Journal of Clinical Medicine

Editorial

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3 pages, 194 KiB

Open AccessEditorial

En Route to Personalised Medicine in Obstructive Sleep Apnoea

by Andras Bikov

J. Clin. Med. 2023, 12(10), 3457; https://doi.org/10.3390/jcm12103457 - 14 May 2023

Viewed by 1309

Abstract

Obstructive sleep apnoea (OSA) is a common disorder that can cause night- and daytime symptoms and impair driving and work performance [...] Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

Research

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19 pages, 385 KiB

Open AccessArticle

The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results

by Monika Chaszczewska-Markowska, Katarzyna Górna, Katarzyna Bogunia-Kubik, Anna Brzecka and Monika Kosacka

J. Clin. Med. 2023, 12(3), 801; https://doi.org/10.3390/jcm12030801 - 19 Jan 2023

Cited by 5 | Viewed by 1868

Abstract

Introduction: Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard [...] Read more.

Introduction: Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. Material and Methods: This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex^® platform was used. Results: In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO₂, low mean nocturnal SaO₂, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). Conclusions: In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO₂ are factors contributing to the chronic inflammatory state in OSA patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

17 pages, 1303 KiB

Open AccessArticle

BDNF and proBDNF Serum Protein Levels in Obstructive Sleep Apnea Patients and Their Involvement in Insomnia and Depression Symptoms

by Agata Gabryelska, Szymon Turkiewicz, Marta Ditmer, Filip Franciszek Karuga, Dominik Strzelecki, Piotr Białasiewicz and Marcin Sochal

J. Clin. Med. 2022, 11(23), 7135; https://doi.org/10.3390/jcm11237135 - 30 Nov 2022

Cited by 17 | Viewed by 2529

Abstract

Introduction: Obstructive sleep apnea (OSA) is a disorder that, apart from somatic sequelae, increases the risk of developing psychiatric conditions. Brain-derived neurotrophic factor (BDNF) signaling pathway is involved in the pathophysiology of depression and insomnia. Therefore, the study aimed to investigate differences in [...] Read more.

Introduction: Obstructive sleep apnea (OSA) is a disorder that, apart from somatic sequelae, increases the risk of developing psychiatric conditions. Brain-derived neurotrophic factor (BDNF) signaling pathway is involved in the pathophysiology of depression and insomnia. Therefore, the study aimed to investigate differences in concentrations of BDNF and proBDNF in patients with OSA and healthy individuals, to evaluate diurnal changes of these proteins, and to assess the correlations with psychiatric symptoms. Methods: Sixty individuals following polysomnography (PSG) were divided into two groups based on the apnea-hypopnea index (AHI): OSA patients (AHI ≥ 30; n = 30) and control group (AHI < 5; n = 30). Participants filled out questionnaires: Beck Depression Inventory (BDI), Athens Insomnia Scale (AIS), and Pittsburgh Sleep Quality Index (PSQI). Peripheral blood was collected before and after PSG. Protein concentrations were measured using ELISA. OSA group was divided into subgroups: AIS (−)/AIS (+) (AIS > 5), PSQI (−)/PSQI (+) (PSQI > 5), and BDI (−)/BDI (+) (BDI > 19). Results: No differences in BDNF and proBDNF protein levels were observed between OSA and the control groups. However, BDNF and proBDNF evening protein concentrations were higher in the AIS (+) and PSQI (+) groups (p < 0.001 for all). The BDI (+) group was characterized by lower morning levels of both proteins (p = 0.047 and p = 0.003, respectively). Conclusions: BDNF signaling pathway might be involved in the pathophysiology of depression and insomnia in patients with OSA. BDNF and proBDNF protein levels might be useful in defining OSA phenotypes. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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11 pages, 1546 KiB

Open AccessArticle

Impact of a Weight-Loss Rehabilitation Program on Sleep Apnea Risk and Subjective Sleepiness in Patients with Overweight/Obesity: The DietSleep Study

by Sébastien Bailly, Odile Fabre, Mallory Cals-Maurette, Laurent Pantagis, Robin Terrail, Rémy Legrand, Arne Astrup and Jean-Louis Pépin

J. Clin. Med. 2022, 11(23), 6890; https://doi.org/10.3390/jcm11236890 - 22 Nov 2022

Cited by 5 | Viewed by 2103

Abstract

Obstructive sleep apnea (OSA) is one of the most frequent chronic diseases, and comorbid obesity occurs in more than 60% of cases. Variations in body weight influence both OSA severity and OSA-related symptoms. We prospectively assessed the impact of a weight-loss program using [...] Read more.

