Gender‐specific anthropometric markers of adiposity,metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea

Obstructive sleep apnea often coexists with visceral adiposity and metabolic syndrome. In this study, we analysed gender‐related differences in anthropometrics according to sleep apnea severity and metabolic abnormalities. In addition, the visceral adiposity index, a recently introduced marker of cardiometabolic risk, was analysed. Consecutive subjects with suspected obstructive sleep apnea (n = 528, 423 males, mean age ± standard deviation: 51.3 ± 12.8 years, body mass index: 31.0 ± 6.2 kg m^?2) were studied by full polysomnography (apnea–hypopnea index 43.4 ± 27.6 h^?1). Variables of general and visceral adiposity were measured (body mass index, neck, waist and hip circumferences, waist‐to‐hip ratio). The visceral adiposity index was calculated, and metabolic syndrome was assessed (NCEP‐ATP III criteria). The sample included controls (apnea–hypopnea index <10 h^?1, n = 55), and patients with mild–moderate (apnea–hypopnea index 10–30 h^?1, n = 144) and severe sleep apnea (apnea–hypopnea index >30 h^?1, n = 329). When anthropometric variables were entered in stepwise multiple regression, body mass index, waist circumference and diagnosis of metabolic syndrome were associated with the apnea–hypopnea index in men (adjusted R² = 0.308); by contrast, only hip circumference and height‐normalized neck circumference were associated with sleep apnea severity in women (adjusted R² = 0.339). These results changed little in patients without metabolic syndrome; conversely, waist circumference was the only correlate of apnea–hypopnea index in men and women with metabolic syndrome. The visceral adiposity index increased with insulin resistance, but did not predict sleep apnea severity. These data suggest gender‐related interactions between obstructive sleep apnea, obesity and metabolic abnormalities. The visceral adiposity index was a good marker of metabolic syndrome, but not of obstructive sleep apnea.     

Estrogen deprivation,rather than age,is responsible for the poor lipid profile and carbohydrate metabolism in women

The protective effect of estrogen against cardiovascular diseases (CVD) in women disappears after menopause. However, it is not clear whether the change in risk factors after menopause is related to aging or estrogen deprivation. Objective: To assess the risks for CVD and the contribution of aging in estrogen-deprived women. Methods: Forty-one patients with premature ovarian failure (POF) (group 1) and 30 patients with natural menopause (group 2) were investigated with respect to well-known risk factors for CVD. Fifteen young women at reproductive age (group 3) were taken as controls. The median ages (ranges) of the groups were 31 (19–40), 52 (46–67) and 26 (24–29) years, respectively. Family and personal history for CVD, smoking, oral contraceptive usage, physical examination, blood pressure measurement, body mass index (BMI), blood level of fasting insulin, diabetes mellitus, and the levels of lipoprotein proteins were the examined parameters regarding the risks for CVD. Results: The levels of triglycerides and very low density lipoprotein (VLDL) cholesterol were not different in the 3 groups. The levels of fasting insulin (11.3 ± 6.6 vs. 10.2 ± 5.8 IU/ml), the ratio of fasting insulin to fasting blood glucose (12.2 ± 6.3% vs. 10.5 ± 5.4%), high density lipoprotein (HDL) cholesterol (51.9 ± 12.9 vs. 51.6 ± 9.7 mg/d), low density lipoprotein (LDL) cholesterol (113 ± 47 vs. 127 ± 37 mg/dl) and the ratio of HDL to total cholesterol (27.2 ± 9.8% vs. 24.1 ± 6.9%) were not different in women with POF and natural menopause. These parameters were all better in controls with respect to risk for CVD (respectively, 6.5 ± 2.0 IU/ml, 7.4 ± 2.2%, 37.9 ± 5.3 mg/dl, 80 ± 40 mg/dl, P < 0.05). Conclusion: Risk factors for CVD are related to estrogen deprivation. Aging does not have an important impact on CVD within the age range of this study group.     

