The Effect of Obesity on Sleep Apnea Pathogenesis Differs in Women vs Men: Multiple Mediation Analyses in the Retrospective SNOOzzzE Cohort

BACKGROUND AND OBJECTIVE

There are multiple mechanisms underlying obstructive sleep apnea (OSA) development. However, how classic OSA risk factors such as body mass index (BMI) and sex portend to OSA development have not been fully described. Thus, we sought to evaluate how obesity leads to OSA, and assess how these mechanisms differ between men and women. Methods The San Diego Multi-Outcome OSA Endophenotype (SNOOzzzE) cohort includes 3,319 consecutive adults who underwent a clinical in-laboratory polysomnography at the UCSD sleep clinic between 1/2017-12/2019. Using routine polysomnography signals, we determined OSA endotypes. We then performed mediation analyses stratified by sex to determine how BMI influenced apnea hypopnea index (AHI) using OSA endotypic traits as mediators. Results We included 2,146 patients of whom 919 (43%) were women and 1,227 (57%) were obese. BMI was significantly associated with AHI in both women and men. In men, the effect of BMI on AHI was partially mediated by a reduction in upper airway stiffness (31% of total effect, TE), by a reduction in circulatory delay (16%TE), and by an increase in arousal threshold (7%TE). In women, the effect of BMI on AHI was partially mediated by a reduction in circulatory delay (22%TE). Discussion BMI-related OSA pathogenesis differs by sex. An increase in upper airway collapsibility (in men) is consistent with prior studies. A reduction in circulatory delay may lead to shorter and thus more events per hour (i.e., higher AHI), while the association between a higher arousal threshold and higher AHI may reflect reverse causation.

Physiological Determinants of Snore Loudness

Rationale: The physiological factors modulating the severity of snoring have not been adequately described. Airway collapse or obstruction is generally the leading determinant of snore sound generation; however, we suspect that ventilatory drive is of equal importance. Objective: To determine the relationship between airway obstruction and ventilatory drive on snore loudness. Methods: In 40 patients with suspected or diagnosed obstructive sleep apnea (1-98 events/hr), airflow was recorded via a pneumotachometer attached to an oronasal mask, ventilatory drive was recorded using calibrated intraesophageal diaphragm electromyography, and snore loudness was recorded using a calibrated microphone attached over the trachea. "Obstruction" was taken as the ratio of ventilation to ventilatory drive and termed flow:drive, i.e., actual ventilation as a percentage of intended ventilation. Lower values reflect increased flow resistance. Using 165,063 breaths, mixed model analysis (quadratic regression) quantified snore loudness as a function of obstruction, ventilatory drive, and the presence of extreme obstruction (i.e., apneic occlusion). Results: In the presence of obstruction (flow:drive = 50%, i.e., doubled resistance), snore loudness increased markedly with increased drive (+3.4 [95% confidence interval, 3.3-3.5] dB per standard deviation [SD] change in ventilatory drive). However, the effect of drive was profoundly attenuated without obstruction (at flow:drive = 100%: +0.23 [0.08-0.39] dB per SD change in drive). Similarly, snore loudness increased with increasing obstruction exclusively in the presence of increased drive (at drive = 200% of eupnea: +2.1 [2.0-2.2] dB per SD change in obstruction; at eupneic drive: +0.14 [-0.08 to 0.28] dB per SD change). Further, snore loudness decreased substantially with extreme obstruction, defined as flow:drive <20% (-9.9 [-3.3 to -6.6] dB vs. unobstructed eupneic breathing). Conclusions: This study highlights that ventilatory drive, and not simply pharyngeal obstruction, modulates snore loudness. This new framework for characterizing the severity of snoring helps better understand the physiology of snoring and is important for the development of technologies that use snore sounds to characterize sleep-disordered breathing.

