Obstructive sleep apnea and insight into mechanisms of sympathetic overactivity

Abboud, François M.; Kumar, Ravinder

doi:10.1172/jci70420

Cited by 123 publications

(77 citation statements)

References 41 publications

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“…More specifically, C-reactive protein, a serum maker of systemic inflammation, plays a direct role in the manifestation of atherosclerosis 19,20 and is elevated in those with sleep apnea independent of BMI 21 and visceral obesity 22 . Other possible mechanisms associated with sleep apnea that may contribute to the progression of atherosclerosis include increased oxidative stress 23 , endothelial dysfunction 24,25 , and sustained sympathetic nerve activity due to decreased baroreflex-mediated suppression of chemoreceptor-mediated sympathoexcitation 26 . Sleep apnea could also contribute to atherosclerosis indirectly, by causing insulin resistance due to elevated leptin levels 27 and dyslipidemia 28 .…”

Section: Discussionmentioning

confidence: 99%

Relation of Obstructive Sleep Apnea to Coronary Artery Calcium in Non-Obese Versus Obese Men and Women Aged 45–75 Years

Luyster¹,

Kip²,

Aiyer³

et al. 2014

The American Journal of Cardiology

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Sleep apnea and obesity are strongly associated and both increase the risk for coronary artery disease. Several cross-sectional studies have reported discrepant results regarding the role that obesity plays in the relation between sleep apnea and coronary artery calcium (CAC), a marker of subclinical coronary disease. The present study investigated the association between sleep apnea and presence of CAC in a community cohort of middle-aged men and women without preexisting cardiovascular disease, stratified by body mass index (BMI) (BMI < 30 versus ≥ BMI 30). Participants underwent electron beam computed tomography to measure CAC and underwent home sleep testing for sleep apnea. The presence of CAC was defined as an Agatston score > 0. Sleep apnea was analyzed categorically using apnea hypopnea index (AHI). The sample was comprised of primarily males (61%) and Caucasians (56%), with a mean age of 61 years. The prevalence of CAC was 76%. Among participants with a BMI < 30 (n = 139), AHI ≥ 15 (compared to AHI < 5) was associated with a 2.7-fold odds of having CAC, but the effect only approached significance. Conversely, in participants with a BMI ≥ 30, sleep apnea was not independently associated CAC. In conclusion, sleep apnea is independently associated with early atherosclerotic plaque burden in non-obese individuals.

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Section: Discussionmentioning

confidence: 99%

Relation of Obstructive Sleep Apnea to Coronary Artery Calcium in Non-Obese Versus Obese Men and Women Aged 45–75 Years

Luyster¹,

Kip²,

Aiyer³

et al. 2014

The American Journal of Cardiology

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“…Notably, pulmonary hypertension, another potential consequence of chronic lung inflammation 213 , is much more frequent in patients with stage 3-5 CKD 214,215 and in patients undergoing dialysis 216 than in the general population. As mentioned below, hypoxic episodes during sleep apnoea -a disease characterized by chronic inflammation 217 , persisting sympathetic overactivity 218 and pulmonary hypertension 219 -are increasingly common as renal function deteriorates 220 and evolve to become almost universal in patients maintained on chronic dialysis 221 . Thus, ample evidence demonstrates that the lung and the kidney are linked through neuroendocrine-mediated inflammation and that this relationship is bidirectional.…”

Section: Kidney and Lung Dysfunctionmentioning

confidence: 99%

The systemic nature of CKD

et al. 2017

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The accurate definition and staging of chronic kidney disease (CKD) is one of the major achievements of modern nephrology. Intensive research is now being undertaken to unravel the risk factors and pathophysiologic underpinnings of this disease. In particular, the relationships between the kidney and other organs have been comprehensively investigated in experimental and clinical studies in the last two decades. Owing to technological and analytical limitations, these links have been studied with a reductionist approach focusing on two organs at a time, such as the heart and the kidney or the bone and the kidney. Here, we discuss studies that highlight the complex and systemic nature of CKD. Energy balance, innate immunity and neuroendocrine signalling are highly integrated biological phenomena. The diseased kidney disrupts such integration and generates a high-risk phenotype with a clinical profile encompassing inflammation, protein-energy wasting, altered function of the autonomic and central nervous systems and cardiopulmonary, vascular and bone diseases. A systems biology approach to CKD using omics techniques will hopefully enable in-depth study of the pathophysiology of this systemic disease, and has the potential to unravel critical pathways that can be targeted for CKD prevention and therapy.

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“…Growing evidence also links psychological stress [10,11] to hypertension and may be one reason why a low socioeconomic status is strongly associated with incident hypertension [12]. Night-time hypertension and excessive activation of the sympathetic nervous system and hypertension was reported in patients with obstructive sleep apnea (OSA) [13,14]. Blood pressure (BP) is not a static variable and stress may also influence BP on a much shorter timescale as reflected by BP variability.…”

Section: Introductionmentioning

confidence: 99%