1
|
Nathani A, Attaway A, Mehra R. Hypoxic and Autonomic Mechanisms from Sleep-Disordered Breathing Leading to Cardiopulmonary Dysfunction. Sleep Med Clin 2024; 19:229-237. [PMID: 38692748 DOI: 10.1016/j.jsmc.2024.02.003] [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] [Indexed: 05/03/2024]
Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Its prevalence has increased due to increasing obesity and improved screening and diagnostic strategies. OSA overlaps with cardiopulmonary diseases to promote intermittent hypoxia and autonomic dysfunction. Intermittent hypoxia increases the risk for oxidative stress and inflammation, which promotes endothelial dysfunction and predisposes to atherosclerosis and other cardiovascular complications. OSA is associated with an increased sympathetic nervous system drive resulting in autonomic dysfunction leading to worsening of cardiopulmonary diseases. Cardiovascular diseases are observed in 40% to 80% of OSA patients. Therefore, it is essential to screen and treat cardiovascular diseases.
Collapse
Affiliation(s)
- Avantika Nathani
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA.
| | - Amy Attaway
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA
| | - Reena Mehra
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA; Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
2
|
Hu BZ, Jiang C, Ding YJ, Qin W, Yu W, Shi Y, Li FJ, Li CH, Li QY. The clinical and hemodynamic characteristics of pulmonary hypertension in patients with OSA-COPD overlap syndrome. Am J Med Sci 2024; 367:375-381. [PMID: 38467374 DOI: 10.1016/j.amjms.2024.03.014] [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: 02/20/2023] [Revised: 10/11/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Our study aimed to assess the clinical and hemodynamic characteristics of pulmonary hypertension (PH) in patients with overlapping obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), referred to OSA-COPD overlap syndrome (OS). METHODS We enrolled a total of 116 patients with OS, COPD, or OSA who underwent right heart catheterization (RHC) due to suspected PH. We conducted a retrospective analysis of the clinical and hemodynamic characteristics of these patients. RESULTS Among the three groups (OS group, n = 26; COPD group, n = 36; OSA group, n = 54), the prevalence of PH was higher in the OS group (n = 17, 65.4%)compared to OSA group (n = 26,48.1%) and COPD group (n = 20,55.6 %). Among three groups with PH, the superior vena cava pressure (CVP) and right ventricular pressure (RAP) were higher in the OS group than in the OSA group (P < 0.05). Patients in the OS and COPD groups had higher pulmonary artery wedge pressure (PAWP) than in the OSA group (14.88 ± 4.79 mmHg, 13.45 ± 3.68 mmHg vs. 11.00 ± 3.51 mmHg, respectively, P < 0.05). OS patients with PH exhibited higher respiratory event index (REI), time spent with SpO2 <90%, oxygen desaturation index (ODI), minimal SpO2 (MinSpO2) and mean SpO2 (MSpO2) compared to OS patients without PH. After adjusting for potential covariates, we found that MinSpO2 (OR 0.937, 95 % CI 0.882-0.994, P = 0.032), MSpO2 (OR 0.805, 95% CI 0.682-0.949, P = 0.010), time spent with SpO2 <90% (OR 1.422, 95% CI 1.137-1.780, P = 0.002), and FEV1 % pred (OR 0.977, 95 % CI 0.962-0.993, P = 0.005) were related to the development of PH. CONCLUSIONS Patients with OS showed higher prevalence of PH, along with higher PAWP, CVP and RAP. Worse nocturnal hypoxemia was found in OS patients with PH.
Collapse
Affiliation(s)
- Bing Zhu Hu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Cheng Jiang
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Yong Jie Ding
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Qin
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Wei Yu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Fa Jiu Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Cheng Hong Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
3
|
Balcan B, Akdeniz B, Peker Y, Collaborators TTURCOSACT. Obstructive Sleep Apnea and Pulmonary Hypertension: A Chicken-and-Egg Relationship. J Clin Med 2024; 13:2961. [PMID: 38792502 PMCID: PMC11122166 DOI: 10.3390/jcm13102961] [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: 03/18/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep, and it is closely linked to several cardiovascular issues due to intermittent hypoxia, nocturnal hypoxemia, and disrupted sleep patterns. Pulmonary hypertension (PH), identified by elevated pulmonary arterial pressure, shares a complex interplay with OSA, contributing to cardiovascular complications and morbidity. The prevalence of OSA is alarmingly high, with studies indicating rates of 20-30% in males and 10-15% in females, escalating significantly with age and obesity. OSA's impact on cardiovascular health is profound, particularly in exacerbating conditions like systemic hypertension and heart failure. The pivotal role of hypoxemia increases intrathoracic pressure, inflammation, and autonomic nervous system dysregulation in this interplay, which all contribute to PH's pathogenesis. The prevalence of PH among OSA patients varies widely, with studies reporting rates from 15% to 80%, highlighting the variability in diagnostic criteria and methodologies. Conversely, OSA prevalence among PH patients also remains high, often exceeding 25%, stressing the need for careful screening and diagnosis. Treatment strategies like continuous positive airway pressure (CPAP) therapy show promise in mitigating PH progression in OSA patients. However, this review underscores the need for further research into long-term outcomes and the efficacy of these treatments. This review provides comprehensive insights into the epidemiology, pathophysiology, and treatment of the intricate interplay between OSA and PH, calling for integrated, personalized approaches in diagnosis and management. The future landscape of OSA and PH management hinges on continued research, technological advancements, and a holistic approach to improving patient outcomes.
Collapse
Affiliation(s)
- Baran Balcan
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir 35340, Turkey;
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | | |
Collapse
|
4
|
Chen Y, Zhang S, Lu X, Xie W, Wang C, Zhai Z. Unusual cause of muscle weakness, type II respiratory failure and pulmonary hypertension: a case report of ryanodine receptor type 1(RYR1)-related myopathy. BMC Pulm Med 2024; 24:194. [PMID: 38649898 PMCID: PMC11034144 DOI: 10.1186/s12890-024-03016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with congenital myopathies may experience respiratory involvement, resulting in restrictive ventilatory dysfunction and respiratory failure. Pulmonary hypertension (PH) associated with this condition has never been reported in congenital ryanodine receptor type 1(RYR1)-related myopathy. CASE PRESENTATION A 47-year-old woman was admitted with progressively exacerbated chest tightness and difficulty in neck flexion. She was born prematurely at week 28. Her bilateral lower extremities were edematous and muscle strength was grade IV-. Arterial blood gas analysis revealed hypoventilation syndrome and type II respiratory failure, while lung function test showed restrictive ventilation dysfunction, which were both worse in the supine position. PH was confirmed by right heart catheterization (RHC), without evidence of left heart disease, congenital heart disease, or pulmonary artery obstruction. Polysomnography indicated nocturnal hypoventilation. The ultrasound revealed reduced mobility of bilateral diaphragm. The level of creatine kinase was mildly elevated. Magnetic resonance imaging showed myositis of bilateral thigh muscle. Muscle biopsy of the left biceps brachii suggested muscle malnutrition and congenital muscle disease. Gene testing revealed a missense mutation in the RYR1 gene (exon33 c.C4816T). Finally, she was diagnosed with RYR1-related myopathy and received long-term non-invasive ventilation (NIV) treatment. Her symptoms and cardiopulmonary function have been greatly improved after 10 months. CONCLUSIONS We report a case of RYR1-related myopathy exhibiting hypoventilation syndrome, type II respiratory failure and PH associated with restrictive ventilator dysfunction. Pulmonologists should keep congenital myopathies in mind in the differential diagnosis of type II respiratory failure, especially in patients with short stature and muscle weakness.
Collapse
Affiliation(s)
- Yinong Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Shuai Zhang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
| | - Xin Lu
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Wanmu Xie
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Chen Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
- Department of Respiratory Medicine, Capital Medical University, Beijing, P.R. China
| | - Zhenguo Zhai
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China.
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China.
- Department of Respiratory Medicine, Capital Medical University, Beijing, P.R. China.
| |
Collapse
|
5
|
Li HT, Yuan P, Jiang R, Zhao QH, Sun YY, Zhang J, Gong SG, Li JL, Qiu HL, Wu WH, Luo CJ, Xu J, Wang L, Liu JM. Sleep-disordered breathing and nocturnal hypoxemia in chronic thromboembolic pulmonary disease. Intern Med J 2024. [PMID: 38563467 DOI: 10.1111/imj.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Sleep-disordered breathing (SDB) and nocturnal hypoxemia were known to be present in patients with chronic thromboembolic pulmonary hypertension (CTEPH), but the difference between SDB and nocturnal hypoxemia in patients who have chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) at rest remains unknown. METHODS Patients who had CTEPH (n = 80) or CTEPD without PH (n = 40) and who had undergone sleep studies from July 2020 to October 2022 at Shanghai Pulmonary Hospital were enrolled. Nocturnal mean SpO2 (Mean SpO2) <90% was defined as nocturnal hypoxemia, and the percentage of time with a saturation below 90% (T90%) exceeding 10% was used to evaluate the severity of nocturnal hypoxemia. Logistic and linear regression analyses were performed to investigate the difference and potential predictor of SDB or nocturnal hypoxemia between CTEPH and CTEPD without PH. RESULTS SDB was similarly prevalent in CTEPH and CTEPD without PH (P = 0.104), both characterised by obstructive sleep apnoea (OSA). Twenty-two patients with CTEPH were diagnosed with nocturnal hypoxemia, whereas only three were diagnosed with CTEPD without PH (P = 0.021). T90% was positively associated with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance in patients with CTEPH and CTEPD without PH (P < 0.001); T90% was also negatively related to cardiac output in these patients. Single-breath carbon monoxide diffusing capacity, sex and mPAP were all correlated with nocturnal hypoxemia in CTEPH and CTEPD without PH (all P < 0.05). CONCLUSION Nocturnal hypoxemia was worse in CTEPD with PH; T90%, but not SDB, was independently correlated with the hemodynamics in CTEPD with or without PH.
