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Can the complete blood count be used as a reliable screening tool for obstructive sleep apnea? Sleep Breath 2021; 26:613-620. [PMID: 34185230 DOI: 10.1007/s11325-021-02383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Since hypoxia increases erythropoietin production and inflammation, the complete blood count (CBC) has been proposed as an inexpensive alternative for obstructive sleep apnea (OSA) screening. The objective of this study was to determine whether or not intermittent hypoxia and OSA severity, as measured by the mean oxygen saturation (SpO2) and apnea-hypopnea index (AHI), affect parameters measured by the CBC. METHODS This retrospective study included a total of 941 surgical patients who had a pre-operative home sleep study. The pre-operative CBC was extracted from the electronic patient records. Patients were stratified according to their AHI scores, into mild (AHI ≥ 5 - < 15), moderate (AHI ≥ 15 - < 30), and severe (AHI ≥ 30) OSA groups. RESULTS There were 244 patients without OSA, 294 with mild, 223 with moderate, and 180 with severe OSA. Our analysis showed that hemoglobin (P = 0.010), hematocrit (P = 0.027), and basophils (P = 0.006) showed significant changes among the different severities of OSA. For mean SpO2, there were negative associations with body mass index (r = - 0.287; P < 0.001), age (r = - 0.077; P = 0.021), hemoglobin (r = - 0.208; P < 0.001), hematocrit (r = - 0.220; P < 0.001), red blood cells (r = - 0.107; P = 0.001), mean corpuscular volume (MCV) (r = - 0.159; P < 0.001), mean corpuscular hemoglobin (r = - 0.142; P < 0.001), and basophils (r = - 0.091; P = 0.007). All analyzed parameters remained within normal clinical range. Multivariable regression identified hemoglobin, MCV, and basophils to be independent predictors of mean SpO2 and AHI. CONCLUSION Hemoglobin, MCV, and basophils were independently associated with intermittent hypoxia defined by mean SpO2 and AHI. Adding CBC parameters to other screening tools for OSA may have additional value due to its association with changes in mean SpO2.
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Khemliche H, Ouayoun MC. [Physiopathology of obstructive sleep apnea syndrome]. Orthod Fr 2019; 90:263-271. [PMID: 34643514 DOI: 10.1051/orthodfr/2019028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An excellent grasp of the physiopathology of obstructive sleep apnea syndrome (OSAS) is essential to understanding its diagnostic and therapeutic modalities. A systematic review of the literature was performed on data specific to humans. Two aspects are involved: on one hand, the mechanisms contributing to intermittent obstruction of the upper airways (UA) during sleep and, on the other hand, the impact of this obstruction, e.g. neurocognitive disorders, cardiovascular disease and metabolic dysregulation. UA obstruction can be explained by anatomical, mechanical and neuro-functional conditions, especially the proprioceptive and chemical feedback of UA neuromuscular activity. Our understanding of the impact of OSAS has benefited from the recently developed concepts of oxidative stress and low-grade systemic inflammation, the discovery of hypoxia-sensitive agents and of the role of cytokines. The onset of this chain of events is determined by chronic intermittent hypoxia.
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Affiliation(s)
| | - Michel-Christian Ouayoun
- Université Sorbonne Paris Cité, Faculté de médecine Léonard de Vinci, 74 rue Marcel Cachin, 93017 Bobigny cedex, France
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Fleming WE, Holty JEC, Bogan RK, Hwang D, Ferouz-Colborn AS, Budhiraja R, Redline S, Mensah-Osman E, Osman NI, Li Q, Azad A, Podolak S, Samoszuk MK, Cruz AB, Bai Y, Lu J, Riley JS, Southwick PC. Use of blood biomarkers to screen for obstructive sleep apnea. Nat Sci Sleep 2018; 10:159-167. [PMID: 29942168 PMCID: PMC6005302 DOI: 10.2147/nss.s164488] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study. PATIENTS AND METHODS This multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c), C-reactive protein (CRP), uric acid, erythropoietin (EPO), and interleukin-6 (IL-6). RESULTS The study enrolled 264 subjects. The combination of HbA1c+CRP+EPO (area under the curve 0.78) was superior to the Epworth Sleepiness Scale (ESS; 0.53) and STOP-Bang (0.70) questionnaires. In non-obese subjects, the combination of biomarkers (0.75) was superior to body mass index (BMI; 0.61). Sensitivity and specificity results, respectively, were: HbA1c+CRP+EPO (81% and 60%), ESS (78% and 19%), STOP-Bang (75% and 52%), BMI (81% and 56%), and BMI in non-obese patients (81% and 38%). CONCLUSION We verify our hypothesis and replicate our prior feasibility findings that OSA is associated with a characteristic signature cluster of biomarker changes in men. Concurrent elevations of HbA1c, CRP, and EPO levels should generate a high suspicion of OSA and may have utility as an OSA screening tool. Biomarker combinations correlate with OSA severity and, therefore, may assist sleep centers in identifying and triaging higher risk patients for sleep study diagnosis and treatment.
