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Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, Yue H, Yin Q. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther 2023; 8:218. [PMID: 37230968 DOI: 10.1038/s41392-023-01496-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.
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Affiliation(s)
- Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xueying Liu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yue Zhang
- Department of Geriatrics, the 2nd Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Na Dong
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xiao Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Yao He
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Hongmei Yue
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Qingqing Yin
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Geng YJ, Smolensky M, Sum-Ping O, Hermida R, Castriotta RJ. Circadian rhythms of risk factors and management in atherosclerotic and hypertensive vascular disease: Modern chronobiological perspectives of an ancient disease. Chronobiol Int 2023; 40:33-62. [PMID: 35758140 PMCID: PMC10355310 DOI: 10.1080/07420528.2022.2080557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022]
Abstract
Atherosclerosis, a chronic inflammatory disease of the arteries that appears to have been as prevalent in ancient as in modern civilizations, is predisposing to life-threatening and life-ending cardiac and vascular complications, such as myocardial and cerebral infarctions. The pathogenesis of atherosclerosis involves intima plaque buildup caused by vascular endothelial dysfunction, cholesterol deposition, smooth muscle proliferation, inflammatory cell infiltration and connective tissue accumulation. Hypertension is an independent and controllable risk factor for atherosclerotic cardiovascular disease (CVD). Conversely, atherosclerosis hardens the arterial wall and raises arterial blood pressure. Many CVD patients experience both atherosclerosis and hypertension and are prescribed medications to concurrently mitigate the two disease conditions. A substantial number of publications document that many pathophysiological changes caused by atherosclerosis and hypertension occur in a manner dependent upon circadian clocks or clock gene products. This article reviews progress in the research of circadian regulation of vascular cell function, inflammation, hemostasis and atherothrombosis. In particular, it delineates the relationship of circadian organization with signal transduction and activation of the renin-angiotensin-aldosterone system as well as disturbance of the sleep/wake circadian rhythm, as exemplified by shift work, metabolic syndromes and obstructive sleep apnea (OSA), as promoters and mechanisms of atherogenesis and risk for non-fatal and fatal CVD outcomes. This article additionally updates advances in the clinical management of key biological processes of atherosclerosis to optimally achieve suppression of atherogenesis through chronotherapeutic control of atherogenic/hypertensive pathological sequelae.
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Affiliation(s)
- Yong-Jian Geng
- The Center for Cardiovascular Biology and Atherosclerosis Research, Division of Cardiovascular Medicine, Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael Smolensky
- The Center for Cardiovascular Biology and Atherosclerosis Research, Division of Cardiovascular Medicine, Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Oliver Sum-Ping
- The Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Ramon Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Richard J. Castriotta
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Keck Medical School, University of Southern California, Los Angeles, CA, USA
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3
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Khalaji A, Behnoush AH, Shobeiri P, Saeedian B, Teixeira AL, Rezaei N. Association between brain-derived neurotrophic factor levels and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2022; 27:829-841. [DOI: 10.1007/s11325-022-02707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
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Cederberg KLJ, Hanif U, Peris Sempere V, Hédou J, Leary EB, Schneider LD, Lin L, Zhang J, Morse AM, Blackman A, Schweitzer PK, Kotagal S, Bogan R, Kushida CA, Ju YES, Petousi N, Turnbull CD, Mignot E. Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response. Int J Mol Sci 2022; 23:7983. [PMID: 35887329 PMCID: PMC9317550 DOI: 10.3390/ijms23147983] [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: 06/24/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA), a disease associated with excessive sleepiness and increased cardiovascular risk, affects an estimated 1 billion people worldwide. The present study examined proteomic biomarkers indicative of presence, severity, and treatment response in OSA. Participants (n = 1391) of the Stanford Technology Analytics and Genomics in Sleep study had blood collected and completed an overnight polysomnography for scoring the apnea−hypopnea index (AHI). A highly multiplexed aptamer-based array (SomaScan) was used to quantify 5000 proteins in all plasma samples. Two separate intervention-based cohorts with sleep apnea (n = 41) provided samples pre- and post-continuous/positive airway pressure (CPAP/PAP). Multivariate analyses identified 84 proteins (47 positively, 37 negatively) associated with AHI after correction for multiple testing. Of the top 15 features from a machine learning classifier for AHI ≥ 15 vs. AHI < 15 (Area Under the Curve (AUC) = 0.74), 8 were significant markers of both AHI and OSA from multivariate analyses. Exploration of pre- and post-intervention analysis identified 5 of the 84 proteins to be significantly decreased following CPAP/PAP treatment, with pathways involving endothelial function, blood coagulation, and inflammatory response. The present study identified PAI-1, tPA, and sE-Selectin as key biomarkers and suggests that endothelial dysfunction and increased coagulopathy are important consequences of OSA, which may explain the association with cardiovascular disease and stroke.