Obstructive sleep apnea is associated with increased arterial stiffness in severe obesity

Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non‐invasively measures peripheral pulse waveforms and derives measures of haemodynamic status, including arterial stiffness, augmentation pressure and subendocardial viability ratio. We hypothesized that the presence of obstructive sleep apnea in severe obesity, even in the absence of an antecedent history of cardiovascular disease, would affect measurements derived from pulse wave analysis. Seventy‐two severely obese adult subjects [obstructive sleep apnea 47 (body mass index 42 ± 7 kg m^?2), without obstructive sleep apnea (non‐OSA) 25 (body mass index 40 ± 5 kg m^?2)] were characterised using anthropometric, respiratory and cardio‐metabolic parameters. Groups were similar in age, body mass index and gender. More subjects with obstructive sleep apnea had metabolic syndrome [obstructive sleep apnea 60%, without obstructive sleep apnea (non‐OSA) 12%]. Those with obstructive sleep apnea had greater arterial stiffness, augmentation pressure and decreased subendocardial viability ratio (all P < 0.001), with significantly higher systolic (P = 0.003), diastolic (P = 0.04) and mean arterial pressures (P = 0.004) than patients without obstructive sleep apnea (non‐OSA). Arterial stiffness correlated with mean arterial blood pressure (P = 0.003) and obstructive sleep apnea severity (apnea–hypopnea index; P < 0.001). apnea–hypopnea index significantly predicted arterial stiffness in multiple regression analysis, but components of the metabolic syndrome did not. Thus, patients with obstructive sleep apnea with severe obesity have increased arterial stiffness that may potentially influence cardiovascular risk independently of metabolic abnormalities. The presence of obstructive sleep apnea in severe obesity identifies a group at high cardiovascular risk; clinicians should ensure that risk factors are managed appropriately in this group whether or not treatment of obstructive sleep apnea is offered or accepted by patients.     

Plasma cytokine levels in patients with obstructive sleep apnea syndrome: a preliminary study

The levels of some pro- and anti-inflammatory cytokines [interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha, IL-6, IL-10, and transforming growth factor (TGF)-beta], were measured by enzyme-linked immunosorbent assay (ELISA) method in the plasma of patients affected by obstructive sleep apnea syndrome (OSAS) at 22:00 hours before polysomnographic recording and immediately after the first obstructive apnea causing an SaO2 below 85%. Significantly higher levels of TNF-alpha were found in OSAS patients assessed before polysomnography compared with the control group (P < 0.01). A slight but significant increase in the plasma levels of IL-6 was also present (P < 0.05). Conversely, a significant decrease in the plasma levels of IL-10 was evident at baseline in OSAS patients (P < 0.04). No significant difference emerged between the mean values of IL-1alpha and TGF-beta between OSAS patients and controls. The present data support a prevailing activation of the Th1-type cytokine pattern in OSAS patients, which is not associated with the severity and duration of OSAS. This can have important consequences for the outcome of OSAS patients, especially with regard to the increased risk for developing atherosclerosis and cardiovascular and cerebrovascular diseases. Immediately after the first obstructive apnea causing an SaO2 <85%, a significant variation was observed in the plasma levels of TNF-alpha in OSAS patients compared with those measured before the beginning of polysomnographic recording (P < 0.001). The role played by this further increase in TNF-alpha levels after the obstructive apnea in OSAS patients remains to be established in the light of the pathogenic mechanisms of this sleep disorder.     

Evaluation of Pregnancy-Associated Plasma Protein-A Levels in Patients with Chronic Obstructive Pulmonary Disease and Associations with Disease Severity

Chronic obstructive pulmonary disease (COPD) represents a systemic disorder characterized by chronic airflow limitation and an increased inflammatory response of the airways. Comorbidities are frequent in COPD and it is crucial to predict these in early stage for adequate management of COPD. Recent studies have reported that elevated levels of pregnancy-associated plasma protein-A (PAPP-A), a zinc-binding metalloproteinase, detected in patients with asthma, lung cancer, and pulmonary embolism and independently associated with cardiovascular events. We aimed to assess serum PAPP-A levels in COPD and the associations between disease severity. The study population consisted of 75 COPD patients and 35 healthy subjects as a control group. PAPP-A levels were measured by using ultrasensitive enzyme-linked immunosorbent assay. Elevated levels of PAPP-A were observed in patients with COPD on comparison with the controls (p?=?0.000). The levels in stage 1 (34.73?±?22.97) and stage 2 (48.29?±?53.35) were significantly higher than stage 3 (20.58?±?22.98) and stage 4 (27.36?±?21.46) (p?=?0.049). Increased PAPP-A levels may be a useful marker in management of COPD that seeks to prevent the development of comorbidities such as adverse cardiovascular diseases.     

