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12 pages, 1304 KiB

Open AccessArticle

Effect of Obstructive Sleep Apnea and CPAP Treatment on Cardiovascular Outcomes in Acute Coronary Syndrome in the RICCADSA Trial

by Yüksel Peker, Erik Thunström, Helena Glantz and Christine Eulenburg

J. Clin. Med. 2020, 9(12), 4051; https://doi.org/10.3390/jcm9124051 - 15 Dec 2020

Cited by 28 | Viewed by 3015

Abstract

We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n [...] Read more.

We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n = 353) of the Randomized Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), participants with non-sleepy OSA (apnea-hypopnea-index [AHI] ≥ 15 events/h on a home sleep apnea testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were randomized to CPAP (n = 86) or no-CPAP (n = 85). The sleepy OSA patients (AHI ≥ 15 events/h and ESS ≥ 10) who were offered CPAP, and the ones with no-OSA (AHI < 5 events/h) were included in the observational arm. A post-hoc analysis was done to compare untreated OSA (no-CPAP; n = 78) and nonadherent sleepy/non-sleepy OSA (n = 96) with the reference group without OSA (n = 81). The primary endpoint (the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality) during a median 4.7-year follow-up was evaluated in time-dependent Cox proportional hazards models adjusted for confounding factors. The incidence of MACCE did not differ significantly in intention-to-treat population. On-treatment analysis showed a significant risk reduction in those who used CPAP for ≥4 vs. <4 h/day or did not receive treatment (adjusted hazard ratio [HR] 0.17; 95% confidence interval [CI] 0.03–0.81; p = 0.03). Compared with the reference group, nonadherent/untreated OSA was associated with an increased cardiovascular risk (adjusted HR 1.97, 95% CI 1.03–3.77; p = 0.04). We conclude that OSA is an independent risk factor for adverse cardiovascular outcomes in patients with ACS. CPAP treatment may reduce this risk, if the device is used at least 4 h/day. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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10 pages, 373 KiB

Open AccessArticle

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

by Andras Bikov, Stefan Frent, Roxana Pleava, Laszlo Kunos, Saba Bokhari, Martina Meszaros and Stefan Mihaicuta

J. Clin. Med. 2020, 9(11), 3583; https://doi.org/10.3390/jcm9113583 - 6 Nov 2020

Cited by 13 | Viewed by 3356

Abstract

Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts [...] Read more.

Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romania. Methods: Data from 588 (282 from Hungary, 306 from Romania) untreated patients with OSA were retrospectively analyzed. The prevalence rates of hypertension, diabetes, dyslipidemia, allergic rhinitis, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, cerebrovascular and cardiovascular disease, arrhythmia and depression were compared between the two populations following adjustment for demographics, body mass index, smoking history, comorbidities and sleep parameters. Results: The prevalence rates of hypertension, arrhythmia, cerebrovascular and cardiovascular disease, diabetes and COPD in the whole study population were directly related to the severity of OSA. We found an inverse correlation between the prevalence of osteoporosis and OSA severity (all p < 0.05). Following adjustment, the prevalence of dyslipidemia was higher in the Hungarian cohort, whilst the prevalence of asthma, cardiovascular and cerebrovascular diseases was higher in the Romanian cohort (all p < 0.05). Conclusions: There was no difference in the prevalence rate of most comorbidities in patients with OSA from the two cohorts, except for dyslipidemia, asthma, cardiovascular and cerebrovascular disease. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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16 pages, 2410 KiB

Open AccessArticle

Clinical Usefulness of New R-R Interval Analysis Using the Wearable Heart Rate Sensor WHS-1 to Identify Obstructive Sleep Apnea: OSA and RRI Analysis Using a Wearable Heartbeat Sensor

by Takuo Arikawa, Toshiaki Nakajima, Hiroko Yazawa, Hiroyuki Kaneda, Akiko Haruyama, Syotaro Obi, Hirohisa Amano, Masashi Sakuma, Shigeru Toyoda, Shichiro Abe, Takeshi Tsutsumi, Taishi Matsui, Akio Nakata, Ryo Shinozaki, Masayuki Miyamoto and Teruo Inoue

J. Clin. Med. 2020, 9(10), 3359; https://doi.org/10.3390/jcm9103359 - 20 Oct 2020

Cited by 12 | Viewed by 3684

Abstract

Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for [...] Read more.

Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for OSA. We investigated the usefulness of RRI analysis to identify OSA using the wearable heart rate sensor WHS-1 and newly developed algorithm. WHS-1 and polysomnography simultaneously applied to 30 cases of OSA. By using the RRI averages calculated for each time series, tachycardia with CVHR was identified. The ratio of integrated RRIs determined by integrated RRIs during CVHR and over all sleep time were calculated by our newly developed method. The patient was diagnosed as OSA according to the predetermined criteria. It correlated with the apnea hypopnea index and 3% oxygen desaturation index. In the multivariate analysis, it was extracted as a factor defining the apnea hypopnea index (r = 0.663, p = 0.003) and 3% oxygen saturation index (r = 0.637, p = 0.008). Twenty-five patients could be identified as OSA. We developed the RRI analysis using the wearable heart rate sensor WHS-1 and a new algorithm, which may become an expeditious and cost-effective screening tool for identifying OSA. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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9 pages, 451 KiB

Open AccessArticle

Association between Obstructive Sleep Apnea and SYNTAX Score

by Sayaki Ishiwata, Yasuhiro Tomita, Sugao Ishiwata, Koji Narui, Hiroyuki Daida and Takatoshi Kasai

J. Clin. Med. 2020, 9(10), 3314; https://doi.org/10.3390/jcm9103314 - 15 Oct 2020

Cited by 7 | Viewed by 2231

Abstract

Obstructive sleep apnea (OSA) is related to an increased risk of cardiovascular diseases, including coronary artery disease (CAD). We investigated the association between OSA and the severity of CAD by assessing coronary angiography findings. We retrospectively analyzed patients who underwent their first coronary [...] Read more.

Obstructive sleep apnea (OSA) is related to an increased risk of cardiovascular diseases, including coronary artery disease (CAD). We investigated the association between OSA and the severity of CAD by assessing coronary angiography findings. We retrospectively analyzed patients who underwent their first coronary angiography to evaluate CAD and polysomnography (PSG) to investigate the severity of OSA in our hospital from March 2002 to May 2015. The severity of CAD was determined based on coronary angiography findings using the SYNTAX score. The patients were divided into two groups according to the apnea-hypopnea index (AHI): mild OSA (AHI < 15/h) and moderate-to-severe OSA (AHI ≥ 15/h). Overall, 98 patients were enrolled. The SYNTAX score was significantly different between the two groups (p = 0.001). After adjustment for other risk factors, including age, sex, obesity, hypertension, hyperlipidemia, diabetes mellitus, smoking status, and family history of CAD, moderate-to-severe OSA significantly correlated to the SYNTAX score (partial correlations = 0.24, p = 0.039). These results suggest that the severity of CAD is related to moderate-to-severe OSA. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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15 pages, 867 KiB

Open AccessArticle

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

by Roxana Pleava, Stefan Mihaicuta, Costela Lacrimioara Serban, Carmen Ardelean, Iosif Marincu, Dan Gaita and Stefan Frent

J. Clin. Med. 2020, 9(9), 2802; https://doi.org/10.3390/jcm9092802 - 30 Aug 2020

Cited by 6 | Viewed by 2975

Abstract

Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study [...] Read more.

Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy. Results: 33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. −1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients. Conclusions: In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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8 pages, 559 KiB

Open AccessArticle

Association between Respiratory Sleep Indices and Cardiovascular Disease in Sleep Apnea—A Community-Based Study in Cyprus

by Frangiskos Frangopoulos, Ivi Nicolaou, Savvas Zannetos, Nicholas-Tiberio Economou, Tonia Adamide and Georgia Trakada

J. Clin. Med. 2020, 9(8), 2475; https://doi.org/10.3390/jcm9082475 - 1 Aug 2020

Cited by 11 | Viewed by 2992

Abstract

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and [...] Read more.