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Affiliation(s)
- Katie L. J. Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Umaer Hanif
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, 2600 Glostrup, Denmark
| | - Vicente Peris Sempere
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Julien Hédou
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Eileen B. Leary
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Jazz Pharmaceuticals, 3170 Porter Drive, Palo Alto, CA 94304, USA
| | - Logan D. Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Alphabet, Inc., 1600 Amphitheater Parkway Mountain View, Palo Alto, CA 94043, USA
- Stanford/VA Alzheimer’s Research Center, 3801 Miranda Ave, Building 4, C-141, Mail Code 116F-PAD, Palo Alto, CA 94304, USA
| | - Ling Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Jing Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Anne M. Morse
- Division of Child Neurology and Pediatric Sleep Medicine, Geisinger, Janet Weis Children’s Hospital, 100 N Academy Ave, Danville, PA 17822, USA;
| | - Adam Blackman
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1L5, Canada;
| | - Paula K. Schweitzer
- Sleep Medicine & Research Center, St. Lukes Hospital, 232 S. Woods Mill Road, Chesterfield, MO 63017, USA;
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, 200 First St., Rochester, MN 55905, USA;
| | - Richard Bogan
- College of Medicine, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA;
| | - Clete A. Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Yo-El S. Ju
- Department of Neurology, Washington University, St. Louis, MO 63110, USA;
- Hope Center for Neurological Disorders, Washington University, St. Louis, MO 63110, USA
- Center on Biological Rhythms and Sleep (COBRAS), Washington University, 1600 S. Brentwood Blvd, St. Louis, MO 63144, USA
| | - Nayia Petousi
- Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Chris D. Turnbull
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
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Badran M, Gozal D. PAI-1: A Major Player in the Vascular Dysfunction in Obstructive Sleep Apnea? Int J Mol Sci 2022; 23:5516. [PMID: 35628326 PMCID: PMC9141273 DOI: 10.3390/ijms23105516] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea is a chronic and prevalent condition that is associated with endothelial dysfunction, atherosclerosis, and imposes excess overall cardiovascular risk and mortality. Despite its high prevalence and the susceptibility of CVD patients to OSA-mediated stressors, OSA is still under-recognized and untreated in cardiovascular practice. Moreover, conventional OSA treatments have yielded either controversial or disappointing results in terms of protection against CVD, prompting the need for the identification of additional mechanisms and associated adjuvant therapies. Plasminogen activator inhibitor-1 (PAI-1), the primary inhibitor of tissue-type plasminogen activator (tPA) and urinary-type plasminogen activator (uPA), is a key regulator of fibrinolysis and cell migration. Indeed, elevated PAI-1 expression is associated with major cardiovascular adverse events that have been attributed to its antifibrinolytic activity. However, extensive evidence indicates that PAI-1 can induce endothelial dysfunction and atherosclerosis through complex interactions within the vasculature in an antifibrinolytic-independent matter. Elevated PAI-1 levels have been reported in OSA patients. However, the impact of PAI-1 on OSA-induced CVD has not been addressed to date. Here, we provide a comprehensive review on the mechanisms by which OSA and its most detrimental perturbation, intermittent hypoxia (IH), can enhance the transcription of PAI-1. We also propose causal pathways by which PAI-1 can promote atherosclerosis in OSA, thereby identifying PAI-1 as a potential therapeutic target in OSA-induced CVD.
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Affiliation(s)
- Mohammad Badran
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, 400 N Keene St, Suite 010, Columbia, MO 65201, USA;
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, 400 N Keene St, Suite 010, Columbia, MO 65201, USA;
- Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65201, USA
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Arslan B, Şemsi R, İriz A, Sepici Dinçel A. The evaluation of serum brain-derived neurotrophic factor and neurofilament light chain levels in patients with obstructive sleep apnea syndrome. Laryngoscope Investig Otolaryngol 2021; 6:1466-1473. [PMID: 34938889 PMCID: PMC8665460 DOI: 10.1002/lio2.683] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/09/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to compare serum levels of brain-derived neurotrophic factor (BDNF) and neurofilament light (NfL) chain in normal individuals and patients with mild and moderate-severe obstructive sleep apnea syndrome (OSAS). METHODS We enrolled 81 subjects referred to Otorhinolaryngology (Ear-Nose-Throat), Gazi University Faculty of Medicine, between 2017 and 2019. Based on the severity of OSAS, patients were divided into three groups: group 1 with mild OSAS (apnea-hypopnea index [AHI] 5-15; n = 26), group 2 with moderate-severe OSAS (AHI > 15; n = 32), and group 3 with normal individuals (AHI scores < 5; n = 23). RESULTS Serum NfL and BDNF levels were evaluated together with the clinical data for all subjects. Significant differences were seen in the oxygen desaturation index (ODI), apnea index, hypopnea index, sleep efficiency, and NfL levels (P < .05) between the three groups. In the moderate-severe group, NfL levels showed a significant positive correlation with apnea index (P < .05, r = .389), hypopnea index (P < .05, r = .455), and ODI (P = .04; r = .362). CONCLUSIONS Our findings clarify the pathophysiology of OSAS in cases of repetitive hypoxia and chronic neuronal damage. Based on our results, we recommend that in addition to BDNF, NfL should also be evaluated in different and larger patient cohorts.
