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Xue J, Allaband C, Zuffa S, Poulsen O, Meadows J, Zhou D, Dorrestein PC, Knight R, Haddad GG. Gut microbiota and derived metabolites mediate obstructive sleep apnea induced atherosclerosis. Gut Microbes 2025; 17:2474142. [PMID: 40025767 PMCID: PMC11881840 DOI: 10.1080/19490976.2025.2474142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 02/03/2025] [Accepted: 02/25/2025] [Indexed: 03/04/2025] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia/hypercapnia (IHC), affects predominantly obese individuals, and increases atherosclerosis risk. Since we and others have implicated gut microbiota and metabolites in atherogenesis, we dissected their contributions to OSA-induced atherosclerosis. Atherosclerotic lesions were compared between conventionally-reared specific pathogen free (SPF) and germ-free (GF) Apoe-/- mice following a high fat high cholesterol diet (HFHC), with and without IHC conditions. The fecal microbiota and metabolome were profiled using 16S rRNA gene amplicon sequencing and untargeted tandem mass spectrometry (LC-MS/MS) respectively. Phenotypic data showed that HFHC significantly increased atherosclerosis as compared to regular chow (RC) in both aorta and pulmonary artery (PA) of SPF mice. IHC exacerbated lesions in addition to HFHC. Differential abundance analysis of gut microbiota identified an enrichment of Akkermansiaceae and a depletion of Muribaculaceae (formerly S24-7) family members in the HFHC-IHC group. LC-MS/MS showed a dysregulation of bile acid profiles with taurocholic acid, taurodeoxycholic acid, and 12-ketodeoxycholic acid enriched in the HFHC-IHC group, long-chain N-acyl amides, and phosphatidylcholines. Interestingly, GF Apoe-/- mice markedly reduced atherosclerotic formation relative to SPF Apoe-/- mice in the aorta under HFHC/IHC conditions. In contrast, microbial colonization did not show a significant impact on the atherosclerotic progression in PA. In summary, this research demonstrated that (1) IHC acts cooperatively with HFHC to induce atherosclerosis; (2) gut microbiota modulate atherogenesis, induced by HFHC/IHC, in the aorta not in PA; (3) different analytical methods suggest that a specific imbalance between Akkermansiaceae and Muribaculaceae bacterial families mediate OSA-induced atherosclerosis; and (4) derived bile acids, such as deoxycholic acid and lithocholic acid, regulate atherosclerosis in OSA. The knowledge obtained provides novel insights into the potential therapeutic approaches to prevent and treat OSA-induced atherosclerosis.
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MESH Headings
- Animals
- Gastrointestinal Microbiome/physiology
- Atherosclerosis/etiology
- Atherosclerosis/microbiology
- Atherosclerosis/metabolism
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/microbiology
- Sleep Apnea, Obstructive/metabolism
- Mice
- Male
- Bacteria/classification
- Bacteria/genetics
- Bacteria/metabolism
- Bacteria/isolation & purification
- Diet, High-Fat/adverse effects
- Feces/microbiology
- Mice, Inbred C57BL
- RNA, Ribosomal, 16S/genetics
- Bile Acids and Salts/metabolism
- Metabolome
- Specific Pathogen-Free Organisms
- Disease Models, Animal
- Tandem Mass Spectrometry
- Mice, Knockout, ApoE
- Apolipoproteins E/genetics
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Affiliation(s)
- Jin Xue
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Celeste Allaband
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Simone Zuffa
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, San Diego, CA, USA
| | - Orit Poulsen
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Jason Meadows
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Dan Zhou
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Pieter C. Dorrestein
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, San Diego, CA, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Gabriel G. Haddad
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
- The Division of Respiratory Medicine, Rady Children’s Hospital, San Diego, CA, USA
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Hu Z, Chen X. Primary aldosteronism in hypertensive patients with obstructive sleep apnea. Blood Press 2025; 34:2507680. [PMID: 40381611 DOI: 10.1080/08037051.2025.2507680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 04/25/2025] [Accepted: 05/09/2025] [Indexed: 05/20/2025]
Abstract
OBJECTIVE To investigate the prevalence and clinical characteristics of primary aldosteronism (PA) in patients with hypertension and obstructive sleep apnoea (OSA) in a newly established cohort, given inconsistencies in previous studies and intolerance to drug washout in some cases. DESIGN AND METHOD A single-centre cross-sectional study enrolled 316 hypertensive patients diagnosed with OSA via polysomnography. All participants underwent PA screening, followed by confirmatory testing for positive cases. Patients with confirmed PA underwent further subtype diagnosis and were assigned to the OSA and PA group. Those unable to undergo antihypertensive drug washout but with a high clinical suspicion of PA were categorised into the OSA and suspected PA group. RESULTS Among 316 patients, 41 (13.0%) were PA. The prevalence was 4.8% in OSA alone, and 50.0% in OSA with hypokalaemia. Compared to the OSA group, the OSA and PA group had a lower proportion of current smokers, a longer duration of hypertension, lower serum triglycerides, lower serum potassium, higher plasma aldosterone concentration, urinary aldosterone excretion, and lower renin. Multivariable logistic regression showed that the diagnosis of PA in OSA patients was positively associated with hypertension duration, and negatively associated with serum potassium levels and smoking. CONCLUSIONS PA screening may be considered in patients with hypertension and OSA; however, given the relatively low prevalence in those with OSA alone, routine screening may not be cost-effective. In contrast, the presence of hypokalaemia was strongly associated with a higher prevalence of PA, suggesting that targeted screening is warranted in this subgroup.
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Affiliation(s)
- Zhe Hu
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Chen
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Katz SL, Blinder H, Dussah N, Bijelić V, Barrowman N, Cox G, Leitman AR, Hamutcu Ersu R. Inter-rater reliability of video clips to assess for obstructive sleep apnea in children. Sleep Med 2025; 131:106483. [PMID: 40188803 DOI: 10.1016/j.sleep.2025.106483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 03/24/2025] [Accepted: 03/27/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Pediatric obstructive sleep apnea (OSA) involves repeated breathing interruptions during sleep and is linked to neurocognitive impairment and cardiovascular issues. Early diagnosis is crucial, but the current gold-standard -overnight polysomnography-is expensive, complex, and scarce, causing long wait times. This underscores the need for a more efficient screening tool for pediatric OSA. METHOD This cross-sectional study recruited children aged 3-18 years referred for polysomnography for suspected OSA (2019-2024). Parents recorded 3-min videos of their children sleeping. Two blinded pediatric sleep physicians scored videos for OSA using clinical impressions and the Monash score. Inter-rater reliability was evaluated with Cohen's Kappa. Monash score's ability to predict OSA was evaluated with receiver operating characteristic (ROC) analysis. RESULTS 109 children (median age: 7.2 years, 61 % male) participated, including 66 healthy children, 21 with Down syndrome, 9 with obesity, and 13 with autism. Inter-rater reliability was high for both Monash score severity and dichotomized Monash score (kappa 0.94 and 0.79, both p < 0.001), with strong agreement on clinician impression of OSA presence and severity (kappa 0.84 and 0.70, both p < 0.001). Inter-rater reliability was highest in healthy children, with no significant differences between groups. The Monash score effectively discriminated OSA presence (area under curve 0.99 (95 % CI: 0.98, 1.00), with excellent performance across groups. DISCUSSION Video assessments showed high inter-rater reliability for OSA presence and severity. Although videos are promising for OSA screening, further research comparing them to polysomnography is needed to confirm clinical validity.
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Affiliation(s)
- S L Katz
- Children's Hospital of Eastern Ontario, Division of Pediatric Respirology, Department of Pediatrics, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - H Blinder
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - N Dussah
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - V Bijelić
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - N Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - G Cox
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A R Leitman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - R Hamutcu Ersu
- Children's Hospital of Eastern Ontario, Division of Pediatric Respirology, Department of Pediatrics, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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4
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Hicks R, Gozal D, Ahmed S, Khalyfa A. Interplay between gut microbiota and exosome dynamics in sleep apnea. Sleep Med 2025; 131:106493. [PMID: 40203611 DOI: 10.1016/j.sleep.2025.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/19/2025] [Accepted: 03/29/2025] [Indexed: 04/11/2025]
Abstract
Sleep-disordered breathing (SDB) is characterized by recurrent reductions or interruptions in airflow during sleep, termed hypopneas and apneas, respectively. SDB impairs sleep quality and is linked to substantive health issues including cardiovascular and metabolic disorders, as well as cognitive decline. Recent evidence suggests a link between gut microbiota (GM) composition and sleep apnea. Indeed, GM, a community of microorganisms residing in the gut, has emerged as a potential player in various diseases, and several studies have identified associations between sleep apnea and GM diversity along with shifts in bacterial populations. Additionally, the concept of "leaky gut," a compromised intestinal barrier with potentially increased inflammation, has emerged as another key player in the potential bidirectional relationship between GM and sleep apnea. One of the potential effectors could be extracellular vesicles (EVs) underlying gut-brain communication pathways that are relevant to sleep regulation and function. Thus, therapeutic implications afforded by targeting the GM or exosomes for sleep apnea management have surfaced as promising areas of research. This review explores current understanding of the relationship between GM, exosomes and sleep apnea, highlighting key research dynamics and potential mechanisms. A comprehensive review of the literature was conducted, focusing on studies investigating GM composition, intestinal barrier function and gut-brain communication in relation to sleep apnea.
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Affiliation(s)
- Rebecca Hicks
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA
| | - David Gozal
- Department of Pediatrics and Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA
| | - Sarfraz Ahmed
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA
| | - Abdelnaby Khalyfa
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
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Wu H, Xie J, Wu C. The role of insomnia in the development of resistant hypertension in uncontrolled hypertensive patients with obstructive sleep apnea: A prospective study. Sleep Med 2025; 131:106508. [PMID: 40220530 DOI: 10.1016/j.sleep.2025.106508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 03/12/2025] [Accepted: 04/05/2025] [Indexed: 04/14/2025]
Abstract
OBJECTIVES To investigate the independent predictive value of insomnia for resistant hypertension (RH) in uncontrolled hypertensive patients with obstructive sleep apnea (OSA). METHODS This prospective follow-up study enrolled 386 OSA patients with uncontrolled blood pressure (BP) using 1 or 2 classes of antihypertensive drugs visiting Sleep Medicine Center from April 2021 to August 2022. Information on demographic characteristics, comorbidities, BP control and classes of antihypertensive medication, sleep related symptoms and sleep parameters was collected. Insomnia was assessed using DSM-V criteria and the Insomnia Severity Index (ISI). RH incidence according to the BP control and classes of antihypertensive drugs data during the 5 months follow-up was collected. Logistic regression models were used to assess the association between insomnia and RH, adjusting for potential confounders. RESULTS After 5 months follow-up, 301 participants were included for final data analysis. Insomnia was prevalent in 23.9 % of the participants and was associated with a higher risk of RH (adjusted ORs around 2.0, all P < 0.05). Participants with clinical insomnia (ISI >14) had a 4-6 times higher risk of RH compared to those without insomnia. Insomnia treatment improved ISI score significantly, but didn't reduce the incidence of RH significantly. Effective insomnia treatment was associated with antihypertensive drugs reduction (OR, 5.57; 95 % CI, 1.24-25.01). CONCLUSIONS Insomnia is an independent predictor of RH in uncontrolled hypertensive patients with OSA. Addressing insomnia may be crucial for managing RH in this patient population.
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Affiliation(s)
- Hao Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
| | - Jiang Xie
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Chan Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China
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6
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Wu Y, Li T, Shao D, Wang Y, Chen B, Yan Y, Ma F. Peripheral and central auditory dysfunction induced by intermittent hypoxia via a novel recurrent airway obstruction device in rats. Hear Res 2025; 462:109277. [PMID: 40311509 DOI: 10.1016/j.heares.2025.109277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 04/04/2025] [Accepted: 04/09/2025] [Indexed: 05/03/2025]
Abstract
OBJECTIVE This study aimed to investigate the effects of intermittent hypoxia (IH) on auditory thresholds, auditory brainstem response (ABR) latency, and neuronal activity in the auditory cortex using a novel recurrent airway obstruction device. METHODS Twenty-four male Sprague-Dawley rats (300-350 g) were randomly assigned to experimental or control groups. A custom 3D-printed mask with one-way valves and a ventilation system was used to induce IH in the experimental group via periodic airflow cessation. The control group wore the same apparatus without hypoxic exposure. Blood oxygen saturation was continuously monitored using a pulse oximeter. A three-dimensional gas dynamics model was constructed to validate the oxygen and carbon dioxide dynamics within the mask. After 3 h of exposure, ABR and the spontaneous firing rate (SFR) of auditory cortical neurons were recorded. RESULTS The experimental group showed periodic desaturation, with minimum and maximum oxygen saturation values of 80.19 ± 0.34 % and 97.68 ± 0.31 %, respectively. ABR thresholds at 24 and 32 kHz significantly increased to 19.17 ± 1.54 dB and 25.00 ± 1.83 dB (P<0.05). ABR wave III-V latency at 32 kHz was significantly shortened from 2.79 ± 0.17 ms to 2.27 ± 0.16 ms (P<0.05). Additionally, the SFR of auditory cortical neurons increased to 2.67 ± 0.18 Hz in the experimental group versus 1.02 ± 0.11 Hz in controls (P<0.01). CONCLUSION Short-term IH induces high-frequency hearing loss, reduces ABR latency, and enhances cortical neuronal excitability, implicating both peripheral and central auditory pathways.
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Affiliation(s)
- Yue Wu
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, PR China.
| | - Tao Li
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, PR China.
| | - Dong Shao
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing 100190, PR China.
| | - Yiwei Wang
- Key Laboratory for Mechanics in Fluid Solid Coupling Systems, Institute of Mechanics, Chinese Academy of Sciences, Beijing 100190, PR China.
| | - Boyu Chen
- Beijing xingying technology Company Limited 100101, PR China.
| | - Yan Yan
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, PR China.
| | - Furong Ma
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, PR China.
