|
1
|
Akdağ G, Çetiner M. Evaluatıng osa rısk in drıvers: polysomnography and anthropometric measurements. Sleep Breath 2025; 29:124. [PMID: 40056314 DOI: 10.1007/s11325-025-03290-7] [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: 08/31/2024] [Revised: 01/05/2025] [Accepted: 02/24/2025] [Indexed: 03/10/2025]
Abstract
BACKGROUND Sleepiness significantly contributes to traffic accidents, with obstructive sleep apnea syndrome (OSA) being the leading medical cause. Effective treatment of OSA has been shown to reduce accident-related deaths and injuries. Turkish legislation has been updated to address driver's license issues for individuals with OSA, but implementation challenges and debates persist. METHODS Data from 159 patients who applied to obtain or renew their driver's licenses and underwent polysomnography between January 2020 and January 2024 were evaluated retrospectively. RESULTS The body mass index of 126 patients (79.24%) exceeded 33 kg per meter of height squared. OSA (apnea hypopnea index greater than 5) was detected in 85.5% of our patients, and the rate of severe OSA was 31.4%. We evaluated the presence of severe OSA using logistic regression analysis. Among the variables, the most important factor was neck circumference Receiver operating characteristic curve analysis identified severe OSA risk thresholds as neck circumference of 42.5 cm or greater and waist circumference of 122 cm or greater. CONCLUSIONS Considering neck and waist circumference rather than body mass index may facilitate informed decisions based on empirical measurements to identify OSA in driver's license applicants who require overnight polysomnography assessment.
Collapse
Affiliation(s)
- Gönül Akdağ
- Department of Neurology, School of Medicine, Kutahya Health Sciences University, Kütahya, Türkiye.
- Osmangazi Mah. Fatin Rüştü Zorlu Cad. Modernevler Sitesi, B13, D:6, Kütahya, Türkiye.
| | - Mustafa Çetiner
- Department of Neurology, School of Medicine, Kutahya Health Sciences University, Kütahya, Türkiye
| |
Collapse
|
|
2
|
Sami MM, Jamai MJ, Alkareem TAA, Ayram NB. Low progesterone levels and their role in the co-existence of polycystic ovary syndrome and rheumatoid arthritis: A comprehensive analysis among Iraqi patient. J Steroid Biochem Mol Biol 2025; 247:106680. [PMID: 39870327 DOI: 10.1016/j.jsbmb.2025.106680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 01/29/2025]
Abstract
Polycystic ovarian syndrome (PCOS) is a low-grade and chronic inflammation defined by irregular hormonal status that primarily triggers females in their reproductive age. Multi cysts are a primary manifestation of PCOS; a high level of androgen production characterizes the condition via ovaries. Rheumatoid arthritis (RA) is a chronic, systemic, and symmetrical inflammatory autoimmune disease that affects 1-2 % of adults. Females are more likely to generate RA. During the inflammatory activity, immune cells attack the synovium and the synovial space. This invasion is essential in releasing many cytokines in the synovial and joint spaces, leading to joint damage and pain, stiffens, heat, and tenderness in the joint. To evaluate the strength of the link between PCOS and RA, the cross-sectional study examined hormonal, metabolic, and autoantibodies in PCOS, RA as a positive control and the study groups. Statistical analysis Shapiro-Wilk test, student t-test, one-way ANOVA, and multi-linear regression analysis were used to evaluate the results. The data highlights significant values for the BMI, WHR, and hirsutism of PCOS and RA groups in comparison to the negative control. The ANOVA results of these parameters also showed a significant p < 0.05 among the groups. According to the negative control, the levels of insulin, HOMA-IR, testosterone, LH, estradiol, and CRP showed a substantial increase in the PCOS group. Also, the RA group showed a significant p < 0.05 rise in CRP, RF, and Ani-CCP, and the ANOVA results showed significant value among the groups under investigation. Progesterone D as a model showed a correlation with Anti-CCP B, RF C, Anti-CCP C, CRP D, RF D, and Anti-CCP D with the highest level of f2 between other models. In addition, statistical tests show that progesterone D with R2= 0.565 and RMSE equal to 0.996 have heteroscedasticity, which means that low levels of progesterone are associated inversely with high levels of RF and Anit-CCP. There is a relative association between the progesterone D model and corresponding predictions. Regardless of solid f2, only 56 % of the sample shows an association between the model and predictors; this relation may differ if we consider the study's limitations.
Collapse
Affiliation(s)
- Mohammed Mahdi Sami
- Department of Remote Sensing, College of Remote Sensing and geophysics-Al-Karkh University of Science, Baghdad, Iraq.
| | - Mataz J Jamai
- Department of Remote Sensing, College of Remote Sensing and geophysics-Al-Karkh University of Science, Baghdad, Iraq.
| | - Tamara Ahmed Abd Alkareem
- Department of Remote Sensing, College of Remote Sensing and geophysics-Al-Karkh University of Science, Baghdad, Iraq.
| | - Nabeel Bunyan Ayram
- Department of chemistry-College of Science, Mustansiriyah University, Baghdad, Iraq.
| |
Collapse
|
|
3
|
Abreu Lomba A, Montoya Ospina JM, Vernaza Trujillo DA, Sierra Castillo S, Aristizabal Colorado D, López Osorio GM, Guerrero Gonzalez LF, Pantoja Guerrero D, Arenas Quintero HM, Castellanos Pinedo AA, Valenzuela Rincón A, Pinzón Tovar A. Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) in Patients With Acromegaly in Colombia. Cureus 2025; 17:e77557. [PMID: 39958072 PMCID: PMC11829809 DOI: 10.7759/cureus.77557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2025] [Indexed: 02/18/2025] Open
Abstract
Background Acromegaly is a rare, chronic, and progressive disorder characterized by excessive secretion of growth hormone (GH) after the closure of the epiphyseal plates. The disease has an estimated annual incidence of 5 cases per 1,100,000 individuals. Sleep apnea/hypopnea syndrome (OSAHS) affects up to 80% of individuals with acromegaly and is recognized as an independent risk factor for the development of cardiovascular disease. This study aims to estimate the prevalence of SAHS and its associated factors in patients with acromegaly in Colombia. Methods This observational, retrospective cohort study utilized the National Registry of Patients with Acromegaly (RAPACO) data. The study evaluated patients who had undergone baseline polysomnography as a criterion for inclusion. Results A total of 163 patients were included in the study, of whom 89 (54.6%) were diagnosed with OSAHS. Women accounted for 99 (60.7%) of the cohort, aged 34.4 to 63.54 years. Patients with OSAHS exhibited a higher BMI and a longer disease duration. Additionally, they demonstrated elevated levels of IGF-1 (936.2 ± 447.2) and baseline GH (20.0 ± 20.4), both of which were statistically significant (p = 0.006 and p = 0.027, respectively). Severe apnea was the most prevalent form of the condition, and microadenoma was the predominant tumor type. Multivariate analysis identified disease duration and IGF-1 levels as the primary variables associated with OSAHS. Conclusion OSAHS is a prevalent comorbidity in patients with acromegaly, with hormonal factors playing a critical role in its pathogenesis. Consistent with previous studies, our findings demonstrate that elevated IGF-1 and GH levels are associated with greater OSAHS severity. Routine polysomnography (PSG) is recommended following the diagnosis of acromegaly. If OSAHS is confirmed, appropriate treatment should be initiated, and follow-up PSG should be performed during acromegaly management.
Collapse
Affiliation(s)
| | | | - David Alexander Vernaza Trujillo
- Epidemiology, Fundación Universitaria del Área Andina, Bogotá, COL
- Interinstitutional Group of Internal Medicine 1 (GIMI1), Universidad Libre, Cali, COL
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
4
|
Florescu AR, Mihaicuta S, Frent SM, Deleanu OC, Birza MR, Popa AM, Manzur AR, Gligor L, Bikov A. The relationship between composite lipid indices and baveno classification in patients with obstructive sleep apnoea. Sci Rep 2024; 14:30384. [PMID: 39638821 PMCID: PMC11621549 DOI: 10.1038/s41598-024-80113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 11/14/2024] [Indexed: 12/07/2024] Open
Abstract
Obstructive Sleep Apnoea (OSA) is associated with the development of cardiovascular disease (CVD); however, the risk is only weekly related to OSA severity traditionally determined by the apnoea-hypopnoea index. The Baveno classification was developed to improve patient selection who would benefit from OSA treatment in terms of symptoms improvement and CVD risk reduction. However, it is unclear how the classification relates to biomarkers of CVD risk. Composite lipid indices were evaluated in various populations and showed good predictive value for incident CVD. One thousand two hundred and forty-two patients with OSA were included in the study. Composite lipid indices, including the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP) and cardiometabolic index (CMI) were compared between different Baveno groups (A - minor symptoms, minor comorbidities, B - severe symptoms, minor comorbidities, C - minor symptoms, severe comorbidities, D - severe symptoms, severe comorbidities). All composite lipid indices were higher in group D versus groups A and C. Only LAP (86.93 /58.40-119.49/ vs. 75.73 /48.37-99.04/) and CMI (1.03 /0.69-1.42/ vs. 0.91 /0.63-1.12/) were significantly different between the minimally symptomatic groups (C vs. A), and solely LAP was significantly higher (110.69 /76.76-147.22/ vs. 82.32 /60.35-113.50/) when the highly symptomatic groups (D vs. B) were compared. The Baveno classification correlates with cardiovascular risk estimated with composite lipid indices. Composite lipid indices may help better stratifying cardiovascular risk in both minimally- and highly symptomatic patients.
Collapse
Affiliation(s)
- Andreea-Roxana Florescu
- Institute of Pulmonology "Marius Nasta", Bucharest, Romania
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
| | - Stefan Mihaicuta
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania
| | - Stefan Marian Frent
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania
| | | | - Mariela Romina Birza
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania.
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania.
| | - Alina Mirela Popa
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania
| | - Andrei Raul Manzur
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania
| | - Loredana Gligor
- University of Medicine and Pharmacy "Victor Babeș", Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, Timisoara, Romania
| | - Andras Bikov
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| |
Collapse
|
|
5
|
Crescimanno G, Lupica A, Tommasello V, Di Stefano V, Brighina F, Marrone O. Spectrum of sleep-disordered breathing and quality of sleep in adolescent and adult patients with spinal muscular atrophy. J Sleep Res 2024; 33:e14222. [PMID: 38654474 DOI: 10.1111/jsr.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
Sleep-disordered breathing is common among children with spinal muscular atrophy, but has been hardly studied among adult subjects. Little is known about sleep quality in spinal muscular atrophy. The aims of this study were to evaluate occurrence and characteristics of sleep-disordered breathing and subjective sleep quality among adolescent and adult patients with spinal muscular atrophy type 2 or 3. Twenty patients aged 33.9 ± 15.2 years were studied. They underwent nocturnal cardiorespiratory monitoring, lung and muscular function evaluation, and were administered the Pittsburgh Sleep Quality Index questionnaire. Nineteen patients showed sleep-disordered breathing, with obstructive events in seven subjects and non-obstructive events in the remaining 12. In the latter group, 10 patients showed pseudo-obstructive hypopneas. Patients with non-obstructive sleep-disordered breathing were younger (p = 0.042), had a lower body mass index (p = 0.0001), were more often affected by spinal muscular atrophy type 2 (p = 0.001), and showed worse impairment of respiratory function than patients with obstructive sleep-disordered breathing. Ten patients were classified as poor sleepers and 10 patients good sleepers. In the whole sample, sniff nasal inspiratory pressure proved to be the only independent predictor of sleep quality (p = 0.009). In conclusion, sleep-disordered breathing is common even among adult patients with spinal muscular atrophy type 2 and 3, and may show either obstructive or different types on non-obstructive features. A worse respiratory muscle function is associated to non-obstructive sleep-disordered breathing and poorer sleep quality. Sleep quality should receive greater attention especially in patients with spinal muscular atrophy type 2, who have a poorer respiratory muscle function, as it could affect their quality of life.
