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He Y, Dong N, Wang X, Lv RJ, Yu Q, Yue HM. Obstructive sleep apnea affects cognition: dual effects of intermittent hypoxia on neurons. Sleep Breath 2024; 28:1051-1065. [PMID: 38308748 DOI: 10.1007/s11325-024-03001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Abstract
Obstructive sleep apnea (OSA) is a common respiratory disorder. Multiple organs, especially the central nervous system (CNS), are damaged, and dysfunctional when intermittent hypoxia (IH) occurs during sleep for a long time. The quality of life of individuals with OSA is significantly impacted by cognitive decline, which also escalates the financial strain on their families. Consequently, the development of novel therapies becomes imperative. IH induces oxidative stress, endoplasmic reticulum stress, iron deposition, and neuroinflammation in neurons. Synaptic dysfunction, reactive gliosis, apoptosis, neuroinflammation, and inhibition of neurogenesis can lead to learning and long-term memory impairment. In addition to nerve injury, the role of IH in neuroprotection was also explored. While causing neuron damage, IH activates the neuronal self-repairing mechanism by regulating antioxidant capacity and preventing toxic protein deposition. By stimulating the proliferation and differentiation of neural stem cells (NSCs), IH has the potential to enhance the ratio of neonatal neurons and counteract the decline in neuron numbers. This review emphasizes the perspectives and opportunities for the neuroprotective effects of IH and informs novel insights and therapeutic strategies in OSA.
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Affiliation(s)
- Yao He
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Na Dong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiao Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ren-Jun Lv
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Qin Yu
- Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hong-Mei Yue
- Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, China.
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Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, Corlateanu A. The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP. Clocks Sleep 2023; 5:333-349. [PMID: 37366660 DOI: 10.3390/clockssleep5020025] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.
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Affiliation(s)
- Victoria Sircu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Silvia-Iaroslava Colesnic
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, 125284 Moscow, Russia
- Department of Emergency Medicine № 76, Botkin Hospital, 125284 Moscow, Russia
| | - Olga Corlateanu
- Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Anna Sukhotko
- Department of General Oncology № 71, Botkin Hospital, 125284 Moscow, Russia
| | - Cristian Popovici
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Alexandru Corlateanu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
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Parveen N, Parganiha A. Consequences and factors associated with OSA: a brief review. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2054558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Noorshama Parveen
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur, India
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Circulating Superoxide Dismutase Concentrations in Obstructive Sleep Apnoea (OSA): A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2021; 10:antiox10111764. [PMID: 34829635 PMCID: PMC8614927 DOI: 10.3390/antiox10111764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022] Open
Abstract
Obstructive Sleep Apnoea (OSA) is characterized by a pro-oxidant state that results from the recurrent hypoxia-reoxygenation cycles. Superoxide dismutase (SOD), a key antioxidant enzyme involved in the detoxification of superoxide radicals, could represent a reliable marker to monitor the antioxidant defences in OSA. In order to capture and critically appraise the available evidence, we performed a systematic review and meta-analysis of studies reporting SOD concentrations in OSA patients and non-OSA controls in the electronic databases Pubmed, Web of Science, Scopus and Google Scholar. In total, 13 studies in 847 OSA patients and 438 non-OSA controls were included in the meta-analysis. Blood SOD concentrations were significantly lower in OSA patients (SMD = 0.87, p < 0.001). By contrast, serum/plasma SOD concentrations were not significantly different between the two groups. Although extreme between-study heterogeneity was observed, the SMD was not substantially modified when individual studies were sequentially removed. In conclusion, we observed that whole blood, but not serum/plasma, SOD concentrations were significantly lower in OSA patients compared with controls. Our meta-analysis suggests an impaired antioxidant defence in OSA that is more robustly assessed in the corpuscular biological matrix and provides useful background information for further studies investigating the association between SOD changes and clinical status in OSA.