Assessing vitamin D levels in an anti-DFS70 positive population: New insights emerging

Abstract

Background: Anti-dense fine speckled 70 (DFS70) autoantibodies have more often been described in apparently healthy individuals than in patients with systemic autoimmune rheumatic diseases (SARD). The aim of this study was to explore the link between anti-DFS70 autoantibodies and vitamin D (25(OH)D) levels in an Italian adult cohort.

Methods: Serum samples from 34 (five males and 29 females) anti-DFS70 positive patients (index cases), 34 ANA-negative healthy controls, 34 ANA-positive anti-DFS70 negative SLE patients, both groups age- and gender-matched with the index cases, 23 ANA-positive anti-DFS70 negative healthy blood donors and six female SARD patients showing mixed DFS positive pattern were collected and tested for 25(OH)D levels. Relevant demographics and lifestyle practices, body mass index (BMI), comorbidities, and use of medication were recorded for patients and healthy controls.

Results: Mean serum levels of 25(OH)D were significantly higher in anti-DFS70 positive subjects (mean?±?SD: 22.1?±?9.8?ng/ml) than in ANA-negative healthy controls (mean?±?SD: 17.3?±?6.7?ng/ml; p?=?.03), ANA-positive healthy controls (mean?±?SD: 15.2?±?6.8?ng/ml; p?=?.01), SLE patients (16.6?±?11.0?ng/ml; p?=?.01) and in patients with SARD (15.0?±?5.6?ng/ml; p?=?.01). No statistically relevant differences in BMI, clinical, or demographic parameters were found.

Conclusions: Our findings showed higher levels of vitamin D in anti-DFS70 positive subjects than in the controls, which is compatible with the hypothesis of the “benign” nature of anti-DFS70 antibodies.     

Exhaled nitric oxide in patients with sleep apnea

Cardiovascular diseases are frequent in patients with obstructive sleep apnea syndrome (OSAS), but the mechanisms underlying this association are largely unknown. Nitric oxide (NO) is a key regulatory element of vascular physiology. The concentration of NO in the exhaled air ([NOexh]) appears to be reduced in patients with systemic and pulmonary hypertension. This study sought to investigate whether [NOexh] is abnormal in patients with OSAS, and to explore potential relationships between [NOexh] and the severity of OSAS. We measured [NOexh] in 24 patients with OSAS (apnea-hypopnea index (AHI), 55 +/- 4 hour-1) (x +/- SEM), and in 7 healthy volunteers in whom OSAS was excluded clinically. [NOexh] was measured on line by a chemiluminescence analyzer (Dasibi Environmental Corporation, Glendale, Calif). Seven patients with OSAS (29%) had a positive history of cardiovascular disease. Mean [NOexh] was 19.7 +/- 3.2 ppb in healthy subjects, and 22.2 +/- 3.0 ppb in patients with OSAS (p = ns). [Noexh] was not significantly different in those patients with or without cardiovascular disease. [NOexh] was not significantly related to the AHI, the body mass index, or the arterial O2 saturation at night. These results show that [NOexh] is not abnormal in patients with OSAS, and that it does not relate to the presence of cardiovascular disease or to any of various common indices of disease severity.     

