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Koseoglu HI, Pazarli AC, Kanbay A, Yakar Hİ, Aykun G, Demir O. NoSAS score predicts cardiovascular disease in patients with obstructive sleep apnea. Sleep Breath 2024; 28:87-93. [PMID: 37420146 DOI: 10.1007/s11325-023-02856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE The Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) score is a new tool for the identification of high-risk patients for obstructive sleep apnea (OSA). Up to now, no study has attempted to determine the role of NoSAS score in cardiovascular morbidity of patients with OSA. We aimed to investigate the relationships between NoSAS scores and CVD and also between severity of OSA, polysomnographic parameters, and NoSAS scores in patients with OSA. METHODS Patients with diagnosis of OSA by full-night polysomnography were recruited in the study. Based on apnea-hypopnea index (AHI) scores, the patients were categorized as OSA-negative (AHI < 5), mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). The definition of cardiovascular diseases (CVD) included the presence of any of the diseases such as hypertension, coronary artery disease, heart failure, or arrhythmia. RESULTS A total of 1514 patients including cases with 199 OSA-negative, 391 mild, 342 moderate, and 582 severe OSA were enrolled in the study. NoSAS scores were significantly different between mild, moderate, and severe OSA groups. NoSAS scores were negatively correlated with minimum oxygen saturation values and positively with AHI and ODI (oxygen desaturation index) values (P < 0.001). NoSAS scores were significantly higher in patients with CVD, diabetes mellitus, and cerebrovascular disease compared with those without (P < 0.005). NoSAS cut-off values for hypertension (14), congestive heart failure (8.5), coronary artery disease (9), cerebrovascular event (11), and diabetes mellitus (10) were also determined. CONCLUSION NoSAS scores are associated with CVD and the severity of OSA. NoSAS scores may be useful to predict CVD in patients with OSA.
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Affiliation(s)
- Handan Inonu Koseoglu
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey.
| | - Ahmet Cemal Pazarli
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | | | - Halil İbrahim Yakar
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | - Gökhan Aykun
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | - Osman Demir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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Shimizu M, Kasai T, Naito R, Sato A, Ishiwata S, Yatsu S, Shitara J, Matsumoto H, Murata A, Kato T, Suda S, Hiki M, Kuwabara M, Murase T, Nakamura T, Daida H. Overnight changes in uric acid, xanthine oxidoreductase and oxidative stress levels and their relationships with sleep-disordered breathing in patients with coronary artery disease. Hypertens Res 2023; 46:2293-2301. [PMID: 37258622 DOI: 10.1038/s41440-023-01331-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
Serum uric acid (UA) level is associated with the high cumulative incidence or prevalence of coronary artery disease (CAD), and hyperuricemia is considered as an independent risk marker for CAD. Sleep-disordered breathing (SDB) is also associated with an increased risk of CAD. Several studies have shown that SDB is associated with hyperuricemia, but the mechanisms are unclear. We measured serum levels of UA and xanthine oxidoreductase (XOR) activity and urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), all of which were assessed at 6 p.m. and the following 6 a.m. in males with CAD. In addition, nocturnal pulse oximetry was performed for the night. Overall 32 eligible patients with CAD were enrolled. Serum UA levels significantly increased overnight. (5.32 ± 0.98 mg/dl to 5.46 ± 1.02 mg/dl, p < 0.001) Moreover, XOR activity and urinary 8-OHdG levels significantly increased from 6 p.m. to 6 a.m. Furthermore, 3% Oxygen desaturation index (ODI) was correlated with the overnight changes in XOR activity (r = 0.36, P = 0.047) and urinary 8-OHdG levels (r = 0.41, P = 0.02). In addition, 3%ODI was independently correlated with the changes in XOR activity (correlation coefficient, 0.36; P = 0.047) and 8-OHdG (partial correlation coefficient, 0.63; P = 0.004) in multivariable analyses. SDB severity was associated with the overnight changes in XOR activity and urinary 8-OHdG, suggesting that SDB may be associated with oxidative stress via UA production. This trial is registered at University Hospital Medical Information Network (UMIN), number: UMIN000021624.
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Affiliation(s)
- Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiro Sato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanari Kuwabara
- Intensive Care Unit and Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Rabec C, Sombrun C, Bentounes SA, Georges M, Bisson A, Bichat F, Bodin A, Herbert J, Zeller M, Cottin Y, Fauchier L. Outcomes in Patients with Acute Myocardial Infarction and Known Sleep Apnea: A Nationwide Analysis. J Clin Med 2023; 12:5924. [PMID: 37762864 PMCID: PMC10532263 DOI: 10.3390/jcm12185924] [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: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background. Sleep apnea (SA) is a common breathing disorder characterized by repetitive upper airway narrowing and closure. Although SA has been demonstrated to be an independent risk factor for all-cause mortality, the direct contribution of SA to worse cardiovascular prognosis may be difficult to evaluate, and its independent association with the different types of cardiovascular outcomes may be debated, particularly in the context of patients with acute myocardial infarction (AMI). The aim of this study was to assess the impact of known SA on the outcomes of hospitalized patients who have had an AMI by analyzing 10-year data collected from a national registry. Methods. This longitudinal cohort study was based on the national hospitalization database that covers hospital care for the entire French population, including all patients admitted with AMI from January 2010 to June 2019. The clinical outcomes for the analysis were as follows: all-cause death, cardiovascular death, ischemic stroke, new-onset atrial fibrillation (FA), and re-hospitalization for heart failure (HF). Results. Among the 797,212 patients who presented with an AMI (528,351 men and 268,861 women), 37,075 (4.7%) had documented SA. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1-3.1] years), 163,845 deaths (of which 85,649 were cardiovascular deaths), 20,168 ischemic strokes, 58,498 new-onset AF, and 92,381 rehospitalizations due to HF were recorded. Patients with known SA had a worse prognosis in the short and medium term, but after adjusting for all covariables, SA was only independently associated with a higher risk of rehospitalization for HF and new-onset AF in men and women. Conclusion. Data from our large nationwide analysis confirm that known SA is associated with poor cardiovascular outcomes in patients who have had an AMI. However, this impact is tem-pered when the model is adjusted for age, cardiovascular risk, or other covariables. Further studies need to be conducted to assess the independent impact of SA on the prognosis of patients with AMI.
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Affiliation(s)
- Claudio Rabec
- Pneumology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.R.); (M.G.)
| | - Chan Sombrun
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Sid Ahmed Bentounes
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
- Service D’information Médicale, D’épidémiologie et D’économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France
| | - Marjolaine Georges
- Pneumology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.R.); (M.G.)
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Florence Bichat
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
| | - Marianne Zeller
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
- PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche Comté, 21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, CHU Dijon Bourgogne, 21000 Dijon, France; (C.S.); (F.B.); (M.Z.)
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France; (S.A.B.); (A.B.); (A.B.); (J.H.); (L.F.)
- Service D’information Médicale, D’épidémiologie et D’économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, 37020 Tours, France
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Eulenburg C, Celik Y, Redline S, Thunström E, Glantz H, Strollo PJ, Peker Y. Cardiovascular Outcomes in Adults with Coronary Artery Disease and Obstructive Sleep Apnea with versus without Excessive Daytime Sleepiness in the RICCADSA Cinical Trial. Ann Am Thorac Soc 2023; 20:1048-1056. [PMID: 36800433 DOI: 10.1513/annalsats.202208-676oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Rationale: Recent randomized controlled trials did not show cardiovascular benefits of continuous positive airway pressure (CPAP) in adults with coronary artery disease (CAD) and obstructive sleep apnea (OSA) in intention-to-treat analyses. It has been argued that exclusion of patients with OSA with excessive daytime sleepiness (EDS), who may be most likely to benefit from CPAP treatment, may be a reason for the null results. Objectives: We addressed 1) the effect of concomitant EDS on adverse outcomes in patients with CAD and OSA; and 2) whether the cardiovascular benefit of CPAP adherence differs between individuals with versus without EDS. Methods: This was a secondary analysis of the RICCADSA (Randomized Intervention with CPAP in CAD and Obstructive Sleep Apnea) trial, conducted in Sweden between 2005 and 2013. Data were analyzed from 155 patients with CAD with OSA (apnea-hypopnea index ⩾ 15/h) and EDS (Epworth Sleepiness Scale score ⩾ 10), who were allocated to CPAP and 244 patients without EDS (ESS < 10), who were randomized to CPAP or no CPAP. Patients who were allocated to no CPAP or were nonadherent (CPAP usage < 4 h/night) were compared with adherent patients (CPAP usage ⩾ 4 h/night) at 1-year follow-up. Inverse probability of treatment weighting was applied to mimic randomization of EDS. The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Results: The median follow-up was 52.2 months. The incidence of the primary endpoint did not differ significantly between the EDS versus no-EDS groups in the entire cohort. Within the adherent group, patients without EDS had a significantly decreased risk compared with patients with EDS (adjusted hazard ratio, 0.41; 95% confidence interval, 0.20-0.85; P = 0.02). Conclusions: Adverse cardiovascular outcomes did not differ by degrees of EDS for patients with CAD with OSA who were untreated or nonadherent to treatment. CPAP use, at least 4 h/night, was associated with reduced adverse outcomes in participants without EDS. Clinical trial registered with www.clinicaltrials.gov (NCT00519597).