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Affiliation(s)
| | - Jon-Erik C Holty
- Stanford Medical School, VA Palo Alto Health Care System, Pulmonary, Critical Care and Sleep Medicine Section, Palo Alto, CA, USA
| | - Richard K Bogan
- SleepMed Inc., Bogan Sleep Consultants, LLC, Columbia, SC, USA
| | - Dennis Hwang
- Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA
| | - Aliya S Ferouz-Colborn
- Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA
| | - Rohit Budhiraja
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Nadir Ishag Osman
- EENA Comprehensive Neurology and Sleep Center, Boynton Beach, FL, USA
| | - Qing Li
- South Bend Medical Foundation, New Technology and Test Development, South Bend, IN, USA
| | | | | | | | - Amabelle B Cruz
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - Yang Bai
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - Jiuliu Lu
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
| | - John S Riley
- Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USA
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Félez M, Grau N, Ruiz A, Guardiola E, Sanjuas C, Estirado C, Navarro-Muñoz M, Pascual A, Orozco-Levi M, Gea J. Increased Urinary Erythropoietin Excretion in Severe Sleep Apnea-Hipoapnea Syndrome: The Effect of CPAP. Arch Bronconeumol 2017; 54:255-259. [PMID: 29217205 DOI: 10.1016/j.arbres.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/04/2017] [Accepted: 10/21/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Tissue hypoxia stimulates the production of erythropoietin (EPO), the main effect of which is, in turn, to stimulate erythropoiesis. Sleep apnea-hypopnea syndrome (SAHS) is an entity characterized by repeated episodes of hypoxemia during sleep. OBJECTIVE To analyze whether hypoxemia stimulated increased urinary excretion of EPO, and if so, to evaluate if treatment with continuous positive airway pressure (CPAP) can inhibit this phenomenon. METHODS We studied 25 subjects with suspected SAHS who underwent a polysomnography study (PSG). EPO levels in first morning urine (uEPO) and blood creatinine and hemoglobin were determined in all patients. Patients with severe SAHS repeated the same determinations after CPAP treatment. RESULTS Twelve subjects were diagnosed with severe SAHS (mean ± SD, AHI 53.1 ± 22.7). Creatinine and hemoglobin levels were normal in all subjects. uEPO was 4 times higher in the SAHS group than in the control group (1.32 ± 0.83 vs. 0.32 ± 0.35 UI/l, p <.002). CPAP treatment reduced uEPO to 0.61 ± 0.9 UI/l (p <.02), levels close to those observed in healthy subjects. No dose-response relationship was observed between severity of PSG changes and uEPO values. CONCLUSIONS Patients with severe SAHS show increased uEPO excretion, but this normalizes after treatment with CPAP.
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Affiliation(s)
- Miquel Félez
- Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España; Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España.