Collapse
Affiliation(s)
- Hui-Ting Li
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuan-Yuan Sun
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Industry/the Second Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Su-Gang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Ling Li
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong-Ling Qiu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wen-Hui Wu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ci-Jun Luo
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiang Xu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Ming Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
6
|
Hu X, Sun Y, Wang S, Zhao H, Wei Y, Fu J, Huang Y, Wu W, Li J, Liu J, Gong S, Zhao Q, Wang L, Jiang R, Song X, Yuan P. CircALMS1 Alleviates Pulmonary Microvascular Endothelial Cell Dysfunction in Pulmonary Hypertension. J Am Heart Assoc 2024; 13:e031867. [PMID: 38497483 PMCID: PMC11009991 DOI: 10.1161/jaha.123.031867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Circular RNAs can serve as regulators influencing the development of pulmonary hypertension (PH). However, their function in pulmonary vascular intimal injury remains undefined. Thus, we aimed to identify specifically expressed circular RNAs in pulmonary microvascular endothelial cells (PMECs) under hypoxia and PH. METHODS AND RESULTS Deep RNA sequencing and quantitative real-time polymerase chain reaction revealed that circALMS1 (circular RNA Alstrom syndrome protein 1) was reduced in human PMECs under hypoxia (P<0.0001). Molecular biology and histopathology experiments were used to elucidate the roles of circALMS1 in regulating PMEC dysfunction among patients with PH. The circALMS1 expression was decreased in the plasma of patients with PH (P=0.0315). Patients with lower circALMS1 levels had higher risk of death (P=0.0006). Moreover, the circALMS1 overexpression of adeno-associated viruses improved right ventricular function and reduced pulmonary vascular remodeling in monocrotaline-PH and sugen/hypoxia-PH rats (P<0.05). Furthermore, circALMS1 overexpression promoted apoptosis and inhibited PMEC proliferation and migration under hypoxia by directly downregulating miR-17-3p (P<0.05). Dual luciferase assay confirmed the direct binding of circALMS1 to miR-17-3p and miR-17-3p binding to its target gene YT521-B homology domain-containing family protein 2 (YTHDF2) (P<0.05). The YTHDF2 levels were also downregulated in hypoxic PMECs (P<0.01). The small interfering RNA YTHDF2 reversed the effects of miR-17-3p inhibitors on PMEC proliferation, migration, and apoptosis. Finally, the results indicated that, although YTHDF2, as an N(6)-methyladenosine reader protein, contributes to the degradation of many circular RNAs, it could not regulate the circALMS1 levels in PMECs (P=0.9721). CONCLUSIONS Our study sheds new light on circALMS1-regulated dysfunction of PMECs by the miR-17-3p/YTHDF2 pathway under hypoxia and provides insights into the underlying pathogenesis of PH.
Collapse
Affiliation(s)
- Xiaoyi Hu
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yuanyuan Sun
- Department of Respiratory and Critical Care MedicineShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shang Wang
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Hui Zhao
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
- Institute of Bismuth Science, University of Shanghai for Science and TechnologyShanghaiChina
| | - Yaqin Wei
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of GeriatricsShanghai Institute of Geriatrics, Huadong Hospital, Fudan UniversityShanghaiChina
| | - Jiaqi Fu
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
- Institute of Health Science and EngineeringUniversity of Shanghai Science and TechnologyShanghaiChina
| | - Yuxia Huang
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Wenhui Wu
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jinling Li
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jinming Liu
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Sugang Gong
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Qinhua Zhao
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Lan Wang
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Rong Jiang
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiao Song
- Department of Thoracic SurgeryShanghai Pulmonary Hospital, School of Medicine, Tongji UniversityShanghaiChina
| | - Ping Yuan
- Department of Cardio‐Pulmonary Circulation, Shanghai Pulmonary Hospital, School of MedicineTongji UniversityShanghaiChina
| |
Collapse
|
7
|
Liao LY, Chien LW, Liu CF. Far-infrared stimulation of Neiguan acupoints improves heart rate variability and ameliorate fatigue in hemodialysis patients: A randomized trial. J Chin Med Assoc 2024; 87:340-345. [PMID: 38289295 DOI: 10.1097/jcma.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In 2018, 84 615 patients in Taiwan received hemodialysis, of which about 62% to 97% suffered from fatigue. Fatigue caused by hemodialysis may be mental or physical. However, the detailed mechanism remains unclear. This study aimed to evaluate whether far-infrared stimulation of the Neiguan acupoint (P6) could effectively reduce fatigue and improve heart rate variability (HRV) in hemodialysis patients. METHODS We conducted a two-arm, randomized trial in a hemodialysis center between March 2015 and March 2016. A total of 73 hemodialysis patients were included and were randomly assigned to an experimental group (n = 37) and a control group (n = 36). The experimental group received far-infrared radiation on Neiguan acupoint during hemodialysis for 12 weeks. The outcomes were fatigue level and HRV. RESULTS All patients showed moderate fatigue ( M = 26.00 ± 13.01, range = 0-78) at baseline. Far-infrared stimulation on Neiguan acupoint significantly reduced overall fatigue ( β = 24, p < 0.001) and improved HRV ( β = 74.36, p < 0.001). Compared to the control group, the experiment group had significantly reduced fatigue levels in all aspects such as reduced energy and motivation ( β = -2.97, p < 0.001), reduced physical strength ( β = -1.28, p < 0.01), reduced mental capability ( β = -2.38, p < 0.001), reduction in daily activities ( β = -1.48, p < 0.01), depressed mood and loss of control ( β = -1.21, p < 0.05) as well as increased autonomous nervous system activity ( β = 14.71, p < 0.01) in the third month of stimulation. CONCLUSION Far-infrared stimulation of the Neiguan acupoints effectively reduces fatigue and increases autonomic nervous system activity in hemodialysis patients.
Collapse
Affiliation(s)
- Ling-Yu Liao
- Department of Nursing, Taiwan Adventist Hospital, Taipei, Taiwan, ROC
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Li-Wei Chien
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Chi-Feng Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| |
Collapse
|
8
|
Kim Y, Jo H, Jang TG, Park SY, Park HY, Cho SP, Park J, Kim SH, Urtnasan E. SleepMI: An AI-based screening algorithm for myocardial infarction using nocturnal electrocardiography. Heliyon 2024; 10:e26548. [PMID: 38444951 PMCID: PMC10912038 DOI: 10.1016/j.heliyon.2024.e26548] [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: 07/19/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Myocardial infarction (MI) is a common cardiovascular disease, the early diagnosis of which is essential for effective treatment and reduced mortality. Therefore, novel methods are required for automatic screening or early diagnosis of MI, and many studies have proposed diverse conventional methods for its detection. In this study, we aimed to develop a sleep-myocardial infarction (sleepMI) algorithm for automatic screening of MI based on nocturnal electrocardiography (ECG) findings from diagnostic polysomnography (PSG) data using artificial intelligence (AI) models. The proposed sleepMI algorithm was designed using representation and ensemble learning methods and optimized via dropout and batch normalization. In the sleepMI algorithm, a deep convolutional neural network and light gradient boost machine (LightGBM) models were mixed to obtain robust and stable performance for screening MI from nocturnal ECG findings. The nocturnal ECG signal was extracted from 2,691 participants (2,331 healthy individuals and 360 patients with MI) from the PSG data of the second follow-up stage of the Sleep Heart Health Study. The nocturnal ECG signal was extracted 3 h after sleep onset and segmented at 30-s intervals for each participant. All ECG datasets were divided into training, validation, and test sets consisting of 574,729, 143,683, and 718,412 segments, respectively. The proposed sleepMI model exhibited very high performance with precision, recall, and F1-score of 99.38%, 99.38%, and 99.38%, respectively. The total mean accuracy for automatic screening of MI using a nocturnal single-lead ECG was 99.387%. MI events can be detected using conventional 12-lead ECG signals and polysomnographic ECG recordings using our model.
Collapse
Affiliation(s)
- Youngtae Kim
- Medical Intelligence Lab, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
| | - Hoon Jo
- Artificial Intelligence Big Data Medical Center, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
| | - Tae Gwan Jang
- Medical Intelligence Lab, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
| | - So Yeon Park
- Medical Intelligence Lab, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
| | - Ha Young Park
- Medical Intelligence Lab, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
| | - Sung Pil Cho
- MEZOO Co., Ltd., 668 Namwon-ro, Wonju-si, 26442, Republic of Korea
| | - Junghwan Park
- MEZOO Co., Ltd., 668 Namwon-ro, Wonju-si, 26442, Republic of Korea
| | - Sang-Ha Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju-si, 26426, Republic of Korea
| | - Erdenebayar Urtnasan
- Medical Intelligence Lab, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
- Artificial Intelligence Big Data Medical Center, Wonju College of Medicine, Yonsei University, Wonju-si, 26426, Republic of Korea
- Yonsei Institute of AI Data Convergence Science, Yonsei University Mirae Campus, Wonju-si, 26493, Republic of Korea
| |
Collapse
|
9
|
Huang Z, Duan A, Zhao Z, Zhao Q, Zhang Y, Li X, Zhang S, Gao L, An C, Luo Q, Liu Z. Sleep-disordered breathing patterns and prognosis in pulmonary arterial hypertension: A cluster analysis of nocturnal cardiorespiratory signals. Sleep Med 2024; 113:61-69. [PMID: 37984019 DOI: 10.1016/j.sleep.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common among pulmonary arterial hypertension (PAH) patients and has been associated with unfavorable outcomes. This study aims to cluster overnight cardiorespiratory signals to investigate PAH phenotypes and examining their prognostic implications. METHODS In this retrospective cohort study, we recruited consecutive PAH patients who underwent right heart catheterization and nocturnal cardiorespiratory polygraphy to evaluate SDB. Cluster analysis was employed to classify patients based on their SDB patterns. Cox regression analysis and Kaplan-Meier curves were utilized to assess the association between cluster membership and clinical outcomes. Logistic regression was used to identify risk factors associated with the cluster at higher risk of adverse outcomes. RESULTS The study comprised 386 PAH patients, with a mean age of 44.7 ± 17.0 years, of which 46.6 % were male. Three distinct clusters of PAH patients were identified: Cluster 1 (N = 182) presented with minimal SDB, Cluster 2 (N = 125) displayed obstructive sleep apnea (OSA) without significant hypoxemia, and Cluster 3 (N = 79) exhibited predominantly severe hypoxemic burden along with comorbid OSA. Notably, patients in Cluster 3 had an independent association with an increased risk of clinical worsening (hazard ratio 1.96, 95 % confidence interval [CI] 1.08-3.56, P = 0.027) compared to those in Clusters 1, even after adjusting for common confounders. The rate of clinical worsening for PAH-related events and mortality was higher in Cluster 3 than in Clusters 1 and 2 (26.6 % vs. 12.6 % and 19.2 %, respectively, log-rank P = 0.024). Moreover, the left ventricular mass index was identified as an independent risk factor for Cluster 3 (odds ratios 1.01, 95 % CI 1.00-1.02, P = 0.004). CONCLUSIONS Patients with PAH who have nocturnal hypoxemia and OSA had worse clinical outcomes compared to those with only minimal SDB. Tailored management strategies that address both PAH and nocturnal hypoxemia may be effective in improving clinical outcomes.
