSA patients (32 mild OSA cases; 20 moderate/severe OSA cases) received nCPAP treatment for 12 months. Variables associated with OSA severity and estimated glomerular filtration rate (eGFR) were evaluated before and after the 12-month nCPAP treatment. RESULTS Among all 269 CKD patients, body mass index (BMI), and eGFR had significant associations with OSA severity. Age, BMI, apnea-hypopnea index (AHI), mean SaO2%, and SaO2 <90% monitoring time had independent associations with lower eGFR. The 12-month nCPAP treatment significantly reduced the rate of eGFR decline. Univariate and multivariate analysis indicated that age, BMI, AHI, mean SaO2%, and SaO2 <90% monitoring time were independently associated with reduced eGFR. Furthermore, nCPAP treatment significantly improved eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time in patients with mild OSA, and improved systolic/diastolic blood pressure, urinary protein level, eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time for patients with moderate/severe OSA. CONCLUSION This study of patients with CKD and OSA indicated that nCPAP therapy significantly ameliorated CKD progression, especially in those with moderate/severe OSA.
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Affiliation(s)
| | | | | | | | - Miaoqing Zhao
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong University
| | - Dianshui Sun
- Cancer Center, the Second Hospital of Shandong University, Shandong University, Jinan, Shandong Province
| | | | - Min Han
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Linz D, Baumert M, Catcheside P, Floras J, Sanders P, Lévy P, Cowie MR, Doug McEvoy R. Assessment and interpretation of sleep disordered breathing severity in cardiology: Clinical implications and perspectives. Int J Cardiol 2018; 271:281-288. [DOI: 10.1016/j.ijcard.2018.04.076] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
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13
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The effect of the bedtime-dosing doxazosin on nocturnal hypoxia-triggered blood pressure surge in a young adult man with severe obstructive sleep apnea syndrome and a history of three recurrent sleep-onset strokes. Blood Press Monit 2018; 22:173-174. [PMID: 28459764 DOI: 10.1097/mbp.0000000000000233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Zhao E, Chen S, Du Y, Zhang Y. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A Meta-Analysis of Cohort Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5215868. [PMID: 29581977 PMCID: PMC5822830 DOI: 10.1155/2018/5215868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/04/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Numerous reports have been done to seek the relationship between sleep apnea hypopnea syndrome (SAHS) and the risk of atrial fibrillation (AF). However, definite conclusion has not yet been fully established. We examined whether SAHS increases AF incidence in common population and summarized all existing studies in a meta-analysis. We summarized the current studies by searching related database for potential papers of the association between SAHS and the risk of AF. Studies that reported original data or relative risks (RRs) with 95% confidence intervals (CIs) for the associations were included. Sensitivity analyses were performed by omitting each study iteratively and publication bias was detected by Begg's tests. Eight eligible studies met the inclusion criteria. Fixed effects meta-analysis showed that SAHS increased AF risk in the common population (RR = 1.70, 95% CI: 1.53-1.89, P = 0.002, I2 = 69.2%). There was a significant association between mild SAHS and the risk of AF (RR = 1.52, 95% CI: 1.28-1.79, P = 0.01, I2 = 78.4%), moderate SAHS (RR = 1.88, 95% CI: 1.55-2.27, P = 0.017, I2 = 75.6%), and severe SAHS (RR = 2.16, 95% CI: 1.78-2.62, P < 0.001, I2 = 91.0%). The results suggest that sleep apnea hypopnea syndrome could increase the risk of AF, and the higher the severity of SAHS, the higher risk of atrial fibrillation.