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Affiliation(s)
- Christine Eulenburg
- Department for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yeliz Celik
- Koc University Research Center for Translational Medicine, Istanbul, Turkey
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Glantz
- Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yüksel Peker
- Koc University Research Center for Translational Medicine, Istanbul, Turkey
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey; and
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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5
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Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, Corlateanu A. The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP. Clocks Sleep 2023; 5:333-349. [PMID: 37366660 DOI: 10.3390/clockssleep5020025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.
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Affiliation(s)
- Victoria Sircu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Silvia-Iaroslava Colesnic
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, 125284 Moscow, Russia
- Department of Emergency Medicine № 76, Botkin Hospital, 125284 Moscow, Russia
| | - Olga Corlateanu
- Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Anna Sukhotko
- Department of General Oncology № 71, Botkin Hospital, 125284 Moscow, Russia
| | - Cristian Popovici
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Alexandru Corlateanu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
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Özkan E, Celik Y, Yucel-Lindberg T, Peker Y. Current Smoking Determines the Levels of Circulating MPO and MMP-9 in Adults with Coronary Artery Disease and Obstructive Sleep Apnea. J Clin Med 2023; 12:4053. [PMID: 37373746 DOI: 10.3390/jcm12124053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which a rupture of atherosclerotic plaques and oxidative stress play a role in the initiation and progression of the disorder. Circulating levels of myeloperoxidase (MPO), as an oxidative stress marker, as well as matrix metalloproteinase-9 (MMP-9), as a destabilizer of plaques, are known to be elevated in patients with CAD and are associated with worse prognosis. Some studies have suggested that OSA is associated with MPO and MMP-9, but the effect of OSA on these biomarkers in cardiac cohorts is unknown. (2) Aims: We addressed the determinants of high MPO and MMP-9 in a CAD cohort with concomitant OSA. (3) Materials and Methods: The current study was a secondary analysis of the RICCADSA trial that was conducted in Sweden between 2005 and 2013. A total of 502 revascularized CAD patients with OSA (apnea-hypopnea index [AHI] ≥ 15 events/h; n = 391) or no-OSA (AHI < 5 events/h; n = 101), based on a home sleep apnea test, and who had blood samples at baseline were included in the analysis. The patients were dichotomized into a high or low MPO and MMP-9 groups, based on the median cut-off values. (4) Results: The mean age of the participants was 63.9 (±8.6), and 84% of the study cohort were men. Median values of MPO and MMP-9 levels were 116 ng/mL and 269 ng/mL, respectively. In different multivariate linear and logistic regression models, neither OSA nor OSA severity in terms of AHI and oxygenation indices were associated with the high MPO and MMP-9 levels. Current smoking was significantly associated with both high MPO (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.06-2.84; p = 0.030) and high MMP-9 levels (OR 2.41, 95% CI 1.44-4.03; p < 0.001), respectively. Other significant determinants were revealed as beta blocker use (OR 1.81, 95% CI 1.04-3.16; p = 0.036) for high MPO as well as male sex (OR 2.07, 95% CI 1.23-3.50; p = 0.006) and calcium antagonist use (OR 1.91, 95% CI 1.18-3.09; p = 0.008) for high MMP-9 levels. (5) Conclusions: Current smoking, but not OSA, was significantly associated with high MPO and MMP-9 levels in this revascularized CAD cohort. Smoking status should be seriously taken into consideration while evaluating the effects of OSA and its treatment on long-term adverse cardiovascular outcomes in adults with CAD.
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Affiliation(s)
- Esra Özkan
- Graduate School of Health Sciences, Koc University, Istanbul 34450, Turkey
- Research Center for Translational Medicine [KUTTAM], School of Medicine, Koc University, Istanbul 34450, Turkey
| | - Yeliz Celik
- Graduate School of Health Sciences, Koc University, Istanbul 34450, Turkey
- Research Center for Translational Medicine [KUTTAM], School of Medicine, Koc University, Istanbul 34450, Turkey
- Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tülay Yucel-Lindberg
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institute, 141 86 Huddinge, Sweden
| | - Yüksel Peker
- Research Center for Translational Medicine [KUTTAM], School of Medicine, Koc University, Istanbul 34450, Turkey
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital & Harvard Medical School, Boston, MA 02115, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 220 02 Lund, Sweden
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Fadaei R, Mohassel Azadi S, Rhéaume E, Khazaie H. High-density lipoprotein cholesterol efflux capacity in patients with obstructive sleep apnea and its relation with disease severity. Lipids Health Dis 2022; 21:116. [PMID: 36344946 PMCID: PMC9639319 DOI: 10.1186/s12944-022-01723-w] [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] [Received: 08/18/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is linked to an accelerated risk of cardiovascular disease (CVD). Some key CVD risk factors are present in patients suffering from OSA such as hypertension, inflammation, oxidative stress, and dyslipidemia. High-density lipoprotein (HDL) cholesterol efflux capacity (CEC) is proposed as a reliable biomarker of HDL function and the present study aimed to quantify this biomarker in patients with OSA. Methods ATP binding cassette subfamily A member 1 (ABCA1), non-ABCA1, and total CEC were determined in 69 polysomnographic-confirmed OSA patients and 23 controls. Moreover, paraoxonase (PON) activities, high-sensitivity C-reactive protein (hsCRP), apolipoprotein B (apo B), and apolipoprotein A-I (apo A-I) circulating levels were quantified in the studied population. Results: All CEC measures were reduced in the OSA group compared to the control group. Strikingly, ABCA1 CEC was diminished in severe OSA in comparison with mild OSA. Furthermore, PON activities and apo A-I showed lower levels, while hsCRP and apo B were elevated in OSA patients compared to controls. Moreover, ABCA1 CEC showed an inverse association with hsCRP and a positive association with apo A-I, while non-ABCA1 CEC presented an association with HDL-C. Conclusion These results suggest the presence of an impaired HDL function in OSA. In particular, ABCA1 CEC was associated with disease severity and inflammation which could be a factor increasing the risk of CVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-022-01723-w.
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Affiliation(s)
- Reza Fadaei
- grid.412112.50000 0001 2012 5829Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samaneh Mohassel Azadi
- grid.411705.60000 0001 0166 0922Department of Clinical Biochemistry, Faculty of Medicine Tehran University of Medical Sciences, Tehran, Iran
| | - Eric Rhéaume
- grid.482476.b0000 0000 8995 9090Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4 Canada
| | - Habibolah Khazaie
- grid.412112.50000 0001 2012 5829Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Liu Y, Wang M, Shi J. Influence of obstructive sleep apnoea on coronary artery disease in a Chinese population. J Int Med Res 2022; 50:3000605221115389. [PMID: 36036372 PMCID: PMC9434670 DOI: 10.1177/03000605221115389] [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: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between obstructive sleep apnoea (OSA) and the severity of coronary artery disease (CAD) assessed by angiography. METHODS This prospective study screened 273 patients diagnosed with CAD by coronary angiography. The severity of CAD was assessed by SYNTAX score. A total of 255 subjects were enrolled of whom 161 were diagnosed with OSA, with an apnoea-hypopnoea index ≥5/hour. Ninety-four CAD patients without OSA were used as controls. The relationship between OSA and CAD was analysed by multiple linear regression. RESULTS The prevalence of OSA in CAD patients was 63.1%. The prevalences of single-vessel, two-vessel, and three-vessel disease were similar in the two groups. However, CAD was significantly more severe in patients with OSA, measured by SYNTAX score, than in those without OSA. OSA was independently associated with CAD after adjusting for traditional risk factors. CONCLUSIONS OSA is relatively common among patients with CAD in China. The independent association between OSA and CAD, even after adjusting for traditional confounders, suggests that OSA should be taken into account when considering the risk factors for CAD. The present findings highlight the important adverse influence of OSA on the severity of CAD.