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7
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Demirci M, Ozben B, Karaca S, Sayar N, Esen F, Tigen K. Assessment of Cardiac Functions in Patients With Keratoconus Using Two-Dimensional Speckle-Tracking Echocardiography and Three-Dimensional Echocardiography. Echocardiography 2025; 42:e70207. [PMID: 40433730 DOI: 10.1111/echo.70207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2025] [Revised: 05/02/2025] [Accepted: 05/11/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Keratoconus (KC) is a multifactorial disease characterized by progressive corneal thinning and structural deformation. Despite being an ophthalmological disorder, KC is proposed to have systemic implications. The aim of this study was to evaluate cardiac functions in KC patients by two-dimensional (2D) speckle-tracking echocardiography (STE) and three-dimensional (3D) echocardiography. METHODS The study included 45 consecutive patients with KC (mean age: 37.6 ± 12.6 years, 23 male) and 42 healthy controls (mean age: 38.1 ± 8.6 years, 23 male). All participants underwent standard transthoracic echocardiography, 3D echocardiography, and 2D STE to evaluate cardiac functions. RESULTS Although there were no significant differences in the conventional echocardiographic markers regarding left ventricular (LV) and right ventricular (RV) functions except tricuspid annular plane systolic excursion; patients with KC had significantly lower LV global longitudinal strain (GLS) compared to controls (-17.75 ± 2.43% vs. -19.71 ± 1.97%, p < 0.001). They also had lower RV GLS, left and right atrial reservoir, and conduit strains, although the differences were not statistically significant. LV GLS negatively correlated with corneal densitometry in KC patients. Linear regression analysis showed that KC was independently associated with LV GLS when adjusted for age and sex. CONCLUSION Patients with KC had significantly lower LV GLS, suggesting the presence of a subclinical LV dysfunction in these patients, which supports that KC may be a component of a systemic disease.
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Affiliation(s)
- Murat Demirci
- Department of Cardiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Serap Karaca
- Department of Ophthalmology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Fehim Esen
- Department of Ophthalmology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
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Zhang X, Xu H, Yin S, Gozal D, Khalyfa A. Obstructive sleep apnea and memory impairments: Clinical characterization, treatment strategies, and mechanisms. Sleep Med Rev 2025; 81:102092. [PMID: 40286536 DOI: 10.1016/j.smrv.2025.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 03/31/2025] [Accepted: 04/07/2025] [Indexed: 04/29/2025]
Abstract
Obstructive sleep apnea (OSA), is associated with dysfunction in the cardiovascular, metabolic and neurological systems. However, the relationship between OSA and memory impairment, intervention effects, and underlying pathways are not well understood. This review summarizes recent advances in the clinical characterization, treatment strategies, and mechanisms of OSA-induced memory impairments. OSA patients may exhibit significant memory declines, including impairments in working memory from visual and verbal sources. The underlying mechanisms behind OSA-related memory impairment are complex and multifactorial with poorly understood aspects that require further investigation. Neuroinflammation, oxidative stress, neuronal damage, synaptic plasticity, and blood-brain barrier dysfunction, as observed under exposures to intermittent hypoxia and sleep fragmentation are likely contributors to learning and memory dysfunction. Continuous positive airway pressure treatment can provide remarkable relief from memory impairment in OSA patients. Other treatments are emerging but need to be rigorously evaluated for cognitive improvement. Clinically, reliable and objective diagnostic tools are necessary for accurate diagnosis and clinical characterization of cognitive impairments in OSA patients. The complex links between gut-brain axis, epigenetic landscape, genetic susceptibility, and OSA-induced memory impairments suggest new directions for research. Characterization of clinical phenotypic clusters can facilitate advances in precision medicine to predict and treat OSA-related memory deficits.
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Affiliation(s)
- Xiaoman Zhang
- Department of Otolaryngology Head and Neck Surgery & Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Shanghai Key Laboratory of Sleep Disordered Breathing & Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - David Gozal
- Department of Pediatrics and Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA
| | - Abdelnaby Khalyfa
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
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Somers KR, Becari C, Polonis K, Singh P. Contrasting effects of acute versus chronic intermittent hypoxia on leptin secretion in differentiated human adipocytes - Implications for sleep apnea. Biochem Biophys Rep 2025; 42:102030. [PMID: 40421278 PMCID: PMC12104651 DOI: 10.1016/j.bbrep.2025.102030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 04/17/2025] [Accepted: 04/23/2025] [Indexed: 05/28/2025] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder associated with repetitive episodes of nocturnal intermittent hypoxia (IH), obesity and elevated leptin. Newly diagnosed OSA patients have a history of significant recent weight gain. While IH is implicated in OSA pathophysiology, the factors contributing to weight gain in OSA are not completely understood. Leptin is an adipokine with a central role in energy homeostasis and appetite control. Increases in leptin suppress appetite, while decreases in leptin increase appetite and may consequently cause weight gain. Using an in vitro approach, we examined the role of acute and chronic IH exposure on leptin secretion in differentiated human white preadipocytes. We show that acute 24-h exposure to IH and sustained hypoxia both increased leptin secretion, compared to normoxic controls (p = 0.01). In contrast, chronic repetitive IH exposure for 7 days decreased leptin secretion, compared to normoxic controls (p = 0.02). The decrease in leptin secretion during chronic IH exposure suggests a mechanism which may contribute to increased appetite and thereby predispose patients with untreated OSA to weight gain and obesity in early stages. As obesity progresses, leptin levels likely rise secondary to the increase in body fat. Elevated leptin levels in patients with longstanding OSA may be indicative of increased fat mass and not a consequence of IH-mediated effects on adipocytes.
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Affiliation(s)
- Kiran R. Somers
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, USA
| | - Christiane Becari
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, USA
- School of Dentistry of Bauru, University of Sao Paulo, Department of Biological Sciences, Bauru, SP, Brazil
| | - Katarzyna Polonis
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, USA
- Washington University School of Medicine, Department of Pathology and Immunology, Saint Louis, MO, USA
| | - Prachi Singh
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, USA
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
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10
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Tang Y, Liu J, Zhang J, Zhu Y, Zhou J. Association of serum uric acid-to-high-density lipoprotein cholesterol ratio with obstructive sleep apnea: a cross-sectional study. Lipids Health Dis 2025; 24:188. [PMID: 40413493 DOI: 10.1186/s12944-025-02604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 05/08/2025] [Indexed: 05/27/2025] Open
Abstract
BACKGROUND Characterized by intermittent hypoxia (IH), sleep fragmentation, and enhanced sympathetic nervous system activity, obstructive sleep apnea (OSA) precipitates oxidative stress, systemic inflammation, and metabolic perturbations. These disturbances manifest as alterations in serum uric acid (SUA) and high-density lipoprotein cholesterol (HDL-C) levels. Recently, the ratio of SUA to HDL-C (UHR) has emerged as a potential biomarker reflecting both inflammatory and metabolic status. This study investigates the association between UHR and OSA. METHODS Using a cross-sectional design, data were extracted from adults aged 20 years and older in the National Health and Nutrition Examination Survey (NHANES) database, covering the period from 2015 to March 2020. OSA was determined via the NHANES Sleep Disorders Questionnaire. The investigation employed weighted logistic regression alongside trend tests to evaluate the relationship between UHR and OSA. Nonlinear relationships were examined with restricted cubic spline analysis and threshold effect analysis. Receiver operating characteristic (ROC) curves were utilized to compare the predictive capacities of UHR, SUA, and HDL-C for OSA, with the area under the curve (AUC) calculated to assess the models' predictive accuracy. In addition, mediation analyses were conducted to explore the role of body mass index (BMI) in this association, and sensitivity analyses confirmed the robustness of the findings. Subgroup analyses further assessed the impact of various covariates. RESULTS Among the 9985 adults included, 4906 were identified as individuals with OSA. A positive association between UHR and the risk of OSA was observed (OR = 1.02; 95% CI: 1.01, 1.04; P = 0.014). Moreover, a nonlinear relationship was confirmed (P for nonlinearity = 0.024), with an inflection point at a UHR level of 10.23. UHR demonstrated greater predictive accuracy for OSA (AUC = 0.591) compared to SUA (AUC = 0.568) and HDL-C (AUC = 0.580). Additionally, BMI was found to partially mediate the relationship between UHR and OSA, with a mediation proportion of 61.99%. This association remained significant within specific subpopulations (P < 0.05) and was further modulated by factors such as age, alcohol consumption, and diabetes status (P for interaction < 0.05). Sensitivity analyses underscored the stability of these results. CONCLUSION UHR is positively correlated with the risk of OSA in adults, with BMI serving as a partial mediator. The findings support UHR as a viable biomarker for early detection and risk assessment in patients with OSA. Strategies focusing on weight management may reduce the risk of OSA among individuals with elevated UHR levels.
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Affiliation(s)
- Yan Tang
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingmen, 448000, China
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingchu University of Technology, Jingmen, 448000, China
| | - Jiaxin Liu
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingmen, 448000, China
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingchu University of Technology, Jingmen, 448000, China
| | - Junchi Zhang
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingmen, 448000, China
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingchu University of Technology, Jingmen, 448000, China
| | - Yuying Zhu
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingmen, 448000, China
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingchu University of Technology, Jingmen, 448000, China
| | - Jinling Zhou
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingmen, 448000, China.
- Department of Pulmonary and Critical Care Medicine, Jingmen Central Hospital, Jingchu University of Technology, Jingmen, 448000, China.
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11
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Zhang R, Liu Z, Li R, Ai L, Li Y. Construction and Validation of a Nomogram Model for Predicting Pulmonary Hypertension in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2025; 17:1049-1066. [PMID: 40438636 PMCID: PMC12118492 DOI: 10.2147/nss.s520758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 04/23/2025] [Indexed: 06/01/2025] Open
Abstract
Purpose Pulmonary hypertension (PH) is a common cardiovascular complication of obstructive sleep apnea (OSA), posing a significant threat to the health and life of patients with OSA. However, no clinical prediction model is currently available to evaluate the risk of PH in OSA patients. This study aimed to develop and validate a nomogram for predicting PH risk in OSA patients. Patients and Methods We collected medical records of OSA patients diagnosed by polysomnography (PSG) from January 2016 to June 2024. Transthoracic echocardiography (TTE) was performed to evaluate PH. A total of 511 OSA patients were randomly divided into training and validation sets for model development and validation. Potential predictive factors were initially screened using univariate logistic regression and Lasso regression. Independent predictive factors for PH risk were identified via multivariate logistic regression, and a nomogram model was constructed. Model performance was assessed in terms of discrimination, calibration, and clinical applicability. Results Eight independent predictive factors were identified: age, recent pulmonary infection, coronary atherosclerotic heart disease (CHD), apnea-hypopnea index (AHI), mean arterial oxygen saturation (MSaO2), lowest arterial oxygen saturation (LSaO2), alpha-hydroxybutyrate dehydrogenase (α-HBDH), and fibrinogen (FIB). The nomogram model demonstrated good discriminative ability (AUC = 0.867 in the training set, AUC = 0.849 in the validation set). Calibration curves and decision curve analysis (DCA) also indicated good performance. Based on this model, a web-based nomogram tool was developed. Conclusion We developed and validated a stable and practical web-based nomogram for predicting the probability of PH in OSA patients, aiding clinicians in identifying high-risk patients for early diagnosis and treatment.
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Affiliation(s)
- Rou Zhang
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Zhijuan Liu
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Ran Li
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Li Ai
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Yongxia Li
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
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12
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Kang H, Chow C, Lobo J, Logan J, Bonner H, Cho Y, Liu X, Mazimba S, Kwon Y. Positional obstructive sleep apnea and cardiovascular outcomes. Sleep Breath 2025; 29:190. [PMID: 40392385 DOI: 10.1007/s11325-025-03342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 03/28/2025] [Accepted: 04/21/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND A tendency to obstruct the upper airway is markedly increased in supine sleep. Positional obstructive sleep apnea (OSA) (POSA) occurs predominantly in the supine position. The implication of POSA in terms of future cardiovascular (CV) risk is unknown. We hypothesized that patients with POSA have decreased future CV risks compared to OSA patients without POSA (non-POSA). METHODS This single-center study included patients who underwent clinically indicated polysomnography. POSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour and supine AHI at least twice as high as non-supine AHI (nsAHI). Exclusive POSA (ePOSA) includes the additional requirement that the nsAHI normalizes to an AHI of < 5/hour. A Cox proportional hazard model was used to assess the future risk of new CV events in patients with POSA compared to non-POSA (reference group). RESULTS There were 3,779 patients (mean age 51, female 59.7%), consisting of 35.9% POSA, 38.4% non-POSA, and 25.7% no OSA. Using the ePOSA definition, 17.3% had ePOSA, 57.1% had non-ePOSA, and 25.7% had no OSA. Over a median 8.4 years, there were 1,297 composite events. Patients with POSA had a lower risk of CV events compared to non-POSA (HR 0.85, CI:0.74-0.96; p = 0.010). There was a non-significant trend towards lower risk of CV events in patients with ePOSA compared to non-ePOSA (HR 0.86, CI:0.73-1.01; p = 0.061). CONCLUSIONS POSA is associated with lower CV risk than non-POSA. Future studies should consider POSA as a distinct subtype when studying OSA and CV outcomes.
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Affiliation(s)
- Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
| | - Christine Chow
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22903, USA
| | - Jeongok Logan
- School of Nursing, University of Virginia, Charlottesville, VA, 22908, USA
| | - Heather Bonner
- Department of Public Health Sciences, University of Virginia Health Sleep Disorder Center, Charlottesville, VA, 22903, USA
| | - Yeilim Cho
- Veteran Affairs Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Xiaoyue Liu
- New York University Rory Meyers College of Nursing, New York, NY, 10010, USA
| | | | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA.
- University of Washington Cardiovascular Medicine, PO Box 359748, Seattle, WA, 98104, USA.
