Serum cardiovascular risk factors in obstructive sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) patients have increased cardiovascular morbidity and mortality. The cardiovascular markers associated with OSA are currently not defined. OBJECTIVES: The aims of this study were to determine whether OSA is associated with serum cardiac risk markers and to investigate the relationship between them. METHODS: Sixty-two male patients were classified into two groups with respect to apnea-hypopnea index (AHI): group 1, sleep apnea (n = 30), with AHI > 5; and group 2 (n = 32), with AHI < 5. We compared cardiovascular risk factors in both groups with control subjects (n = 30) without OSA (AHI < 1). Serum cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I, apolipoprotein B, lipoprotein (a), C-reactive protein (CRP), and homocysteine were measured. Statistical significance was assessed with analysis of variance at p < 0.05. In correlation analysis, Pearson correlation was used. RESULTS: There was no significant difference between group 1 and group 2 in total cholesterol, LDL-C, HDL-C, triglyceride, apolipoprotein A-I, apolipoprotein B, and lipoprotein (a). All of the M-mode echocardiographic parameters were in the normal reference range. Serum homocysteine and CRP levels were significantly increased in group 1 compared to group 2 (p < 0.05). Serum CRP values were increased in both group 1 and group 2 when compared with control subjects (p < 0.05). Serum homocysteine values were higher in group 1 than in control subjects (p < 0.05). CONCLUSIONS: Our results show that OSA syndrome is associated not only with slight hyperhomocysteinemia but also with increased CRP concentrations. Increased plasma concentrations of homocysteine and CRP can be useful in clinical practice to be predictor of long-term prognosis for cardiovascular disease and the treatment of OSA.     

Aortic pressure augmentation as a marker of cardiovascular risk in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is associated with increases in cardiovascular morbidity and mortality. Vascular changes in individuals with OSAS have not been fully elucidated, however. The possible impact of OSAS on the extent of aortic pressure augmentation (AG), an indicator of cardiovascular risk, was investigated. Forty-five consecutive male patients aged 35 to 78 years (56.0+/-9.6 years) who were referred to the sleep clinic of Nagoya University Hospital for screening and treatment of OSAS and 71 age-matched healthy men were enrolled in the study. AG was derived from the pressure waveform measured at the radial artery by applanation tonometry. The number of apnea and hypopnea episodes per hour (apnea-hypopnea index [AHI]) was determined by standard polysomnography. AG was significantly greater in OSAS patients than in controls (9.0+/-4.1 vs. 6.4+/-3.4 mmHg, p<0.001), and it was significantly reduced in 19 OSAS patients treated with continuous positive airway pressure. AG was also significantly correlated with the AHI (r=0.562, p<0.001) and age (r=0.356, p=0.016) but not with the serum concentrations of low and high density lipoprotein-cholesterol, triglyceride, or glycosylated hemoglobin. Stepwise multiple regression analysis revealed that the AHI was the most significant contributing factor to the increased AG in OSAS patients (beta=0.109, r=0.530, p<0.001). OSAS may thus have an adverse effect on vascular function that can be ameliorated by appropriate treatment.     

Interactions between obstructive sleep apnea and the metabolic syndrome

The metabolic syndrome, an emerging public health problem, represents a constellation of cardiovascular risk factors. It has been suggested that the presence of obstructive sleep apnea (OSA) may increase the risk of developing some of the features of the metabolic syndrome, including hypertension, insulin resistance, and type 2 diabetes. In this article, we discuss the parallels between the metabolic syndrome and obstructive sleep apnea and describe possible OSA-related factors that may contribute to the metabolic syndrome, specifically the roles of obesity, hypertension, dyslipidemia, sex hormones, inflammation, vascular dysfunction, leptin, insulin resistance, and sleep deprivation.     

阻塞性睡眠呼吸暂停低通气综合征与代谢综合征的关系

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是由多种致病因素引起的发病率高、危险性大的一种慢性睡眠呼吸疾病.OSAHS患者常常与代谢综合征(metabolic syndrome,MS)大家族中的多种疾病,如肥胖、胰岛素抵抗、高血压、糖尿病等伴发或先后出现.其最终结果导致心血管事件发生和死亡的危险性增加.本文对OSAHS和MS的相互关系作一综述.     