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Affiliation(s)
- Yufei Liu
- The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, China
| | - Meitan Wang
- Harbin Children's Hospital affiliated to Harbin Medical University, Harbin, China
| | - Jinghui Shi
- The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, China
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9
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Gavrilin MA, Porter K, Samouilov A, Khayat RN. Pathways of Microcirculatory Endothelial Dysfunction in Obstructive Sleep Apnea: A Comprehensive Ex Vivo Evaluation in Human Tissue. Am J Hypertens 2022; 35:347-355. [PMID: 34694354 PMCID: PMC8976176 DOI: 10.1093/ajh/hpab169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The mechanism and markers of cardiovascular disease (CVD) in obstructive sleep apnea (OSA) remain unknown. The microcirculation is the site of early changes in OSA patients who are free of CVD risk. METHODS Patients with newly diagnosed moderate to severe OSA (n = 7) were studied before and 12 weeks after intensive treatment with continuous positive airway pressure (CPAP), along with weight and age matched controls (n = 7). Microcirculatory vessels were isolated from gluteal biopsies and changes in critical functional genes were measured. RESULTS The following genes changed after 12 weeks of intensive CPAP therapy in the microcirculatory vessels: angiotensin receptor type 1 (AGTR-1) (11.6 (3.4) to 6 (0.8); P = 0.019); NADPH oxidase (NOX4) (0.85 (0.02) to 0.79 (0.11); P = 0.016); and dimethylarginine dimethylaminohydrolase (DDAH 1) (1 (0.31) to 0.55 (0.1); P = 0.028). Despite decreased nitric oxide (NO) availability as measured indirectly through brachial artery flow-mediated dilation, endothelial NO synthase (NOS3) did not change with CPAP. Other disease markers of OSA that changed with treatment in the microcirculation were endothelin, hypoxia inducible factor 1a, nuclear factor kappa B, interleukin-8, and interleukin-6. CONCLUSIONS In this ex vivo evaluation of the microcirculation of patients with OSA and no CVD risk, several pathways of CVD were activated supporting that OSA independently induces microcirculatory endothelial dysfunction and serving as disease-specific markers for future pharmacological targeting of OSA-related CVD risk. The findings support the role of renin-angiotensin activation and endothelial oxidative stress in the decreased microcirculatory NO availability in OSA.
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Affiliation(s)
| | - Kyle Porter
- The Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Alexandre Samouilov
- Department of Medicine, The Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rami N Khayat
- The Sleep Heart Program, The Ohio State University, Columbus, Ohio, USA
- The Division of Pulmonary and Critical Medicine and the UCI Sleep Disorders Center, Departments of Medicine and Psychiatry, the University of California-Irvine, Irvine, California, USA
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10
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Labeix P, Berger M, Zellag A, Garcin A, Barthelemy JC, Roche F, Hupin D. Resistance Training of Inspiratory Muscles After Coronary Artery Disease May Improve Obstructive Sleep Apnea in Outpatient Cardiac Rehabilitation: RICAOS Study. Front Physiol 2022; 13:846532. [PMID: 35360234 PMCID: PMC8961327 DOI: 10.3389/fphys.2022.846532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) affects 5% of the adult population and its prevalence is up to 13 times higher in coronary artery disease (CAD) patients. However, OSA in this population is less symptomatic, leading to lower adherence to positive airway pressure (CPAP). While oropharyngeal exercise showed a significant decrease in apnea-hypopnea index (AHI) in patients with moderate OSA, there have been no studies testing the impact of specific inspiratory muscle training (IMT) for these patients. The aim of our study was to assess the effectiveness of IMT on AHI reduction in CAD patients with moderate OSA. Methods We included patients with CAD involved in a cardiac rehabilitation program and presenting an AHI between 15 and 30. Patients were randomized in a 1:1 allocation to a control group (CTL – classic training) or an IMT group (classic training + IMT). IMT consisted in 60 deep inspirations a day, 6 days a week, into a resistive load device set at 70% of the maximum inspiratory pressure (MIP). After 6 weeks, we compared AHI, neck circumference, Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, and quality of life with the 12-item Short Form Survey before and after rehabilitation. Results We studied 45 patient (60 ± 9 y, BMI = 27 ± 6 kg.m−2). The IMT group (n = 22) significantly improved MIP ( p < 0.05) and had a significant decrease in AHI by 25% (−6.5 ± 9.5, p = 0.02). In the CTL group (n = 23), AHI decreased only by 3.5% (−0.7 ± 13.1; p = 0.29). Between groups, we found a significant improvement in MIP ( p = 0.003) and neck circumference ( p = 0.01) in favor of the IMT group. However, we did not find any significant improvement of AHI in the IMT group compared to CTL ( p = 0.09). Conclusion A specific IMT during cardiac rehabilitation contributes to reduce significantly AHI in CAD patients with moderate OSA. Magnitude of the decrease in OSA severity could be enhanced according to implementation of specific IMT in this population.
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Affiliation(s)
- Pierre Labeix
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mathieu Berger
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Center for Investigation and Research in Sleep, CHUV and UNIL, Lausanne, Switzerland
| | - Amandine Zellag
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Infectious Diseases Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Arnauld Garcin
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Innovation and Pharmacology Clinical Research Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Claude Barthelemy
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Frederic Roche
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - David Hupin
- SAINBIOSE, U1059 INSERM, University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France
- *Correspondence: David Hupin,
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11
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Deep Singh T. Abnormal Sleep-Related Breathing Related to Heart Failure. Sleep Med Clin 2022; 17:87-98. [PMID: 35216764 DOI: 10.1016/j.jsmc.2021.10.007] [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: 10/19/2022]
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure (HF). Untreated obstructive sleep apnea (OSA) and central sleep apnea (CSA) in patients with HF are associated with worse outcomes. Detailed sleep history along with polysomnography (PSG) should be conducted if SDB is suspected in patients with HF. First line of treatment is the optimization of medical therapy for HF and if symptoms persist despite optimization of the treatment, positive airway pressure (PAP) therapy will be started to treat SDB. At present, there is limited evidence to prescribe any drugs for treating CSA in patients with HF. There is limited evidence for the efficacy of continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV) in improving mortality in patients with heart failure with reduced ejection fraction (HFrEF). There is a need to perform well-designed studies to identify different phenotypes of CSA/OSA in patients with HF and to determine which phenotype responds to which therapy. Results of ongoing trials, ADVENT-HF, and LOFT-HF are eagerly awaited to shed more light on the management of CSA in patients with HF. Until then the management of SDB in patients with HF is limited due to the lack of evidence and guidance for treating SDB in patients with HF.
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Affiliation(s)
- Tripat Deep Singh
- Academy of Sleep Wake Science, #32 St.no-9 Guru Nanak Nagar, near Gurbax Colony, Patiala, Punjab, India 147003.
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12
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Lee WJ, Jung KH, Nam HW, Lee YS. Effect of obstructive sleep apnea on cerebrovascular compliance and cerebral small vessel disease. PLoS One 2021; 16:e0259469. [PMID: 34767578 PMCID: PMC8589195 DOI: 10.1371/journal.pone.0259469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Reduced cerebrovascular compliance is the major mechanism of cerebral small vessel disease (SVD). Obstructive sleep apnea (OSA) also promotes SVD development, but the underlying mechanism was not elucidated. We investigated the association among OSA, cerebrovascular compliance, and SVD parameters. This study retrospectively included individuals ≥ 50 years of age, underwent overnight polysomnographic (PSG) for the evaluation of OSA, and performed MRI and transcranial Doppler (TCD) within 12 months of interval without a neurological event between the evaluations. TCD parameters for the cerebrovascular compliance included middle cerebral artery pulsatility index (MCA PI) and mean MCA resistance index ratio (MRIR). SVD parameters included white matter hyperintensity (WMH) volume, number of lacunes, enlarged perivascular space (ePVS) score, and the presence of microbleeds or lacunes. Ninety-seven individuals (60.8% male, mean age 70.0±10.5 years) were included. MRIR was associated with higher respiratory distress index (B = 0.003; 95% confidence interval [CI] 0.001-0.005; P = 0.021), while MCA PI was not associated with any of the PSG markers for OSA severity. Apnea-hypopnea index was associated with the log-transformed total WMH volume (B = 0.008; 95% confidence interval [CI] 0.001-0.016; P = 0.020), subcortical WMH volume (B = 0.015; 95% CI 0.007-0.022; P<0.001), total ePVS score (B = 0.024; 95% CI 0.003-0.045; P = 0.026), and centrum semiovale ePVS score (B = 0.026; 95% CI 0.004-0.048; P = 0.019), and oxygen-desaturation index with periventricular WMH volume, independently from age, MCA PI, and MRIR. This study concluded that OSA is associated with reduced cerebrovascular compliance and also with SVD independently from cerebrovascular compliance. Underlying pathomechanistic link might be region specific.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Woo Nam
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Yong-Seok Lee
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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13
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Abstract
Obstructive sleep apnea (OSA) is a complex medical disorder with significant impact on mortality, quality of life, and long-term cardiovascular outcomes. The apnea-hypopnea index does not correlate well with either quality-of-life measures or health outcomes, so other outcome measures must be evaluated in treatment of OSA. OSA can be successfully treated through behavioral, nonsurgical, and surgical methods with improvements in quality of life, morbidity, and mortality. Surgical intervention should be considered in patients who are noncompliant with or fail positive airway pressure use. As is true with PAP therapy, surgery for OSA improves mortality and symptoms of OSA even when the polysomnogram does not fully normalize.
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Affiliation(s)
- Kara D Brodie
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, Room 309, San Francisco, CA 94115-1225, USA
| | - Andrew N Goldberg
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, Room 309, San Francisco, CA 94115-1225, USA.
