Circulating biomarkers to identify cardiometabolic complications in patients with Obstructive Sleep Apnea: A systematic review

Peres, Bernardo Urbanetto; Allen, A J Hirsch; Fox, Nurit; Laher, Ismail; Hanly, Patrick J.; Skomro, Robert; Almeida, Fernanda R.; Ayas, Najib

doi:10.1016/j.smrv.2018.12.004

Cited by 23 publications

(14 citation statements)

References 45 publications

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“…The RICCADSA study also con rmed that OSA was an independent risk factor for poor cardiovascular prognosis in patients with acute coronary syndrome [24] . A meta-analysis revealed that the risk of fatal or non-fatal cardiovascular events in OSA patients was 3 times higher than controls [25] . Another study concluded that the mortality of ST-segment elevation MI in OSA patients was lower than non-OSA patients as OSA could initiate the mechanism of 'ischaemic preconditioning' to protect the myocardium [15] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

Gao

et al. 2021

Preprint

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BackgroundThe prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.MethodsFrom January 2015 to October 2017, 1113 eligible elderly patients with OSA were enrolled in this consecutive multicentre prospective cohort study. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to determine the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.ResultsA total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between OSA and MACE (log-rank P=0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR=1.68, 95% CI:1.10-2.58, P=0.018), hospitalisation for unstable angina (HR=1.87, 95% CI:1.03-3.39, P=0.038) and a composite of all events in elderly patients with OSA (HR=1.72, 95% CI:1.12-2.64, P=0.012). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P>0.05). The subgroup analysis demonstrated that females (AHR=2.50, 95% CI:1.15-5.43, P=0.021), ≥ 70 years (AHR=1.99, 95% CI:1.08-3.65, P=0.027), overweight and obese (AHR=1.75, 95% CI:1.10-2.80, P=0.019) with mild OSA (AHR=2.30, 95% CI: 1.01-5.26, P=0.49) were at a higher risk for MACE by diabetes.ConclusionOSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.

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Section: Discussionmentioning

confidence: 99%

Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

Gao

et al. 2021

Preprint

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“…Although prospective studies need to be done using robust clinical outcomes to verify this, isoprostane might represent a useful biomarker of cardiovascular risk in patients with OSA and could be used to help stratify risk at the time of diagnosis. This is important as currently there is a paucity of studies published using prospective biomarkers in the context of OSA [ 24 ]. Furthermore, this biomarker might represent a reasonable intermediate target for reduction by therapies for OSA (e.g., continuous positive airway pressure (CPAP) ) or antioxidants.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea and Circulating Biomarkers of Oxidative Stress: A Cross-Sectional Study

et al. 2020

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Oxidative stress (OS) drives cardiometabolic diseases. Intermittent hypoxia consistently increases oxidative stress markers. Obstructive sleep apnea (OSA) patients experience intermittent hypoxia and an increased rate of cardiovascular disease, however, the impact of OSA on OS markers is not clear. The objective was to assess relationships between OSA severity and biomarker levels. Patients with suspected OSA referred for a polysomnogram (PSG) provided fasting blood sample. Plasma levels of 8-isoprostane, 8-hydroxydeoxyguanosine (8-OHdG), and superoxide dismutase (SOD) were measured. The relationship between OSA and OS was assessed both before and after controlling for confounders (age, sex, smoking history, history of cardiovascular disease, ethnicity, diabetes, statin usage, body mass index (BMI)). 402 patients were studied (68% male, mean age ± SD = 50.8 ± 11.8 years, apnea-hypopnea index (AHI) = 22.2 ± 21.6 events/hour, BMI = 31.62 ± 6.49 kg/m2). In a multivariable regression, the AHI significantly predicted 8-isoprostane levels (p = 0.0008) together with age and statin usage; AHI was not a predictor of 8-OHdG or SOD. Female sex (p < 0.0001) and no previous history of cardiovascular disease (p = 0.002) were associated with increased antioxidant capacity. Circulating 8-isoprostane levels may be a promising biomarker of the severity of oxidative stress in OSA patients. Prospective studies are needed to determine whether this biomarker is associated with long-term cardiometabolic complications in OSA.

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“…Together with questionnaires, neck circumference and neck grasp are also useful for identifying patients with type 2 diabetes who are at risk of OSA in the primary care setting [33]. However, there is still a long way to go before we have biological markers that can help us in this matter [34].…”

Section: Discussionmentioning

confidence: 99%

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

Gutiérrez-Carrasquilla

López‐Cano

Sánchez

et al. 2020

JCM

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Type 2 diabetes exerts a negative impact on sleep breathing. It is unknown whether a long-term improvement in glycemic control ameliorates this effect. We conducted an interventional study with 35 patients with type 2 diabetes and obstructive sleep apnea (OSA) to explore this. At home, sleep breathing parameters were assessed at baseline and after a 4-month period in which antidiabetic therapy was intensified. Patients who decreased their body mass index ≥2kg/m 2 were excluded. Those with an HbA1c reduction ≥0.5% were considered good responders (n = 24). After the follow-up, good responders exhibited an improvement in the apnea-hypopnea index (AHI: 26-1 (95% IC: 8.6-95.0) vs. 20.0 (4.0-62.4) events/hour, p = 0.002) and in time with oxygen saturation below 90% (CT90: 13.3 (0.4-69.0) vs. 8.1 (0.4-71.2) %, p = 0.002). No changes were observed in the group of non-responders (p = 0.722 and p = 0.138, respectively). The percentage of moderate and severe OSA decreased among good responders (p = 0.040). In the wider population, the change in HbA1c correlated positively to decreases in AHI (r = 0.358, p = 0.035) and negatively to increases in the minimum arterial oxygen saturation (r = −0.386, p = 0.039). Stepwise multivariate regression analysis showed that baseline AHI and the absolute change in HbA1c independently predicted decreased AHI (R 2 = 0.496). The improvement of glycemic control exerts beneficial effects on sleep breathing parameters in type 2 diabetes, which cannot be attributed merely to weight loss.

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Circulating biomarkers to identify cardiometabolic complications in patients with Obstructive Sleep Apnea: A systematic review

Cited by 23 publications

References 45 publications

Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

Obstructive Sleep Apnea and Circulating Biomarkers of Oxidative Stress: A Cross-Sectional Study

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

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