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Šmon J, Kočar E, Pintar T, Dolenc-Grošelj L, Rozman D. Is obstructive sleep apnea a circadian rhythm disorder? J Sleep Res 2023:e13875. [PMID: 36922163 DOI: 10.1111/jsr.13875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
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Affiliation(s)
- Julija Šmon
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Kočar
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc-Grošelj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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BaHammam AS, Alshahrani M, Aleissi SA, Olaish AH, Alhassoon MH, Shukr A. Blood pressure dipping during REM and non-REM sleep in patients with moderate to severe obstructive sleep apnea. Sci Rep 2021; 11:7990. [PMID: 33846490 PMCID: PMC8041780 DOI: 10.1038/s41598-021-87200-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
A limited number of papers have addressed the association between non-dipping-blood pressure (BP) obstructive sleep apnea (OSA), and no study has assessed BP-dipping during rapid eye movement (REM) and non-REM sleep in OSA patients. This study sought to noninvasively assess BP-dipping during REM and non-REM (NREM)-sleep using a beat-by-beat measurement method (pulse-transit-time (PTT)). Thirty consecutive OSA patients (men = 50%) who had not been treated for OSA before and who had > 20-min of REM-sleep were included. During sleep, BP was indirectly determined via PTT. Patients were divided into dippers and non-dippers based on the average systolic-BP during REM and NREM-sleep. The studied group had a a median age of 50 (42–58.5) years and a body mass index of 33.8 (27.6–37.5) kg/m2. The median AHI of the study group was 32.6 (20.1–58.1) events/h (range: 7–124), and 89% of them had moderate-to-severe OSA. The prevalence of non-dippers during REM-sleep was 93.3%, and during NREM-sleep was 80%. During NREM sleep, non-dippers had a higher waist circumference and waist-hip-ratio, higher severity of OSA, longer-time spent with oxygen saturation < 90%, and a higher mean duration of apnea during REM and NREM-sleep. Severe OSA (AHI ≥ 30) was defined as an independent predictor of non-dipping BP during NREM sleep (OR = 19.5, CI: [1.299–292.75], p-value = 0.03). This short report demonstrated that BP-dipping occurs during REM and NREM-sleep in patients with moderate-to-severe OSA. There was a trend of more severe OSA among the non-dippers during NREM-sleep, and severe OSA was independently correlated with BP non-dipping during NREM sleep.
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Affiliation(s)
- Ahmed S BaHammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in The Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
| | - Mana Alshahrani
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salih A Aleissi
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed H Alhassoon
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Shukr
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Morra S, Gauthey A, Hossein A, Rabineau J, Racape J, Gorlier D, Migeotte PF, le Polain de Waroux JB, van de Borne P. Influence of sympathetic activation on myocardial contractility measured with ballistocardiography and seismocardiography during sustained end-expiratory apnea. Am J Physiol Regul Integr Comp Physiol 2020; 319:R497-R506. [PMID: 32877240 DOI: 10.1152/ajpregu.00142.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ballistocardiography (BCG) and seismocardiography (SCG) assess vibrations produced by cardiac contraction and blood flow, respectively, through micro-accelerometers and micro-gyroscopes. BCG and SCG kinetic energies (KE) and their temporal integrals (iK) during a single heartbeat are computed in linear and rotational dimensions. Our aim was to test the hypothesis that iK from BCG and SCG are related to sympathetic activation during maximal voluntary end-expiratory apnea. Multiunit muscle sympathetic nerve traffic [burst frequency (BF), total muscular sympathetic nerve activity (tMSNA)] was measured by microneurography during normal breathing and apnea (n = 28, healthy men). iK of BCG and SCG were simultaneously recorded in the linear and rotational dimension, along with oxygen saturation ([Formula: see text]) and systolic blood pressure (SBP). The mean duration of apneas was 25.4 ± 9.4 s. SBP, BF, and tMSNA increased during the apnea compared with baseline (P = 0.01, P = 0.002,and P = 0.001, respectively), whereas [Formula: see text] decreased (P = 0.02). At the end of the apnea compared with normal breathing, changes in iK computed from BCG were related to changes of tMSNA and BF only in the linear dimension (r = 0.85, P < 0.0001; and r = 0.72, P = 0.002, respectively), whereas changes in linear iK of SCG were related only to changes of tMSNA (r = 0.62, P = 0.01). We conclude that maximal end expiratory apnea increases cardiac kinetic energy computed from BCG and SCG, along with sympathetic activity. The novelty of the present investigation is that linear iK of BCG is directly and more strongly related to the rise in sympathetic activity than the SCG, mainly at the end of a sustained apnea, likely because the BCG is more affected by the sympathetic and hemodynamic effects of breathing cessation. BCG and SCG may prove useful to assess sympathetic nerve changes in patients with sleep disturbances.NEW & NOTEWORTHY Ballistocardiography (BCG) and seismocardiography (SCG) assess vibrations produced by cardiac contraction and blood flow, respectively, through micro-accelerometers and micro-gyroscopes. Kinetic energies (KE) and their temporal integrals (iK) during a single heartbeat are computed from the BCG and SCG waveforms in a linear and a rotational dimension. When compared with normal breathing, during an end-expiratory voluntary apnea, iK increased and was positively related to sympathetic nerve traffic rise assessed by microneurography. Further studies are needed to determine whether BCG and SCG can probe sympathetic nerve changes in patients with sleep disturbances.