Designing, optimization, and validation of whole blood direct T-ARMS PCR for precise and rapid genotyping of complex vertebral malformation in cattle

Background

DNA testing in the cattle industry undergoes multiple hurdles. Successful genotyping involves the transportation of samples from the field to the laboratory in a chilled environment followed by DNA extraction, and finally, a specific genotyping protocol is followed. Various researches are focused on overcoming these issues. Microcards offer blood transportation at ambient temperature. Direct PCR methods can save the time of DNA extraction but available only for simplex PCR. Tetra Primer-Amplification Refractory Mutation System based Polymerase Chain Reaction (T-ARMS PCR) can make DNA testing faster in a low-cost setting. The present study was aimed to design, optimize, and validate a T-ARMS PCR for faster DNA testing of SNP responsible for Complex Vertebral Malformation (CVM)-an important genetic disease of the cattle industry. Further, a direct T-ARMS PCR from whole blood was developed to avoid the DNA extraction steps. Lastly, using the optimized protocol, genotyping of blood spotted on Microcard eliminates the need for cold chain maintenance in the transportation of samples.

Results

The present study demonstrated a novel T-ARMS PCR-based genotyping of the SNP rs438228855, which is responsible for CVM. Here, wild genotypes were recognized by 389 bp and 199 bp bands in agarose gel, while the carrier genotype showed an additional 241 bp band. The developed protocol was validated using PCR-Primer Introduced Restriction Analysis (PCR-PIRA) and sequencing. The present study further established a direct T-ARMS PCR for this SNP from whole blood. Different conditions such as heparin and EDTA treated blood, the need for pre-treatment, and two different DNA Polymerases for the direct PCR were optimized. Finally, our optimized protocol successfully genotyped the whole blood samples dried on Insta™DNA cards.

Conclusions

The present study reported the usefulness of primer modified T-ARMS PCR for detecting CVM for the first time. To the best of our knowledge, direct PCR in T-ARMS PCR has never been reported. Lastly, the use of microcards in the developed protocol can make the assay useful in the DNA testing of field samples.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12896-021-00696-5.

Association analysis of novel polymorphisms in 2', 5'-oligoadenylate synthetase gene with reproductive traits in indigenous and cross-bred cattle of Indian Origin

2', 5'-Oligoadenylate synthetases (OAS) are important components of an interferon-mediated antiviral pathway. No polymorphisms in exonic regions of bovine OAS1 gene have been identified and associated with reproduction traits. The objective of the study was to detect and evaluate the effects of mutations in exonic region of bovine OAS1 gene with reproduction traits in cattle. DNA samples collected from 250 individual cows of two Indian dairy breeds (Sahiwal and Frieswal) of cattle were used in the study. The genetic variants of the OAS1 gene were identified with polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and sequence analysis using seven set of primer pairs. The PCR-SSCP analysis revealed polymorphism in the fragments comprising of exon 2, exon 5 and first fragment of exon 6 while the fragments of exons 1, 3, 4 and second fragment of exon 6 were monomorphic in Sahiwal and Frieswal cattle. The mutations in the amplified region comprising of exon 2 were found to have significant association with age at first breeding and calving, service period, dry period and pregnancy rate. Significant associations were found between SNPs in the exon 5 and service and dry periods of the animal, whereas the genetic variants in the first fragment of the exon 6 showed significant association with age at first breeding and calving. To our knowledge, this study demonstrated for the first time that the polymorphisms in OAS1 gene were associated with reproductive traits and it can be chosen as a candidate gene for improvement of reproductive performance of cattle.

The impact of intermittent or sustained carbon dioxide on intermittent hypoxia initiated respiratory plasticity. What is the effect of these combined stimuli on apnea severity?

