Investigation of serum bisphenol A, vitamin D, and parathyroid hormone levels in patients with obstructive sleep apnea syndrome

BRIEF SUMMARYCurrent Knowledge/Study Rationale: Vitamin D not only participates in bone metabolism and regulates calcium homeostasis, but also has pleiotropic effects, modulating numerous metabolic processes. Considering that patients with obstructive sleep apnea (OSA) suffer from vitamin D defi ciency and show high serum parathyroid hormone (PTH) levels, we tested the effects of short-term continuous positive airway pressure (CPAP) on serum vitamin D and PTH levels. Study Impact: These fi ndings suggest that short-term CPAP therapy in male patients with OSA determines an increase of serum vitamin D levels. Therefore, the current study provides evidence that OSA seems to be an etiopathogenetic factor involved in vitamin D defi ciency, which may recover after CPAP therapy in male patients. Study Objective:Recent studies report a link between obstructive sleep apnea (OSA) syndrome, low vitamin D levels, and high parathyroid hormone (PTH) concentrations. The aim of the current study is to evaluate the effect of 7-night continuous positive airway pressure (CPAP) therapy on serum vitamin D, PTH, and calcium levels in patients with severe OSA syndrome. Methods: Patients with severe OSA were enrolled into the study and compared to control subjects. Patients with OSA underwent CPAP therapy for 7 nights and were consequently divided into responders (OSA-R, mean residual AHI < 5/h) and nonresponders (OSA-nR, mean residual AHI > 5/h). Serum vitamin D, PTH, and calcium levels were measured at baseline in patients with severe OSA (apnea-hypopnea index > 30/h) and control subjects. Patients with OSA underwent a fi nal morning blood sample after 7-night CPAP therapy. Results: We enrolled 90 patients with OSA into the study (65 OSA-R and 25 OSA-nR) compared to 32 control subjects. At baseline, lower vitamin D and higher PTH levels were detected in the OSA group compared to controls. After 7-night CPAP therapy, male OSA-R patients showed a signifi cant increase in vitamin D levels. Conversely, female OSA-R patients did not show the same increase in vitamin D levels. It was also observed that OSA-nR subjects did not show modifi cations of serum markers after nCPAP-therapy. Conclusions:The study demonstrates that short-term nCPAP treatment is able to promote the recovery of vitamin D homeostasis in male patients with OSA. The mediation of sexual hormones in regulating vitamin D is a possible explanation of the lack of recovery of vitamin D homeostasis in female patients with OSA as it often affects postmenopausal women. Keywords: calcium, CPAP, OSA, PTH, vitamin D Citation: Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E, Giambrone MP, Marciani MG, Placidi F. Continuous positive airway pressure treatment increases serum vitamin D levels in male patients with obstructive sleep apnea.

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] Vitamin D and PTH participate in bone metabolism and calcium homeostasis. Additionally, vitamin D has pleiotropic effects, modulating numerous metabolic processes in multiple tissues throughout the body.…”

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confidence: 99%

Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea

Liguori

Romigi

Izzi

et al. 2015

“…1 Recent reports have suggested that patients with OSA have a higher prevalence of vitamin D deficiency than healthy patients. 2,3 Vitamin D plays a key role in calcium absorption and homeostasis, and is obtained both from dietary sources and through the skin via exposure to sunlight. The accepted definition of vitamin D deficiency is vitamin D levels less than 20 ng/ mL in serum [4][5][6] ; such deficiency can lead to additional comorbidities, including multiple bone disorders.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea

Salepçi

Çağlayan

Nahid

et al. 2017

Study Objectives: A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. Methods: Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. Results: From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m 2 . Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. I NTRO DUCTI O NObstructive sleep apnea (OSA) is characterized by recurrent, partial, or complete upper airway obstruction resulting in intermittent hypoxia during sleep. OSA is associated with obesity and diabetes, and is also a risk factor for hypertension and coronary artery disease. 1 Recent reports have suggested that patients with OSA have a higher prevalence of vitamin D deficiency than healthy patients.2,3 Vitamin D plays a key role in calcium absorption and homeostasis, and is obtained both from dietary sources and through the skin via exposure to sunlight. The accepted definition of vitamin D deficiency is vitamin D levels less than 20 ng/ mL in serum [4][5][6] ; such deficiency can lead to additional comorbidities, including multiple bone disorders. 6 Obesity is a risk factor for vitamin D deficiency. Vitamin D is fat soluble and stored in adipose tissue. Obese individuals have more subcutaneous fat, which reduces the release of vitamin D from the skin into circulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: There are contradictory results about association between obstructive slee...

“…[6][7][8] We and others have observed widespread vitamin D OSA. [9][10][11][12][13][14] Interestingly, 25(OH)D levels have been shown to be inversely correlated with OSA severity 10,11,13 and with metabolic alterations associated with OSA, including abnormal glucose metabolism 11,12 and nocturnal heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] A recent study suggested that the association between lower 25(OH) D and OSA was largely confounded by larger BMI and neck circumference. 9 In contrast, our group 10 and others [11][12][13][14] have reported a high rate of vitamin D deficiency in OSA, where vitamin D levels (25(OH)D) are lower in severe OSA 10,11,13 and inversely correlate with some of its associated metabolic alterations, including abnormal glucose metabolism 11,12 as well as nocturnal heart rate. 10 Vitamin D receptors are located systemically and recent advances have demonstrated the potential of vitamin D to influence a wide variety of organs.…”

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confidence: 82%

Vitamin D Improves Selected Metabolic Parameters but Not Neuropsychological or Quality of Life Indices in OSA: A Pilot Study

Kerley

Hutchinson

Bramham

et al. 2017

Study Objectives: Our group and others have reported a high rate of vitamin D deficiency in obstructive sleep apnea (OSA), where vitamin D levels (25(OH) D) correlate negatively with OSA severity and some of its associated metabolic alterations. Data regarding vitamin D supplementation in OSA are lacking. We wanted to evaluate the effect of vitamin D 3 supplementation on OSA symptoms and metabolic parameters.