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Affiliation(s)
- Burak Arslan
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
- Department of Medical BiochemistryErciş State HospitalVanTurkey
| | - Rabia Şemsi
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
| | - Ayşe İriz
- Department of Otorhinolaryngology (Ear‐Nose‐Throat)Gazi University Faculty of MedicineAnkaraTurkey
| | - Aylin Sepici Dinçel
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
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Martinez-Nicolas A, Guaita M, Santamaría J, Montserrat JM, Madrid JA, Rol MA. Ambulatory circadian monitoring in sleep disordered breathing patients and CPAP treatment. Sci Rep 2021; 11:14711. [PMID: 34282278 PMCID: PMC8290024 DOI: 10.1038/s41598-021-94315-0] [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: 03/04/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Our aim was to evaluate the circadian rhythm of motor activity, body position and integrated variable TAP (composed by wrist Temperature, motor Activity and body Position) in Sleep Disordered Breathing (SDB), its relation to SDB severity and the effect of continuous positive airway pressure (CPAP) on these circadian rhythms. To do this, we monitored motor activity and body position rhythms of 78 SDB patients (53.3 ± 1.2 years old, 26.9% women) and 32 healthy subjects (51.4 ± 3.2 years old, 43.8% women) for 1 week. On the last day of that week, SDB patients underwent a polysomnography followed by a Maintenance of Wakefulness Test, Multiple Sleep Latency Test and Sustained Attention to Response Task protocol. A subgroup of 18 moderate to severe SDB patients was treated with CPAP and monitored again after 3 months under treatment. A non-parametrical analysis was performed to characterize the circadian patterns to assess differences between groups and associations between sleep and circadian parameters. Circadian variables were altered in SDB, exhibiting a direct relationship to SDB severity. The motor activity pattern showed a clear improvement with CPAP treatment. Thus, circadian ambulatory monitoring, including the integrated variable TAP, could be used to evaluate the circadian alterations caused by SDB and activity pattern to monitor the effect of CPAP treatment.
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Affiliation(s)
- Antonio Martinez-Nicolas
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Marc Guaita
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Santamaría
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Montserrat
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Juan Antonio Madrid
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - María Angeles Rol
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain. .,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Bikov A, Meszaros M, Schwarz EI. Coagulation and Fibrinolysis in Obstructive Sleep Apnoea. Int J Mol Sci 2021; 22:ijms22062834. [PMID: 33799528 PMCID: PMC8000922 DOI: 10.3390/ijms22062834] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.
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Affiliation(s)
- Andras Bikov
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9MT, UK
- Correspondence: ; Tel.: +44-161-291-2493; Fax: +44-161-291-5730
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary;
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
- Centre of Competence Sleep & Health Zurich, University of Zurich, 8091 Zurich, Switzerland
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Qiu Y, Li X, Zhang X, Wang W, Chen J, Liu Y, Fang X, Ni X, Zhang J, Wang S, Tai J. Prothrombotic Factors in Obstructive Sleep Apnea: A Systematic Review With Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP412-NP421. [PMID: 33167693 DOI: 10.1177/0145561320965208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies revealed that the prothrombotic factors in patients with obstructive sleep apnea (OSA) remain controversial. AIM/OBJECTIVE The aim of the systematic review is to elucidate the relationship between prothrombotic factors and OSA. MATERIALS AND METHODS This systematic review was performed under the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The literature we investigated was extracted from 4 main medical databases (PubMed, Web of Science, Cochrane Library, and Chinese databases) as of February 2020. We used significant weighted mean differences (SMDs) with 95% CIs from random-effects model. RESULTS A total of 15 studies comprising 2190 patients were available for the meta-analysis. The pooled results showed that the levels of fibrinogen (SMD = 0.95, 95% CI = 0.26 to 1.65, P = .000), vascular endothelial growth factor (SMD = 0.37, 95% CI = -0.90 to 1.63, P = .000), and plasminogen activator inhibitor 1 (SMD = 0.61, 95% CI = 0.29 to 0.92, P = .040) increased in patients with OSA. There were no statistical differences between groups in terms of d-dimer (P = .108) and platelet counts (P = .233). Subgroup analyses demonstrated that specimen types and age could account for the heterogeneity. CONCLUSIONS AND SIGNIFICANCE This meta-analysis indicated the relationship between prothrombotic factors in OSA hypopnea. Obstructive sleep apnea-related effects may underline the importance of considering the dysfunction of the hemostatic system. The prothrombotic factors in OSA can influence making a choice of appropriate therapy.
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Affiliation(s)
- Yue Qiu
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Zhang
- Big Data and Engineering Research Center, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Chen
- Big Data and Engineering Research Center, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaolian Fang
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jun Tai
- Department of Otolaryngology-Head and Neck Surgery, 117984Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Chuchalin AG, Gusev EI, Martynov MY, Kim TG, Shogenova LV. [Pulmonary insufficiency in acute stroke: risk factors and mechanisms of development]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-16. [PMID: 32790970 DOI: 10.17116/jnevro20201200717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Various degrees of pulmonary insufficiency (PI) (PaO2 ≤60 mm Hg, SaO2 ≤90%) are diagnosed in most of patients with severe acute stroke (AS). Frequency and severity of PI positively correlates with the severity of AS. PI worsens patient's condition, prolongs the hospitalization period, and increases the probability of fatal outcome. Early clinical signs of PI may be undiagnosed due to the severity of stroke and thus not treated. The initiating pathogenic mechanism of PI is stress-related activation of sympathetic nervous system (SNS) and systemic immunosuppression. In severe stroke with mass effect, the rapid and significant increase in intracranial pressure may additionally activate the SNS. Risk factors of PI include older age, previous pulmonary disease, prolonged supine position, respiratory muscle dysfunction, apnea, and concomitant somatic diseases. Decompensation of somatic diseases leads to multiple stage reactions with facilitation of functional and morphologic changes in the pulmonary system, hypoxemia and hypoxia, promotes infectious complications and multiple organ failure and worsens neurological outcome. Diagnosis and treatment of PI in AS decreases mortality and improves rehabilitation prognosis.
