Hypertension and catecholamine levels in sleep apnoea

Vardhan, Vasu; Shanmuganandan, Krishnan

doi:10.1016/s0377-1237(11)60128-7

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…Diastolic dysfunction due to cardiac remodeling owing to the intravascular volume expansion among the obese could be a possible explanation for the higher prevalence of congestive heart failure among the obese TCM group . Obesity is also often associated with obstructive sleep apnea, and obstructive sleep apnea has been associated with high catecholamine levels . Increase in catecholamine levels is one of the most accepted pathogenic mechanisms in TCM .…”

Section: Discussionmentioning

confidence: 99%

“…19 Obesity is also often associated with obstructive sleep apnea, and obstructive sleep apnea has been associated with high catecholamine levels. 20 Increase in catecholamine levels is one of the most accepted pathogenic mechanisms in TCM. 21 Overall, an excellent long-term prognosis of the disease with the recovery of the LV dysfunction within the few weeks could be a potential reason for the lower and nonsignificant difference in the in-hospital all-cause mortality, LOS, and hospitalization charges, despite higher complications among the obese TCM.…”

Section: Discussionmentioning

confidence: 99%

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Does obesity affect the outcomes in takotsubo cardiomyopathy? Analysis of the Nationwide Inpatient Sample database, 2010‐2014

Desai

Singh

Baikpour

et al. 2018

Clinical Cardiology

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Background Obesity can lead to increased oxidative stress which is one of the proposed mechanisms in the etiopathogenesis of takotsubo cardiomyopathy (TCM). Hypothesis The presence of obesity adversely impacts clinical outcomes in TCM patients. Methods We queried the Nationwide Inpatient Sample database (2010‐2014) to identify adult patients admitted with a principal diagnosis of TCM with and without obesity. We compared the categorical and continuous variables by Pearson χ2 and Student t test, respectively, in propensity‐score matched cohorts. Results The study cohort comprised 612 obese TCM (weighted n = 3034) and 5696 nonobese TCM (weighted n = 28 186) patients. Obese TCM patients were more often younger and private‐insurance enrollees. Cardiac complications including acute myocardial infarction (9.0% vs 7.4%; P = 0.04), cardiac arrest (2.3% vs. 0.4%; P < 0.001), cardiogenic shock (4.3% vs. 3.2%; P = 0.03), congestive heart failure (5.0% vs. 3.8%; P = 0.02), respiratory failure (12.9% vs. 11.0%; P = 0.021) and use of mechanical hemodynamic support (Impella; 0.2% vs. 0.0%, P = 0.02) were significantly higher among obese TCM patients. There were no significant differences between the 2 groups in all‐cause mortality (1.0% vs. 0.8%; P = 0.35), arrhythmia (24.5% vs. 22.7%, P = 0.123), length of stay (3.7 ±3.5 vs. 3.7 ±3.6 days; P = 0.68), and total hospital charges ($40 780.16 vs. $42 575.14; P = 0.08). Conclusions Obese TCM patients were more susceptible to developing TCM‐related cardiac complications than were nonobese TCM patients, without any impact on all‐cause in‐hospital mortality, LOS, and hospital charges.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does obesity affect the outcomes in takotsubo cardiomyopathy? Analysis of the Nationwide Inpatient Sample database, 2010‐2014

Desai

Singh

Baikpour

et al. 2018

Clinical Cardiology

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“… 21 In the current study, we found increased 24-hour urinary norepinephrine was independently and significantly associated with elevated blood pressure in patients with OSA, which was consistent with previous findings. 22 However, this relationship was evident only in normal-weight, but not in overweight/obese patients with OSA.…”

Section: Discussionmentioning

confidence: 98%

“…Strengths of our study include the measurement of sympathetic drive using 24-hour urinary norepinephrine. Because the norepinephrine levels are easily influenced by stress, and their moment-to-moment variation is great due to the very short half-life in plasma (only 2 to 3 minutes), 22 , 47 we used 24-hour urinary norepinephrine to assess overall systemic sympathetic drive, rather than use a single measurement of plasma norepinephrine or the direct measurement of sympathetic nerve traffic via microneurography. Furthermore, compared to the direct measurement of sympathetic nerve traffic via microneurography, 24-hour urinary norepinephrine is a noninvasive, convenient and easy operative measure in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Moderating Effect of BMI on the Relationship Between Sympathetic Activation and Blood Pressure in Males with Obstructive Sleep Apnea