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Affiliation(s)
- Sofia Morra
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Anais Gauthey
- Department of Cardiology, Saint-Luc hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Amin Hossein
- Laboratory of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jérémy Rabineau
- Laboratory of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Judith Racape
- Research Centre in Epidemiology, Biostatistics and Clinical Research. School of Public Health. Université Libre de Bruxelles, Brussels, Belgium
| | - Damien Gorlier
- Laboratory of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Philippe van de Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Association between Respiratory Sleep Indices and Cardiovascular Disease in Sleep Apnea-A Community-Based Study in Cyprus. J Clin Med 2020; 9:jcm9082475. [PMID: 32752220 PMCID: PMC7464413 DOI: 10.3390/jcm9082475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.
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Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time. Sci Rep 2020; 10:3342. [PMID: 32094479 PMCID: PMC7039871 DOI: 10.1038/s41598-020-60281-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 02/01/2023] Open
Abstract
Rapid eye movement-predominant obstructive sleep apnea has been shown to be independently associated with hypertension. This study aimed to non-invasively measure blood pressure during the rapid eye movement (REM) and non-rapid eye movement (NREM) obstructive events and the post-obstructive event period. Thirty-two consecutive continuous positive airway pressure-naïve obstructive sleep apnea patients (men, 50%) aged 50.2 ± 12 years underwent overnight polysomnography. Blood pressure was assessed indirectly using a validated method based on the pulse transit time and pulse wave velocity during the NREM and REM obstructive events (both apneas and hypopneas) and the post-obstructive event period. Among the recruited patients, 10 (31.3%) had hypertension. Mean apnea-hypopnea index was 40.1 ± 27.6 events/hr. Apnea-hypopnea indexes were 38.3 ± 30.6 and 51.9 ± 28.3 events/hr for NREM and REM sleep, respectively. No differences were detected in obstructive respiratory event duration or degree of desaturation between REM and NREM sleep. Additionally, no difference in blood pressure (systolic and diastolic) was detected between REM and NREM sleep during obstructive events and post-obstructive event period. Simple linear regression identified history of hypertension as a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in both rapid eye movement and non-rapid eye movement sleep. Oxygen desaturation index was also a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in REM sleep. When obstructive event duration and the degree of desaturation were comparable, no difference in blood pressure was found between REM and NREM sleep during obstructive events and post-obstructive event period.
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Lau HL, Rundek T, Ramos AR. Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment. CURRENT SLEEP MEDICINE REPORTS 2019; 5:71-82. [PMID: 31850157 PMCID: PMC6916645 DOI: 10.1007/s40675-019-00142-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss the most recent data on sleep disorders and stroke, highlighting relevant findings for the practicing neurologist or health providers who encounter patients with sleep disorders and stroke. RECENT FINDINGS Sleep apnea and abnormal sleep duration have the strongest association with stroke risk. Possible mechanisms include non-dipping of blood pressure during sleep, hypoxemia or reoxygenation leading to sympathetic activation, hypertension, atrial fibrillation and impaired cerebral hemodynamics. Treatment studies suggest that continuous positive airway pressure (CPAP) for sleep apnea could improve primary prevention of stroke, but data is equivocal for secondary prevention. However, CPAP could improve functional outcomes after stroke. SUMMARY Sleep disorders present an opportunity to improve stroke risk and functional outcomes. However, new strategies are needed to determine the patients at high-risk who would most likely benefit from targeted care. Novel methods for phenotyping sleep disorders could provide personalized stroke care to improve clinical outcomes and public health strategies.