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13
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De Weerdt S, Schotte C, Demolder F, Verbanck S, Verbraecken J. Cardiovascular diseases and type D personality in patients with obstructive sleep apnea: a prospective cohort study. Sleep Breath 2025; 29:189. [PMID: 40389699 DOI: 10.1007/s11325-025-03352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 11/18/2024] [Accepted: 05/02/2025] [Indexed: 05/21/2025]
Abstract
PURPOSE To determine the influence of type D personality on the prevalence of cardiovascular diseases (CVD), anxiety, depression, sleep quality and insomnia in OSA patients. METHODS Patients planned for a polysomnography filled out the DS-14 questionnaire, Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). History of cardiovascular diseases and current medication intake were assessed. RESULTS In a cohort of 948, OSA patients with type D personality did not have CVD more often (40%) compared to OSA patients without type D personality (42%) (P = 0.625). Out of 395 patients with OSA and CVD, 70% were treated for isolated arterial hypertension (AHT) and 30% for cerebrovascular and/or cardiac pathologies. Cerebrovascular and/or cardiac pathologies were significantly more prevalent in OSA patients with type D personality vs. without (39% vs. 26%; P = 0.001). In OSA patients with CVD and type D personality, medication intake was significantly higher (> 2 cardiovascular medications (P = 0.009), anxiolytics (P = 0.001), antidepressants (P = 0.011), sleep medication (P = 0.002)) as well as scores of HADS for anxiety (P < 0.0001) and depression (P < 0.0001), ISI (P = < 0.0001) and PSQI (P < 0.0001). CONCLUSION The prevalence of CVD in OSA patients was not related to the presence of type D personality. Apart from arterial hypertension, cerebrovascular and/or cardiac pathologies were more frequently observed in OSA patients with type D personality. In OSA patients with CVD, the presence of type D personality was associated with more depression, anxiety, insomnia, poor sleep quality and more medication intake.
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Affiliation(s)
- Sonia De Weerdt
- Sleep Laboratory, Respiratory Division, UZ Brussels, Sleep laboratory, Laarbeeklaan 101, Jette, 1090, Belgium.
| | - C Schotte
- Faculty of Psychology and Educational al Sciences, Brussels University Consultation Center (BRUCC), Vrije Universiteit Brussel, Brussels, Belgium
| | - F Demolder
- Respiratory Division, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Verbanck
- Respiratory Division, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Wang T, Zhang G, Tang L, Ou Y, Li H, Zhang X, Chen Y, Pan J. Association Between Obstructive Sleep Apnea and Regional Fat: A Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2015-2018. Metab Syndr Relat Disord 2025. [PMID: 40387578 DOI: 10.1089/met.2025.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025] Open
Abstract
Purpose: The relationship between regional fat and obstructive sleep apnea (OSA) remains poorly understood. This study seeks to explore the link between regional fat and OSA, utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional analysis used NHANES 2015-2018 data. OSA symptoms were assessed through sleep questionnaires. Regional fat mass (FM) was measured using dual-energy X-ray absorptiometry, including trunk, arm, leg, android, gynoid, and abdominal FM. The fat mass index (FMI) was calculated by dividing FM by the square of height. Logistic regression evaluated the association between regional FMI and OSA, with univariate and stratified analyses to identify potential effect modifiers. Results: A total of 3,099 participants were included, with 1,595 classified into the OSA group. Significant associations were found between OSA and several regional FMIs, including trunk, arm, leg, android, gynoid, and abdomen. These associations were consistent in males, and in females, leg and gynoid FMI were not linked to OSA. Stratified analyses by race revealed significant associations between OSA and regional FMI indices (trunk, arm, leg, android, gynoid, and abdominal FMI) in non-Hispanic Whites and between OSA and trunk, android, and abdominal FMI in other Hispanics. No associations were observed in the Mexican American or non-Hispanic Black groups. Stratification by body mass index (BMI) indicated distinct profiles: obese individuals (BMI ≥30) showed associations limited to trunk, arm, android, and abdominal FMIs, while nonobese participants (BMI <30) displayed broader associations encompassing all regional FMIs. Both univariate and stratified analyses highlighted abdominal FMI as the strongest predictor of OSA. Conclusion: Higher regional FMI, particularly abdominal fat, is associated with an increased risk of OSA, with stronger associations observed in male, White, and nonobese populations.
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Affiliation(s)
- Tuzhi Wang
- Department of Psychiatry, Sleep Medicine Centre, First Affiliated Hospital of Jinan University, Guangzhou, P.R. China
| | - Guimei Zhang
- Department of Applied Psychology, Guangzhou Medical University, Guangzhou, P.R. China
| | - Lei Tang
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, P.R. China
| | - Yangfu Ou
- Department of General Practice, Affiliated Hospital of Guilin Medical University, Guilin, P.R. China
| | - Hongyao Li
- Department of Psychiatry, Sleep Medicine Centre, First Affiliated Hospital of Jinan University, Guangzhou, P.R. China
| | - Xiaotao Zhang
- Department of Psychiatry, Sleep Medicine Centre, First Affiliated Hospital of Jinan University, Guangzhou, P.R. China
| | - Yushan Chen
- Department of Psychiatry, Sleep Medicine Centre, First Affiliated Hospital of Jinan University, Guangzhou, P.R. China
| | - Jiyang Pan
- Department of Psychiatry, Sleep Medicine Centre, First Affiliated Hospital of Jinan University, Guangzhou, P.R. China
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Wegermann K, Chouairi F, Karachaliou GS, Ahlers C, Au S, Miller K, Biering-Sørensen T, Abdelmalek MF, Diehl AM, Moylan CA, Fudim M. Incident heart failure is common and underrecognized in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease. Eur J Heart Fail 2025. [PMID: 40389356 DOI: 10.1002/ejhf.3697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 04/02/2025] [Accepted: 04/23/2025] [Indexed: 05/21/2025] Open
Abstract
AIMS Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with heart failure (HF), independent of shared risk factors. Our aim was to describe the incidence of HF in patients with biopsy-proven MASLD. METHODS AND RESULTS We followed patients with biopsy-proven MASLD from the prospective Duke NAFLD Biorepository and Clinical Database from liver biopsy (2007-2013) until death or 5 January 2023. Clinical and echocardiographic data were abstracted via manual chart review. Incident HF was defined as one of the following: (1) hospitalization for HF, (2) medical record diagnosis of HF, (3) ≥1 sign/symptom of HF and elevated natriuretic peptide, or (4) diastolic dysfunction on transthoracic echocardiography with ≥1 sign/symptom of HF. Univariable and multivariable logistic regression models were evaluated. Overall, 570 patients with biopsy-proven MASLD were included. The mean age was 49.5 years, 42.5% were male and 87.0% were non-Hispanic White. Ten patients (1.8%) had baseline HF, leaving 560 patients to assess for incident HF. Over a median follow up of 4009 days (11.0 years) (interquartile range 2270-4672 days), 100 (17.9%) patients developed incident HF while 268 (47.9%) met criteria for HF suspicion. In a multivariable model, increasing age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08, p < 0.001) and female sex (OR 1.85, 95% CI 1.12-3.04, p = 0.02) were associated with incident HF. CONCLUSIONS We found a high incidence of HF in patients with biopsy-proven MASLD. Despite nearly half of patients having suspected HF, very few carried a chart diagnosis. Screening for HF in high-risk patients and establishment of formal care pathways to address early HF may reduce morbidity and mortality.
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Affiliation(s)
- Kara Wegermann
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Fouad Chouairi
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Georgia Sofia Karachaliou
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Carolyn Ahlers
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Sandra Au
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Kaela Miller
- Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Anna Mae Diehl
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
| | - Cynthia A Moylan
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, NC, USA
- Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Health System, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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16
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Suusgaard J, West AS, Frandsen R, Iversen HK, Kruuse C, Rauen K, Loft BMI, Dysted C, Jennum PJ. Sleepiness, fatigue, and obstructive sleep apnea in stroke patients. J Stroke Cerebrovasc Dis 2025:108345. [PMID: 40393640 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 05/05/2025] [Accepted: 05/11/2025] [Indexed: 05/22/2025] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) impacts approximately 70% of stroke patients, often causing fatigue and sleepiness. Although continuous positive airway pressure (CPAP) reduces sleepiness, systematic OSA screening is not standard in post-stroke care, and the effect of untreated OSA on fatigue is unclear. This study investigated changes in sleepiness and fatigue among OSA patients following ischemic stroke or transient ischemic attack (TIA) who underwent CPAP treatment. METHODS This prospective multi-center cohort study, ischemic stroke and TIA patients were screened for OSA using respiratory polygraphy. CPAP-eligible patients (Apnea-Hypopnea Index ≥15) were assessed with the Epworth Sleepiness Scale (ESS) and Visual Analogue Scale-Fatigue (VAS-F) at baseline and seven to eight months post-stroke. CPAP compliance was classified into high (≥70%), moderate (50-69%), and low (<50%) compliance based on nights using CPAP more than four hours per night. Poisson regression models analyzed differences in ESS and VAS-F between compliance groups, with low-compliance as the reference. RESULTS Of 2605 patients, 1518 (mean age: 70 ± 12 years; 61% male) were screened, and 648 were CPAP-eligible. At follow-up, 333 patients were assessed (49% lost to follow-up). Sleepiness significantly decreased in the high-compliance group compared to low-compliance (p<0.001). Fatigue levels decreased across all compliance groups, b no differences were observed between groups. CONCLUSIONS High CPAP compliance in post-stroke or TIA patients with OSA was associated with a reduction in sleepiness but not fatigue. These findings support the recommendation to systematically screen post-stroke patients for OSA and encourage CPAP compliance to mitigate sleepiness.
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Affiliation(s)
- Jeppe Suusgaard
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
| | - Anders Sode West
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Rune Frandsen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
| | - Helle Klingenberg Iversen
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Christina Kruuse
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Katrin Rauen
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany; Department of Traumatology, University Hospital Zurich & Sleep Health Center & Neuroscience Center Zurich & Center for Psychiatric Research, University of Zurich, Switzerland; Institute for Stroke and Dementia Research, LMU Munich, Germany.
| | - Belle Mia Ingerslev Loft
- Clinical Stroke Research Unit, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Camilla Dysted
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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17
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Zhang Z, Li S, Wang G, Zhou Y, Yan Y, Fan J, Ai H, Gong W, Nie S. Adverse effect of beta-blockers in non-ST elevation acute coronary syndrome patients with obstructive sleep apnea. Sleep Med 2025; 132:106593. [PMID: 40403449 DOI: 10.1016/j.sleep.2025.106593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 05/06/2025] [Accepted: 05/16/2025] [Indexed: 05/24/2025]
Abstract
BACKGROUND Currently, beta-blockers are recommended for non-ST elevation acute coronary syndrome (NSTE-ACS). However, there is still a lack of studies evaluating the use of beta-blockers in patients with NSTE-ACS complicated by obstructive sleep apnea (OSA). METHODS This is the sub-analysis of OSA-ACS project (NCT03362385), a prospective, observational study recruited ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. Patients with NSTE-ACS were selected in this analysis. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction or ischemia-driven revascularization. RESULTS After exclusion, 1452 NSTE-ACS patients were enrolled, and 75.3 % of patients received beta-blockers at discharge. The proportion of beta-blockers users in the OSA group was 77.4 % and 73.2 % in the non-OSA group, with no significant difference (P = 0.068). In OSA group, beta-blocker users had higher rate of MACE (18.2 % versus 9.0 %, adjusted hazard ratio [HR] 1.90, 95 % confidence interval [CI] 1.04-3.45, p = 0.037) but not in non-OSA group (14.1 % versus 9.9 %, adjusted HR 1.45, 95 % CI 0.80-2.62, p = 0.219). After propensity score matching, beta-blocker users were still at higher risk of MACE (19.3 % versus 9.3 %, adjusted HR 2.18, 95 % CI 1.09-4.35, p = 0.028) in OSA group, in contrast the risk was comparable in non-OSA group (13.2 % versus 9.9 %, adjusted HR 1.27, 95 % CI 0.63-2.57, p = 0.501). Sensitivity analysis was consistent with the main results. Subgroup analysis showed no significant interactions (P > 0.10, for all comparisons). CONCLUSION The administration of beta-blockers is associated with higher risk of adverse cardiovascular outcomes in NSTE-ACS patients with concomitant OSA.
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Affiliation(s)
- Zekun Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ge Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yun Zhou
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China. 1 Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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18
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Abdul Jafar NK, Mansfield DR. Obstructive Sleep Apnoea Screening and Diagnosis Across Adult Populations: Are We Ready? Respirology 2025. [PMID: 40369862 DOI: 10.1111/resp.70058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2025] [Accepted: 05/05/2025] [Indexed: 05/16/2025]
Affiliation(s)
- Nur K Abdul Jafar
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
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Moulin S, Blachot-Minassian B, Kneppers A, Thomas A, Paradis S, Bultot L, Arnaud C, Pépin JL, Bertrand L, Mounier R, Belaidi E. Metformin protects the heart against chronic intermittent hypoxia through AMPK-dependent phosphorylation of HIF-1α. FEBS J 2025. [PMID: 40364612 DOI: 10.1111/febs.70110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 02/11/2025] [Accepted: 04/14/2025] [Indexed: 05/15/2025]
Abstract
Chronic intermittent hypoxia (IH), a major feature of obstructive sleep apnea syndrome (OSA), is associated with greater severity of myocardial infarction. In this study, we performed RNA sequencing of cardiac samples from mice exposed to IH, which reveals a specific transcriptomic signature of the disease, relative to mitochondrial remodeling and cell death. Corresponding to its activation under chronic IH, we stabilized the Hypoxia Inducible Factor-1α (HIF-1α) in cardiac cells in vitro and observed its association with an increased autophagic flux. In accordance, IH induced autophagy and mitophagy, which are decreased in HIF-1α+/- mice compared to wild-type animals, suggesting that HIF-1 plays a significant role in IH-induced mitochondrial remodeling. Next, we showed that the AMPK metabolic sensor, typically activated by mitochondrial stress, is inhibited after 3 weeks of IH in hearts. Therefore, we assessed the effect of metformin, an anti-diabetic drug and potent activator of AMPK, on myocardial response to ischemia-reperfusion (I/R) injury. Daily administration of metformin significantly decreases infarct size without any systemic beneficial effect on insulin resistance under IH conditions. The cardioprotective effect of metformin was lost in AMPKα2 knock-out mice, demonstrating that AMPKα2 isoform promotes metformin-induced cardioprotection in mice exposed to IH. Mechanistically, we found that metformin inhibits IH-induced mitophagy in myocardium and decreases HIF-1α nuclear expression in mice subjected to IH. In vitro experiments demonstrated that metformin induced HIF-1α phosphorylation, decreased its nuclear localization, and HIF-1 transcriptional activity. Collectively, these results identify the AMPKα2 metabolic sensor as a novel modulator of HIF-1 activity. Our data suggest that metformin could be considered as a cardioprotective drug in OSA patients independently of their metabolic status.