| | - Nuria Grau
- Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España; Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España
| | - Antonia Ruiz
- Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España
| | - Encarna Guardiola
- Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España
| | - Carles Sanjuas
- Unidad Multidisciplinar de Trastornos del Sueño, Hospital del Mar, Parc de Salut Mar, UAB-UPF, Barcelona, España; Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España
| | - Cristina Estirado
- Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España
| | - Maribel Navarro-Muñoz
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, España
| | - Antoni Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, España; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, España
| | - Mauricio Orozco-Levi
- Servicio de Neumología, Fundación Cardiovascular de Colombia, Hospital Internacional de Colombia, Bucaramanga, Colombia
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar, Parc de Salut Mar, IMIM, UAB-UPF, CIBERES, ISC III, Barcelona, España
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Erythropoietin levels in patients with sleep apnea: a meta-analysis. Eur Arch Otorhinolaryngol 2017; 274:2505-2512. [PMID: 28280920 PMCID: PMC5420001 DOI: 10.1007/s00405-017-4483-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/24/2017] [Indexed: 02/08/2023]
Abstract
Currently available data regarding the blood levels of erythropoietin (EPO) in sleep apnea (SA) patients are contradictory. The aim of the present meta-analysis was to evaluate the EPO levels in SA patients via quantitative analysis. A systematic search of Pubmed, Embase, and Web of Science were performed. EPO levels in SA group and control group were extracted from each eligible study. Weight mean difference (WMD) or Standard mean difference (SMD) with 95% confidence interval (CI) was calculated by using fixed-effects or random effect model analysis according to the degree of heterogeneity between studies. A total of 9 studies involving 407 participants were enrolled. The results indicated that EPO levels in SA group were significantly higher than that in control group (SMD 0.61, 95% CI 0.11–1.11, p = 0.016). Significantly higher EPO levels were found in patients with body mass index <30 kg/m2, and cardiovascular complications in the subsequent subgroup analysis (both p < 0.05). High blood EPO levels were found in SA patients in the present meta-analysis.
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Blood biomarkers of endocrine, immune, inflammatory, and metabolic systems in obstructive sleep apnea. Clin Biochem 2016; 49:854-61. [PMID: 27184708 DOI: 10.1016/j.clinbiochem.2016.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE/BACKGROUND Obstructive sleep apnea (OSA) is a common disorder, affecting over 100 million adults. Untreated OSA leads to serious health consequences and perturbations in endocrine, immune, inflammatory, and metabolic systems. Study objectives are to evaluate the association between OSA and biomarkers, and to test the hypothesis that a combination of markers may be useful in screening for OSA. PATIENTS/METHODS A multicenter trial was conducted enrolling symptomatic male patients with suspected OSA. All subjects underwent in-laboratory overnight polysomnography. A non-symptomatic control group was also obtained. Eleven biomarkers were tested: HbA1c, CRP, EPO, IL-6, uric acid, cortisol, hGH, prolactin, testosterone, DHEA (Beckman Coulter UniCel DxC 600i Synchron® Access® Clinical Systems), IGF-1. RESULTS 73 male subjects were enrolled; 26 had moderate/severe OSA. ROC curve analysis showed HbA1c, CRP, EPO, IL-6, and Uric Acid (AUCs: 0.76, 0.73, 0.65, 0.65, 0.61) were superior to the Epworth Sleepiness Scale (AUC: 0.52). Concurrent elevation of HbA1c and CRP provide even greater predictive power. A combination of elevated HbA1c, CRP, and EPO provided 0.08 increase in AUC (0.84 [0.75 - 0.94]) over individual markers (p<0.05), with high sensitivity (85%), and specificity (79%) for moderate/severe OSA. CONCLUSIONS OSA induces characteristic endocrine, immune, inflammatory, and metabolic disturbances that can be detected with blood biomarkers. These biomarkers are superior to standard screening questionnaires. Various clusters of these biomarkers have an even greater association with OSA and thus may represent physiologic signatures of the disorder that may have value in initial screening for OSA as well as for follow-up of therapy response.
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Wang JY, Han F, Dong SX, Li J, An P, Zhang XZ, Chang Y, Zhao L, Zhang XL, Liu YN, Yan H, Li QH, Hu Y, Lv CJ, Gao ZC, Strohl KP. Cerebrospinal Fluid Orexin A Levels and Autonomic Function in Kleine-Levin Syndrome. Sleep 2016; 39:855-60. [PMID: 26943469 DOI: 10.5665/sleep.5642] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. METHODS From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS. Cerebrospinal fluid orexin A levels and diurnal blood pressure were measured in relapse versus remission in a subgroup of patients. RESULTS Presenting symptoms included relapsing or remitting excessive sleepiness-associated parallel complaints of cognitive changes (82%), eating disorders (84%); depression (45%); irritability (36%); hypersexuality (18%); and compulsions (11%). Episodes were 8.2 ± 3.3 days in duration. In relapse, diurnal values for blood pressure and heart rate were lower (P < 0.001). In a subgroup (n = 34), cerebrospinal fluid orexin A levels were ∼31% lower in a relapse versus remission (215.7 ± 81.5 versus 319.2 ± 95.92 pg/ml, P < 0.001); in three patients a pattern of lower levels during subsequent relapses was documented. CONCLUSIONS There are lower orexin A levels in the symptomatic phase than in remission and a fall and rise in blood pressure and heart rate, suggesting a role for orexin dysregulation in KLS pathophysiology.