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Affiliation(s)
- A G Chuchalin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - T G Kim
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Shogenova
- Pirogov Russian National Research Medical University, Moscow, Russia
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11
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Ryan S, Cummins EP, Farre R, Gileles-Hillel A, Jun JC, Oster H, Pepin JL, Ray DW, Reutrakul S, Sanchez-de-la-Torre M, Tamisier R, Almendros I. Understanding the pathophysiological mechanisms of cardiometabolic complications in obstructive sleep apnoea: towards personalised treatment approaches. Eur Respir J 2020; 56:13993003.02295-2019. [PMID: 32265303 DOI: 10.1183/13993003.02295-2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/15/2020] [Indexed: 12/19/2022]
Abstract
In January 2019, a European Respiratory Society research seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide, which occur frequently in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the detailed mechanisms of these processes is of major importance to the field and this seminar offered an ideal platform to exchange knowledge, and to discuss pitfalls of current models and the design of future collaborative studies. In addition, we debated the limitations of current treatment strategies for cardiometabolic complications in OSA and discussed potentially valuable alternative approaches.
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Affiliation(s)
- Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin P Cummins
- School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramon Farre
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Dept of Pediatrics, and The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan C Jun
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | | | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Manuel Sanchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Renaud Tamisier
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
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12
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Bocskei RM, Meszaros M, Tarnoki AD, Tarnoki DL, Kunos L, Lazar Z, Bikov A. Circulating Soluble Urokinase-Type Plasminogen Activator Receptor in Obstructive Sleep Apnoea. ACTA ACUST UNITED AC 2020; 56:medicina56020077. [PMID: 32075014 PMCID: PMC7074407 DOI: 10.3390/medicina56020077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/27/2020] [Accepted: 02/05/2020] [Indexed: 01/06/2023]
Abstract
Background and Objectives: Obstructive sleep apnoea (OSA) is associated with heightened systemic inflammation and a hypercoagulation state. Soluble urokinase-type plasminogen activator receptor (suPAR) plays a role in fibrinolysis and systemic inflammation. However, suPAR has not been investigated in OSA. Materials and Methods: A total of 53 patients with OSA and 15 control volunteers participated in the study. Medical history was taken and in-hospital sleep studies were performed. Plasma suPAR levels were determined by ELISA. Results: There was no difference in plasma suPAR values between patients with OSA (2.198 ± 0.675 ng/mL) and control subjects (2.088 ± 0.976 ng/mL, p = 0.62). Neither was there any difference when patients with OSA were divided into mild (2.134 ± 0.799 ng/mL), moderate (2.274 ± 0.597 ng/mL) and severe groups (2.128 ± 0.744 ng/mL, p = 0.84). There was no significant correlation between plasma suPAR and indices of OSA severity, blood results or comorbidities, such as hypertension, diabetes, dyslipidaemia or cardiovascular disease. Plasma suPAR levels were higher in women when all subjects were analysed together (2.487 ± 0.683 vs. 1.895 ± 0.692 ng/mL, p < 0.01), and also separately in controls (2.539 ± 0.956 vs. 1.411 ± 0.534 ng/mL, p = 0.02) and patients (2.467 ± 0.568 vs. 1.991 ± 0.686 ng/mL, p < 0.01). Conclusions: Our results suggest that suPAR does not play a significant role in the pathophysiology of OSA. The significant gender difference needs to be considered when conducting studies on circulating suPAR.
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Affiliation(s)
- Renata Marietta Bocskei
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (R.M.B.); (M.M.)
- Department of Pulmonology, Szent Borbala County Hospital, 2800 Tatabánya, Hungary
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (R.M.B.); (M.M.)
| | - Adam Domonkos Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.D.T.); (D.L.T.)
| | - David Laszlo Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.D.T.); (D.L.T.)
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (R.M.B.); (M.M.)
| | - Zsofia Lazar
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (R.M.B.); (M.M.)
| | - Andras Bikov
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (R.M.B.); (M.M.)
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Correspondence: ; Tel.: +36-203-141-599
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Abstract
Essentially all biological processes fluctuate over the course of the day, observed at cellular (eg, transcription, translation, and signaling), organ (eg, contractility and metabolism), and whole-body (eg, physical activity and appetite) levels. It is, therefore, not surprising that both cardiovascular physiology (eg, heart rate and blood pressure) and pathophysiology (eg, onset of adverse cardiovascular events) oscillate during the 24-hour day. Chronobiological influence over biological processes involves a complex interaction of factors that are extrinsic (eg, neurohumoral factors) and intrinsic (eg, circadian clocks) to cells. Here, we focus on circadian governance of 6 fundamentally important processes: metabolism, signaling, electrophysiology, extracellular matrix, clotting, and inflammation. In each case, we discuss (1) the physiological significance for circadian regulation of these processes (ie, the good); (2) the pathological consequence of circadian governance impairment (ie, the bad); and (3) whether persistence/augmentation of circadian influences contribute to pathogenesis during distinct disease states (ie, the ugly). Finally, the translational impact of chronobiology on cardiovascular disease is highlighted.