Collapse
Affiliation(s)
- Grazia Crescimanno
- National Research Council, Institute of Biomedical Research and Innovation (IRIB-CNR), Palermo, Italy
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Antonino Lupica
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Vito Tommasello
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Vincenzo Di Stefano
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council, Institute of Biomedical Research and Innovation (IRIB-CNR), Palermo, Italy
| |
Collapse
|
|
6
|
Liu W, Song S, Zhang H, An C. A comparative analysis of anthropometric indices for diagnosing obstructive sleep apnea among American Adults. Sci Rep 2024; 14:29578. [PMID: 39609575 PMCID: PMC11604657 DOI: 10.1038/s41598-024-81191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 11/25/2024] [Indexed: 11/30/2024] Open
Abstract
The occurrence of obstructive sleep apnea (OSA) syndrome is related to not only the overall obesity, but also the local distribution of fat. Therefore, we introduced anthropometric indicators to comprehensively assess the risks associated with obesity, including body mass index (BMI), which is used to assess the overall obesity, together with waist circumference (WC), body roundness index (BRI), visceral adiposity index (VAI) and lipid accumulation product (LAP), all of which reflect fat distribution. This cross-sectional study analyzed data from the 2005-2008 and 2015-2018 NHANES cycles, comprising 8966 participants. Logistic regression models were used to examine the associations between anthropometric indices and OSA, adjusting for relevant covariates. Receiver operating characteristic (ROC) curves were constructed, and values of the area under the curve (AUC) were calculated to assess diagnostic performance. AUC comparisons between men and women were conducted using the DeLong's test. After adjusting for covariates, WC and BMI emerged as the strongest diagnostic indicators of OSA risk. A ROC analysis revealed that WC and BMI had higher diagnostic performance performance among women (AUC: WC: 0.651, BMI: 0.653) than men (AUC: WC: 0.616, BMI: 0.619). Other indices demonstrated weaker diagnostic abilities. Both WC and BMI demonstrated a strong diagnostic ability for OSA across both sexes, with slightly better performance observed among women. These findings suggest that WC and BMI are practical and effective tools for the early detection, risk stratification and management of OSA in clinical practices.
Collapse
Affiliation(s)
- Wenjia Liu
- Psychology of Traditional Chinese Medicine, Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, 150006, China
| | - Shangyi Song
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Hongguo Zhang
- Psychology of Traditional Chinese Medicine, Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, 150006, China
| | - Chunping An
- Psychology of Traditional Chinese Medicine, Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, 150006, China.
| |
Collapse
|
|
7
|
Franklin A, Nieri C, Gallo N, Gillespie MB. Impact of social vulnerability index on severity of obstructive sleep apnea: Insights from drug-induced sleep endoscopy. Am J Otolaryngol 2024; 45:104450. [PMID: 39102761 DOI: 10.1016/j.amjoto.2024.104450] [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: 06/27/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVES To examine the association between neighborhood-level social vulnerability on the severity of obstructive sleep apnea (OSA) in patients undergoing drug-induced sleep endoscopy (DISE). STUDY DESIGN Single center retrospective cohort study. METHODS We conducted a retrospective chart review of patients >18 years of age that underwent DISE from July 2016 to July 2022. Patient addresses were geocoded with geographic information systems, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores in the four sub-themes: Socioeconomic (theme 1), Household Composition/Disability (theme 2), Minority Status/Language (theme 3), and Housing/Transportation (theme 4). RESULTS The study included 165 patients (61.2 years ± 11.6; 31.0 BMI ± 6.1, 102 male, 63 female). Mild OSA was present in13 patients; 55 patients had moderate OSA; and 97 patients had severe OSA. A higher SVI value in minority status and language, and a higher BMI both predicted an increased Apnea Hypopnea Index (AHI) (p = 0.042, and <0.001, respectively) in the multivariate model; whereas, race, age, gender, or the other three SVI sub-theme values were not predictive. CONCLUSION Adults residing in areas of greater social vulnerability - specifically a larger minority presence or English as a second language - and patients who are obese are more likely to have more severe OSA. There was no correlation, however, between obesity and residence in an area of high SVI. These results suggest that both neighborhood conditions and obesity are associated with OSA severity. This elevated risk has potential implications for diagnostic testing, clinic follow-ups, screening, and treatment plans for adults residing in disenfranchised neighborhoods. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Andrew Franklin
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Chad Nieri
- Department of Otolaryngology - Head and Neck Surgery, Washington University, St. Louis, MO, USA
| | - Nina Gallo
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - M Boyd Gillespie
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
|
8
|
Kazemi K, Abiri A, Zhou Y, Rahmani A, Khayat RN, Liljeberg P, Khine M. Improved sleep stage predictions by deep learning of photoplethysmogram and respiration patterns. Comput Biol Med 2024; 179:108679. [PMID: 39033682 DOI: 10.1016/j.compbiomed.2024.108679] [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: 09/12/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
Sleep staging is a crucial tool for diagnosing and monitoring sleep disorders, but the standard clinical approach using polysomnography (PSG) in a sleep lab is time-consuming, expensive, uncomfortable, and limited to a single night. Advancements in sensor technology have enabled home sleep monitoring, but existing devices still lack sufficient accuracy to inform clinical decisions. To address this challenge, we propose a deep learning architecture that combines a convolutional neural network and bidirectional long short-term memory to accurately classify sleep stages. By supplementing photoplethysmography (PPG) signals with respiratory sensor inputs, we demonstrated significant improvements in prediction accuracy and Cohen's kappa (k) for 2- (92.7 %; k = 0.768), 3- (80.2 %; k = 0.714), 4- (76.8 %, k = 0.550), and 5-stage (76.7 %, k = 0.616) sleep classification using raw data. This relatively translatable approach, with a less intensive AI model and leveraging only a few, inexpensive sensors, shows promise in accurately staging sleep. This has potential for diagnosing and managing sleep disorders in a more accessible and practical manner, possibly even at home.
Collapse
Affiliation(s)
| | - Arash Abiri
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, United States
| | - Yongxiao Zhou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, United States
| | - Amir Rahmani
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States; School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Rami N Khayat
- Division of Pulmonary and Critical Care Medicine, The UCI Comprehensive Sleep Center, University of California. Irvine, Newport Beach, CA, United States
| | | | - Michelle Khine
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, United States.
| |
Collapse
|
|
9
|
Gyasi RM, Asiedu HB, Siaw LP, Nyaaba E, Affum-Osei E, Lamptey RB, Muhonja F, Arthur DD, Asamoah E, Nimoh M, Adu-Gyamfi S. Food insecurity and mobility difficulty in middle-aged and older adults: The importance of bio-psychosocial factors. J Psychosom Res 2024; 184:111849. [PMID: 38950509 DOI: 10.1016/j.jpsychores.2024.111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. METHODS Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; Mage = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. RESULTS Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. CONCLUSIONS Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life.
Collapse
Affiliation(s)
- Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya; National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia.
| | - Hubert Bimpeh Asiedu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lawrencia Pokuah Siaw
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Nyaaba
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Affum-Osei
- Department of Human Resources, School of Business, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Bruce Lamptey
- College of Science Library, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Faith Muhonja
- School of Public Health, Mount Kenya University, Kenya
| | - Dominic Degraft Arthur
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Asamoah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Nimoh
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Adu-Gyamfi
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
|
10
|
Meng X, Wen H, Lian L. Association between triglyceride glucose-body mass index and obstructive sleep apnea: a study from NHANES 2015-2018. Front Nutr 2024; 11:1424881. [PMID: 39221158 PMCID: PMC11363548 DOI: 10.3389/fnut.2024.1424881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Background The association between TyG-BMI index and the risk of obstructive sleep apnea (OSA), a recently identified biomarker indicating insulin resistance, has yet to be elucidated. Therefore, this study aimed to investigate the association between TyG-BMI index and the risk of OSA using the NHANES database. Methods Analyses were performed on NHANES data conducted between 2015 and 2018. Logistic regression, stratified analyses, curve-fitting analyses, and threshold effects analyses were utilized to assess the association between TyG-BMI index and the risk of OSA. Results The study included 4,588 participants. Multifactorial logistic regression analyses found a significant association between TyG-BMI and increased risk of OSA [OR: 1.54 (CI:1.39-1.70)]. In stratified analyses, age interacted with the association, with TyG-BMI being associated with increased risk of OSA only in a subgroup of subjects younger than 60 years [1.31 (1.14-1.50)], but gender, smoking status, and alcohol use, did not influence the association. The presence of diabetes, hypertension, and cardiovascular diseases also modified the association, but the number of the included subjects with such conditions was significantly lower, therefore the significance of associations was not observed in those subgroups. Additionally, the risk was non-linearly associated, with the inflection point of TyG-BMI at 12.09, after which the lower slope in the risk was observed. Conclusion This study demonstrates that elevated levels of the TyG-BMI index are correlated with risk for OSA, underscoring the significance of these findings in facilitating early prevention or timely intervention for OSA.