Low leptin concentration may identify heart failure patients with central sleep apnea

Low leptin concentration has been shown to be associated with central sleep apnea in heart failure patients. We hypothesized that low leptin concentration predicts central sleep apnea. Consecutive ambulatory New York Heart Association (NYHA ) classes I–IV heart failure patients were studied prospectively, including measurement of serum leptin, echocardiography and polysomnography. Sleep apnea was defined by type (central/mixed/obstructive) and by apnea–hypopnea index ≥5 by polysomnography. Subjects were divided into four groups by polysomnography: (1) central sleep apnea, (2) mixed apnea, (3) no apnea and (4) obstructive sleep apnea. Fifty‐six subjects were included. Eighteen subjects were diagnosed with central sleep apnea, 15 with mixed apnea, 12 with obstructive apnea and 11 with no sleep apnea. Leptin concentration was significantly lower in central sleep apnea compared to obstructive apnea (8 ± 10.7 ng mL^?1 versus 19.7 ± 14.7 ng mL^?1, P  ? 0.01) or no sleep apnea (8 ± 10.7 ng mL^?1 versus 17.1 ± 8.4 ng mL^?1, P  ? 0.01). Logistic regression showed leptin to be associated independently with central sleep apnea [odds ratio (OR ): 0.19; 95% confidence interval (CI ): 0.06–0.62; area under the curve (AUC ): 0.80, P  < 0.01]. For the detection of central sleep apnea, a cut‐off value for leptin concentration 5 ng mL^?1 yielded a sensitivity of 50% and specificity of 89%. In conclusion, a low leptin concentration may have utility for the screening of heart failure patients for central sleep apnea.     

Middle patellar tendon to posterior cruciate ligament (PT–PCL) and normalized PT–PCL: New magnetic resonance indices for tibial tubercle position in patients with patellar instability

Background

To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT–PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle–PCL (TT–PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT–PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI).

Peripheral whole blood FOXP3 TSDR methylation: a potential marker in severity assessment of autoimmune diseases and chronic infections

Immune dysregulation is a cardinal feature of autoimmune diseases and chronic microbial infections. In particular, regulatory T cells are downregulated in autoimmune diseases while upregulated in chronic microbial infections. FOXP3 is the master regulator of Treg development. Treg-specific demethylated region (TSDR) is a highly conserved locus on the FOXP3 gene that is fully demethylated in natural Tregs but methylated in effector T cells. In our study, we used high resolution melt-polymerase chain reaction (HRM-PCR) to determine the FOXP3 TSDR methylation status in autoimmune diseases and chronic microbial infections. We found that FOXP3 TSDR to have the highest mean melting temperature (highly methylated) in active SLE patients compared to all the other groups (p?<?0.001). The psoriasis group also had a significantly high mean melting temperature (78.62?±?0.20) when compared with the inactive SLE group (78.49?±?0.29, p?<?0.05) and control group (78.44?±?0.25, p?<?0.01). There was no significant difference in melting temperature between inactive SLE and healthy controls. Disease activity in SLE was directly associated with methylation of the FOXP3 TSDR. On the other hand, patients with chronic microbial infections had significantly lower FOXP3 TSDR mean melting temperature (demethylated) when compared with healthy controls (78.28?±?0.21 vs 78.44?±?0.25, p?<?0.05). Our results suggest that the use of HRM-PCR to detect FOXP3 TSDR methylation status is a reliable and easy method to predict natural regulatory T cell levels in peripheral blood in different disease conditions. Determining FOXP3 TSDR methylation status can be a useful tool in diagnosis, and monitoring the severity of autoimmune diseases and chronic microbial infections.     

Altersgebrechlichkeit und Schlafapnoe

Background

Frailty and sleep apnea are common entities in the elderly. Frailty causes dependency and need of care. The prevention of frailty is a major topic in geriatrics. However, the relationship between sleep apnea and frailty has hardly been studied.

Methods

In a prospective pilot study, the relationship between the presence of at least one of the five frailty criteria proposed by Fried and sleep apnea were examined. Patients were eligible, if they able to communicate and had no dementia. Sleep apnea was diagnosed by overnight pulse oximetry. Tiredness was obtained using the questionnaire by Siegrist.

Results

A total of 42 patients with a mean age of 82?±?7 years were enrolled. There were 15 (36%) male and and 27 (64%) female patients, of which 28 (67%) patients met at least one frailty criterion. Patients with frailty criteria experienced significantly more often daytime sleepiness (1/14 vs. 17/28, p?<0.001), had a significantly higher incidence of severe sleep apnea with an oxygen desaturation index >?30/h (p?<0.04) and had a lower mean nocturnal oxygen saturation (95?±?2% vs. 91?±?4%, p?<0.02).