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Affiliation(s)
- H Lee Lau
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
| | - Tanja Rundek
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
| | - Alberto R Ramos
- Departments of Neurology, Miller School of Medicine University of Miami, Miami, Florida, USA
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Gregori-Pla C, Delgado-Mederos R, Cotta G, Giacalone G, Maruccia F, Avtzi S, Prats-Sánchez L, Martínez-Domeño A, Camps-Renom P, Martí-Fàbregas J, Durduran T, Mayos M. Microvascular cerebral blood flow fluctuations in association with apneas and hypopneas in acute ischemic stroke. NEUROPHOTONICS 2019; 6:025004. [PMID: 31037244 PMCID: PMC6477863 DOI: 10.1117/1.nph.6.2.025004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
In a pilot study on acute ischemic stroke (AIS) patients, unexpected periodic fluctuations in microvascular cerebral blood flow (CBF) had been observed. Motivated by the relative lack of information about the impact of the emergence of breathing disorders in association with stroke on cerebral hemodynamics, we hypothesized that these fluctuations are due to apneic and hypopneic events. A total of 28 patients were screened within the first week after stroke with a pulse oximeter. Five (18%) showed fluctuations of arterial blood oxygen saturation ( ≥ 3 % ) and were included in the study. Near-infrared diffuse correlation spectroscopy (DCS) was utilized bilaterally to measure the frontal lobe CBF alongside respiratory polygraphy. Biphasic CBF fluctuations were observed with a bilateral increase of 27.1 % ± 17.7 % and 29.0 % ± 17.4 % for the ipsilesional and contralesional hemispheres, respectively, and a decrease of - 19.3 % ± 9.1 % and - 21.0 % ± 8.9 % for the ipsilesional and contralesional hemispheres, respectively. The polygraph revealed that, in general, the fluctuations were associated with apneic and hypopneic events. This study motivates us to investigate whether the impact of altered respiratory patterns on cerebral hemodynamics can be detrimental in AIS patients.
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Affiliation(s)
- Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Raquel Delgado-Mederos
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Giacomo Giacalone
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- San Raffaele Scientific Institute, Milan, Italy
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Universitat Autònoma de Barcelona, Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron University Research Institute, Barcelona, Spain
| | - Stella Avtzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Luís Prats-Sánchez
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Pol Camps-Renom
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Mercedes Mayos
- Hospital de la Santa Creu i Sant Pau, Sleep Unit, Department of Respiratory Medicine, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CB06/06), Madrid, Spain
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Borges MA, Prado M, Santini TRDS, Barbosa AHP, Moreira AC, Ishibe EI, Katz M, Cintra FD. Development and clinical validation of a non-invasive, beat-to-beat blood pressure monitoring device, compared to invasive blood pressure monitoring during coronary angiography. EINSTEIN-SAO PAULO 2019; 17:eAO4156. [PMID: 30892376 PMCID: PMC6422362 DOI: 10.31744/einstein_journal/2019ao4156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
Objective To develop and test a beat-to-beat blood pressure monitoring device during coronary angiography, and compare it with invasive blood pressure monitoring. Methods Twenty-eight patients with an indication for hemodynamic study were selected for this investigation, and kept in supine position. Before starting the coronary angiography, they were instructed about the use of the left radial bracelet for beat-to-beat blood pressure monitoring. Results There was a significant difference between the time required for the catheterization laboratory team to acquire the first invasive blood pressure reading and the time to obtain the first beat-to-beat reading (11.1±5.1 and 1.5±1.8, respectively; p<0.0001). The intraclass correlation coefficients (95%CI) of systolic and diastolic blood pressures were 0.897 (0.780-0.952) and 0.876 (0.734-0.942), indicating good reproducibility. Conclusion This study showed the process to develop a beat-to-beat blood pressure monitoring device. When compared to invasive blood pressure monitoring, there were no significant differences between the two methods. This technique may play a promising coadjuvant role when combined with invasive monitoring during coronary angiography procedures.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Katz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Wu H, Lv Q, Zhang H, Qin Y, Fang F, Sun H, Wei Y. The reduction of apnea–hypopnea duration ameliorates endothelial dysfunction, vascular inflammation, and systemic hypertension in a rat model of obstructive sleep apnea. Sleep Breath 2019; 23:1187-1196. [DOI: 10.1007/s11325-019-01798-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/26/2019] [Accepted: 02/01/2019] [Indexed: 01/15/2023]
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10