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Affiliation(s)
- Sophie Moulin
- HP2, Université Grenoble Alpes, INSERM, Laboratory HP2, France
| | | | - Anita Kneppers
- Institut NeuroMyoGène, CNRS UMR 5261, INSERM U1315, Université Lyon 1, France
| | - Amandine Thomas
- Team Atherosclerosis, Thrombosis and Physical Activity, LIBM UR7424, Université Lyon 1, France
| | | | - Laurent Bultot
- Pole of Cardiovascular Research, UCLouvain, Institute of Experimental and Clinical Research (IREC), Brussels, Belgium
| | - Claire Arnaud
- HP2, Université Grenoble Alpes, INSERM, Laboratory HP2, France
| | - Jean-Louis Pépin
- HP2, Université Grenoble Alpes, INSERM, Laboratory HP2, France
- Cardiovascular and Respiratory Function Laboratory, Grenoble Alpes University Hospital, France
| | - Luc Bertrand
- Pole of Cardiovascular Research, UCLouvain, Institute of Experimental and Clinical Research (IREC), Brussels, Belgium
- WELBIO Department, WEL Research Institute, Wavre, Belgium
| | - Rémi Mounier
- Institut NeuroMyoGène, CNRS UMR 5261, INSERM U1315, Université Lyon 1, France
| | - Elise Belaidi
- HP2, Université Grenoble Alpes, INSERM, Laboratory HP2, France
- Institut NeuroMyoGène, CNRS UMR 5261, INSERM U1315, Université Lyon 1, France
- Laboratory of Tissue Biology and Therapeutic Engineering, CNRS, LBTI UMR 5305, Université Lyon 1, France
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Muñoz-Martínez MJ, Fernández-Villar A, Casal-Guisande M, García-Campo E, Corbacho-Abelaira D, Souto-Alonso A, Sopeña B. Prevalence of Sleep Apnea in Patients with Syncope of Unclear Cause: SINCOSAS Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:887. [PMID: 40428845 PMCID: PMC12113598 DOI: 10.3390/medicina61050887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 05/02/2025] [Accepted: 05/09/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: The association between syncope and sleep apnea (SA) has been scarcely investigated. Dysfunction of the autonomic nervous system (ANS) may represent a shared pathophysiological mechanism. This study aimed to determine the prevalence of SA in patients with syncope of unclear cause (SUC), identify potential associated factors, and evaluate nocturnal heart rate variability (HRV) as a marker of ANS function. Materials and Methods: A prospective cohort study was conducted in adult patients diagnosed with SUC. Nocturnal cardiorespiratory polygraphy was performed to detect the presence of SA. A range of variables potentially associated with SA was collected. Both SA diagnosis and HRV parameters were assessed using the Embletta® MPR polygraph system. Results: A total of 156 patients were enrolled (57% male), with a mean age of 64 years and a mean body mass index of 27.5 kg/m2 (range: 24.8-32.2). Hypertension was present in 46% of the cohort. The overall prevalence of SA was 78.2% (95% CI: 71.7-84.4%), with 28.7% classified as severe. Age (OR = 1.04; 95% CI: 1.01-1.07) and BMI (OR = 1.17; 95% CI: 1.06-1.28) were independent predictors of SA. Mean RR interval was significantly lower in patients with SA compared to those without (942 ms vs. 995 ms; p = 0.04). No significant differences in HRV parameters were observed between the two groups. Conclusions: This study found a high prevalence (nearly 78%) of SA among adult patients with SUC, particularly in individuals over 50 years of age and those who were overweight. However, this association could not be predicted based on clinical variables alone. No significant differences in nocturnal HRV were detected between patients with SUC with and without SA.
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Affiliation(s)
- María-José Muñoz-Martínez
- Pulmonary Department, Hospital Universitario Álvaro Cunqueiro, 36312 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
- Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Universitario Álvaro Cunqueiro, 36312 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
- School of Industrial Engineering, University of Vigo, 36310 Vigo, Spain
| | - Manuel Casal-Guisande
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
- Fundación Pública Galega de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - Enrique García-Campo
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, 36312 Vigo, Spain
| | - Dolores Corbacho-Abelaira
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
- Pulmonary Department, Hospital Ribera Povisa, 36211 Vigo, Spain
| | - Ana Souto-Alonso
- Pulmonary Department, Hospital Universitario de A Coruña, 15006 A Coruña, Spain
| | - Bernardo Sopeña
- Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Internal Medicine Department, Hospital Clínico Universitario de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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21
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Wang X, Zhang J, Zou J, Zhou T, Zhou E, Shen L, Yang S, Huang W, Zhu H, Guan J, Yi H, Yin S. Polysomnographic endotypes of successful multilevel upper airway surgery for obstructive sleep apnea. Sleep 2025; 48:zsaf012. [PMID: 39821631 PMCID: PMC12068058 DOI: 10.1093/sleep/zsaf012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 12/22/2024] [Indexed: 01/19/2025] Open
Abstract
STUDY OBJECTIVES Multilevel upper airway surgery is effective for some patients with obstructive sleep apnea (OSA), but predicting the response to surgery remains a challenge. The underlying endotypes of OSA include upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold. This study aimed to explore the effect of surgery on polysomnography (PSG)-derived OSA endotypes and establish a surgical response prediction model. METHODS Our study included 54 Chinese patients with OSA who underwent multilevel upper airway surgery. Participants underwent PSG before and after surgery with a median follow-up time of 6.5 months. Using AHIBaseline/AHIpost-surgery ≥ 2 and AHIpost-surgery < 10 events/h as criteria, participants were classified as surgery responders and non-responders. The surgical success rate was 26%. These endotypic traits were derived from a standard PSG data by validated methods. RESULTS The surgery altered both anatomical and non-anatomical endotypic traits, including increased Vpassive (baseline vs post-surgery: 51.5 [18.7-84.2] vs 86.8 [67.4-93.7] %Veupnea, p < .001), decreased loop gain (baseline vs post-surgery: 0.7 [0.7-0.8] vs 0.6 [0.5-0.6]; p < .001), and a higher arousal threshold (baseline vs post-surgery: 202.9 [183.7-222.0] vs 160.7 [143.9-177.4] %Veupnea; p < .001). However, it did not significantly affect muscle compensation. Fully adjusted logistic regression analyses indicated that a favorable response to surgery was independently associated with a lower LG (OR [CI 95%], 0.1 [0.0-0.5], p = .032). In patients with improved muscle compensation or a more collapsible airway (lower Vpassive), a lower loop gain was more strongly indicative of success. However, when muscle compensation was lower or collapsibility was less severe (higher Vpassive), a lower loop gain was less predictive of success. CONCLUSIONS This study demonstrated that multilevel upper airway surgery altered both anatomical and non-anatomical endotypes in Chinese patients with OSA. An endotype based regression model may meaningfully predict surgical success.
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Affiliation(s)
- Xiaoting Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jingyu Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jianyin Zou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Tianjiao Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Enhui Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Li Shen
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyu Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Weijun Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Huaming Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Hongliang Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shankai Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
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Badran M, Puech C, Gozal D. The cardiovascular consequences of chronic sleep fragmentation: Evidence from experimental models of obstructive sleep apnea. Sleep Med 2025; 132:106566. [PMID: 40398206 DOI: 10.1016/j.sleep.2025.106566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2025] [Revised: 05/09/2025] [Accepted: 05/11/2025] [Indexed: 05/23/2025]
Abstract
Sleep fragmentation (SF) and intermittent hypoxia (IH), hallmark features of obstructive sleep apnea (OSA), disrupt restorative processes by inducing sympathetic activation and endothelial dysfunction, contributing to cardiovascular risk. While IH has been extensively studied, the independent effects of SF remain underexplored. This study investigated the cardiovascular impact of chronic SF in a murine model mimicking moderate-to-severe OSA. Male C57BL/6J mice were exposed to chronic SF or control conditions for 12 weeks. Mean blood pressure (MBP), cardiac function, pulse wave velocity (PWV), and coronary flow velocity reserve (CFVR) were assessed. Endothelium-dependent relaxation in aortic and coronary vessels was examined ex vivo, and aortic histological analysis evaluated intima-to-media thickness and collagen content. SF significantly elevated MBP (107 ± 8 mmHg vs. 89 ± 5 mmHg; p = 0.0001) and PWV (4.3 ± 0.6 m/s vs. 3.1 ± 0.2 m/s; p = 0.0001), indicating hypertension and arterial stiffness. Endothelium-dependent relaxation was impaired in coronary (67 ± 9 % vs. 86 ± 5 %; p = 0.0004) and aortic (73 ± 12 % vs. 87 ± 7 %; p = 0.045) vessels. Histology revealed increased intima-to-media thickness (128 ± 9 μm vs. 102 ± 14 μm; p = 0.008) and collagen deposition (56 ± 10 μm vs. 41 ± 7 μm; p = 0.027). Cardiac function and CFVR were unaffected. Chronic SF independently drives cardiovascular dysfunction through hypertension, arterial stiffness, endothelial impairment, and vascular remodeling. These findings emphasize SF as a distinct pathological factor in OSA, necessitating adjunctive interventions to mitigate cardiovascular risks.
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Affiliation(s)
- Mohammad Badran
- Department of Pediatrics, University of Missouri, Columbia, MO, USA; Department of Medical Physiology and Pharmacology, University of Missouri, Columbia, MO, USA.
| | - Clementine Puech
- Department of Pediatrics, University of Missouri, Columbia, MO, USA.
| | - David Gozal
- Department of Pediatrics and Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA.
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Nielsen S, Nyvad J, Grove EL, Poulsen PL, Laugesen E, Christensen KL, Buus NH. Obstructive sleep apnea is associated with cardiac structural and functional alterations in patients with advanced diabetic kidney disease. Diabetes Res Clin Pract 2025:112225. [PMID: 40360122 DOI: 10.1016/j.diabres.2025.112225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 04/09/2025] [Accepted: 05/03/2025] [Indexed: 05/15/2025]
Abstract
AIMS Obstructive sleep apnea (OSA) is common in type 2 diabetes mellitus (T2DM), but its association with cardiac structure and function in advanced diabetic kidney disease (DKD) remains unclear. METHODS T2DM patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and albuminuria were assessed for OSA using the apnea-hypopnea index (AHI). Cardiac structure and function were assessed by transthoracic echocardiography following standard guidelines. 39 patients without OSA (AHI < 5) were compared to 34 patients with moderate-severe OSA (AHI ≥ 15). RESULTS Mean age was 71.4 ± 9.4 years (73 % male), and eGFR was 32.1 ± 12.3 mL/min/1.73 m2. DKD patients with moderate-severe OSA had a higher left atrial volume index (LAVI: 36.6 ± 13.9 vs. 28.1 ± 10.5 mL/m2, p < 0.01) left ventricular mass index (LVMI: 48.8 ± 11.7 vs. 41.8 ± 9.7 g/m2.7, p < 0.01) and right ventricular diameter (RVD: 34.1 ± 5.8 vs. 28.4 ± 4.4 mm, p < 0.001) than DKD patients without OSA. Left ventricular ejection fraction (LVEF) did not differ, but global longitudinal strain (GLS) was reduced (-15.1 ± 3.0 vs. -16.6 ± 2.8 %, p < 0.05). In multivariable linear regression analyses, moderate-severe OSA remained significantly associated with LAVI, LVMI, RVD, and GLS but not with LVEF. CONCLUSIONS Moderate-severe OSA is associated with cardiac hypertrophy and chamber dilatation, potentially contributing to cardiovascular risk in advanced DKD.
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Affiliation(s)
- Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
| | - Esben Laugesen
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark; Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Heath, Aarhus University, Aarhus, Denmark
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24
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Niu Y, Sun S, Wang Y, Chen L, Shao Y, Zhang X. Spatiotemporal Trends in the Prevalence of Obstructive Sleep Apnoea Across China: A Multilevel Meta-Analysis Incorporating Geographic and Demographic Stratification (2000-2024). Nat Sci Sleep 2025; 17:879-903. [PMID: 40370656 PMCID: PMC12075409 DOI: 10.2147/nss.s525547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Accepted: 04/15/2025] [Indexed: 05/16/2025] Open
Abstract
Purpose China bears the highest global burden of obstructive sleep apnea (OSA), yet its spatiotemporal and occupational patterns remain unclear. We quantified OSA prevalence across Chinese subpopulations, focusing on geographic disparities, temporal trends, and occupational risks. Methods Following PRISMA guidelines, we systematically searched six databases (2000-2024) for population-based OSA studies using polysomnography or validated portable monitoring. Two researchers independently screened studies with third-party adjudication of discrepancies. Risk of bias was assessed using Joanna Briggs Institute criteria. Random-effects models pooled prevalence estimates; meta-regression identified heterogeneity contributors. OSA diagnosis followed 2012 AASM criteria (AHI ≥5; pediatric studies: OAHI ≥1.5). Results From 62 studies (N=178,049), pooled OSA prevalence was 11.8% (95% CI:10.1-13.4%), rising from 8.1% (2000-2005) to 26.9% (2021-2024). Prevalence was higher in males vs females (11.1% vs 6.0%, P<0.001), with marked geographic disparities: Northwest China had the highest prevalence (17.8%, 16.3-19.3%) versus Southwest (6.9%, 3.7-10.9%). Drivers exhibited the highest occupational risk (15.3%). Low-quality studies overestimated prevalence (15.0% vs 7.6-10.2% in higher-quality studies), and two-step sampling yielded higher estimates than single-risk-group designs (13.6% vs 7.4%, P<0.001). Meta-regression identified survey period (β=0.036, P=0.025), male sex (β=-0.062, P=0.047), geographic area (β=0.268, P=0.035), occupation (β=0.254, P=0.047), and sampling strategy (β=-0.029, P=0.012) as key predictors of heterogeneity. Conclusion OSA prevalence in China has accelerated significantly. Standardized screening is urgently needed for aging populations, high-risk occupations (particularly drivers), and underserved regions. Policy priorities should address rural diagnostic inequities and integrate OSA surveillance into public health programs. Methodological harmonization is critical for tracking OSA's evolving burden.