Collapse
Affiliation(s)
- Xingru Meng
- Department of Respiratory Medicine, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Haihua Wen
- The Ninth Clinical Medical College, Guangzhou University of Chinese Medicine, Dongguan, Guangdong, China
| | - Leshen Lian
- Department of Respiratory Medicine, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| |
Collapse
|
|
11
|
Jabarpour M, Amidi F, Aleyasin A, Nashtaei MS, Marghmaleki MS. Randomized clinical trial of astaxanthin supplement on serum inflammatory markers and ER stress-apoptosis gene expression in PBMCs of women with PCOS. J Cell Mol Med 2024; 28:e18464. [PMID: 39036884 PMCID: PMC11261353 DOI: 10.1111/jcmm.18464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/27/2024] [Accepted: 05/19/2024] [Indexed: 07/23/2024] Open
Abstract
Polycystic ovarian syndrome (PCOS) is related to pro-apoptotic and pro-inflammatory conditions generated by Endoplasmic reticulum (ER) stress. This study aimed to determine the effect of Astaxanthin (ASX), as carotenoid with potent antioxidant and anti-inflammatory properties, on serum inflammatory markers, apoptotic factors and ER stress-apoptotic genes in peripheral blood mononuclear cells (PBMCs) of women with PCOS. This randomized, double-blind clinical trial included 56 PCOS patients aged 18-40. For 8 weeks, subjects were randomly assigned to one of two groups: either 12 mg ASX (n = 28) or placebo (n = 28). Real-time PCR was used to quantify gene expression associated with ER stress-apoptosis in PCOS women's PBMCs. The levels of TNF-α, IL18, IL6 and CRP were determined by obtaining blood samples from all patients before and after the intervention using Enzyme-linked immunosorbent assay (ELISA). Also, the levels of active caspase-3 and caspase-8 were detected in the PBMC by ELISA kit. Furthermore, we evaluated the efficacy of ASX on disease symptoms. Following the 8-week intervention, ASX supplementation was able to reduce the expression of GRP78 (p = 0.051), CHOP (p = 0.008), XBP1 (p = 0.002), ATF4 (0.038), ATF6 (0.157) and DR5 (0.016) when compared to the placebo. However, this decrease was not statistically significant for ATF6 (p = 0.067) and marginally significant for GRP78 (p = 0.051). The levels of TNF-α (p = 0.009), IL-18 (p = 0.003), IL-6 (p = 0.013) and active caspase-3 (p = 0.012) were also statistically significant lower in the therapy group. However, there was no significant difference in CRP (p = 0.177) and caspase-8 (p = 0.491) levels between the treatment and control groups. In our study, ASX had no significant positive effect on BMI, hirsutism, hair loss and regularity of the menstrual cycle. It appears that ASX may benefit PCOS by changing the ER stress-apoptotic pathway and reducing serum inflammatory markers; however, additional research is required to determine this compound's potential relevance.
Collapse
Affiliation(s)
- Masoome Jabarpour
- Department of Anatomy, School of MedicineTehran University of Medical SciencesTehranIran
- Department of Infertility, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Fardin Amidi
- Department of Anatomy, School of MedicineTehran University of Medical SciencesTehranIran
- Department of Infertility, Yas HospitalTehran University of Medical SciencesTehranIran
| | - Ashraf Aleyasin
- Department of Infertility, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Maryam Shabani Nashtaei
- Department of Anatomy, School of MedicineTehran University of Medical SciencesTehranIran
- Department of Infertility, Shariati HospitalTehran University of Medical SciencesTehranIran
| | | |
Collapse
|
|
12
|
Biose IJ, Bakare AB, Wang H, Gressett TE, Bix GJ. Sleep apnea and ischemic stroke- a perspective for translational preclinical modelling. Sleep Med Rev 2024; 75:101929. [PMID: 38581800 DOI: 10.1016/j.smrv.2024.101929] [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: 08/11/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
Obstructive sleep apnea (OSA) is associated with ischemic stroke. There is, however, a lack of knowledge on the exact cause-effect relationship, and preclinical models of OSA for experimental ischemic stroke investigations are not well characterized. In this review, we discuss sleep apnea and its relationship with stroke risk factors. We consider how OSA may lead to ischemic stroke and how OSA-induced metabolic syndrome and hypothalamic-pituitary axis (HPA) dysfunction could serve as therapeutic targets to prevent ischemic stroke. Further, we examine the translational potential of established preclinical models of OSA. We conclude that metabolic syndrome and HPA dysfunction, which are often overlooked in the context of experimental stroke and OSA studies, are crucial for experimental consideration to improve the body of knowledge as well as the translational potential of investigative efforts.
Collapse
Affiliation(s)
- I J Biose
- Department of Pharmacology, Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.
| | - A B Bakare
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
| | - H Wang
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
| | - T E Gressett
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA; Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
| | - G J Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70122, USA.
| |
Collapse
|
|
13
|
Peixoto de Miranda ÉJF, Mazzotti DR, Santos RB, Souza SP, Parise BK, Giatti S, Aielo AN, Cunha LF, Silva WA, Bortolotto LA, Lorenzi-Filho G, Lotufo PA, Bensenor IM, Bittencourt MS, Drager LF. Incident Coronary Calcium Score in Patients With OSA With and Without Excessive Sleepiness: Brazilian Longitudinal Study of Adult Health. Chest 2024; 165:202-212. [PMID: 37356709 DOI: 10.1016/j.chest.2023.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/06/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Uncertainty exists about the impact of OSA and its phenotypes on cardiovascular disease. RESEARCH QUESTION Are OSA and clinical features such as daytime sleepiness associated with incident subclinical coronary atherosclerosis? STUDY DESIGN AND METHODS In this prospective community-based cohort study, we administered a sleepiness questionnaire, actigraphy, and home sleep studies at baseline. Coronary artery calcium (CAC; 64-slice multidetector CT scan imaging) was measured at two different time points throughout the study (baseline, between 2010 and 2014, and follow-up, between 2016 and 2018). Incidence of subclinical atherosclerosis was defined as baseline CAC of 0 followed by CAC of > 0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression. Stratified analyses based on excessive daytime sleepiness (EDS) were performed. RESULTS We analyzed 1,956 participants with available CAC scores at baseline (mean age, 49 ± 8 years; 57.9% female; 32.4% with OSA). In covariate-adjusted analyses (n = 1,247; mean follow-up, 5.1 ± 0.9 years), we found a significant association between OSA and incidence of subclinical atherosclerosis (OR, 1.26; 95% CI, 1.06-1.48), with stronger effects among those reporting EDS (OR, 1.66; 95% CI, 1.30-2.12; P = .028 for interaction). Interestingly, EDS per se was not associated with any CAC outcome. An exploratory analysis of the square root of CAC progression (baseline CAC > 0 followed by a numerical increase in scores at follow-up; n = 319) showed a positive association for both OSA (β = 1.084; 95% CI, 0.032-2.136; P = .043) and OSA with EDS (β = 1.651; 95% CI, 0.208-3.094; P = .025). INTERPRETATION OSA, particularly with EDS, predicts the incidence and progression of CAC. These results support biological plausibility for the increased cardiovascular risk observed among patients with OSA with excessive sleepiness.
Collapse
Affiliation(s)
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS; Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Ronaldo B Santos
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Silvana P Souza
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Barbara K Parise
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Soraya Giatti
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Aline N Aielo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Lorenna F Cunha
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil
| | - Wagner A Silva
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratório do Sono, Disciplina de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil
| | - Márcio S Bittencourt
- Cardiac CT Program, Heart and Vascular Institute, University of Pittsburgh., Pittsburgh, PA
| | - Luciano F Drager
- Center for Clinical and Epidemiological Research, University Hospital, São Paulo, SP, Brazil; Unidade de Hipertensão, Instituto do Coração (InCor), São Paulo, SP, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, São Paulo, SP, Brazil.
| |
Collapse
|
|
14
|
Ben Salem A, Ezzidi I, Ben Abdennebi H, Mahjoub T, Sarray S, Mtiraoui N. Interleukin 10 (IL-10) gene variants and haplotypes in Tunisian women with polycystic ovary syndrome (PCOS): a case-control study. Mol Biol Rep 2023; 50:8089-8096. [PMID: 37541999 DOI: 10.1007/s11033-023-08706-9] [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: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder that affects women in their child-bearing age, and is associated with insulin resistance and type 2 diabetes. The etiology of PCOS involves multiple factors including genetic, metabolic and immunological factors. Interleukin - 10 (IL-10), as an anti-inflammatory cytokine, plays a critical role in this regard. We investigated the potential role of IL-10 gene variants in the development of PCOS in Tunisian population. METHODS AND RESULTS 115 cases and 120 controls were recruited in the current case control study. Rotterdam consensus criteria were used to diagnose PCOS patients. Genotyping for IL-10, rs1800896, rs1800871 and rs1800872 variants, was performed by real time PCR. The results obtained showed that the minor allele frequency of rs1800896, rs1800871and rs1800872 were comparable between PCOS cases and control subjects (P = 0.30, P = 0.71, and P = 0.57 respectively). The distribution analysis revealed an unsignificant association of the three tested variants, in all genetic models. Haplotype analysis identified one haplotype CCA with a protective role in PCOS development (P = 0.05; OR (95% CI) = 0.56 (0.32 - 0.99)). This association did not persist after adjustment for multiples covariates (Pc = 0.154). CONCLUSIONS Our study is the first to show how ethnicity influences the association of IL-10 gene variants with PCOS susceptibility. No allelic nor genetic association were observed between the tested variants and PCOS in Tunisian women, however, a particular IL-10 haplotype with a protective effect for PCOS was identified.
Collapse
Affiliation(s)
- Assila Ben Salem
- Laboratory of Human Genome and Multifactorial Diseases, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, LR12ES07, Tunisia.
| | - Intissar Ezzidi
- Laboratory of Human Genome and Multifactorial Diseases, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, LR12ES07, Tunisia
- Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, Tunisia
| | - Hassen Ben Abdennebi
- Laboratory of Human Genome and Multifactorial Diseases, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, LR12ES07, Tunisia
| | - Touhami Mahjoub
- Laboratory of Human Genome and Multifactorial Diseases, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, LR12ES07, Tunisia
| | - Sameh Sarray
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Faculty of Sciences of Tunis, University of Tunis EL Manar II, Tunis, Tunisia
| | - Nabil Mtiraoui
- Laboratory of Human Genome and Multifactorial Diseases, Faculty of Pharmacy of Monastir, University of Monastir, Monastir, LR12ES07, Tunisia
- Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, Tunisia
| |
Collapse
|
|
15
|
Wang J, Yin T, Liu S. Dysregulation of immune response in PCOS organ system. Front Immunol 2023; 14:1169232. [PMID: 37215125 PMCID: PMC10196194 DOI: 10.3389/fimmu.2023.1169232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder affecting women, which can lead to infertility. Infertility, obesity, hirsutism, acne, and irregular menstruation are just a few of the issues that PCOS can be linked to. PCOS has a complicated pathophysiology and a range of clinical symptoms. Chronic low-grade inflammation is one of the features of PCOS. The inflammatory environment involves immune and metabolic disturbances. Numerous organ systems across the body, in addition to the female reproductive system, have been affected by the pathogenic role of immunological dysregulation in PCOS in recent years. Insulin resistance and hyperandrogenism are associated with immune cell dysfunction and cytokine imbalance. More importantly, obesity is also involved in immune dysfunction in PCOS, leading to an inflammatory environment in women with PCOS. Hormone, obesity, and metabolic interactions contribute to the pathogenesis of PCOS. Hormone imbalance may also contribute to the development of autoimmune diseases. The aim of this review is to summarize the pathophysiological role of immune dysregulation in various organ systems of PCOS patients and provide new ideas for systemic treatment of PCOS in the future.
Collapse
Affiliation(s)
- Jingxuan Wang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| |
Collapse
|
|
16
|
GÜRBÜZ T, GÖKMEN O, AYAR MADENLİ A, DİLBAZ B. R-Spondin1 and tumor necrosis factor-alpha in infertile women with polycystic ovary syndrome: relationships with insulin resistance and other parameters. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1210721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: To evaluate the relationship between R-spondin1 (RSPO1) and Tumor Necrosis Factor-Alpha (TNF-α) levels with insulin resistance (IR) and other parameters in infertile women with polycystic ovary syndrome (PCOS).