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Zirak P, Gregori-Pla C, Blanco I, Fortuna A, Cotta G, Bramon P, Serra I, Mola A, Solà-Soler J, Giraldo-Giraldo BF, Durduran T, Mayos M. Characterization of the microvascular cerebral blood flow response to obstructive apneic events during night sleep. NEUROPHOTONICS 2018; 5:045003. [PMID: 30681667 PMCID: PMC6215085 DOI: 10.1117/1.nph.5.4.045003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/10/2018] [Indexed: 05/09/2023]
Abstract
Obstructive apnea causes periodic changes in cerebral and systemic hemodynamics, which may contribute to the increased risk of cerebrovascular disease of patients with obstructive sleep apnea (OSA) syndrome. The improved understanding of the consequences of an apneic event on the brain perfusion may improve our knowledge of these consequences and then allow for the development of preventive strategies. Our aim was to characterize the typical microvascular, cortical cerebral blood flow (CBF) changes in an OSA population during an apneic event. Sixteen patients (age 58 ± 8 years , 75% male) with a high risk of severe OSA were measured with a polysomnography device and with diffuse correlation spectroscopy (DCS) during one night of sleep with 1365 obstructive apneic events detected. All patients were later confirmed to suffer from severe OSA syndrome with a mean of 83 ± 15 apneas and hypopneas per hour. DCS has been shown to be able to characterize the microvascular CBF response to each event with a sufficient contrast-to-noise ratio to reveal its dynamics. It has also revealed that an apnea causes a peak increase of microvascular CBF ( 30 ± 17 % ) at the end of the event followed by a drop ( - 20 ± 12 % ) similar to what was observed in macrovascular CBF velocity of the middle cerebral artery. This study paves the way for the utilization of DCS for further studies on these populations.
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Affiliation(s)
- Peyman Zirak
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
- Address all correspondence to: Clara Gregori-Pla, E-mail:
| | - Igor Blanco
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Ana Fortuna
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pau Bramon
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
| | - Anna Mola
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
| | - Jordi Solà-Soler
- Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Department of Automatic Control (ESAII), Barcelona, Spain
- The Barcelona Institute of Science and Technology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Beatriz F. Giraldo-Giraldo
- Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Department of Automatic Control (ESAII), Barcelona, Spain
- The Barcelona Institute of Science and Technology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Mercedes Mayos
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain
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Abstract
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain). Each of these phenotypes is a target for therapy. This review summarizes the latest knowledge on the different contributors to OSA with a focus on measurement techniques including emerging clinical tools designed to facilitate translation of new cause-driven targeted approaches to treat OSA. The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted.
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Affiliation(s)
- Amal M Osman
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sophie G Carter
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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12
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Sola-Soler J, Giraldo BF, Fiz JA, Jane R. Relationship between heart rate excursion and apnea duration in patients with Obstructive Sleep Apnea. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1539-1542. [PMID: 29060173 DOI: 10.1109/embc.2017.8037129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a sleep disorder with a high prevalence in the general population. It is a risk factor for many cardiovascular diseases, and an independent risk factor for cerebrovascular diseases such as stroke. After an apnea episode, both arterial blood pressure and cerebral blood flow velocity change in function of the apnea duration (AD). We hypothesized that the relative excursion in heart rate (AHR), defined as the percentage difference between the maximum and the minimum heart rate values associated to an obstructive apnea event, is also related to AD. In this work we studied the relationship between apnea-related AHR and AD in a population of eight patients with severe OSA. AHR and AD showed a moderate but statistically significant correlation (p <; 0.0001) in a total of 1454 obstructive apneas analyzed. The average heart rate excursion for apneas with AD ≥ 30s (ΔHR = 31.29 ± 6.64%) was significantly greater (p = 0.0002) than for apneas with AD ∈ [10,20)s (ΔHR = 18.14±3.08%). We also observed that patients with similar Apnea-Hypopnea Index (AHI) may exhibit remarkably different distributions of AHR and AD, and that patients with a high AHI need not have a higher average AHR than others with a lower severity index. We conclude that the overall apnea-induced heart rate excursion is partially explained by the duration of apnoeic episodes, and it may be a simple measure of the cardiovascular stress associated with OSA that is not directly reflected in the AHI.