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Circulating Malondialdehyde Concentrations in Obstructive Sleep Apnea (OSA): A Systematic Review and Meta-Analysis with Meta-Regression. Antioxidants (Basel) 2021; 10:antiox10071053. [PMID: 34210032 PMCID: PMC8300833 DOI: 10.3390/antiox10071053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Oxidative stress induced by nocturnal intermittent hypoxia plays a significant pathophysiological role in obstructive sleep apnea (OSA). Malondialdehyde (MDA), one of the most commonly investigated markers of lipid peroxidation, might assist with the monitoring of oxidative balance in OSA. We conducted a systematic review and meta-analysis to evaluate the differences in circulating MDA concentrations between patients with OSA and non-OSA controls. A systematic search was conducted in the electronic databases Pubmed, Web of Science, Scopus and Google Scholar from inception to December 2020 by using the following terms: “malondialdehyde” or “MDA”; and “Obstructive Sleep Apnea Syndrome”, “OSAS” or “OSA”. We identified 26 studies in 1223 OSA patients and 716 controls. The pooled MDA concentrations were significantly higher in patients with OSA (standardized mean difference (SMD) 1.43 μmol/L, 95% confidence interval (CI) 1.03 to 1.83 μmol/L, p < 0.001). There was extreme heterogeneity between the studies (I2 = 92.3%, p < 0.001). In meta-regression analysis, the SMD was significantly associated with age, the assay type used and publication year. In our meta-analysis, MDA concentrations were significantly higher in OSA patients than in controls. This finding suggests that MDA, which is a marker of lipid peroxidation, is involved in the pathogenesis of OSA and provides insights for future studies investigating its potential clinical use.
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Mc Carthy CE. Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person. Med Sci (Basel) 2021; 9:medsci9020031. [PMID: 34063838 PMCID: PMC8162526 DOI: 10.3390/medsci9020031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023] Open
Abstract
Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.
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Affiliation(s)
- Christine E. Mc Carthy
- Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland;
- HRB-Clinical Research Facility, National University of Ireland, Galway, Co., Galway, Ireland
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Pauletto P, Réus JC, Bolan M, Massignan C, Flores-Mir C, Maia I, Gozal D, Hallal ALC, Porporatti AL, Canto GDL. Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review. Sleep Breath 2021; 25:1773-1789. [PMID: 33709191 DOI: 10.1007/s11325-021-02323-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this systematic review was to answer the question: "Is there association between obstructive sleep apnea (OSA) and health-related quality of life (HRQoL) in untreated adults?" METHODS We included observational studies that evaluated the health-related quality of life of patients with OSA vs control groups, through generic and disease-specific questionnaires. The searches were conducted in six databases: Embase, Lilacs, PsycINFO, PubMed, Scopus, and Web of Science. Additional search in the grey literature and hand search were performed, and also experts were consulted. Risk of bias was performed by using Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional, cohort, and case-control studies. We analyzed the data using a narrative synthesis. The Grading of Recommendations Assessment, Development, and Evaluation evidence profile was used to verify the overall certainty of the assessed evidence. RESULTS Nineteen studies were included for qualitative analysis. Generic questionnaires showed worse HRQoL in the OSA group compared to the control group in at least one domain of the HRQoL questionnaires. The affected domains that showed statistical and clinically relevant differences were physical functioning, physical role, pain, general health, vitality, emotional role, and mental health. The certainty of evidence assessment was very low. CONCLUSION The available literature suggests that OSA in untreated adults is associated with worse HRQoL. However, this association seems to disappear when we consider only studies adjusted for related covariates. REGISTRATION CRD42018114746.