The following review explores the effect that intermittent or sustained hypercapnia coupled to intermittent hypoxia has on respiratory plasticity. The review explores published work which suggests that intermittent hypercapnia leads to long-term depression of respiration when administered in isolation and prevents the initiation of long-term facilitation when administered in combination with intermittent hypoxia. The review also explores the impact that sustained hypercapnia alone and in combination with intermittent hypoxia has on the magnitude of long-term facilitation. After exploring the outcomes linked to intermittent hypoxia/hypercapnia and intermittent hypoxia/sustained hypercapnia the translational relevance of the outcomes as it relates to breathing stability during sleep is addressed. The likelihood that naturally induced cycles of intermittent hypoxia, coupled to oscillations in carbon dioxide that range between hypocapnia and hypercapnia, do not initiate long-term facilitation is addressed. Moreover, the conditions under which intermittent hypoxia/sustained hypercapnia could serve to improve breathing stability and mitigate co-morbidities associated with sleep apnea are considered.

Dynamic modeling of apnea induced concurrent variations in arterial blood pressure and cerebral blood flow velocity

Obstructive Sleep Apnea (OSA) is characterized by partial (hypopnea) or complete cessation (apnea) of airflow to the lungs during sleep. It has been previously reported that apnea episodes lead to significant rise in instantaneous blood pressure concomitant with a rise in cerebral blood flow velocity, indicating loss of cerebral autoregulation during the episodes. In this study, we have used Auto Regressive Moving Average model (ARMA (n_a, n_b, n_k)) to quantify OSA induced dynamic changes in cerebral blood flow velocity (CBFV) with beat to beat blood pressure (BP) as an input. BP and CBFV were recorded from 11 positively diagnosed sleep apnea subjects (6 Males, 5 Females; Age: 54.27±6.23 years, BMI:34.95±7.06kg/m², AHI: 57.39±28.43). The results suggest that two separate models, ARMA (5, 9, 1) and ARMA (5, 10, 0) can be used to quantify dynamic CBFV variations during apneas with a duration of less than and greater than 30s respectively with reasonable accuracy (<;6% error).

LAMP assay for rapid diagnosis of cow DNA in goat milk and meat samples

Animal species detection is one of the crucial steps for consumer's food analysis. In the present study we developed an in-house built loop-mediated isothermal amplification (LAMP) assay for rapid detection of adulterated cow DNA in goat milk/meat samples. The cow milk/tissue DNA in goat milk/meat samples were identified in the developed LAMP assay by either naked eye visualizing with SYBR Green I dyes or by detecting the typical ladder pattern on gel electrophoresis. This test can detect up to minimum 5% level of cow components admixed in goat milk/meat samples and can be completed within 1 h 40 min starting from DNA extraction from milk/meat samples and can be performed in a water bath. Developed LAMP methodology is simple; rapid and sensitive techniques that can detect adulterant like cow components in goat milk/meat are more accurate than other existing DNA based technologies.

A study of apnea induced covariations of cerebral blood flow and exhaled CO2

Sleep apnea is identified by repetitive reduction or complete cessation of breathing during sleep. Sleep apnea affects cerebral hemodynamics and it is important to study this effect. Measuring cerebral blood flow during sleep is challenging due to the need to maintain a contact between the flow probe and the skull. It is hypothesized that there exists a relationship between the variations in the exhaled CO2 and Cerebral Blood Flow during sleep apnea. To test this hypothesis, the present study was conducted in two parts: simulated and nocturnal sleep study. 9 volunteer subjects (6 Male and 3 Female Age: 23.11±1.59 years BMI: 21.9±2.409kg/m2) participated in the simulated study and 10 volunteer subjects (9 Male and 1 Female Age: 50.2±7.48 years BMI: 31.541±4.56 kg/m2 AHI: 62.84±20.44) participated in a nocturnal sleep study. Analyzing full waveforms of cerebral blood flow velocity (CBFV) and exhaled CO2, the relationship between 4 metrics from CBFV and 2 metrics from exhaled CO2 were investigated. Although one metric pair showed statistically significant and relatively high correlation (ρ= 0.68 p=7.96×10-7) during the simulated study, the same was not observed during the nocturnal study. Therefore, the proposed hypothesis could not be proven.