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14
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Castro-Grattoni AL, Suarez-Giron M, Benitez I, Tecchia L, Torres M, Almendros I, Farre R, Targa A, Montserrat JM, Dalmases M, Barbé F, Gozal D, Sánchez-de-la-Torre M. The effect of chronic intermittent hypoxia in cardiovascular gene expression is modulated by age in a mice model of sleep apnea. Sleep 2021; 44:6071377. [PMID: 33417710 DOI: 10.1093/sleep/zsaa293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Chronic intermittent hypoxia (CIH) is a major determinant in obstructive sleep apnea cardiovascular morbidity and this effect is influenced by age. The objective of the present study was to assess the differential molecular mechanisms at gene-level expression involved in the cardiovascular remodeling induced by CIH according to chronological age. METHODS Two- and 18-month-old mice (N = 8 each) were subjected to CIH or normoxia for 8 weeks. Total messenger RNA (mRNA) was extracted from left ventricle myocardium and aortic arch, and gene expression of 46 intermediaries of aging, oxidative stress, and inflammation was measured by quantitative real-time polymerase chain reaction. RESULTS Cardiac gene expression of Nrf2 (2.05-fold increase, p < 0.001), Sod2 (1.9-fold increase, p = 0.035), Igf1r (1.4-fold increase, p = 0.028), Mtor (1.8-fold increase, p = 0.06), Foxo3 (1.5-fold increase, p = 0.020), Sirt4, Sirt6, and Sirt7 (1.3-fold increase, p = 0.012; 1.1-fold change, p = 0.031; 1.3-fold change, p = 0.029) was increased after CIH in young mice, but not in old mice. In aortic tissue, endothelial isoform of nitric oxide synthase was reduced in young mice (p < 0.001), Nrf2 was reduced in 80% (p < 0.001) in young mice and 45% (p = 0.07) in old mice, as its downstream antioxidant target Sod2 (82% reduced, p < 0.001). IL33. CONCLUSIONS CIH effect in gene expression is organ-dependent, and is modulated by age. CIH increased transcriptional expression of genes involved in cardioprotection and cell survival in young, but not in old mice. In aortic tissue, CIH reduced gene expression related to an antioxidant response in both young and old mice, suggesting vascular oxidative stress and a proaging process.
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Affiliation(s)
- Anabel L Castro-Grattoni
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Department of Child Health, University of Missouri, School of Medicine, Columbia, MO, USA
| | | | - Ivan Benitez
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Lourdes Tecchia
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Marta Torres
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona - CIBER de Enfermedades Respiratorias - CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Farre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Adriano Targa
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Josep M Montserrat
- Laboratori del son, Servei de Pneumologia, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - David Gozal
- Department of Child Health, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
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15
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Requirements for Supporting Diagnostic Equipment of Respiration Process in Humans. SENSORS 2021; 21:s21103479. [PMID: 34067611 PMCID: PMC8156866 DOI: 10.3390/s21103479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
There is abundant worldwide research conducted on the subject of the methods of human respiration process examination. However, many of these studies describe methods and present the results while often lacking insight into the hardware and software aspects of the devices used during the research. This paper’s goal is to present new equipment for assessing the parameters of human respiration, which can be easily adopted for daily diagnosis. This work deals with the issue of developing the correct method of obtaining measurement data. The requirements of the acquisition parameters are clearly pointed out and examples of the medical applications of the described device are shown. Statistical analysis of acquired signals proving its usability is also presented. In the examples of selected diseases of the Upper Respiratory Tract (URT), the advantages of the developed apparatus for supporting the diagnosis of URT patency have been proven.
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16
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Loboda D, Stepanik M, Golba A, Dzierzawa M, Szajerska-Kurasiewicz A, Simionescu K, Turski M, Kucia-Kuzma S, Durmala J, Golba KS. The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease. J Clin Sleep Med 2021; 17:403-412. [PMID: 33089775 DOI: 10.5664/jcsm.8900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease. METHODS The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge. RESULTS Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively. CONCLUSIONS High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.
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Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.,Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
| | - Michalina Stepanik
- Department of Rehabilitation, Medical University of Silesia, Katowice, Poland
| | - Agata Golba
- Department of Rehabilitation, Medical University of Silesia, Katowice, Poland
| | - Monika Dzierzawa
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | | | - Karolina Simionescu
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.,Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
| | - Maciej Turski
- Day Treatment Cardiac Rehabilitation Ward, Upper-Silesian Medical Centre, Katowice, Poland
| | | | - Jacek Durmala
- Department of Rehabilitation, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.,Department of Electrocardiology, Upper-Silesian Medical Centre, Katowice, Poland
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17
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Kubota K, Hoshide S, Kario K. Association of lower nighttime diastolic blood pressure and hypoxia with silent myocardial injury: The Japan Morning Surge-Home Blood Pressure study. J Clin Hypertens (Greenwich) 2020; 23:272-280. [PMID: 33314712 PMCID: PMC8029661 DOI: 10.1111/jch.14132] [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] [Received: 10/18/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Whether marked nocturnal blood pressure (BP) reduction is associated with cardiovascular disease (CVD) is still controversial. In addition, no report has yet discussed the relationship between lower nocturnal BP and CVD, involving modification by nighttime hypoxia. We evaluated 840 patients who had one or more cardiovascular risk factors by measuring their high‐sensitivity cardiac troponin T (Hs‐cTnT), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP), and nighttime saturation levels and performing ambulatory BP monitoring. The lowest tertile in nighttime diastolic BP (DBP) (≤66 mmHg) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the second tertile (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.01–3.63), and the lowest tertile of minimum blood oxygen saturation (≤81%) had increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with the third tertile (OR 2.15, 95% CI 1.13–4.10). Additionally, the patients with both lowest tertile of nighttime DBP and minimum SpO2 showed increased likelihood of the presence of ≥0.014 ng/ml of Hs‐cTnT compared with those without this combination (OR 2.93, 95% CI 1.40–6.16). On the other hand, these associations were not found in the presence of ≥125 pg/ml of NT‐pro BNP. In the clinical population, each of lower nocturnal DBP and nighttime hypoxia was associated with asymptomatic myocardial injury, which was represented as higher Hs‐cTnT, and coexisting lower nocturnal DBP and nighttime hypoxia had an additive effect on the risk of myocardial injury.
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Affiliation(s)
- Kana Kubota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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18
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Reyes SJ, Pak T, Moon TS. Metabolic syndrome - Evidence-based strategies for patient optimization. Best Pract Res Clin Anaesthesiol 2020; 34:131-140. [PMID: 32711824 DOI: 10.1016/j.bpa.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
With the increasing prevalence of obesity worldwide, it is inevitable that anesthesiologists will encounter patients with metabolic syndrome. Metabolic syndrome encompasses multiple diseases, which include central obesity, hypertension, dyslipidemia, and hyperglycemia. Given the involvement of multiple diseases, metabolic syndrome involves numerous complex pathophysiological processes that negatively impact several organ systems. Some of the organ systems that have been well-documented to be adversely affected include the cardiovascular, pulmonary, and endocrine systems. Metabolic syndrome also leads to prolonged hospital stays, increased rates of infections, a greater need for care after discharge, and overall increased healthcare costs. Several interventions have been suggested to mitigate these negative outcomes ranging from lifestyle modifications to surgeries. Therefore, anesthesiologists should understand metabolic syndrome and formulate management strategies that may modify perianesthetic and surgical risks.
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Affiliation(s)
- Shuhan J Reyes
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Taylor Pak
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Tiffany Sun Moon
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
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19
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Mendelson M, Inami T, Lyons O, Alshaer H, Marzolini S, Oh P, Bradley TD. Long-term effects of cardiac rehabilitation on sleep apnea severity in patients with coronary artery disease. J Clin Sleep Med 2019; 16:65-71. [PMID: 31957654 DOI: 10.5664/jcsm.8124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Sleep apnea (SA) is prevalent among patients with coronary artery disease (CAD) and increases cardiovascular risk. A previous study showed that 1 month of cardiac rehabilitation (CR) reduced severity of SA in patients with CAD by reducing fluid accumulation in the legs during the day and the amount of fluid shifting rostrally into the neck overnight. The aim of this study was to evaluate whether CR will lead to longer-term attenuation of SA in patients with CAD. METHODS Fifteen patients with CAD and SA who had participated in a 1-month randomized trial of the effects of exercise training on SA were followed up until they completed 6 months of CR (age: 65 ± 10 years; body mass index: 27.0 ± 3.9 kg/m²; apnea-hypopnea index [AHI]: 39.0 ± 16.7). The AHI was evaluated at baseline by polysomnography and then at 6 months by portable monitoring at home. Cardiorespiratory fitness (VO2peak) was evaluated via a graded cardiopulmonary exercise test at baseline and 6 months later. The 6-month CR program included once weekly, 90-minute, in-facility exercise sessions, and 4 days per week at-home exercise sessions. RESULTS After 6 months of CR, there was a 54% reduction in the AHI (30.5 ± 15.2 to 14.1 ± 7.5, P < .001). Body mass index remained unchanged, but VO2peak increased by 27% (20.0 ± 6.1 to 26.0 ± 8.9 mL/kg/min, P = .04). CONCLUSIONS Participation in CR is associated with a significant long-term decrease in the severity of SA. This finding suggests that attenuation of SA by exercise could be a mechanism underlying reduced mortality following participation in CR in patients with CAD and SA. CLINICAL TRIAL REGISTRATION This study is registered at www.controlled-trials.com with identifier number ISRCTN50108373.