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Affiliation(s)
- Patrícia Pauletto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.
| | - Jéssica Conti Réus
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Michele Bolan
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Carla Massignan
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.,Department of Dentistry, Federal University of Brasília, Brasilia, Distrito Federal, Brazil
| | | | - Israel Maia
- Baía Sul Research Institute, Florianópolis, Santa Catarina, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, 65201, USA
| | - Ana Luiza Curi Hallal
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - André Luís Porporatti
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Graziela De Luca Canto
- Department of Dentistry, Brazilian Centre for Evidence-Based Research, Health Sciences Center, Federal University of Santa Catarina, Campus Universitário Caixa Postal 476 - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
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Fadaei R, Koushki M, Sharafkhaneh A, Moradi N, Ahmadi R, Rostampour M, Khazaie H. The impact of continuous positive airway pressure therapy on circulating levels of malondialdehyde: a systematic review and meta-analysis. Sleep Med 2020; 75:27-36. [PMID: 32853915 DOI: 10.1016/j.sleep.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder which associated with increased oxidative stress and cardiovascular diseases. Malondialdehyde (MDA) is a reliable marker of lipid peroxidation and is elevated in patients with OSA. Studies reported inconsistent findings on the effect of continuous positive airway pressure (CPAP) therapy on MDA levels. As the study power maybe a reason for the inconsistent findings, we aimed to use meta-analysis to assess effect of CPAP therapy on MDA in patients with OSA. METHOD Electronic search was performed to find out studies on the effect of CAPA on MDA levels in OSA patients. Search carried out in databases of PubMed, EMBASE, Scopus, Cochrane library and web of science. RESULTS Search resulted in 161 records of which 83 remained after removing duplicated records. Further, 51 articles were removed by title and abstract and 22 records evaluated by full text. Finally 13 articles were included in the intended meta-analysis. Pooled analysis demonstrated that CPAP therapy reduced MDA levels significantly [SMD (-1.51) (95% CI, -2.06 to -0.97) p < 0.05]. Subgroup analyses showed that CPAP therapy was effective in categories of age (≤50 and > 50 years), BMI (≤30 and > 30 kg/m2) and therapy duration (≤12 week and >12 week). CONCLUSION the results of the present study demonstrated considerable effect of CPAP therapy on MDA as independent risk factor for cardiovascular diseases and robust marker of lipid peroxidation.
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Affiliation(s)
- Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Koushki
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sharafkhaneh
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nariman Moradi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Ahmadi
- Clinical Biochemistry Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Chen Q, Chen LD, Chen MX, Wu YH, Zeng HX, Hu MF, Zhang WL, Zheng YF, Lin QC. The effect of continuous positive airway pressure on circulating malondialdehyde among obstructive sleep apnea patients: a meta-analysis. Sleep Breath 2019; 24:1407-1415. [PMID: 31873838 DOI: 10.1007/s11325-019-01998-x] [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: 10/21/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been demonstrated to be associated with an increase of oxidative stress. However, whether circulating malondialdehyde (MDA), a widely used biomarker of oxidative stress, could be reduced by the treatment of OSA by continuous positive airway pressure (CPAP) is debated. The present meta-analysis was performed to determine the effect of CPAP treatment on circulating MDA among patients with OSA. METHODS A systematic search of PubMed, Embase, and Web of Science was performed for literature covering the period between 1967 and August 2019. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-CPAP therapy. RESULTS A total of 10 studies with 220 patients were included in this meta-analysis. A significant decrease in circulating MDA was observed after CPAP treatment (SMD = 1.164, 95% CI = 0.443 to 1.885, z = 3.16, p = 0.002) in OSA patients. Subgroup analyses revealed that CPAP therapy was associated with a significant decrease of circulating MDA in elder (SMD = 1.629, 95% CI = 0.265 to 2.994, z = 2.34, p = 0.019), more obese patients (SMD = 0.954, 95% CI = 0.435 to 1.473, z = 3.61, p = 0.000), more severe OSA patients (SMD = 0.879, 95% CI = 0.421 to 1.336, z = 3.76, p = 0.000), patients with therapeutic duration ≥ 3 months (SMD = 1.867, 95% CI = 0.563 to 3.172, z = 2.80, p = 0.005), and patients with good compliance (SMD = 1.004, 95% CI = 0.703 to 1.305, z = 6.54, p = 0.000). CONCLUSIONS This meta-analysis suggested that CPAP therapy exerted significant lowering effects on circulating MDA, especially in elder, more obese, and more severe OSA patients and patients with good compliance as well as longer duration of CPAP application.