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Affiliation(s)
- Samir Rana
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Sumanth D Prabhu
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Martin E Young
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
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15
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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16
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More CE, Papp C, Harsanyi S, Gesztelyi R, Mikaczo A, Tajti G, Kardos L, Seres I, Lorincz H, Csapo K, Zsuga J. Altered irisin/BDNF axis parallels excessive daytime sleepiness in obstructive sleep apnea patients. Respir Res 2019; 20:67. [PMID: 30952206 PMCID: PMC6449996 DOI: 10.1186/s12931-019-1033-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/26/2019] [Indexed: 02/08/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep-related breathing disorder, characterized by excessive daytime sleepiness (EDS), paralleled by intermittent collapse of the upper airway. EDS may be the symptom of OSAHS per se but may also be due to the alteration of central circadian regulation. Irisin is a putative myokine and has been shown to induce BDNF expression in several sites of the brain. BDNF is a key factor regulating photic entrainment and consequent circadian alignment and adaptation to the environment. Therefore, we hypothesized that EDS accompanying OSAHS is reflected by alteration of irisin/BDNF axis. METHODS Case history, routine laboratory parameters, serum irisin and BDNF levels, polysomnographic measures and Epworth Sleepiness Scale questionnaire (ESS) were performed in a cohort of OSAHS patients (n = 69). Simple and then multiple linear regression was used to evaluate data. RESULTS We found that EDS reflected by the ESS is associated with higher serum irisin and BDNF levels; β: 1.53; CI: 0.35, 6.15; p = 0.012 and β: 0.014; CI: 0.0.005, 0.023; p = 0.02, respectively. Furthermore, influence of irisin and BDNF was significant even if the model accounted for their interaction (p = 0.006 for the terms serum irisin, serum BDNF and their interaction). Furthermore, a concentration-dependent effect of both serum irisin and BDNF was evidenced with respect to their influence on the ESS. CONCLUSIONS These results suggest that the irisin-BDNF axis influences subjective daytime sleepiness in OSAS patients reflected by the ESS. These results further imply the possible disruption of the circadian regulation in OSAHS. Future interventional studies are needed to confirm this observation.
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Affiliation(s)
- Csaba E More
- Department of Psychiatry, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Csaba Papp
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Szilvia Harsanyi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Angela Mikaczo
- Department of Pulmonology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Gabor Tajti
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Laszlo Kardos
- Institute of Clinical Pharmacology, Infectious Diseases and Allergology, Kenezy Gyula Teaching County Hospital and Outpatient Clinic, Bartok Bela ut 2-26, Debrecen, 4031, Hungary
| | - Ildiko Seres
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Hajnalka Lorincz
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Krisztina Csapo
- Department of Neurology, Faculty of Medicine, University of Debrecen, Moricz Zsigmond krt. 22, Debrecen, 4032, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
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17
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Pavlov M, Ćelap I. Plasminogen activator inhibitor 1 in acute coronary syndromes. Clin Chim Acta 2019; 491:52-58. [PMID: 30659821 DOI: 10.1016/j.cca.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
Abstract
Plasminogen activator inhibitor 1 (PAI-1) is the main regulator of endogenous fibrinolysis, overriding the impact of other constituents of fibrinolysis. In plasma, it can be found in three forms: active, latent and inactive. There are numerous commercially available tests, analysing the activity of PAI-1 or the antigen level, with variable correlations between the two. PAI-1 has been extensively studied regarding incidence and outcomes of acute coronary syndromes, and showed positive association with both in numerous studies. Higher PAI-1 has been associated with worse short- and long-term outcomes. Studies are more consistent in the primary percutaneous coronary intervention era. Higher rise of PAI-1 within the first 24 h of acute myocardial infarction has been linked to some of its high-risk features. The circadian pattern of PAI-1 kinetics has been previously described, and the mechanisms behind this phenomenon and its impact on the incidence of acute coronary syndromes are well known. Further investigations are needed to test the safety and efficacy of PAI-1 as a pharmacological target in cardiovascular diseases.
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Affiliation(s)
- Marin Pavlov
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Vinogradska cesta 29, 10000 Zagreb, Croatia.
| | - Ivana Ćelap
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Centre, Vinogradska cesta 29, 10000 Zagreb, Croatia
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18
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Milenković J, Miljković E, Milenković K, Bojanić N. PLASMINOGEN ACTIVATOR INHIBITOR 1 (PAI - 1) AS A POTENTIAL DIAGNOSTIC AND THERAPEUTIC TARGET. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Martinez-Nicolas A, Guaita M, Santamaría J, Montserrat JM, Rol MÁ, Madrid JA. Circadian Impairment of Distal Skin Temperature Rhythm in Patients With Sleep-Disordered Breathing: The Effect of CPAP. Sleep 2018; 40:3748299. [PMID: 28444396 DOI: 10.1093/sleep/zsx067] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Study objectives Our aim was to evaluate the circadian rhythm of distal skin temperature (DST) in sleep-disordered breathing (SDB), its relation to excessive daytime sleepiness and the effect of continuous positive airway pressure (CPAP) on DST. Methods Eighty SDB patients (53.1 ± 1.2 years old, 27.6% women) and 67 healthy participants (52.3 ± 1.6 years old, 26.9% women) wore a temperature data logger for 1 week. On the last day of that week, SDB patients underwent a polysomnography followed by a Maintenance of Wakefulness Test (MWT), Multiple Sleep Latency Test, and Sustained Attention to Response Task protocol to objectively quantify daytime sleepiness. A subset of 21 moderate to severe SDB patients were treated with CPAP during at least 3 months and revaluated with the same procedure. A nonparametric analysis was performed to characterize DST to assess differences between groups and associations among DST, polysomnography, and daytime sleepiness measures. Results SDB patients showed an unstable, fragmented, flattened, phase-advanced, and less robust DST rhythm as compared to healthy participants. The more severe the SDB, the worse the DST pattern was, as indicated by the correlation coefficient. Sleepiness, according to MWT sleep latencies, was also associated with the higher fragmentation, lower amplitude, and less robustness of the DST rhythm. Treatment with CPAP improved DST pattern regularity and robustness. Conclusion DST is altered in SDB, exhibiting a direct relationship to the severity of this condition, and improves with CPAP treatment. DST independently correlates with sleepiness, thus, its measurement may contribute to the understanding of the pathophysiology of sleepiness in these patients.