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Affiliation(s)
- Monique Mendelson
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - Toru Inami
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - Owen Lyons
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Canada.,Department of Medicine, Women's College Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Hisham Alshaer
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - Susan Marzolini
- Cardiac Rehabilitation and Prevention, University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention, University Health Network Toronto Rehabilitation Institute, Toronto, Canada
| | - T Douglas Bradley
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Canada
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20
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Wada H, Dohi T, Kasai T, Yatsu S, Naito R, Kato Y, Okai I, Iwata H, Isoda K, Okazaki S, Miyauchi K, Daida H. Culprit Plaque Characteristics in Patients With Sleep-Disordered Breathing Undergoing Percutaneous Coronary Intervention: An Intravascular Ultrasound Study. J Am Heart Assoc 2019; 7:e009826. [PMID: 30371319 PMCID: PMC6404903 DOI: 10.1161/jaha.118.009826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sleep‐disordered breathing (SDB) is a novel cardiovascular risk factor. However, the coronary plaque characteristics of patients with SDB with coronary artery disease are still unclear. Methods and Results This study included 289 consecutive patients with coronary artery disease undergoing percutaneous coronary intervention. Plaque characteristics of the culprit lesion were assessed by preintervention intravascular ultrasound. The presence of SDB was defined as a 3% oxygen desaturation index of ≥15 events per hour measured by nocturnal pulse oximetry. Of 289 patients, the median 3% oxygen desaturation index was 9.6 (interquartile range, 5.1–16.6), and 88 patients (30.4%) were defined as having SDB. Compared with the no‐SDB group, the SDB group had a larger total atheroma volume of the culprit lesion (224.5 mm3 versus 190.8 mm3, P=0.05). The median maximum attenuation and calcification angle were 140° and 130°, respectively. Attenuated plaque with a maximum attenuation angle >140° was more frequently observed in the SDB group compared with the no‐SDB group (34.9% versus 22.6%; P=0.03). However, there were no statistically significant differences between groups in the maximum calcium angle and the frequency of calcific plaques with a maximum calcium angle >130°. Multivariable logistic regression analysis showed that the presence of SDB was a significant predictor of a greater ultrasound attenuation angle (>140°) (odds ratio, 1.86; 95% confidence interval, 1.02–3.39; P=0.04). Conclusions SDB was associated with larger atheroma plaque volume and a greater ultrasound attenuation, which are discriminators of plaque vulnerability. Further studies are needed to clarify the effects of SDB treatment on coronary plaque lesions.
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Affiliation(s)
- Hideki Wada
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Tomotaka Dohi
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Takatoshi Kasai
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shoichiro Yatsu
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Ryo Naito
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Yoshiteru Kato
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Iwao Okai
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroshi Iwata
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Kikuo Isoda
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shinya Okazaki
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Katsumi Miyauchi
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroyuki Daida
- 1 Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
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21
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Oh MS, Bliwise DL, Smith AL, Collop NA, Quyyumi AA, Dedhia RC. Obstructive sleep apnea, sleep symptoms, and their association with cardiovascular disease. Laryngoscope 2019; 130:1595-1602. [PMID: 31532856 DOI: 10.1002/lary.28293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine the frequency of obstructive sleep apnea (OSA), insomnia, restless legs, and other sleep symptoms in patients with cardiovascular disease and the association of these sleep disorders with quantitative cardiovascular measures. METHODS Study design was a cross-sectional survey and retrospective chart review. A questionnaire containing validated sleep symptoms was distributed to 202 patients with cardiovascular disease at a tertiary referral cardiology clinic. Following a focused review of these patients' medical charts, their questionnaire responses were examined for associations with clinical cardiovascular parameters. RESULTS Twenty-one percent of patients reported a prior diagnosis of OSA. A total of 115 patients (60%) had at least one additional sleep symptom. Clinically significant insomnia was significantly associated with heart disease (relative risk [RR] = 1.5, confidence interval [CI] = 1.1 to 2.1), prior myocardial infarction or cerebrovascular accident (RR = 2.1, CI = 1.2 to 3.6), and heart failure (RR = 2.2, CI = 1.3 to 3.8). Left ventricular ejection fraction was significantly associated with insomnia by Insomnia Severity Index (β = -0.52, CI = -0.89 to -0.13). CONCLUSION The frequency of OSA in patients in this tertiary cardiology clinic was higher than the general population in the United States, with the majority of patients experiencing at least one sleep symptom. Insomnia symptoms were shown to be associated with multiple cardiovascular measures, including left ventricular ejection fraction. These findings imply an interwoven relationship between cardiovascular and sleep symptoms as captured by validated sleep questionnaires. LEVEL OF EVIDENCE IV Laryngoscope, 130:1595-1602, 2020.
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Affiliation(s)
- Melissa S Oh
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Donald L Bliwise
- Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Andrew L Smith
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Nancy A Collop
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Raj C Dedhia
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.,Department of Neurology, Division of Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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22
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Pang KP, Pang SB, Rotenberg B. Clinical Outcomes in OSA—SLEEP GOAL—a More Holistic Approach. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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The association between obstructive sleep apnea during REM sleep and autonomic dysfunction as measured by heart rate variability. Sleep Breath 2019; 23:865-871. [DOI: 10.1007/s11325-018-01779-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/05/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
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24
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Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent disorder, which causes significant nocturnal and daytime symptoms, reduced quality of life, and impaired functional capacity. Importantly, however, OSA also appears to predispose to the development of a number of cardiovascular and metabolic diseases, including diabetes, hypertension, and stroke. In this review we explore its relationship with coronary artery disease (CAD), discussing mechanisms whereby it may promote the development of atherosclerosis, evidence of its effect on CAD incidence and outcomes, and coronary imaging studies in subjects with OSA. Finally, we shall evaluate the current evidence regarding the impact of continuous positive airway pressure therapy on CAD outcomes in OSA patients.
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Affiliation(s)
- Swapna Mandal
- Department of Respiratory and Sleep Medicine, Royal Free Hospital, London, UK.,University College London, UK
| | - Brian D Kent
- Sleep Disorders Centre, Guy's & St. Thomas' Hospitals, London, UK.,King's College London, London, UK
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25
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Randerath W. Positive Airway Pressure for Sleep-Related Breathing Disorders in Heart Failure—Overview and Discussion of Potential Mechanisms of Harm. CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Yatsu S, Naito R, Kasai T, Matsumoto H, Shitara J, Shimizu M, Murata A, Kato T, Suda S, Hiki M, Sai E, Miyauchi K, Daida H. Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention. Clin Res Cardiol 2018; 107:711-718. [PMID: 29605831 DOI: 10.1007/s00392-018-1238-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI). METHODS We conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke. RESULTS Of 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9 years. The cumulative incidence of MACCE was significantly higher in patients with SDB (P = 0.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05-5.4, P = 0.036). CONCLUSIONS SDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.
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Affiliation(s)
- Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Azusa Murata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiryu Sai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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27
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Abstract
PURPOSE OF REVIEW In this review, we discuss the current treatment options for sleep-disordered breathing (SDB) in patients with heart failure (HF). We address the role of positive airway pressure (PAP) devices and other emerging therapies. The review includes discussion of recent trials that reported negative consequences for the PAP devices in patients with heart failure. RECENT FINDINGS Optimal guideline-directed medical therapies of HF and PAP devices have been the mainstay treatments for HF patients with SDB. Recently, randomized controlled trials (RCTs) evaluated the effect of PAP on clinical outcomes in patients with cardiovascular (CV) disease and heart failure and found no benefit in decreasing fatal and non-fatal CV events. The Sleep Apnea Cardiovascular Endpoints (SAVE) trial evaluated continuous positive airway pressure (CPAP) ventilation in patients with CV disease and obstructive sleep apnea (OSA) and did not observe any improvement in CV effect. In patients with HF and central sleep apnea (CSA), adaptive servo-ventilation (ASV) was hypothesized to help HF outcomes, but the Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure (SERVE-HF) trial did not show any mortality benefit. Instead, the trial suggested an increase in all-cause and CV mortality in the treatment arm. currently, studies have not shown the use of PAP therapy to improve any risks of CV outcomes or death in HF patients with sleep apnea, but some associations with improvements in symptoms from OSA have been observed.