Material and Method: This case-control prospective observational study was carried out on 84 patients admitted to the University of Health Sciences Etlik Zübeyde Hanım Training and Research Hospital Gynecology and IVF Clinic and Medistate Hospital Gynecology and IVF Clinic between September 2020 and June 2021. Women aged 18-36 years diagnosed with infertility and PCOS constituted the PCOS group. Women who were diagnosed with infertility but not PCOS formed the control group. Cases were divided according to their body mass index (BMI) values into obese (BMI≥25) and non-obese (BMI
Collapse
Affiliation(s)
- Tuğba GÜRBÜZ
- Medistate Hospital, Gynecology and Obstetric Clinic ,Istanbul/Turkey
| | - Oya GÖKMEN
- Department of Gynecology Obstetrics & Reproductive Medicine, Medistate Kavacik Hospital, Istanbul, Turkey
| | - Asena AYAR MADENLİ
- Department of Obstetrics and Gynecology, Liv Hospital Vadistanbul,Istanbul,Turkey
| | - Berna DİLBAZ
- Department of Gynecology Obstetrics & Reproductive Medicine, University of Health Sciences Etlik Zubeyde Hanim Training and Research Hospital, Ankara,Turkey
| |
Collapse
|
|
17
|
Hayton J, Azhari A, Esposito G, Iles R, Chadiarakos M, Gabrieli G, Dimitriou D, Mangar S. Short Report: Lack of Diurnal Variation in Salivary Cortisol Is Linked to Sleep Disturbances and Heightened Anxiety in Adolescents with Williams Syndrome. Behav Sci (Basel) 2023; 13:220. [PMID: 36975245 PMCID: PMC10045386 DOI: 10.3390/bs13030220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE The aim of the current study was to examine the potential relationship between sleep patterns, cortisol levels, and anxiety profiles in adolescents with Williams Syndrome (WS) compared to typically developing adolescents. METHOD Thirteen adolescents with WS and thirteen TD adolescents (age range 12-18 years) were recruited. Participants were provided with a "testing kit", containing instructions for collecting data through a sleep diary, MotionWare actigraphy, the Childhood Sleep Habits Questionnaire (CSHQ), and the Spence Children's Anxiety Scale, and a salivary cortisol collection kit. RESULTS Adolescents in the WS group did not show diurnal variation in salivary cortisol. Significantly higher scores were reported for two CSHQ subsections, night wakings and parasomnias, in the WS group. Regarding the actigraphy, only significantly longer sleep latency was observed in the WS group. In comparison to the TD group, the WS group had significantly higher anxiety. As expected, the TD group showed typical diurnal variation in cortisol, whereas the WS group showed a flattened cortisol profile throughout the day. CONCLUSIONS From the developmental perspective, this study provides new data supporting the conclusion that sleep problems are not transient but continue to persist into adolescence in WS. Future studies ought to consider examining the role of cortisol and its interplay with anxiety levels and sleep problems across the lifespan in individuals with WS.
Collapse
Affiliation(s)
- Jessica Hayton
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
| | - Atiqah Azhari
- Psychology Programme, School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Gianluca Esposito
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Ray Iles
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Michaella Chadiarakos
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
| | - Giulio Gabrieli
- Neuroscience and Behaviour Laboratory, Italian Institute of Technology, 00161 Roma, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
| | - Stephen Mangar
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| |
Collapse
|
|
18
|
Jafar NKA, Bennett CJ, Moran LJ, Mansfield DR. Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health. Semin Reprod Med 2023; 41:45-58. [PMID: 38113883 DOI: 10.1055/s-0043-1777724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.
Collapse
Affiliation(s)
- Nur K Abdul Jafar
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christie J Bennett
- Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Darren R Mansfield
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
|
19
|
Tete B, Albdewi MA, Nkodila A, Muhala B, Akilimali P, Bisuta S, Makulo JR, Kayembe JM. Prevalence of risk and factors associated with obstructive sleep apnea-hypopnea syndrome in an adult population in Kinshasa, Democratic Republic of Congo. J Sleep Res 2023; 32:e13637. [PMID: 35624083 DOI: 10.1111/jsr.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an underdiagnosed and lesser known disease in sub-Saharan Africa. We believe that this is the first descriptive and analytical cross-sectional study in Kinshasa (from February 1 to October 31, 2021), which included respondents aged ≥18 years. The study aimed to determine the prevalence of the risk and factors associated with OSAHS. Each participant signed a free and informed consent. Statistical analyses were performed using XLStat 2020 and the Statistical Package for the Social Sciences version 24 for Windows. Odds ratios (ORs) were calculated to determine the degree of association between these variables and a high risk of OSAHS. The significance threshold was p < 0.05 and confidence interval (CI) at 95%. There were 4,162 participants, including 2,287 men (54.9%), with an mean (SD) age of 32 ± 12.6 years. The prevalence of OSAS risk was 17.4% and 7.9% for men and women, respectively. The associated risk factors were male sex (OR 4, 95% CI 3.20-5.54), hypertension (OR 6.7, 95% CI 4.87-9.30), age ≥60 years (OR 8.7, 95% CI 4.07-18.88), obesity/overweight (OR 1.94, 95% CI 1.13-3.78), and excessive daytime sleepiness (OR 2.63, 95% CI 2.05-3.56). The risk of OSAS in Kinshasa is high and it increases with age, male sex, obesity, and hypertension. The Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and male Gender (STOP-BANG) questionnaire is an easy-to-use tool for diagnostic orientation.
Collapse
Affiliation(s)
- Boniface Tete
- Sleep Exploration Unit, Department of Internal Medicine, Department of Pulmonology, University of Kinshasa-Faculty of Medicine, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.,Sleep Exploration Unit, Pulmonology Department, Centre Hospitalier Arpajon, Arpajon, France
| | - Mohamad Ammar Albdewi
- Sleep Exploration Unit, Pulmonology Department, Centre Hospitalier Arpajon, Arpajon, France
| | - Aliocha Nkodila
- Department of Family Medicine and Primary Health Care, Protestant University in Congo-Faculty of Medicine, Kinshasa, Democratic Republic of Congo
| | - Blaise Muhala
- Department of Mathematics and Computer Science, University of Kinshasa-Faculty of Science, Kinshasa, Democratic Republic of Congo
| | - Pierre Akilimali
- School of Public Health, University of Kinshasa-Faculty of Medicine, Kinshasa, Democratic Republic of Congo
| | - Serge Bisuta
- Sleep Exploration Unit, Department of Internal Medicine, Department of Pulmonology, University of Kinshasa-Faculty of Medicine, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean Robert Makulo
- Department of Internal Medicine, Department of Nephrology, University of Kinshasa-Faculty of Medicine, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean Marie Kayembe
- Sleep Exploration Unit, Department of Internal Medicine, Department of Pulmonology, University of Kinshasa-Faculty of Medicine, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo
| |
Collapse
|
|
20
|
The Implication of Mechanistic Approaches and the Role of the Microbiome in Polycystic Ovary Syndrome (PCOS): A Review. Metabolites 2023; 13:metabo13010129. [PMID: 36677054 PMCID: PMC9863528 DOI: 10.3390/metabo13010129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
As a complex endocrine and metabolic condition, polycystic ovarian syndrome (PCOS) affects women's reproductive health. These common symptoms include hirsutism, hyperandrogenism, ovulatory dysfunction, irregular menstruation, and infertility. No one knows what causes it or how to stop it yet. Alterations in gut microbiota composition and disruptions in secondary bile acid production appear to play a causative role in developing PCOS. PCOS pathophysiology and phenotypes are tightly related to both enteric and vaginal bacteria. Patients with PCOS exhibit changed microbiome compositions and decreased microbial diversity. Intestinal microorganisms also alter PCOS patient phenotypes by upregulating or downregulating hormone release, gut-brain mediators, and metabolite synthesis. The human body's gut microbiota, also known as the "second genome," can interact with the environment to improve metabolic and immunological function. Inflammation is connected to PCOS and may be caused by dysbiosis in the gut microbiome. This review sheds light on the recently discovered connections between gut microbiota and insulin resistance (IR) and the potential mechanisms of PCOS. This study also describes metabolomic studies to obtain a clear view of PCOS and ways to tackle it.
Collapse
|
|
21
|
Chetan IM, Gergely-Domokos B, Beyer R, Tomoaia R, Cabau G, Vulturar D, Chis A, Lesan A, Vesa CS, Pop D, Todea DA. The role of 3D speckle tracking echocardiography in the diagnosis of obstructive sleep apnea and its severity. Sci Rep 2022; 12:22347. [PMID: 36572720 PMCID: PMC9791147 DOI: 10.1038/s41598-022-26940-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
There is a consistent relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. It is already recognized that OSA may influence the geometry and function of the right ventricle (RV). This has encouraged the development of echocardiographic evaluation for screening of OSA and its severity. Three-dimensional speckle tracking echocardiography (3D STE) is in assumption better, compared with 2D STE, because it overcomes the standard 2D echo limitations. Thus, the purpose of our study is to evaluate whether 3D STE measurements, could predict the positive diagnosis and severity of OSA. We enrolled 69 patients with OSA and 37 healthy volunteers who underwent a cardiorespiratory sleep study. 2DE was performed in all patients. RVEF and 3D RVGLS were measured by 3DSTE. NT pro BNP plasma level was also assessed in all participants. 3D RV GLS (- 13.5% vs. - 22.3%, p < 0.001) and 3D RVEF (31.9% vs. 50%, p < 0.001) were reduced in patients with OSA, compared with normal individuals. 3D Strain parameters showed better correlation to standard 2D variables, than 3D RVEF. Except for NT pro BNP (p = 0.059), all parameters served to distinguish between severe and mild-moderate cases of OSA. 3D STE may be a reliable and accurate method for predicting OSA. Consequently, 3D RV GLS is a good tool of assessing the RV global function in OSA, because it correlates well with other established measurements of RV systolic function. Furthermore, 3D RV GLS was a precise parameter in identifying severe cases of OSA, while NT pro BNP showed no association.
Collapse
Affiliation(s)
- Ioana Maria Chetan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bianca Gergely-Domokos
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Ruxandra Beyer
- Heart Institute "Nicolae Stancioiu", Cluj-Napoca, Romania
| | - Raluca Tomoaia
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Cabau
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Damiana Vulturar
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana Chis
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Lesan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Stefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Pop
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Adina Todea
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
|
22
|
Durmuş M, Uzunlar Ö, Çelik H, Çandar T. Does alpha-1-acid glycoprotein determine for infertility in polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol 2022; 274:155-159. [PMID: 35653904 DOI: 10.1016/j.ejogrb.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The underlying cause of metabolic abnormalities and ovarian dysfunction in PCOS is thought to be chronic low-grade inflammation. This study aimed to show whether alpha-1-acid glycoprotein (AGP), an inflammatory marker, predicts the risk of infertility in fertile and infertile women with PCOS. Our study had a cros-sectional case-control design. STUDY DESIGN A total of 20 fertile and 50 infertile patients with PCOS who wanted a child were in the early follicular phase were included in our study. Among the study groups (fertil (n = 20) and infertile (n = 50), AGP, CRP, NLR, BMI, FAI, VAI, triglyceride, HDL-cholesterol, fasting blood sugar, HOMA-IR, SHBG, testosterone values and waist circumference were measured. RESULTS Among the inflammatory markers compared in the fertile and infertile groups included in the study, only the difference between the AGP variable was statistically significant (p = 0.011). The mean AGP was found to be higher at a statistically significant level in the infertile group (p < 0.05). Age, BMI, waist circumference and AGP were weakly positive and CRP was moderately positive in the infertile group (p < 0.05). CONCLUSION AGP can be a good indicator of inflammation in PCOS, especially in infertility.Revealing the risk of infertility in PCOS with AGP measurement may contribute to the correct management of the reproductive process.