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Affiliation(s)
- Antonio Martinez-Nicolas
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE, IMIB-Arrixaca, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Marc Guaita
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Santamaría
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Neurology Department, Hospital Clinic of Barcelona, Spain
| | - Josep M Montserrat
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Pneumology Department, Hospital Clinic of Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - María Ángeles Rol
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE, IMIB-Arrixaca, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Juan Antonio Madrid
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE, IMIB-Arrixaca, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
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20
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Uyar M, Kervancioglu S, Bayram N, Taskin-Dogan B, Filiz A. Obstructive sleep apnea is the triggering factor for massive hemoptysis. Sleep Breath 2017; 21:475-478. [DOI: 10.1007/s11325-016-1446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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21
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Uyar M, Davutoglu V. An update on cardiovascular effects of obstructive sleep apnoea syndrome. Postgrad Med J 2016; 92:540-4. [PMID: 27317753 DOI: 10.1136/postgradmedj-2016-134093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/24/2016] [Indexed: 01/25/2023]
Abstract
Obstructive sleep apnoea syndrome is an important health problem which may cause or worsen systemic diseases. Chronic intermittent hypoxia during repetitive airflow cessations may cause endothelial dysfunction. Sleep apnoea is also shown to be associated with hypercoagulability which may be due to decreased nitric oxide levels and impaired vasodilatation. Endothelial dysfunction, increased systemic inflammation, sympathetic nervous system activation, increased oxidative stress and dysglycaemia may all contribute to cardiovascular processes such as hypertension, arrhythmia, stroke, heart failure and coronary artery disease in patients with obstructive sleep apnoea. Treatment approaches in patients with obstructive sleep apnoea mainly focus on maintaining upper airway patency either with positive airway pressure devices or upper airway appliances. Strategies involving positive airway pressure therapy are associated with decreased morbidity and mortality. Obstructive sleep apnoea should be suspected as an underlying mechanism in patients with cardiovascular disease and warrants appropriate treatment.
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Affiliation(s)
- Meral Uyar
- Department of Respiratory Medicine, Gaziantep University, Gaziantep, Turkey
| | - Vedat Davutoglu
- Department of Cardiology, Gaziantep University, Gaziantep, Turkey
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22
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Daulatzai MA. Fundamental role of pan-inflammation and oxidative-nitrosative pathways in neuropathogenesis of Alzheimer's disease in focal cerebral ischemic rats. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:102-30. [PMID: 27335702 PMCID: PMC4913220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 06/06/2023]
Abstract
Alzheimer's disease (AD) is a chronic progressive neurodegenerative condition of the brain, and it is the most common cause of dementia. Several neurobiological etiologies of AD are described in the literature. These include vascular, infectious, toxic, nutritional, metabolic, and inflammatory. However, these heterogeneous etiologies have a common denominator - viz. Inflammation and oxidative stress. Lipopolysaccharide (LPS) elevates the synthesis of proinflammatory cytokines and chemokines; chronically, together they trigger various pathological responses in the periphery and the CNS including dysfunctional memory consolidation and memory decline. Aging - the main risk factor for AD is inherently associated with inflammation. There are several age-related comorbidities that are also associated with inflammation and oxidative stress. Such co-prevailing aggravating factors, therefore, persist against a background of underlying aging-related pathology. They may converge, and their synergistic propagation may modify the disease course. A critical balance exists between homeostasis/repair and inflammatory factors; chronic, unrelenting inflammatory milieu succeeds in promoting a neuroinflammatory and neurodegenerative outcome. Extensive evidence is available that CNS inflammation is associated with neurodegeneration. LPS, proinflammatory cytokines, several mediators secreted by microglia, and oxidative-nitrosative stress in concert play a pivotal role in triggering neuroinflammatory processes and neurodegeneration. The persistent uncontrolled activity of the above factors can potentiate cognitive decline in tandem enhancing vulnerability to AD. Despite significant progress during the past twenty years, the prevention and treatment of AD have been tantalizingly elusive. Current studies strongly suggest that amelioration/prevention of the deleterious effects of inflammation may prove beneficial in preventing AD onset and retarding cognitive dysfunction in aging and AD. A concerted multi-focal therapeutic effort around the inflammation-oxidative-nitrosative stress paradigm may be crucial in preventing and treating AD. This paper informs on such relevant polypharmacy approach.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne Parkville, Victoria 3010, Australia
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23
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Barcelo A, Bauça JM, Yañez A, Fueyo L, Gomez C, de la Peña M, Pierola J, Rodriguez A, Sanchez-de-la-Torre M, Abad J, Mediano O, Amilibia J, Masdeu MJ, Teran J, Montserrat JM, Mayos M, Sanchez-de-la-Torre A, Barbé F. Impact of Obstructive Sleep Apnea on the Levels of Placental Growth Factor (PlGF) and Their Value for Predicting Short-Term Adverse Outcomes in Patients with Acute Coronary Syndrome. PLoS One 2016; 11:e0147686. [PMID: 26930634 PMCID: PMC4773070 DOI: 10.1371/journal.pone.0147686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/07/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Placental growth factor (PlGF) induces angiogenesis and promotes tissue repair, and plasma PlGF levels change markedly during acute myocardial infarction (AMI). Currently, the impact of obstructive sleep apnea (OSA) in patients with AMI is a subject of debate. Our objective was to evaluate the relationships between PlGF levels and both the severity of acute coronary syndrome (ACS) and short-term outcomes after ACS in patients with and without OSA. METHODS A total of 538 consecutive patients (312 OSA patients and 226 controls) admitted for ACS were included in this study. All patients underwent polygraphy in the first 72 hours after hospital admission. The severity of disease and short-term prognoses were evaluated during the hospitalization period. Plasma PlGF levels were measured using an electrochemiluminescence immunoassay. RESULTS Patients with OSA were significantly older and more frequently hypertensive and had higher BMIs than those without OSA. After adjusting for age, smoking status, BMI and hypertension, PlGF levels were significantly elevated in patients with OSA compared with patients without OSA (19.9 pg/mL, interquartile range: 16.6-24.5 pg/mL; 18.5 pg/mL, interquartile range: 14.7-22.7 pg/mL; p<0.001), and a higher apnea-hypopnea index (AHI) was associated with higher PlGF concentrations (p<0.003). Patients with higher levels of PlGF had also an increased odds ratio for the presence of 3 or more diseased vessels and for a Killip score>1, even after adjustment. CONCLUSIONS The results of this study show that in patients with ACS, elevated plasma levels of PlGF are associated with the presence of OSA and with adverse outcomes during short-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT01335087.