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Affiliation(s)
- Enfa Zhao
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shimin Chen
- Department of Gastroenterology, The First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yajuan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yushun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the Global SYMPLICITY Registry. J Hypertens 2017; 35:148-153. [PMID: 27906840 DOI: 10.1097/hjh.0000000000001142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep-disordered breathing, predominantly obstructive sleep apnea (OSA), is highly prevalent in patients with hypertension. OSA may underlie the progression to resistant hypertension, partly due to increased activation of the sympathetic nervous system. This analysis of patients with and without OSA evaluated the blood pressure (BP)-lowering effect of sympathetic modulation by renal denervation (RDN) in a real-world setting. METHODS The Global SYMPLICITY Registry (NCT01534299) is a prospective, open-label, multicenter registry conducted worldwide to evaluate the safety and effectiveness of RDN in patients with uncontrolled hypertension. Office and 24-h ambulatory BP were reported for all patients, based on the presence of OSA. RESULTS Among 1868 patients, self-reported OSA occurred in 205 patients, who were more likely to be men (76 vs 57%, P < 0.001), have a higher BMI (34 ± 6 vs 30 ± 5 kg/m, P < 0.001), chronic kidney disease (30 vs 21%, P = 0.003), left ventricular hypertrophy (25 vs 15%, P < 0.001), and type 2 diabetes (50 vs 36%, P < 0.001). Among OSA patients, the baseline office SBP (166 ± 26 mmHg) was reduced by 14.0 ± 25.3 mmHg at 6 months (P < 0.001). Ambulatory 24-h SBP was reduced by 4.9 ± 18.0 mmHg (n = 115, P = 0.005) from 155 ± 19 mmHg at baseline. The 6-month change in SBP from baseline was not statistically different between OSA and non-OSA patients. BP reduction after RDN was also similar in OSA patients already treated with and not treated with continuous positive airway pressure. CONCLUSION RDN resulted in significant BP reductions at 6 months in hypertensive patients with and without OSA, and regardless of continuous positive airway pressure usage in OSA patients.
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Nocturnal blood pressure fluctuations measured by using pulse transit time in patients with severe obstructive sleep apnea syndrome. Sleep Breath 2017; 22:337-343. [PMID: 28828627 DOI: 10.1007/s11325-017-1555-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is related to arterial hypertension. In the present study, we test the hypothesis that patients with severe OSAS have excessive apnea induced blood pressure (BP). METHODS We investigated 97 patients with an apnea/hypopnea index (AHI) greater than 30. Systolic BP (SBP) was continuously determined by using the pulse transit time (PTT). Apnea/hypopnea induced nocturnal BP fluctuations (NBPFs) were detected and showed phenomena of continuous increases of the SBP baseline. Such periods of SBP baseline elevations ≥ 10 mmHg were called superposition. Respiratory and cardiac parameters were obtained from the polysomnographic investigation. RESULTS Eighty-four periods of superposition were detected in 48 patients. They occurred mainly during REM sleep (76%). Apnea duration was increased and the time in respiration was reduced in periods of superposition compared to non-superposition periods. In superposition periods mean oxygen saturation (SpO2) and the minimal SpO2 were lower, desaturations were more pronounced, and the mean heart rate (HR) was increased. The maximum SBP during superposition was significantly increased (204 ± 32 vs.171 ± 28 mmHg). The clinic BP was higher in patients with superposition (SBP 149.2 ± 17.5 vs. 140 ± 19.1, DBP 91.5 ± 11.5 vs. 86.3 ± 11.8). CONCLUSIONS The study reveals that patients with severe OSAS can have periods of BP superposition during night with extremely high SBP and very low oxygen saturation, which may add to a high risk for cardiovascular events during the night.
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Xu LF, Zhou XF, Hu K, Tang S, Luo YC, Lu W. Establishment of a Rabbit Model of Chronic Obstructive Sleep Apnea and Application in Cardiovascular Consequences. Chin Med J (Engl) 2017; 130:452-459. [PMID: 28218220 PMCID: PMC5324383 DOI: 10.4103/0366-6999.199828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Although obstructive sleep apnea (OSA) has been recognized as a major risk factor for cardiovascular complications and its clinical features are well characterized, it is difficult to replicate the OSA hypoxic model in humans. We aimed to establish an experimental rabbit model for chronic OSA and to explore its application to measure blood pressure (BP), myocardial systolic function, and oxidative stress. Methods: The rabbit model for OSA was established by repeatedly closing the airway and then reopening it. A tube specially designed with a bag that could be alternately inflated and deflated according to a predetermined time schedule, resulting in recurrent airway occlusions and chronic intermittent hypoxia (CIH) imitating OSA patterns in humans, was used. Twenty-four rabbits were randomly divided into obstruction, sham, and control groups, and their upper airways were alternately closed for 15 s and then reopened for 105 s in a 120-s-long cycle, for 8 h each day over 12 consecutive weeks. Before and after the experiment, the BP of each rabbit was monitored. Levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the serum, superoxide dismutase (SOD) activity, malondialdehyde (MDA) and reactive oxygen species (ROS) contents, as well as Na+-K+-ATPase/Ca2+-ATPase activities in cardiac muscle were examined. In addition, cardiac functional parameters were measured using echocardiography. Results: After 3 months, all rabbits in the obstruction group manifested sleepiness performance similar to that observed in OSA patients. Traces of airflow and SpO2 showed that this model mimicked the respiratory events involved in OSA, including increased respiratory effort and decreased oxygen saturation. Gradually, the BP rose each month. CIH led to obvious oxidative stress and injured myocardial systolic performance. The serum levels of IL-6 and TNF-α increased significantly (64.75 ± 9.05 pg/ml vs. 147.00 ± 19.24 pg/ml and 59.38 ± 8.21 pg/ml vs. 264.75 ± 25.54 pg/ml, respectively, both P < 0.001). Compared with the sham and the control groups, myocardial activities of Na+-K+-ATPase/Ca2+-ATPase and SOD in the obstruction group decreased markedly, while ROS and MDA content increased. Conclusions: These results show that the rabbit model for OSA simulates the pathophysiological characteristics of OSA in humans, which implies that this animal model is feasible and useful to study the mechanisms involved in the cardiovascular consequences of OSA.
