Sleep apnoea and the hypothalamic–pituitary–adrenal axis in men and women: effects of continuous positive airway pressure

Kritikou, Ilia; Basta, Maria; Vgontzas, Alexandros N.; Pejovic, Slobodanka; Fernández-Mendoza, Julio; Liao, Duanping; Bixler, Edward O.; Gaines, Jordan; Chrousos, George P.

doi:10.1183/13993003.00319-2015

Cited by 69 publications

(58 citation statements)

References 33 publications

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“…Kritikou et al showed that OSA patients have higher 24-hr cortisol levels compared to controls, and the cortisol profile was reduced by CPAP [50]. Similarly, CPAP withdrawal increased nocturnal cortisol and was shown to increase dynamically with awakenings from sleep [24].…”

Section: Evaluation Of the Hypothesismentioning

confidence: 99%

Sleep apnea: An overlooked cause of lipotoxicity?

Younas

Jun

2017

Medical Hypotheses

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Obstructive sleep apnea (OSA) is a common sleep disorder associated with diabetes and cardiovascular disease. However, the mechanisms by which OSA causes cardiometabolic dysfunction are not fully elucidated. OSA increases plasma free fatty acids (FFA) during sleep, reflecting excessive adipose tissue lipolysis. In animal studies, intermittent hypoxia simulating OSA also increases FFA, and the increase is attenuated by beta-adrenergic blockade. In other contexts, excessive plasma FFA can lead to ectopic fat accumulation, insulin resistance, vascular dysfunction, and dyslipidemia. Herein, we propose that OSA is a cause of excessive adipose tissue lipolysis contributing towards systemic “lipotoxicity”. Since visceral and upper-body obesity contributes to OSA pathogenesis, OSA-induced lipolysis may further aggravate the consequences of this metabolically harmful state. If this hypothesis is correct, then OSA may represent a reversible risk factor for cardio-metabolic dysfunction, and this risk might be mitigated by preventing OSA-induced lipolysis during sleep.

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Section: Evaluation Of the Hypothesismentioning

confidence: 99%

Sleep apnea: An overlooked cause of lipotoxicity?

Younas

Jun

2017

Medical Hypotheses

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“…However, it is not known whether aldosterone secretion decreases after the treatment of obstructive sleep apnea in women. Obstructive sleep apnea is related to the activation of the hypothalamic‐pituitary‐adrenal axis and increased cortisol levels, although these results vary between studies 28. Continuous positive airway pressure lowers the cortisol levels, but it is not known whether there are sex differences in this effect 28…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Rietz

Franklin

Carlberg

et al. 2018

JAHA

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BackgroundObstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea‐hypopnea index, <30).Methods and ResultsIn this 4‐month, double‐blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24‐hour blood pressure measurements were performed at baseline and at follow‐up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0–17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea‐hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7–10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.ConclusionsA mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

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“…More recently, CPAP has been shown to potentially have a protective role in decreasing the hypothalamic-pituitaryadrenal axis activity [18] and stabilising but not decreasing the inflammatory cytokine interleukin (IL)-6 [19]. Increased nightly usage of CPAP or a dose response is associated with improved neurocognitive function and better mood [20][21][22].…”

Section: Treatment With Cpapmentioning

confidence: 99%

An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults

D'Rozario

Galgut

Bartlett

2016

Curr Sleep Medicine Rep

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Obstructive sleep apnoea (OSA) is a common sleep disorder which if left untreated results in considerable physical and psychological co-morbidity and mortality. With the development of continuous positive airway pressure (CPAP), an effective treatment was available to counteract the partial and complete airway closures, hypoxia and sleep fragmentation. Technological advances in CPAP devices improved the interface between machine and man, reduced noise levels and improved many aspects of the treatment process. Yet, with all these advancements over the last 35 years, adherence to CPAP remains low. There are a number of underlying factors in the poor uptake and discontinuation of treatment. Previous CPAP adherence interventions are discussed along with behavioural programmes which have emerged in the last 3 years. Of importance are the insights gained from emerging qualitative research in this area to enable a better understanding of patient perceptions and how these continue to impact on adherence rates.

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Sleep apnoea and the hypothalamic–pituitary–adrenal axis in men and women: effects of continuous positive airway pressure

Cited by 69 publications

References 33 publications

Sleep apnea: An overlooked cause of lipotoxicity?

Sleep apnea: An overlooked cause of lipotoxicity?

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults

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