阻塞性睡眠呼吸暂停低通气综合征与代谢综合征的相关性研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与代谢综合征(MS)及其组分之间的相关性。方法:本研究为回顾性研究,选取2008年1月至2018年8月,北京安贞医院收治的1 042例行多导睡眠监测的患者,总OSAHS组842例,并按睡眠呼吸暂停低通气指数(AHI)分为三个亚组,分别为轻度OSAHS组320例、中度OSAHS组224例、重度OSAHS组298例;入选AHI5且年龄、性别与OSAHS组相匹配的患者为对照组(200例)。所有患者均测身高、体质量、腰围、血压,并检测FPG、血脂、尿酸、肝肾功能、Hb Alc等指标。结果:OSAHS各组的MS患病率均明显高于对照组,且重度组明显高于轻度组(P0. 05),随着OSAHS程度的加重,伴有多个(≥3个) MS的组分的比例也逐渐增加。AHI与MS、腹型肥胖、高血压、血脂异常均呈明显正相关(r=0. 243、0. 211、0. 125、0. 196,P 0. 01)。总OSAHS组患者的MS患病风险是对照组的3倍(OR=3. 077)。轻、中、重OSAHS组患MS的风险分别是对照组的2. 1倍、3. 4倍、4. 7倍(OR=2. 084,3. 426,4. 691)。多因素Logistic回归分析中,OSAHS进入方程(OR=1. 638,P0. 05)。结论:OSAHS与MS密切相关,是MS的危险因素之一。     

Obesity, obstructive sleep apnea, and cardiovascular risk

Obesity is a major risk factor for cardiovascular disease, the number one killer of Americans. It is also a major risk factor for obstructive sleep apnea, which is rising in the US population as the obesity epidemic continues. Obstructive sleep apnea, in turn, has been implicated as a risk factor for hypertension, glucose dysregulation, and cardiovascular disease. Understanding the pathophysiologic links and the common-soil hypothesis for these rapidly growing disorders is of paramount importance for developing strategic therapeutic and preventive plans. This article discusses the associations of obesity, obstructive sleep apnea, and cardiovascular disease, highlighting the pathophysiologic mechanisms, including increased oxidative stress, endothelial dysfunction, and inflammation.     

An update on obstructive sleep apnea and the metabolic syndrome

PURPOSE OF REVIEW: Patients with obstructive sleep apnea are often overweight or obese, and they frequently exhibit metabolic aberrations, collectively known as the metabolic syndrome, an established cardiovascular risk factor. We review recent data on the relationship between obstructive sleep apnea and metabolic syndrome or its components, including abdominal obesity, insulin resistance, hypertension, and dyslipidemia. RECENT FINDINGS: There is accumulating evidence for an independent association between obstructive sleep apnea and metabolic syndrome or its components. Recent epidemiologic and clinical data suggest a causal role of severe obstructive sleep apnea in development of hypertension, but findings for insulin resistance and dyslipidemia are controversial. Visceral obesity remains a confounding issue in analyses. Animal models and translational studies indicate that obstructive sleep apnea may promote metabolic dysfunction through cycles of intermittent hypoxia; proposed underlying pathophysiologic mechanisms include oxidative stress, sympathetic activation, and inflammation. SUMMARY: There is suggestive evidence, but independent associations between obstructive sleep apnea and metabolic syndrome or its components are not fully established because of the confounding effect of obesity. Large randomized interventional trials are needed to identify any cause-effect relationship. Long-term follow-up studies would help to clarify the role of treatment of sleep apnea in reducing cardio-metabolic morbidity.     

APAP impact on metabolic syndrome in obstructive sleep apnea patients

Purpose  

Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effect of autoadjusting positive airway pressure (APAP) on MS remains unclear. This study aimed to determine the prevalence of MS in OSA patients before and 6 months after APAP, and to identify potential determinants of metabolic status change.     