Obstructive sleep apnea (OSA) is one of the most frequent chronic diseases, and comorbid obesity occurs in more than 60% of cases. Variations in body weight influence both OSA severity and OSA-related symptoms. We prospectively assessed the impact of a weight-loss program using the Berlin score to reflect OSA risk, and we also used the Epworth Sleepiness Scale (ESS) to assess daytime sleepiness. DietSleep was a prospective multicentric cohort study investigating OSA risk and daytime sleepiness before and after weight-loss intervention. One hundred and twenty-seven patients were included (initial OSA risk 36%), most of whom were women (85.8%) with a median body mass index (BMI) of 29.7 kg/m², and the interquartile range was (27.6; 34). The diet-based weight-loss program induced a median decrease in BMI of 3.7 kg/m² (−5; −2.9) (body weight~12.1% (−16.0; −8.8)) over a period of 171 days (114; 269). Changes in anthropometric values were similar regarding OSA risk after adjusting for initial values. Berlin scores significantly improved from 3 (1; 5) to 1 (0; 2), p < 0.01; the proportion of patients with a Berlin score ≥2 decreased from 36% to 7% after the intervention. The proportion of patients with ESS ≥11 decreased from 13% to 2%. These results confirm that a weight-loss program produces clinically relevant weight loss and a significant improvement in both OSA and subjective daytime sleepiness. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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10 pages, 237 KiB

Open AccessArticle

Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea

by Matteo Pollis, Frank Lobbezoo, Ghizlane Aarab, Marco Ferrari, Rosario Marchese-Ragona and Daniele Manfredini

J. Clin. Med. 2022, 11(15), 4572; https://doi.org/10.3390/jcm11154572 - 5 Aug 2022

Cited by 5 | Viewed by 1967

Abstract

Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features [...] Read more.

Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 ± 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea–hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI ≤ 30; severe = AHI > 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p > 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

13 pages, 1137 KiB

Open AccessArticle

REM-Predominant Obstructive Sleep Apnea in Patients with Coronary Artery Disease

by Baran Balcan, Yeliz Celik, Jennifer Newitt, Patrick J. Strollo, Jr. and Yüksel Peker

J. Clin. Med. 2022, 11(15), 4402; https://doi.org/10.3390/jcm11154402 - 28 Jul 2022

Cited by 3 | Viewed by 2141

Abstract

Obstructive sleep apnea (OSA) is common in adults with coronary artery disease (CAD). OSA that occurs predominantly during rapid-eye movement (REM) sleep has been identified as a specific phenotype (REM-predominant OSA) in sleep clinic cohorts. We aimed to examine the association of REM-predominant [...] Read more.

Obstructive sleep apnea (OSA) is common in adults with coronary artery disease (CAD). OSA that occurs predominantly during rapid-eye movement (REM) sleep has been identified as a specific phenotype (REM-predominant OSA) in sleep clinic cohorts. We aimed to examine the association of REM-predominant OSA with excessive sleepiness, functional outcomes, mood, and quality of life in a CAD cohort, of whom 286 OSA patients with total sleep time ≥ 240 min, and REM sleep ≥ 30 min, were included. REM-predominant OSA was defined as a REM-apnea-hypopnea-index (AHI) /non-REM (NREM) AHI ≥ 2. In all, 73 (25.5%) had REM-predominant OSA. They were more likely to be female (26.0% vs. 9.9%; p = 0.001), and more obese (42.5% vs. 24.4%; p = 0.003) but had less severe OSA in terms of AHI (median 22.6/h vs. 36.6/h; p < 0.001) compared to the patients with non-stage specific OSA. In adjusted logistic regression models, female sex (odds ratio [OR] 4.64, 95% confidence interval [CI] 1.85–11.64), body-mass-index (BMI; OR 1.17; 95% CI 1.07–1.28) and AHI (OR 0.93, 95% CI 0.91–0.95) were associated with REM-predominant OSA. In univariate linear regression models, there was a dose-response relationship between REM-AHI and Zung Self-rated Depression Scale but not excessive sleepiness, functional outcomes, and anxiety scores. Among the Short Form-36 subdomains, Vitality, Mental Health, and Mental Component Summary (MCS) scores were inversely correlated with REM-AHI. In multivariate linear models, only MCS remained significantly associated with REM-AHI after adjustment for age, BMI, and sex (β-coefficient −2.20, %95 CI [−0.56, −0.03]; p = 0.028). To conclude, female sex and BMI were related to REM-predominant OSA in this revascularized cohort. MCS was inversely associated with REM-AHI in the multivariate model. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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7 pages, 544 KiB