Collapse
Affiliation(s)
- Merve Durmuş
- Department of Obstetrics and Gynecology, Private Ege Yasam Hospital, Izmir, Turkey.
| | - Özlem Uzunlar
- Department of Obstetrics and Gynecology, University of Health Science, Ankara City Hospital, Ankara, Turkey
| | - Hümeyra Çelik
- Department of Physiology, Bolu Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Tuba Çandar
- Department of Biochemistry, Ufuk University Dr. Rıdvan Ege Hospital, Ankara, Turkey
| |
Collapse
|
|
23
|
Bikov A, Frent S, Reisz D, Negru A, Gaita L, Breban Schwarzkopf D, Mihaicuta S. Comparison of Composite Lipid Indices in Patients with Obstructive Sleep Apnoea. Nat Sci Sleep 2022; 14:1333-1340. [PMID: 35923809 PMCID: PMC9342428 DOI: 10.2147/nss.s361318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a recognised risk factor for cardiovascular disease. However, it is difficult to evaluate the risk of cardiovascular disease in patients with OSA due to multiple shared risk factors. Composite lipid indices, such as atherogenic index of plasma (AIP), visceral adiposity index (VAI) and lipid accumulation product (LAP) have been shown to predict cardiovascular disease better than their individual lipid components. This study aimed to evaluate these indices in patients with OSA. PATIENTS AND METHODS Six hundred sixty-seven (667) patients with OSA and 139 non-OSA control volunteers participated in the study. Fasting serum triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C) levels were measured, and AIP, LAP and VAI were calculated following cardiorespiratory polygraphy. The relationship between lipid parameters, OSA and its comorbidities was evaluated using receiver operating curve (ROC) analysis. RESULTS We found a significant difference in all lipid parameters between OSA patients and controls. Comparing ROCs, LAP was significantly more strongly associated with OSA compared to all the other parameters. The optimal cut-off value for LAP to detect OSA was 76.4, with a sensitivity of 63% and a specificity of 76%. In addition, LAP was the best parameter to predict hypertension and diabetes in patients with OSA, and it was predictive for ischaemic heart disease together with HDL-C. CONCLUSION Our results support the use of LAP in clinical practice when evaluating cardiovascular risk in patients with OSA. However, the optimal cut-off value should be determined in large-scale follow-up studies.
Collapse
Affiliation(s)
- Andras Bikov
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Stefan Frent
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Daniela Reisz
- Department of Neurology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alina Negru
- Department of Cardiology (II), "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Department of Clinical Research, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Laura Gaita
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Daniel Breban Schwarzkopf
- Department of Anatomy, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| |
Collapse
|
|
24
|
Martins FO, Conde SV. Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases. Front Physiol 2022; 12:792633. [PMID: 34970158 PMCID: PMC8712658 DOI: 10.3389/fphys.2021.792633] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
The relationship between obstructive sleep apnea (OSA) and endocrine and metabolic disease is unequivocal. OSA, which is characterized by intermittent hypoxia and sleep fragmentation, leads to and exacerbates obesity, metabolic syndrome, and type 2 diabetes (T2D) as well as endocrine disturbances, such as hypothyroidism and Cushing syndrome, among others. However, this relationship is bidirectional with endocrine and metabolic diseases being considered major risk factors for the development of OSA. For example, polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, is significantly associated with OSA in adult patients. Several factors have been postulated to contribute to or be critical in the genesis of dysmetabolic states in OSA including the increase in sympathetic activation, the deregulation of the hypothalamus-pituitary axis, the generation of reactive oxygen species (ROS), insulin resistance, alteration in adipokines levels, and inflammation of the adipose tissue. However, probably the alterations in the hypothalamus-pituitary axis and the altered secretion of hormones from the peripheral endocrine glands could play a major role in the gender differences in the link between OSA-dysmetabolism. In fact, normal sleep is also different between men and women due to the physiologic differences between genders, with sex hormones such as progesterone, androgens, and estrogens, being also connected with breathing pathologies. Moreover, it is very well known that OSA is more prevalent among men than women, however the prevalence in women increases after menopause. At the same time, the step-rise in obesity and its comorbidities goes along with mounting evidence of clinically important sex and gender differences. Metabolic and cardiovascular diseases, seen as a men's illness for decades, presently are more common in women than in men and obesity has a higher association with insulin-resistance-related risk factors in women than in men. In this way, in the present manuscript, we will review the major findings on the overall mechanisms that connect OSA and dysmetabolism giving special attention to the specific regulation of this relationship in each gender. We will also detail the gender-specific effects of hormone replacement therapies on metabolic control and sleep apnea.
Collapse
Affiliation(s)
- Fátima O Martins
- Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Sílvia V Conde
- Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| |
Collapse
|
|
25
|
Kim J, Pyo SS, Yoon DW. Obesity, Obstructive Sleep Apnea, and Metabolic Dysfunction. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2021. [DOI: 10.15324/kjcls.2021.53.4.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jinkwan Kim
- Department of Biomedical Laboratory Science, Jungwon University, Goesan, Korea
- Sleep Medicine Institute, Jungwon University, Goesan, Korea
| | - Sang Shin Pyo
- Department of Biomedical Laboratory Science, Jungwon University, Goesan, Korea
- Sleep Medicine Institute, Jungwon University, Goesan, Korea
| | - Dae Wui Yoon
- Department of Biomedical Laboratory Science, Jungwon University, Goesan, Korea
- Sleep Medicine Institute, Jungwon University, Goesan, Korea
| |
Collapse
|
|
26
|
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is associated with incident coronary and cerebral vascular disease. The mechanisms underlying this association are thought to include increased sympathetic nervous system activity, oxidative stress, and systemic inflammation, with these effects mediated in part by elevated blood pressure and impaired glucose metabolism. In observational studies, OSA treatment with positive airway pressure (PAP) is associated with a reduction in cardiovascular disease risk. The aim of this review is to evaluate evidence from recent clinical trials that tested the impact of OSA treatment on major cardiovascular disease outcomes. RECENT FINDINGS Multicenter randomized trials have demonstrated a significant, albeit modest, reduction in blood pressure with OSA treatment. Treatment of OSA has generally not demonstrated improvement in type 2 diabetes mellitus, although limited evidence suggests that treatment may be effective in the prediabetic period. However, recent randomized trials of PAP treatment for OSA failed to demonstrate a reduction in incident or recurrent cardiovascular disease events. This may reflect the enrollment of a mostly non-sleepy study sample, as recent evidence suggests that sleepiness is a predictor of adverse cardiovascular outcomes from OSA. PAP treatment of OSA lowers blood pressure and may improve glucose metabolism; however, randomized clinical trials do not indicate a reduction in cardiovascular risk with treatment of minimally symptomatic OSA patients.
Collapse
Affiliation(s)
- Daniel J Gottlieb
- VA Boston Healthcare System, 1400 VFW Parkway (111PI), West Roxbury, MA, 02132, USA.
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA, USA.
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
|
27
|
PCOS and Depression: Common Links and Potential Targets. Reprod Sci 2021; 29:3106-3123. [PMID: 34642910 DOI: 10.1007/s43032-021-00765-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
PCOS or polycystic ovary syndrome is a common endocrine disorder that occurs during the reproductive age in females. It manifests in the form of a wide range of symptoms including (but not limited to) hirsutism, amenorrhea, oligomenorrhea, obesity, acne vulgaris, infertility, alopecia, and insulin resistance. The incidence of depression in PCOS population is increasing as compared to the general population. Increased depression in PCOS significantly alters the quality of life (QOL) of affected females. Also, self-esteem is found to be low in both depression and PCOS. The loss in self-esteem in such patients can be largely attributed to the associated factors including (but not limited to) obesity, acne, androgenic alopecia, and hirsutism. The reason behind the occurrence of depression in PCOS remains elusive to date. Literature suggests that there is an overlap of clinical symptoms between depression and PCOS. As the symptoms overlap, there is a possibility of common associations between depression, PCOS, and PCOS-associated abnormalities including insulin resistance (IR), obesity, CVD, and androgen excess. Studies demonstrate that depression is an inflammatory disorder marked with increased levels of inflammatory markers. On the other hand, PCOS is also regarded as a pro-inflammatory state that is characterized by increased levels of pro-inflammatory markers. Thus, there is a possibility of an inflammatory relationship existing between depression and PCOS. It is also possible that the inflammatory markers in PCOS can cross the blood-brain barrier (BBB) leading to the development of depression. Through the present review, we have attempted to shed light on common associations/shared links between depression and PCOS with respect to the levels of cortisol, androgen, vitamin D, neurotransmitters, monoaminoxidase (MAO), and insulin-like growth factor-1 (IGF-1). Tracking down common associations between depression and PCOS will help find potential drug therapies and improve the QOL of females with depression in PCOS.
Collapse
|
|
28
|
Hur S, Oh B, Kim H, Kwon O. Associations of Diet Quality and Sleep Quality with Obesity. Nutrients 2021; 13:nu13093181. [PMID: 34579058 PMCID: PMC8466020 DOI: 10.3390/nu13093181] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women (n = 1165) aged 19–64, who participated in the prospective Ewha–Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027–4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.
Collapse
Affiliation(s)
- Soohee Hur
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Bumjo Oh
- Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea;
| | - Hyesook Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- Correspondence: (H.K.); (O.K.); Tel./Fax: +82-2-3277-6860 (O.K.)
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- Correspondence: (H.K.); (O.K.); Tel./Fax: +82-2-3277-6860 (O.K.)
| |
Collapse
|
|
29
|
Obstructive sleep apnea syndrome in non-obese patients. Sleep Breath 2021; 26:513-518. [PMID: 34324126 PMCID: PMC9130173 DOI: 10.1007/s11325-021-02412-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is characterized by symptoms and signs of more than 5 apneas per hour (AHI) at polysomnography or 15 or more apneas per hour without symptoms. In this review, the focus will be a subgroup of patients: adult non-obese subjects with OSA and their specific features. In non-obese OSA patients (patients with BMI < 30 kg/m2), there are specific polysomnographic features which reflect specific pathophysiological traits. Previous authors identified an anatomical factor (cranial anatomical factors, retrognatia, etc.) in OSA non-obese. We have hypothesized that in this subgroup of patients, there could be a non-anatomical pathological prevalent trait. Little evidence exists regarding the role of low arousal threshold. This factor could explain the difficulty in treating OSA in non-obese patients and emphasizes the importance of a specific therapeutic approach for each patient.