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Affiliation(s)
- Qin Chen
- College of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, People's Republic of China
| | - Li-Da Chen
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Meng-Xue Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No 20, Chazhong road, Taijiang district, Fuzhou, 350005, Fujian Province, People's Republic of China
| | - Yan-Hua Wu
- Medical Intensive Care Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Hui-Xue Zeng
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Miao-Fen Hu
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Wei-Liang Zhang
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Yi-Feng Zheng
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, People's Republic of China
| | - Qi-Chang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No 20, Chazhong road, Taijiang district, Fuzhou, 350005, Fujian Province, People's Republic of China. .,Fujian Provincial Sleep-disordered Breathing Clinic Center, Fuzhou, Fujian Province, People's Republic of China. .,Laboratory of Respiratory Disease of the Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
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Feliciano A, Vaz F, Torres VM, Valentim-Coelho C, Silva R, Prosinecki V, Alexandre BM, Carvalho AS, Matthiesen R, Malhotra A, Pinto P, Bárbara C, Penque D. Evening and morning peroxiredoxin-2 redox/oligomeric state changes in obstructive sleep apnea red blood cells: Correlation with polysomnographic and metabolic parameters. Biochim Biophys Acta Mol Basis Dis 2016; 1863:621-629. [PMID: 27864139 DOI: 10.1016/j.bbadis.2016.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/18/2016] [Accepted: 11/14/2016] [Indexed: 12/20/2022]
Abstract
We have examined the effects of Obstructive Sleep Apnea (OSA) on red blood cell (RBC) proteome variation at evening/morning day time to uncover new insights into OSA-induced RBC dysfunction that may lead to OSA manifestations. Dysregulated proteins mainly fall in the group of catalytic enzymes, stress response and redox regulators such as peroxiredoxin 2 (PRDX2). Validation assays confirmed that at morning the monomeric/dimeric forms of PRDX2 were more overoxidized in OSA RBC compared to evening samples. Six month of positive airway pressure (PAP) treatment decreased this overoxidation and generated multimeric overoxidized forms associated with chaperone/transduction signaling activity of PRDX2. Morning levels of overoxidized PRDX2 correlated with polysomnographic (PSG)-arousal index and metabolic parameters whereas the evening level of disulfide-linked dimer (associated with peroxidase activity of PRDX2) correlated with PSG parameters. After treatment, morning overoxidized multimer of PRDX2 negatively correlated with fasting glucose and dopamine levels. Overall, these data point toward severe oxidative stress and altered antioxidant homeostasis in OSA RBC occurring mainly at morning time but with consequences till evening. The beneficial effect of PAP involves modulation of the redox/oligomeric state of PRDX2, whose mechanism and associated chaperone/transduction signaling functions deserves further investigation. RBC PRDX2 is a promising candidate biomarker for OSA severity and treatment monitoring, warranting further investigation and validation.
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Affiliation(s)
- Amélia Feliciano
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Fátima Vaz
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal
| | - Vukosava M Torres
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal
| | - Cristina Valentim-Coelho
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Rita Silva
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Vesna Prosinecki
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Bruno M Alexandre
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Ana S Carvalho
- Departamento da Promoção da Saúde, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Rune Matthiesen
- Departamento da Promoção da Saúde, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal
| | - Atul Malhotra
- Pulmonary, Critical Care and Sleep Medicine Division, University of California San Diego, CA, USA
| | - Paula Pinto
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cristina Bárbara
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte (CHLN), Lisboa, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Deborah Penque
- Laboratório de Proteómica, Departamento de Genética Humana, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa 1640-016, Portugal; ToxOmics- Centre of Toxicogenomics and Human Health, Universidade Nova de Lisboa, Portugal..