Collapse
Affiliation(s)
- Zhihua Huang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anqi Duan
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Li
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sicheng Zhang
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luyang Gao
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenhong An
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Luo
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhihong Liu
- Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
10
|
Bonsignore MR. Adaptive responses to chronic intermittent hypoxia: contributions from the European Sleep Apnoea Database (ESADA) Cohort. J Physiol 2023; 601:5467-5480. [PMID: 37218069 DOI: 10.1113/jp284108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease in the general population, and is associated with increased cardiovascular risk and several comorbidities. Obesity favours upper airway collapsibility, but other pathophysiological traits have been identified, i.e. upper airway muscle activity, modulation of the respiratory drive, and the arousal threshold. OSA causes chronic intermittent hypoxia, inflammatory activation and autonomic imbalance with diurnal and nocturnal sympathetic hyperactivity. Disentangling so many components to investigate the pathogenesis of OSA's consequences is very hard clinically. However, albeit imperfect, clinical medicine constitutes a major source of inspiration for basic research, and a mutual exchange of information is essential between clinicians and physiologists to improve our understanding of disease states. OSA is no exception, and this narrative review will summarize the results of clinical studies performed over the years by the European Sleep Apnoea Database (ESADA) Study Group, to explore the variables linked to markers of intermittent hypoxia as opposed to the traditional assessment of OSA severity based on the frequency of respiratory events during sleep (the Apnoea Hypopnoea Index). The results of the clinical studies indicate that intermittent hypoxia variables are associated with several comorbidities, although evidence of a cause-effect relationship is still missing in many cases. It is also possible that adaptive rather than maladaptive responses could be evoked by intermittent hypoxia. The intensity, duration and frequency of intermittent hypoxia episodes causing adaptive rather than maladaptive responses, and their clinical implications, deserve further investigation.
Collapse
Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- Sleep Disordered Breathing Clinic, Division of Pneumology, V. Cervello Hospital, Palermo, Italy
| |
Collapse
|
11
|
Blanco I, Hernández-González F, García A, Torres-Castro R, Barberà JA. Management of Pulmonary Hypertension Associated with Chronic Lung Disease. Semin Respir Crit Care Med 2023; 44:826-839. [PMID: 37487524 DOI: 10.1055/s-0043-1770121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Pulmonary hypertension (PH) is a common complication of chronic lung diseases, particularly in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) and especially in advanced disease. It is associated with greater mortality and worse clinical course. Given the high prevalence of some respiratory disorders and because lung parenchymal abnormalities might be present in other PH groups, the appropriate diagnosis of PH associated with respiratory disease represents a clinical challenge. Patients with chronic lung disease presenting symptoms that exceed those expected by the pulmonary disease should be further evaluated by echocardiography. Confirmatory right heart catheterization is indicated in candidates to surgical treatments, suspected severe PH potentially amenable with targeted therapy, and, in general, in those conditions where the result of the hemodynamic assessment will determine treatment options. The treatment of choice for these patients who are hypoxemic is long-term oxygen therapy and pulmonary rehabilitation to improve symptoms. Lung transplant is the only curative therapy and can be considered in appropriate cases. Conventional vasodilators or drugs approved for pulmonary arterial hypertension (PAH) are not recommended in patients with mild-to-moderate PH because they may impair gas exchange and their lack of efficacy shown in randomized controlled trials. Patients with severe PH (as defined by pulmonary vascular resistance >5 Wood units) should be referred to a center with expertise in PH and lung diseases and ideally included in randomized controlled trials. Targeted PAH therapy might be considered in this subset of patients, with careful monitoring of gas exchange. In patients with ILD, inhaled treprostinil has been shown to improve functional ability and to delay clinical worsening.
Collapse
Affiliation(s)
- Isabel Blanco
- Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Spain
| | - Fernanda Hernández-González
- Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Spain
| | - Agustín García
- Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Spain
| | - Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Spain
| | - Joan A Barberà
- Department of Pulmonary Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic-University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Spain
| |
Collapse
|
12
|
Lichtblau M, Harutyunova S, Nechwatal R, Mayer L, Kabitz HJ, Wilkens FM, Uiker S, Grünig E, Ritter D, Florea A, Benjamin N. [General measures and management of pulmonary arterial hypertension]. Pneumologie 2023; 77:907-915. [PMID: 37963480 DOI: 10.1055/a-2145-4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Care of patients with pulmonary arterial hypertension (PAH) needs a multi-facetet concept and measures, including management of adverse reactions, right heart insufficiency as well as information on pregnancy, travels by air, psychosocial support, physical exercise training and prophylaxis by vaccination.Positive study results led to an higher recommendation of specialized exercise training in pulmonary hypertension. Also, the recommendation on iron substitution was amended according to the current evidence.In the current guidelines, special focus was given to the elaboration of recommendations regarding pregnancy, including patient information, contraception and patient management in case of pregnancy.This article aims to provide an overview on the recommendations of general measuremes, special circumstances and patient management according to the ESC/ERS guidelines. Amendments to the guideline recommendations are given as comments from the authors of this article.
Collapse
Affiliation(s)
- Mona Lichtblau
- Klinik für Pneumologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Satenik Harutyunova
- Zentrum für pulmonale Hypertonie, Thoraxklinik Heidelberg gGmbH am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | | | - Laura Mayer
- Klinik für Pneumologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Hans-Joachim Kabitz
- Klinik für Pneumologie und Schlafmedizin, Kantonsspital Aarau (KSA), Schweiz
| | - Finn Moritz Wilkens
- Zentrum für pulmonale Hypertonie, Thoraxklinik Heidelberg gGmbH am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Sören Uiker
- Rehaklinik Heidelberg Königstuhl, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für pulmonale Hypertonie, Thoraxklinik Heidelberg gGmbH am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Daniel Ritter
- Klinikum Würzburg Mitte, Standort Missionsärztliche Klinik, Würzburg, Deutschland
| | - Andreea Florea
- Zentrum für pulmonale Hypertonie, Thoraxklinik Heidelberg gGmbH am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Nicola Benjamin
- Zentrum für pulmonale Hypertonie, Thoraxklinik Heidelberg gGmbH am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
13
|
Fernandes JL, Martins FO, Olea E, Prieto-Lloret J, Braga PC, Sacramento JF, Sequeira CO, Negrinho AP, Pereira SA, Alves MG, Rocher A, Conde SV. Chronic Intermittent Hypoxia-Induced Dysmetabolism Is Associated with Hepatic Oxidative Stress, Mitochondrial Dysfunction and Inflammation. Antioxidants (Basel) 2023; 12:1910. [PMID: 38001763 PMCID: PMC10669005 DOI: 10.3390/antiox12111910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
The association between obstructive sleep apnea (OSA) and metabolic disorders is well-established; however, the underlying mechanisms that elucidate this relationship remain incompletely understood. Since the liver is a major organ in the maintenance of metabolic homeostasis, we hypothesize that liver dysfunction plays a crucial role in the pathogenesis of metabolic dysfunction associated with obstructive sleep apnea (OSA). Herein, we explored the underlying mechanisms of this association within the liver. Experiments were performed in male Wistar rats fed with a control or high fat (HF) diet (60% lipid-rich) for 12 weeks. Half of the groups were exposed to chronic intermittent hypoxia (CIH) (30 hypoxic (5% O2) cycles, 8 h/day) that mimics OSA, in the last 15 days. Insulin sensitivity and glucose tolerance were assessed. Liver samples were collected for evaluation of lipid deposition, insulin signaling, glucose homeostasis, hypoxia, oxidative stress, antioxidant defenses, mitochondrial biogenesis and inflammation. Both the CIH and HF diet induced dysmetabolism, a state not aggravated in animals submitted to HF plus CIH. CIH aggravates hepatic lipid deposition in obese animals. Hypoxia-inducible factors levels were altered by these stimuli. CIH decreased the levels of oxidative phosphorylation complexes in both groups and the levels of SOD-1. The HF diet reduced mitochondrial density and hepatic antioxidant capacity. The CIH and HF diet produced alterations in cysteine-related thiols and pro-inflammatory markers. The results obtained suggest that hepatic mitochondrial dysfunction and oxidative stress, leading to inflammation, may be significant factors contributing to the development of dysmetabolism associated with OSA.
Collapse
Affiliation(s)
- Joana L. Fernandes
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Fátima O. Martins
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Elena Olea
- Departamento de Enfermeria, Universidad de Valladolid, 47005 Valladolid, Spain;
- Unidad de Excelencia Instituto de Biomedicina y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas, Universidad de Valladolid, 47005 Valladolid, Spain; (J.P.-L.); (A.R.)
| | - Jesus Prieto-Lloret
- Unidad de Excelencia Instituto de Biomedicina y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas, Universidad de Valladolid, 47005 Valladolid, Spain; (J.P.-L.); (A.R.)
- Departamento de Bioquímica, Biologia Molecular y Fisiologia, Universidad de Valladolid, 47005 Valladolid, Spain
| | - Patrícia C. Braga
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal; (P.C.B.); (M.G.A.)
- ITR-Laboratory for Integrative and Translational Research in Population Health, 4050-313 Porto, Portugal
- Institute of Biomedicine—iBiMED and Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Joana F. Sacramento
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Catarina O. Sequeira
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Ana P. Negrinho
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Sofia A. Pereira
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| | - Marco G. Alves
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal; (P.C.B.); (M.G.A.)
- ITR-Laboratory for Integrative and Translational Research in Population Health, 4050-313 Porto, Portugal
- Institute of Biomedicine—iBiMED and Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Asunción Rocher
- Unidad de Excelencia Instituto de Biomedicina y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas, Universidad de Valladolid, 47005 Valladolid, Spain; (J.P.-L.); (A.R.)
- Departamento de Bioquímica, Biologia Molecular y Fisiologia, Universidad de Valladolid, 47005 Valladolid, Spain
| | - Silvia V. Conde
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1150-069 Lisboa, Portugal; (J.L.F.); (F.O.M.); (J.F.S.); (C.O.S.); (A.P.N.); (S.A.P.)
| |
Collapse
|
14
|
Blaszczyk B, Wieckiewicz M, Kusztal M, Michalek-Zrabkowska M, Lachowicz G, Mazur G, Martynowicz H. Fabry disease and sleep disorders: a systematic review. Front Neurol 2023; 14:1217618. [PMID: 37869133 PMCID: PMC10586315 DOI: 10.3389/fneur.2023.1217618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Fabry disease (FD) is an X-chromosome-linked disorder characterized by a reduced or complete absence of the enzyme α-galactosidase, resulting in the accumulation of lysosomal globotriaosylceramide. Despite the presence of these deposits in multiple organs, the problem of sleep disorders within this population has very rarely been documented. Objective This study aimed to investigate the types and prevalence of sleep disorders among patients with FD. Methods Screening of the following medical databases using key terms was performed on 10 February 2023: PubMed, Scopus, and Embase. A total of 136 records were identified. The quality assessment of the studies was conducted by using tools from the National Institutes of Health (NIH) and critical appraisal tools from the Joanna Briggs Institute (JBI). Results The study included nine studies on sleep disorders in patients with FD. The overall quality of the majority of these studies was assessed as either poor or fair. Among 330 patients, there was a slightly higher representation of female patients (56%). Sleep problems manifested 4-5 years after the onset of FD and sometimes even after 10-11 years. Genotypes of disease associated with sleep problems were rarely described. Within the FD population, the most commonly reported conditions were excessive daytime sleepiness (EDS) as well as obstructive and central sleep apnea (OSA, CSA). However, EDS occurred more frequently in FD patients, while the prevalence of OSA and CSA was within the ranges observed in the general population. The studies included indicated a lack of association between organ impairment by primary disease and EDS and OSA. The effectiveness of enzyme replacement therapy (ERT) in treating sleep disorders was not demonstrated. Conclusion The findings of this report revealed the presence of many sleep-related disorders within the FD population. However, very few studies on this subject are available, and their limited results make it difficult to truly assess the real extent of the prevalence of sleep disturbances among these individuals. There is a need to conduct further studies on this topic, involving a larger group of patients. It is important to note that there are no guidelines available for the treatment of sleep disorders in patients with FD.