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Affiliation(s)
- Jing Yu Wang
- Binzhou Medical University Hospital, Shandong Province, China
| | - Fang Han
- Binzhou Medical University Hospital, Shandong Province, China.,Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Song X Dong
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Pei An
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xiao Zhe Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yuan Chang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xue Li Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Ya Nan Liu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Han Yan
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Qing Hua Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yan Hu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Chang Jun Lv
- Binzhou Medical University Hospital, Shandong Province, China
| | - Zhan Cheng Gao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, OH
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Ismail K, Roberts K, Manning P, Manley C, Hill NS. OSA and pulmonary hypertension: time for a new look. Chest 2015; 147:847-861. [PMID: 25732450 DOI: 10.1378/chest.14-0614] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OSA is a common yet underdiagnosed disorder encountered in everyday practice. The disease is a unique physiologic stressor that contributes to the development or progression of many other disorders, particularly cardiovascular conditions. The pulmonary circulation is specifically affected by the intermittent hypoxic apneas associated with OSA. The general consensus has been that OSA is associated with pulmonary hypertension (PH), but only in a minority of OSA patients and generally of a mild degree. Consequently, there has been no sense of urgency to screen for either condition when evaluating the other. In this review, we explore available evidence describing the interaction between OSA and PH and seek to better understand underlying pathophysiology. We describe certain groups of patients who have a particular preponderance of OSA and PH. Failure to recognize the mutual additive effects of these disorders can lead to suboptimal patient outcomes. Among patients with PH and OSA, CPAP, the mainstay treatment for OSA, may ameliorate pulmonary pressure elevations, but has not been studied adequately. Conversely, among patients with OSA, PH significantly limits functional capacity and potentially shortens survival; yet, there is no routine screening for PH in patients with OSA. We think it is time to study the interaction between OSA and PH more carefully to identify high-risk subgroups. These would be screened for the presence of combined disorders, facilitating earlier institution of therapy and improving outcomes.
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Daulatzai MA. Neurotoxic Saboteurs: Straws that Break the Hippo’s (Hippocampus) Back Drive Cognitive Impairment and Alzheimer’s Disease. Neurotox Res 2013; 24:407-59. [DOI: 10.1007/s12640-013-9407-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 12/29/2022]
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Hämäläinen P, Saltevo J, Kautiainen H, Mäntyselkä P, Vanhala M. Erythropoietin, ferritin, haptoglobin, hemoglobin and transferrin receptor in metabolic syndrome: a case control study. Cardiovasc Diabetol 2012; 11:116. [PMID: 23016887 PMCID: PMC3471017 DOI: 10.1186/1475-2840-11-116] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/22/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increased ferritin concentrations are associated with metabolic syndrome (MetS). The association between ferritin as well as hemoglobin level and individual MetS components is unclear. Erythropoietin levels in subjects with MetS have not been determined previously. The aim of this study was to compare serum erythropoietin, ferritin, haptoglobin, hemoglobin, and transferrin receptor (sTFR) levels between subjects with and without MetS and subjects with individual MetS components. METHODS A population based cross-sectional study of 766 Caucasian, middle-aged subjects (341 men and 425 women) from five age groups born in Pieksämäki, Finland who were invited to a health check-up in 2004 with no exclusion criteria. Laboratory analyzes of blood samples collected in 2004 were done during year 2010. MetS was defined by National Cholesterol Education Program criteria. RESULTS 159 (53%) men and 170 (40%) women of study population met MetS criteria. Hemoglobin and ferritin levels as well as erythropoietin and haptoglobin levels were higher in subjects with MetS (p < 0.001, p = 0.018). sTFR level did not differ significantly between subjects with or without MetS. Hemoglobin level was significantly higher in subjects with any of the MetS components (p < 0.001, p = 0.002). Ferritin level was significantly higher in subjects with abdominal obesity or high TG or elevated glucose or low high density cholesterol component (p < 0.001, p = 0.002, p = 0.02). Erythropoietin level was significantly higher in subjects with abdominal obesity component (p = 0.015) but did not differ significantly between subjects with or without other MetS components. Haptoglobin level was significantly higher in subjects with blood pressure or elevated glucose component o MetS (p = 0.028, p = 0.025). CONCLUSION Subjects with MetS have elevated hemoglobin, ferritin, erythropoietin and haptoglobin concentrations. Higher hemoglobin levels are related to all components of MetS. Higher ferritin levels associate with TG, abdominal obesity, elevated glucose or low high density cholesterol. Haptoglobin levels associate with blood pressure or elevated glucose. However, erythropoietin levels are related only with abdominal obesity. Higher serum erythropoietin concentrations may suggest underlying adipose tissue hypoxemia in MetS.