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Affiliation(s)
- Li-Fang Xu
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Xiu-Fang Zhou
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Ke Hu
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Si Tang
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Yu-Chuan Luo
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Wen Lu
- Department of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
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Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications. Int J Cardiol 2017; 230:293-300. [DOI: 10.1016/j.ijcard.2016.12.120] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/12/2016] [Accepted: 12/17/2016] [Indexed: 12/12/2022]
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Lu W, Kang J, Hu K, Tang S, Zhou X, Xu L, Li Y, Yu S. The role of the Nox4-derived ROS-mediated RhoA/Rho kinase pathway in rat hypertension induced by chronic intermittent hypoxia. Sleep Breath 2017; 21:667-677. [PMID: 28078487 DOI: 10.1007/s11325-016-1449-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 11/23/2016] [Accepted: 12/22/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome, which is a risk factor for resistant hypertension, is characterized by chronic intermittent hypoxia (CIH) and is associated with many cardiovascular diseases. CIH elicits systemic oxidative stress and sympathetic hyperactivity, which lead to hypertension. Rho kinases (ROCKs) are considered to be major effectors of the small GTPase RhoA and have been extensively studied in the cardiovascular field. Upregulation of the RhoA/ROCK signaling cascade is observed in various cardiovascular disorders, such as atherosclerosis, pulmonary hypertension, and stroke. However, the exact molecular function of RhoA/ROCK in CIH remains unclear and requires further study. OBJECTIVE This study aimed to investigate the role of the NADPH oxidase 4 (Nox4)-induced ROS/RhoA/ROCK pathway in CIH-induced hypertension in rats. METHODS Male Sprague-Dawley rats were exposed to CIH for 21 days (intermittent hypoxia of 21% O2 for 60 s and 5% O2 for 30 s, cyclically repeated for 8 h/day). We randomly assigned 56 male rats to groups of normoxia (RA) or vertically implemented CIH together with vehicle (CIH-V), GKT137831 (CIH-G), N-acetyl cysteine (NAC) (CIH-N), or Y27632 (CIH-Y). The rats in the RA group were continuously exposed to room air, whereas the rats in the other groups were exposed to CIH. Systolic blood pressure (BP) was monitored at the beginning of each week. After the experiment, renal sympathetic nerve activity (RSNA) was recorded, and serum and renal tissues were subjected to molecular biological and biochemical analyses. RESULTS Compared with the BP of RA rats, the BP of CIH-V rats started to increase 2 weeks after the beginning of the experiment, subsequently stabilizing at a high level at the end of the third week. CIH increased both RSNA and oxidative stress. This response was attenuated by treatment of the rats with GKT137831 or NAC. Inhibiting Nox4 activity or ROS production reduced RhoA/ROCK expression. Treatment with Y27632 reduced both BP and RSNA in rats exposed to CIH. CONCLUSION Hypertension can be induced by CIH in SD rats. The CIH-induced elevation of BP is at least partially mediated via the Nox4-induced ROS/RhoA/ROCK pathway.