Conclusion

Our small pilot study showed an association between the presence of at least one frailty criterion, daytime sleepiness, and severe sleep apnea. Given the high frequency of both phenomena and regarding the clinical relevance of frailty, prospective studies are warranted to prove a causal relationship between sleep apnea and frailty.     

2型糖尿病合并阻塞性睡眠呼吸暂停综合征患者肾脏并发症患病情况及相关因素分析

目的 研究住院2型糖尿病合并阻塞性睡眠呼吸暂停征(OSAS)患者肾脏合并症情况.方法 收集符合条件的2型糖尿病患者,记录年龄、病程、体重指数、腰围、血压等指标,使用便携式睡眠呼吸监测仪进行睡眠呼吸监测,同时完善糖化血红蛋白、空腹血糖、餐后2小时血糖、肌酐、尿素氮、24小时尿微量白蛋白及尿蛋白检验,并计算肾小球滤过率.结果完成研究106例,71例合并OSAS.合并OSAS的患者肌酐(64.49±15.72μmol/L vs 57.28±8.69μmol/L,P<0.05)、尿素氮(5.04±0.61mmol/L vs 4.71±0.64mmol/L,P<0.05)、24小时尿微量白蛋白[25.30(12.64,68.70)mg vs 8.74(4.8,16.24)mg,P<0.05]及24小时尿蛋白[0.24(0.1,1.45)g vs 0.15(0.06,0.26)g,P<0.05]高于未合并OSAS患者,合并OSAS患者肾小球滤过率(89.83±13.97mL·min-1·1.73m-2 vs 102.88±8.02mL·min-1·1.73m-2,P<0.05)偏低.合并OSAS的患者中,出现Ⅲ期以上糖尿病肾病比未合并OSAS的患者更多见(53.5%vs46.5%,P<0.05).采用多因素logistics回归分析后发现,糖化血红蛋白(OR1.36,95% CI 1.01~1.07,P<0.05),空腹血糖(OR 1.01,95%CI 0.73~1.16,P<0.05)及每小时睡眠呼吸暂停次数(AHI)(OR 1.11,95%CI 1.00~1.23,P<0.05)与Ⅲ期以上糖尿病肾病患病独立相关.结论 合并OSAS的2型糖尿病患者肾脏功能下降更明显,更容易出现肾脏并发症,OSAS是糖尿病肾脏病变的独立危险因素.     

A study on the antioxidant defense system of psoriasis patients in the ethnic population of Kashmir-India

The study was designed to evaluate the role of antioxidant defense system in the etiology of psoriasis, a chronic skin disorder of complex etiology and pathology. Hospital-based case–control study was carried out in major referral hospital in Kashmir, North India. Cases (N?=?40) were composed of patients with psoriasis vulgaris, and controls (N?=?20) were healthy volunteers. Study included estimation in plasma of both patients and controls of glutathione (GSH) levels, superoxide dismutase (SOD) activity, and total antioxidant potential (AOP) as indices of antioxidant defense system and malondialdehyde (MDA) as a measure of lipid peroxidation (LP), an indicator of oxidative stress. The GSH levels, SOD activity, AOP, and malondialdehyde levels in plasma of psoriasis patients were 2.58?±?0.22 μM/l, 5.24?±?0.69 U/ml, 0.020?±?.011?nmol^?1/ml?h, and 0.88?±?0.20 nmol/ml and were 4.76?±?0.52 μM/l, 4.14?±?0.56U/ml, 0.042?±?0.018 nmol^?1/ml?h, and 0.53?±?0.16 nmol/ml in healthy voluntary controls, respectively. A significant decrease in GSH levels (p?<?0.005) and AOP (p?<?0.005) and significant increase in SOD activity (p?<?0.01) MDA levels (p?<?0.005) as an indicator of LP was observed.     

