Prevalence of elevated hemoglobin and hematocrit levels in patients with obstructive sleep apnea and the impact of treatment with continuous positive airway pressure: a meta-analysis

Martelli, Vanessa; Carelli, Eric; Tomlinson, George; Orchanian‐Cheff, Ani; Kuo, Kevin H.M.; Lyons, Owen D.; Ryan, Clodagh M.

doi:10.1080/16078454.2022.2109346

Cited by 9 publications

(16 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3C), possibly secondary to the activation of erythropoietin secretion by the repeated exposure to hypoxia. Small increases in haematocrit induced by CIH have also been reported before in rats (McGuire & Bradford, 1999) as well as in sleep apnoea patients (Choi, et al, 2006;Martelli, et al, 2022;Rha, et al, 2022). However, the rise in haematocrit induced by CIH was much smaller than the increase reported by our own group in rats exposed to the same levels of chronic sustained hypoxia (d' Anglemont de Tassigny et al, 2015).…”

Section: Sympathetic Overactivation Induced By Chronic Intermittent H...supporting

confidence: 73%

Rearrangement of cell types in the rat carotid body neurogenic niche induced by chronic intermittent hypoxia

Caballero-Eraso

Colinas

Sobrino

et al. 2023

The Journal of Physiology

View full text Add to dashboard Cite

The carotid body (CB) is a prototypical acute oxygen (O2)‐sensing organ that mediates reflex hyperventilation and increased cardiac output in response to hypoxaemia. CB overactivation, secondary to the repeated stimulation produced by the recurrent episodes of intermittent hypoxia, is believed to contribute to the pathogenesis of sympathetic hyperactivity present in sleep apnoea patients. Although CB functional plasticity induced by chronic intermittent hypoxia (CIH) has been demonstrated, the underlying mechanisms are not fully elucidated. Here, we show that CIH induces a small increase in CB volume and rearrangement of cell types in the CB, characterized by a mobilization of immature quiescent neuroblasts, which enter a process of differentiation into mature, O2‐sensing and neuron‐like, chemoreceptor glomus cells. Prospective isolation of individual cell classes has allowed us to show that maturation of CB neuroblasts is paralleled by an upregulation in the expression of specific glomus cell genes involved in acute O2‐sensing. CIH enhances mitochondrial responsiveness to hypoxia in maturing neuroblasts as well as in glomus cells. These data provide novel perspectives on the pathogenesis of CB‐mediated sympathetic overflow that may lead to the development of new pharmacological strategies of potential applicability in sleep apnoea patients. Key points Obstructive sleep apnoea is a frequent condition in the human population that predisposes to severe cardiovascular and metabolic alterations. Activation of the carotid body, the main arterial oxygen‐sensing chemoreceptor, by repeated episodes of hypoxaemia induces exacerbation of the carotid body‐mediated chemoreflex and contributes to sympathetic overflow characteristic of sleep apnoea patients. In rats, chronic intermittent hypoxaemia induces fast neurogenesis in the carotid body with rapid activation of neuroblasts, which enter a process of proliferation and maturation into O2‐sensing chemoreceptor glomus cells. Maturing carotid body neuroblasts and glomus cells exposed to chronic intermittent hypoxia upregulate genes involved in acute O2 sensing and enhance mitochondrial responsiveness to hypoxia. These findings provide novel perspectives on the pathogenesis of carotid body‐mediated sympathetic hyperactivation. Pharmacological modulation of carotid body fast neurogenesis could help to ameliorate the deleterious effects of chronic intermittent hypoxaemia in sleep apnoea patients.

show abstract

Section: Sympathetic Overactivation Induced By Chronic Intermittent H...supporting

confidence: 73%

Rearrangement of cell types in the rat carotid body neurogenic niche induced by chronic intermittent hypoxia

Caballero-Eraso

Colinas

Sobrino

et al. 2023

The Journal of Physiology

View full text Add to dashboard Cite

show abstract

“…Hemoglobin and hematocrit reached normal values three months after treatment implementation. Considering the known association between elevated hematocrit levels and increased cardiovascular and all-cause mortality [ 16 ], the reduction of almost 10% in our case (from 56.2% to 47.2%) may translate into potentially favorable clinical outcomes.…”

Section: Discussionmentioning

confidence: 87%

The Role of Inverted Papilloma Surgical Removal for Sleep Apnea Treatment Success—A Case Report

et al. 2023

View full text Add to dashboard Cite

In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. These symptoms, determined by sleep fragmentation and chronic hypoxemia, can result in a decrease in professional performance and, moreover, could have tragic implications, especially in patients with high-risk professions. We present the case of a 58-year-old male-truck driver, known to suffer from uncontrolled OSA and chronic obstructive pulmonary disease, who presented to our ENT department for incapacitating daytime somnolence and severe nasal obstruction. These symptoms were caused by a voluminous sinonasal inverted papilloma, occupying the entire left cavity with extension in the nasopharynx. Following nose permeabilization, the patients’ APAP compliance grew substantially, with a dramatic decrease in daytime sleepiness and improvement in polysomnographic parameters. Due to the overlap syndrome of OSA and COPD, an oxygen supplementation was added to PAP therapy by a pulmonologist, improving pulse-oximetry parameters and resulting in the best outcome for the patient. Through this case report, we aim to emphasize the importance of multimodal, personalized treatment of sleep apnea with a focus on nasal surgical permeabilization. At the same time, we sustain a multidisciplinary approach, especially in patients with sleep apnea and associated pathologies, to obtain therapeutic success. We propose increased attention to the early recognition and proper treatment of sleep apnea in patients with high-risk professions as it prevents catastrophes.