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Affiliation(s)
- Päivi Hämäläinen
- Department of Internal Medicine, Tampere University Hospital, Teiskontie, Tampere, Finland.
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Hoareau GL, Jourdan G, Mellema M, Verwaerde P. Evaluation of arterial blood gases and arterial blood pressures in brachycephalic dogs. J Vet Intern Med 2012; 26:897-904. [PMID: 22574946 DOI: 10.1111/j.1939-1676.2012.00941.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 03/09/2012] [Accepted: 03/27/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Brachycephalic dogs (BD) are prone to congenital upper airway obstruction (brachycephalic syndrome, BS). In humans suffering from sleep apnea, upper airway obstruction is known to cause hypertension. There is no information regarding the influence of BS in dogs on cardiorespiratory physiology. HYPOTHESIS BD are prone to lower P(a) O(2), higher P(a) CO (2), and hypertension compared with meso- or dolicocephalic dogs (MDD). ANIMALS Eleven BD and 11 MDD. METHODS After a questionnaire was completed by the owner, a physical examination was performed. Height and thoracic circumferences were measured. Arterial blood gases, electrolyte concentrations, and packed cell volume (PCV) were measured. Systolic (SAP), mean (MAP), and diastolic (DAP) arterial blood pressure recordings were performed. RESULTS A total of 7 French and 4 English bulldogs met the inclusion criteria. The control group consisted in 6 Beagles, 2 mixed breed dogs, 1 Staffordshire Bull Terrier, 1 Parson Russell Terrier, and 1 Australian Cattle Dog. Statistically, BD had lower P(a) O(2), higher P(a) CO2, and higher PCV when compared with controls (86.2 ± 15.9 versus 100.2 ± 12.6 mmHg, P = .017; 36.3 ± 4.6 versus 32.7 ± 2.6 mmHg, P = .019; 48.2 ± 3.5 versus 44.2 ± 5.4%, P = .026, respectively). Also, they had significantly higher SAP (177.6 ± 25.0 versus 153.5 ± 21.7 mmHg, P = .013), MAP (123.3 ± 17.1 versus 108.3 ± 12.2 mmHg, P = .014), and DAP (95.3 ± 19.2 versus 83.0 ± 11.5 mmHg, P = .042). BD with a P(a) CO (2) >35 mmHg were significantly older than those with a P(a) CO (2) ≤35 mmHg (58 ± 16 and 30 ± 11 months, P = .004). CONCLUSION Results of this study suggest that some BD are prone to lower P(a) O(2), higher P(a) CO (2), and hypertension when compared with MDD. Age may be a contributing factor.
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Affiliation(s)
- G L Hoareau
- School of Veterinary Medicine, William R. Pritchard Veterinary Medical Teaching Hospital.
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The price of obstructive sleep apnea-hypopnea: hypertension and other ill effects. Am J Hypertens 2009; 22:474-83. [PMID: 19265785 DOI: 10.1038/ajh.2009.43] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This review addresses the cardiovascular, cerebrovascular, and metabolic consequences that accompany obstructive sleep apnea-hypopnea (OSAH) in conjunction with the mechanistic pathways implicated in mediating these effects. Particular emphasis is placed on the association with hypertension (HTN). Varying levels of evidence support a role of OSAH in perpetuating sustained HTN, nocturnal HTN, and difficult to control HTN as well as in contributing to the occurrences of nondipping of blood pressure (BP) and increased BP variability. In this context, the emergence of matched designs, adjusted analyses, meta-analyses as well as longitudinal and interventional studies strengthens causal inferences drawn from older observational studies, which suffered from such limitations as confounding.