Collapse
|
|
30
|
D Prabhu Y, Valsala Gopalakrishnan A. Can polyunsaturated fatty acids regulate Polycystic Ovary Syndrome via TGF-β signalling? Life Sci 2021; 276:119416. [PMID: 33774033 DOI: 10.1016/j.lfs.2021.119416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022]
Abstract
Polycystic Ovary Syndrome (PCOS) is a metabolic condition that affects women in their reproductive age by altering the ovarian hormone levels, leading to infertility. Increased inflammation, insulin resistance, hyperandrogenism, irregular menses, and infertility are the causes of morbidity when PCOS is the disease in question. PCOS is considered a multifactorial disease resulting from the disruption of multiple signalling pathways. Hence, the mono-targeted drugs are hardly adequate and conventional therapeutic strategies provide only palliative care. Studies show that the consumption of polyunsaturated fatty acids (PUFAs) regulates menstrual cycle, decrease testosterone and insulin levels, and improve metabolic health. This could favourably affect diabetes and infertility. In recent years, the fibrillin-3 gene has been linked to PCOS. Fibrillins along with the molecules in the extracellular matrix modulate the Transforming Growth Factor-β (TGF-β) signalling. So, mutations in the fibrillin-3 gene could cause TGF-β dysregulation, which might further contribute to PCOS pathogenesis. Therefore, the current study aimed to understand whether PUFAs could manage PCOS via the TGF-β pathway and function as a therapeutic agent for PCOS and its complications. To understand this, we have focused on the involvement of TGF-β in PCOS pathogenesis, discussed the effect of PUFA on hormones, insulin resistance, inflammation, obesity, adiponectin, and cardiovascular conditions. Using PUFAs to target TGF-β or its receptor molecules to modulate the TGF-β production might function as a treatment option for PCOS. PUFA therapy could be a good alternative, supportive medication for PCOS.
Collapse
Affiliation(s)
- Yogamaya D Prabhu
- Department of Biomedical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India.
| |
Collapse
|
|
31
|
Bock JM, Vungarala S, Karim S, Somers VK. Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP. Can J Cardiol 2021; 37:756-765. [PMID: 33610689 DOI: 10.1016/j.cjca.2021.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience repetitive partial or complete airway collapse during sleep resulting in nocturnal hypoxia-normoxia cycling, and are at increased cardiovascular risk. The number of apneas and hypopneas indexed per hour of sleep (apnea-hypopnea index) along with the associated intermittent hypoxia predict the increased cardiovascular risk; thus, their attenuation or prevention are objectives of OSA therapy. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA and, when effective, mitigates the apnea-hypopnea index and hypoxemia. As such, it is reasonable to expect CPAP would decrease cardiovascular risk. However, 3 recent randomized clinical trials of CPAP vs usual care did not show any significant effects of CPAP in attenuating incident cardiovascular events in patients with OSA. In this review, we discuss these studies in addition to potential complementary therapeutic options to CPAP (eg, neurostimulation) and conclude with suggested therapeutic targets for future interventional studies (eg, the autonomic nervous system). Although these areas of research are exciting, they have yet to be tested to any similar degree of rigour as CPAP.
Collapse
Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Soumya Vungarala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
|
32
|
Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update. Arch Gynecol Obstet 2021; 303:631-643. [PMID: 33439300 DOI: 10.1007/s00404-020-05951-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is the most prevalent metabolic disorder in reproductive-age women. It is indeed a multifactorial condition evidenced by ovarian dysfunction, hyperandrogenaemia, infertility, hormonal imbalance and chronic anovulation. Experimental evidence infers that PCOS women are prone to cardiovascular problems and insulin resistance. PURPOSE To furnish the details about the association of inflammatory markers in PCOS. DESIGN An extensive literature search on PubMed, science direct and google scholar has been performed for articles about PCOS and inflammation in PCOS. A comprehensive analysis using original articles, reviews, systemic and meta-analysis was conducted for better understanding the relationship between inflammatory cytokines and PCOS. RESULTS The inflammatory markers perform a substantial part in managing the functions of the ovary. Any disturbances in their levels can lead to ovarian dysfunction. Inflammatory markers are associated with PCOS pathogenesis. The interplay between inflammatory cytokines in the PCOS ovary strongly implies that inflammation is one of the most potent risk factors of PCOS. CONCLUSION Inflammatory markers have a significant role in regulating the ovary. This manuscript highlights the significance of metabolic and inflammatory markers with PCOS. Since PCOS is always considered as a metabolic disorder, researchers can also consider focusing on the relationship between the inflammatory markers in PCOS to establish a new treatment or management of the disease and to improve women's health.
Collapse
|
|
33
|
Wang W, Zheng Y, Li M, Lin S, Lin H. Recent Advances in Studies on the Role of Neuroendocrine Disorders in Obstructive Sleep Apnea-Hypopnea Syndrome-Related Atherosclerosis. Nat Sci Sleep 2021; 13:1331-1345. [PMID: 34349578 PMCID: PMC8326525 DOI: 10.2147/nss.s315375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease is a common cause of death worldwide, and atherosclerosis (AS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) critically contribute to the initiation and progression of cardiovascular diseases. OSAHS promotes endothelial injury, vascular smooth muscle cell (VSMC) proliferation, abnormal lipid metabolism, and elevated arterial blood pressure. However, the exact OSAHS mechanism that causes AS remains unclear. The nervous system is widely distributed in the central and peripheral regions. It regulates appetite, energy metabolism, inflammation, oxidative stress, insulin resistance, and vasoconstriction by releasing regulatory factors and participates in the occurrence and development of AS. Studies showed that OSAHS can cause changes in neurophysiological plasticity and affect modulator release, suggesting that neuroendocrine dysfunction may be related to the OSAHS mechanism causing AS. In this article, we review the possible mechanisms of neuroendocrine disorders in the pathogenesis of OSAHS-induced AS and provide a new basis for further research on the development of corresponding effective intervention strategies.
Collapse
Affiliation(s)
- Wanda Wang
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Yanli Zheng
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Meimei Li
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Shu Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China.,Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, 2010, Australia
| | - Huili Lin
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| |
Collapse
|
|
34
|
Impact of CPAP treatment for obstructive sleep apnea on visceral adipose tissue: a meta-analysis of randomized controlled trials. Sleep Breath 2020; 25:555-562. [PMID: 32857319 DOI: 10.1007/s11325-020-02181-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is still controversial if the continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea (OSA) can markedly influence an effect on visceral adipose tissue (VAT). The current study aimed to assess the efficacy of CPAP interventions in reducing VAT in OSA patients. METHODS The Web of Science, PubMed, Embase, and Cochrane Library (up to December, 2019) were searched for randomized trials that assessed the effect of CPAP therapy in decreasing VAT in OSA patients. Information on the study, pre- and post-CPAP treatment of VAT, and patient characteristics were extracted for analysis. The standardized mean difference (SMD) was applied to measure the summary estimates. The analysis was conducted with STATA 13.0 and RevMan v.5.3. RESULTS Five studies (6 cohorts) that involved 169 patients were enrolled in the meta-analysis. There was no significant change of VAT in patients with OSA before and after CPAP treatment (SMD = - 0.00, 95% CI = - 0.21 to 0.21, z = 0.01, p = 0.99). Subgroup analyses further demonstrated that the results were not influenced by CPAP therapy duration, patient age, sample size, or baseline body mass index. CONCLUSIONS Among the patients with OSA, our meta-analysis revealed that treatment with CPAP does not significantly lead to a reduction of VAT. High-quality randomized controlled trials may provide further clarifying information.
Collapse
|
|
35
|
Hoel HC, Kvinnesland K, Berg S. Impact of nasal resistance on the distribution of apneas and hypopneas in obstructive sleep apnea. Sleep Med 2020; 71:83-88. [PMID: 32502854 DOI: 10.1016/j.sleep.2020.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to investigate how increased nasal resistance affects respiratory variables in obstructive sleep apnea (OSA). In this setting, to assess how nasal resistance, as measured by 4-phase rhinomanometry, affects the distribution of hypopneas and apneas when measured with routine Sleep Polygraphy (PG). METHODS PG recordings were analysed and 4-phase rhinomanometry was conducted. Crude differences between groups were compared using Mann-Whitney Wilkoxon test. Odds for higher nasal resistance were modelled using logistic regression. All tests were two-sided. P < 0.05 was considered statistically significant. RESULTS In sum, 126 OSA patients referred to our center examined with PG were included. OSA Patients with a higher ratio of hypopneas relative to apneas are more than three times more likely (OR = 3.72, 95%CI [1.30-10.66], p = 0.015) to have increased nasal resistance as measured by 4-phase rhinomanometry, compared to those who have a lower ratio of hypopneas relative to apneas, regardless of OSA severity. The median Hypopnea to Apnea Ratio (HAR) in the low nasal resistance group was 0.8 compared to 2.6 in the high nasal resistance group (p = 0.000). The median apnea index in the low nasal resistance group was 13.6, in the high nasal group it was 5.2 (p = 0.001). CONCLUSIONS Our investigation shows that OSA patients presenting with increased nasal resistance demonstrate significant differences in the distribution of hypopneas and apneas. OSA patients with increased nasal resistance exhibit a significantly lower apnea index and a higher hypopnea to apnea ratio compared to OSA patients presenting with low nasal resistance. Thus, analysis of the HAR in sleep studies is a useful tool to identify patients who may potentially have nasal obstruction as part of their respiratory pathophysiology. We therefore recommend that OSA patients with a predominance of hypopneas relative to apneas should undergo further nasal measurements.
Collapse
Affiliation(s)
- Hans Christian Hoel
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery and Sleep Medicine, Lovisenberg Diaconal Hospital, Norway; Medical Faculty, University of Lund, Sweden.
| | - Knut Kvinnesland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery and Sleep Medicine, Lovisenberg Diaconal Hospital, Norway
| | - Søren Berg
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery and Sleep Medicine, Lovisenberg Diaconal Hospital, Norway; Medical Faculty, University of Lund, Sweden
| |
Collapse
|
|
36
|
Wolters TLC, Roerink SHPP, Drenthen LCA, van Haren-Willems JHGM, Wagenmakers MAEM, Smit JWA, Hermus ARMM, Netea-Maier RT. The Course of Obstructive Sleep Apnea Syndrome in Patients With Acromegaly During Treatment. J Clin Endocrinol Metab 2020; 105:5587082. [PMID: 31612224 PMCID: PMC7705224 DOI: 10.1210/clinem/dgz050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is common in active acromegaly and negatively influences quality of life, morbidity, and mortality. This prospective study with 3 predetermined timepoints and a standardized treatment protocol investigates changes in sleep parameters during the first 2.5 years of acromegaly treatment. METHODS Before initiation of acromegaly treatment (medical pretreatment followed by surgery), polysomnography (PSG) was performed in 27 consecutive patients with treatment-naive acromegaly. PSG was repeated after 1 year (N = 24) and 2.5 years (N = 23), and anthropometric and biochemical parameters were obtained. RESULTS At baseline, 74.1% of the patients was diagnosed with OSAS. The respiratory disturbance index (RDI; P = 0.001), oxygen desaturation index (ODI; P = 0.001), lowest oxygen saturation (LSaO2; P = 0.007) and the Epworth Sleepiness Scale (ESS; P < 0.001) improved significantly during treatment, with the greatest improvement in the first year. After 2.5 years of treatment, all patients had controlled acromegaly. Of the 16 patients with repeated PSG and OSAS at baseline, 11 (68.8%) were cured of OSAS. Changes in RDI, ODI, LSaO2, and ESS correlated with insulin-like growth factor 1 levels. CONCLUSION OSAS has a high prevalence in active acromegaly. There is a substantial decrease in prevalence and severity of OSAS following acromegaly treatment, with the largest improvement during the first year. Most patients recover from OSAS following surgical or biochemical control of the acromegaly. Therefore, a PSG is advised after diagnosis of acromegaly. When OSAS is present, it should be treated and PSG should be repeated during acromegaly treatment.
