Homocysteine levels in patients with obstructive sleep apnea syndrome

The exact mechanism of development of cardiovascular disease in patients with obstructive sleep apnea syndrome (OSAS) remains to be unknown. The role of homocysteine in atherosclerotic disease process has become well established over the past ten years. Our aim was to study to compare homoscysteine levels between OSAS and control levels. Sixty-two subjects with OSAS and twelve similar controls in age, gender, body mass index, smoking and coronary heart disease were included in this prospective study. Serum levels of homocysteine (13.5 +/- 6.0 micromol/L vs. 10.2 +/- 2.9 micromol/L, p= 0.03) in the OSAS group were significantly greater than those in the control group. Logistic regression analyses showed that OSAS (Odds ratio: 9.08 95% CI 2.347-35.120; p= 0.001) was independent risk factors for high levels of serum homocysteine in age, smoking status, diabetes mellitus and coronary heart disease. We conclude that homocysteine may be an important factor for development of cardiovascular disease in patients with OSAS.     

Leptin and ghrelin levels in patients with obstructive sleep apnea syndrome

BACKGROUND: Leptin is a hormone with well-investigated functions concerning body composition, energy homeostasis and feeding behavior in humans. The obstructive sleep apnea syndrome (OSAS) is strongly associated with obesity, which is known to be closely associated with hyperleptinemia. More recently, ghrelin, a hormone that also influences appetite and energy homeostasis, has been discovered. OBJECTIVES: The aim of this study was to investigate serum leptin and ghrelin levels in obese patients with OSAS in comparison with equally obese controls without OSAS. METHODS: Thirty untreated obese patients with moderate-severe OSAS (apnea-hypopnea index: AHI > or =15) and 22 obese controls (AHI <5) were studied. To confirm the diagnosis, all patients underwent standard polysomnography in our sleep disorders center. Serum samples were taken at 08:00 h in the morning after overnight fasting. RESULTS: Significantly higher serum leptin levels were found in OSAS patients compared to controls (p = 0.012), but there was no significant difference in serum ghrelin levels between OSAS patients and controls. Serum leptin levels were significantly correlated with body mass index in both OSAS patients (r = 0.55, p = 0.002) and controls (r = 0.46, p = 0.028), but only in OSAS patients was the leptin level significantly correlated with AHI (r = 0.38, p = 0.036). CONCLUSION: These data support findings suggesting that leptin is a hormonal factor affected by OSAS and not determined by obesity alone. Further studies are needed to investigate the relationship between serum ghrelin and OSAS.     

Serum omentin levels in patients with obstructive sleep apnea

Background

Obstructive sleep apnea syndrome (OSAS) is associated with increased rates of cardiovascular diseases (CVD). The basic mechanisms involved in the increased cardiovascular risk of OSAS remain unclear. Recent discoveries of fat-secreted substances which serve endocrine roles improve our understanding of the relationship between OSAS, CVD, and the metabolic syndrome. In this study, we aimed to examine associations between omentin levels and OSA.

Methods

Forty-six newly diagnosed OSA patients and 35 non-apneic controls were enrolled in this study. Demographical data, cigarette smoking status, previous history of chronic diseases including CVD and metabolic diseases and drugs, and habits were obtained using a standardized questionnaire. All patients underwent polysomnographic evaluation. Omentin was measured the following morning.

Results

The mean age was 48.1?±?12.5 (24–74) years in the OSA group and 42.8?±?14.1 (21–69) years in the control group. Of the 81 patients, 46 (34 males and 12 females) were classified as having OSA and 35 patients (20 males and 15 females) as control. Plasma levels of omentin were found to be markedly higher in OSA patients (570.8 ng/ml) than in the control group (432.0 ng/ml; p?<?0.001). In addition, plasma levels of omentin were found to be high in all OSA subgroups than in controls. The plasma omentin levels were significantly correlated only with age in patients with OSA.

Conclusions

We conclude that circulating omentin levels are elevated in OSA patients. To the best of our knowledge, this is the first clinical study that demonstrated the association between omentin and OSA.     