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Application of Personalized, Predictive, Preventative, and Participatory (P4) Medicine to Obstructive Sleep Apnea. A Roadmap for Improving Care? Ann Am Thorac Soc 2018; 13:1456-67. [PMID: 27387483 DOI: 10.1513/annalsats.201604-235ps] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dr. Leroy Hood promotes a paradigm to advance medical care that he calls P4 medicine. The four Ps are: personalized, predictive, preventative, and participatory. P4 medicine encourages a convergence of systems medicine, the digital revolution, and consumer-driven healthcare. Might P4 medicine be applicable to obstructive sleep apnea (OSA)? OSA should be personalized in that there are different structural and physiological pathways to disease. Obesity is a major risk factor. The link between obesity and OSA is likely to be fat deposits in the tongue compromising the upper airway. Clinical features at presentation also vary between patients. There are three distinct subgroups: (1) patients with a primary complaint of insomnia, (2) relatively asymptomatic patients with a high prevalence of cardiovascular comorbidities, and (3) excessively sleepy patients. Currently, there have been limited efforts to identify subgroups of patients on the basis of measures obtained by polysomnography. Yet, these diagnostic studies likely contain considerable predictive information. Likewise, there has currently been limited application of -omic approaches. Determining the relative role of obesity and OSA for particular consequences is challenging, because they both affect the same molecular pathways. There is evidence that the effects of OSA are modified by the level of obesity. These insights may lead to improvements in predicting outcomes to personalized therapies. The final P-participatory-is ideally suited to OSA, with technology to obtain extensive data remotely from continuous positive airway pressure machines. Providing adherence data directly to patients increases their use of continuous positive airway pressure. Thus, the concept of P4 medicine is very applicable to obstructive sleep apnea and can be the basis for future research efforts.
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29
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Luyster FS, Strollo PJ, Thunström E, Peker Y. Long-term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea. Clin Cardiol 2017; 40:1297-1302. [PMID: 29243273 DOI: 10.1002/clc.22827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/22/2017] [Accepted: 09/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Excessive daytime sleepiness is a frequent symptom of obstructive sleep apnea (OSA) and has been proposed as a motivator for adherence to continuous positive airway pressure (CPAP) therapy. However, excessive daytime sleepiness is absent in many patients with coronary artery disease (CAD) and concomitant OSA. We evaluated long-term use of CPAP and predictors of CPAP use in nonsleepy and sleepy OSA patients from a CAD cohort. HYPOTHESIS Long-term CPAP use is lower in CAD patients with nonsleepy OSA vs sleepy OSA. METHODS Nonsleepy (Epworth Sleepiness Scale [ESS] score < 10) OSA patients randomized to CPAP (n = 122) and sleepy (ESS ≥10) OSA patients offered CPAP (n = 155) in the RICCADSA trial in Sweden were included in this substudy. The median follow-up was 4.8 years for the main trial, with a predefined minimum follow-up of 2 years. RESULTS The probability of remaining on CPAP at 2 years was 60% in nonsleepy patients and 77% in sleepy patients. Multivariate analyses indicated that age and hours of CPAP use per night at 1 month were independently associated with long-term CPAP use in nonsleepy patients. In the sleepy phenotype, body mass index, acute myocardial infarction at baseline, and hours of CPAP use per night at 1 month were predictors of long-term CPAP use. CONCLUSIONS Long-term use of CPAP is likely to be challenging for CAD patients with nonsleepy OSA. Early CPAP use is an important predictor of continued long-term use of CPAP, so optimizing patients' initial experience with CPAP could promote adherence.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
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30
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Prevalence of Sleep-Disordered Breathing and Patient Characteristics in a Coronary Artery Disease Cohort Undergoing Cardiovascular Rehabilitation. J Cardiopulm Rehabil Prev 2017; 36:421-429. [PMID: 27490427 DOI: 10.1097/hcr.0000000000000192] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Coronary artery disease (CAD) is a leading cause of death and identification of risk factors for CAD is crucial. One such potential risk factor is sleep-disordered breathing (SDB). This prospective cohort study investigated the prevalence of SDB and determined risk factors for the presence of SDB in a large CAD cohort undergoing cardiac rehabilitation. METHODS A total of 1425 patients with confirmed CAD starting rehabilitation were screened for SDB using cardiorespiratory polygraphy (n = 921) or polygraphy plus pulse oximetry (n = 484). RESULTS A total of 1408 patients were included; 69.5% were male, 78% had acute coronary syndrome, and 22% had stable CAD. The prevalence of SDB (apnea-hypopnea index [AHI] ≥5/h) was 83%. Moderate to severe SDB (AHI ≥15/h) was present in 53%. Up to 70% of coronary artery bypass graft (CABG) recipients had an AHI ≥15/h versus 33% of those who had not undergone CABG. SDB severity did not vary significantly in patients with stable CAD or on the basis of left ventricular ejection fraction. SDB was more severe and the frequency of oxygen desaturation was higher in men than in women. Multivariate logistic regression identified age, sex, body mass index, and CABG as independent risk factors for severe SDB. CONCLUSION SDB is a highly prevalent comorbidity in patients with CAD, particularly those who have undergone CABG. These results strengthen existing associations and emphasize the importance of diagnosing and monitoring SDB in patients with CAD entering a cardiac rehabilitation program. Early diagnosis and intervention has the potential to have a beneficial effect on CAD prognosis.
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31
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Farrell PC, Richards G. Recognition and treatment of sleep-disordered breathing: an important component of chronic disease management. J Transl Med 2017; 15:114. [PMID: 28545542 PMCID: PMC5445298 DOI: 10.1186/s12967-017-1211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/13/2017] [Indexed: 12/14/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a highly prevalent condition, and is associated with many debilitating chronic diseases. The role of untreated obstructive sleep apnea (OSA) in arterial hypertension has been recognized in international guidelines. Treatment with continuous positive airway pressure (CPAP) is associated with clinically-relevant reductions in blood pressure. In heart failure (HF), SDB is associated with worse prognosis and increased mortality. Major HF guidelines recommend that patients should be treated for sleep apnea to improve their HF status. Severe OSA increases the risk of arrhythmias, including atrial fibrillation, influences risk management in stroke, and is highly prevalent in patients with type 2 diabetes. Effective treatment with CPAP improves the success of antiarrhythmic interventions, improves outcomes in stroke and reduces hyperglycemia in diabetes. Patients with coronary artery disease also have a high prevalence of SDB, which is independently associated with worse outcomes. The role of CPAP for secondary cardiovascular prevention remains to be determined. Data from large, well-conducted clinical trials have shown that noninvasive ventilation, targeted to markedly reduce hypercapnia, significantly improves survival and reduces readmission in stable hypercapnic chronic obstructive pulmonary disease. The association of SDB with chronic diseases contributes to the high healthcare costs incurred by SDB patients. SDB also has an important negative impact on quality of life, which is reversed by CPAP treatment. The high prevalence of SDB, and its association with diseases that cause significant morbidity and mortality, suggest that the diagnosis and management of SDB is an important therapeutic goal. First, adherent CPAP treatment significantly improves the quality of life of all patients with SDB; second, it eliminates the negative impact of untreated SDB on any associated chronic diseases; and third, it significantly reduces the increased costs of all hospital and medical services directly associated with untreated SDB. In short, the recognition and treatment of SDB is vital for the continued health and wellbeing of individual patients with SDB.
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Affiliation(s)
- Peter C. Farrell
- ResMed Science Center, c/o ResMed, 9001 Spectrum Center Blvd., San Diego, CA 92123 USA
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32
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Kahwash R, Khayat RN. A Practical Approach to the Identification and Management of Sleep-Disordered Breathing in Heart Failure Patients. Sleep Med Clin 2017; 12:205-219. [PMID: 28477775 DOI: 10.1016/j.jsmc.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sleep-disordered breathing (SDB) is a major health problem affecting much of the general population. Although SDB is responsible for rapid progression of heart failure (HF) and the worsening morbidity and mortality, advanced HF state is associated with accelerated development of SDB. In the face of recent developments in SDB treatment and availability of effective therapeutic options known to improve quality of life, exercise tolerance, and heart function, most HF patients with SDB are left unrecognized and untreated. This article provides an overview of SDB in HF with focus on practical approaches intended to facilitate screening and treatment.
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Affiliation(s)
- Rami Kahwash
- Section of Heart Failure and Transplant, Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA.
| | - Rami N Khayat
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA
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33
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Oh YJ, Jung JY, Kim SS, Chae KS, Rhu J, Lee C. The association of kidney function with repetitive breath-hold diving activities of female divers from Korea, Haenyeo. BMC Nephrol 2017; 18:75. [PMID: 28228118 PMCID: PMC5322595 DOI: 10.1186/s12882-017-0481-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023] Open
Abstract
Background Voluntary apnea during breath-hold diving (BHD) induces cardiovascular changes including bradycardia, reduced cardiac output, and arterial hypertension. Although the impacts of repetitive BHD on cardiovascular health have been studied previously, the long-term risk for kidney dysfunction has never been investigated. Methods A cross-sectional propensity score-matched study was performed to evaluate the influence of repetitive long-lasting BHD on kidney function. Using matching propensity scores (PS), 715 breath-hold female divers (Haenyeo) and non-divers were selected for analysis from 1,938 female divers and 3,415 non-divers, respectively. The prevalence of chronic kidney disease (CKD) defined as an estimated glomerular filtration rate (eGFR) calculated to be less than 60 ml/min/1.73 m2 was investigated in both diver and non-diver groups. Results The prevalence of CKD was significantly higher in breath-hold divers compared with non-divers after PS matching (12.6% vs. 8.0%, P = 0.004). In multivariate analysis, BHD activity was significantly associated with the risk of CKD in an unmatched cohort (OR, 1.976; 95% CI, 1.465–2.664). In the PS-matched cohort, BHD remained the independent risk factor for CKD even after adjusting for multiple covariates (OR 1.967; 95% CI, 1.341–2.886). Conclusion Shallow but repetitive intermittent apnea by BHD, sustained for a long period of time, may potentially cause a deterioration in kidney function, as a long-term consequence. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0481-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yun Jung Oh
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea.,Department of Internal Medicine, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.,Department of Internal Medicine, Division of Nephrology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Soo Kim
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Kyong-Suk Chae
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Jiwon Rhu
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Chungsik Lee
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea.