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Affiliation(s)
- Yuqi Niu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Shanwen Sun
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yali Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Linlin Chen
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yefan Shao
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Xiaochun Zhang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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25
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Zhu Y, Jiang Q, Zhang Y, Xie D, Yang Z, Lu N, Zeng C, Lei G, Wei J, Yang T. Osteoarthritis and the risk of sleep apnea: a general population-based cohort study. Clin Rheumatol 2025:10.1007/s10067-025-07457-1. [PMID: 40329131 DOI: 10.1007/s10067-025-07457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 03/25/2025] [Accepted: 04/22/2025] [Indexed: 05/08/2025]
Abstract
OBJECTIVE Osteoarthritis (OA) is the most common joint disease, leading to pain and inflammation, two risk factors for sleep apnea (SA). We aimed to examine whether OA may increase the risk of incident SA, a common source of mortality and sudden death. METHOD Using data from the IQVIA Medical Research Database, we conducted three cohort studies (i.e., knee, hip, and hand cohort) among individuals aged 50 years or older. For each patient with incident OA, up to five non-OA individuals were matched by age, sex, entry-time, and BMI. We calculated the incidence rate of SA for the OA and non-OA cohorts, respectively, and examined the relation of OA to the risk of incident SA using a Cox proportional hazard model adjusting for potential confounders. RESULTS During the follow-up, 869 SA cases occurred in 58,674 patients with knee OA and 2,186 in 235,850 non-OA individuals (2.29 vs. 1.41/1000 person-years). Compared with the non-OA cohort, the multivariable-adjusted hazard ratio (HR) of SA in the knee OA cohort was 1.45 (95% confidence interval [CI]: 1.34-1.56). A higher risk of SA was also observed among patients with incident hip OA (adjusted HR: 1.45, 95%CI: 1.28-1.66) and hand OA (adjusted HR: 1.50, 95%CI: 1.26-1.78) than the matched non-OA individuals. CONCLUSIONS This general population-based study provides the first evidence that patients with knee, hip, and hand OA may have an increased risk of incident SA. Strategies aimed at screening, prevention, and treatment of SA could be developed to reduce the disease burden in OA patients.
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Affiliation(s)
- Yanqiu Zhu
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiao Jiang
- Departmenf of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dongxing Xie
- Departmenf of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zidan Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Central South University, Changsha, Hunan, China
| | - Na Lu
- Arthritis Research Canada, Richmond, BC, Canada
| | - Chao Zeng
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Departmenf of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Departmenf of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Key Laboratory of Aging-Related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Central South University, Changsha, Hunan, China
| | - Tuo Yang
- Departmenf of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
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26
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Tong Y, Chen YJ, Cui GB. The genetic overlap and causal relationship between attention deficit hyperactivity disorder and obstructive sleep apnea: a large-scale genomewide cross-trait analysis. BMC Psychiatry 2025; 25:454. [PMID: 40329273 PMCID: PMC12057209 DOI: 10.1186/s12888-025-06899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Accepted: 04/23/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and Obstructive sleep apnea (OSA) are highly clinically co-occurring, but the mechanisms behind this remain unclear, so this article analyzes the reasons for the co-morbidities from a genetic perspective. METHODS We examined the genetic architecture of ADHD and OSA based on the large genome-wide association studies (GWAS). The global genetic relationship between OSA and ADHD was explored. Cross-trait analysis from single nucleotide polymorphism (SNP) and gene level was performed subsequently to detect the crucial genomic regions. Finally, we revealed the anatomical change on which genetic overlap relies and further explored whether genetic factors exert a causal effect. RESULTS After using both linkage disequilibrium score regression (LDSC) and High-definition likelihood inference (HDL) methods, we identified a significant genetic correlation between OSA and ADHD (PLDSC = 2.45E-28, PHDL = 1.09E-25), demonstrating a consistent direction. Furthermore, through the application of various cross-trait methods, we pinpointed 5 loci and 57 genes involved in regulating the co-occurrence of these disorders. These genetic regions were thought to be associated with the prefrontal lobes (P = 3.07E-06) and the nucleus accumbens basal ganglia (P = 2.85E-06). Lastly, utilizing Mendelian randomization (MR), we established a link indicating that individuals with ADHD were at an elevated risk of developing OSA (PIVM = 0.02, OR (95%CI):1.09 (1.01-1.17)). CONCLUSIONS This study reveals a strong genetic correlation between ADHD and OSA. It offers insights for future drug target development and sleep management in ADHD.
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Affiliation(s)
- Yao Tong
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi Province, China
| | - Yan-Jing Chen
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Guang-Bin Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi Province, China.
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27
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Chen Q, Lai H, Chen Y, Peng Z, Wu S, Liu D. Characterization of circRNA expression profiles and functional roles in a mouse model of liver injury induced by OSA. Sci Rep 2025; 15:15615. [PMID: 40320447 PMCID: PMC12050294 DOI: 10.1038/s41598-025-99612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 04/21/2025] [Indexed: 05/08/2025] Open
Abstract
Despite mounting evidence linking circular RNAs (circRNAs) to various diseases, their specific role in liver damage triggered by obstructive sleep apnea (OSA) remains ambiguous. This study investigates alterations in circRNA expression patterns in a mouse model subjected to chronic intermittent hypoxia (CIH), aiming to elucidate the pathways that lead to liver damage associated with OSA. We established the CIH model and conducted circRNA microarray analysis on liver samples from both CIH and control groups. The findings were substantiated via qRT-PCR. Furthermore, a comprehensive circRNA-miRNA-mRNA (ceRNA) network was developed, followed by the analysis of GO and KEGG pathways to further elucidate the underlying biological processes. We identified 259 differentially expressed circRNAs, comprising 86 that were upregulated and 173 that were downregulated in CIH mice. The ceRNA analysis suggested that these circRNAs may modulate gene expression by sequestering miRNAs. Our findings highlight potential therapeutic targets for liver pathologies associated with OSA.
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Affiliation(s)
- Qingshi Chen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
| | - Huiting Lai
- Department of Interventional Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yuwei Chen
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhuli Peng
- Department of Interventional Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Siying Wu
- Department of Interventional Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Dexin Liu
- Department of Interventional Therapy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
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Wang L, Hui X, Cao W, Huang R, Xiao Y. Sleep breathing impairment index predicts incident atrial fibrillation in obstructive sleep apnea: A prospective cohort study. Sleep Med 2025; 129:386-393. [PMID: 40132385 DOI: 10.1016/j.sleep.2025.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 03/15/2025] [Accepted: 03/18/2025] [Indexed: 03/27/2025]
Abstract
OBJECTIVES Respiratory-event-associated hypoxia is crucial in cardiovascular comorbidities of obstructive sleep apnea (OSA). Intermittent hypoxia is an independent risk factor for atrial fibrillation (AF). The sleep breathing impairment index (SBII) is a novel metric that quantifies respiratory events and hypoxia, showing exceptional efficacy in predicting cardiovascular diseases. This study aims to evaluate the association between SBII and AF in OSA patients and compare the predictive performance of various OSA severity indices in predicting incident AF. METHODS This study included 1660 OSA patients without pre-existing AF from the Sleep Heart Health Study. Baseline SBII values were stratified into quartiles. Multivariate logistic regression analysis and restricted cubic spline analysis were conducted to explore the association between SBII and incident AF. Harrell's concordance statistic (C-statistic) was performed to compare the predictive value of SBII against other OSA severity indices. RESULTS During a mean follow-up of 5.3 years, 190 (11.5 %) OSA patients developed AF. SBII and hypoxic burden (HB) were associated with an increased risk of incident AF, with adjusted odds ratios of 1.87 (95 %CI: 1.14, 3.11; P = 0.015) and 2.01 (95 %CI: 1.20, 3.41; P = 0.009) for the third and fourth quartiles of SBII, respectively, and 1.70 (95 %CI: 1.04, 2.81; P = 0.038) for the fourth quartile of HB. Moreover, SBII had the largest C-statistic (0.75, 95 % CI: 0.709, 0.782) compared with HB, AHI, and ODI. CONCLUSION This study demonstrated that elevated SBII and HB levels increased the risk of incident AF in OSA patients, with SBII outperforming other OSA severity indices in predicting AF.
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Affiliation(s)
- Lixia Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xinjie Hui
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wenhao Cao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Lo JE, Schmickl CN, Vaida F, Nemati S, Singh K, Sands SA, Owens RL, Malhotra A, Orr JE. The combination of physiology and machine learning for prediction of CPAP pressure and residual AHI in OSA. J Clin Sleep Med 2025; 21:775-782. [PMID: 39745438 PMCID: PMC12048318 DOI: 10.5664/jcsm.11498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 12/06/2024] [Accepted: 12/23/2024] [Indexed: 01/30/2025]
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnea; however, some people have residual respiratory events or require significantly higher CPAP pressure while on therapy. Our objective was to develop predictive models for CPAP outcomes and assess whether the inclusion of physiological traits enhances prediction. METHODS We constructed predictive models from baseline information for subsequent residual apnea-hypopnea index and optimal CPAP pressure. We compared models utilizing clinical variables with those incorporating both clinical and physiological factors. Furthermore, we assessed the performance of regression vs machine learning. All performances, including root mean square error, R-squared, accuracy, and area under the curve, were evaluated using a 5-fold cross validation with 10 repeats. RESULTS For predicting residual apnea-hypopnea index, random forest models outperformed regression models, and models that incorporated both clinical and physiological variables also outperformed models using only clinical variables across all performance metrics. Random forest using both clinical features and physiological traits achieved the best performance. In both regression and random forest models, central apnea index is found to be the most important feature in predicting residual apnea-hypopnea index. For predicting CPAP pressure, there was no additional predictive value of physiological traits or random forest modeling. CONCLUSIONS Our findings demonstrated that the combined use of clinical and physiological variables yields the most robust predictive models for residual apnea-hypopnea index, with random forest models performing best. These findings support the notion that prediction of obstructive sleep apnea therapy outcomes may be improved by more flexible models using machine learning, potentially in combination with physiology-based models. CITATION Lo J-E, Schmickl CN, Vaida F, et al. The combination of physiology and machine learning for prediction of CPAP pressure and residual AHI in OSA. J Clin Sleep Med. 2025;21(5):775-782.
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Affiliation(s)
- Jui-En Lo
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Christopher N. Schmickl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Florin Vaida
- School of Public Health, University of California San Diego, San Diego, California
| | - Shamim Nemati
- Department of Biomedical Informatics, University of California San Diego, San Diego, California
| | - Karandeep Singh
- Department of Biomedical Informatics, University of California San Diego, San Diego, California
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert L. Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Jeremy E. Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
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Gaspar LS, Pyakurel S, Xu N, D'Souza SP, Koritala BSC. Circadian Biology in Obstructive Sleep Apnea-Associated Cardiovascular Disease. J Mol Cell Cardiol 2025; 202:116-132. [PMID: 40107345 DOI: 10.1016/j.yjmcc.2025.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Revised: 02/16/2025] [Accepted: 03/14/2025] [Indexed: 03/22/2025]
Abstract
A dysregulated circadian system is independently associated with both Obstructive Sleep Apnea (OSA) and cardiovascular disease (CVD). OSA and CVD coexistence is often seen in patients with prolonged untreated OSA. However, the role of circadian dysregulation in their relationship is unclear. Half of the human genes, associated biological pathways, and physiological functions exhibit circadian rhythms, including blood pressure and heart rate regulation. Mechanisms related to circadian dysregulation and heart function are potentially involved in the coexistence of OSA and CVD. In this article, we provide a comprehensive overview of circadian dysregulation in OSA and associated CVD. We also discuss feasible animal models and new avenues for future research to understand their relationship. Oxygen-sensing pathways, inflammation, dysregulation of cardiovascular processes, oxidative stress, metabolic regulation, hormone signaling, and epigenetics are potential clock-regulated mechanisms connecting OSA and CVD.
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Affiliation(s)
- Laetitia S Gaspar
- Centre for Neuroscience and Cell Biology, University of Coimbra, Portugal; Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Portugal
| | - Santoshi Pyakurel
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Na Xu
- Division of Molecular Cardiovascular Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Shane P D'Souza
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Bala S C Koritala
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
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Ebrahim M, Hussain S, Al-Bader M, Abdulateef H, AlSihan M, de Vries N, AlTerki A. Effect of multi-level upper airway surgery on obese patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2025; 282:2641-2648. [PMID: 39833433 DOI: 10.1007/s00405-025-09208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 01/07/2025] [Indexed: 01/22/2025]
Abstract
PURPOSE Obesity is a major risk factor in Obstructive sleep apnea (OSA), which is a prevalent disease that leads to significant morbidity. Multi-level Sleep Surgery (MLS) is a method of treatment for patients who cannot tolerate continuous positive airway pressure. Obesity has previously been identified as a risk factor that may decrease the success rate of MLS. The purpose of our study is to assess the success rates of MLS in obese patients. METHODS A retrospective cohort study in 109 adults that underwent MLS in our institution. All the participants completed pre-operative and post-operative level 1 polysomnography. They were divided into four groups as per their body mass index (BMI): Normal (BMI < 25), overweight (25-30), obese (30-35), morbid obese (> 35) and the variables were compared. We measured the surgical success as defined by Sher Criteria (AHI drop > 50% from preoperative baseline and AHI < 20) and cure rates (AHI < 5). RESULTS The average BMI was 30.9 pre-op and 30.4 post-op. The mean AHI was 29.8 pre-op and decreased to 10.1 (p < 0.001) and the Epworth Sleepiness Scale from 12.9 to 4.8 (p < 0.001). There were 13, 31, 43, and 22 patients in normal, overweight, obese and morbidly obese groups, respectively. The surgical success rate as defined by Sher's criteria was 84%, 84%, 72%, and 77% in the respective groups, with no statistical difference (p = 0.662). Moreover, the cure rate was 77%, 45%, 44%, and 45%, with no statistical difference (p = 0.192). The AHI reduction was 9.93, 19.73, 21.1 and 22.8 in the respective groups. A linear regression analysis revealed no significant difference in assessing the surgical success and cure rates as BMI increases. CONCLUSION Data regarding MLS success rates on obese patients is scarce. The current study demonstrates that MLS can offer positive outcomes for this population. However, further studies are warranted to investigate this relationship. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Mahmoud Ebrahim
- Department of Otolaryngology-Head and Neck Surgery, McGill, Montreal, Canada
- Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Salman Hussain
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Mohammed Al-Bader
- Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Hiba Abdulateef
- Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Mutlaq AlSihan
- Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait
| | - Nico de Vries
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | - Abdulmohsen AlTerki
- Department of Otolaryngology-Head and Neck Surgery, Zain Hospital, Kuwait City, Kuwait
- Department of Otolaryngology Head and Neck Surgery, Dasman Diabetes Institute, Kuwait City, Kuwait
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Iacovoni A, Navazio A, De Luca L, Gori M, Corda M, Milli M, Iacoviello M, Di Lenarda A, Di Tano G, Marini M, Iorio A, Mortara A, Mureddu GF, Zilio F, Chimenti C, Cipriani MG, Senni M, Bilato C, Di Marco M, Geraci G, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gulizia MM, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F. ANMCO position paper: diagnosis and treatment of heart failure with preserved systolic function. Eur Heart J Suppl 2025; 27:v216-v246. [PMID: 40385467 PMCID: PMC12078774 DOI: 10.1093/eurheartjsupp/suaf070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.