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Role of Oxidative Stress in the Neurocognitive Dysfunction of Obstructive Sleep Apnea Syndrome. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:9626831. [PMID: 27774119 PMCID: PMC5059616 DOI: 10.1155/2016/9626831] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is characterized by chronic nocturnal intermittent hypoxia and sleep fragmentations. Neurocognitive dysfunction, a significant and extraordinary complication of OSAS, influences patients' career, family, and social life and reduces quality of life to some extent. Previous researches revealed that repetitive hypoxia and reoxygenation caused mitochondria and endoplasmic reticulum dysfunction, overactivated NADPH oxidase, xanthine oxidase, and uncoupling nitric oxide synthase, induced an imbalance between prooxidants and antioxidants, and then got rise to a series of oxidative stress (OS) responses, such as protein oxidation, lipid peroxidation, and DNA oxidation along with inflammatory reaction. OS in brain could trigger neuron injury especially in the hippocampus and cerebral cortex regions. Those two regions are fairly susceptible to hypoxia and oxidative stress production which could consequently result in cognitive dysfunction. Apart from continuous positive airway pressure (CPAP), antioxidant may be a promising therapeutic method to improve partially reversible neurocognitive function. Understanding the role that OS played in the cognitive deficits is crucial for future research and therapeutic strategy development. In this paper, recent important literature concerning the relationship between oxidative stress and cognitive impairment in OSAS will be summarized and the results can provide a rewarding overview for future breakthrough in this field.
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Netzer NC, Ancoli-Israel S, Bliwise DL, Fulda S, Roffe C, Almeida F, Onen H, Onen F, Raschke F, Martinez Garcia MA, Frohnhofen H. Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force. Eur Respir J 2016; 48:992-1018. [DOI: 10.1183/13993003.01975-2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.
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Impaired sustained attention and lapses are present in patients with mild obstructive sleep apnea. Sleep Breath 2015; 20:681-7. [PMID: 26564169 DOI: 10.1007/s11325-015-1279-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/12/2015] [Accepted: 10/21/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe obstructive sleep apnea (OSA) directly affects the quality of life, mood, and sustained attention of individuals, but it has not yet been established in the literature, if these changes also affect patients with mild OSA. The purpose of this study was to investigate such negative effects on the parameters described above. METHODS A controlled study was held at the Universidade Federal de Sao Paulo, Department of Psychobiology. Thirty-nine mild OSA patients and 25 controls were included. Volunteers could be of both genders with body mass index (BMI) ≤35 kg/m(2) and age between 18 and 65 years. Both groups were subjected to full-night polysomnography (PSG), the subjective assessment of mood (Beck Inventory of Anxiety and Depression), Functional Outcomes of Sleep Questionnaire (FOSQ), and the psychomotor vigilance task (PVT) five times during the day. We considered mild OSA patients those with apnea-hypopnea index (AHI) score between 5 and 15. The control group included subjects with AHI scores <5, respiratory disturbance index (RDI) scores ≤5, arousal index values ≤15, and Epworth Sleepiness Scale (ESS) values ≤9. RESULTS Mild OSA patients were older and more obese than the controls. After adjusting for age, BMI, and schooling years, there was an increased number of total lapses (3.90 ± 4.16 and 2.43 ± 5.55, p = 0.004). CONCLUSIONS Patients with mild OSA showed increased sustained attention lapses compared with normal subjects.
