Obstructive Sleep Apnea and Serious Adverse Outcomes in Patients with Cardiovascular or Cerebrovascular Disease

Xie, Wuxiang; Zheng, Feihu; Song, Xiaoyu

doi:10.1097/md.0000000000000336

Cited by 68 publications

(54 citation statements)

References 32 publications

(66 reference statements)

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“…Systematic reviews: The literature search revealed two systematic reviews [116,117]. The original studies included in the systematic reviews were of quality ranging from class I to IV.…”

Section: Results Of the Literature Searchmentioning

confidence: 99%

“…One systemic review included seven cohort studies and one cross-sectional study with 47-174 patients [116]. The systematic review with meta-analysis of 13 hospital-based cohort studies focussed on stroke (five studies, 860 patients) and mortality (11 studies, 930 patients) [117]. The mean ages in both reviews were between 56 and 79 years; 41-87% of subjects were males.…”

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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“…Systematic reviews: The literature search revealed two systematic reviews [116,117]. The original studies included in the systematic reviews were of quality ranging from class I to IV.…”

Section: Results Of the Literature Searchmentioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…Another possible explanation for the neutral RCT results is that the relationship between OSA and CV risk may not be as strong as previously reported in meta regression analyses of prospective cohort studies (i.e. ~30% increase in CV risk for 10-unit increase in AHI [14][15][16] 72,73 , using algorithms to assess the patterns and cumulative extent of oxygen desaturation in polysomnography pulse oximetry recordings have shown that the overall cumulative night-time burden of hypoxia is more strongly predictive of CV events and CV mortality than is AHI or the frequency of desaturation events. Results from the DREAM clinical cohort study that identified seven distinct polysomnographic phenotypes also support the importance of hypoxic burden rather than AHI in predicting CV outcomes 74 .…”

Section: Central Sleep Apnoeamentioning

confidence: 85%

“…Meta-analyses suggest that OSA is more strongly associated with cerebrovascular than coronary artery events 13,14 , and CV risk is greater in men than women. While the data in patients with co-existing CV disease and OSA are limited, they suggest that the risk is similar for recurrent stroke, myocardial infarction and all-cause mortality 15 . Whilst there is uncertainty regarding the dose response relationship between apnoea-hypopnoea index (AHI) and these various CV outcomes, meta-regression of available studies suggest that it is semi-logarithmic 14,16 .…”

Section: Cohort Studiesmentioning

confidence: 99%

The Case of Sleep Apnoea and Cardiovascular Events

McEvoy¹

2021

BRN

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For 30 years evidence has pointed to sleep apnoea being a cause of cardiovascular (CV) disease and major CV events. However, five recent large randomised controlled trials (RCTs) of positive airways pressure treatment of sleep apnoea in high CV risk populations have reported neutral results, and in one case, harm. I review the various strands of evidence in an attempt to reconcile these conflicting results arguing that: 1) Cohort and clinical case control studies have likely overestimated the CV risk associated with sleep apnoea; 2) Rodent models have similarly overstated the risk of CV injury from sleep apnoea by focussing on the effects of extremely severe intermittent hypoxia; and 3) Significant heterogeneity in susceptibility to vascular injury may exist between patients. These factors, coupled with low adherence to positive airway pressure mask treatment, may help explain the neutral results of recent RCTs. Suggestions for future research are provided.

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“… 4 The ensuing sympathetic activation, oxidative stress, and inflammatory cytokines are correlated closely with a range of sequelae (ie, hypertension, stroke, cardiovascular disease (CVD), diabetes mellitus, and cancer). 5 – 11 Moreover, OSA is associated with all-cause mortality. 12 Thus, OSA has become a major challenge for global public healthcare.…”

Section: Introductionmentioning

confidence: 99%

Chromatography/Mass Spectrometry-Based Biomarkers in the Field of Obstructive Sleep Apnea

Zheng

Wei³

et al. 2015

Medicine

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Biomarker assessment is based on quantifying several proteins and metabolites. Recent developments in proteomics and metabolomics have enabled detection of these small molecules in biological samples and exploration of the underlying disease mechanisms in obstructive sleep apnea (OSA). This systemic review was performed to identify biomarkers, which were only detected by chromatography and/or mass spectrometry (MS) and to discuss the role of these biomarkers in the field of OSA.We systemically reviewed relevant articles from PubMed and EMBASE referring to proteins and metabolite profiles of biological samples in patients with OSA. The analytical platforms in this review were focused on chromatography and/or MS.In total, 30 studies evaluating biomarkers in patients with OSA using chromatography and/or MS methods were included. Numerous proteins and metabolites, including lipid profiles, adrenergic/dopaminergic biomarkers and derivatives, amino acids, oxidative stress biomarkers, and other micromolecules were identified in patients with OSA.Applying chromatography and/or MS methods to detect biomarkers helps develop an understanding of OSA mechanisms. More proteomic and metabolomic studies are warranted to develop potential diagnostic and clinical monitoring methods for OSA.

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Obstructive Sleep Apnea and Serious Adverse Outcomes in Patients with Cardiovascular or Cerebrovascular Disease

Abstract: Supplemental Digital Content is available in the text

Cited by 68 publications

References 32 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

The Case of Sleep Apnoea and Cardiovascular Events

Chromatography/Mass Spectrometry-Based Biomarkers in the Field of Obstructive Sleep Apnea

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