Serum Magnesium Levels in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis

Impact of weight loss and lifestyle intervention on vitamin D in men with obstructive sleep apnea: The INTERAPNEA trial

INTRODUCTION

Vitamin D deficiency is commonly found among patients with obstructive sleep apnea (OSA). We aimed to determine the effect of an eight-week interdisciplinary weight loss and lifestyle intervention on circulating vitamin D levels in patients with moderate-to-severe OSA.

METHODS

89 men were assigned to a usual-care group (n = 49) or an 8-week interdisciplinary weight loss and lifestyle intervention combined with usual-care (n = 40). Evaluations were conducted at baseline, intervention endpoint (i.e., 8 weeks), and 6 months post-intervention. Serum 25-hydroxyvitamin D (25(OH)D) was determined using a chemiluminescence immunoassay. Sleep (i.e., sleep efficiency, apnea-hypopnea index [AHI], and oxygen desaturation index) and body weight and composition (i.e., fat mass, and visceral adipose tissue) variables were also determined.

RESULTS

Serum 25(OH)D concentrations showed an insufficient vitamin D status at baseline, which significantly increased (all p ≤ 0.034) at intervention endpoint (19 %) and at 6 months after intervention (45 %) in the intervention group to the point of potentially resolving vitamin D deficiency. Higher serum 25(OH)D concentrations were related to increased sleep efficiency and reduced AHI, oxygen desaturation index, and body weight and composition variables (all p < 0.001) from baseline to 6 months and from 8 weeks to 6 months after intervention. These results were also noted from baseline to 8 weeks, except for body composition (all p ≤ 0.007).

CONCLUSION

The intervention improved and potentially resolved vitamin D deficiency. Together with the improvement of adverse sleep patterns and body composition parameters, it may be considered as a promising approach in the treatment of OSA.

CLINICAL TRIAL REGISTRATION

(ClinicalTrials.gov NCT03851653).

Association between magnesium depletion score and the prevalence of kidney stones in the low primary income ratio: a cross-sectional study of NHANES 2007-2018

INTRODUCTION

To explore the association between magnesium depletion score (MgDS) and the prevalence of kidney stones in the low primary income ratio (PIR).

METHOD

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 2007-2018. Within the low PIR, people aged ≥20 years with complete information on MgDS and kidney stones questionnaires were enrolled. Multivariable logistic regression and stratified logistic regression analyses were performed to examine the association between MgDS and the prevalence of kidney stones and the recurrence of kidney stones by confounding factors adjusted. Stratified and interaction analysis was conducted to find whether some factors modified the association. In addition, sensitive analyses were also conducted to observe the stability. The work has been reported in line with the strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery (STROCSS) criteria (Supplemental Digital Content 1, http://links.lww.com/JS9/C781 ).

RESULT

A total of 7600 adults were involved in the study, and the individuals were classified into four groups: 0 points for MgDS ( n =3814), 1 point for MgDS ( n =2229), 2 points for MgDS ( n =1020), and ≥3 points for MgDS ( n =537). The multivariable logistic regression suggested that a positive association between MgDS and the prevalence of kidney stones (OR=1.123, 95% CI: 1.019-1.238) in the fully adjusted model. Compared with the lowest group, people with ≥3 points of MgDS had a significant relationship with kidney stones (OR=1.417, 95% CI: 1.013-1.983). No significant association was observed between the recurrence of kidney stones and MgDS. The result of the sensitive analysis showed the robustness of the main analysis.

CONCLUSION

The prevalence of kidney stones is positively correlated with MgDS, which suggests that maintaining a higher MgDS is accompanied by higher prevalence rates of kidney stones in the low PIR.

Association between magnesium deficiency score and sleep quality in adults: A population-based cross-sectional study

BACKGROUND

The association between magnesium status and sleep quality is unclear. The aim of this study was to determine the relationship between renal reabsorption-related magnesium depletion score (MDS) and sleep quality.

METHODS

This study was conducted through a cross-sectional survey of adults aged ≥20 years who participated in NHANES 2005-2014. We used weighted logistic regression to examine the association between MDS and sleep quality and performed trend tests to analyze for the presence of a dose-response relationship. Subgroup analyses were performed based on various sleep outcomes and covariates.

