Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Xie, Junbo; Kuniyoshi, Fatima H. Sert; Covassin, Naima; Singh, Prachi; Gami, Apoor S.; Chahal, Anwar A.; Somers, Virend K.

doi:10.1161/jaha.117.007221

Cited by 79 publications

(45 citation statements)

References 37 publications

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“…Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and is associated with many adverse health consequences, as well as with increased overall mortality risk [ 1 , 2 , 3 , 4 , 5 ]. OSA is characterized by repetitive obstructions of the upper airway during sleep that result in increased inspiratory efforts, sleep fragmentation (SF), and intermittent hypoxia (IH).…”

Section: Sleep-disordered Breathingmentioning

confidence: 99%

Exosome and Macrophage Crosstalk in Sleep-Disordered Breathing-Induced Metabolic Dysfunction

Kheirandish‐Gozal

Gozal

2018

IJMS

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Obstructive sleep apnea (OSA) is a highly prevalent worldwide public health problem that is characterized by repetitive upper airway collapse leading to intermittent hypoxia, pronounced negative intrathoracic pressures, and recurrent arousals resulting in sleep fragmentation. Obesity is a major risk factor of OSA and both of these two closely intertwined conditions result in increased sympathetic activity, oxidative stress, and chronic low-grade inflammation, which ultimately contribute, among other morbidities, to metabolic dysfunction, as reflected by visceral white adipose tissue (VWAT) insulin resistance (IR). Circulating extracellular vesicles (EVs), including exosomes, are released by most cell types and their cargos vary greatly and reflect underlying changes in cellular homeostasis. Thus, exosomes can provide insights into how cells and systems cope with physiological perturbations by virtue of the identity and abundance of miRNAs, mRNAs, proteins, and lipids that are packaged in the EVs cargo, and are secreted from the cells into bodily fluids under normal as well as diseased states. Accordingly, exosomes represent a novel pathway via which a cohort of biomolecules can travel long distances and result in the modulation of gene expression in selected and targeted recipient cells. For example, exosomes secreted from macrophages play a critical role in innate immunity and also initiate the adaptive immune response within specific metabolic tissues such as VWAT. Under normal conditions, phagocyte-derived exosomes represent a large portion of circulating EVs in blood, and carry a protective signature against IR that is altered when secreting cells are exposed to altered physiological conditions such as those elicited by OSA, leading to emergence of IR within VWAT compartment. Consequently, increased understanding of exosome biogenesis and biology should lead to development of new diagnostic biomarker assays and personalized therapeutic approaches. Here, the evidence on the major biological functions of macrophages and exosomes as pathophysiological effectors of OSA-induced metabolic dysfunction is discussed.

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Section: Sleep-disordered Breathingmentioning

confidence: 99%

Exosome and Macrophage Crosstalk in Sleep-Disordered Breathing-Induced Metabolic Dysfunction

Kheirandish‐Gozal

Gozal

2018

IJMS

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“…Patients with EDS presented with significantly higher rates of major cardiovascular events (48.4% versus 27.4%) and re-infarction (29.0% versus 5.5%) compared to those patients without sleepiness. After adjusting for age, diabetes, depression, LVEF, AHI and nocturnal nadir oxygen saturation, EDS was also a significant risk factor in moderate to severe OSA [54].…”

Section: Prognostic Relevance Of Osa In Acs/amimentioning

confidence: 93%

Obstructive sleep apnoea in acute coronary syndrome

2019

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Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7–9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk.

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“…33,34 The risk of recurrence of cardiovascular events after a heart attack is higher in patients with excessive daytime sleepiness, regardless of AHI and oxygen desaturation. 35 OSA may induce or worsen an existing heart failure via various mechanisms regardless of the presence or absence of hypertension.…”

Section: Hypertension and Cerebrovascular Diseasementioning

confidence: 99%

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

et al. 2020

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Obstructive sleep apnoea (OSA) syndrome is characterised by the presence of apnoea or obstructive hypopnoea during sleep, accompanied by hypoxia. It is estimated that the syndrome affects approximately 10% of men and 15% of women. Diagnosis and treatment rates have increased in recent years, but the condition remains undiagnosed in a high percentage of patients. Recent evidence suggests that OSA may increase the risk of cardiovascular disease. The relationship between OSA and cardiovascular disease can be explained, at least in part, by the coexistence of cardiovascular risk factors in the two pathologies, such as age, overweight, smoking and sedentary lifestyle. However, OSA has been independently associated with the risk of developing hypertension, cerebrovascular disease, ischaemic heart disease, heart failure and arrhythmias. Clinical trials that have evaluated the efficacy of continuous positive airway pressure (CPAP) treatment in primary and secondary cardiovascular prevention have not demonstrated a significant reduction in the incidence or recurrence of cardiovascular events. This article analyses the relationship between OSA and cardiovascular risk and discusses recent clinical trials on the efficacy of CPAP in primary and secondary cardiovascular prevention.

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Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Cited by 79 publications

References 37 publications

Exosome and Macrophage Crosstalk in Sleep-Disordered Breathing-Induced Metabolic Dysfunction

Exosome and Macrophage Crosstalk in Sleep-Disordered Breathing-Induced Metabolic Dysfunction

Obstructive sleep apnoea in acute coronary syndrome

Obstructive Sleep Apnoea Syndrome: Continuous Positive Airway Pressure Therapy for Prevention of Cardiovascular Risk

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