Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica

Pedrosa, Rodrigo Pinto; Krieger, E M; Lorenzi‐Filho, Geraldo; Drager, Luciano F.

doi:10.1590/s0066-782x2011005000017

Cited by 22 publications

(7 citation statements)

References 74 publications

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“…The relationship between OSA and high blood pressure is supported by a large body of evidence and has been extensively discussed in previous reviews (60,61). Increased blood pressure in patients with OSA is multifactorial in origin and may depend on sympathetic overactivity, systemic inflammation, oxidative stress, endogenous vasoactive factors, and endothelial dysfunction (60,61).…”

Section: Can Osa Have Independent Effects On the Cardiometabolic Riskmentioning

confidence: 84%

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Obstructive Sleep Apnea

Drager

Togeiro

Polotsky

et al. 2013

Journal of the American College of Cardiology

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585

161

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Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.

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Section: Can Osa Have Independent Effects On the Cardiometabolic Riskmentioning

confidence: 84%

“…Increased blood pressure in patients with OSA is multifactorial in origin and may depend on sympathetic overactivity, systemic inflammation, oxidative stress, endogenous vasoactive factors, and endothelial dysfunction (60,61). …”

Section: Can Osa Have Independent Effects On the Cardiometabolic Riskmentioning

confidence: 99%

Obstructive Sleep Apnea

Drager

Togeiro

Polotsky

et al. 2013

Journal of the American College of Cardiology

Self Cite

585

161

View full text Add to dashboard Cite

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“…A principal and potential damage of OSAHS is the disturbance of the normal sleep structure ( 20 ). Microarousal is a neurological event, during which sleep fragmentation is activated, including the autonomic nervous system and multiple neural networks ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Significance of vaspin in obstructive sleep apnea-hypopnea syndrome

Pan

Zhuang

et al. 2016

Experimental and Therapeutic Medicine

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Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a commonly-diagnosed chronic sleep disorder. It is considered to be an important independent risk factor in the development of insulin resistance (IR). Patients with OSAHS exhibit a variety of metabolic disorders, including obesity and metabolic syndrome. Visceral adipose tissue-derived serpin (vaspin) is an adipokine that is considered to be a link between obesity and IR. The present study aimed to evaluate the levels of plasma vaspin in patients with OSAHS and examine their potential correlation with sleep characteristics. A total of 20 healthy male subjects and 42 male patients with OSAHS were selected, and patients were divided into mild (n=22) and severe (n=20) OSAHS groups. The 20 patients in the severe OSAHS group received nasal continuous positive airway pressure (nCPAP) treatment for 2 months. Venous blood samples were drawn from all patients in a fasting state prior to and subsequent to nCPAP treatment, which were used to measure the levels of biochemical indicators. The sleep parameters and serologic index changes were compared prior to and following treatment. The values of contractive pressure (SBP), neck circumference (NC), waist circumference (WC), waist-to-hip ratio (WHR), body mass index (BMI) and hip circumference (HC) in the two OSAHS groups were significantly increased compared with those in the control group. In addition, the levels of vaspin in OSAHS patients were markedly increased and vaspin was revealed to be positively associated with fasting blood sugar, fasting insulin, triglycerides, homeostasis model assessment-IR, apnea-hypopnea index (AHI), NC, WC, BMI and WHR (P<0.05). After 2 months of nCPAP treatment, the SBP and AHI were significantly reduced. In conclusion, vaspin may have an important role in OSAHS patients with IR and treatment using nCPAP may improve the condition of OSAHS patients.

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“…It has been reported that OSAS is associated with many cardiovascular disorders, such as heart failure [1], hypertension [2], atherosclerosis [3], arrhythmia [4], and higher cardiovascular mortality and morbidity rates [5], [6]. However, the exact mechanisms of poor cardiovascular outcomes resulting from OSAS remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Adiponectin Protects Rat Myocardium against Chronic Intermittent Hypoxia-Induced Injury via Inhibition of Endoplasmic Reticulum Stress

et al. 2014

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Obstructive sleep apnea syndrome (OSAS) is associated with many cardiovascular disorders such as heart failure, hypertension, atherosclerosis, and arrhythmia and so on. Of the many associated factors, chronic intermittent hypoxia (CIH) in particular is the primary player in OSAS. To assess the effects of CIH on cardiac function secondary to OSAS, we established a model to study the effects of CIH on Wistar rats. Specifically, we examined the possible underlying cellular mechanisms of hypoxic tissue damage and the possible protective role of adiponectin against hypoxic insults. In the first treatment group, rats were exposed to CIH conditions (nadir O2, 5–6%) for 8 hours/day, for 5 weeks. Subsequent CIH-induced cardiac dysfunction was measured by echocardiograph. Compared with the normal control (NC) group, rats in the CIH-exposed group experienced elevated levels of left ventricular end-systolic dimension and left ventricular end-systolic volume and depressed levels of left ventricular ejection fraction and left ventricular fractional shortening (p<0.05). However, when adiponectin (Ad) was added in CIH + Ad group, we saw a rescue in the elevations of the aforementioned left ventricular function (p<0.05). To assess critical cardiac injury, we detected myocardial apoptosis by Terminal deoxynucleotidyl transfer-mediated dUTP nick end-labeling (TUNEL) analysis. It was showed that the apoptosis percentage in CIH group (2.948%) was significantly higher than that in NC group (0.4167%) and CIH + Ad group (1.219%) (p<0.05). Protein expressions of cleaved caspase-3, cleaved caspase-9, and cleaved-caspase-12 validated our TUNEL results (p<0.05). Mechanistically, our results demonstrated that the proteins expressed with endoplasmic reticulum stress and the expression of reactive oxygen species (ROS) were significantly elevated under CIH conditions, whereas Ad supplementation partially decreased them. Overall, our results suggested that Ad augmentation could improve CIH-induced left ventricular dysfunction and associated myocardial apoptosis by inhibition of ROS-dependent ER stress.

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Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica

Cited by 22 publications

References 74 publications

Obstructive Sleep Apnea

Obstructive Sleep Apnea

Significance of vaspin in obstructive sleep apnea-hypopnea syndrome

Adiponectin Protects Rat Myocardium against Chronic Intermittent Hypoxia-Induced Injury via Inhibition of Endoplasmic Reticulum Stress

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