Collapse
Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| |
Collapse
|
15
|
Fox TH, LaNasa M, Saketkoo LA, Saito S, deBoisblanc BP, Lammi MR. STOP-Bang for OSA screening in patients with pulmonary hypertension. Respir Med 2023; 217:107339. [PMID: 37419376 DOI: 10.1016/j.rmed.2023.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/25/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Thomas H Fox
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Michael LaNasa
- Section of Internal Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA, United States
| | - Lesley Ann Saketkoo
- Comprehensive Pulmonary Hypertension Center-University Medical Center, New Orleans, LA, United States; Tulane University School of Medicine, New Orleans, LA, United States; Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Shigeki Saito
- Comprehensive Pulmonary Hypertension Center-University Medical Center, New Orleans, LA, United States; Tulane University School of Medicine, New Orleans, LA, United States
| | - Bennett P deBoisblanc
- Comprehensive Pulmonary Hypertension Center-University Medical Center, New Orleans, LA, United States; Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Matthew R Lammi
- Comprehensive Pulmonary Hypertension Center-University Medical Center, New Orleans, LA, United States; Section of Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
| |
Collapse
|
16
|
Haynes ZA, Chandel A, King CS. Pulmonary Hypertension in Interstitial Lung Disease: Updates in Disease, Diagnosis, and Therapeutics. Cells 2023; 12:2394. [PMID: 37830608 PMCID: PMC10572438 DOI: 10.3390/cells12192394] [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: 07/02/2023] [Revised: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Pulmonary hypertension is a debilitating condition that frequently develops in the setting of interstitial lung disease, likely related to chronic alveolar hypoxemia and pulmonary vascular remodeling. This disease process is likely to be identified more frequently by providers given recent advancements in definitions and diagnostic modalities, and provides practitioners with emerging opportunities to improve patient outcomes and quality of life. Despite years of data suggesting against the efficacy of pulmonary vasodilator therapy in patients with pulmonary hypertension due to interstitial lung disease, new data have emerged identifying promising advancements in therapeutics. The authors present to you a comprehensive review of pulmonary hypertension in interstitial lung disease, reviewing our current understanding of pathophysiology, updates in diagnostic approaches, and highlights of recent clinical trials which provide an effective approach for medical management.
Collapse
Affiliation(s)
- Zachary A. Haynes
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Abhimanyu Chandel
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher S. King
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Fairfax, VA 22031, USA;
| |
Collapse
|
17
|
Oliveira A, Fabbri G, Gille T, Bargagli E, Duchemann B, Evans R, Pinnock H, Holland AE, Renzoni E, Ekström M, Jones S, Wijsenbeek M, Dinh-Xuan AT, Vagheggini G. Holistic management of patients with progressive pulmonary fibrosis. Breathe (Sheff) 2023; 19:230101. [PMID: 37719243 PMCID: PMC10501708 DOI: 10.1183/20734735.0101-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Abstract
Progressive pulmonary fibrosis (PF) is a complex interstitial lung disease that impacts substantially on patients' daily lives, requiring personalised and integrated care. We summarise the main needs of patients with PF and their caregivers, and suggest a supportive care approach. Individualised care, education, emotional and psychological support, specialised treatments, and better access to information and resources are necessary. Management should start at diagnosis, be tailored to the patient's needs, and consider end-of-life care. Pharmacological and non-pharmacological interventions should be individualised, including oxygen therapy and pulmonary rehabilitation, with digital healthcare utilised as appropriate. Further research is needed to address technical issues related to oxygen delivery and digital healthcare. Educational aims To identify the main needs of patients with PF and their caregivers.To describe the components of a comprehensive approach to a supportive care programme for patients with PF.To identify further areas of research to address technical issues related to the management of patients with PF.
Collapse
Affiliation(s)
- Ana Oliveira
- Lab 3R Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), IBMED Aveiro PT, Aveiro, Portugal
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Gaia Fabbri
- Respiratory Diseases and Lung Transplantation Unit, Department of Medical and Surgical Sciences and Neuro-Sciences, University of Siena, Siena, Italy
| | - Thomas Gille
- Inserm U1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
- Service Physiologie et Explorations Fonctionnelles, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medical and Surgical Sciences and Neuro-Sciences, University of Siena, Siena, Italy
| | - Boris Duchemann
- Inserm U1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
- Service d'oncologie médicale et thoracique, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Rachel Evans
- Department of Respiratory Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Anne E. Holland
- Central Clinical School, Monash University and Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | - Steve Jones
- European Pulmonary Fibrosis Federation, Brussels, Belgium
| | - Marlies Wijsenbeek
- Centre for Expertise for Interstitial Lung Disease and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Anh Tuan Dinh-Xuan
- Service de Physiologie-Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Guido Vagheggini
- Department of Internal Medicine and Medical Specialties, Respiratory Failure Pathway, Azienda USL Toscana Nordovest, Pisa, Italy
- Fondazione Volterra Ricerche ONLUS, Volterra (PI), Italy
| |
Collapse
|
18
|
Hu J, Singh P, Li J, Zhang J, Li F, Zhang H, Xie J. Persistent Hypoxia with Intermittent Aggravation Causes Imbalance in Smad3/Myocardin-Related Transcription Factor Signaling with Consequent Endothelial Senescence and Pulmonary Arterial Remodeling. Biomedicines 2023; 11:2351. [PMID: 37760802 PMCID: PMC10526072 DOI: 10.3390/biomedicines11092351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Loss of Smad3 and the consequent activation of myocardin-related transcription factor (MRTF) are associated with vascular pathologies. This study aimed to examine the impact of persistent hypoxia with intermittent aggravation (PI hypoxia) on cellular senescence and pulmonary arterial remodeling mediated by the Smad3/MRTF imbalance. We examined the effects of PI hypoxia on the Smad3/MRTF pathway and cellular senescence using human pulmonary artery endothelial cells (HPAECs) and in vivo studies in rats. The senescent degree was evaluated using β-galactosidase staining, p16 quantitation and the measurement of senescence-associated secretory phenotype. Structural data in the pathological analysis of pulmonary artery remodeling were collected. Compared to the control, HPAECs and pulmonary tissue from rats exposed to PI hypoxia showed a significantly higher senescent degree, lower expression of Smad3, and higher MRTF levels. The overexpression of Smad3 significantly mitigated HPAECs senescence in vitro. Further, treatment with CCG-203971, which inhibits MRTF, increased Smad3 levels and reduced β-galactosidase positive cells in rat lung tissue. This intervention also alleviated PI hypoxia-induced pathological changes, including remodeling indices of pulmonary arterial thickening, muscularization, and collagen formation. In conclusion, imbalanced Smad3/MRTF signaling is linked to PI hypoxia-induced senescence and pulmonary arterial remodeling, making it a potential therapeutic target for patients with sleep apnea and chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Jiaxin Hu
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (J.H.); (F.L.); (H.Z.)
| | - Prachi Singh
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | - Jingrui Li
- First Hospital of Lanzhou University, Lanzhou 730009, China;
| | - Jing Zhang
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China;
| | - Fei Li
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (J.H.); (F.L.); (H.Z.)
| | - Hehe Zhang
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (J.H.); (F.L.); (H.Z.)
- Beijing Anzhen Hospital Centre for Sleep Medicine and Science, Capital Medical University, Beijing 100029, China
| | - Jiang Xie
- Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (J.H.); (F.L.); (H.Z.)
- Beijing Anzhen Hospital Centre for Sleep Medicine and Science, Capital Medical University, Beijing 100029, China
| |
Collapse
|
19
|
Zhao Y, Zou J, Chen Y, Zhou J, Dai W, Peng M, Li X, Jiang S. Changes of the acute myocardial infarction-related resident deaths in a transitioning region: a real-world study involving 3.17 million people. Front Public Health 2023; 11:1096348. [PMID: 37670829 PMCID: PMC10476525 DOI: 10.3389/fpubh.2023.1096348] [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: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 09/07/2023] Open
Abstract
Background The impact of acute myocardial infarction (AMI) on the life span of residents in a transitioning region has not been studied in depth. Therefore, we aimed to evaluate the changes in AMI-related resident deaths in a transitioning region in China. Methods A longitudinal, population-based study was performed to analyze the deaths with/of AMI in Pudong New Area (PNA), Shanghai from 2005 to 2021. The average annual percentage change (AAPC) of AMI in crude mortality rates (CMR), age-standardized mortality rates worldwide (ASMRW), and rates of years of life lost (YLLr) were calculated by the joinpoint regression. The impact of demographic and non-demographic factors on the mortality of residents who died with/of AMI was quantitatively analyzed by the decomposition method. Results In 7,353 residents who died with AMI, 91.74% (6,746) of them were died of AMI from 2005 to 2021. In this period, the CMR and ASMRW of residents died with/of AMI were 15.23/105 and 5.17/105 person-years, the AAPC of CMR was 0.01% (95% CI: -0.71,0.72, p = 0.989) and 0.06% (95% CI: -0.71,0.84, p = 0.868), and the ASMRW decreased by 2.83% (95% CI: -3.66,-2.00, p < 0.001) and 2.76% (95% CI: -3.56,-1.95, p < 0.001), respectively. The CMR of people died of AMI showed a downward trend (all p < 0.05) in people ≥60 years but an upward trend [AAPC = 2.47% (95% CI: 0.07,4.94, p = 0.045)] in people of 45-59 years. The change in CMR of people died with/of AMI caused by demographic factors was 28.70% (95% CI: 12.99,46.60, p = 0.001) and 28.07% (95% CI: 12.71,45.52, p = 0.001) per year, respectively. Conclusion Preventative strategies for AMI should be applied to enhance the health management of residents aged 45-59 years or with comorbidities in the transitioning region.