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Affiliation(s)
- Wen Lu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Jing Kang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Ke Hu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China.
| | - Si Tang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Xiufang Zhou
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Lifang Xu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Yuanyuan Li
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Shuhui Yu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
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The effect of sleep apnea on all-cause mortality in nondialyzed chronic kidney disease patients. Sleep Med 2016; 27-28:32-38. [DOI: 10.1016/j.sleep.2016.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022]
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Gildeh N, Drakatos P, Higgins S, Rosenzweig I, Kent BD. Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer. J Thorac Dis 2016; 8:E901-E917. [PMID: 27747026 DOI: 10.21037/jtd.2016.09.23] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.
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Affiliation(s)
- Nadia Gildeh
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK;; Danish Epilepsy Centre, Dianalund, Denmark
| | - Brian D Kent
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Maski MR, Thomas RJ, Karumanchi SA, Parikh SM. Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with Obstructive Sleep Apnea. PLoS One 2016; 11:e0154503. [PMID: 27149121 PMCID: PMC4858300 DOI: 10.1371/journal.pone.0154503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a well-established risk factor for hypertension and cardiovascular morbidity and mortality. More recently, OSA has been implicated as an independent risk factor for chronic kidney disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well-accepted early biomarker of subclinical kidney tubular injury, preceding an increase in serum creatinine. The goal of this study was to determine if an association exists between OSA and increased urinary NGAL levels. Methods We prospectively enrolled adult patients from the sleep clinic of an academic medical center. Each underwent polysomnography and submitted a urine specimen upon enrollment. We measured NGAL and creatinine levels on all urine samples before participants received treatment with continuous positive airway pressure (CPAP), and, in a subset of OSA patients, after CPAP therapy. We compared the urinary NGAL/creatinine ratio between untreated participants with and without OSA, and within a subset of 11 OSA patients also after CPAP therapy. Results A total of 49 subjects were enrolled: 16 controls based on an apnea-hypopnea index (events with at least 4% oxygen desaturation; AHI-4%) <5 events/hour (mean AHI-4% = 0.59 +/- 0.60); 33 OSA patients based on an AHI-4% >5 events/hour (mean AHI-4% = 43.3 +/- 28.1). OSA patients had a higher mean body-mass index than the control group (36.58 +/- 11.02 kg/m2 vs. 26.81 +/- 6.55 kg/m2, respectively; p = 0.0005) and were more likely to be treated for hypertension (54.5% vs. 6.25% of group members, respectively; p = 0.0014). The groups were otherwise similar in demographics, and there was no difference in the number of diabetic subjects or in the mean serum creatinine concentration (control = 0.86 +/- 0.15 mg/dl, OSA = 0.87 +/- 0.19 mg/dl; p = 0.7956). We found no difference between the urinary NGAL-to-creatinine ratios among untreated OSA patients versus control subjects (median NGAL/creatinine = 6.34 ng/mg vs. 6.41 ng/mg, respectively; p = 0.4148). Furthermore, CPAP therapy did not affect the urinary NGAL-to-creatinine ratio (p = 0.7758 for two-tailed, paired t-test). Conclusions In this prospective case-control study comparing patients with severe, hypoxic OSA to control subjects, all with normal serum creatinine, we found no difference between urinary levels of NGAL. Furthermore, CPAP therapy did not change these levels pre- and post-treatment.