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Wu H, Zhan X, Zhao M, Wei Y. Mean apnea-hypopnea duration (but not apnea-hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea. Medicine (Baltimore) 2016; 95:e5493. [PMID: 27902610 PMCID: PMC5134767 DOI: 10.1097/md.0000000000005493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To determine which polysomnography parameters are associated with severity of hypertension.This retrospective study collected data on all patients admitted to our urban, academic center in Beijing with hypertension who had undergone polysomnograms (PSG) and were diagnosed with obstructive sleep apnea (OSA) (apnea-hyponea index [AHI] ≥5/hour). We then compared polysomnographic parameters (AHI, oxygen desaturation index [ODI], lowest oxygen saturation [LOS], and mean apnea-hypopnea duration [MAD]) by hypertension severity in this cohort.There were 596 subjects who met entry criteria. Age, sex distribution, body mass index (BMI), history of current smoking and alcohol were similar among groups. Subjects with longer MAD suffered from more severe hypertension (P = 0.011). There were no relationship between AHI, ODI, and LOS and hypertension in our cohort. There were no significant differences in age, sex, BMI, history of current smoking and alcohol use between hypertension groups. MAD had a small but significant independent association (odds ratio [OR] = 1.072, 95% confidence interval [CI] 1.019-1.128, P = 0.007) with moderate to severe hypertension, using logistic regression analysis that accounted for age, sex, BMI, history of current smoking and alcohol, AHI, and LOS.Chinese inpatients with longer MAD by PSG face higher odds of moderate to severe hypertension. The mechanism of these effects may be due to aggravated nocturnal hypoxaemia and hypercapnia, as well as disturbed sleep architecture. These results suggest that additional information available in the polysomnogram, such as MAD, should be considered when evaluating OSA patients.
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Tsapanou A, Gu Y, O'Shea D, Manly J, Schupf N, Scarmeas N, Stern Y. Self-Reported Sleep Disordered Breathing as Risk Factor for Mortality in the Elderly. J Stroke Cerebrovasc Dis 2016; 25:1524-31. [PMID: 27053028 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study aimed to examine the association between self-reported sleep disordered breathing (SDB) ("awaken short of breath or with a headache") and mortality in a large and ethnically diverse group of community-dwelling elderly people. METHODS A total of 1288 participants, 65 years and older, were examined longitudinally. Sleep problems were estimated using the Medical Outcomes Study Sleep Scale examining sleep disturbance, snoring, awaken short of breath or with a headache, sleep adequacy, and sleep somnolence. Cox regression analysis was used to examine the association between sleep problems and mortality. Age, gender, education, ethnicity, and body mass index were included as covariates. In further analyses we included hypertension, diabetes, heart disease, and stroke as additional covariates. RESULTS The participants were followed for up to 6 years (mean = 2.9, standard deviation = 1.1), and 239 (18.6%) participants died during the follow-up. In unadjusted models, SDB at the initial visit was associated with mortality (hazard ratio [HR] = 1.37; 95% confidence interval [CI] 1.21-1.55; P < .0001). After adjusting for all the covariates, the relationship between SDB and mortality remained significant (HR = 1.48; 95% CI 1.29-1.70; P < .0001). Participants with Caribbean-Hispanic ancestry have higher risk for mortality. CONCLUSIONS Our results suggest that SDB is a risk factor for mortality in a large and ethnically diverse group of older adults, independent of demographic and clinical factors. Further research is needed to examine the underlying mechanisms of this association.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York
| | - Deirdre O'Shea
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jennifer Manly
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; National and Kapodistrian University of Athens Medical School, Athens, Greece; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, New York; The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York; The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
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Butler MP, Smales C, Wu H, Hussain MV, Mohamed YA, Morimoto M, Shea SA. The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea. Sleep 2015; 38:1793-801. [PMID: 26039970 DOI: 10.5665/sleep.5166] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/28/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. DESIGN Within-subject and between-subjects. SETTINGS Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. PARTICIPANTS Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. INTERVENTIONS Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. MEASUREMENTS AND RESULTS Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. CONCLUSIONS The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea.
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Affiliation(s)
- Matthew P Butler
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Carolina Smales
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Huijuan Wu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Mohammad V Hussain
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Yusef A Mohamed
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Miki Morimoto
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR.,Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
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