Collapse
Affiliation(s)
- Yajun Zhao
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Zou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yichen Chen
- Office of Scientific Research and Information Management, Centres for Disease Control and Prevention, Shanghai, China
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Jing Zhou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Dai
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minghui Peng
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaopan Li
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Shanghai, China
| | - Sunfang Jiang
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
20
|
Bo B, Guo A, Kaila SJ, Hao Z, Zhang H, Wei J, Yao Y. Elucidating the primary mechanisms of high-intensity interval training for improved cardiac fitness in obesity. Front Physiol 2023; 14:1170324. [PMID: 37608837 PMCID: PMC10441243 DOI: 10.3389/fphys.2023.1170324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
Obesity is a global and rising multifactorial pandemic associated with the emergence of several comorbidities that are risk factors for malignant cardiac remodeling and disease. High-intensity interval training (HIIT) has gained considerable attention due to its favorable outcomes of cardiometabolic health in individuals with overweight or obese. The primary aim of this review is to discuss the fundamental processes through which HIIT improves cardiac impairment in individuals with obesity to develop viable treatments for obesity management. In this review, a multiple database search and collection were conducted from the earliest record to January 2013 for studies included the qualitative component of HIIT intervention in humans and animals with overweight/obesity related to cardiac remodeling and fitness. We attempt to integrate the main mechanisms of HIIT in cardiac remolding improvement in obesity into an overall sequential hypothesis. This work focus on the ameliorative effects of HIIT on obesity-induced cardiac remodeling with respect to potential and pleiotropic mechanisms, including adipose distribution, energy metabolism, inflammatory response, insulin resistance, and related risk profiles in obesity. In conclusion, HIIT has been shown to reduce obesity-induced risks of cardiac remodeling, but the long-term effects of HIIT on obesity-induced cardiac injury and disease are presently unknown. Collective understanding highlights numerous specific research that are needed before the safety and effectiveness of HIIT can be confirmed and widely adopted in patient with obesity.
Collapse
Affiliation(s)
- Bing Bo
- Department of Kinesiology, School of Physical Education, Henan University, Kaifeng, China
- Sports Reform and Development Research Center, School of Physical Education, Henan University, Kaifeng, China
| | - Aijing Guo
- Department of Kinesiology, School of Physical Education, Henan University, Kaifeng, China
| | - Severa Jafeth Kaila
- Department of Kinesiology, School of Physical Education, Henan University, Kaifeng, China
| | - Zhe Hao
- Department of Kinesiology, School of Physical Education, Henan University, Kaifeng, China
| | - Huiqing Zhang
- Sports Reform and Development Research Center, School of Physical Education, Henan University, Kaifeng, China
| | - Jianshe Wei
- Institute for Brain Sciences Research, School of Life Sciences, Henan University, Kaifeng, China
| | - Yuan Yao
- Sports Reform and Development Research Center, School of Physical Education, Henan University, Kaifeng, China
| |
Collapse
|
21
|
Omer KA, Mlauzi R, Basera W, McGuire J, Meyer H, Lawrenson J, Peer S, Singh Y, Zampoli M. Low incidence of pulmonary hypertension in children with suspected obstructive sleep apnea: A prospective observational study. Int J Pediatr Otorhinolaryngol 2023; 171:111648. [PMID: 37419069 DOI: 10.1016/j.ijporl.2023.111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Pulmonary hypertension (PH) secondary to obstructive sleep apnea (OSA) is an uncommon but serious perioperative risk factor in children undergoing surgery for adenotonsillar hypertrophy. Routine pre-operative echocardiography is commonly requested if severe OSA is suspected. We investigated the incidence of PH in children with suspected OSA and explored the association between PH and OSA severity. METHODS A prospective study of children aged 1-13 years with suspected OSA admitted for overnight oximetry (OO) and echocardiography at a pediatric referral hospital in Cape Town, South Africa from 2018 to 2019. OSA severity was defined by McGill Oximetry Score (MOS): MOS 1-2 (mild-moderate) and MOS 3-4 (severe). PH was defined as mean pulmonary arterial pressure (mPAP) ≥20 mmHg estimated on echocardiographic criteria. Children with congenital heart disease, underlying cardio-respiratory or genetic disorders, and severe obesity were excluded. RESULTS One hundred and seventy children median age 3.8 years (IQR 2.7-6.4) were enrolled and 103 (60%) were female. Twenty-two (14%) had a BMIz >1.0 and 99 (59%) had tonsillar enlargement grade 3/4. One hundred and twenty-two (71%) and 48 (28%) children had mild-moderate and severe OSA, respectively. Echocardiographic assessment for PH was successful in 160 (94%) children of which eight (5%) had PH with mPAP 20.8 mmHg (SD 0.9): six with mild-moderate OSA and two with severe OSA. No significant difference in mPAP and other echocardiographic indices was observed in children with mild-moderate (16.1 mmHg; SD 2.4) and severe OSA (15.7 mmHg; SD 2.1). Similarly, no clinical and OSA severity differences were observed in children with and without PH. CONCLUSION PH is uncommon in children with uncomplicated OSA and there is no association of PH with severity of OSA measured by OO. Routine echocardiographic screening for PH in children with clinical symptoms of OSA without co-morbidity is unwarranted.
Collapse
Affiliation(s)
- Khadar A Omer
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Raphael Mlauzi
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Jessica McGuire
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Heidi Meyer
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town. Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Shazia Peer
- Division of Otorhinolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - Yanita Singh
- Paediatric Cardiology Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, University of Cape Town, South Africa.
| |
Collapse
|
22
|
Zhao Y, Wu J, Guan S, Xue T, Wei X, Cao D, Kong P, Zhang X. PIF1 Promotes Autophagy to Inhibit Chronic Hypoxia Induced Apoptosis of Pulmonary Artery Endothelial Cells. Int J Chron Obstruct Pulmon Dis 2023; 18:1319-1332. [PMID: 37396201 PMCID: PMC10312211 DOI: 10.2147/copd.s406453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose Pulmonary artery hypertension (PAH) is a common complication of chronic obstructive pulmonary disease and obstructive sleep apnea/hypopnea syndrome worldwide. Pulmonary vascular alterations associated with PAH have multifactorial causes, in which endothelial cells play an important role. Autophagy is closely related to endothelial cell injury and the development of PAH. PIF1 is a multifunctional helicase crucial for cell survival. The present study investigated the effect of PIF1 on autophagy and apoptosis in human pulmonary artery endothelial cells (HPAECs) under chronic hypoxia stress. Methods Chronic hypoxia Gene expression profiling chip-assays identified the PIF1 gene as differentially expressed, which was verified by RT-qPCR analysis. Electron microscopy, immunofluorescence, and Western blotting were used to analyze autophagy and the expression of LC3 and P62. Apoptosis was analyzed using flow cytometry. Results Our study found that chronic hypoxia induces autophagy in HPAECs, and apoptosis was exacerbated by inhibiting autophagy. Levels of the DNA helicase PIF1 were increased in HPAECs after chronic hypoxia. PIF1 knockdown inhibited autophagy and promoted the apoptosis of HPAECs under chronic hypoxia stress. Conclusion Based on these findings, we conclude that PIF1 inhibits the apoptosis of HPAECs by accelerating the autophagy pathway. Therefore, PIF1 plays a crucial role in HPAEC dysfunction in chronic hypoxia-induced PAH and may be a potential target for the treatment of PAH.
Collapse
Affiliation(s)
- Yujing Zhao
- Department of the First Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Juan Wu
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Shuai Guan
- Department of Pediatric Infectious Diseases, The First People’s Hospital of Datong, Datong, Shanxi, People’s Republic of China
| | - Ting Xue
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Xiaolei Wei
- Department of the First Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Dawei Cao
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Pengzhou Kong
- Department of Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Xinri Zhang
- Department of NHC Key Laboratory of Pneumoconiosis, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Shanxi Key Laboratory of Respiratory Diseases, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| |
Collapse
|
23
|
Sun J, Fang D, Wang Z, Liu Y. Sleep Deprivation and Gut Microbiota Dysbiosis: Current Understandings and Implications. Int J Mol Sci 2023; 24:ijms24119603. [PMID: 37298553 DOI: 10.3390/ijms24119603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Gut microbiota comprises the microbial communities inhabiting our gastrointestinal (GI) tracts. Accordingly, these complex communities play a fundamental role in many host processes and are closely implicated in human health and diseases. Sleep deprivation (SD) has become increasingly common in modern society, partly owing to the rising pressure of work and the diversification of entertainment. It is well documented that sleep loss is a significant cause of various adverse outcomes on human health including immune-related and metabolic diseases. Furthermore, accumulating evidence suggests that gut microbiota dysbiosis is associated with these SD-induced human diseases. In this review, we summarize the gut microbiota dysbiosis caused by SD and the succedent diseases ranging from the immune system and metabolic system to various organs and highlight the critical roles of gut microbiota in these diseases. The implications and possible strategies to alleviate SD-related human diseases are also provided.
Collapse
Affiliation(s)
- Jingyi Sun
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China
| | - Dan Fang
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China
| | - Zhiqiang Wang
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, The Ministry of Education of China, Yangzhou University, Yangzhou 225009, China
- Institute of Comparative Medicine, Yangzhou University, Yangzhou 225009, China
| | - Yuan Liu
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, The Ministry of Education of China, Yangzhou University, Yangzhou 225009, China
- Institute of Comparative Medicine, Yangzhou University, Yangzhou 225009, China
| |
Collapse
|
24
|
Fabyan KD, Chandel A, King CS. Pulmonary Hypertension in Interstitial Lung Disease: Management Options to Move Beyond Supportive Care. CURRENT PULMONOLOGY REPORTS 2023; 12:1-8. [PMID: 37362782 PMCID: PMC10200699 DOI: 10.1007/s13665-023-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review This review delineates current diagnostic and management strategies for pulmonary hypertension due to interstitial lung disease (PH-ILD). Recent Findings The INCREASE trial, a phase III multicenter, randomized, placebo-controlled trial demonstrated both improved 6-min walk distance and decreased disease progression with inhaled treprostinil. This pivotal trial led to inhaled treprostinil becoming the first FDA approved medication for treatment of PH-ILD. The availability of this treatment has generated subsequent recommendations for the screening for PH in patients with ILD. As a result, it is becoming increasingly important for clinicians to gain awareness and familiarity with the evolving management options for PH-ILD. Summary The management of PH-ILD has its roots in goal-directed treatment of the underlying lung disease. However, recent medication advances and ongoing clinical studies are opening opportunities for more disease-specific treatment.