老年男性阻塞性睡眠呼吸暂停综合征患者血清脂联素水平的变化

目的探讨老年男性阻塞性睡眠呼吸暂停综合征(OSAS)血清脂联素水平的变化。方法选择62例习惯性打鼾老年人行多导睡眠仪监测,根据呼吸暂停低通气指数(AHI)分为单纯打鼾组(对照组),OSAS组,以放射免疫法测定血清中脂联素水平。结果OSAS组的血清脂联素水平显著低于对照组(P<0.01)。而血清脂联素水平在轻度OSAS患者中即有显著降低(P<0.05),在中度和重度OSAS患者中进一步降低(P<0.01)。OSAS各亚组间的比较发现:中、重度组的血清脂联素水平均明显低于轻度OSAS组(P<0.05)。Pearson相关分析提示OSAS患者血清脂联素水平与AHI、体重指数(BMI)、腰围(WC)、颈围(NC)、反应性胰岛素抵抗的体内稳态模式(HOMA)指数呈负相关,与最低血氧饱和度(mini SpO2)呈正相关。偏相关分析提示血清脂联素水平与AHI呈负相关(r=-0.26,P<0.05),与SpO2呈正相关(r=0.24,P<0.05)。多元逻辑回归分析提示血清脂联素水平与OSAS独立相关。结论老年男性OSAS患者血清中脂联素水平较单纯打鼾者为低。     

Serum adiponectin levels in adult male patients with obstructive sleep apnea hypopnea syndrome

BACKGROUND: Adiponectin has been found to be associated with the pathogenesis of diabetes, obesity and some cardiovascular diseases, which usually coexist with obstructive sleep apnea hypopnea syndrome (OSAHS). However, an association between adiponectin and OSAHS has rarely been reported. OBJECTIVES: To investigate the levels of serum adiponectin in adult male patients with OSAHS. METHODS: Following polysomnographic examination, 86 adult male habitual snorers were divided into simple snorers (control group) and OSAHS patients (OSAHS group) who were further divided into mild, moderate and severe OSAHS subgroups based on their apnea hypopnea index (AHI). There was no significant difference in age, body mass index (BMI), fasting blood glucose (FBG) and insulin resistance expressed as homeostasis model assessment (HOMA) between the two groups. The serum adiponectin levels were measured by radioimmunoassay. RESULTS: Serum adiponectin levels were significantly lower in the OSAHS group than in the control (p < 0.01). Such a decrease in adiponectin level was most significant in patients with moderate and severe OSAHS. Pearson correlation analysis showed that in OSAHS patients, serum adiponectin level was negatively correlated with BMI, waist (WC) and neck (NC) circumferences, AHI and HOMA, but positively correlated with nadir pulse oxyhemoglobin saturation (nadir SpO2). After controlling for HOMA, BMI, NC and WC in OSAHS patients, a partial correlation analysis showed that adiponectin levels were negatively correlated with AHI but positively correlated with nadir SpO2. Multiple logistic regression analysis indicated that adiponectin was independently associated with OSAHS. CONCLUSIONS: Serum adiponectin levels were significantly lower in OSAHS patients than in simple snorers. OSAHS may cause a decrease in serum adiponectin level.     

Oxidative stress in patients with obstructive sleep apnea syndrome

Purpose

We aimed to investigate whether systemic oxidative stress is increased in patients with obstructive sleep apnea syndrome (OSAS).

Methods

A total of 18 patients with severe OSAS and 13 controls were included in the study. Inclusion criteria for OSAS patients were: snoring and apnea–hypopnea index (AHI) of >30 in full polysomnography, no previous treatment for OSAS, non-smoking status, and a medical history of being free of comorbidities known to increase oxidative stress. Controls were recruited among subjects assessed for snoring in the Sleep Laboratory Department if they had AHI<5. At baseline, patients were evaluated by the Epworth Sleepiness Scale and underwent spirometry, echocardiography, and full polysomnographic study. Blood samples were collected for evaluation of oxidative stress biomarkers [protein carbonyls, reduced (GSH) and oxidized (GSSG) glutathione, 8-isoprostane, thiobarbituric acid-reactive substances (TBARS), catalase activity, Cu–Zn superoxide dysmutase (SOD), total antioxidant capacity (TAC)] before and on the morning following polysomnography.

Results

The overnight (morning–night) change (%) of GSH/GSSG ratio and GSH was significantly different between OSAS and controls (p?=?0.03 and p?=?0.048, respectively). Plasma protein carbonyls, erythrocyte catalase activity, 8-isoprostane, SOD, TBARS, and TAC plasma values were not different between OSAS and controls (p?>?0.05). No significant correlation was found between changes in the levels of biomarkers and AHI, arousal, or desaturation index.

Conclusion

The present prospective investigation in a population free of comorbidities or factors which may increase systemic oxidative stress provides evidence that obstructive sleep apnea per se might be associated with increased oxidative burden possibly via GSH/GSSG pathway.     

