Increased Inflammatory Activity in Nonobese Patients with Coronary Artery Disease and Obstructive Sleep Apnea

Thunström, Erik; Glantz, Helena; Fu, Michael; Yucel‐Lindberg, Tülay; Petzold, Max; Lindberg, Kristin; Peker, Yüksel

doi:10.5665/sleep.4510

Cited by 35 publications

(35 citation statements)

References 39 publications

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“…57 Both inflammation and oxidative stress have been known to play major roles in the pathogenesis of OSAS. 52,58 These findings showed that inflammatory markers play a potential role in a mechanism of CVD via inflammation, and oxidative stress for OSAS. There is also evidence that OSAS has some relationship with the development of CVD, coronary artery disease, 22 Our findings suggested that RDW levels increased in the presence of OSAS and CVD, which might be an independent predicting factor in patients with OSAS having CVD.…”

Section: Discussionmentioning

confidence: 93%

Hematological Parameters as Predictors of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Patients

et al. 2015

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We investigated the role of the red cell distribution width (RDW) and other parameters including platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) in patients with obstructive sleep apnea syndrome (OSAS) having cardiovascular diseases (CVDs). Patients (n = 142) having sleep disorders and who applied for a night polysomnography were included in this study. For statistical analysis, chi-square test, bivarite correlation, and logistic and stepwise regression tests were used. A positive correlation between RDW MPV, RDW, and body mass index as well as PLT and apnea-hypopnea index were observed. A negative correlation between AHI and PDW (P= .041) and a positive correlation between AHI and PLT (P= .010) were found in the patients ≥40 years old with CVD. The RDW was higher in patients ≥40 years old who had CVD (P= .016), and 19% of them had RDW >14%. The PDW (odds ratio = 6.02 [95% confidence interval = 1.3-28.2],P= .023) appeared to be associated with increased risk of hyperlipidemia in patients with severe OSAS. If these results are confirmed, RDW could be used with other markers, especially PLT and PDW, in prediction of CVD in patients with severe OSAS.

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Section: Discussionmentioning

confidence: 93%

Hematological Parameters as Predictors of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Patients

et al. 2015

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“…44 Studies of a sleep apnea cohort have documented higher concentrations of proinflammatory cytokines such as tumor necrosis factor, interleukin-1, and interleukin-6 in patients with sleep apnea compared with controls; however, the association of these markers with AHI has not been universal. 45,46 Considering that these biomarkers have been linked to impaired endovascular and cognitive functioning, 47,48 abatement of these inflammatory biomarkers following treatment whether by using CPAP or MAD 49,50 may infer additional benefit beyond the rectification of respiratory abnormalities by either modality.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder

El-Solh

Homish

Ditursi

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Despite the overall improvement in posttraumatic stress disorder (PTSD) symptomatology with continuous positive airway pressure (CPAP) therapy, adherence to CPAP is far worse in veterans with PTSD compared to the general population with obstructive sleep apnea (OSA). The aim of this study was to compare the efficacy, adherence, and preference of CPAP versus mandibular advancement device (MAD) and the effect of these treatments on health outcomes in veterans with PTSD. Methods: Forty-two subjects with PTSD and newly diagnosed OSA by polysomnography were treated in a randomized, crossover trial of 12 weeks with CPAP alternating with MAD separated by a 2-week washout period. The primary outcome was the difference in titration residual apnea-hypopnea index (AHI) between CPAP and MAD. Secondary outcome measures included PTSD Checklist and health-related quality of life (Medical Outcomes Study 36-Item Short Form and Pittsburgh Sleep Quality Index). Results: Analyses were limited to the 35 subjects (mean age 52.7 ± 11.6 years) who completed the trial, regardless of compliance with their assigned treatment. CPAP was more efficacious in reducing AHI and improving nocturnal oxygenation than MAD (P < .001 and P = .04, respectively). Both treatments reduced PTSD severity and ameliorated scores of the Medical Outcomes Study Short Form 36 and Pittsburgh Sleep Quality Index, although no differences were detected between the CPAP and MAD arms. The reported adherence to MAD was significantly higher than CPAP (P < .001), with 58% preferring MAD to CPAP. Conclusions: Although CPAP is more efficacious than MAD at improving sleep apnea, both treatment modalities imparted comparable benefits for veterans with PTSD in relation to PTSD severity and health-related quality of life. 1 Veterans having PTSD suffer from nonrestorative sleep and nightmares leading to heightened state of arousal and anxiety, increased severity of depression, and poor quality of life.2 Accruing evidence suggests that patients with PTSD are at higher risk for sleep-disordered breathing than the general population.3,4 In a series of studies looking at postdeployment combat veterans with PTSD, rates of overall sleep disturbance symptoms approached 90%, with up to 70% considered to be at high risk for OSA. and substance abuse. BRIEF SUMMARYCurrent Knowledge/Study Rationale: In veterans with posttraumatic stress disorder (PTSD), the disturbed sleep can worsen the cognitive-behavioral manifestations of PTSD and contribute to poor mental and physical health outcomes. Because adherence to treatment with CPAP is less than optimal in this population, this study was undertaken to examine the clinical efficacy, compliance, and quality of sleep of mandibular advancement devices (MAD) compared to CPAP in veterans with OSA and PTSD. Study Impact: Although CPAP is more efficacious in eliminating respiratory events, both MAD and CPAP result in similar beneficial changes in daytime sleepiness, PTSD symptomatology, and healthrelated quality of life measures in v...

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“…OSA independently associated with increase of inflammatory biomarkers CRP, TNF-α and IL-6 activity related to intermittent hypoxia (Thunstrom et al, 2015). Leon-Cabrera and colleagues found decrease in IL-10 levels were significantly related to increased Apnea-Hypopnea Index (AHI), hyperinsulinemia, and insulin resistance than morbid and control individuals without OSA.…”

Section: Intermittent Hypoxia and Inflammationmentioning

confidence: 95%

“…At same time the process of hypoxia/reoxygenation would affect cell components, such as mitochondrial function, which increased production of reactive oxygen species (ROS) (Suzuki et al, 2006). Oxidative stress as important inflammatory activator component in OSA (Thunstrom et al, 2015). That adipose tissue considered as major source of cytokines/adipokines whether they are produced in obesity per se and/or because of OSA (Lavie & Polotsky, 2009) (Figure.1.).…”

Section: Introductionmentioning

confidence: 97%

“…Obesity increased adipose tissue (AT) mass accompanied by adipose tissue remodeling and macrophages infiltration (Albakri et al, 2014). And OSA independently associated with increased inflammatory activity related to intermittent hypoxia (Thunstrom et al, 2015). Several mechanisms have been proposed to explain the association between OSA and cardiovascular disease (Lavie & Polotsky, 2009).…”

Section: Introductionmentioning

confidence: 99%

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Could omega-3 fatty acids a therapeutic treatment of the immune-metabolic consequence of intermittent hypoxia in obstructive sleep apnea?

Alzoubi

Al-Domi

2017

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Increased Inflammatory Activity in Nonobese Patients with Coronary Artery Disease and Obstructive Sleep Apnea

Abstract: OSA with ODI ≥ 5 was independently associated with increased inflammatory activity in this nonobese CAD cohort. The intermittent hypoxemia, rather than the number of apneas and hypopneas, appears to be primarily associated with enhanced inflammation.

Cited by 35 publications

References 39 publications

Hematological Parameters as Predictors of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Patients

Hematological Parameters as Predictors of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Patients

A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder

Could omega-3 fatty acids a therapeutic treatment of the immune-metabolic consequence of intermittent hypoxia in obstructive sleep apnea?

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