Effect of apnea duration on apnea induced variations in cerebral blood flow velocity and arterial blood pressure

Obstructive Sleep Apnea (OSA), defined by shallow breaths or complete cessation of breathing for more than 10s, is a significant contributing factor for the developments of hypertension, myocardial infarction, stroke and neuropsychological impairments. In this study, we have investigated the relation between apnea duration and apnea induced variations in cerebral blood flow velocity (CBFV) concomitant with blood pressure changes in 9 sleep apnea subjects (8 male and 1 female; Age: 46.0±11.6 years; BMI: 34.5±7.8 kg/m(2); AHI: 81.6±41). As apnea duration increased from 10s to greater than 30s, the mean percentage rise in CBFV increased from 22% to 42% for amplitude and 22% to 33% for area respectively. For blood pressure, the values increased from 14% to 26% for amplitude and 14% to 23% for area respectively. The results suggest that the apnea duration has a measurable effect on the degree of rise in both cerebral blood flow velocity and arterial blood pressure during apnea episodes (p=0.0002).

An investigation of simultaneous variations in cerebral blood flow velocity and arterial blood pressure during sleep apnea

Obstructive Sleep Apnea (OSA) is a major sleep disorder with a prevalence of about 15 % among US adult population and can lead to cardiovascular diseases and stroke. In this study, we have investigated the OSA-induced concurrent rise in cerebral blood flow velocity and blood pressure in 5 positively diagnosed sleep apnea subjects. The subject population had a mean AHI of 57.94±25.73 and BMI of 33.66±7.27 kg/m(2). The results of this preliminary study yielded a relatively high correlation between rise in blood pressure and rise in cerebral blood flow velocity during apnea episodes (r=0.61±0.16) compared to normal breathing (r=0.28±0.26). These findings suggest that cerebral autoregulation may be less effective during apnea episodes.

Compatibilization of SBR/NBR Blends Using Chemically Modified Styrene Butadiene Rubber

The effect of dichlorocarbene modified styrene butadiene rubber (DCSBR) as a compatibilizer in blends of acrylonitrile butadiene rubber and styrene butadiene rubber (SBR/NBR) has been studied. The cure characteristics, physical properties, crosslink density, FTIR studies and low temperature transitions of the blends were determined as a function of chlorine content of DCSBR. Compatibilizing efficiency depended on the chlorine content of DCSBR and composition of blend constituents. Effective compatibilization was achieved when chlorine content of compatibilizer was 25% and SBR content of blend was either 50% or lower. FTIR studies, glass transition behavior measured by DSC and DMA showed that an appreciable extent of molecular level miscibility has been achieved in SBR/NBR blends by using DCSBR as a compatibilizer. Improvement in mechanical properties such as tensile strength, tear strength, resilience, hardness and compression set were achieved both when DCSBR was added and chlorine content of DCSBR increased up to 25%. The resistance of the vulcanizate towards air and oil aging improved with compatibilization. The change in technological properties correlated with crosslink density of the blends assessed from swelling studies and stress-strain data.

Relation between arterial blood pressure and cerebral blood flow velocity in simulated sleep apnea

Obstructive Sleep Apnea (OSA) is one of the most common breathing disorder, affecting approximately 27% of U.S. adults. Limited data have suggested that OSA causes cerebral autoregulation impairment, thus being an important risk factor to stroke. The objective of this paper is to investigate and measure the relation between arterial blood pressure (BP) and cerebral blood flow velocity (CBFV) in simulated apnea. Sixteen healthy subjects (9 male, 7 female) of 29±4.89 yrs age and body mass index of 24.07±4.84 kg/m(2) participated in the study. Four protocols were used; sitting 30 seconds, 90 s, and supine 30 s and 90 s. Our results showed that systolic BP and peak CBFV were correlated with average r=0.672 +0.265. Also, CBFV exhibited a significantly higher percent rise than BP. Thus, our findings suggest that cerebral autoregulation may be impaired during apnea episodes.