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Affiliation(s)
- Attilio Iacovoni
- S.S.D. Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Reggio Emilia, Italy
| | - Leonardo De Luca
- S.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mauro Gori
- U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Corda
- S.C. Cardiologia, Azienda di Rilievo Nazionale e Alta Specializzazione ‘G. Brotzu’, Cagliari, Italy
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Florence, Italy
| | | | - Andrea Di Lenarda
- S.C. Patologie Cardiovascolari, Dipartimento Specialistico Territoriale, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Giuseppe Di Tano
- U.O. CARDIOLOGIA - UCC, Ospedale Cernusco sul Naviglio, Cernusco sul Naviglio, MI, Italy
| | - Marco Marini
- S.O.S. Terapia Intensiva Cardiologica, S.O.D. Cardiologia-UTIC, Dipartimento di Scienze Cardiovascolari, AOU delle Marche, Ancona, Italy
| | - Annamaria Iorio
- S.S.D. Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Andrea Mortara
- Dipartimento di Cardiologia Clinica, Policlinico di Monza, Monza, Italy
| | - Gian Francesco Mureddu
- U.O.S.D. Cardiologia Riabilitativa, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Filippo Zilio
- U.O. Cardiologia, Ospedale Santa Chiara, Trento, Italy
| | - Cristina Chimenti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Azienda Ospedaliera Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | - Manlio Gianni Cipriani
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT)-IRCCS, Palermo, Italy
| | - Michele Senni
- S.S.D. Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Claudio Bilato
- U.O.C. Cardiologia, Ospedali dell’Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | - Giovanna Geraci
- U.O.C. Cardiologia, Presidio Ospedaliero Sant’Antonio Abate, ASP Trapani, Erice, TP, Italy
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro, Italy
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant’Anna e San Sebastiano, Caserta, Italy
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli, TO, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania, Italy
| | - Federico Nardi
- Dipartimento di Cardiologia, Ospedale Santo Spirito, Casale Monferrato, AL, Italy
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Florence, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Rome, Italy
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti, BA, Italy
| | - Fabrizio Oliva
- Fondazione per il Tuo cuore—Heart Care Foundation, Florence, Italy
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy
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St-Onge MP, Aggarwal B, Fernandez-Mendoza J, Johnson D, Kline CE, Knutson KL, Redeker N, Grandner MA. Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2025; 18:e000139. [PMID: 40223596 DOI: 10.1161/hcq.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2025]
Abstract
Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.
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Wang L, Hui X, Huang R, Xiao Y. Association between atherogenic index of plasma level and cardiovascular events in patients with obstructive sleep apnea: The sleep heart health study. Sleep Med 2025; 129:375-382. [PMID: 40132383 DOI: 10.1016/j.sleep.2025.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 02/09/2025] [Accepted: 03/18/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND The atherogenic index of plasma (AIP) has been demonstrated as a predictor for cardiovascular disease (CVD) in various populations. However, there are quite limited studies on the association between AIP and incident CVD among adults with obstructive sleep apnea (OSA). METHODS Data were obtained from the Sleep Heart Health Study, including 2578 participants with OSA and without pre-existing CVD. AIP was calculated as lg (triglycerides/high-density lipoprotein-cholesterol). Baseline AIP was stratified into quartiles (Q1-Q4). Multivariate logistic regression and restricted cubic spline analyses were performed to examine the relationship between AIP and CVD. RESULTS After a median follow-up of 11.67 years, 580 (22.50 %) OSA patients developed CVD, including 184 (7.10 %) with myocardial infarction (MI), and 400 (15.50 %) with coronary artery disease (CHD [including MI]), and 127 (4.90 %) with stroke. The multivariate logistic regression and restricted cubic spline analyses demonstrated a significant association between AIP and incidence of CVD, CHD, and MI, but not stroke. Compared with Q1 group, the fully adjusted odds ratios from Q2 group to Q4 group were: 1.33 (0.98, 1.80), 1.41 (1.03, 1.92), and 1.54 (1.12, 2.14) for CVD; 1.71 (1.04, 2.86), 1.92 (1.17, 3.21), and 2.01 (1.19, 3.45) for MI; 1.48 (1.04, 2.11), 1.68 (1.18, 2.40), and 1.70 (1.18, 2.47) for CHD. CONCLUSION This study demonstrated that higher AIP level is associated with incident CVD, except stroke, independent of OSA severity and hypoxia among OSA patients. These findings suggest that monitoring AIP can facilitate the early identification of OSA patients at high risk of CVD.
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Affiliation(s)
- Lixia Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xinjie Hui
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Rong Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yi Xiao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Marzouqah R, Jairam S, Ntale I, Preston KSJ, Black SE, Swartz RH, Murray BJ, Younes M, Boulos MI. The association of odds ratio product with respiratory and arousal measures in post-stroke patients. Sleep Med 2025; 129:257-263. [PMID: 40056661 DOI: 10.1016/j.sleep.2025.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 02/13/2025] [Accepted: 02/28/2025] [Indexed: 03/10/2025]
Abstract
STUDY OBJECTIVES Obstructive Sleep Apnea (OSA) affects up to 70 % of post-stroke patients, complicating recovery and rehabilitation. This study aimed to evaluate the utility of the Odds Ratio Product (ORP), a continuous EEG-derived metric of sleep depth, in predicting conventional respiratory and arousal measures in stroke patients. We hypothesized that ORP metrics will predict conventional measures in patients with a history of stroke or Transient ischemic attack (TIA). METHODS A retrospective analysis was conducted on 113 stroke/TIA individuals who underwent in-laboratory polysomnography (PSG). ORP metrics, including ORPnrem, ORPrem, ORP9, and Wake Intrusion Indices (WIIs), were analyzed using multivariate linear regression models. Models were stratified by OSA status. Standardized coefficients were used to assess associations with the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and arousal indices. RESULTS ORP metrics demonstrated statistically significant associations with conventional respiratory and arousal measures, with varying predictive strength across models. Specifically, ORPnrem and WIIs exhibited strong predictive effects across all models. ORP9 significantly predicted respiratory and arousal measures in the overall sample and the OSA subgroup, but its predictive value diminished in the non-OSA subgroup. ORPrem was statistically significantly associated with respiratory and arousal measures; however, its associations with arousal measures were weaker in participants with OSA compared to those without OSA. CONCLUSION ORP metrics have the potential to refine OSA diagnoses and improve therapeutic strategies in post-stroke/TIA populations. Their integration into sleep assessments could facilitate early intervention and potentially optimize stroke recovery outcomes, addressing gaps in current evaluation methods.
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Affiliation(s)
- Reeman Marzouqah
- Department of Communication Sciences and Disorders, College of Communications, California State University - Fullerton, Fullerton, CA, United States.
| | - Sean Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ivan Ntale
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kathleen S J Preston
- Department of Psychology, College of Humanities and Social Sciences, California State University - Fullerton, Fullerton, CA, United States
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, United States
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Goldstein C, Ghanbari H, Sharma S, Collop N, Loring Z, Walsh C, Torstrick B, Herreshoff E, Pollock M, Frankel DS, Rosen IM. Multidiagnostic chest-worn patch to detect obstructive sleep apnea and cardiac arrhythmias. J Clin Sleep Med 2025; 21:855-866. [PMID: 39878749 PMCID: PMC12048333 DOI: 10.5664/jcsm.11522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 01/31/2025]
Abstract
STUDY OBJECTIVES Evaluate the performance of the SANSA device to simultaneously assess obstructive sleep apnea and cardiac arrhythmias. METHODS Participants suspected or known to have obstructive sleep apnea underwent polysomnography while wearing SANSA. SANSA's algorithm was trained using 86 records and tested on 67 to evaluate training bias. SANSA performance was evaluated against ground truth polysomnography scored by the consensus of 3 technologists. Polysomnography scoring from individual testing sites was also evaluated against consensus. Diagnostic performance was evaluated using standard apnea-hypopnea index cutoffs. Apnea-hypopnea index and total sleep time agreement was analyzed using correlation and Bland-Altman plots. Electrocardiogram was reviewed for presence of significant arrhythmias (frequent premature atrial/ventricular complexes and atrial fibrillation). RESULTS SANSA's sensitivity and specificity to detect obstructive sleep apnea ranged from 91-97% and 78-97%, respectively, across all severity levels. SANSA total sleep time correlation with consensus polysomnography total sleep time was 0.83 with a mean difference of 3.8 minutes (limits of agreement: -91.1 to 98.7). Significant arrhythmias were detected in 32% of participants. These participants had a greater apnea-hypopnea index (27.5 vs 15.8 events/h, P = .003) and spent nearly twice as long at reduced oxygenation levels (47.5 vs 20.5 minutes under 88% oxygen saturation, P = .009). CONCLUSIONS SANSA is a promising tool for comprehensive obstructive sleep apnea evaluation, offering the unique advantage of concurrent arrhythmia detection. This dual functionality may improve patient outcomes through early diagnosis and management of both conditions. CITATION Goldstein C, Ghanbari H, Sharma S, et al. Multidiagnostic chest-worn patch to detect obstructive sleep apnea and cardiac arrhythmias. J Clin Sleep Med. 2025;21(5):855-866.
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Affiliation(s)
- Cathy Goldstein
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Hamid Ghanbari
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Surina Sharma
- Emory Sleep Center, Emory University, Atlanta, Georgia
| | - Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, Georgia
| | - Zak Loring
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Colleen Walsh
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Emily Herreshoff
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | | | - David S. Frankel
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ilene M. Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Larsen LM, Winther SV, Kørvel-Hanquist A, Marott SCW, Landt EM, Homøe P, Nordestgaard BG, Dahl M. Alpha-1 antitrypsin deficiency and risk of sleep apnea: a nationwide cohort study. Eur Arch Otorhinolaryngol 2025; 282:2679-2686. [PMID: 40087166 PMCID: PMC12055952 DOI: 10.1007/s00405-025-09270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/03/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVES α1-Antitrypsin deficiency is a disease characterized by increased neutrophil elastase activity leading to tissue getting less elastic and robust. It is known that if tissue in the pharynx becomes less elastic and robust, it could contribute to obstructive sleep apnea. This paper seeks to investigate whether patients with α1-antitrypsin deficiency have an increased risk of sleep apnea. METHODS We tested this hypothesis by doing a nationwide cohort study of 2702 individuals diagnosed with α1-antitrypsin deficiency compared with 26,750 individuals without α1-antitrypsin deficiency matched on sex, age, and municipality. All individuals were followed from birth and were censored at the time of outcome, emigration, death, or end of follow-up 31st of December 2018, whichever came first. RESULTS Individuals with α1-antitrypsin deficiency had a higher risk of sleep apnea with an adjusted hazard ratio of 1.81 (95% CI 1.36-2.40) compared to controls without α1-antitrypsin deficiency. Similarly, the risk of obstructive sleep apnea was nominally higher in individuals with α1-antitrypsin deficiency compared to controls without the disease (1.47, 95% CI 0.95-2.28). In stratified analysis, the risk of sleep apnea was higher in individuals without chronic obstructive pulmonary disease (2.33, 95% CI 1.54-3.51) (P for interaction < 0.05). The increased risk of SA was unaffected when the analysis was stratified by ischemic heart disease, ischemic cerebrovascular disease, type 2 diabetes, hypertension, and liver cirrhosis. CONCLUSION Individuals with α1-antitrypsin deficiency have a higher risk of sleep apnea in the Danish population.