Open AccessArticle

Association between Frequency of Central Respiratory Events and Clinical Outcomes in Heart Failure Patients with Sleep Apnea

by Ryo Naito, Takatoshi Kasai, Koji Narui and Shin-Ichi Momomura

J. Clin. Med. 2022, 11(9), 2403; https://doi.org/10.3390/jcm11092403 - 25 Apr 2022

Cited by 6 | Viewed by 1629

Abstract

Heart failure (HF) is a progressive cardiac disorder associated with high mortality and morbidity. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. When HF coexists with SA, both central and obstructive respiratory events often [...] Read more.

Heart failure (HF) is a progressive cardiac disorder associated with high mortality and morbidity. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. When HF coexists with SA, both central and obstructive respiratory events often occur. However, few studies have investigated the association between the frequency of central respiratory events coexisting with obstructive events and clinical outcomes in patients with HF and SA. This was a retrospective observational study. Patients with stable HF, defined as a left ventricular ejection fraction of ≤50%, New York Heart Association class ≥ II, and SA (apnea–hypopnea index of ≥15/h on overnight polysomnography) were enrolled. The primary endpoint was a composite of all-cause death and hospitalization for HF. Overall, 144 patients were enrolled. During a period of 23.4 ± 16 months, 45.8% of patients experienced the outcome. The cumulative event-free survival rates were higher in the central SA-predominant group. Multivariate analyses showed that a greater percentage of central respiratory events was associated with an increased risk of clinical outcomes. In patients with HF and SA, the frequency of central respiratory events was an independent factor for all-cause death and hospitalization for HF. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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14 pages, 1531 KiB

Open AccessArticle

The Impact of Sleep-Disordered Breathing on Ghrelin, Obestatin, and Leptin Profiles in Patients with Obesity or Overweight

by Piotr Pardak, Rafał Filip and Jarosław Woliński

J. Clin. Med. 2022, 11(7), 2032; https://doi.org/10.3390/jcm11072032 - 5 Apr 2022

Cited by 5 | Viewed by 2277

Abstract

Background: The impact of concomitant obesity and sleep disorders on neuropeptides related to energy balance is poorly understood. The aim of this study was to assess the nocturnal profile of total ghrelin, obestatin, and leptin in patients with elevated BMI and to investigate [...] Read more.

Background: The impact of concomitant obesity and sleep disorders on neuropeptides related to energy balance is poorly understood. The aim of this study was to assess the nocturnal profile of total ghrelin, obestatin, and leptin in patients with elevated BMI and to investigate the impact of breathing-related sleep disorders on these hormone levels. Methods: The study involved 58 patients with suspicion of obstructive sleep apnea (OSA). Patients underwent anthropometric and sleep examination and measurements of night ghrelin, leptin, and obestatin levels. Results: In patients with OSA (n = 46), recognized on the basis of sleep examination outcomes, the correlation of anthropometric measurements with parameters of sleep disorders and ghrelin levels was observed, contrary to the control group (n = 12). In the OSA group, levels of ghrelin were significantly lower than in the control group at 5:00 and 7:00. Levels of leptin in the OSA group were also lower than those in the control groups (not statistically significant). Profiles of obestatin in both groups were similar. Conclusions: Our results confirm the relationship between obesity and sleep-disordered breathing. Both these disorders affect ghrelin levels—parameters of obesity negatively correlate with hormone concentration, and OSA seems to lower ghrelin values in the second half of the night. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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9 pages, 2081 KiB

Open AccessArticle

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

by Carlos O’Connor-Reina, Jose María Ignacio Garcia, Laura Rodriguez Alcala, Elisa Rodríguez Ruiz, María Teresa Garcia Iriarte, Juan Carlos Casado Morente, Peter Baptista and Guillermo Plaza

J. Clin. Med. 2021, 10(24), 5772; https://doi.org/10.3390/jcm10245772 - 9 Dec 2021

Cited by 16 | Viewed by 4343

Abstract

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym^®, which is used by patients who have rejected [...] Read more.