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Affiliation(s)
- Manish R. Maski
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care, & Sleep Medicine/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - S. Ananth Karumanchi
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samir M. Parikh
- Division of Nephrology/ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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Linz D, Linz B, Hohl M, Böhm M. Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications. Sleep Med Rev 2016; 26:87-94. [DOI: 10.1016/j.smrv.2015.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Chu H, Shih CJ, Ou SM, Chou KT, Lo YH, Chen YT. Association of sleep apnoea with chronic kidney disease in a large cohort from Taiwan. Respirology 2016; 21:754-60. [DOI: 10.1111/resp.12739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/15/2015] [Accepted: 11/15/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Hsi Chu
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Respiratory Medicine; Department of Chest; Taipei City Hospital; Heping Fuyou Branch Taipei Taiwan
| | - Chia-Jen Shih
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Taipei Veterans General Hospital; Yuanshan Branch Yilan Taiwan
- Deran Clinic; Yilan Taiwan
| | - Shuo-Ming Ou
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Nephrology; Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Kun-Ta Chou
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Chest Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Yuan-Hao Lo
- Department of Medicine; Taipei Veterans General Hospital; Yuanshan Branch Yilan Taiwan
| | - Yung-Tai Chen
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Nephrology; Department of Medicine; Taipei City Hospital; Heping Fuyou Branch Taipei Taiwan
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Kario K, Ikemoto T, Kuwabara M, Ishiyama H, Saito K, Hoshide S. Catheter-Based Renal Denervation Reduces Hypoxia-Triggered Nocturnal Blood Pressure Peak in Obstructive Sleep Apnea Syndrome. J Clin Hypertens (Greenwich) 2015; 18:707-9. [DOI: 10.1111/jch.12759] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuomi Kario
- Jichi Medical University School of Medicine; Tochigi Japan
| | | | | | | | - Kimiyo Saito
- Jichi Medical University School of Medicine; Tochigi Japan
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Schirmer SH, Sayed MMYA, Reil JC, Lavall D, Ukena C, Linz D, Mahfoud F, Böhm M. Atrial Remodeling Following Catheter-Based Renal Denervation Occurs in a Blood Pressure- and Heart Rate-Independent Manner. JACC Cardiovasc Interv 2015; 8:972-80. [PMID: 26003031 DOI: 10.1016/j.jcin.2015.02.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/21/2015] [Accepted: 02/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to investigate left atrial (LA) remodeling in relation to blood pressure (BP) and heart rate (HR) after renal sympathetic denervation (RDN). BACKGROUND In addition to reducing BP and HR in certain patients with hypertension, RDN can decrease left ventricular (LV) mass and ameliorate LV diastolic dysfunction. METHODS Before and 6 months after RDN, BP, HR, LV mass, left atrial volume index (LAVI), diastolic function (echocardiography), and premature atrial contractions (PAC) (Holter electrocardiogram) were assessed in 66 patients with resistant hypertension. RESULTS RDN reduced office BP by 21.6 ± 3.0/10.1 ± 2.0 mm Hg (p < 0.001), and HR by 8.0 ± 1.3 beats/min (p < 0.001). At baseline, LA size correlated with LV mass, diastolic function, and pro-brain natriuretic peptide, but not with BP or HR. Six months after RDN, LAVI was reduced by 4.0 ± 0.7 ml/kg/m(2) (p < 0.001). LA size decrease was stronger when LAVI at baseline was higher. In contrast, the decrease in LAVI was not dependent on LV mass or diastolic function (E/E' or E/A) at baseline. Furthermore, LAVI decreased without relation to decrease in systolic BP or HR. Additionally, occurrence of PAC (median of >153 PAC/24 h) was reduced (to 68 PAC/24 h) by RDN, independently of changes in LA size. CONCLUSIONS In patients with resistant hypertension, LA volume and occurrence of PAC decreased 6 months after RDN. This decrease was independent of BP and HR at baseline or the reduction in BP and HR reached by renal denervation. These data suggest that there is a direct, partly BP-independent effect of RDN on cardiac remodeling and occurrence of premature atrial contractions.
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Affiliation(s)
- Stephan H Schirmer
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Marwa M Y A Sayed
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jan-Christian Reil
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Daniel Lavall
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Böhm M, Oldenburg O. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 2015; 104:705-18. [DOI: 10.1007/s00392-015-0859-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/22/2023]
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Wu H, Zhou S, Kong L, Chen J, Feng W, Cai J, Miao L, Tan Y. Metallothionein deletion exacerbates intermittent hypoxia-induced renal injury in mice. Toxicol Lett 2015; 232:340-8. [DOI: 10.1016/j.toxlet.2014.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/16/2014] [Accepted: 11/14/2014] [Indexed: 11/24/2022]
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Lobo MD, de Belder MA, Cleveland T, Collier D, Dasgupta I, Deanfield J, Kapil V, Knight C, Matson M, Moss J, Paton JFR, Poulter N, Simpson I, Williams B, Caulfield MJ. Joint UK societies' 2014 consensus statement on renal denervation for resistant hypertension. Heart 2014; 101:10-6. [PMID: 25431461 PMCID: PMC4283620 DOI: 10.1136/heartjnl-2014-307029] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.