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Abstract
Obstructive sleep apnea (OSA) is associated with significant cardiovascular morbidity and excess in mortality. Atherosclerosis has been shown to occur in OSA patients free of any other significant risk factors. In particular, intima media thickness, an early marker of atherosclerosis, may be increased at the carotid level in OSA. Thus, early atherosclerosis could be one of the intermediary mechanisms supporting the link between OSA and cardiovascular morbidity. The current concept is that the development of atherosclerotic lesions results from a dynamic interplay between the native cells of the vasculature and different proinflammatory leukocytes issued from the general circulation. Immunoinflammatory cells dominate early atherosclerotic processes, with the secretion of several proinflammatory molecules aggravating lesion progression. There is now substantial evidence that intermittent hypoxia in rodents, as a partial model of sleep apnea, triggers atherogenesis. Blood pressure alterations and hemodynamic strains on the vascular wall, impairment in vascular reactivity, lipid metabolism dysregulation, and activation of proinflammatory transcription factors at the vascular wall level are among the key factors promoting atherosclerosis. Specifically, increases in leukocyte rolling and adhesion molecule expression at the endothelial cell level have been shown to occur in the first 2 weeks after intermittent hypoxia exposure initiation. Early changes at the vascular wall level have been shown in OSA patients and its reversibility under continuous positive airway pressure has also been suggested. Several biological markers potentially linked with early atherosclerosis development are under study in OSA patients. Further studies are needed to identify at-risk subjects prone to develop vascular changes because OSA treatment may either be initiated earlier or combined with specific drug treatments.
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Increased erythropoietin concentration after repeated apneas in humans. Eur J Appl Physiol 2007; 102:609-13. [DOI: 10.1007/s00421-007-0639-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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15
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Siyam M, Benhamou D. [Anaesthetic management of adult patients with obstructive sleep apnea syndrome]. ACTA ACUST UNITED AC 2006; 26:39-52. [PMID: 17158016 DOI: 10.1016/j.annfar.2006.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 06/20/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this review article is to update the anaesthetic management of adult patients with obstructive sleep apnoea syndrome (OSAS). DATA SOURCES All references obtained from the medical database Medline related to OSAS and anaesthesia from 1963 until May 2006 were reviewed. References included original articles, observations, clinical cases, and reviews published in English or in French. DATA SYNTHESIS The anaesthetic literature related to OSAS and anaesthesia is poor. Understanding anatomy and pathophysiology is important for an optimal anaesthetic management. Since the diagnosis is unknown in almost 80-90% of these patients, many undergo general or regional anaesthesia every day without recognition of the main dangers associated with the condition. Recognition of these patients, especially in the preanaesthetic assessment, is an essential step to prevent perioperative complications. Patients with OSAS are very sensitive to sedatives, hypnotics and opioids. The use of these drugs must be controlled and monitored. Anticipation of difficult intubation avoids complications during induction of general anaesthesia and the use of nasal CPAP decreases the incidence of respiratory complications in the perioperative period. CONCLUSION Further research is needed in this field of anesthesia. Intraoperative difficulties in the control of airway and postoperative cardiac and respiratory complications may happen. The use of nasal CPAP in the perioperative period makes the anaesthetic management easier and safer.
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Affiliation(s)
- M Siyam
- Département d'anesthésie-réanimation, hôpital d'Arpajon
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16
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Marley RA, Hoyle B, Ries C. Perianesthesia respiratory care of the bariatric patient. J Perianesth Nurs 2006; 20:404-31; quiz 432-4. [PMID: 16387272 DOI: 10.1016/j.jopan.2005.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our nation's obesity problem has reached epidemic proportions and is only projected to worsen. The morbidly obese patient is at risk for experiencing a multitude of health-related conditions. Morbidly obese patients are presenting for surgery at an increasing rate, especially with the growing popularity of weight-loss surgery. Therefore the perianesthesia nurse has to remain informed of optimal care strategies for this sometimes challenging population. The obese patient presents with distinct respiratory care considerations of which the perianesthesia nurse must be knowledgeable. This review article will specifically focus on the respiratory care of the bariatric patient presenting for surgery.