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Affiliation(s)
- Antonia Barcelo
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | | | - Aina Yañez
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Laura Fueyo
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Cristina Gomez
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | | | - Javier Pierola
- Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | | | | | - Jorge Abad
- Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Olga Mediano
- Hospital Universitario de Guadalajara, Guadalajara, Castilla-La Mancha, Spain
| | - Jose Amilibia
- Hospital Universitario Cruces, Bilbao, Basque Country, Spain
| | | | - Joaquin Teran
- Hospital General Yagüe, Burgos, Castilla-León, Spain
| | | | - Mercè Mayos
- Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | | | - Ferran Barbé
- Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia, Spain
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Daulatzai MA. Fundamental role of pan-inflammation and oxidative-nitrosative pathways in neuropathogenesis of Alzheimer's disease. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2016; 5:1-28. [PMID: 27073740 PMCID: PMC4788729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 06/05/2023]
Abstract
Alzheimer's disease (AD) is a chronic progressive neurodegenerative condition of the brain, and it is the most common cause of dementia. Several neurobiological etiologies of AD are described in the literature. These include vascular, infectious, toxic, nutritional, metabolic, and inflammatory. However, these heterogeneous etiologies have a common denominator - viz. Inflammation and oxidative stress. Lipopolysaccharide (LPS) elevates the synthesis of proinflammatory cytokines and chemokines; chronically, together they trigger various pathological responses in the periphery and the CNS including dysfunctional memory consolidation and memory decline. Aging - the main risk factor for AD is inherently associated with inflammation. There are several age-related comorbidities that are also associated with inflammation and oxidative stress. Such co-prevailing aggravating factors, therefore, persist against a background of underlying aging-related pathology. They may converge, and their synergistic propagation may modify the disease course. A critical balance exists between homeostasis/repair and inflammatory factors; chronic, unrelenting inflammatory milieu succeeds in promoting a neuroinflammatory and neurodegenerative outcome. Extensive evidence is available that CNS inflammation is associated with neurodegeneration. LPS, proinflammatory cytokines, several mediators secreted by microglia, and oxidative-nitrosative stress in concert play a pivotal role in triggering neuroinflammatory processes and neurodegeneration. The persistent uncontrolled activity of the above factors can potentiate cognitive decline in tandem enhancing vulnerability to AD. Despite significant progress during the past twenty years, the prevention and treatment of AD have been tantalizingly elusive. Current studies strongly suggest that amelioration/prevention of the deleterious effects of inflammation may prove beneficial in preventing AD onset and retarding cognitive dysfunction in aging and AD. A concerted multi-focal therapeutic effort around the inflammation-oxidative-nitrosative stress paradigm may be crucial in preventing and treating AD. This paper informs on such relevant polypharmacy approach.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE/Melbourne School of Engineering, The University of Melbourne Parkville, Victoria 3010, Australia
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25
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Takeda N, Maemura K. Circadian clock and the onset of cardiovascular events. Hypertens Res 2016; 39:383-90. [PMID: 26888119 DOI: 10.1038/hr.2016.9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 02/07/2023]
Abstract
The onset of cardiovascular diseases often shows time-of-day variation. Acute myocardial infarction or ventricular arrhythmia such as ventricular tachycardia occurs mainly in the early morning. Multiple biochemical and physiological parameters show circadian rhythm, which may account for the diurnal variation of cardiovascular events. These include the variations in blood pressure, activity of the autonomic nervous system and renin-angiotensin axis, coagulation cascade, vascular tone and the intracellular metabolism of cardiomyocytes. Importantly, the molecular clock system seems to underlie the circadian variation of these parameters. The center of the biological clock, also known as the central clock, exists in the suprachiasmatic nucleus. In contrast, the molecular clock system is also activated in each cell of the peripheral organs and constitute the peripheral clock. The biological clock system is currently considered to have a beneficial role in maintaining the homeostasis of each organ. Discoordination, however, between the peripheral clock and external environment could potentially underlie the development of cardiovascular events. Therefore, understanding the molecular and cellular pathways by which cardiovascular events occur in a diurnal oscillatory pattern will help the establishment of a novel therapeutic approach to the management of cardiovascular disorders.