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Diagnostic accuracy of carotid intima media thickness in predicting coronary plaque burden on coronary computed tomography angiography in patients with obstructive sleep apnoea. J Cardiovasc Comput Tomogr 2017; 11:227-233. [PMID: 28229911 DOI: 10.1016/j.jcct.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 01/07/2023]
Abstract
AIM To assess the diagnostic accuracy of common carotid artery intima media thickness (CIMT) for coronary artery disease (CAD) detection in patients with obstructive sleep apnoea (OSA). MATERIALS & METHODS Patients with clinically suspected OSA prospectively underwent polysomnography (PSG), ultrasound CIMT measurement and coronary computed tomography angiography (CTA). An average CIMT of ≥0.9 mm in either common carotid artery designated as a positive test. Coronary CTA was the reference standard for the presence of CAD. Coronary plaque presence, volume, density and type were correlated with CIMT findings. RESULTS 35 consecutive male patients were enrolled from sleep clinic. Two patients had no evidence of OSA on PSG (apnoea-hypopnea index [AHI]<5/hr), and were excluded. Of the remaining 33, 18 (54%) had mild-moderate OSA (AHI 5-30/hr) and 15 (46%) had severe OSA (AHI >30/hr). Eight (24%) patients had CAD on coronary CTA. Coronary plaques were predominantly non- or partly calcified, and located in proximal coronary artery segments. Sensitivity, specificity, positive and negative predictive and likelihood ratios for a positive CIMT (≥0.9 mm) in diagnosing CAD were 0.5 (95% confidence interval: 0.76-0.12), 0.96 (1-0.89), 80, 85.7, 12.5 and 0.52 respectively. The adjusted odds ratio was 40.8. CONCLUSION In patients with OSA, CIMT is a highly specific but poorly sensitive test for detecting CAD.
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Hoyos CM, Drager LF, Patel SR. OSA and cardiometabolic risk: What's the bottom line? Respirology 2017; 22:420-429. [DOI: 10.1111/resp.12984] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Camilla M. Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
- Healthy Brain Ageing Program, School of Psychology, Faculty of Science; University of Sydney; Sydney New South Wales Australia
| | - Luciano F. Drager
- Hypertension Unit - Heart Institute (InCor); University of Sao Paulo Medical School; Sao Paulo Brazil
| | - Sanjay R. Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine; University of Pittsburgh; Pittsburgh Pennsylvania USA
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Evaluation of Fibrinolytic Inhibitors: Alpha-2-Antiplasmin and Plasminogen Activator Inhibitor 1 in Patients with Obstructive Sleep Apnoea. PLoS One 2016; 11:e0166725. [PMID: 27861608 PMCID: PMC5115791 DOI: 10.1371/journal.pone.0166725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/02/2016] [Indexed: 11/19/2022] Open
Abstract
Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.
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Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb Hemost 2016; 24:139-144. [PMID: 27837155 DOI: 10.1177/1076029616677803] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Although monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality, no study has attempted to determine the role of MHR in cardiovascular morbidity of patients with OSAS. We aimed to investigate the association between MHR and CVD in patients with OSAS and the relationship between severity of OSAS, polysomnographic parameters, and MHR. METHODS In this cohort study, patients who had undergone a full-night polysomnography for the diagnosis of OSAS were recruited. Included patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-15), moderate (15-30), and severe (>30) OSAS. Patients with AHI < 5 served as the control group. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD. RESULTS A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65, and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, P < .001). The MHRs were significantly correlated with AHI, oxygen desaturation index, and minimum O2 saturation values ( P < .001). Values of MHR were significantly higher in patients with CVD compared with those without ( P < .001). Multiple regression analysis demonstrated that MHR is an independent predictor of CVD. CONCLUSION The MHR is strongly associated with CVD and the severity of OSAS and might be used as a biomarker to predict CVD in patients with OSAS.
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Affiliation(s)
- Handan Inonu Koseoglu
- 1 Faculty of Medicine, Department of Pulmonary Diseases, Gaziosmanpasa University, Tokat, Turkey
| | - Ahmet Cemal Pazarli
- 2 Department of Pulmonary Diseases, Elbistan State Hospital, Kahramanmaras, Turkey
| | - Asiye Kanbay
- 3 Department of Pulmonary Diseases, İstanbul Medeniyet University, İstanbul, Turkey
| | - Osman Demir
- 4 Faculty of Medicine, Department of Biostatistics and Medical Informatics, Gaziosmanpasa University, Tokat, Turkey
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Mazaki T, Kasai T, Yokoi H, Kuramitsu S, Yamaji K, Morinaga T, Masuda H, Shirai S, Ando K. Impact of Sleep-Disordered Breathing on Long-Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:JAHA.116.003270. [PMID: 27307401 PMCID: PMC4937269 DOI: 10.1161/jaha.116.003270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has been recognized as an important risk factor for cardiovascular diseases; however, the impact of SDB on long-term outcomes in patients with acute coronary syndrome has not been fully evaluated. METHODS AND RESULTS We performed overnight cardiorespiratory monitoring of 241 patients with acute coronary syndrome who were successfully treated with primary percutaneous coronary intervention between January 2005 and December 2008. The presence of SDB was defined as apnea-hypopnea index ≥5 events per hour. The end point was incidence of major adverse cardiocerebrovascular events, defined as a composite of all-cause death, recurrence of acute coronary syndrome, nonfatal stroke, and hospital admission for congestive heart failure. Patients were followed for a median period of 5.6 years. Among the 241 patients who were finally enrolled, comorbidity of SDB with acute coronary syndrome was found in 126 patients (52.3%). The cumulative incidence of major adverse cardiocerebrovascular events was significantly higher in patients with SDB than in those without SDB (21.4% versus 7.8%, P=0.006). Multivariable analysis revealed that the presence of SDB was a significant predictor of major adverse cardiocerebrovascular events (hazard ratio 2.28, 95% CI 1.06-4.92; P=0.035). CONCLUSIONS The study's results showed that the presence of SDB among patients with acute coronary syndrome following primary percutaneous coronary intervention is associated with a higher incidence of major adverse cardiocerebrovascular events during long-term follow-up.
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Affiliation(s)
- Toru Mazaki
- Department of Cardiology, Kobe Central Hospital, Kobe, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hisaki Masuda
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Bauters F, Rietzschel ER, Hertegonne KBC, Chirinos JA. The Link Between Obstructive Sleep Apnea and Cardiovascular Disease. Curr Atheroscler Rep 2016; 18:1. [PMID: 26710793 DOI: 10.1007/s11883-015-0556-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is common in the general population and highly prevalent in patients with cardiovascular disease. In this paper, we review (1) the pathophysiological mechanisms of OSA that may causally contribute to cardiovascular disease; (2) current evidence regarding the association between OSA and hypertension, stroke, ischemic heart disease, heart failure, atrial fibrillation, and cardiovascular mortality; and (3) the impact of continuous positive airway pressure (CPAP) treatment on cardiovascular risk factors and outcomes. We emphasize the importance of obesity as a comorbidity of OSA and a confounder in the association between OSA and cardiovascular disease. We also discuss the importance of addressing obesity in patients with OSA, as a strategy to reduce the burden of cardiovascular risk factors in this population. Implications for the approach of patients' OSA in clinical practice and future research directions are discussed.
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Affiliation(s)
| | | | | | - Julio A Chirinos
- Ghent University Hospital, Ghent, Belgium.
- Hospital of the University of Pennsylvania, 3400 Spruce Street. Gates 9021, Philadelphia, PA, 19060, USA.
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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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Pavelec V, Rotenberg BW, Maurer JT, Gillis E, Verse T. A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility. Nat Sci Sleep 2016; 8:137-44. [PMID: 27217804 PMCID: PMC4862357 DOI: 10.2147/nss.s103702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Many cases of obstructive sleep apnea (OSA) involve collapse of the tongue base and soft palate during sleep, causing occlusion of the upper airway and leading to oxygen desaturation. Existing therapies can be effective, but they are plagued by patient adherence issues and the invasiveness of surgical approaches. A new, minimally invasive implant for OSA has been developed, which is elastic and contracts a few weeks after deployment, stabilizing the surrounding soft tissue. The device has had good outcomes in preclinical testing; this report describes the preliminary feasibility and safety of its implementation in humans. PATIENTS AND METHODS A prospective, multicenter, single-arm feasibility study was conducted. Subjects were adults with moderate-to-severe OSA who had previously failed or refused conventional continuous positive airway pressure treatment. Intraoperative feasibility data, postoperative pain, and safety information were collected for a 30-day postoperative period. RESULTS Forty subjects participated (37 men, three women; average age of 46.1 years); each received two tongue-base implants and two soft-palate implants. Surgical procedure time averaged 43 minutes. Postsurgical pain resolved readily in most cases; at 30 days post implantation, <20% of subjects reported pain, which averaged less than two out of ten. Adverse events were generally the mild and expected sequelae of a surgical procedure with general anesthesia and intraoral manipulation. The device was well tolerated. Implant extrusions were reported with soft-palate implants (n=12), while tongue-base implants required few revisions (n=2). Quantitative and qualitative sleep effectiveness outcomes (including full-night polysomnographic and quality-of-life measures) will be presented in a subsequent report. CONCLUSION Implantation of the device was feasible. Although a relatively high rate of extrusions occurred in the now-discontinued palate implants, tongue-base implants were largely stable and well tolerated. The minimally invasive and maintenance-free implant may provide a new alternative to higher morbidity surgical procedures.