Concurrent variations of cerebral blood flow and arterial blood pressure in simulated sleep apnea

Obstructive Sleep Apnea (OSA) is one of the most common sleep disordered breathing which affects about 15 % of US adult population. OSA is considered to be an important risk factor for the development of cardiac dysfunction and stroke. In this paper, we present the initial results of our investigation of the relationship between arterial blood pressure and cerebral blood flow velocity in simulated apnea. Sixteen healthy subjects (9 male, 7 female) of 29 ± 4.89 yrs age and body mass index of 24.07 ± 4.84 kg/m(2) participated in the study. Our findings indicate that cerebral blood flow velocity variations has a relatively high correlation to changes in blood pressure during simulated apnea (r = 0.74 ± 0.06), suggesting that cerebral autoregulation may not compensate for the pressure changes during apnea.

Is nitrocellulose filter binding really a universal assay for protein-DNA interactions?

The ability to bind to nitrocellulose is commonly accepted as being a universal property of proteins and has been widely used in many different fields of study. This property was first exploited in the study of DNA-binding proteins 30 years ago, in studies involving DNA binding by the lactose repressor (LacR) of Escherichia coli. Termed the filter-binding assay, it remains the quickest and easiest assay available for the study of protein-DNA interactions. However, the exact mechanism by which proteins bind to nitrocellulose remains uncertain. Given the supposedly universal nature of the interaction, we were surprised to notice that certain LacR variants were completely unable to bind simultaneously to DNA containing a single lac operator and nitrocellulose. Investigation of this loss of binding suggests that LacR requires a protein region that is both hydrophobic in nature and more or less unstructured, in order to bind to both nitrocellulose and DNA. In the case of wild-type, tetrameric LacR, the DNA-recognition domain that is not bound to DNA suffices. Dimeric LacR variants will only bind if they have certain C-terminal extensions. These experiments sound a cautionary note for the use of filter binding as an assay of choice, particularly in applications involving screening for the DNA-binding site of putative DNA-binding proteins.

Active apical secretory efflux of the HIV protease inhibitors saquinavir and ritonavir in Caco-2 cell monolayers

PURPOSE

To investigate in vitro the mechanisms involved in the gastro-intestinal absorption of the HIV protease inhibitor, saquinavir mesylate (Invirase), whose oral bioavailability is low, variable, and significantly increased by co-administration with ritonavir, also an HIV protease inhibitor but with higher oral bioavailability.

METHODS

Confluent epithelial layers of human Caco-2 cells mimicking the intestinal barrier.

RESULTS

Both saquinavir and ritonavir showed polarized transport through Caco-2 cell monolayers in the basolateral to apical direction (secretory pathway), exceeding apical to basolateral transport (absorptive pathway) by factors of 50-70 and 15-25, respectively. Active efflux was temperature dependent, saturable and inhibited by verapamil and cyclosporin A. Saquinavir and ritonavir decreased each other's secretory permeability and hence elevated their net transport by the absorptive pathway.

CONCLUSIONS

Saquinavir and ritonavir are both substrates for an efflux mechanism in the gut, most likely P-glycoprotein, which acts as a counter-transporter for both drugs. Together with sensitivity to gutwall metabolism by cytochrome P-450 3A, this may partially account for the low and variable oral bioavailability of saquinavir in clinical studies and for its increased bioavailability after co-administration with ritonavir.

A basic tail increases repression by dimeric lac repressor

Tetrameric Lac repressor achieves cooperative repression by binding simultaneously to O1 and to one of the auxiliary operators O2 or O3, thereby forcing the intervening DNA into a loop. Dimeric Lac repressor is not able to form DNA loops and consequently shows no cooperative repression. We constructed a dimeric Lac repressor mutant which exhibits increased repression to the lac operon that does not depend on specific operator-repressor-operator loops. This Lac repressor carries a synthetic tail of basic residues attached to its C terminus. With this construct, we observe an increase of the in vivo repression upon addition of auxiliary lac operators to a chromosomal lac operon controlled by O1. This suggests that the basic tail enables dimeric Lac repressor to enhance its repression by additional non-specific DNA contacts.