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Yüksel M, Okur HK, Pelin Z, Öğünç AV, Öztürk L. Arginase activity and nitric oxide levels in patients with obstructive sleep apnea syndrome. Clinics (Sao Paulo) 2014; 69:247-52. [PMID: 24714832 PMCID: PMC3971361 DOI: 10.6061/clinics/2014(04)05] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/22/2013] [Accepted: 09/19/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea syndrome is characterized by repetitive obstruction of the upper airways, and it is a risk factor for cardiovascular diseases. There have been several studies demonstrating low levels of nitric oxide in patients with obstructive sleep apnea syndrome compared with healthy controls. In this study, we hypothesized that reduced nitric oxide levels would result in high arginase activity. Arginase reacts with L-arginine and produces urea and L-ornithine, whereas L-arginine is a substrate for nitric oxide synthase, which produces nitric oxide. METHODS The study group consisted of 51 obstructive sleep apnea syndrome patients (M/F: 43/8; mean age 49±10 years of age) and 15 healthy control subjects (M/F: 13/3; mean age 46±14 years of age). Obstructive sleep apnea syndrome patients were divided into two subgroups based on the presence or absence of cardiovascular disease. Nitric oxide levels and arginase activity were measured via an enzyme-linked immunosorbent assay of serum samples. RESULTS Serum nitric oxide levels in the control subjects were higher than in the obstructive sleep apnea patients with and without cardiovascular diseases (p<0.05). Arginase activity was significantly higher (p<0.01) in obstructive sleep apnea syndrome patients without cardiovascular diseases compared with the control group. Obstructive sleep apnea syndrome patients with cardiovascular diseases had higher arginase activity than the controls (p<0.001) and the obstructive sleep apnea syndrome patients without cardiovascular diseases (p<0.05). CONCLUSION Low nitric oxide levels are associated with high arginase activity. The mechanism of nitric oxide depletion in sleep apnea patients suggests that increased arginase activity might reduce the substrate availability of nitric oxide synthase and thus could reduce nitric oxide levels.
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Affiliation(s)
- Meral Yüksel
- Department of Medical Laboratory Techniques, Vocational School of Health Services, Marmara University, Istanbul, Turkey
| | - Hacer Kuzu Okur
- Chest Diseases Clinics, Fatih Sultan Mehmet Research and Education Hospital, Istanbul, Turkey
| | - Zerrin Pelin
- Vocational School of Health-related Professions, Gazikent Hasan Kalyoncu University, Gaziantep, Turkey
| | - Ayliz Velioğlu Öğünç
- Department of Medical Laboratory Techniques, Vocational School of Health Services, Marmara University, Istanbul, Turkey
| | - Levent Öztürk
- Department of Physiology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Yang LX, Ma SG, Liu H, Xu W. Influence of obstructive sleep apnea on serum butyrylcholinesterase activity and ischemia-modified albumin levels. Clinics (Sao Paulo) 2013; 68:968-73. [PMID: 23917661 PMCID: PMC3714914 DOI: 10.6061/clinics/2013(07)13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the effect of obstructive sleep apnea and continuous positive airway pressure treatment on serum butyrylcholinesterase activity and ischemia-modified albumin levels. METHODS Thirty-two patients with obstructive sleep apnea and 30 age- and sex-matched controls were enrolled and underwent a diagnostic polysomnogram. The serum butyrylcholinesterase activity, ischemia-modified albumin levels, metabolic parameters, and polysomnography scores were detected and evaluated. Nine patients were studied before and after treatment with continuous positive airway pressure. RESULTS The serum ischemia-modified albumin levels were significantly higher and the butyrylcholinesterase activity was significantly lower in patients with obstructive sleep apnea than in the controls (p<0.001). The continuous positive airway pressure treatment decreased the modified albumin levels and elevated the buthrylcholinesterase activity (p=0.019 and p=0.023, respectively). The modified albumin levels were positively correlated with the apnea-hypopnea index (r=0.462, p=0.008) at baseline. Elevated ischemia-modified albumin levels can be more accurate than butyrylcholinesterase activity at reflecting the presence of obstructive sleep apnea. Receiver operating characteristic curves revealed a significant difference between the areas under the curve 0.916 for ischemia-modified albumin and 0.777 for butyrylcholinesterase (z=2.154, p=0.031). CONCLUSION The elevated ischemia-modified albumin level was significantly associated with obstructive sleep apnea and was more sensitive than butyrylcholinesterase activity in reflecting obstructive sleep apnea. The continuous positive airway pressure treatment helped to ameliorate the imbalance.
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Affiliation(s)
- Liu-Xue Yang
- Guangxi Medical University Graduate School, Guangxi, China
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