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym^®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea–hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O₂ saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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10 pages, 1252 KiB

Open AccessArticle

A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

by Andras Bikov, Safia Khalil, Meg Gibbons, Andrew Bentley, David Jones and Saba Bokhari

J. Clin. Med. 2021, 10(19), 4310; https://doi.org/10.3390/jcm10194310 - 22 Sep 2021

Cited by 10 | Viewed by 2948

Abstract

The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, [...] Read more.

The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10–4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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8 pages, 1093 KiB

Open AccessArticle

Nocturnal Oxygen Saturation Parameters as Independent Risk Factors for Type 2 Diabetes Mellitus among Obstructive Sleep Apnea Patients

by Agata Gabryelska, Jędrzej Chrzanowski, Marcin Sochal, Piotr Kaczmarski, Szymon Turkiewicz, Marta Ditmer, Filip Franciszek Karuga, Leszek Czupryniak and Piotr Białasiewicz

J. Clin. Med. 2021, 10(17), 3770; https://doi.org/10.3390/jcm10173770 - 24 Aug 2021

Cited by 26 | Viewed by 2808

Abstract

Obstructive sleep apnea (OSA) is a recognized independent risk factor for metabolic disorders, type 2 diabetes mellites (DM2) in particular. Therefore, the study aimed to assess the influence of nocturnal oxygen saturation parameters on the onset of DM2 among OSA patients. The study [...] Read more.

Obstructive sleep apnea (OSA) is a recognized independent risk factor for metabolic disorders, type 2 diabetes mellites (DM2) in particular. Therefore, the study aimed to assess the influence of nocturnal oxygen saturation parameters on the onset of DM2 among OSA patients. The study consisted of 549 participants, who underwent polysomnography examination. Based on apnea hypopnea index (AHI), 465 patients were diagnosed with OSA. One hundred and seven individuals had comorbid DM2. Cox regression models were used to assess the effect of oxygen saturation parameters on the onset of DM2. Classification and regression trees (CART) analysis was used to assess the onset of the DM2 in the study group in context of oxygen saturation variables. One-way Cox regression showed higher risk of earlier DM2 for increased values of BMI, AHI, decreased basal O₂ and O₂ nadir value, while lowered mean O₂ desaturation has not shown statistical significance. In the CART analysis, the following cut-off points 92.2%, 81.7%, 87.1% were determined for basal O₂, O₂ nadir and mean O₂ desaturation, respectively, with the first two parameters being statistically significant. Therefore, basal O₂ is independent from AHI, BMI and age is a risk factor of DM2 among OSA patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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12 pages, 1230 KiB

Open AccessArticle

The Role of Soluble Low-Density Lipoprotein Receptor-Related Protein-1 in Obstructive Sleep Apnoea

by Martina Meszaros, Laszlo Kunos, Adam Domonkos Tarnoki, David Laszlo Tarnoki, Zsofia Lazar and Andras Bikov

J. Clin. Med. 2021, 10(7), 1494; https://doi.org/10.3390/jcm10071494 - 3 Apr 2021

Cited by 11 | Viewed by 3218

Abstract

Intermittent hypoxia in obstructive sleep apnoea (OSA) is related to inflammation and metabolic abnormalities. Soluble low-density lipoprotein receptor-related protein-1 (sLRP-1) is involved in anti-inflammatory and metabolic processes. However, its ligand, calreticulin (CALR) promotes pro-inflammatory responses and apoptosis. Our aim was to analyse the [...] Read more.

