Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort

Marshall, Nathaniel S.; Wong, Keith; Cullen, Stewart R J; Knuiman, Matthew; Grunstein, Ronald R.

doi:10.5664/jcsm.3600

Cited by 391 publications

(312 citation statements)

References 38 publications

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“…This could be explained if correction of hypoxia were the major driver for improvements in channel levels. Consistent with this idea, in a population of 10 701 adults, the magnitude of SCD risk was predicted by AHI and nocturnal oxygen desaturation 3. In our study, even with CPAP, severe OSA patients had higher residual AHI with statistical difference, and there was no change in potassium channel levels with CPAP.…”

Section: Discussionsupporting

confidence: 88%

“…OSA predicted incident SCD in a longitudinal study of 10 701 adults 3. In OSA patients who had no evidence of underlying cardiac, pulmonary, or central nervous system disease, the QT interval was prolonged at the onset of apnea 7…”

Section: Discussionmentioning

confidence: 99%

“…A recent large clinical trial established OSA as a novel risk factor for sudden cardiac death (SCD) 2. After 20 years of follow‐up, the Busselton health study cohort showed that moderate to severe sleep apnea was independently associated with an increased risk of all‐cause mortality 3. In a longitudinal study of 10 701 adults, OSA was associated with SCD, and the magnitude of risk varied with OSA severity 2…”

Section: Introductionmentioning

confidence: 99%

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Obstructive Sleep Apnea and Circulating Potassium Channel Levels

Zhou

Prasad

et al. 2016

JAHA

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BackgroundCardiac arrhythmias and sudden cardiac death are more frequent in patients with obstructive sleep apnea (OSA). OSA is associated with QT prolongation, and QT prolongation is an independent risk factor for sudden cardiac death. Because QT prolongation can be mediated by potassium channel loss of function, we tested whether OSA or continuous positive airway pressure therapy altered mRNA expression of circulating white blood cell potassium channels.Methods and ResultsIn total, 28 patients with OSA newly diagnosed by polysomnogram and 6 participants without OSA were enrolled. Potassium channel levels in white blood cells at baseline and at a 4‐week follow‐up visit were compared. There was a significant inverse correlation between the severity of the OSA stratified by apnea–hypopnea index and mRNA expression of the main potassium channels assessed: KCNQ1 (r=−0.486, P=0.007), KCNH2 (r=−0.437, P=0.016), KCNE1 (r=−0.567, P=0.001), KCNJ2 (r=−0.442, P=0.015), and KCNA5 (r=−0.468, P=0.009). In addition, KCNQ1, KCNH2, and KCNE1 inversely correlated with the oxygen desaturation index 4. After 4 weeks of continuous positive airway pressure therapy, circulating KCNQ1 and KCNJ2 were increased 1.4±0.4‐fold (P=0.040) and 2.1±1.4‐fold (P=0.046) in the moderate OSA group. Compared with patients with mild or moderate OSA, patients with severe OSA had a persistently higher apnea–hypopnea index (mild 2.0±1.8, moderate 1.0±0.9, severe 5.8±5.6; P=0.015), perhaps explaining why the potassium channel changes were not seen in the severe OSA group.ConclusionsThe mRNA expression of most potassium channels inversely correlates with the severity of OSA and hypoxemia. Continuous positive airway pressure therapy improves circulating KCNQ1 and KCNJ2 in patients with moderate OSA.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obstructive Sleep Apnea and Circulating Potassium Channel Levels

Zhou

Prasad

et al. 2016

JAHA

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“…This relationship was strongest in participants under the age of 65 yrs. A smaller study of 400 community based Australian subjects found that moderate-severe OSA (RDI >15) predicted a 2.5-fold risk of incident cancer over a 20-year follow-up (115). Data from an administrative claims database in Taiwan examined the relationship of OSA with organspecific cancer risk.…”

Section: Cancer Incidence and Outcomes In Osa Populationsmentioning

confidence: 99%

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Gildeh¹,

Drakatos²,

Higgins³

et al. 2016

J. Thorac. Dis.

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Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.

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“…3,4 OSA is closely associated with diseases or symptoms such as sudden cardiac death, 4,5 heart failure, 4,6 hypertension, 4,7 acute myocardial infarction, 4,8 and arrhythmias. 4,9,10 Various cohort studies have shown that OSA and OSA-associated symptoms may increase mortality 11,12 and incidence of cardiovascular diseases by up to 50%. 12 Pathophysiological mechanisms involved in OSA are hypoxia due to collapsed upper airways and recurrent breathing against the closed or nearly closed oropharynx, which then results in negative intrathoracic pressure.…”

Section: Introductionmentioning

confidence: 99%

Real-time phase-contrast flow MRI of haemodynamic changes in the ascending aorta and superior vena cava during Mueller manoeuvre

et al. 2014

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AIM: To evaluate the potential of real-time phase-contrast flow magnetic resonance imaging (MRI) at 40 ms resolution for the simultaneous determination of blood flow in the ascending aorta (AA) and superior vena cava (SVC) in response to reduced intrathoracic pressure (Mueller manoeuvre).MATERIALS AND METHODS: Through-plane flow was assessed in 20 healthy young subjects using real-time phase-contrast MRI based on highly undersampled radial fast low-angle shot (FLASH) with image reconstruction by regularized non-linear inversion. Haemodynamic alterations (three repetitions per subject ¼ 60 events) were evaluated during normal breathing (10 s), inhalation with nearly closed epiglottis (10 s), and recovery (20 s).RESULTS: Relative to normal breathing and despite interindividual differences, reduced intrathoracic pressure by at least 30 mmHg significantly decreased the initial peak mean velocity (averaged across the lumen) in the AA by À24 AE 9% and increased the velocity in the SVC by þ28 AE 25% (p < 0.0001, n ¼ 23 successful events). Respective changes in flow volume per heartbeat were À25 AE 9% in the AA and þ49 AE 44% in the SVC (p < 0.0001, n ¼ 23). Flow parameters returned to baseline during sustained pressure reduction, while the heart rate was elevated by 10% (p < 0.0001) after the start (n ¼ 24) and end (n ¼ 17) of the manoeuvre. CONCLUSIONS: Real-time flow MRI during low intrathoracic pressure non-invasively revealed quantitative haemodynamic adjustments in both the AA and SVC.

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Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort

Cited by 391 publications

References 38 publications

Obstructive Sleep Apnea and Circulating Potassium Channel Levels

Obstructive Sleep Apnea and Circulating Potassium Channel Levels

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Real-time phase-contrast flow MRI of haemodynamic changes in the ascending aorta and superior vena cava during Mueller manoeuvre

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