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Affiliation(s)
- Rex A Marley
- Northwestern Colorado Anesthesia Professional Consultants, Fort Collins, CO 80524, USA.
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17
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García-García F, Krueger JM. Intracerebroventricular injection of erythropoietin enhances sleep in the rat. Brain Res Bull 2003; 61:541-6. [PMID: 13679254 DOI: 10.1016/s0361-9230(03)00191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Systemic injection of erythropoietin (EPO) over several days reduces sleep fragmentation in patients with periodic limb movements in sleep (PLMS). However, there are no studies concerning the effects of EPO on spontaneous sleep. In this study, we determined the effects of intracerebroventricular (i.c.v.) administration of EPO on spontaneous rat sleep. Three doses of EPO (25, 75, and 125 ng) were injected i.c.v. at the onset of the dark period. All doses of EPO increased non-rapid eye movement sleep (NREMS). In addition, high and low doses of EPO (125 and 25 ng) increased rapid eye movement sleep (REMS), but the medium dose of EPO (75 ng) inhibited REMS. Electroencephalogram slow-wave activity during NREMS also increased following the two higher doses of EPO. In contrast, EPO injection during the light period failed to affect sleep. Brain temperature (Tbr) was not affected by any dose of EPO. These results suggest that EPO could be part of the cytokine network involved in sleep regulation.
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MESH Headings
- Animals
- Brain/drug effects
- Brain/metabolism
- Circadian Rhythm/drug effects
- Circadian Rhythm/physiology
- Cytokines/metabolism
- Dose-Response Relationship, Drug
- Erythropoietin/metabolism
- Erythropoietin/pharmacology
- Injections, Intraventricular
- Male
- Photic Stimulation
- Rats
- Rats, Sprague-Dawley
- Receptors, Erythropoietin/drug effects
- Receptors, Erythropoietin/metabolism
- Sleep/drug effects
- Sleep/physiology
- Sleep Disorders, Circadian Rhythm/drug therapy
- Sleep Disorders, Circadian Rhythm/metabolism
- Sleep Disorders, Circadian Rhythm/physiopathology
- Sleep Wake Disorders/drug therapy
- Sleep Wake Disorders/metabolism
- Sleep Wake Disorders/physiopathology
- Sleep, REM/drug effects
- Sleep, REM/physiology
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Affiliation(s)
- Fabio García-García
- Department of Veterinary and Comparative Anatomy, Pharmacology and Physiology, College of Veterinary Medicine, Washington State University, P.O. Box 99164-6520, Pullman, WA, USA
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18
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Abstract
Obstructive sleep apnoea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. However, the underlying mechanisms are not entirely understood. This review will summarize the evidence that substantiates the notion that the repeated apnoea-related hypoxic events in OSA, similarly to hypoxia/reperfusion injury, initiate oxidative stress. Thus, affecting energy metabolism, redox-sensitive gene expression, and expression of adhesion molecules. A limited number of studies substantiate this hypothesis directly by demonstrating increased free radical production in OSA leukocytes and increased plasma-lipid peroxidation. A great number of studies, however, support this hypothesis indirectly. Increase in circulating levels of adenosine and urinary uric acid in OSA are implicated with increased production of reactive oxygen species (ROS). Activation of redox-sensitive gene expression is suggested by the increase in some protein products of these genes, including VEGF, erythropoietin, endothelin-1, inflammatory cytokines and adhesion molecules. These implicate the participation of redox-sensitive transcription factors as HIF-1 AP-1 and NFkappaB. Finally, adhesion molecule-dependent increased avidity of OSA monocytes to endothelial cells, combined with diminished NO bioavailability, lead to exaggerated endothelial cell damage and dysfunction. Cumulatively, these processes may exacerbate atherogenic sequelae in OSA.
