Low Plasma Orexin-A Levels Were Improved by Continuous Positive Airway Pressure Treatment in Patients With Severe Obstructive Sleep Apnea-Hypopnea Syndrome

Sakurai, Shigeru; Nishijima, Tsuguo; Takahashi, Susumu; Yamauchi, Kohei; Arihara, Zenei; Takahashi, Kazuhiro

doi:10.1378/chest.127.3.731

Cited by 54 publications

(43 citation statements)

References 40 publications

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“…Given that hypocretin play a role in respiratory and cardiac control as well as interaction between sleep and cardiovascular system, authors supposed that may be the result not only of the hypocretinergic deficiency per se but also of the altered sleep/wake regulation. Because it was reported that OSAHS patients had lower levels of plasma orexin-A 41 and could be improved by CPAP treatment 42, we suppose this might also contribute to the association between EDS and hypertension in our study of OSAHS.…”

Section: Discussionmentioning

confidence: 83%

The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Wang¹,

Zhang²,

Jia³

et al. 2014

Int. J. Med. Sci.

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Objective Investigate the clinical features and the blood pressure (BP) pattern of the phenotype of excessive daytime sleepiness (EDS) in OSAHS.Methods A total of 508 Chinese adults with suspected OSAHS were referred to our sleep laboratory from October 2009 to May 2012. On the same night of polysomnography (PSG), the levels of blood pressure were measured before sleeping (bedtime BP) and immediately after waking up in the next morning (morning BP). EDS was recognized as Epworth Sleepiness Scale (ESS)≥9. Subjects were classified into four groups based on the apnea-hypopnea index (AHI) from PSG as follows: control (simple snoring) group (control, n=104) with AHI<5; mild group (mild, n=89) with AHI≥5 and <15; moderate group (moderate, n=70) with AHI≥15 and<30; and severe group (severe, n=245) with AHI ≥30. The differences and correlations between BP and PSG parameters in EDS and non-EDS group of OSAHS patients were analyzed.Results In all subjects, ESS was positively correlated with morning diastolic blood pressure (DBP), Mean arterial pressure (MAP) and bedtime DBP (r=0.144, 0.102 and 0.114, respectively, each P value<0.05). In OSAHS patients, ESS was only positively correlated with morning DBP (r=0.137, P<0.05). OSAHS patients with EDS phenotype were younger and were more likely to have the symptom of waking up feeling tired (36.1% vs. 23.2%, p=0.023), who had lower MSaO2, longer SIT90 (the ratio of time of SpO2 below 90% in total sleep time) and higher DBP (bedtime as well as morning). In patients with AHI≥15, ESS was correlated positively with both bedtime and morning DBP after controlling the confounding effects of age, sex, BMI, AHI and nadir nocturnal oxygen saturation( r=0.126,0.143, respectively, both P values<0.05). And in OSAHS patients of EDS phenotype, the bedtime DBP, bedtime MAP, morning DBP, and morning MAP were 3~5 mm Hg higher than that in patients of non-EDS phenotype(P<0.05). In the moderate and severe OSAHS group, patients with EDS phenotype were younger and had a lower mean blood oxygen saturation (MSaO2), longer time of SpO2 below 90% and higher SIT90 than patients with non-EDS phenotype (P<0.05). In hypertensive OSAHS patients, patients with EDS were also younger and had higher micro-arousal index (MiI), as well as higher morning DBP, morning MAP and bedtime DBP than that in non-EDS group (P<0.05).Conclusions EDS in OSAHS patients is a special phenotype, which was characterized by younger age, higher DBP and more severe hypoxic load. This feature is mainly manifested in moderate and severe OSAHS patients. It is very important to identify the phenotype of EDS in patients with OSAHS, who may meet more benefits from effective treatment of OSAHS by correcting the intermittent nocturnal hypoxia and sleep fragmentation.

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Section: Discussionmentioning

confidence: 83%

The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Wang¹,

Zhang²,

Jia³

et al. 2014

Int. J. Med. Sci.

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“…Findings on the effects of CPAP on orexin (a hypothalamic neuropeptide which increases food intake) are inconsistent, owing mainly to the small number of studies, which varied in design [62–64]. In a within-subject pre–post comparison, treatment with CPAP of 3–4 months was found to reduce plasma orexin when sampled in the morning in the fasted state [63].…”

Section: Resultsmentioning

confidence: 99%

Effects of continuous positive airway pressure on energy balance regulation: a systematic review

Shechter

2016

Eur Respir J

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Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain. The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance. CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation. It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients.

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“…However, OSA may also predispose to obesity due to daytime somnolence, decreased activity, and decreased sleep duration, as well as due to neurohumoral changes seen in OSA, including elevation in the orexigenic hormones ghrelin and orexin and suppression of the anorexigenic hormone leptin (seen in many though not all studies of adults with OSA) 343,345–347. As discussed in the OSA epidemiology section above, although there is a strong association between OSA and obesity, treatment of OSA in adults may result in weight gain, possibly due to a decrease in resting energy expenditure (which has been found to be proportional to the decrease in AHI and in urinary catechol-amine production and also to CPAP adherence),348 suggesting that decreased sympathetic activation promoted the weight gain with CPAP therapy.…”

Section: Obstructive Sleep Apnea and Cardiometabolic Riskmentioning

confidence: 99%

Role of sleep quality in the metabolic syndrome

Koren¹,

Dumin²,

Gozal³

2016

DMSO

142

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Emerging evidence has assigned an important role to sleep as a modulator of metabolic homeostasis. The impact of variations in sleep duration, sleep-disordered breathing, and chronotype to cardiometabolic function encompasses a wide array of perturbations spanning from obesity, insulin resistance, type 2 diabetes, the metabolic syndrome, and cardiovascular disease risk and mortality in both adults and children. Here, we critically and extensively review the published literature on such important issues and provide a comprehensive overview of the most salient pathophysiologic pathways underlying the links between sleep, sleep disorders, and cardiometabolic functioning.

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Low Plasma Orexin-A Levels Were Improved by Continuous Positive Airway Pressure Treatment in Patients With Severe Obstructive Sleep Apnea-Hypopnea Syndrome

Cited by 54 publications

References 40 publications

The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

The Association between the Phenotype of Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Effects of continuous positive airway pressure on energy balance regulation: a systematic review

Role of sleep quality in the metabolic syndrome

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