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Affiliation(s)
- Lucas Møller Larsen
- Department of Clinical Biochemistry, Zealand University Hospital, 4600, Køge, Denmark
| | - Sine Voss Winther
- Department of Clinical Biochemistry, Zealand University Hospital, 4600, Køge, Denmark.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Asbjørn Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Sarah C W Marott
- Department of Clinical Biochemistry, Zealand University Hospital, 4600, Køge, Denmark
| | - Eskild M Landt
- Department of Clinical Biochemistry, Zealand University Hospital, 4600, Køge, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev-Gentofte University Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, 4600, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Sahlin C, Hedström M, Claesson M, Lindberg E, Svensson J, Blomberg A, Franklin KA. Cardiovascular effects after five nights without continuous positive airway pressure for obstructive sleep apnea: a randomized controlled trial. J Hypertens 2025; 43:864-870. [PMID: 40105199 PMCID: PMC11970607 DOI: 10.1097/hjh.0000000000003990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/08/2025] [Accepted: 02/01/2025] [Indexed: 03/20/2025]
Abstract
OBJECTIVES Although continuous positive airway pressure (CPAP) effectively prevents sleep apnea and reduces blood pressure, many patients do not use CPAP every night. This trial investigates cardiovascular effects after sleeping five nights without CPAP. METHODS We randomized 100 patients (67 men and 33 women with a mean age 64 ± 9 years) using CPAP treatment for moderate-to-severe sleep apnea to either withdraw treatment for five nights ( n = 50) or to continue with CPAP ( n = 50). The primary outcomes were arterial stiffness and 24 h blood pressure. RESULTS The 24 h SBP increased by a mean of 2.8 mmHg [95% confidence interval (CI) 0.2-5.4 mmHg] ( P = 0.035) and DBP increased by a mean of 1.7 mmHg (95% CI 0.1-3.3 mmHg) ( P = 0.032) in the group without CPAP compared to the CPAP group. There was a significant effect on blood pressure in women but not in men. In women, SBP increased by 5.1 mmHg (95% CI 1.0-9.5 mmHg) ( P = 0.017) and DBP by 2.9 mmHg (95% CI 0.4-5.6 mmHg) ( P = 0.029). Arterial stiffness remained unaffected. Secondary outcomes that worsened in patients without CPAP included apnea-hypopnea index, oxygen desaturation index, hemoglobin levels, and daytime sleepiness. CONCLUSION Blood pressure is affected after five nights of CPAP interruption, along with a rapid return of sleep apneas, nocturnal hypoxic events, daytime sleepiness and increased hemoglobin levels, but arterial stiffness was not affected. Blood pressure was affected in women only, suggesting a sex-related CPAP effect on blood pressure.
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Affiliation(s)
- Carin Sahlin
- Department of Public Health and Clinical Medicine, Medicine
| | | | - Martin Claesson
- Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala
| | - Johan Svensson
- Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | | | - Karl A. Franklin
- Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå
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Cappadona I, Ielo A, Pagano M, Anselmo A, Micali G, Giambò FM, Duca A, D’Aleo P, Costanzo D, Carcione G, Dispenzieri C, Speciale F, Bramanti P, Bramanti A, Garofano M, Corallo F. Observational protocol on neuropsychological disorders in cardiovascular disease for holistic prevention and treatment. Future Cardiol 2025; 21:349-358. [PMID: 40117170 PMCID: PMC12026235 DOI: 10.1080/14796678.2025.2483155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 03/19/2025] [Indexed: 03/23/2025] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. In view of the close correlation between the functions of the body, which cannot be examined in a piecemeal manner but as an integrated system, a holistic approach allows for a comprehensive assessment of the patient. Our study aims to (i) examine the connection between CVD and cognitive deficits; (ii) examine the presence of anxiety and depression; (iii) evaluate the presence of dysphagia, pneumophonic coordination disorders, respiratory and sleep disorders; (iv) analyze the impact of CVD on the caregiver; and (v) evaluate the effectiveness of psychoeducational intervention. At least 218 patients will participate in the survey. At T0, they will undergo neuropsychological, psychological and associated clinical condition assessment through standardized tests. In addition, at least one psychoeducation meeting will be held. After 6 months (T1), the same tests will be repeated, and the effectiveness of psychoeducation will be evaluated. Assessment of associated disorders will provide a comprehensive view of the patient. In addition, it will be observed how psychoeducational intervention can make changes on general well-being. Comprehensive, multi-step observation allows for identification of risk factors, tailoring of treatment, and prevention of future complications.Clinical Trial Registration: registered on Clinicaltrials.gov (ID: NCT06413823).
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Affiliation(s)
- Irene Cappadona
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Augusto Ielo
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Maria Pagano
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Anna Anselmo
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Giuseppe Micali
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | - Antonio Duca
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | - Daniela Costanzo
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Giuseppa Carcione
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | | | - Placido Bramanti
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
- Faculty of Psychology, Università degli Studi eCampus, Novedrate, Italy
| | - Alessia Bramanti
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Baronissi, Italy
| | - Marina Garofano
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Baronissi, Italy
| | - Francesco Corallo
- Piemonte Hospital, IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Battisha A, Kahlon A, Kalra DK. Sleep-Disordered Breathing and Hypertension-A Systematic Review. J Clin Med 2025; 14:3115. [PMID: 40364148 PMCID: PMC12072724 DOI: 10.3390/jcm14093115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 04/21/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Sleep-disordered breathing (SDB), historically referred to as "sleep apnea syndrome", particularly obstructive sleep apnea (OSA), is an independent risk factor for hypertension (HTN), stroke, heart failure, arrhythmias, and other cardiovascular disorders. Despite the well-established link between OSA and HTN and its high occurrence in cardiovascular disorders, the focus on the complex OSA-HTN axis is often overlooked or inadequately managed, which might explain the lack of notable improvements in cardiovascular outcomes for this patient population. Understanding the complex relationship between OSA and HTN is crucial due to its significant implications for clinical practice and public health. Methods: Using an expanded list of relevant MeSH terms, including "sleep-disordered breathing" and "sleep apnea syndrome", and following the PRISMA model, peer-reviewed articles were systematically selected. Studies published from January 2000 through December 2024 were identified and screened based on predefined inclusion and exclusion criteria. Results: This review emphasizes both OSA's independent and interaction effects on cardiovascular health and outcomes across different populations. It identifies key factors mediating the association between OSA and HTN. Conclusions: Multimodal management, including continuous positive airway pressure and lifestyle modification, is essential for treating hypertension related to OSA. Effective management of the OSA-HTN relationship is vital to improving cardiovascular outcomes.
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Affiliation(s)
| | | | - Dinesh K. Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA; (A.B.); (A.K.)
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Xie L, Wu Q, Huang H, Wang K, Ying K, Liu Z, Li S. Neuroregulation of histamine of circadian rhythm disorder induced by chronic intermittent hypoxia. Eur J Pharmacol 2025; 999:177662. [PMID: 40311833 DOI: 10.1016/j.ejphar.2025.177662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 04/20/2025] [Accepted: 04/22/2025] [Indexed: 05/03/2025]
Abstract
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, sleep fragmentation, and excessive daytime sleepiness. OSA patients are at an elevated risk for circadian rhythm disturbances. Histamine is known to regulate the sleep-wake cycle predominantly via histamine H1 receptors. We utilized a C57BL/6 mouse model exposed to chronic intermittent hypoxia (CIH) for three weeks to assess alterations in circadian rhythmicity. Sleep architecture and voluntary wheel-running activity were evaluated. Additionally, c-fos expression and mPer2 levels in the frontal cortex (FC) and the suprachiasmatic nucleus (SCN) were examined. BV-2 microglial cells were subjected to intermittent hypoxia (IH) for 12 h to explore the underlying signaling pathways. CIH exposure led to a significant prolongation of the wake phase and a reduction in the Non-rapid eye movement (NREM) phase, accompanied by increased sleep fragmentation and disruption of circadian rhythms. Treatment with mepyramine, an H1 receptor antagonist, mitigated these effects by reducing arousal duration, extending NREM phase, and decreasing sleep fragmentation. CIH also resulted in increased c-fos expression and elevated mPer2 levels in the FC and SCN, both of which were reversed following mepyramine administration. In vitro studies on BV-2 cells demonstrated that histamine exerts its modulatory effects through the activation of the PLC and PKA signaling pathways, influencing mPer2 expression via the regulation of K+, Na + -Ca2+, and Ca2+ ion channels. In conclusion, CIH disrupts circadian rhythms through histamine-mediated mechanisms, and mepyramine effectively ameliorates these disruptions. These findings highlight histamine as a promising therapeutic target for addressing circadian rhythm disorders associated with OSA.
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Affiliation(s)
- Liang Xie
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinhan Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huai Huang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kexin Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kelu Ying
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China; Clinical Centre for Sleep Breathing Disorders and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China.
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Zhang P, An X, Yang R, Qi M, Gao Z, Zhang X, Wu Z, Zheng Z, Dong X, Wang W, Wang X, Zha D. Echoes in the night: How sleep quality influences auditory health. Neuroscience 2025; 577:200-216. [PMID: 40294844 DOI: 10.1016/j.neuroscience.2025.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 03/27/2025] [Accepted: 04/23/2025] [Indexed: 04/30/2025]
Abstract
The intricate relationship between sleep disorders and hearing loss emerges as a burgeoning field of scholarly inquiry. Numerous studies have illuminated a potential correlation between the two, affecting the quality of life and overall health of individuals. Hearing loss, or auditory impairment, serves as a critical indicator of physiological dysfunction, casting a pall over the daily existence and professional endeavors of those affected, potentially leading to irreversible deafness if left untreated. Sleep disorders may cause physical and psychological changes that further affect hearing, while auditory dysfunction may detrimentally impact sleep experienced by individuals. Although certain studies have failed to find a direct link between sleep duration and hearing loss, it is evident that sleep-related issues do increase the risk of hearing loss. Thus, understanding the relationship between sleep disorders and hearing loss, alongside the underlying mechanisms, will help establish interventions aimed at enhancing sleep quality and safeguarding auditory health. This systematic review endeavors to elucidate the correlation between sleep disorders and hearing loss, offering valuable insights and guidance for future basic research and clinical applications.
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Affiliation(s)
- Peng Zhang
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Xiaogang An
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Runqin Yang
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Meihao Qi
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Zejun Gao
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Xinyu Zhang
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Ziqi Wu
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Zeyu Zheng
- Center of Clinical Aerospace Medicine, School of Aerospace Medicine, Key Laboratory of Aerospace Medicine of Ministry of Education, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Xinyu Dong
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Wenyue Wang
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China
| | - Xiaocheng Wang
- Center of Clinical Aerospace Medicine, School of Aerospace Medicine, Key Laboratory of Aerospace Medicine of Ministry of Education, Air Force Medical University, Xi'an 710032 Shaanxi Province, China.
| | - Dingjun Zha
- Department of Otolaryngology, Xijing Hospital, Air Force Medical University, Xi'an 710032 Shaanxi Province, China.
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Iannella G, Pace A, Bellizzi MG, Magliulo G, Greco A, De Virgilio A, Croce E, Gioacchini FM, Re M, Costantino A, Casale M, Moffa A, Lechien JR, Cocuzza S, Vicini C, Caranti A, Marchese Aragona R, Lentini M, Maniaci A. The Global Burden of Obstructive Sleep Apnea. Diagnostics (Basel) 2025; 15:1088. [PMID: 40361906 PMCID: PMC12071658 DOI: 10.3390/diagnostics15091088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Revised: 04/10/2025] [Accepted: 04/18/2025] [Indexed: 05/15/2025] Open
Abstract
This study reviewed the global prevalence, health and socioeconomic impact, and management approaches of obstructive sleep apnea. The narrative review examined three key dimensions: (1) worldwide OSA prevalence across different regions, accounting for variations in diagnostic standards; (2) OSA's effects on health outcomes and socioeconomic conditions across diverse populations and healthcare systems; and (3) current global approaches to OSA diagnosis, treatment, and public health management. Despite advances in diagnosis and treatment, a large proportion of OSA cases remain undiagnosed or inadequately managed. The findings show that untreated OSA significantly increases public safety risks, particularly regarding motor vehicle and occupational accidents, while also creating a substantial pool of patients at high risk for systemic complications with severe impacts on overall health. There is a critical need for increased public awareness, universal screening approaches, and integrated care strategies to address this global health challenge and reduce its considerable socioeconomic burden. Our review uniquely addresses global disparities in OSA prevalence, clarifies the health and socioeconomic impacts that remain underexplored in the current literature, and suggests concrete strategies for public health and clinical management improvement worldwide.
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Affiliation(s)
- Giannicola Iannella
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | - Annalisa Pace
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | | | - Giuseppe Magliulo
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | - Antonio Greco
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | - Armando De Virgilio
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | - Enrica Croce
- Organi di Senso Department, Sapienza University of Rome, 00161 Rome, Italy; (G.I.)
| | - Federico Maria Gioacchini
- Ear, Nose and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Massimo Re
- Ear, Nose and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Andrea Costantino
- Department of Otolaryngology—Head and Neck Surgery, AdventHealth Orlando, Orlando, FL 32789, USA
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Jerome R. Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Claudio Vicini
- Department ENT & Audiology, University of Ferrara, 44121 Ferrara, Italy
| | - Alberto Caranti
- Department ENT & Audiology, University of Ferrara, 44121 Ferrara, Italy
| | | | - Mario Lentini
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy (A.M.)
| | - Antonino Maniaci
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy (A.M.)
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Li H, Sun R, Li Y, Yue X, Ni L, Zhou L, Zhao C. Controversies in hypertension therapy: bedtime dosing or daytime dosing? J Hypertens 2025:00004872-990000000-00675. [PMID: 40271565 DOI: 10.1097/hjh.0000000000004035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 03/30/2025] [Indexed: 04/25/2025]
Abstract
Hypertension management strategies have evolved from solely controlling office blood pressure (BP) to comprehensive 24-h BP regulation. This review synthesizes current evidence on the timing of antihypertensive medication, with a focus on circadian BP rhythms and patients with specific BP patterns or comorbidities. Bedtime dosing may benefit individuals with nocturnal hypertension and nondipper BP patterns, but large trials, such as the TIME study, have shown no significant cardiovascular outcome differences between morning and bedtime dosing. However, the optimal timing of antihypertensive medication for patients with distinct BP rhythms or comorbidities remains uncertain. Future research should investigate the potential benefits of personalized medication timing tailored to BP patterns and clinical conditions. Additionally, treatment strategies should consider BP rhythms, comorbidities, and adherence to optimize outcomes, paving the way for more effective management of hypertensive patients with complex clinical profiles.