Collapse
Affiliation(s)
- Thalijn L C Wolters
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Sean H P P Roerink
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Linda C A Drenthen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | | | - Margaretha A E M Wagenmakers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands GD
| | - Johannes W A Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Adrianus R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Correspondence: Romana T. Netea-Maier, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands. E-mail:
| |
Collapse
|
|
37
|
Löw U, Schießl G, Spira-Eppig C, Seitz B. [Floppy eyelid syndrome : A frequently underdiagnosed entity of interdisciplinary importance]. Ophthalmologe 2019; 116:1091-1102. [PMID: 31641846 DOI: 10.1007/s00347-019-00985-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinically, the floppy eyelid syndrome is a frequent but underdiagnosed condition. This clinical phenotype is characterized by an extreme laxity of the eyelid, which is enlarged and has a rubber-like structure in combination with a pronounced hyperelastic tarsus. When looking down, minimal vertical tension can trigger spontaneous eversion of the upper eyelid leading to chronic papillary conjunctivitis. This syndrome usually affects older, adipose men who also suffer from sleep apnea and metabolic syndrome. Due to the resistance of chronic papillary conjunctivitis to conservative treatment, surgical treatment is often necessary; however, due to the frequent association between floppy eyelid syndrome, sleep apnea and metabolic syndrome a collaborative interdisciplinary approach is necessary.
Collapse
Affiliation(s)
- U Löw
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | - G Schießl
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
|
38
|
Chen Q, Lin G, Huang J, Chen L, Li C, Feng D, Huang X, Lin Q. Effects of CPAP on visceral adipose tissue in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 2019; 24:425-432. [PMID: 31463777 DOI: 10.1007/s11325-019-01932-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The efficacy of obstructive sleep apnea (OSA) treatment with continuous positive airway pressure (CPAP) on visceral adipose tissue (VAT) yielded conflicting results. This meta-analysis was performed to assess whether OSA treatment with CPAP could reduce VAT. METHODS The PubMed, Cochrane Library, Embase, and Web of Science were searched before April 2019. Information on characteristics of study participants, pre- and post-CPAP treatment of VAT, and study design was utilized for analysis. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to fully analyze the overall effects. Eleven studies were obtained and the meta-analysis was performed using RevMan v.5.2 and STATA 12.0. RESULTS A total of 11 studies (16 cohorts) were pooled into meta-analysis, which included 398 patients. The value of VAT before and after CPAP treatment showed no change in OSA patients (SMD = - 0.02, 95% CI - 0.16 to 0.12, z = 0.24, p = 0.81). Subgroup analyses were further conducted, which revealed that age, gender distribution, baseline body mass index, daily duration, CPAP therapy duration, measure, sample size, and study design did not affect the results. CONCLUSIONS This meta-analysis revealed that CPAP therapy has no effect on VAT in OSA patients. Further large-scale, well-designed randomized controlled trials are required to address this issue.
Collapse
Affiliation(s)
- Qingshi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
- The Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshan North Road, Licheng District, Quanzhou, 362000, China
| | - Guofu Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Jiefeng Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Lida Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, Shenglixi Road, Xiangcheng District, Zhangzhou, 363000, China
| | - Chaowei Li
- The Second Affiliated Hospital of Fujian Medical University, No. 34 Zhongshan North Road, Licheng District, Quanzhou, 362000, China
| | - Dehuai Feng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Xiaoyun Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Qichang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China.
| |
Collapse
|
|
39
|
Saad AMJ, Hiyasat D, Jaddou H, Obeidat N. The prevalence of high risk obstructive sleep apnoea among patients with type 2 diabetes in Jordan. Diabetes Res Clin Pract 2019; 152:16-22. [PMID: 31078669 DOI: 10.1016/j.diabres.2019.04.035] [Citation(s) in RCA: 6] [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: 10/14/2018] [Revised: 04/03/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of Obstructive Sleep Apnea (OSA) among patients with type 2 Diabetes Mellitus (T2DM) in Jordan, and to explore the association between sleep apnea and clinical and demographic variables. METHOD A cross-sectional study was carried out from the 1st of November 2011 to the 1st of February 2012 on 1143 patients with T2DM (aged 30-90 years) at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). The center is considered to be the only referral center in the country and accordingly, the patients represent the population in different parts of the country. All participants completed the Arabic version of the Berlin Questionnaire and were categorized as either low or high-risk patients for OSA. RESULTS A total of 1143 patients with T2DM were included in this study. There were 587 (51.4%) males and 556 (48.6%) females. The findings showed that 554 (48.5%) patients were at high risk for OSA and 589 (51.5%) were low risk for OSA. Logistic regression analysis revealed that age, smoking, and neck circumference were significantly correlated with high risk for OSA. The clinical and demographic variables were also collected for analysis. CONCLUSIONS The study found that high risk for OSA was highly prevalent among Jordanian patients with T2DM and that age, smoking and neck circumference were significantly correlated with OSA. Health care providers should be made aware of the high prevalence of sleep problems affecting patients with diabetes and should consider the appropriate screening and treatment for these patients, therefore improving their quality of life.
Collapse
Affiliation(s)
- Ahmad M J Saad
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan.
| | - Dana Hiyasat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Hashem Jaddou
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| | - Nathir Obeidat
- National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan
| |
Collapse
|
|
40
|
Cepeda FX, Virmondes L, Rodrigues S, Dutra-Marques ACB, Toschi-Dias E, Ferreira-Camargo FC, Hussid MF, Rondon MUPB, Alves MJNN, Trombetta IC. Identifying the risk of obstructive sleep apnea in metabolic syndrome patients: Diagnostic accuracy of the Berlin Questionnaire. PLoS One 2019; 14:e0217058. [PMID: 31112558 PMCID: PMC6528986 DOI: 10.1371/journal.pone.0217058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor frequently present in patients with metabolic syndrome (MetS). Additionally, moderate and severe OSA are highly prevalent in patients with cardiac disease, as they increase the riskfor cardiovascular events by 80%. The gold standard diagnostic method for OSA is overnight polysomnography (PSG), which remains unaffordable for the overall population. The aim of the present study was to evaluate whether the Berlin Questionnaire (BQ) is anuseful tool for assessing the risk of OSA in patients with MetS. METHODS 97 patients, previously untreated and recently diagnosed with MetS (National Cholesterol Education Program, Adult Treatment Panel III, ATP-III) underwent a PSG. OSA was characterized by the apnea-hypopnea index (AHI). BQ was administered before PSG and we evaluated sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS Of the 97 patients with MetS, 81 patients had OSA, with 47 (48.5%) presenting moderate and severe OSA. For all MetS with OSA (AHI≥5 events/hour), the BQ showed good sensitivity (0.65, 95% CI 0.54 to 0.76) and fair specificity (0.38, 95% CI 0.15-0.65) with a positive predictive value of 0.84, a negative predictive value of 0.18 and an 84% accuracy. Similarly, for moderate-to-severe OSA (AHI≥15 events/hour) we found good sensitivity (0.73, 95% CI 0.58-0.85) and fair specificity (0.40, 95% CI 0.27-0.55). Interestingly, for severe OSA (AHI≥30 events/hour), there was a very good sensitivity (0.91, 95% CI 0.72-0.99) and moderate specificity (0.42, 95% CI 0.31-0.54). CONCLUSION The BQ is a valid tool for screening the risk of OSA in MetS patients in general, and it is particularly useful in predicting severe OSA.
Collapse
Affiliation(s)
- Felipe X. Cepeda
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Sara Rodrigues
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Akothirene C. B. Dutra-Marques
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edgar Toschi-Dias
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Universidade Ibirapuera, São Paulo, Brazil
| | | | | | | | - Maria Janieire N. N. Alves
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
|
41
|
Bahman M, Hajimehdipoor H, Afrakhteh M, Bioos S, Hashem-Dabaghian F, Tansaz M. The Importance of Sleep Hygiene in Polycystic Ovary Syndrome from the View of Iranian Traditional Medicine and Modern Medicine. Int J Prev Med 2018; 9:87. [PMID: 30450170 PMCID: PMC6202781 DOI: 10.4103/ijpvm.ijpvm_352_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/04/2017] [Indexed: 01/18/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is known as the most common hormonal disorder in women at reproductive age. Recent studies have revealed a high prevalence of sleep disorders in PCOS, suggesting that it is an amendable factor for these patients; however, the sleep was not considered in their treatment plan. According to the Iranian traditional medicine (ITM), sleep is an important item in the lifestyle modification of all diseases. The aim of this study is to determine the importance of sleep hygiene in PCOS from the view of ITM and Modern Medicine. In this study, some keywords about “sleep and PCOS” were searched in medical databases and some ITM books. Lifestyle modification is one of the first steps in treatment of patients with PCOS in which the emphasis will be mainly on exercise and diet. Despite proof of the high prevalence of sleep disorders in these patients, modification of sleep is not considered in their lifestyle. ITM as a holistic medicine emphasizes on lifestyle modification under the title of “Settah-e-Zaruria” (In Persian), the six essential schemes for the prevention and treatment of all diseases. Management of sleep is one of these schemes. There are many advices about sleep hygiene in both ITM and modern medicine. It seems that lifestyle modification should be expanded in PCOS patients to include more options, and sleep hygiene should be considered in their lifestyle alongside food and exercise.
Collapse
Affiliation(s)
- Maryam Bahman
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homa Hajimehdipoor
- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- Department of Obstetrics and Gynecology of Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodabeh Bioos
- Department of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fataneh Hashem-Dabaghian
- Research Institute for Islamic and Complementary Medicine, School of Traditional Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mojgan Tansaz
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
42
|
Framnes SN, Arble DM. The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. Front Endocrinol (Lausanne) 2018; 9:440. [PMID: 30127766 PMCID: PMC6087747 DOI: 10.3389/fendo.2018.00440] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, effecting 17% of the total population and 40-70% of the obese population (1, 2). Multiple studies have identified OSA as a critical risk factor for the development of obesity, diabetes, and cardiovascular diseases (3-5). Moreover, emerging evidence indicates that metabolic disorders can exacerbate OSA, creating a bidirectional relationship between OSA and metabolic physiology. In this review, we explore the relationship between glycemic control, insulin, and leptin as both contributing factors and products of OSA. We conclude that while insulin and leptin action may contribute to the development of OSA, further research is required to determine the mechanistic actions and relative contributions independent of body weight. In addition to increasing our understanding of the etiology, further research into the physiological mechanisms underlying OSA can lead to the development of improved treatment options for individuals with OSA.