CPAP compliance in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP. In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly. Group-III patients had higher apnea–hypopnea index (AHI) than groups I and II (respectively, 56.6 ± 27.7, 26.3 ± 7.5, and 32.3 ± 7.06; p < 0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II (44.6 ± 22.3, 15.9 ± 8.3, and 25.6 ± 9.5; p < 0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 ± 27.7). Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications of OSAS should be keynoted.     

Circulating levels of ghrelin,galanin, and orexin-A orexigenic neuropeptides in obstructive sleep apnea syndrome

Sleep and Breathing - The orexigenic peptides, ghrelin, galanin, and orexin-A, have an important role in food intake and energy homeostasis and regulate the higher brain functions including the...     

Metabolic syndrome in Japanese patients with obstructive sleep apnea syndrome.

We investigated the prevalence of metabolic syndrome in patients with obstructive sleep apnea syndrome (OSAS) referred to a tertiary university-based medical center. A cross-sectional study of patients with a definite diagnosis of OSAS was performed using new diagnostic criteria for metabolic syndrome that were designed for the Japanese population. Clinical features and comorbidities related to metabolic syndrome were compared between 819 patients with OSAS (719 men and 100 women) and 89 control subjects without OSAS. Metabolic syndrome was significantly more common in the patients with OSAS than in the controls (49.5% vs. 22.0% for men, p < 0.01; 32.0% vs. 6.7% for women, p < 0.01). Men with OSAS (apnea-hypopnea index [AHI] > or =5/h) had a higher risk of metabolic syndrome compared with controls (odds ratio [OR]: 3.47; 95% confidence interval [CI]: 1.84-6.53). There was a significantly increased risk of metabolic syndrome in men with moderate OSAS (AHI: 15-29.9/h) (OR: 2.83; 95% CI: 1.42-5.66) and men with severe OSAS (AHI > or =30/h) (OR: 5.09; 95% CI: 2.67-9.71). Women with OSAS (AHI> or =5/h) also had an increased risk of metabolic syndrome (OR: 6.59; 95% CI: 1.47-29.38), and the risk was significantly higher in women with severe OSAS (AHI > or =30/h) (OR 14.00; 95% CI: 2.93-66.82). Risk factors for metabolic syndrome differed by gender: in men, age, body mass index (BMI), and OSAS (AHI > or =15/h) were significantly associated with metabolic syndrome, whereas, in women, BMI was the only risk factor for metabolic syndrome. The increase of metabolic syndrome in Japanese OSAS patients suggests that this patient population is burdened with multiple risk factors for cardiovascular disease.     

Low serum copeptin levels in patients with obstructive sleep apnea

Purpose

Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group.

Methods

A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method.

Results

Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48?±?0.24. vs. 0.64?±?0.28 ng/ml, p?=?0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n?=?13) and severe (n?=?47) obstructive sleep apnea patients (0.42?±?0.18 vs. 0.49?±?0.26 ng/ml, p?=?0.409).

Conclusions

Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.     

阻塞性睡眠呼吸暂停综合征合并高血压患者的睡眠分析

目的 分析阻塞性睡眠呼吸暂停综合征(OSAHS)合并高血压患者的睡眠.方法 将我院收治的OSAHS合并高血压患者作为研究1组,OSAHS血压正常患者作为研究2组,并以单纯鼾症患者作为对照组,应用多导睡眠监测仪对三组患者进行睡眠监测.结果①研究1组、研究2组觉醒时间较对照组明显增多,研究1组浅睡眠较研究2组、对照组明显增多;中度睡眠研究2组、对照组明显减少(P<0.05).② 研究1组呼吸暂停低通气指数、呼吸暂停指数明显高于研究2组(P<0.05).③研究1组呼吸暂停时间占睡眠时间百分比较研究2组升高(P<0.05).④ 研究1组最低血氧饱和度明显高于研究2组(P<0.05).结论 OSAHS合并高血压患者呼吸紊乱较血氧正常患者重,睡眠质量相对较差.     

阻塞性睡眠呼吸暂停综合征术前评估方法的研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种常见的因郡分或全部上呼吸道反复阻塞引起的睡眠障碍,其特征是睡眠时呼吸气流暂停超过10 s.手术患者合并OSAS可使患者更易发生围手术期并发症.目前OSAS诊断的金标准是多导睡眠图,其术前评估方法有量表法和便携式仪器诊断等多种方法.