Intermittent Hypoxic-Hyperoxic Exposures Effects in Patients with Metabolic Syndrome: Correction of Cardiovascular and Metabolic Profile

Abstract

The aim of this study was to evaluate efficacy and applicability of the “intermittent hypoxic-hyperoxic exposures at rest” (IHHE) protocol as an adjuvant method for metabolic syndrome (MS) cardiometabolic components. A prospective, single-center, randomized controlled clinical study was conducted on 65 patients with MS subject to optimal pharmacotherapy, who were randomly allocated to IHHE or control (CON) groups. The IHHE group completed a 3-week, 5 days/week program of IHHE, each treatment session lasting for 45 min. The CON group followed the same protocol, but was breathing room air through a facial mask instead. The data were collected 2 days before, and at day 2 after the 3-week intervention. As the primary endpoints, systolic (SBP) and diastolic (DBP) blood pressure at rest, as well as arterial stiffness and hepatic tissue elasticity parameters, were selected. After the trial, the IHHE group had a significant decrease in SBP and DBP (Cohen’s d = 1.15 and 0.7, p < 0.001), which became significantly lower (p < 0.001) than in CON. We have failed to detect any pre-post IHHE changes in the arterial stiffness parameters (judging by the Cohen’s d), but after the intervention, cardio-ankle vascular indexes (RCAVI and LCAVI) were significantly lowered in the IHHE group as compared with the CON. The IHHE group demonstrated a medium effect (0.68; 0.69 and 0.71 Cohen’s d) in pre-post decrease of Total Cholesterol (p = 0.04), LDL (p = 0.03), and Liver Steatosis (p = 0.025). In addition, the IHHE group patients demonstrated a statistically significant decrease in pre-post differences (deltas) of RCAVI, LCAVI, all antropometric indices, NTproBNP, Liver Fibrosis, and Steatosis indices, TC, LDL, ALT, and AST in comparison with CON (p = 0.001). The pre-post shifts in SBP, DBP, and HR were significantly correlated with the reduction degree in arterial stiffness (ΔRCAVI, ΔLCAVI), liver fibrosis and steatosis severity (ΔLFibr, ΔLS), anthropometric parameters, liver enzymes, and lipid metabolism in the IHHE group only. Our results suggested that IHHE is a safe, well-tolerated intervention which could be an effective adjuvant therapy in treatment and secondary prevention of atherosclerosis, obesity, and other components of MS that improve the arterial stiffness lipid profile and liver functional state in MS patients.

Influence of acute and chronic intermittent hypoxic-hyperoxic exposure prior to aerobic exercise on cardiovascular risk factors in geriatric patients—a randomized controlled trial

“…For instance, Bestavashvili et al showed higher absolute changes in tCh (-0.8 vs. 0.3 mmol/L), LDL-C (-0.8 vs. 0.3 mmol/L), and Tgl (-0.3 vs. 0.1 mmol/L) concentrations after 3 weeks (5 sessions•week −1 ) of IHHE (40-45 min, F i O 2 = 0.11-0.12 for 4-7 min, F i O 2 = 0.30-0.35 for 2-4 min) compared to a control group (sham IHHE: F i O 2 ~0.21 for 40-45 min) in patients with metabolic syndrome (Bestavashvili et al, 2021). Similar results were found by Bestavashvili et al in another study for tCh (-0.8 vs. 0.3) and LDL-C levels (-0.8 vs. 0.3) using a similar IHHE program in patients with metabolic syndrome (Bestavashvili et al, 2022). However, in both studies, the baseline lipid and lipoprotein concentrations (i.e., tCh, LDL-C and Tgl concentration) were statistically higher in patients who completed the IHHE program than in those who underwent sham IHHE.…”

“…The authors found no differences in blood concentrations of tCh, HDL-C, LDL-C, and Tgl between patients who completed an IHHE program (30–40 min, F i O 2 = 0.10–0.14 for 4–7 min, F i O 2 = 0.30–0.40 for 2–4 min) in addition to a multimodal training and those who completed a multimodal training only. In contrast, studies in patients with metabolic syndrome ( Bestavashvili et al, 2021 ; Bestavashvili et al, 2022 ), prediabetes ( Serebrovska et al, 2019 ), and coronary arteria disease ( Glazachev et al, 2017 ) found that IHHE promotes beneficial effects on patients’ lipid and lipoprotein profile. For instance, Bestavashvili et al showed higher absolute changes in tCh (-0.8 vs. 0.3 mmol/L), LDL-C (-0.8 vs. 0.3 mmol/L), and Tgl (-0.3 vs. 0.1 mmol/L) concentrations after 3 weeks (5 sessions∙week −1 ) of IHHE (40–45 min, F i O 2 = 0.11–0.12 for 4–7 min, F i O 2 = 0.30–0.35 for 2–4 min) compared to a control group (sham IHHE: F i O 2 ∼ 0.21 for 40–45 min) in patients with metabolic syndrome ( Bestavashvili et al, 2021 ).…”

Varying Oxygen Partial Pressure Elicits Blood-Borne Microparticles Expressing Different Cell-Specific Proteins—Toward a Targeted Use of Oxygen?

“…Moreover, O 2 breathing goes beyond mere therapeutic use. Breathing an O 2 mixture at different concentrations, either hypoxic or hyperoxic, has been used for sport training [ 9 ], cardiovascular conditioning [ 10 , 11 ], or before extreme environmental exposure, such as SCUBA diving [ 12 , 13 ], military high-altitude free fall [ 14 , 15 ], or space flight [ 16 , 17 ], to avoid the occurrence of decompression sickness (DCS).…”

Intermittent hypoxia conditioning as a potential prevention and treatment strategy for ischemic stroke: Current evidence and future directions

“…Intermittent hypoxia-hyperoxia (IHH) is a modified IH protocol. The normoxia period is replaced by a moderate hyperoxia period (FiO 2 = 30-40%), resulting in a faster recovery from deoxygenation (Bayer et al, 2017;Glazachev et al, 2017;Dudnik et al, 2018;Serebrovska et al, 2019cSerebrovska et al, , 2022Afina et al, 2021;Behrendt et al, 2022;Bestavashvili et al, 2022). Compared with IH, IHH offers a more obvious improvement in the clinical parameters and is considered to offer more beneficial effects (Serebrovska et al, 2019a).…”

“…IHH training in patients with coronary artery disease not only reduced blood pressure, but also improved exercise capacity, reduced angina attacks, enhanced the left ventricular ejection fraction, and reduced blood glucose (Glazachev et al, 2017). In patients with metabolic syndrome, IHH exposure can significantly reduce systolic and diastolic blood pressure (Bestavashvili et al, 2022). Mild IH can reduce blood pressure in patients with obstructive sleep apnea (OSA) complicated with hypertension (Panza et al, 2022).…”