Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Wang, Xia; Ouyang, Yingying; Wang, Zhen; Zhao, Gang; Liu, Liegang; Bi, Yang

doi:10.1016/j.ijcard.2013.08.088

Cited by 257 publications

(189 citation statements)

References 46 publications

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“…We know that OSAS is accompanied by several complications such as arterial hypertension, coronary disease and cerebrovascular events [7,21,37,39], and it should be considered if the behavior of the gelatinases might play a role in the development of these vascular complications. Up to now, the literature data show a controversial relationship between gelatinases and pulse wave velocity, that reflects arterial stiffness: in subjects with isolated systolic hypertension [40] and in subjects with chronic kidney disease, with or without diabetes mellitus [5], a correlation between gelatinases and arterial stiffness was observed, but not in healthy individuals [34] and in type 2 diabetic subjects [25].…”

Section: Discussionmentioning

confidence: 99%

“…OSAS is independently associated with an increased risk of morbidity and mortality [28] considering that the most important complications are arterial hypertension, coronary artery disease, and cerebrovascular accidents [7,21,37,39]. Atherosclerosis is common in OSAS, and several studies have demonstrated that the elevated mortality in OSAS is associated with the severity of the atherosclerosis [33].…”

Section: Introductionmentioning

confidence: 99%

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Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Hopps¹,

Canino²,

Montana

et al. 2016

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Abstract. Obstructive sleep apnea syndrome (OSAS) is associated with an elevated risk of cardiovascular events and stroke. Matrix metalloproteinases (MMPs) are endopeptidases involved in extracellular matrix degradation and then in the development and progression of cardiovascular diseases. Our aim was to evaluate plasma levels of gelatinases (MMP-2 and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2) in a group of subjects with OSAS. We enrolled 48 subjects (36 men and 12 women; mean age 49.7 ± 14.68 yrs) with OSAS diagnosed with a 1-night cardiorespiratory study and then we subdivided these subjects into two subgroups according to the apnea/hypopnea index (AHI): Low (L = 21 subjects with AHI <30) and High (H = 27 subjects with AHI >30). We measured plasma concentration of the gelatinases and their inhibitors using ELISA kits. We observed a significant increase in plasma concentration of MMP-9, MMP-2, TIMP-1 and TIMP-2 in the entire group of OSAS subjects and in the two subgroups, with higher levels in the H in comparison with the L subgroup. In the whole group of OSAS subjects we also noted a significant decrease in MMP-9/TIMP-1 ratio in comparison with normal controls. Only MMP-9 was significantly correlated with the severity of the disease, expressed as AHI, with the oxygen desaturation index and also with the mean oxygen saturation. MMPs pattern is altered in OSAS and significantly influenced by the severity of the disease; it probably contributes to the vascular remodeling that leads to the atherosclerotic disease and cardiovascular complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Hopps¹,

Canino²,

Montana

et al. 2016

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“…In addition, most separated OSA patients from the reference group (with no OSA) based only on apnea-hypopnea index (AHI) or respiratory distress index (RDI) criteria, and did not screen out other sleep disorders. [20][21][22][23][24] Although previous studies have evaluated the associations of the two common sleep disorders, OSA and insomnia, with mortality, none has compared the two disorders and mortality rate simultaneously. Moreover, data on the mortality rate of patients with insomnia have been inconsistent.…”

Section: Brief Summarymentioning

confidence: 99%

Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography

Choi

Song

Lee

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: To elucidate the links between the two most prevalent sleep disorders, insomnia and obstructive sleep apnea (OSA), and mortality. Methods: We studied 4,225 subjects who were referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from January 1994 to December 2008. We divided the subjects into five groups: mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), severe OSA (AHI ≥ 30), insomnia, and a no-sleep-disorder group consisting of subjects without sleep disorders. Standardized mortality ratio (SMR), hazard ratio, and the survival rates of the five groups were calculated and evaluated. Results:The SMR of all-cause mortality was significantly higher in the severe OSA group than in the general population (1.52, 95% CI 1.23-1.85, p < 0.05). The SMR of cardiovascular mortality increased progressively with the severity of OSA (no-sleep-disorder: 0.09, mild: 0.40, moderate: 0.52, severe: 1.79, p < 0.05). Statistical analyses of the hazard ratios indicated that severe OSA is a risk factor for all-cause mortality (HR 3.50, 95% CI 1.03-11.91, p = 0.045) and cardiovascular mortality (HR 17.16, 95% CI 2.29-128.83, p = 0.006). Cardiovascular mortality was also significantly elevated in the insomnia group (HR 8.11, 95% CI 1.03-63.58, p = 0.046). Conclusions: Severe OSA was associated with increased all-cause mortality and cardiovascular mortality compared to the no-sleep-disorder group. Insomnia was associated with increased cardiovascular mortality compared to the no-sleep-disorder group. Keywords: insomnia, OSA, mortality Citation: Choi JW, Song JS, Lee YJ, Won TB, Jeong DU. Increased mortality in relation to insomnia and obstructive sleep apnea in Korean patients studied with nocturnal polysomnography. J Clin Sleep Med. 2017;13(1):49-56. I NTRO DUCTI O NSleep disorders have negative effects on physical and mental health.1-3 Two of the most common sleep disorders are insomnia and obstructive sleep apnea (OSA). The estimated prevalence of insomnia varies according to the criteria used for its definition, ranging from 14.7% for the RDC/ICSD-2 criteria to 22.1% for the DSM-IV-TR criteria. 4 The prevalence of insomnia in Korea is 22.8%. The prevalence is higher in women (25.3%) than in men (20.2%).5 OSA is the second most common sleep disorder with a prevalence of about 3% to 7% in men and 2% to 5% in women. 6 In Korea, an epidemiologic study found that the prevalence of OSA was 4.5% in men and 3.2% in women. Although the mechanistic basis for the association between insomnia and death is unclear, a growing number of studies have suggested that insomnia is related to inflammation, an increase in the activation of the hypothalamic-pituitary-adrenal (HPA) axis, and the sympathetic system, which, in turn, can lead to hypertension, increased heart rate, metabolic dysfunction, and possibly death. [8][9][10][11][12] Moreover, insomnia is comorbid with other psychiatric disorders such as mood disorder and anxiety disorder, which are both closely associated with risk factors for de...

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“…Similarly, the study populations of SAVE and RICCADSA were comprised of patients with moderate or severe OSA. Recent metaanalyses suggest that more severe OSA is associated with the highest risk for development of cardiovascular complications (20). Again, it remains unknown if a study including only patients with severe disease would have produced different results A number of the centres participating in the SAVE trial had limited resources, therefore the diagnosis of OSA was made via home sleep studies, while control of sleep disordered breathing was assessed via data from CPAP machines.…”

Section: Editorialmentioning

confidence: 99%

“…This is of particular importance when patients are relatively asymptomatic and therefore cannot reliably confirm if they are experiencing benefit. Furthermore, a high proportion of other studies looking at cardiovascular disease risk in OSA used PSG to determine diagnosis (20).…”

Section: Editorialmentioning

confidence: 99%

Lessons from randomised controlled trials of continuous positive airways pressure therapy in the prevention of cardiovascular morbidity and mortality

2017

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Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Cited by 257 publications

References 46 publications

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography

Lessons from randomised controlled trials of continuous positive airways pressure therapy in the prevention of cardiovascular morbidity and mortality

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