Collapse
Affiliation(s)
| | - Deanna M. Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI, United States
| |
Collapse
|
|
43
|
Nagao H, Nishizawa H, Tanaka Y, Fukata T, Mizushima T, Furuno M, Bamba T, Tsushima Y, Fujishima Y, Kita S, Funahashi T, Maeda N, Mori M, Fukusaki E, Shimomura I. Hypoxanthine Secretion from Human Adipose Tissue and its Increase in Hypoxia. Obesity (Silver Spring) 2018; 26:1168-1178. [PMID: 29877616 DOI: 10.1002/oby.22202] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The production of uric acid in murine white adipose tissue (mWAT), and that such production was augmented in obese mice, was recently reported. However, little is known about the secretion of metabolites associated with purine catabolism in human WAT (hWAT). The present study analyzed this in hWAT. METHODS Freshly isolated hWAT and mWAT were cultured. The secretion of metabolites associated with purine catabolism was measured. Tissue distribution profiles of genes associated with purine metabolism and metabolite profiling of adipocytes in hypoxia were analyzed. RESULTS Secretion of hypoxanthine from hWAT was higher than those of xanthine and uric acid. On the other hand, secretion of uric acid was relatively higher than xanthine and hypoxanthine in mWAT. Xanthine oxidoreductase (XOR) mRNA expression levels in hWAT were markedly lower than that in the human liver. In murine tissues, XOR mRNA expression levels in mWAT were comparable with those in the liver. Cultured human adipocytes secreted hypoxanthine, and its secretion was increased under hypoxia. The metabolic analysis of human adipocytes showed that hypoxia increased metabolites associated with de novo biosynthesis of purine nucleotides. CONCLUSIONS The present study revealed that hypoxanthine was secreted from human adipose tissue, and the secretion might be increased in local hypoxia.
Collapse
Affiliation(s)
- Hirofumi Nagao
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshimitsu Tanaka
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tadafumi Fukata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masahiro Furuno
- Department of Biotechnology, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Takeshi Bamba
- Department of Biotechnology, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
- Division of Metabolomics, Research Center for Transomics Medicine, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - Yu Tsushima
- Teijin Institute for Bio-medical Research, Teijin Pharma Limited, Hino, Tokyo, Japan
| | - Yuya Fujishima
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shunbun Kita
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tohru Funahashi
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Norikazu Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Eiichiro Fukusaki
- Department of Biotechnology, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| |
Collapse
|
|
44
|
Carneiro G, Zanella MT. Obesity metabolic and hormonal disorders associated with obstructive sleep apnea and their impact on the risk of cardiovascular events. Metabolism 2018. [PMID: 29534971 DOI: 10.1016/j.metabol.2018.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze metabolic and hormonal disorders resulting from the association between obesity and obstructive sleep apnea (OSA) syndrome that predispose to cardiovascular diseases and investigate the clinical benefits obtained from treatment approaches for both conditions. METHODS A literature review between 1997 and 2017 was conducted in the PubMed search database. RESULTS Obesity is the most important risk factor for OSA, and the progressive increase in its prevalence also affects OSA incidence. In addition, OSA may aggravate weight gain and obesity comorbidities. Both conditions lead to an increase in the risk of cardiovascular events and mortality. The gold standard treatment for moderate to severe OSA is CPAP, but significant reduction in major cardiovascular events was not observed in clinical trials. Body weight reduction appears effective to improve OSA, as long as it is maintained. Lifestyle modifications and drug therapy seem to be the preferred approach to treat obesity, but in severe obesity and moderate to severe OSA, bariatric surgery is probably the most adequate treatment. CONCLUSIONS Weight control is essential to decrease the risk of cardiovascular events and mortality potentially linked to both obesity and OSA. CPAP seems to treat only OSA without decreasing these risks. Other treatment strategies are lifestyle modifications and drug therapy, which need further investigation as well as bariatric surgery for severe cases.
Collapse
Affiliation(s)
- Glaucia Carneiro
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | - Maria T Zanella
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
|
45
|
Eckert DJ, Oliven A. When insulin has to work hard to keep the sugar at bay the upper airway collapses away. Eur Respir J 2018; 47:1611-4. [PMID: 27246074 DOI: 10.1183/13993003.00590-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Danny J Eckert
- Neuroscience Research Australia (NeuRA) and the School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Arie Oliven
- Dept of Medicine, Bnai-Zion Medical Center and the Technion, Haifa, Israel
| |
Collapse
|
|
46
|
Abstract
OBJECTIVE Adolescents from Puerto Rican backgrounds are found to have higher rates of obesity than adolescents from other ethnic groups in the US. The objective of this study is to examine whether sleeping the recommended number of hours and depression or anxiety disorder are independently related to risk for obesity in a sample of Island Puerto Rican adolescents, and whether the association between sleep and obesity is moderated by depression or anxiety disorder. METHODS Data from the study were derived from the third wave of an island wide probability sample of Puerto Rican youth residing on the Island, 10-25 years of age (N = 825), with a response rate of 79.59%. The current study focuses on youth 10 to 19 years of age (n = 436). RESULTS In this sample, youth who slept less than the recommended number of hours (defined as 7-9 h per night) had a significantly increased risk for obesity and were three times as likely to be obese. Youth who met criteria for a depressive/anxiety disorder were almost 2.5 times as likely to be obese. However, the presence of an anxiety/depressive disorders did not moderate the association between sleeping the recommended number of hours and risk for obesity. CONCLUSION Sleeping less than the recommended number of hours may be an important risk factor for obesity status in Island Puerto Rican youth. These findings suggest that attention to healthy sleep behaviors and a sleep environment that promotes high quality sleep may be important for Puerto Rican adolescents at risk for obesity.
Collapse
|
|
47
|
Stefanaki C, Pervanidou P, Boschiero D, Chrousos GP. Chronic stress and body composition disorders: implications for health and disease. Hormones (Athens) 2018; 17:33-43. [PMID: 29858868 DOI: 10.1007/s42000-018-0023-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
Recent studies have suggested that body composition is key to health and disease. First, fat tissue is a complex, essential, and highly active metabolic and endocrine organ that responds to afferent signals from traditional hormone systems and the central nervous system but also expresses and secretes factors with important endocrine, metabolic, and immune functions. Second, skeletal muscle mass is an important predictor of health in adult life, while severe mass loss has been associated with the frailty of old age. Studies have shown that skeletal muscle is also an important endocrine organ that secretes factors with autocrine, paracrine, or endocrine actions, which have been associated with inflammatory processes. Third, the bone is also a systemic endocrine regulator playing a pivotal role in health and disease. Finally, proper hydration in humans has been neglected as a health factor, especially in adults. Chronic stress and stress hormone hypersecretion alone or associated with distinct disorders, such as anxiety, depression, obesity, metabolic syndrome, autoimmune disorders, type 2 diabetes mellitus, and polycystic ovary syndrome (PCOS), have been associated with psychological and somatic manifestations, typically, increased fat mass, osteosarcopenia/frailty, cellular dehydration, and chronic systemic inflammation. This review aims to provide new insights into the newly developed concept of stress-related osteosarcopenic obesity and its prevention.
Collapse
Affiliation(s)
- Charikleia Stefanaki
- Choremeion Research Laboratory, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Thivon and Levadeias streets, Goudi, 11527, Athens, Greece.
- Unit of Translational and Clinical Research in Endocrinology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panagiota Pervanidou
- Choremeion Research Laboratory, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Thivon and Levadeias streets, Goudi, 11527, Athens, Greece
| | | | - George P Chrousos
- Choremeion Research Laboratory, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Thivon and Levadeias streets, Goudi, 11527, Athens, Greece
- Unit of Translational and Clinical Research in Endocrinology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
|
48
|
Examining the association between obstructive sleep apnea and cardiometabolic risk factors in the elderly. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0145-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
|
49
|
Vizzardi E, Sciatti E, Bonadei I, D'Aloia A, Curnis A, Metra M. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates. J Cardiovasc Med (Hagerstown) 2018; 18:490-500. [PMID: 25000252 DOI: 10.2459/jcm.0000000000000043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. METHODS We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. RESULTS Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. CONCLUSION Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.
Collapse
Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
| | | | | | | | | | | |
Collapse
|
|
50
|
Scartabelli G, Querci G, Marconi L, Ceccarini G, Piaggi P, Fierabracci P, Salvetti G, Cizza G, Mazzeo S, Vitti J, Berger S, Palla A, Santini F. Liver Enlargement Predicts Obstructive Sleep Apnea-Hypopnea Syndrome in Morbidly Obese Women. Front Endocrinol (Lausanne) 2018; 9:293. [PMID: 29928260 PMCID: PMC5998798 DOI: 10.3389/fendo.2018.00293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is frequently present in patients with severe obesity, but its prevalence especially in women is not well defined. OSAHS and non-alcoholic fatty liver disease are common conditions, frequently associated in patients with central obesity and metabolic syndrome and are both the result of the accumulation of ectopic fat mass. Identifying predictors of risk of OSAHS may be useful to select the subjects requiring instrumental sleep evaluation. In this cross-sectional study, we have investigated the potential role of hepatic left lobe volume (HLLV) in predicting the presence of OSAHS. OSAHS was quantified by the apnea/hypopnea index (AHI) and oxygen desaturation index in a cardiorespiratory inpatient sleep study of 97 obese women [age: 47 ± 11 years body mass index (BMI): 50 ± 8 kg/m2]. OSAHS was diagnosed when AHI was ≥5. HLLV, subcutaneous and intra-abdominal fat were measured by ultrasound. After adjustment for age and BMI, both HLLV and neck circumference (NC) were independent predictors of AHI. OSAHS was found in 72% of patients; HLLV ≥ 370 cm3 was a predictor of OSAHS with a sensitivity of 66%, a specificity of 70%, a positive and negative predictive values of 85 and 44%, respectively (AUC = 0.67, p < 0.005). A multivariate logistic model was used including age, BMI, NC, and HLLV (the only independent predictors of AHI in a multiple linear regression analyses), and a cut off value for the predicted probability of OSAHS equal to 0.7 provided the best diagnostic results (AUC = 0.79, p < 0.005) in terms of sensitivity (76%), specificity (89%), negative and positive predictive values (59 and 95%, respectively). All patients with severe OSAHS were identified by this prediction model. In conclusion, HLLV, an established index of visceral adiposity, represents an anthropometric parameter closely associated with OSAHS in severely obese women.
Collapse
Affiliation(s)
| | - Giorgia Querci
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | | | - Giovanni Ceccarini
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Paolo Piaggi
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States
| | - Paola Fierabracci
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Guido Salvetti
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Cizza
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD, United States
| | - Salvatore Mazzeo
- Department of Radiology, University of Hospital of Pisa, Pisa, Italy
| | - Jacopo Vitti
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Slava Berger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Antonio Palla
- Pulmonary Unit, University of Hospital of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Obesity Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
- *Correspondence: Ferruccio Santini,
| |
Collapse
|