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Affiliation(s)
- Vaclav Pavelec
- LENTE Clinic, Plzeň, Czech Republic
- Faculty of Health Studies of West Bohemia University, Plzeň, Czech Republic
| | - Brian W Rotenberg
- Department of Otolaryngology, Head and Neck Surgery, Western University, London, ON, Canada
| | - Joachim T Maurer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany
| | | | - Thomas Verse
- Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Klinikum Harburg, Hamburg, Germany
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Randerath W, Javaheri S. Sleep-Disordered Breathing in Patients with Heart Failure. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0047-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mendelson M, Lyons OD, Yadollahi A, Inami T, Oh P, Bradley TD. Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial. Eur Respir J 2016; 48:142-50. [PMID: 27076578 DOI: 10.1183/13993003.01897-2015] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/12/2016] [Indexed: 01/10/2023]
Abstract
Overnight fluid shift from the legs to the neck and lungs may contribute to the pathogenesis of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA). We hypothesised that exercise training will decrease the severity of OSA and CSA in patients with coronary artery disease (CAD) by decreasing daytime leg fluid accumulation and overnight rostral fluid shift.Patients with CAD and OSA or CSA (apnoea-hypopnoea index >15 events per h) were randomised to 4 weeks of aerobic exercise training or to a control group. Polysomnography, with measurement of leg, thoracic and neck fluid volumes and upper-airway cross-sectional area (UA-XSA) before and after sleep, was performed at baseline and follow-up.17 patients per group completed the study. Apnoea-hypopnoea index decreased significantly more in the exercise group than in the control group (31.1±12.9 to 20.5±9.4 versus 28.1±13.5 to 27.0±15.1 events per h, p=0.047), in association with a greater reduction in the overnight change in leg fluid volume (579±222 to 466±163 versus 453±164 to 434±141 mL, p=0.04) and by a significantly greater increase in the overnight change in UA-XSA in the exercise group (p=0.04).In patients with CAD and sleep apnoea, exercise training decreases sleep apnoea severity via attenuation of overnight fluid shift and an increase in UA-XSA.
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Affiliation(s)
- Monique Mendelson
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada
| | - Owen D Lyons
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada Dept of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Azadeh Yadollahi
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Toru Inami
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada Dept of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - T Douglas Bradley
- Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada Dept of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis 2016; 39:179-85. [PMID: 25002338 DOI: 10.1007/s11239-014-1103-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is a strong relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease (CVD). Chronic intermittent hypoxia, inflammation, oxidative stress, and endothelial dysfunction may constitute etiologic mechanisms, linking OSAS to CVD. Inflammation play an important role in the development of CVD. Platelet-lymphocyte ratio (PLR) is a new biomarker showing inflammation. No previous study has ever investigated the association between PLR, CVD and OSAS severity in patients with OSAS. This study was designed to investigate the association between PLR and CVD in patients with OSAS, and relationship between severity of OSAS, polysomnographic parameters and PLR. This was a cohort study in which patients who had undergone a full night polysomnoraphy for diagnosis of OSA were recruited. Patients were divided according to their apnea-hypopnea index (AHI) scores into OSAS negative (Group 1: AHI < 5), mild (Group 2: AHI, 5-15), moderate (Group 3:AHI,15-30), and severe OSAS (Group 4: AHI > 30) groups. The presence of heart failure, coronary artery disease or arrhythmia was defined as CVD. A total of 424 patients were included in this study. There were 57, 93, 82, and 192 patients in Groups 1, 2, 3, and 4, respectively. PLR were significantly different between groups (Group 1: 87.38; Group 2: 95.07; Group 3: 97.01, Group 4: 126.9, P < 0.05). PLR were significantly correlated with AHI, oxygen desaturation index, average and minimum O2 saturation values (P < 0.05). Values of PLR were significantly higher in patients with CVD compared with those without. Multiple regression analysis demonstrated that PLR is an independent predictor of CVD. PLR cut-off value for demonstrating the presence of CVD is higher than 108.56. In the light oh findings, PLR is strongly associated with the severity of OSAS and cardiovascular disease in OSAS patients. PLR might be used as a biomarker to predict CVD in OSAS patients.
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Maeder MT, Schoch OD, Rickli H. A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vasc Health Risk Manag 2016; 12:85-103. [PMID: 27051291 PMCID: PMC4807890 DOI: 10.2147/vhrm.s74703] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.
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Affiliation(s)
- Micha T Maeder
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Otto D Schoch
- Department of Respiratory Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
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46
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The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy. Eur Arch Otorhinolaryngol 2016; 273:1063-5. [PMID: 26902088 DOI: 10.1007/s00405-016-3944-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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47
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Ryan CM, Kendzerska T, Wilton K, Lyons OD. The Different Clinical Faces of Obstructive Sleep Apnea (OSA), OSA in Older Adults as a Distinctly Different Physiological Phenotype, and the Impact of OSA on Cardiovascular Events after Coronary Artery Bypass Surgery. Am J Respir Crit Care Med 2016; 192:1127-9. [PMID: 26360149 DOI: 10.1164/rccm.201507-1472rr] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Clodagh M Ryan
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Recommended Reading from the University of Toronto Sleep Medicine Fellowship Program; Clodagh M. Ryan, M.D., Director of the Fellowship Program
| | - Tetyana Kendzerska
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Recommended Reading from the University of Toronto Sleep Medicine Fellowship Program; Clodagh M. Ryan, M.D., Director of the Fellowship Program
| | - Kelly Wilton
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Recommended Reading from the University of Toronto Sleep Medicine Fellowship Program; Clodagh M. Ryan, M.D., Director of the Fellowship Program
| | - Owen D Lyons
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Recommended Reading from the University of Toronto Sleep Medicine Fellowship Program; Clodagh M. Ryan, M.D., Director of the Fellowship Program
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Current Concepts in Assessing Outcomes for OSA Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Abstract
Sleep disturbances are a common presenting symptom of older-age adults to their physicians. This article explores normal changes in sleep pattern with aging and primary sleep disorders in the elderly. Behavioral factors and primary psychiatric disorders affecting sleep in this population are reviewed. Further discussion examines sleep changes associated with 2 common forms of neurocognitive disorder: Alzheimer disease and Lewy Body Dementia. Common medical illnesses in the elderly are discussed in relation to sleep symptoms. Nonpharmacological and pharmacologic treatment strategies are summarized, with emphasis placed on risk of side effects in older adults. Future targets are considered.
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Affiliation(s)
- Kristina F Zdanys
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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Ghiasi F, Ahmadpoor A, Amra B. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:662-7. [PMID: 26622255 PMCID: PMC4638068 DOI: 10.4103/1735-1995.166212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Pulmonary embolism (PE) is the most life-threatening form of venous thrombosis which causes the majority of mortalities in this category. Obstructive sleep apnea (OSA) has been indicated as one of the risk factors for thromboembolism because of hemostatic alterations. The present study was designed to seek for the relationship between OSA and 30-day mortality of patients with PE. Materials and Methods: This prospective cohort study was conducted among 137 consecutive patients referred to hospital with symptoms of PE and preliminary stable hemodynamic. Confirmation of PE was made by multislice computed tomography pulmonary angiography and in the case of contraindication; V/Q lung scan and Doppler sonography were done. A STOP-Bang Questionnaire was used to determine patients with high- and low-risk of OSA. Patients were followed up for 1-month, and their survivals were recorded. Results: This study showed that there was no relationship between OSA and 30-day mortality (P = 0.389). Chronic kidney disease (P = 0.004), hypertension (P = 0.003), main thrombus (P = 0.004), and segmental thrombus (P = 0.022) were associated with 30-day mortality. In the logistic regression analysis, history of chronic kidney disease was diagnosed as a risk factor for 30-day mortality among the PE patients (P = 0.029, odds ratio = 4.93). Conclusion: Results of this study showed 30-day mortality was not affected by OSA directly. In fact, it was affected by complications of OSA such as hypertension and thrombus. Also, positive history of chronic kidney disease increased the risk of 30-day mortality.
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Affiliation(s)
- Farzin Ghiasi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ahmadpoor
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Amra
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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