Chen

Somers

Tang

et al. 2021

NSS

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Background: Sympathetic activation is a primary mechanism mediating increased blood pressure (BP) in obstructive sleep apnea (OSA). However, the relationships between overweight/obesity, sympathetic activation and BP in OSA are not well understood. We hypothesized that increased sympathetic drive is associated with increased BP in normal weight, but not in overweight/obese males with OSA. We therefore examined the effects of body mass index (BMI) on the association between sympathetic activation and BP in males with OSA. Methods: We studied 115 males with OSA recruited consecutively from clinic. Twenty-fourhour urinary norepinephrine was used to assess sympathetic activation. Blood pressure was measured both in the evening and in the morning. Hypertension was defined based on either BP measurements or an existing diagnosis. Linear and logistic regressions were conducted to examine the associations between sympathetic activation and both BP and risk of hypertension. Results: We found 24-hour urinary norepinephrine levels were associated with systolic and diastolic BP (SBP, β=0.157, p=0.082; DBP, β=0.212, p=0.023) and mean arterial pressure (MAP, β=0.198, p=0.032) after adjusting for confounders. Interestingly, these associations were modified by overweight/obesity. After adjusting for confounders, increased 24-hour urinary norepinephrine levels were significantly associated with elevated SBP (β=0.454, p=0.012), DBP (β=0.399, p=0.041), and MAP (β=0.432, p=0.023) in normal weight, but not in overweight/obese patients (all p>0.2). Similar findings were observed in the associations between 24-hour urinary norepinephrine levels and hypertension. Conclusion: Sympathetic activation is associated with elevated BP in normal weight but not in overweight/obese males with OSA, suggesting that BMI may moderate the association between sympathetic activation and BP in males with OSA.

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“…The observed microcirculatory changes were small, despite high OSA severity (median AHI 64.5). Catecholamine levels were found to be related to OSA severity [ 26 ]. Dose dependent vasoconstrictive effect of both epinephrine and norepinephrine is known [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Increased microcirculatory heterogeneity in patients with obstructive sleep apnea

et al. 2017

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IntroductionObstructive sleep apnea (OSA) is the most common form of sleep disordered breathing and has been associated with major cardiovascular comorbidities. We hypothesized that the microcirculation is impaired in patients with OSA and that the magnitude of impairment correlates to OSA severity.MethodsSubjects were consecutive patients scheduled for routine diagnostic polysomnography (PSG). OSA was defined by paradoxical rib cage movements together with abdominal excursions and by the apnea-hypopnea index (AHI) (events/hour; no apnea AHI<5; mild apnea 5≤AHI<15; moderate apnea 15≤AHI<30; severe apnea AHI ≥30). Sidestream darkfield imaging was used to assess the sublingual microcirculation. Recordings of sublingual microcirculation (5 random sites) were performed before and after overnight PSG. Data are summarized as mean (±SD); p values <0.05 were considered statistically significant.ResultsThirty-three consecutive patients were included. OSA was diagnosed in 16 subjects (4 moderate, 12 severe). There was no significant difference in microcirculation between subjects with moderate OSA and without OSA. However, compared to subjects without OSA, subjects with severe OSA (AHI≥30) showed a significant decrease of microvascular flow index (-0.07±0.17 vs. 0.08±0.14; p = 0.02) and increase of microvascular flow index heterogeneity (0.06±0.15 vs. -0.06±0.11; p = 0.02) overnight. Multiple regression analysis (adjusted for age and gender) showed both decrease of flow and increase of flow heterogeneity associated with AHI (b = -0.41; F = 1.8; p = 0.04 and b = 0.43; F = 1.9; p = 0.03, respectively).ConclusionAcute overnight microcirculatory changes are observed in subjects with severe OSA characterized by decreased flow and increased flow heterogeneity.

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Hypertension and catecholamine levels in sleep apnoea

Cited by 10 publications

References 28 publications

Does obesity affect the outcomes in takotsubo cardiomyopathy? Analysis of the Nationwide Inpatient Sample database, 2010‐2014

Does obesity affect the outcomes in takotsubo cardiomyopathy? Analysis of the Nationwide Inpatient Sample database, 2010‐2014

Moderating Effect of BMI on the Relationship Between Sympathetic Activation and Blood Pressure in Males with Obstructive Sleep Apnea

Increased microcirculatory heterogeneity in patients with obstructive sleep apnea

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