Intermittent hypoxia in obstructive sleep apnoea (OSA) is related to inflammation and metabolic abnormalities. Soluble low-density lipoprotein receptor-related protein-1 (sLRP-1) is involved in anti-inflammatory and metabolic processes. However, its ligand, calreticulin (CALR) promotes pro-inflammatory responses and apoptosis. Our aim was to analyse the levels of these biomarkers in OSA. We recruited 46 patients with OSA and 30 control subjects. Inpatient sleep study was performed and fasting plasma samples were collected. Triglyceride glucose index (TyG) and atherogenic index of plasma (AIP) were calculated. Plasma sLRP-1 levels were significantly lower in the OSA group compared to the controls (1.67 (0.90–2.11) mg/L vs. 1.99 (1.53–3.51) mg/L; p = 0.04) after adjustment for age, gender, BMI and lipid profile. Plasma sLRP-1 concentrations were inversely related to age (r = −0.29), BMI (r = −0.35), cigarette pack years (r = −0.31), LDL-C (r = −0.34) and triglyceride levels (r = −0.27), TyG (r = −0.37) and AIP (r = −0.27) as well as to the oxygen desaturation index (ODI, r = −0.24; all p < 0.05). BMI (p = 0.01) and ODI (p = 0.04) were independent predictors for low sLRP-1 levels. CALR did not differ significantly between the two groups (0.23 (0.17–0.34) ng/mL vs. 0.24 (0.20–0.36) ng/mL p = 0.76). We detected lower sLRP-1 levels in subjects with OSA which could contribute to metabolic abnormalities associated with this disease. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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16 pages, 1721 KiB

Open AccessArticle

High Plasma Cystine Levels Are Associated with Blood Pressure and Reversed by CPAP in Patients with Obstructive Sleep Apnea

by Raphael Boneberg, Anita Pardun, Lena Hannemann, Olaf Hildebrandt, Ulrich Koehler, Ralf Kinscherf and Wulf Hildebrandt

J. Clin. Med. 2021, 10(7), 1387; https://doi.org/10.3390/jcm10071387 - 30 Mar 2021

Cited by 10 | Viewed by 2358

Abstract

Obstructive sleep apnea (OSA) independent of obesity (OBS) imposes severe cardiovascular risk. To what extent plasma cystine concentration (CySS), a novel pro-oxidative vascular risk factor, is increased in OSA with or without OBS is presently unknown. We therefore studied CySS together with the [...] Read more.

Obstructive sleep apnea (OSA) independent of obesity (OBS) imposes severe cardiovascular risk. To what extent plasma cystine concentration (CySS), a novel pro-oxidative vascular risk factor, is increased in OSA with or without OBS is presently unknown. We therefore studied CySS together with the redox state and precursor amino acids of glutathione (GSH) in peripheral blood mononuclear cells (PBMC) in untreated male patients with OSA (apnea-hypopnea-index (AHI) > 15 h⁻¹, n = 28) compared to healthy male controls (n = 25) stratifying for BMI ≥ or < 30 kg m⁻². Fifteen OSA patients were reassessed after 3–5-months CPAP. CySS correlated with cumulative time at an O₂-saturation <90% (Tu90%) (r = 0.34, p < 0.05) beside BMI (r = 0.58, p < 0.001) and was higher in subjects with “hypoxic stress” (59.4 ± 2.0 vs. 50.1 ± 2.7 µM, p < 0.01) defined as Tu90% ≥ 15.2 min (corresponding to AHI ≥ 15 h⁻¹). Moreover, CySS significantly correlated with systolic (r = 0.32, p < 0.05) and diastolic (r = 0.31, p < 0.05) blood pressure. CPAP significantly lowered CySS along with blood pressure at unchanged BMI. Unexpectedly, GSH antioxidant capacity in PBMC was increased with OSA and reversed with CPAP. Plasma CySS levels are increased with OSA-related hypoxic stress and associated with higher blood pressure. CPAP decreases both CySS and blood pressure. The role of CySS in OSA-related vascular endpoints and their prevention by CPAP warrants further studies. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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11 pages, 935 KiB

Open AccessArticle

Atherogenic Index of Plasma in Obstructive Sleep Apnoea

by Andras Bikov, Martina Meszaros, Laszlo Kunos, Alina Gabriela Negru, Stefan Marian Frent and Stefan Mihaicuta

J. Clin. Med. 2021, 10(3), 417; https://doi.org/10.3390/jcm10030417 - 22 Jan 2021

Cited by 16 | Viewed by 3328

Abstract

Background: Dyslipidaemia is well recognised in obstructive sleep apnoea (OSA) and could contribute to the development of cardiovascular disease (CVD). Atherogenic index of plasma (AIP) predicts cardiovascular morbidity and mortality better than the individual lipid levels. The aim of this study was to [...] Read more.