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Affiliation(s)
- Lena Lavie
- Anatomy and Cell Biology, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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19
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Schmidt W. Effects of intermittent exposure to high altitude on blood volume and erythropoietic activity. High Alt Med Biol 2002; 3:167-76. [PMID: 12162861 DOI: 10.1089/15270290260131902] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this review is to describe changes in blood volume and erythropoietic activity occurring under different types of intermittent exposure to hypoxia. These hypoxic episodes can vary from a few seconds or minutes to hours, days, or even weeks. Short hypoxic episodes like sleep apnea only lead to a small increase in hemoglobin concentration, which is mainly due to a hormonal-mediated decrease in plasma volume. In most of these cases the cumulative time spent under hypoxia does not exceed the critical threshold of about 90 min. Endurance athletes and mountaineers who voluntarily expose themselves to hypoxia for some hours or during the night while spending the day at normoxia ("sleep high-train low" concept) do improve their physical performance. Despite raising erythropoietic activity, indicated by elevated plasma concentrations of EPO and the transferrin receptor, the postulated increase in red cell volume has not satisfactorily been proved. Frequent changes between low and high altitudes, which are usual in some South American and Asian countries, provoke similar adaptations in red cell mass as occur in high altitude residents. However, the plasma volume decreases at altitude and increases again when staying at sea level. Even after more than 20 yr of regular moving between low and high altitude, the total blood volume, hemoglobin concentration and hematocrit, as well as the plasma EPO concentration, noticeably oscillate during every hypoxic-normoxic cycle. We assume these changes to be an optimal rapid adaptation of the oxygen transport system to the prevailing hypoxic or normoxic environment. However, possible risks for the organism cannot be excluded.
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Affiliation(s)
- Walter Schmidt
- Department of Sports Medicine/Sports Physiology, University of Bayreuth, Germany.
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20
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Schulz R, Hummel C, Heinemann S, Seeger W, Grimminger F. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med 2002; 165:67-70. [PMID: 11779732 DOI: 10.1164/ajrccm.165.1.2101062] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality; however, some patients with OSA do not develop cardiovascular disease even in the presence of severe nocturnal oxygen desaturations. Vascular endothelial growth factor (VEGF) is a hypoxia-sensitive glycoprotein stimulating neoangiogenesis. We hypothesized that VEGF production is increased in OSA because of repetitive nocturnal hypoxia. Three different groups were investigated: 10 OSA patients with severe nighttime hypoxia (Group A), 10 OSA patients with moderate hypoxia (Group B), and 10 healthy volunteers (Group C). Serum levels of VEGF were measured by ELISA from peripheral venous blood samples obtained at 7 AM. Group A had significantly (p < 0.01) increased VEGF serum levels when compared with Group B and Group C (mean +/- SEM: 410 +/- 77 pg/ml versus 224 +/- 38 pg/ml and 245 +/- 61 pg/ml). The degree of nocturnal oxygen desaturation in OSA significantly correlated with the VEGF concentrations (r = 0.67, p < 0.01). In conclusion, serum levels of VEGF are elevated in severely hypoxic patients with OSA and are related to the degree of nocturnal oxygen desaturation. This might constitute an adaptive mechanism to counterbalance the emergence of OSA-related cardiovascular disease.
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Affiliation(s)
- Richard Schulz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Justus-Liebig-University, Giessen, Germany.
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21
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Abstract
Obstructive sleep apnoea (OSA) is associated with increased cardiovascular morbidity and mortality. Several studies indicate an influence of OSA on haematological features. There is evidence of elevated platelet activation and increased haematocrit in OSA. Studies investigating the underlying cause of polycythaemia in OSA reveal different results: increased haematocrit in OSA might be due to enhanced erythropoietin excretion and/or plasma volume dysregulation based on altered release of volume-regulating hormones such as atrial natriuretic peptide (ANP). This review addresses haematological issues associated with OSA, especially platelet function, haematocrit and haemoconcentration. 2001 Harcourt Publishers Ltd
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Affiliation(s)
- I Eisensehr
- Department of Neurology, University of Munich, Marchioninistrasse 15, Munich, 81377, Germany
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22
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Padayatty SJ. Erythropoietin levels can be used to determine tissue oxygenation in critically ill patients. Med Hypotheses 1998; 51:85-8. [PMID: 9881844 DOI: 10.1016/s0306-9877(98)90261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Critically ill patients often require pharmacological support to maintain blood pressure and cardiac output, and mechanical ventilation to ensure adequate oxygenation. Current methods of measurement of oxygen delivery do not necessarily reflect tissue oxygenation. Levels of circulating erythropoietin reliably reflect the adequacy of renal oxygen supply under physiological and many pathological conditions. It is proposed that the measurement of circulating erythropoietin can be used as a measure of tissue oxygenation in critically ill patients.
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Affiliation(s)
- S J Padayatty
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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