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Affiliation(s)
- Melvin D Lobo
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Mark A de Belder
- The British Cardiovascular Society The British Cardiovascular Intervention Society Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Trevor Cleveland
- The British Society for Interventional Radiology Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - David Collier
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Indranil Dasgupta
- The Renal Association Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - John Deanfield
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK The National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - Vikas Kapil
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - Charles Knight
- Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK The British Cardiovascular Society
| | - Matthew Matson
- The British Society for Interventional Radiology Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jonathan Moss
- The British Society for Interventional Radiology Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, UK
| | - Julian F R Paton
- On behalf of the British Hypertension Society School of Physiology & Pharmacology, Bristol Cardiovascular Medical Sciences Building, University of Bristol, Bristol, UK
| | - Neil Poulter
- On behalf of the British Hypertension Society International Centre for Circulatory Health, Imperial College, London, UK
| | - Iain Simpson
- The British Cardiovascular Society Wessex Regional Cardiac Unit, University Hospital Southampton, UK
| | - Bryan Williams
- On behalf of the British Hypertension Society Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark J Caulfield
- On behalf of the British Hypertension Society Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK Department of Cardiovascular Medicine, Barts Health NHS Trust, London, UK
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Linz D, Hunnik AV, Ukena C, Mahfoud F, Ewen S, Verheule S, Böhm M, Schotten U. Effects of renal denervation on atrial arrhythmogenesis. Future Cardiol 2014; 10:813-22. [DOI: 10.2217/fca.14.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, the activity of the autonomic nervous system has also been suggested to contribute to the progression from paroxysmal to persistent atrial fibrillation. Catheter-based renal denervation was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure reduction and left-ventricular morphological and functional improvement in drug-resistant hypertension. This review focuses on the potential effects of renal denervation on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in atrial fibrillation patients with hypertension, heart failure and sleep apnea.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sebastian Ewen
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Linz D, Ukena C, Wolf M, Linz B, Mahfoud F, Böhm M. Experimental Evidence Of The Role Of Renal Sympathetic Denervation For Treating Atrial Fibrillation. J Atr Fibrillation 2014; 7:1128. [PMID: 27957120 DOI: 10.4022/jafib.1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. In addition to mechanisms such as atrial stretch and atrial remodeling, also the activity of the autonomic nervous system has been suggested to contribute to the progression from paroxysmal to persistent AF. Catheter-based renal denervation (RDN) was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation which may result in atrial antiarrhythmic effects under some pathophysiological conditions. This review focuses on the potential effects of RDN on different arrhythmogenic mechanisms in the atrium and discusses potential anti-remodeling effects in hypertension, heart failure, and sleep apnea.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Milan Wolf
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Benedikt Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes
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Fink GD, Osborn JW. Renal nerves: time for reassessment of their role in hypertension? Am J Hypertens 2014; 27:1245-7. [PMID: 24871630 DOI: 10.1093/ajh/hpu096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gregory D Fink
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan;
| | - John W Osborn
- Department of Integrative Biology and Physiology, University of Minnesota, Minnesota, Minneapolis
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Hohl M, Linz B, Böhm M, Linz D. Obstructive sleep apnea and atrial arrhythmogenesis. Curr Cardiol Rev 2014; 10:362-8. [PMID: 25004989 PMCID: PMC4101201 DOI: 10.2174/1573403x1004140707125137] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with relevant morbidity and mortality. Besides hypertension, valvular disease and cardiomyopathy, mainly ischemic and dilated, also other conditions like obesity, alcohol abusus, genetic factors and obstructive sleep apnea (OSA) are discussed to contribute to the progression from paroxysmal to persistent AF. The prevalence of OSA among patients with AF is 40-50%. OSA is characterized by periodic or complete cessation of effective breathing during sleep due to obstruction of the upper airways. Obstructive respiratory events result in acute intrathoracic pressure swings and profound changes in blood gases together leading to atrial stretch and acute sympatho-vagal dysbalance resulting in acute apnea related to electrophysiological and hemodynamic alterations. Additionally, repetitive obstructive events in patients with OSA may lead to sympathetic and neurohumoral activation and subsequent structural and functional changes in the atrium creating an arrhythmogenic substrate for AF in the long run. This review focuses on the acute and chronic effects of negative thoracic pressure swings, changes in blood pressure and sympatho-vagal dysbalance induced by obstructive respiratory events on atrial electrophysiology and atrial structure in patients with obstructive sleep apnea.
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Affiliation(s)
| | | | | | - Dominik Linz
- Klinik fur Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitatsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, D-66421 Homburg/ Saar, Germany.
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