Background: Dyslipidaemia is well recognised in obstructive sleep apnoea (OSA) and could contribute to the development of cardiovascular disease (CVD). Atherogenic index of plasma (AIP) predicts cardiovascular morbidity and mortality better than the individual lipid levels. The aim of this study was to investigate the AIP in patients with OSA in relation with disease severity. Methods: Four hundred sixty-one patients with OSA and 99 controls participated in this study. AIP was assessed in the morning following a diagnostic sleep study. The association between lipid values and OSA were adjusted for age, gender, and body mass index. Results: Patients with OSA had higher AIP and triglyceride, and lower high-density lipoprotein cholesterol (HDL-C) levels (all p < 0.05). AIP significantly correlated with the Epworth Sleepiness Scale score (ρ = 0.19), the apnoea-hypopnoea index (ρ = 0.40) and oxygen desaturation index (ρ = 0.43, all p < 0.05). However, there was no relationship between the AIP and markers of sleep quality such as total sleep time, sleep period time, sleep efficiency, arousal index or percentage of REM sleep (all p > 0.05). AIP was not a better predictor for self-reported cardiovascular disease or diabetes than HDL-C. Conclusions: AIP is elevated in OSA and is related to disease severity. However, it does not seem to have an additional clinical value compared to HDL-C. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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Review

Jump to: Editorial, Research

12 pages, 283 KiB

Open AccessReview

Obstructive Sleep Apnea and Right Ventricular Remodeling: Do We Have All the Answers?

by Marijana Tadic and Cesare Cuspidi

J. Clin. Med. 2023, 12(6), 2421; https://doi.org/10.3390/jcm12062421 - 21 Mar 2023

Cited by 3 | Viewed by 2030

Abstract

Obstructive sleep apnea (OSA) syndrome is a very important sleep-related breathing disorder related to increased cardiovascular and overall morbidity and mortality. It is associated with multisystemic target organ damage due to micro- and macrovascular changes, resulting in carotid and coronary atherosclerosis, increased arterial [...] Read more.

Obstructive sleep apnea (OSA) syndrome is a very important sleep-related breathing disorder related to increased cardiovascular and overall morbidity and mortality. It is associated with multisystemic target organ damage due to micro- and macrovascular changes, resulting in carotid and coronary atherosclerosis, increased arterial stiffness, retinal damage, microalbuminuria, and cardiac remodeling. The latter consists of left ventricular (LV) hypertrophy, as well as diastolic and systolic dysfunction. The increasing burden of evidence shows that OSA also induces right ventricular (RV) remodeling that is more difficult to diagnose, but may also contribute to cardiovascular morbidity and mortality in these patients. Conventional echocardiographic parameters for assessment of RV systolic and diastolic functions are often not sensitive enough to detect subclinical and subtle changes in the RV function. Data published over last decade showed that the RV function, particularly systolic, is impaired in OSA patients and related with its severity. However, the introduction of speckle tracking echocardiography and the particularly longitudinal strain enabled the earlier detection of functional and mechanical changes even when conventional echocardiographic parameters of RV systolic function remained unchanged. The 3D echocardiography provided the possibility to evaluate the entire RV, with its unique shape, and determine 3D RV ejection fraction, which is comparable with results obtained by cardiac magnetic resonance. The use of this modality also provided a new insight into RV systolic (dys)function in OSA patients. In addition to weight loss, which has been proven very helpful in OSA patients, the only approved therapeutic approach is continuous positive airway pressure (CPAP) therapy. It is very important to assess if this therapy induces any improvement in cardiac structure and function. Limited data on this topic show that RV longitudinal strain is a more sensitive parameter rather than other conventional RV indexes in the detection of improvement in RV systolic function and mechanics. The aim of this review article is to summarize the current understanding of RV structural, functional, and mechanical changes in patients with OSA. Furthermore, we sought to provide the current knowledge regarding the effect of CPAP therapy on RV reverse remodeling in OSA patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea with Cardiovascular, Metabolic and Mental Health Disorders)

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