Impact of sleep‐disordered breathing in patients with acute myocardial infarction: a retrospective analysis

Sleep‐disordered breathing (SDB) is associated with an increased risk of cardiovascular events. Previous studies showed that severe SDB has a negative impact on myocardial salvage and progression of left ventricular dysfunction after acute myocardial infarction (AMI). This study investigated the frequency of SDB and the effects of SDB on left ventricular function after AMI. This retrospective study enrolled all patients with AMI who had undergone cardiorespiratory polygraphy for SDB diagnosis. The apnea–hypopnea index was used as a standard metric of SDB severity. SDB was classified as mild (apnea–hypopnea index >5 to <15 per h), moderate (≥15 to <30 per h) or severe (apnea–hypopnea index ≥30 per h). According to the majority of events, SDB was classified as predominant obstructive sleep apnea, central sleep apnea or mixed sleep apnea (mixed SDB). A total of 223 patients with AMI (112 with ST elevation and 111 without ST elevation; 63.2 ± 11.2 years, 82% male, left ventricular ejection fraction 49 ± 12%) were enrolled. SDB was present in 85.6%, and was moderate‐to‐severe in 63.2%; 40.8% had obstructive sleep apnea, 41.7% had central sleep apnea and 3.1% had mixed SDB. Left ventricular ejection fraction was lower in patients with AMI with severe SDB (45 ± 14%) versus those without SDB (57 ± 7%; P < 0.005). In addition, lower left ventricular ejection fraction (≤45%) was associated with increased frequency (apnea–hypopnea index ≥5 per h in 96%) and severity (apnea–hypopnea index ≥30 per h in 48%) of SDB in general and a higher percentage of central sleep apnea (57%) in particular. SDB is highly frequent in patients with AMI. SDB severity appeared to be linked to impaired left ventricular function, especially in patients with central sleep apnea.     

Interaction of Metabolic Syndrome with Asthma in Postmenopausal Women: Role of Adipokines

The increasing prevalence of both asthma and obesity are major health problems. Recent studies established a possible link between obesity and asthma; however, the underlying mechanism is not clear. The aim of the study was to analyze the prevalence of metabolic syndrome in postmenopausal subjects with asthma and search the interactions between adipokines, metabolic syndrome, and asthma. A total of 45 female patients (57.5?±?13.9 years) with asthma and 30 healthy subjects (59.6?±?12.8 years) in postmenopausal status were enrolled in this study. For the diagnosis of metabolic syndrome, modified World Health Organization diagnostic criteria were used. Blood levels of glucose, lipid profile, HbA1c, insulin, CRP, leptin, adiponectin, tumor necrosis factor-alpha, interleukin (IL)-6, IL-8 and plasminogen activator inhibitor-1 (PAI-1) were measured. The mean body mass index was 29.6?±?5.4 for asthma patients and 28.2?±?5.3 for the control group. The incidence of metabolic syndrome was found as 26 % for both groups. Insulin resistance as calculated by homeostasis model assessment (HOMA-IR) and fasting insulin levels were significantly higher in asthma patients (p?<?0.001 for both parameters). Leptin levels were significantly higher (p?=?0.001) and adiponectin levels were lower (p?=?0.029) in asthma patients compared to controls. We concluded that although incidence of obesity and metabolic syndrome was not higher in postmenopausal asthma patients than controls, there was an impairment of glucose metabolism and altered adipokine levels in asthma patients.     

Periodontal infections and community-acquired pneumonia: a case–control study

The aim of this study was to evaluate if the presence of periodontal infections (PI) is associated with community-acquired pneumonia (CAP) in a group of patients admitted to a hospital. A total of 140 patients were enrolled in this case–control study, with 70 patients having CAP (case group) and the other 70 patients diagnosed with other systemic diseases (control group). A periodontal examination was carried out to assess pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and presence of bacterial plaque (BP). CAL and BOP showed higher scores in the case group over the control group. They were, respectively, 3.16?±?2.43 mm and 0.33?±?0.24 % for the case group, and 1.99?±?2.23 mm and 0.25?±?0.24 % for the control group (p?<?0.05). High scores for BP were observed in both groups (case: 97.1 %; control: 98.6 %, p?=?1.0000). Chronic periodontitis (CP) was more frequent in patients with CAP (case: 61.4 %; control: 41.4 %). The presence of moderate or severe CP increased the risk for CAP [odds ratio (OR)?=?4.4, 95 % confidence interval (CI)?=?1.4–13.8], even when adjusted for age, ethnicity, gender, and smoking. Moderate and severe chronic periodontitis were associated with CAP in this study.     