Collapse
Affiliation(s)
- Kimberly D. Fabyan
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, 8901, Rockville Pike, Bethesda, MD 20889 USA
| | - Abhimanyu Chandel
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, 8901, Rockville Pike, Bethesda, MD 20889 USA
| | - Christopher S. King
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, 3330 Gallows Road, Falls Church, VA 22003 USA
| |
Collapse
|
25
|
Hou X, Hu J, Wang E, Wang J, Song Z, Hu J, Shi J, Zhang C. Self-Reported Sleep Disturbance is an Independent Predictor of All-Cause Mortality and Respiratory Disease Mortality in US Adults: A Population-Based Prospective Cohort Study. Int J Public Health 2023; 68:1605538. [PMID: 36865999 PMCID: PMC9971003 DOI: 10.3389/ijph.2023.1605538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objective: Self-reported sleep disturbance is common but its association with mortality has rarely been investigated. Methods: This prospective cohort analysis included 41,257 participants enrolled in the National Health and Nutrition Examination Survey from 2005 to 2018. Self-reported sleep disturbance in the present study refers to the patients who have ever consulted doctors or other professionals for trouble sleeping. Univariate and multivariate survey-weighted Cox proportional hazards models were used to evaluate the association of self-reported sleep disturbance with all-cause and disease-specific mortality. Results: Approximately 27.0% of US adults were estimated to have self-reported sleep disturbance. After adjusting for all sociodemographic variables, health behavioral factors, and common comorbidities, participants with self-reported sleep disturbance tend to have higher all-cause mortality risk with a hazard ratio (HR) of 1.17 (95% CI, 1.04-1.32) and chronic lower respiratory disease mortality risk (HR, 1.88; 95% CI, 1.26-2.80), but not cardiovascular disease mortality risk (HR, 1.19; 95% CI, 0.96-1.46) and cancer mortality risk (HR, 1.10; 95% CI, 0.90-1.35). Conclusion: Self-reported sleep disturbance could be associated with higher mortality in adults, and may need to be paid more attention in public health management.
Collapse
Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiajia Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Shi
- Department of Anesthesiology, Changsha Yamei Plastic Surgery Hospital, Changsha, China
| | - Chengliang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Chengliang Zhang,
| |
Collapse
|
26
|
Benjamin N, Resag C, Weinstock K, Grünig E. Allgemeine Therapie der pulmonalarteriellen Hypertonie nach den neuen Leitlinien. AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-1968-9488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
ZusammenfassungIn den neuen Leitlinien (LL) für pulmonalarterielle Hypertonie (PAH) sind die allgemeinen Maßnahmen ein integraler Bestandteil der Behandlung der Patienten. Auch die systemischen
Auswirkungen der pulmonalen Hypertonie und Rechtsherzinsuffizienz sollten angemessen berücksichtigt und behandelt werden. Im folgenden Artikel werden die in den LL genannten Maßnahmen unter
Berücksichtigung des bestehenden Empfehlungsgrads und der Evidenzen beschrieben. Leider sind die meisten Allgemeinmaßnahmen, wie die Gabe von Diuretika, Sauerstoff, psychosozialer Support
und Impfungen, nicht oder unzureichend in randomisierten, kontrollierten Studien untersucht worden. So haben sie zwar einen hohen I-Empfehlungsgrad, aber einen niedrigen Evidenzgrad C. Nur
bei dem spezialisierten körperlichen Training liegen bislang insgesamt 7 randomisierte, kontrollierte Studien und 5 Metaanalysen vor, die eine Verbesserung der Sauerstoffaufnahme,
körperlichen Belastbarkeit, der Beschwerden (WHO-Funktionsklasse), Lebensqualität und Hämodynamik nachgewiesen haben (daher neu IA-Empfehlung). Auch weitere Maßnahmen wie die
Antikoagulation, Eisensubstitution und andere werden im Folgenden besprochen.
Collapse
Affiliation(s)
- Nicola Benjamin
- Zentrum für pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Carolin Resag
- Zentrum für pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Kilian Weinstock
- Zentrum für pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| |
Collapse
|
27
|
Liu CF, Chien LW. Triglyceride glucose index and poor sleep patterns in non-diabetic adults: Evidence from NHANES 2005-2016. Front Nutr 2023; 10:1051667. [PMID: 36793924 PMCID: PMC9922746 DOI: 10.3389/fnut.2023.1051667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/06/2023] [Indexed: 02/02/2023] Open
Abstract
Introduction Sleep disorders are commonly encountered in modern populations. This cross-sectional study aimed to investigate the associations between triglyceride glucose (TyG) index and poor sleep patterns in non-diabetic adults. Methods Data of non-diabetic adults aged 20-70 years were extracted from the US National Health and Nutrition Examination Survey database 2005-2016. Pregnant women, individuals with diabetes and cancer history, and individuals lacking complete data on sleep patterns or parameters for calculating TyG index were excluded. Poor sleep pattern was defined as having two or more following conditions: (1) abnormal sleep duration, defined as less than 7 h or longer than 9 h; (2) self-reported trouble sleeping; and (3) physician-confirmed sleep disorders. Associations between poor sleep patterns, TyG index, and an additional index incorporating body mass index (BMI), TyGBMI, and other study variables were determined by univariable and multivariable logistic regression analysis. Results Among 9,390 included participants, 1,422 had poor sleep patterns and 7,968 did not. The individuals with poor sleep patterns had a higher mean TyG index, were older, had higher BMI, and had higher proportions of hypertension and history of CVD than those without poor sleep pattern (all p < 0.001). Multivariable analysis showed no significant association between poor sleep pattern and TyG index. However, among the components of poor sleep pattern, TyG index in the highest quartile (Q4) was significantly associated with trouble sleeping [adjusted OR (aOR): 1.46, 95%CI: 1.04-2.03) as compared with the lowest TyG quartile (Q1). In addition, TyG-BMI in Q4 was indepently associated with increased likelihood for poor sleep patterns (aOR: 2.18, 95%CI: 1.61-2.95), trouble sleeping (aOR: 1.76, 95%CI: 1.30-2.39), abnormal sleep duration (aOR: 1.41, 95%CI: 1.12-1.78), and sleep disorders (aOR: 3.11, 95%CI: 2.08-4.64) as compared to Q1. Discussion Among US adults without diabetes, elevated TyG index is correlated with self-reported trouble sleeping, independent of BMI. Future studies should build upon this preliminary work and examine these associations longitudinally and through treatment trials.
Collapse
Affiliation(s)
- Chi-Feng Liu
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan,*Correspondence: Chi-Feng Liu,
| | - Li-Wei Chien
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
28
|
Duan A, Huang Z, Hu M, Zhao Z, Zhao Q, Jin Q, Yan L, Zhang Y, Li X, An C, Luo Q, Liu Z. The comorbidity burden and disease phenotype in pre-capillary pulmonary hypertension: The contributing role of obstructive sleep apnea. Sleep Med 2023; 101:146-153. [PMID: 36395719 DOI: 10.1016/j.sleep.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pre-capillary pulmonary hypertension (PH) with risk factors for left ventricular diastolic dysfunction, described as an atypical phenotype of "mixed" pre- and post-capillary PH, has become a research focus. However, the relationship between obstructive sleep apnea (OSA), a known risk factor for cardiometabolic conditions, and comorbidity burden and disease phenotype in PH remains unclear. OBJECTIVE This study aimed to investigate the effect of the presence and severity of OSA on the left ventricular function, comorbidity burden and disease phenotype in pre-capillary PH patients. METHODS AND RESULTS We retrospectively examined 450 consecutive pre-capillary PH patients undergoing cardiorespiratory polygraphy and right heart catheterization between May 2020 to November 2021 at Fuwai Hospital. The prevalence of OSA was 34.2%, and the presence and severity of OSA in pre-capillary PH patients was associated with increased left heart mass index (P < 0.001), pulmonary arterial wedge pressure (P = 0.06) and H2FPEF score (P < 0.001). After adjustment for confounding factors, the severity of OSA measured as apnea-hypopnea index (AHI) was an independent risk factor associated with obesity, systemic hypertension, diabetes mellitus and an atypical phenotype (OR: 1.054, P = 0.004) in pre-capillary PH. A dose-response relationship was also identified between sleep parameters (AHI, oxygen desaturation index, the percentage of sleep time with oxygen saturation<80%) and the number of key comorbidities. Patients with ≥3 comorbidities (atypical phenotype) were older, experienced negative alterations in left ventricular structure and function, and were at a higher risk of OSA. CONCLUSION OSA is relatively prevalent in pre-capillary PH patients, independently associated with the presence of a variety of comorbidities and the atypical phenotype of PH. These findings highlight the importance of OSA as a modifiable target for optimal treatment in PH with comorbidities.
Collapse
Affiliation(s)
- Anqi Duan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Zhihua Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Meixi Hu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Qing Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China; Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lu Yan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Yi Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Xin Li
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Chenhong An
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China.
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China.
| |
Collapse
|
29
|
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2023; 61:13993003.00879-2022. [PMID: 36028254 DOI: 10.1183/13993003.00879-2022] [Citation(s) in RCA: 397] [Impact Index Per Article: 397.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Gabor Kovacs
- University Clinic of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Marius M Hoeper
- Respiratory Medicine, Hannover Medical School, Hanover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease (BREATH), member of the German Centre of Lung Research (DZL), Hanover, Germany
| | - Roberto Badagliacca
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma, Italy
- Dipartimento Cardio-Toraco-Vascolare e Chirurgia dei Trapianti d'Organo, Policlinico Umberto I, Roma, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, Dept of Paediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Margarita Brida
- Department of Sports and Rehabilitation Medicine, Medical Faculty University of Rijeka, Rijeka, Croatia
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys and St Thomas's NHS Trust, London, UK
| | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J S Coats
- Faculty of Medicine, University of Warwick, Coventry, UK
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Pilar Escribano-Subias
- Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV (Centro de Investigaciones Biomédicas En Red de enfermedades CardioVasculares), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Pisana Ferrari
- ESC Patient Forum, Sophia Antipolis, France
- AIPI, Associazione Italiana Ipertensione Polmonare, Bologna, Italy
| | - Diogenes S Ferreira
- Alergia e Imunologia, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, University Hospital Giessen, Justus-Liebig University, Giessen, Germany
- Department of Pneumology, Kerckhoff Klinik, Bad Nauheim, Germany
- Department of Medicine, Imperial College London, London, UK
| | - George Giannakoulas
- Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Insigneo Institute, University of Sheffield, Sheffield, UK
| | - Eckhard Mayer
- Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Gergely Meszaros
- ESC Patient Forum, Sophia Antipolis, France
- European Lung Foundation (ELF), Sheffield, UK
| | - Blin Nagavci
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Karen M Olsson
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Göran Rådegran
- Department of Cardiology, Clinical Sciences Lund, Faculty of Medicine, Lund, Sweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - Gerald Simonneau
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Centre de Référence de l'Hypertension Pulmonaire, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
- Faculté Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mark Toshner
- Dept of Medicine, Heart Lung Research Institute, University of Cambridge, Royal Papworth NHS Trust, Cambridge, UK
| | - Jean-Luc Vachiery
- Department of Cardiology, Pulmonary Vascular Diseases and Heart Failure Clinic, HUB Hôpital Erasme, Brussels, Belgium
| | | | - Marion Delcroix
- Clinical Department of Respiratory Diseases, Centre of Pulmonary Vascular Diseases, University Hospitals of Leuven, Leuven, Belgium
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Department of Cardiology, Pulmonology and Intensive Care Medicine), and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Köln, Germany
- The two chairpersons (M. Delcroix and S. Rosenkranz) contributed equally to the document and are joint corresponding authors
| | | |
Collapse
|
30
|
Johnson ZJ, Lestrud SO, Hauck A. Current understanding of the role of sleep-disordered breathing in pediatric pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
31
|
Zhang X, Huangfu Z. Management of pregnant patients with pulmonary arterial hypertension. Front Cardiovasc Med 2022; 9:1029057. [PMID: 36440029 PMCID: PMC9684470 DOI: 10.3389/fcvm.2022.1029057] [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: 08/26/2022] [Accepted: 10/27/2022] [Indexed: 09/19/2023] Open
Abstract
Pregnant individuals with pulmonary arterial hypertension (PAH) have significantly high risks of maternal and perinatal mortality. Profound changes in plasma volume, cardiac output and systemic vascular resistance can all increase the strain being placed on the right ventricle, leading to heart failure and cardiovascular collapse. Given the complex network of opposing physiological changes, strict contraception and reduction of hemodynamic fluctuations during pregnancy are important methods of minimizing the risk of maternal mortality and improving the outcomes following pregnancy. In this review, we discuss the recent research progress into pre-conception management and the various therapeutic strategies for pregnant individuals with PAH.