RESULTS

A total of 20,585 participants were included in the study, with a mean age of 48.8 years and 50.7 % female. After adjusting for all covariates, we found a graded dose-response relationship between MDS and sleep trouble as well as sleep disorder. Further analyses revealed a significant positive association between MDS and sleep apnea (OR = 3.01; 95 % CI 1.37-6.62), but no association with restless legs, insomnia or insufficient sleep. In addition, subgroup analyses revealed that middle-aged, male, obese, low magnesium intake, and depressed patients were more prone to sleep trouble and sleep disorder; interestingly, MDS was positively associated with excessive sleep in subjects ≥60 years and without depression.

CONCLUSIONS

Our study found a significant association between MDS and sleep quality, particularly sleep apnea, but adequate magnesium intake may be beneficial in mitigating this association. MDS may be associated with excessive sleep in older adults, but not with insufficient sleep or insomnia.

The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review

Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

Serum Calcium and Magnesium Levels, Not 25-Hydroxyvitamin D, Are Associated With Sleep Quality in Airline Pilots

INTRODUCTION

Despite the vulnerability of airline pilots (APs) to sleep disturbances, the biological underpinnings responsible for this phenomenon are still not entirely elucidated. However, there is an increasing amount of evidence indicating an association between 25-hydroxyvitamin D, Ca2+, and Mg2+ levels and sleep health. In this cross-sectional study, we sought to examine the potential associations between serum levels of these biomarkers and the occurrence of poor sleep among APs.

METHODS

 We examined a convenience sample of 100 male APs who underwent the Pittsburgh Sleep Quality Index (PSQI) to assess their sleep quality. Those who scored 5 or higher on the PSQI were labeled as poor sleepers. Serum levels of 25-hydroxyvitamin D, Ca2+, and Mg2+ were quantified in all participants.

RESULTS

 Out of the 100 APs, 58 (58%) and 42 (42%) were classified as good and poor sleepers, respectively, based on the PSQI scores. We defined vitamin D deficiency as serum 25-hydroxyvitamin D levels below 10 ng/mL and insufficiency as levels ranging from 10 to 30 ng/mL. The results revealed no significant differences in serum levels of 25-hydroxyvitamin D between the two groups, and there was no evidence of vitamin D deficiency or insufficiency. However, poor sleepers exhibited significantly lower levels of both Mg2+ (1.8 ± 0.1 mg/dL versus2.0 ± 0.1 mg/dL, respectively) and Ca2+ (8.5 ± 0.4 mg/dL versus9.1 ± 0.5 mg/dL, respectively) compared to good sleepers (P < 0.001 for both). Logistic regression analysis identified both Mg2+ and Ca2+ as independent biomarkers associated with poor sleep quality in APs (P < 0.001 for both).

CONCLUSION

Lower serum concentrations of Mg2+ and Ca2+, not 25-hydroxyvitamin D, may be associated with poor sleep in APs.

Association of oxidative balance score with sleep quality: NHANES 2007-2014

BACKGROUND

Oxidative stress is correlated with sleep quality. A common tool for evaluating dietary and lifestyle exposures to oxidative stress is the Oxidative Balance Score (OBS), with higher OBS suggesting more substantial antioxidant exposures. The relationship between OBS and sleep quality is unclear. Investigating the association between OBS and sleep quality was the purpose of this study.

METHODS

To figure out the relationship between OBS and sleep quality, we utilized weighted linear models and weighted logistic regression. Adjusted models were also examined.

RESULTS

6300 participants who took part in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were recruited. OBS was negatively associated with sleep disorder (OR: 0.97; 95 % CI: 0.94-0.99), and positively associated with sleep duration (MD: 0.02; 95%CI: 0.01-0.03). Within the range of OBS > 24, each unit increase in OBS will result in a 40 % reduction in sleep disorder, and a 26 % increasement in sleep duration after adjustment (all P for trend <0.05). Dietary and lifestyle components were closely related to sleep quality independently. The relationship between OBS and sleep quality was prominent in the female population under 50 years of age. After stratification by education level, this relationship persisted.

LIMITATION

This research was cross-sectional design, and it was not possible to deduce causality.

CONCLUSION

Diet and lifestyle might influence sleep quality by modulating oxidative balance. Antioxidant diets and lifestyles were important in reducing sleep problems and our study also provided new ideas for improving sleep quality.