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO₂ (p < 0.001). Arrhythmias correlated with mean SaO₂ (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO₂. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO₂. Arrhythmias correlated only with hypoxemia (mean SaO₂), whereas heart failure correlated only with REI, especially in the supine position. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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16 pages, 2424 KiB

Open AccessArticle

SMAD4 Overexpression in Patients with Sleep Apnoea May Be Associated with Cardiometabolic Comorbidities

by Elena Díaz-García, Ana Jaureguizar, Raquel Casitas, Sara García-Tovar, Begoña Sánchez-Sánchez, Ester Zamarrón, Eduardo López-Collazo, Francisco García-Río and Carolina Cubillos-Zapata

J. Clin. Med. 2020, 9(8), 2378; https://doi.org/10.3390/jcm9082378 - 25 Jul 2020

Cited by 7 | Viewed by 2185

Abstract

Obstructive sleep apnoea (OSA) is associated with several diseases related to metabolic and cardiovascular risk. Although the mechanisms involved in the development of these disorders may vary, OSA patients frequently present an increase in transforming growth factor beta (TGFβ), the activity of which [...] Read more.

Obstructive sleep apnoea (OSA) is associated with several diseases related to metabolic and cardiovascular risk. Although the mechanisms involved in the development of these disorders may vary, OSA patients frequently present an increase in transforming growth factor beta (TGFβ), the activity of which is higher still in patients with hypertension, diabetes or cardiovascular morbidity. Smad4 is a member of the small mother against decapentaplegic homologue (Smad) family of signal transducers and acts as a central mediator of TGFβ signalling pathways. In this study, we evaluate Smad4 protein and mRNA expression from 52 newly diagnosed OSA patients, with an apnoea–hypopnoea index (AHI) ≥30 and 26 healthy volunteers. These analyses reveal that OSA patients exhibit high levels of SMAD4 which correlates with variation in HIF1α, mTOR and circadian genes. Moreover, we associated high concentrations of Smad4 plasma protein with the presence of diabetes, dyslipidaemia and hypertension in these patients. Results suggest that increased levels of SMAD4, mediated by intermittent hypoxaemia and circadian rhythm deregulation, may be associated with cardiometabolic comorbidities in patients with sleep apnoea. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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11 pages, 386 KiB

Open AccessArticle

Insomnia as a Symptom of Rapid Eye Movement-Related Obstructive Sleep Apnea

by Tetsuro Hoshino, Ryujiro Sasanabe, Kenta Murotani, Reiko Hori, Mamiko Mano, Atsuhiko Nomura, Noriyuki Konishi, Masayo Baku, Aki Arita, Wojciech Kuczynski and Toshiaki Shiomi

J. Clin. Med. 2020, 9(6), 1821; https://doi.org/10.3390/jcm9061821 - 11 Jun 2020

Cited by 11 | Viewed by 3130

Abstract

Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12–36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development [...] Read more.

Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12–36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, diabetes, and depressive symptoms. However, to date, the association between REM-related OSA and insomnia still remains unclear. We investigated whether there was a difference between REM- and non-REM-related OSA in terms of insomnia-related sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) in 1736 patients with OSA. REM-related OSA showed a significant association with increased PSQI in all adjusted models. In the subgroup analysis, the coefficients of all models were higher in female than in male patients with REM-related OSA. Insomnia should be considered an important complaint in patients with REM-related OSA, and its indicators, such as the PSQI, should be included in routine diagnostic testing. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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13 pages, 461 KiB

Open AccessArticle

Associations of Sedentary Behaviour, Physical Activity, Cardiorespiratory Fitness and Body Composition with Risk of Sleep-Related Breathing Disorders in Children with Overweight/Obesity: A Cross-Sectional Study

by Lucia V. Torres-Lopez, Cristina Cadenas-Sanchez, Jairo H. Migueles, Mireia Adelantado-Renau, Abel Plaza-Florido, Patricio Solis-Urra, Pablo Molina-Garcia and Francisco B. Ortega

J. Clin. Med. 2020, 9(5), 1544; https://doi.org/10.3390/jcm9051544 - 20 May 2020

Cited by 8 | Viewed by 3383

Abstract

The aim of this study was to examine the associations of sedentary behaviour, physical activity, cardiorespiratory fitness (CRF), and body composition parameters with risk of sleep-related breathing disorders (SRBD) in children with overweight/obesity. One-hundred and nine children (10.0 ± 1.1 years old, 45 [...] Read more.