阻塞性睡眠呼吸暂停综合征与心血管病关系的随访研究

目的调查随访阻塞性睡眠呼吸暂停综合征（OSAS）与心血管病（CVD）的关系。方法自1989年1aY]起入组1868例,其中OSAS患者598例,无OSAS1270例作为对照组,对入组人群每年进行一次体检,以发生CVD为随访终点,如未发生CvD则随访至2009年结束。结果随访期间,OSAS组发生CVD者占83．9％（502／598例）,对照组发生CVD者占28．6％（363／1270例）,两组CVD发生率存在显著统计学差异（P〈0．01）。随访期间死亡率为43．7％（817／1868例）,其中OSAS组死亡率66．2％（396／598例）,对照组死亡率为33．1％（421／1270例）,两组死亡率存在显著统计学差异（P〈0．01）。结论与一般健康人群相比,OSAS患者发生CVD的比例和死亡率均较高。     

阻塞性睡眠呼吸暂停低通气综合征对心脏的影响

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对心血管事件的影响。方法:对237例OSAHS患者与228例健康者的心率变异性(HRV)、24h动态心电图及超声心动图进行对比分析。结果:对照组与OSAHS组间比较,HRV各指标差异有统计学意义(P<0.01);室性期前收缩、房室传导阻滞、窦性停搏发生次数差异有统计学意义(P<0.01);左室质量及质量指数差异有统计学意义(P<0.01)。结论:OSAHS可引起严重的HRV、心律失常及左室质量增加。     

Arterial stiffness alteration and obstructive sleep apnea in an elderly cohort free of cardiovascular event history: the PROOF cohort study

Sleep and Breathing - Several studies suggest in middle-aged subjects a relationship between arterial stiffness, a cardiovascular risk marker, and moderate to severe obstructive sleep apnea (OSA)....     

Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk

BACKGROUND: Cardiovascular complications are common in patients with obstructive sleep apnea (OSA). Blood rheology is a major determent of coagulation and an established risk factor for cardiovascular events. Since nocturnal hypoxemia could influence parameters of blood rheology, we hypothesized that OSA alters blood rheology independent of other cardiovascular risk factors. METHODS: One hundred and ten consecutive patients admitted to the sleep laboratory were included. The association of plasma fibrinogen and viscosity (as parameters of blood rheology) with OSA was evaluated. RESULTS: One hundred and ten patients aged 61.4+/-10.1 years (body mass index 28.4+/-4.1 kg/m2) were included. OSA was confirmed in 63 patients (57.2%) with an apnea-hypopnea index (AHI) of 28.7+/-14.9 events/hour. Patients with OSA showed higher levels of plasma viscosity (1.36+/-0.09 vs. 1.31+/-0.08 mPas, p=0.005). Nevertheless, hypertensive apneics have even higher levels of plasma viscosity than nonapneics (1.38+/-0.091 vs. 1.32+/-0.028 mPas, p=0.018). Similar results were found in patients with coronary artery disease, where OSA was associated with elevated plasma viscosity (1.36+/-0.076 vs. 1.31+/-0.081 mPas, p=0.007). Plasma fibrinogen was correlated with nocturnal minimal oxygen saturation (r=-0275, p=0.0036) and AHI (r=0.297, p=0.001). OSA was associated with higher plasma fibrinogen (353+/-83 vs. 317+/-62 mg/dl, p=0.015). These differences persist with control for cardiovascular risk factors. CONCLUSIONS: Patients with OSA have elevated morning fibrinogen levels and a higher plasma viscosity, which correlate positively with indices of sleep apnea severity. These changes in blood rheology are independent of cardiovascular risk factors, and therefore, might be specific mechanisms of OSA. This supports the pathophysiological concept that sleep apnea is a cardiovascular risk factor.     

The association between obstructive sleep apnea syndrome and metabolic syndrome: a confirmatory factor analysis

Sleep and Breathing - Growing evidence suggests an independent relationship between obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS). Patients with OSAS always show clustering of...