Improvement of diabetic or obese patients’ erythrocyte deformability by the program of the brain-oriented obesity control system (BOOCS)

Diabetes is characterized by absolute or relative insulin deficiency complicated with microangiopathy, whereas obesity stems from insulin resistance. A psychosomatic approach to obesity and diabetes has been highlighted, including the brain-oriented obesity control system (BOOCS). Impaired deformability of erythrocytes in obese or diabetic patients is closely linked to disturbed microcirculation, and improvement of abnormal erythrocyte rheology is a prerequisite for the prevention and treatment of microangiopathy. Therefore, erythrocyte filterability, whole cell deformability defined as flow rate of erythrocyte suspension relative to that of saline, was assessed by the nickel-mesh-filtration technique. Subjects included healthy controls (group A, n?=?14), diabetic, non-obese participants (group B, n?=?29), and non-diabetic, obese participants (group C, n?=?32) in the 6-month BOOCS program, and most patients in groups B and C (86.9?%) completed this program. Baseline mean erythrocyte filterabilities were 89.4?±?1.7?% in group A, 82.8?±?5.2?% in group B, and 84.1?±?5.6?% in group C, showing significant intergroup differences (p?<?0.001). This program significantly improved (p?<?0.001) the impaired erythrocyte filterability in groups B (87.9?±?4.4?%) and C (88.5?±?3.7?%). Declines in HbA1c (p?=?0.387) and body mass index (p?=?0.479) were not correlated to this improvement. These findings indicate that the mechanisms of BOOCS-induced improvement of diabetic or obese patients?? erythrocyte deformability are multifactorial, and that the BOOCS program for these patients is a holistic, cost-effective, and highly compliant approach possibly ameliorating microcirculation.     

Changes of vitamin D levels and bone turnover markers after CPAP therapy: a randomized sham‐controlled trial

The aim was to investigate whether continuous positive airway pressure treatment could modulate serum vitamin D (25‐hydroxyvitamin D) and bone turnover markers (collagen‐type 1 cross‐linked C‐telopeptide, osteocalcin and N‐terminal propeptide of type 1 collagen) in secondary analysis from a randomized controlled trial. Sixty‐five continuous positive airway pressure‐naïve male patients with obstructive sleep apnea (age = 49 ± 12 years, apnea–hypopnea index = 39.9 ± 17.7 events h^?1, body mass index = 31.3 ± 5.2 kg m^?2) were randomized to receive either real (n  = 34) or sham (n  = 31) continuous positive airway pressure for 12 weeks. At 12 weeks, all participants received real continuous positive airway pressure for an additional 12 weeks. After 12 weeks of continuous positive airway pressure (real versus sham), there were no between‐group differences for any of the main outcomes [Δ25‐hydroxyvitamin D: ?0.80 ± 5.28 ng mL ^?1 (mean ± SE ) versus 3.08 ± 3.66 ng mL ^?1, P  = 0.42; Δcollagen‐type 1 cross‐linked C‐telopeptide: 0.011 ± 0.014 ng mL ^?1 versus ?0.004 ± 0.009 ng mL ^?1, P  = 0.48; Δosteocalcin: 1.13 ± 1.12 ng mL ^?1 versus 0.46 ± 0.75 ng mL ^?1, P  = 0.80; ΔN‐terminal propeptide of type 1 collagen: 2.07 ± 3.05 μ g L^?1 versus ?1.05 ± 2.13 μ g L^?1, P  = 0.48]. There were no further differences in subgroup analyses (continuous positive airway pressure‐compliant patients, patients with severe obstructive sleep apnea or sleepy patients). However, after 24 weeks irrespective of initial randomization, vitamin D increased in patients with severe obstructive sleep apnea (9.56 ± 5.51 ng mL ^?1, P  = 0.045) and in sleepy patients (14.0 ± 4.69 ng mL ^?1, P  = 0.007). Also, there was a significant increase in osteocalcin at 24 weeks (3.27 ± 1.06 ng mL ^?1, P  = 0.01) in compliant patients. We conclude that 12 weeks of continuous positive airway pressure did not modulate vitamin D or modulate any of the bone turnover markers compared with sham. However, it is plausible that continuous positive airway pressure may have late beneficial effects on vitamin D levels and bone turnover markers in selected groups of patients with obstructive sleep apnea.     