The aim of this study was to examine the associations of sedentary behaviour, physical activity, cardiorespiratory fitness (CRF), and body composition parameters with risk of sleep-related breathing disorders (SRBD) in children with overweight/obesity. One-hundred and nine children (10.0 ± 1.1 years old, 45 girls) with overweight (n = 27) and obesity (n = 82) were included. Television viewing time was self-reported by using the Spanish adaptation of the “Youth Activity Profile” (YAP) questionnaire. Sedentary time and physical activity were measured with accelerometry. CRF was assessed with the 20-m shuttle-run test and body composition parameters with Dual-energy X-ray absorptiometry. SRBD were evaluated by using the Spanish version of the Pediatric Sleep Questionnaire. Television viewing time was positively associated with risk of SRBD (r = 0.222, p = 0.021). CRF was negatively correlated with risk of SRBD (r = −0.210, p = 0.030). Body composition parameters were positively associated with risk of SRBD (all p < 0.05), except fat mass index. Stepwise regression analyses showed that body mass index (BMI) explained the largest proportion of the variance in SRBD (r² = 0.063, p = 0.01) and television viewing time was the only one added after BMI (r² change = 0.048, p = 0.022). This study supports the notion that higher body weight status negatively influences risk of SRBD and adds that unhealthy behaviours could contribute to worsen SRBD, related to an increased risk of cardiovascular diseases. All the significant association observed in this manuscript were of small magnitude, indicating than other factors in addition to the one hereby studied contribute to explain the variance in SRBD. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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13 pages, 456 KiB

Open AccessArticle

Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients

by Athanasia Pataka, Seraphim Kotoulas, George Kalamaras, Sofia Schiza, Konstantinos Sapalidis, Dimitirios Giannakidis, Nikolaos Michalopoulos, Charilaos Koulouris, Zoi Aidoni, Aikaterini Amaniti, Izoldi Bouloukaki, Evangelos Chatzopoulos, Konstantinos Romanidis, Panagoula Oikonomou, Paschalis Steiropoulos, Georgia Trakada, Anastasios Vagionas, Aris Ioannidis, Iason Nikolaos Katsios, Alexandru Marian Goganau, Pavlos Zarogoulidis and Christoforos Kosmidis Show full author list Hide full author list

J. Clin. Med. 2020, 9(1), 130; https://doi.org/10.3390/jcm9010130 - 3 Jan 2020

Cited by 22 | Viewed by 3298

Abstract

Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth [...] Read more.

Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth Sleepiness Scale (ESS), STOP, STOP Bang (SB), Berlin Questionnaire (BQ), Athens Insomnia Scale (AIS), and Fatigue Scale (FS). Methods: 350 males were matched with 350 women referred to a sleep clinic, according to OSA severity. All responded to the questionnaires and underwent a sleep study. Cardiovascular disease (CVD) patients were separately analyzed. Results: ESS did not differ between genders. SB was higher in males, whereas STOP, BQ, AIS, and FS were higher in females. BQ presented the highest sensitivity in both genders, whereas STOP exhibited the highest specificity in males and ESS in females. AIS and FS were more sensitive and SB more specific in females, whereas BQ was more specific in males. For severe OSA, the predictive values of SB and BQ were almost similar for both genders; however AIS and FS were higher in women. CVD patients presented higher scores, independent of gender, except for AIS, which was higher in females. Conclusion: Gender-specific evaluation of questionnaires is necessary to prevent OSA under-diagnosis. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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14 pages, 1645 KiB

Open AccessArticle

Obstructive Sleep Apnea as a Predictor of Abnormal Heart Rate Turbulence

by Dominika Urbanik, Paweł Gać, Helena Martynowicz, Małgorzata Poręba, Maciej Podgórski, Marta Negrusz-Kawecka, Grzegorz Mazur, Małgorzata Sobieszczańska and Rafał Poręba

J. Clin. Med. 2020, 9(1), 1; https://doi.org/10.3390/jcm9010001 - 18 Dec 2019

Cited by 4 | Viewed by 3856

Abstract

Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy [...] Read more.

Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy one patients with clinical suspicion of OSA were qualified to participate in the study. All participants took part in a survey and were subjected to laboratory tests, 24-hour electrocardiogram (ECG) Holter monitoring with HRT analysis and polysomnography. The group with OSA manifested significantly higher turbulence onset (TO) and lower turbulence slope (TS) as compared to the group without OSA. Older age, diabetes, hypertension and higher apnea/hypopnea index (AHI) were found to be independent risk factors for increased TO, whereas older age, higher body mass index (BMI), higher blood glucose levels, hypertension and higher AHI were independent risk factors for TS reduction. The AHI ≥65 criterion indicates abnormal HRT in patients with OSA with 94.9% sensitivity and 50.0% specificity, which gives a prediction accuracy of 85.7%. In summary, OSA should be considered as a predictor of abnormal HRT. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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Review

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23 pages, 1138 KiB

Open AccessReview

Is the Oxidative Stress in Obstructive Sleep Apnea Associated with Cardiovascular Complications?—Systematic Review

by Piotr Fiedorczuk, Adam Stróżyński and Ewa Olszewska

J. Clin. Med. 2020, 9(11), 3734; https://doi.org/10.3390/jcm9113734 - 20 Nov 2020

Cited by 14 | Viewed by 2474

Abstract

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered an independent risk factor for cardiovascular disease. The exact mechanism of cardiovascular complications (CVC) development as a complication of OSA is not entirely understood. Oxidative stress is suspected to be the [...] Read more.

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered an independent risk factor for cardiovascular disease. The exact mechanism of cardiovascular complications (CVC) development as a complication of OSA is not entirely understood. Oxidative stress is suspected to be the essential factor in initiating various comorbidities in OSA. Biomarkers of nonenzymatic lipid and protein peroxidation, DNA repair and antioxidant capabilities measured in serum, plasma and urine are frequently used to assess the presence of oxidative stress. We conducted a systematic review and quality assessment of available observational analytic studies to determine whether there is an association between oxidative stress and OSA in patients with prevalent CV disease compared to (a) patients with prevalent CV disease but no OSA, (b) patients with prevalent CV disease and less severe OSA and (c) patients with OSA and no overt CV disease. This systematic review demonstrated that, while oxidative stress is associated with OSA, there was no clear difference in the severity of oxidative stress between OSA patients with or without cardiovascular complications. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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17 pages, 729 KiB

Open AccessReview

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

by Colin Suen, Jean Wong, Clodagh M. Ryan, Samuel Goh, Tiffany Got, Rabail Chaudhry, Douglas S. Lee and Frances Chung

J. Clin. Med. 2020, 9(4), 989; https://doi.org/10.3390/jcm9040989 - 2 Apr 2020

Cited by 22 | Viewed by 3989

Abstract

Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range [...] Read more.

Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. Methods: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946–2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. Results: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42–53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). Conclusions: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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11 pages, 464 KiB

Open AccessReview

Environmental Factors as Modulators of the Relationship between Obstructive Sleep Apnea and Lesions in the Circulatory System

by Dominika Urbanik, Helena Martynowicz, Grzegorz Mazur, Rafał Poręba and Paweł Gać

J. Clin. Med. 2020, 9(3), 836; https://doi.org/10.3390/jcm9030836 - 19 Mar 2020

Cited by 15 | Viewed by 3614

Abstract

Obstructive sleep apnea (OSA) is a growing social problem, particularly in well-developed countries. It has been demonstrated that obstructive sleep apnea is a significant risk factor for cardiovascular diseases, including arterial hypertension, ischemic heart disease, heart failure, rhythm/conduction disturbances, as well as cerebral [...] Read more.

Obstructive sleep apnea (OSA) is a growing social problem, particularly in well-developed countries. It has been demonstrated that obstructive sleep apnea is a significant risk factor for cardiovascular diseases, including arterial hypertension, ischemic heart disease, heart failure, rhythm/conduction disturbances, as well as cerebral stroke. The pathophysiology of these diseases is complex and multifactorial. We present the current state of research on behavioral and environmental factors that influence the relationship between OSA and cardiovascular changes. We discuss the relationship between obesity, alcohol, sedatives, environmental tobacco smoke, allergic diseases and environmental pollution on the one hand and OSA on the other. In this context, the environment should be considered as an important modulator of the relationship between OSA and cardiovascular diseases. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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