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Affiliation(s)
- Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Takeda N, Maemura K. The role of clock genes and circadian rhythm in the development of cardiovascular diseases. Cell Mol Life Sci 2015; 72:3225-34. [PMID: 25972277 PMCID: PMC11113935 DOI: 10.1007/s00018-015-1923-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
The time of onset of cardiovascular disorders such as myocardial infarctions or ventricular arrhythmias exhibits a circadian rhythm. Diurnal variations in autonomic nervous activity, plasma cortisol level or renin-angiotensin activity underlie the pathogenesis of cardiovascular diseases. Transcriptional-translational feedback loop of the clock genes constitute a molecular clock system. In addition to the central clock in the suprachiasmatic nucleus, clock genes are also expressed in a circadian fashion in each organ to make up the peripheral clock. The peripheral clock seems to be beneficial for anticipating external stimuli and thus contributes to the maintenance of organ homeostasis. Loss of synchronization between the central and peripheral clocks also augments disease progression. Moreover, accumulating evidence shows that clock genes affect inflammatory and intracellular metabolic signaling. Elucidating the roles of the molecular clock in cardiovascular pathology through the identification of clock controlled genes will help to establish a novel therapeutic approach for cardiovascular disorders.
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Affiliation(s)
- Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
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28
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Abstract
Most living beings, including humans, must adapt to rhythmically occurring daily changes in their environment that are generated by the Earth's rotation. In the course of evolution, these organisms have acquired an internal circadian timing system that can anticipate environmental oscillations and thereby govern their rhythmic physiology in a proactive manner. In mammals, the circadian timing system coordinates virtually all physiological processes encompassing vigilance states, metabolism, endocrine functions and cardiovascular activity. Research performed during the past two decades has established that almost every cell in the body possesses its own circadian timekeeper. The resulting clock network is organized in a hierarchical manner. A master pacemaker, located in the suprachiasmatic nucleus (SCN) of the hypothalamus, is synchronized every day to the photoperiod. In turn, the SCN determines the phase of the cellular clocks in peripheral organs through a wide variety of signalling pathways dependent on feeding cycles, body temperature rhythms, oscillating bloodborne signals and, in some organs, inputs of the peripheral nervous system. A major purpose of circadian clocks in peripheral tissues is the temporal orchestration of key metabolic processes, including food processing (metabolism and xenobiotic detoxification). Here, we review some recent findings regarding the molecular and cellular composition of the circadian timing system and discuss its implications for the temporal coordination of metabolism in health and disease. We focus primarily on metabolic disorders such as obesity and type 2 diabetes, although circadian misalignments (shiftwork or 'social jet lag') have also been associated with the aetiology of human malignancies.
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Affiliation(s)
- C Dibner
- Department of Endocrinology, Diabetes, Nutrition and Hypertension, University Hospital of Geneva, Geneva, Switzerland
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Hoyos CM, Melehan KL, Liu PY, Grunstein RR, Phillips CL. Does obstructive sleep apnea cause endothelial dysfunction? A critical review of the literature. Sleep Med Rev 2015; 20:15-26. [PMID: 25088969 DOI: 10.1016/j.smrv.2014.06.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 01/29/2023]
Affiliation(s)
- Camilla M Hoyos
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - Kerri L Melehan
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Ronald R Grunstein
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig L Phillips
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
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Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study. Int J Obes (Lond) 2015; 39:1094-100. [PMID: 25801692 PMCID: PMC4496251 DOI: 10.1038/ijo.2015.37] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/23/2015] [Accepted: 03/15/2015] [Indexed: 12/30/2022]
Abstract
Background Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions. Aim To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community. Methods Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the 2 PSG were assayed for multiple inflammatory and metabolic markers including interleukin-6 (IL-6), IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase- (MMP-9), adiponectin, apelin C, leptin and osteocrin. Results Out of 122 potential candidates, 100 obese children with OSA completed the study with only 1/3 exhibiting normalization of their PSG after T&A (i.e., AHI≤1/hrTST). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (i.e., AHI≥/hrTST). Conclusions A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.
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Blomster H, Tuomilehto H. Author response to: Endothelial function is not always well preserved in obese patients with mild OSA. Sleep Breath 2015; 19:17-8. [DOI: 10.1007/s11325-014-1017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
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Swanson CM, Shea SA, Stone KL, Cauley JA, Rosen CJ, Redline S, Karsenty G, Orwoll ES. Obstructive sleep apnea and metabolic bone disease: insights into the relationship between bone and sleep. J Bone Miner Res 2015; 30:199-211. [PMID: 25639209 PMCID: PMC4572893 DOI: 10.1002/jbmr.2446] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/19/2014] [Accepted: 12/24/2014] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnea (OSA) and low bone mass are two prevalent conditions, particularly among older adults-a section of the U.S. population that is expected to grow dramatically over the coming years. OSA, the most common form of sleep-disordered breathing, has been linked to multiple cardiovascular, metabolic, hormonal, and inflammatory derangements and may have adverse effects on bone. However, little is known about how OSA (including the associated hypoxia and sleep loss) affects bone metabolism. In order to gain insight into the relationship between sleep and bone, we review the growing information on OSA and metabolic bone disease and discuss the pathophysiological mechanisms by which OSA may affect bone metabolism/architecture.
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Affiliation(s)
- Christine M Swanson
- Division of Endocrinology, Oregon Health and Science University, Portland, OR, USA; Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
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Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study. Mediators Inflamm 2014; 2014:605280. [PMID: 24991089 PMCID: PMC4058796 DOI: 10.1155/2014/605280] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/17/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction. Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.
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