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Affiliation(s)
- Haojiang Li
- Division of Cardiology, Departments of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen H, Wang L, Zhang J, Yan X, Yu L, Jiang Y. Occupational but not leisure-time physical activity associated with high-risk of obstructive sleep apnea status: a population-based study. BMC Pulm Med 2025; 25:195. [PMID: 40275254 PMCID: PMC12020150 DOI: 10.1186/s12890-025-03672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 04/17/2025] [Indexed: 04/26/2025] Open
Abstract
PURPOSE Despite the well-documented benefits of physical activity, the distinct impacts of occupational physical activity (OPA) and leisure-time physical activity (LTPA) on the risk of obstructive sleep apnea (OSA) remain poorly understood. The objective of this study was to examine the relationship between OPA/LTPA and the risk of developing OSA within a nationally representative sample. We hypothesized that high-intensity OPA could potentially elevate the risk of OSA, whereas the effect of LTPA on OSA risk might be different. METHODS The cross-sectional study utilized data from the Korean National Health and Nutritional Examination Survey database (2019-2020), encompassing a total of 8093 participants. OSA risk was assessed using the STOP-BANG questionnaire, where a score of ≥ 3 signified high risk. Physical activity levels were evaluated using questions adapted from the Korean version of the Global Physical Activity Questionnaire. Participants were allocated based on their high or low levels of LTPA or OPA. Logistic regression analyses were conducted to unveil the associations between OSA and LTPA/OPA. RESULTS The multivariate regression analysis revealed that high-intensity OPA posed a risk factor for OSA (odds ratio [OR] = 1.738, 95% confidence interval [CI]: 1.134, 2.666), particularly among individuals with age ≥ 60 years old (OR = 1.321, 95% CI: 1.036, 1.682), those with a BMI ≥ 25 (OR = 1.967, 95% CI: 1.027, 3.767), and individuals with hypertension (OR = 3.729, 95% CI: 1.586, 8.768). Furthermore, a visible association was observed between high-intensity OPA and increased tiredness (OR = 1.447, 95% CI: 1.107, 1.891). However, no notable correlation was detected between LTPA and OSA prevalence in both overall and subgroup analyses (all P > 0.5). CONCLUSION The study supported the link between high-intensity OPA and an elevated risk of OSA, suggesting the need to manage the duration and intensity of OPA.
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Affiliation(s)
- Han Chen
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China
| | - Lin Wang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China
| | - Jisheng Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China
| | - Xudong Yan
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China
| | - Longgang Yu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China.
| | - Yan Jiang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, No 59, Haier Street, Laoshan District, Qingdao, Shandong, China.
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Li Y, Du X, Lang X, Geng Z. Quantitative study on whole brain volume in patients with obstructive sleep apnea based on synthetic magnetic resonance imaging. BMC Med Imaging 2025; 25:129. [PMID: 40264066 PMCID: PMC12016434 DOI: 10.1186/s12880-025-01678-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 04/15/2025] [Indexed: 04/24/2025] Open
Abstract
OBJECTIVE To apply SyMRI to quantify whole brain volume changes in patients with varying degrees of obstructive sleep apnea (OSA). METHODS A total of 49 untreated adult patients diagnosed with OSA via polysomnography (PSG) at our hospital were included in this study. Among these patients, 21 were categorized into the mild-to-moderate OSA group, and 28 into the severe OSA group. Additionally, 31 healthy adults were recruited as the healthy control (HC) group. SyMRI post-processing software was used to obtain whole brain volume segmentation values. RESULTS In terms of the STOP-BANG questionnaire, the score of the severe OSA group was significantly higher than that of the mild-to-moderate OSA group (P < 0.05). Compared with the HC group, the mild-to-moderate OSA group and the severe OSA group exhibited a reduction in N3-stage sleep (both P < 0.05). Post-hoc multiple comparisons showed that compared with the HC group, the severe OSA group had increased GMV, BPV, and ICV, while the mild-to-moderate OSA group showed an increase in CSFV (P < 0.05). Additionally, compared with the HC group, the mild-to-moderate OSA group exhibited a decrease and the severe OSA group showed an increase in MYV (P < 0.05). Multiple comparisons of normalized volume fractions revealed that GMF, WMF, CSFF, MYF and BPVF were significantly different between the HC group and OSA groups (all P < 0.05). CONCLUSION The brain volume parameters generated from SyMRI can quantify the degree of brain injury in patients with OSA. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Yanpeng Li
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, Hebei Province, 050000, China
| | - Xiaomeng Du
- Radiotherapy Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Xiaoyan Lang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Zuojun Geng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Shijiazhuang, Hebei Province, 050000, China.
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Roth LP, Bernier A, Gulley L, Lohse K, Whooten R, Allen L, Brink HV, Sfeir J, Simon S, Finn E, Cree MG. Obesity Management in Female Adolescents. Clin Endocrinol (Oxf) 2025. [PMID: 40255106 DOI: 10.1111/cen.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 03/07/2025] [Indexed: 04/22/2025]
Abstract
BACKGROUND Global childhood obesity continues to rise, particularly in adolescent females. The underlying cause of this change in prevalence is multifactorial with a complex interplay of genetic, socioeconomic and environmental influences. In this review, we aim to emphasize the multiple options available for assisting an adolescent female to improve their overall health and longevity. DESIGN Experts from each of their respective fields reviewed the current literature regarding the management of obesity in female adolescents. RESULTS Lifestyle changes, including decreases in overall calorie consumption and simple carbohydrates as well as increases in activity/exercise have been the mainstay of obesity therapy due to their effects on decreasing insulin resistance and associated metabolic disease, as well as weight loss. However, the combination of provider encouraged weight loss and societal obesity stigma leads to an increased risk for disordered eating. The high prevalence of mental health and sleep disorders in female youth with obesity are recent findings, as is the importance in treating these conditions for improved quality of life as well as success with lifestyle changes. The American Academy of Pediatrics' 2023 obesity guidelines are the first across the globe to recommend early adjunctive use of weight loss medications for obesity. These recommendations correspond with the development and increasing availability of new combinations of existing mediations as well as the glucagon like peptide-1 receptor agonist class of medications. Youth with a body mass index in excess of 35-40 kg/m2, can now undergo bariatric surgery in many countries, with very encouraging short- and medium-term success. CONCLUSION There are now many approaches to consider when treating an adolescent female for obesity or associated metabolic disease, and customized approaches may be needed for optimal success at the individual patient level.
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Affiliation(s)
- Lauryn P Roth
- Pediatric and Adolescent Gynecology, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Angelina Bernier
- Pediatric Endocrinology, University of Florida Gainsville, Gainsville, Florida, USA
| | - Lauren Gulley
- Lifestyle Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Barbara Davis Center, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Kristen Lohse
- Lifestyle Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rachel Whooten
- Pediatric Endocrinology, Harvard/Mass General, Boston, Massachusetts, USA
| | - Leora Allen
- Pediatric Endocrinology, Harvard/Mass General, Boston, Massachusetts, USA
| | - Heidi Vanden Brink
- Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Joelle Sfeir
- Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Stacey Simon
- Ludeman Center for Women's Health Research, Aurora, Colorado, USA
- Pediatric Pulmonology, Sleep Psychology, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Erin Finn
- Endocrinology, University of Colorado Anschutz, Aurora, Colorado, USA
- Pediatric Endocrinology, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Melanie G Cree
- Ludeman Center for Women's Health Research, Aurora, Colorado, USA
- Pediatric Endocrinology, University of Colorado Anschutz, Aurora, Colorado, USA
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Pimpão AB, Teixeira-Santos L, Coelho NR, Correia MJ, Morello J, Antunes AMM, Monteiro EC, Pereira SA. Biotransformation of ketamine in terminal in vivo experiments under chronic intermittent hypoxia conditions and the role of AhR. Arch Toxicol 2025:10.1007/s00204-025-04044-w. [PMID: 40253307 DOI: 10.1007/s00204-025-04044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 03/27/2025] [Indexed: 04/21/2025]
Abstract
We were pioneers in describing aryl hydrocarbon receptor (AhR) activation by chronic intermittent hypoxia (CIH) in a rat pre-clinical model. This model mimics hypertension (HTN) secondary to obstructive sleep apnea, enabling longitudinal investigation of hypertension development. Concerns about the influence of barbiturates on AhR-regulated enzymes led us to opt for ketamine/medetomidine anesthesia in terminal in vivo experiments. However, the biotransformation and the metabolomic pathways of ketamine in CIH conditions, which is associated to AhR overactivation, are yet to be disclosed. A rat model of CIH was used, with experimental groups defined based on the duration of CIH exposure. Ketamine/medetomidine (75/0.5 mg/kg) was administered intraperitoneally as terminal anesthetic. Metabolomic strategies were used to reveal the profiles of ketamine and its metabolites in liver and kidney tissues, uncovering six metabolites, including the first report of norketamine glucuronide formation in the liver. While PCA analysis revealed similar ketamine metabolite fingerprints in normoxia and CIH, a predominance of hydroxynorketamine over norketamine was observed in CIH condition. A consistent association between norketamine, hydroxyketamine and the metabolome was found in both normoxia and CIH conditions. The AhR antagonist CH-223191 (5 mg/kg) influenced hydroxynorketamine glucuronidation in the liver. No changes in medetomidine biotransformation were detected. Overall, these findings expand the knowledge of ketamine metabolism and its tissue-dependence. The results emphasize the importance of considering how ketamine biotransformation may differ between control and experimental conditions in metabolic studies, particularly in chronic intermittent hypoxia conditions. The role of AhR in ketamine biotransformation is herein described for the first time.
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Affiliation(s)
- António B Pimpão
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Luísa Teixeira-Santos
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal
| | - Nuno R Coelho
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Maria João Correia
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Judit Morello
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Alexandra M M Antunes
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Engenharia Química, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
| | - Emília C Monteiro
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal
| | - Sofia A Pereira
- iNOVA4Health, NOVA Medical School | Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal.
- Centro Clínico Académico de Lisboa (CCAL), Lisboa, Portugal.
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Deb B, Vasireddi S, Bhatia NK, Rogers AJ, Clopton P, Heidenreich P, Baykaner T, Wang PJ, Perino AC, Narayan SM. Non-cardiac and cardiac risk for ischemic stroke in young adults: The Stanford Y-CORE (Young Cardiovascular Outcomes and Risk Evaluation) study. Int J Stroke 2025:17474930251338611. [PMID: 40251949 DOI: 10.1177/17474930251338611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2025]
Abstract
BACKGROUND The incidence of stroke is increasing in young to middle-aged adults. Assessing risk factors is important in this large population whose comorbidities may differ from older adults. METHODS In this retrospective cohort analysis of adults aged between 20 and 50 presenting to the Stanford Healthcare system from 1 January 2000 through 31 December 2021, with no prior history of stroke or transient ischemic attack, we studied the effects of 30 risk factors on the primary endpoint of incident ischemic stroke, defined by the presence of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for stroke and confirmed by brain imaging. The secondary endpoint was incident cerebrovascular events defined by the presence of ICD-10 codes for stroke or transient ischemic attacks (TIAs). Associations were measured with time-varying multivariable survival regression. RESULTS From an overall population of 1.3 million, we identified 540,999 individuals aged 20-50 years. Over the study period, 802 experienced the primary endpoint and 5734 the secondary endpoint. On multivariable analysis, non-cardiovascular risk factors were independently associated with the primary endpoint, adjusting for established cardiovascular risk factors, including sleep apnea [1.44, (1.19, 1.74)], bipolar disorder [1.88, (1.23, 2.86)], cancer [2.07 (1.71, 2.51)], and chronic kidney disease (CKD) [2.2, (1.73, 2.81)]. Other non-cardiovascular associations included ethno-racial subgroups of Black [2.05, (1.60, 2.64)], Pacific Islander [2.56, (1.70, 3.84)], and Hispanic [1.71, (1.37, 2.15)] versus white non-Hispanics. Combining non-cardiovascular risk factors significant on multivariable analysis with established cardiovascular factors significantly improved the C-index for de novo stroke to 0.814 over that obtained in either group alone (P < 0.05). CONCLUSIONS In this large population of young adults, several non-cardiovascular factors conferred risk for incident stroke independent of known cardiovascular risk factors and, in combination, significantly improved the prediction of incident stroke over those based on either group of factors alone. These findings may have implications for assessing risk in younger patients with distinct comorbidities.
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Affiliation(s)
- Brototo Deb
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
- Department of Medicine, MedStar Georgetown University - Washington Hospital Center, Washington, DC, USA
| | - Sunil Vasireddi
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Neal K Bhatia
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Albert J Rogers
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Paul Clopton
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Paul Heidenreich
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Tina Baykaner
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Paul J Wang
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Alexander C Perino
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Sanjiv M Narayan
- Department of Medicine, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
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50
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Wang JDJ, Chua NYM, Chan LL, Tan EK. Obstructive Sleep Apnea and Parkinson's Disease: Bidirectional Clinical and Pathophysiologic Links. Int J Mol Sci 2025; 26:3762. [PMID: 40332389 PMCID: PMC12028076 DOI: 10.3390/ijms26083762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 04/11/2025] [Accepted: 04/14/2025] [Indexed: 05/08/2025] Open
Abstract
Obstructive sleep apnea (OSA) and Parkinson's disease (PD) are highly prevalent conditions with significant global health impacts. OSA affects 17-34% of middle-aged adults, while more than 10 million worldwide have PD. Clinical studies demonstrate a bidirectional relationship, with the OSA prevalence being higher among PD patients suggesting that hypoxia and sleep fragmentation contribute to worsening motor and cognitive symptoms. Conversely, PD-associated neurodegeneration impairs respiratory control, exacerbating OSA. Diagnostic differentiation is particularly challenging due to overlapping symptoms, such as sleep disturbances, cognitive decline, and autonomic dysfunction. Emerging neuromodulation therapies, including deep brain stimulation and hypoglossal nerve stimulation, show dual therapeutic potential. The interplay between OSA and PD draws attention to the need for integrated diagnostic and therapeutic approaches. Additional longitudinal studies to evaluate their cause-effect relationship and identify neuroimaging and biochemical biomarkers to elucidate novel pathophysiologic clues can potentially identify novel therapeutic targets.
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Affiliation(s)
- Jia Dong James Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (J.D.J.W.); (N.Y.M.C.)
| | - Nevin Yi Meng Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (J.D.J.W.); (N.Y.M.C.)
| | - Ling-Ling Chan
- Departments of Neurology and Neuroradiology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore 168581, Singapore;
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Eng-King Tan
- Departments of Neurology and Neuroradiology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore 168581, Singapore;
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
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