The performance of critical flicker frequency on determining of neurocognitive function loss in severe obstructive sleep apnea syndrome

This study aimed to compare the critical flicker frequency (CFF) and the mail‐in cognitive function screening ınstrument (MCFSI) tests’ effectiveness in diagnosing neurocognitive function losses in patients having severe obstructive sleep apnea syndrome (OSAS). A total of 85 subjects (47 patients with a diagnosis of severe OSAS and 38 healthy controls) were included into the study. MCFSI scores greater than or equal to five and CFF scores less than 39 Hz were considered abnormal. Demographic and polysomnographic parameters of patients with OSAS were studied, and correlations between the MCFSI, CFF scores and Epworth Sleepiness Scale (ESS) scores were analysed. The mean age of the patients was 49.6 ± 12.0 years. In the OSAS group, the CFF score was found to be low when compared with the control group, while the MCFSI score was found to be high. Pathological CFF scores (<39) were found in 13 patients (27.7%) in the OSAS group, while pathological MCFSI scores (≥5) were found in 19 patients (40.4%). CFF scores were found to be low in only 26% of the patients with OSAS who were found to have high MCFSI scores. MCFSI scores were high in only 38% of the patients with OSAS who were found to have low CFF scores. There was a significant correlation between ESS and CFF scores. In conclusion, the usefulness of the CFF test in determining cognitive function loss in patients with OSAS needs to be demonstrated via studies which utilize a larger sample size.     

Body fatness and clustering of cardiovascular disease risk factors in Portuguese children and adolescents

Modifiable cardiovascular risk factors that increase the risk for cardiovascular diseases (CVD) in adult populations have also been observed in pediatric populations. Childhood and adolescence obesity has been strongly implicated in the clustering of risk factors. The aims of the present study were 1) to examine whether clustering of CVD risk factors, either biological risk factors (high blood pressure (HBP), percentage of high fat mass (%HBF), and high total cholesterol (HTC)) and one behavioral/lifestyle risk factor (low physical activity index (LPAI)) exist, and 2) to analyze the relationship between body fatness and the clustering of other risk factors. The cluster of CVD risk factors was determined in 1,533 (8–15 years of age) children, 731 males (age 10.8 ± 2.3 years; weight, 40.6 ± 12.7 kg; height, 143.1 ± 14.1 cm; BMI, 19.4 ± 3.4 kg^?2) and 802 females (age, 11.0 ± 2.4; weight, 41.0 ± 12.4; height, 142.8 ± 13.2; BMI, 19.7 ± 3.5). Sex‐ and age‐specific “high risk” quartiles were formed for each of the biological risk factors and the lifestyle factor. Thus, for blood pressure (high blood pressure, HBP), cholesterol (high cholesterol, HTC), and obesity (high percent of body fat, HBF), the sex‐ and age‐adjusted 4th quartile (4Q) was defined as the “high risk” quartile, while for physical activity the 1st quartile (1Q) was defined as the “high risk” quartile. The majority of children (62% of boys and 62% of girls) at risk of obesity are at risk of another risk factor. In our sample, estimated ORs indicated that, compared with 1Q, the “risk of obesity” children and adolescents were two times as likely (P < 0.001) to have two or three risk factors. Our results suggest that children 8–15 years old in the highest quartile of body fatness are an increased risk of having a cluster of other risk factors, namely HBP, HTC, and LPAI. These data provide further evidence that juvenile obesity warrants early intervention because the patterns of unhealthy behavior are formed in adolescence and young adulthood. Am. J. Hum. Biol. 16:556–562, 2004. © 2004 Wiley‐Liss, Inc.