Single exchanges of amino acids in the basic region change the specificity of N-Myc

We exchanged specific amino acids in the basic region of the murine N-Myc protein and tested the mutant proteins for their DNA binding specificity. The amino acids we exchanged were chosen in analogy to residues of the homologous basic regions of bHLH and bZIP proteins. Mutant N-Myc peptides were expressed in Escherichia coli and specific DNA binding was monitored by gel shift experiments. For this we used palindromic target sequences with systematic base pair exchanges. Several mutants with altered DNA binding specificity were identified. Amino acid exchanges of residues -14 or -10 of the basic region lead to specificity changes (we define leucine 402 of N-Myc as +1; comparable to GCN4 see (1)). The palindromic N-Myc recognition sequence 5'CACGTG is no longer recognized by the mutant proteins, but DNA fragments with symmetrical exchanges of the target sequence are. Exchanges at position -15 broaden the binding specificity. These data were used to build a computer based model of the putative interactions of the N-Myc basic DNA binding region with its target sequence.

Determination of the DNA sequence recognized by the bHLH-zip domain of the N-Myc protein

The DNA-binding domain of the murine N-Myc protein, comprising the basic helix-loop-helix-zipper (bHLH-zip) region was expressed as a fusion protein in E. coli. The affinity purified glutathione-S-transferase-N-Myc fusion protein (GST-N-MYC) was used to select the N-Myc specific DNA-recognition motif from a pool of random-sequence oligonucleotides. After seven rounds of binding-site selection, specifically enriched oligonucleotides were cloned and sequenced. Of 31 individual oligonucleotides whose sequences were determined, 30 contained a common DNA-motif, defining the hexameric consensus sequence CACGTG. We confirm by mutational analysis that binding of the N-Myc derived bHLH-zip domain to this motif is sequence-specific.

[Biodegradable gentamicin-depot implants made of beta-tricalcium phosphate ceramics. 3. In vivo studies on drug release, tissue tolerance, and biodegradation]

In vivo drug release properties and biocompatibility of gentamicin-loaded controlled release implants made of beta-tricalcium phosphate ceramics designed for the local antibiotic treatment of bone infections were investigated. Controlled release pellets containing 0.4 and 0.8 mg of gentamicin were implanted into the femoral bone of rats. Drug release was measured from renal excretion over a time period of 3 weeks. The excretion pattern can be described by an initial phase of increased drug release was faster at higher drug loading. Drug release from glyceride-containing controlled release pellets occurs at a significantly slower rate than from drug-loaded pellets without glycerides. Histological studies after implantation of the pure ceramic pellets and the controlled release pellets into the bone tissue of rats and rabbits are showing a high tissue tolerance and the biodegradability of the implants. However, the glyceride-containing pellets are degraded at a slower rate than the pure ceramic pellets.

Encapsulation of water-soluble drugs by a modified solvent evaporation method. I. Effect of process and formulation variables on drug entrapment

Pseudoephedrine HCl, a highly water-soluble drug, was entrapped within poly (methyl methacrylate) microspheres by a water/oil/water emulsification-solvent evaporation method. An aqueous drug solution was emulsified into a solution of the polymer in methylene chloride, followed by emulsification of this primary emulsion into an external aqueous phase to form a water/oil/water emulsion. The middle organic phase separated the internal drug-containing aqueous phase from the continuous phase. Microspheres were formed after solvent evaporation and polymer precipitation. The drug content of the microspheres increased with increasing theoretical drug loading, increasing amounts of organic solvent, polymer and polymeric stabilizer, and decreased with increasing stirring time, increasing pH of the continuous phase and increased volume of the internal and external aqueous phase.