show abstract

“…127 In the particular study, treatment with continuous positive airway pressure (CPAP) reduced Hgb and Hct levels by 3.76 g/L and 1%, respectively. 127…”

Section: Obstructive Sleep Apneamentioning

confidence: 89%

“…On the other hand, in a recent meta‐analysis which included a total of 3654 patients with OSA, the overall prevalence of erythrocytosis was 2% and 6%, in patients with mild–moderate, and severe OSA, respectively 127 . In the particular study, treatment with continuous positive airway pressure (CPAP) reduced Hgb and Hct levels by 3.76 g/L and 1%, respectively 127 . Management of OSA includes weight loss and referral to a sleep specialist for institution of overnight CPAP.…”

Section: Diagnostic Approach To Acquired Erythrocytosismentioning

confidence: 97%

“…In a large study of 1604 patients with suspected OSA, only 1.6% had erythrocytosis defined by Hct ≥51% and 48% in males and females, respectively 126 . On the other hand, in a recent meta‐analysis which included a total of 3654 patients with OSA, the overall prevalence of erythrocytosis was 2% and 6%, in patients with mild–moderate, and severe OSA, respectively 127 . In the particular study, treatment with continuous positive airway pressure (CPAP) reduced Hgb and Hct levels by 3.76 g/L and 1%, respectively 127 .…”

Section: Diagnostic Approach To Acquired Erythrocytosismentioning

confidence: 99%

See 1 more Smart Citation

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management

2023

View full text Add to dashboard Cite

Disease Overview JAK2 unmutated or non‐polycythemia vera (PV) erythrocytosis encompasses a heterogenous spectrum of hereditary and acquired entities. Diagnosis Foremost in the evaluation of erythrocytosis is the exclusion of PV through JAK2 (inclusive of exons 12–15) mutation screening. Initial assessment should also include gathering of previous records on hematocrit (Hct) and hemoglobin (Hgb) levels, in order to streamline the diagnostic process by first distinguishing longstanding from acquired erythrocytosis; subsequent subcategorization is facilitated by serum erythropoietin (Epo) measurement, germline mutation screening, and review of historical data, including comorbid conditions and medication list. Hereditary erythrocytosis constitutes the main culprit in the context of longstanding erythrocytosis, especially when associated with a positive family history. In this regard, a subnormal serum Epo level suggests EPO receptor mutation. Otherwise, considerations include those associated with decreased (high oxygen affinity Hgb variants, 2,3‐bisphosphoglycerate deficiency, PIEZO1 mutations, methemoglobinemia) or normal oxygen tension at 50% Hgb saturation (P50). The latter include germline oxygen sensing pathway (HIF2A–PHD2–VHL) and other rare mutations. Acquired erythrocytosis commonly results from central (e.g., cardiopulmonary disease, high‐altitude habitat) or peripheral (e.g., renal artery stenosis) hypoxia. Other noteworthy conditions associated with acquired erythrocytosis include Epo‐producing tumors (e.g., renal cell carcinoma, cerebral hemangioblastoma) and drugs (e.g., testosterone, erythropoiesis stimulating agents, sodium‐glucose cotransporter‐2 inhibitors). Idiopathic erythrocytosis is an ill‐defined terminology that presumes the existence of an increased Hgb/Hct level without an identifiable etiology. Such classification often lacks accounting for normal outliers and is marred by truncated diagnostic evaluation. Management Current consensus treatment guidelines are not supported by hard evidence and their value is further undermined by limited phenotypic characterization and unfounded concerns for thrombosis. We are of the opinion that cytoreductive therapy and indiscriminate use of phlebotomy should be avoided in the treatment of non‐clonal erythrocytosis. However, it is reasonable to consider therapeutic phlebotomy if one were to demonstrate value in symptom control, with frequency determined by symptoms rather than Hct level. In addition, cardiovascular risk optimization and low dose aspirin is often advised. Future Directions Advances in molecular hematology might result in better characterization of “idiopathic erythrocytosis” and expansion of the repertoire for germline mutations in hereditary erythrocytosis. Prospective controlled studies are needed to clarify potential pathology from JAK2 unmutated erythrocytosis, as well as to document the therapeutic value of phlebotomy.

show abstract

Prevalence of elevated hemoglobin and hematocrit levels in patients with obstructive sleep apnea and the impact of treatment with continuous positive airway pressure: a meta-analysis

Cited by 9 publications

References 43 publications

Rearrangement of cell types in the rat carotid body neurogenic niche induced by chronic intermittent hypoxia

Rearrangement of cell types in the rat carotid body neurogenic niche induced by chronic intermittent hypoxia

The Role of Inverted Papilloma Surgical Removal for Sleep Apnea Treatment Success—A Case Report

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management

Contact Info

Product

Resources

About