Collapse
Affiliation(s)
- Xiao Zhang
- Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
32
|
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43:3618-3731. [PMID: 36017548 DOI: 10.1093/eurheartj/ehac237] [Citation(s) in RCA: 945] [Impact Index Per Article: 472.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
33
|
The role of PPARγ in intermittent hypoxia-related human umbilical vein endothelial cell injury. Sleep Breath 2022; 27:1155-1164. [DOI: 10.1007/s11325-022-02696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
|
34
|
Simonson JL, Pandya D, Khan S, Greenberg HE, Talwar A. Comparison of obstructive sleep apnoea prevalence and severity across WHO pulmonary hypertension groups. BMJ Open Respir Res 2022; 9:9/1/e001304. [PMID: 36038192 PMCID: PMC9438054 DOI: 10.1136/bmjresp-2022-001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pulmonary hypertension is classified into five groups in the WHO classification system. Patients with pulmonary hypertension often have comorbid obstructive sleep apnoea (OSA), yet the prevalence and severity of OSA in each of the WHO pulmonary hypertension groups have not been well established. Methods To compare the prevalence and severity of OSA between WHO pulmonary hypertension groups, we performed a retrospective cohort study, including patients who had polysomnography or a home sleep study and confirmed pulmonary hypertension on right heart catheterisation. The primary outcomes of OSA prevalence and severity were measured by median apnoea hypopnea index (AHI) or respiratory event index (REI) and were compared by WHO pulmonary hypertension group. Multivariable negative binomial regression was used to evaluate the association between the outcome of OSA severity by AHI or REI and WHO group. Results Among the cohort of 132 patients, OSA was common in all WHO pulmonary hypertension groups but was most common and most severe in WHO group II pulmonary hypertension. Median AHI or REI in WHO group II was 12.0 events/hour compared with 2.8 in group I, 3.7 in group III, 10.0 in group IV and 6.4 in group V. Multivariable negative binomial regression showed about a twofold increase in AHI or REI in WHO group II compared with WHO group I pulmonary hypertension. Discussion Our findings demonstrate that OSA deserves greater consideration as a treatable comorbidity that may affect pulmonary haemodynamics and quality of life in patients with pulmonary hypertension across all WHO groups.
Collapse
Affiliation(s)
- Joseph L Simonson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Dhwani Pandya
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Sara Khan
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Harly E Greenberg
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Arunabh Talwar
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| |
Collapse
|
35
|
Wei Y, Giunta S, Xia S. Hypoxia in Aging and Aging-Related Diseases: Mechanism and Therapeutic Strategies. Int J Mol Sci 2022; 23:8165. [PMID: 35897741 PMCID: PMC9330578 DOI: 10.3390/ijms23158165] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
As the global aging process continues to lengthen, aging-related diseases (e.g., chronic obstructive pulmonary disease (COPD), heart failure) continue to plague the elderly population. Aging is a complex biological process involving multiple tissues and organs and is involved in the development and progression of multiple aging-related diseases. At the same time, some of these aging-related diseases are often accompanied by hypoxia, chronic inflammation, oxidative stress, and the increased secretion of the senescence-associated secretory phenotype (SASP). Hypoxia seems to play an important role in the process of inflammation and aging, but is often neglected in advanced clinical research studies. Therefore, we have attempted to elucidate the role played by different degrees and types of hypoxia in aging and aging-related diseases and their possible pathways, and propose rational treatment options based on such mechanisms for reference.
Collapse
Affiliation(s)
- Yaqin Wei
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
| | - Sergio Giunta
- Casa di Cura Prof. Nobili–GHC Garofalo Health Care, 40035 Bologna, Italy;
| | - Shijin Xia
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
| |
Collapse
|
36
|
Duarte RLDM, Togeiro SMGP, Palombini LDO, Rizzatti FPG, Fagondes SC, Magalhães-da-Silveira FJ, Cabral MM, Genta PR, Lorenzi-Filho G, Clímaco DCS, Drager LF, Codeço VM, Viegas CADA, Rabahi MF. Brazilian Thoracic Association Consensus on Sleep-disordered Breathing. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220106. [PMID: 35830079 PMCID: PMC9262434 DOI: 10.36416/1806-3756/e20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022]
Abstract
Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.
Collapse
Affiliation(s)
| | - Sonia Maria Guimarães Pereira Togeiro
- . Disciplina de Clínica Médica, Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Instituto do Sono, São Paulo (SP) Brasil
| | | | | | - Simone Chaves Fagondes
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | | | - Pedro Rodrigues Genta
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Geraldo Lorenzi-Filho
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | | | - Luciano Ferreira Drager
- . Unidade de Hipertensão, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Vitor Martins Codeço
- . Hospital Regional da Asa Norte, Secretaria de Estado de Saúde do Distrito Federal, Brasília (DF) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás - UFG - Goiânia (GO) Brasil
| |
Collapse
|
37
|
Murta MS, Duarte RLM, Waetge D, Gozal D, Cardoso AP, Mello FCQ. Sleep-Disordered Breathing in Adults with Precapillary Pulmonary Hypertension: Prevalence and Predictors of Nocturnal Hypoxemia. Lung 2022; 200:523-530. [PMID: 35717489 DOI: 10.1007/s00408-022-00547-w] [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: 04/16/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the frequency of sleep-disordered breathing (SDB) and predictors of the presence of nocturnal desaturation in adults with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. METHODS Outpatients with a hemodynamic diagnosis of precapillary pulmonary hypertension who underwent portable polysomnography were evaluated. Diagnosis and severity of SDB were assessed using three well-established respiratory disturbance index (RDI) thresholds: 5.0/h, 15.0/h, and 30.0/h, while nocturnal hypoxemia was defined by the average oxygen saturation (SpO2) < 90%. Multiple linear regression analysis evaluated the potential relationships among explanatory variables with the dependent variable (average SpO2 values), with comparisons based on the standardized regression coefficient (β). The R-squared (R2; coefficient of determination) was used to evaluate the goodness-of-fit measure for the linear regression model. RESULTS Thirty-six adults were evaluated (69.4% females). The majority of the participants (75.0%) had SDB (26 with obstructive sleep apnea [OSA] and one with central sleep apnea [CSA]); while 50% of them had nocturnal hypoxemia. In the linear regression model (R2 = 0.391), the mean pulmonary artery pressure [mPAP] (β - 0.668; p = 0.030) emerged as the only independent parameter of the average SpO2. CONCLUSION Our study found that the majority of the participants had some type of SDB with a marked predominance of OSA over CSA, while half of them had nocturnal desaturation. Neither clinical and hemodynamic parameters nor the RDI was a predictor of nocturnal desaturation, except for mPAP measured during a right heart catheterization, which emerged as the only independent and significant predictor of average SpO2.
Collapse
Affiliation(s)
- Marcia S Murta
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - Ricardo L M Duarte
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil.
| | - Daniel Waetge
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Alexandre P Cardoso
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| | - Fernanda C Q Mello
- Instituto de Doenças Do Tórax (IDT), Universidade Federal Do Rio de Janeiro (UFRJ), Rua Professor Rodolpho Paulo Rocco, 255 - 1° andar - sala 01D 58/60, Rio de Janeiro, RJ, CEP, 21941-913, Brazil
| |
Collapse
|
38
|
Locke BW, Lee JJ, Sundar KM. OSA and Chronic Respiratory Disease: Mechanisms and Epidemiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095473. [PMID: 35564882 PMCID: PMC9105014 DOI: 10.3390/ijerph19095473] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disorder that has profound implications on the outcomes of patients with chronic lung disease. The hallmark of OSA is a collapse of the oropharynx resulting in a transient reduction in airflow, large intrathoracic pressure swings, and intermittent hypoxia and hypercapnia. The subsequent cytokine-mediated inflammatory cascade, coupled with tractional lung injury, damages the lungs and may worsen several conditions, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and pulmonary hypertension. Further complicating this is the sleep fragmentation and deterioration of sleep quality that occurs because of OSA, which can compound the fatigue and physical exhaustion often experienced by patients due to their chronic lung disease. For patients with many pulmonary disorders, the available evidence suggests that the prompt recognition and treatment of sleep-disordered breathing improves their quality of life and may also alter the course of their illness. However, more robust studies are needed to truly understand this relationship and the impacts of confounding comorbidities such as obesity and gastroesophageal reflux disease. Clinicians taking care of patients with chronic pulmonary disease should screen and treat patients for OSA, given the complex bidirectional relationship OSA has with chronic lung disease.
Collapse
|
39
|
Detection of Sleep Apnea from Electrocardiogram and Pulse Oximetry Signals Using Random Forest. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sleep apnea (SA) is a common sleep disorder which could impair the human physiological system. Therefore, early diagnosis of SA is of great interest. The traditional method of diagnosing SA is an overnight polysomnography (PSG) evaluation. When PSG has limited availability, automatic SA screening with a fewer number of signals should be considered. The primary purpose of this study is to develop and evaluate a SA detection model based on electrocardiogram (ECG) and blood oxygen saturation (SpO2). We adopted a multimodal approach to fuse ECG and SpO2 signals at the feature level. Then, feature selection was conducted using the recursive feature elimination with cross-validation (RFECV) algorithm and random forest (RF) classifier used to discriminate between apnea and normal events. Experiments were conducted on the Apnea-ECG database. The introduced algorithm obtained an accuracy of 97.5%, a sensitivity of 95.9%, a specificity of 98.4% and an AUC of 0.992 in per-segment classification, and outperformed previous works. The results showed that ECG and SpO2 are complementary in detecting SA, and that the combination of ECG and SpO2 enhances the ability to diagnose SA. Therefore, the proposed method has the potential to be an alternative to conventional detection methods.
Collapse
|
40
|
Hajra A, Safiriyu I, Balasubramanian P, Gupta R, Chowdhury S, Prasad AJ, Kumar A, Kumar D, Khan B, Bilberry RSF, Sarkar A, Malik P, Aronow WS. Recent Advances and Future Prospects of Treatment of Pulmonary Hypertension. Curr Probl Cardiol 2022:101236. [PMID: 35500734 PMCID: PMC9171713 DOI: 10.1016/j.cpcardiol.2022.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/30/2022]
Abstract
Pulmonary hypertension is one of the difficult situations to treat. Complex pathophysiology, association of the multiple comorbidities make clinical scenario challenging. Recently it is being shown that patients who had recovered from coronavirus disease infection, are at risk of developing pulmonary hypertension. Studies on animals have been going on to find out newer treatment options. There are recent advancements in the treatment of pulmonary hypertension. Role of anticoagulation, recombinant fusion proteins, stem cell therapy are emerging as therapeutic options for affected patients. SGLT2 inhibitors have potential to have beneficial effects on pulmonary hypertension. Apart from the medical managements, advanced interventions are also getting popular. In this review article, the authors have discussed pathophysiology, recent advancement of treatments including coronavirus disease patients, and future aspect of managing pulmonary hypertension. We have highlighted treatment options for patients with sleep apnea, interstitial lung disease to discuss the challenges and possible options to manage those patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Akshay Kumar
- Jinnah Sindh Medical Univeristy Karachi, Karachi, Pakistan
| | - Deepak Kumar
- Jinnah Sindh Medical Univeristy Karachi, Karachi, Pakistan
| | - Baseer Khan
- Jinnah Sindh Medical Univeristy Karachi, Karachi, Pakistan
| | | | | | | | - Wilbert S Aronow
- Westchester Medical Center, New York Medical College, Valhalla, NY
| |
Collapse
|
41
|
Hannemann J, Böger R. Dysregulation of the Nitric Oxide/Dimethylarginine Pathway in Hypoxic Pulmonary Vasoconstriction—Molecular Mechanisms and Clinical Significance. Front Med (Lausanne) 2022; 9:835481. [PMID: 35252268 PMCID: PMC8891573 DOI: 10.3389/fmed.2022.835481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
The pulmonary circulation responds to hypoxia with vasoconstriction, a mechanism that helps to adapt to short-lived hypoxic episodes. When sustained, hypoxic pulmonary vasoconstriction (HPV) may become deleterious, causing right ventricular hypertrophy and failure, and contributing to morbidity and mortality in the late stages of several chronic pulmonary diseases. Nitric oxide (NO) is an important endothelial vasodilator. Its release is regulated, amongst other mechanisms, by the presence of endogenous inhibitors like asymmetric dimethylarginine (ADMA). Evidence has accumulated in recent years that elevated ADMA may be implicated in the pathogenesis of HPV and in its clinical sequelae, like pulmonary arterial hypertension (PAH). PAH is one phenotypic trait in experimental models with disrupted ADMA metabolism. In high altitude, elevation of ADMA occurs during long-term exposure to chronic or chronic intermittent hypobaric hypoxia; ADMA is significantly associated with high altitude pulmonary hypertension. High ADMA concentration was also reported in patients with chronic obstructive lung disease, obstructive sleep apnoea syndrome, and overlap syndrome, suggesting a pathophysiological role for ADMA-mediated impairment of endothelium-dependent, NO-mediated pulmonary vasodilation in these clinically relevant conditions. Improved understanding of the molecular (dys-)regulation of pathways controlling ADMA concentration may help to dissect the pathophysiology and find novel therapeutic options for these diseases.
Collapse
Affiliation(s)
- Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Hamburg, Germany
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Hamburg, Germany
- *Correspondence: Rainer Böger
| |
Collapse
|
42
|
Blanquez-Nadal M, Piliero N, Guillien A, Salvat M, Thony F, Augier C, Bouvaist H, Degano B. Neural respiratory drive in chronic thromboembolic pulmonary hypertension: Effect of balloon pulmonary angioplasty. Respir Physiol Neurobiol 2022; 299:103857. [PMID: 35121103 DOI: 10.1016/j.resp.2022.103857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
Excessive ventilation (V̇E) during exercise, ascribed to heightened neural ventilatory drive and/or to increased "wasted" ventilation, is a feature of chronic thromboembolic pulmonary hypertension (CTEPH). In selected CTEPH patients, balloon pulmonary angioplasty (BPA) allows near-normalization of resting haemodynamic parameters but does not allow excess exercise hyperventilation to normalize. Neural ventilatory drive can be estimated by studying how arterial PCO2 (PaCO2), end-tidal PCO2 (PETCO2), V̇E and CO2 output (V̇CO2) change across the exercise-to-recovery transition during a cardiopulmonary exercise test. Increased "wasted" ventilation can be quantified by the physiological dead space fraction of tidal volume (VD/VT) calculated with the Enghoff simplification of the Bohr equation. These measurements were made before and after BPA in 22 CTEPH patients without significant cardiac and/or pulmonary comorbidities. Our observations suggest that before BPA, excessive hyperventilation was secondary to both heightened neural ventilatory drive and increased "wasted" ventilation; after BPA, measurements made across the exercise-to-recovery transition suggest that heightened neural ventilatory drive was no longer present.
Collapse
Affiliation(s)
- Mathilde Blanquez-Nadal
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Nicolas Piliero
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Alicia Guillien
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Épidemiologie environnementale appliquée à la reproduction et à la santé respiratoire, INSERM, CNRS, Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), U1209, Grenoble, France
| | - Muriel Salvat
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Frédéric Thony
- Pole Imagerie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Caroline Augier
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Hélène Bouvaist
- Service de Cardiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France; Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France.
| |
Collapse
|
43
|
Liu J, Chang L, Cao L, Huang G. Distribution Characteristics and Influencing Factors of Central Apnea in Chinese Pediatric Patients With Obstructive Sleep Apnea: A Single-Center Study. Front Pediatr 2022; 10:882352. [PMID: 35903166 PMCID: PMC9315042 DOI: 10.3389/fped.2022.882352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Central apnea (CA) events always can be seen in the polysomnographic (PSG) reports of children with obstructive sleep apnea (OSA), and sometimes the central apnea index (CAI) is higher than the obstructive apnea and hypopnea index (OAHI). Commonly, the clinicians only attribute it to the age. This study aims to elucidate the distribution characteristics and major factors associated with CA in pediatric OSA. METHODS A retrospective chart review of PSG data of children with OSA from January 2017 to March 2018 was performed. RESULTS 856 children (317 girls and 539 boys, 4.9 ± 2.4 years) were involved. 50.1% (429/856) had a CAI > 1, and 2.9% (25/856) had a CAI >5. Children with a CAI >1 had a higher OAHI, arousal index (AI), oxygen desaturation index (ODI), and a longer REM period, but a younger age and a shorter slow-wave sleep (SWS) phase. Multivariate binary logistic regression showed that with a 1% increased REM period, the risk of the CAI being >1 increased by 5.3% (p < 0.001). The CAI increased with an increasing OAHI (p = 0.003). The possibility of a CAI ≤ 1 increased with age (p < 0.001), and boys were more likely to have a CAI ≤ 1 (p = 0.001). CONCLUSIONS In addition to obstructive apnea (OA), almost all children with OSA also had CA, and a CAI > 1 was most likely to occur. The OAHI and REM period were risk factors for an increased CAI, and age and male sex were protective factors.
Collapse
Affiliation(s)
- Jing Liu
- Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Chang
- Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ling Cao
- Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Guimin Huang
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China
| |
Collapse
|
44
|
Li X, Liu C, Qi W, Meng Q, Zhao H, Teng Z, Xu R, Wu X, Zhu F, Qin Y, Zhao M, Xu F, Xia M. Endothelial Dec1-PPARγ Axis Impairs Proliferation and Apoptosis Homeostasis Under Hypoxia in Pulmonary Arterial Hypertension. Front Cell Dev Biol 2021; 9:757168. [PMID: 34765605 PMCID: PMC8576361 DOI: 10.3389/fcell.2021.757168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The hypoxia-induced pro-proliferative and anti-apoptotic characteristics of pulmonary arterial endothelial cells (PAECs) play critical roles in pulmonary vascular remodeling and contribute to hypoxic pulmonary arterial hypertension (PAH) pathogenesis. However, the mechanism underlying this hypoxic disease has not been fully elucidated. Methods: Bioinformatics was adopted to screen out the key hypoxia-related genes in PAH. Gain- and loss-function assays were then performed to test the identified hypoxic pathways in vitro. Human PAECs were cultured under hypoxic (3% O2) or normoxic (21% O2) conditions. Hypoxia-induced changes in apoptosis and proliferation were determined by flow cytometry and Ki-67 immunofluorescence staining, respectively. Survival of the hypoxic cells was estimated by cell counting kit-8 assay. Expression alterations of the target hypoxia-related genes, cell cycle regulators, and apoptosis factors were investigated by Western blot. Results: According to the Gene Expression Omnibus dataset (GSE84538), differentiated embryo chondrocyte expressed gene 1-peroxisome proliferative-activated receptor-γ (Dec1-PPARγ) axis was defined as a key hypoxia-related signaling in PAH. A negative correlation was observed between Dec1 and PPARγ expression in patients with hypoxic PAH. In vitro observations revealed an increased proliferation and a decreased apoptosis in PAECs under hypoxia. Furthermore, hypoxic PAECs exhibited remarkable upregulation of Dec1 and downregulation of PPARγ. Dec1 was confirmed to be crucial for the imbalance of proliferation and apoptosis in hypoxic PAECs. Furthermore, the pro-surviving effect of hypoxic Dec1 was mediated through PPARγ inhibition. Conclusion: For the first time, Dec1-PPARγ axis was identified as a key determinant hypoxia-modifying signaling that is necessary for the imbalance between proliferation and apoptosis of PAECs. These novel endothelial signal transduction events may offer new diagnostic and therapeutic options for patients with hypoxic PAH.
Collapse
Affiliation(s)
- Xiaoming Li
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chengcheng Liu
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wenwen Qi
- Department of Otolaryngology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiu Meng
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hui Zhao
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhenxiao Teng
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Runtong Xu
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinhao Wu
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fangyuan Zhu
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yiming Qin
- College of Chemical Engineering and Materials Science, Shandong Normal University, Jinan, China
| | - Miaoqing Zhao
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fenglei Xu
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ming Xia
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|