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Medicina
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Sleep Apnea and Cardiometabolic Health
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Sleep Apnea and Cardiometabolic Health

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 9760

Special Issue Editor

Dr. Athanasia Pataka

E-Mail Website
Guest Editor
Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: sleep apnea; diagnosis; sleep disorders and sleep medicine; sleep medicine; sleep genetics and sleep apnea; sleep disorders; sleep, memory and learning; CPAP; treatment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder characterized by repetitive episodes of apneas and hypopneas occurring during sleep, leading to intermittent hypoxia (IH) and sleep fragmentation with recurrent arousals.

OSA has been associated with considerable morbidity and mortality. In recent years, OSA has emerged as an important potential etiologic factor in a broad range of cardiometabolic disease. Several studies indicated a causal relationship between OSA and hypertension, cardiovascular disease, insulin resistance (IR), and diabetes mellitus, independently of obesity. On the other hand, OSA is highly prevalent in patients suffering from hypertension, atrial fibrillation and stroke. Of all the cardiovascular diseases associated with OSA, the relationship with hypertension, which is especially resistant, is the best established. The pathophysiologic mechanisms linking OSA with cardiovascular disease include increased sympathetic nervous system activity, inflammation and oxidative stress, endothelial dysfunction, hypersecretion of adipocyte-derived hormones, insulin resistance and promotion of a procoagulable state. Several randomized controlled trials have shown small to modest improvements in blood pressure associated with continuous positive airway pressure (CPAP) use, with smaller or uncontrolled studies suggesting that CPAP may improve cardiovascular outcomes.

There are still gaps in the scientific and clinical knowledge about cardiometabolic disease in different OSA phenotypes and outcomes in different severities of the disease. Additionally, further research is needed on the effect of different treatment modalities (CPAP, oral appliances, etc.) on cardiovascular outcomes.

Dr. Athanasia Pataka
Guest Editor

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Keywords

  • obstructive sleep apnea
  • cardio-metabolic disease
  • cardiovascular disease
  • metabolic disease
  • hypertension
  • diabetes
  • hyperlipidemia
  • phenotypes
  • obstructive sleep apnea treatment
  • continuous positive airway pressure (CPAP)
  • sleep apnea outcomes
  • quality of life

Published Papers (4 papers)

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Research

9 pages, 504 KiB  
Article
Characteristics of Patients with Obstructive Sleep Apnea at High Risk for Cardiovascular Disease
by Izolde Bouloukaki, Michail Fanaridis, Georgios Stathakis, Christina Ermidou, Eleftherios Kallergis, Violeta Moniaki, Eleni Mauroudi and Sophia E. Schiza
Medicina 2021, 57(11), 1265; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111265 - 18 Nov 2021
Cited by 5 | Viewed by 1797
Abstract
Background and Objectives: To evaluate the influence of obstructive sleep apnea (OSA)-related symptoms on prevalent cardiovascular disease (CVD) in a large clinical population of patients. Materials and Methods: A total of 2127 patients (mean age 55 years, 24% women) underwent diagnostic polysomnography and [...] Read more.
Background and Objectives: To evaluate the influence of obstructive sleep apnea (OSA)-related symptoms on prevalent cardiovascular disease (CVD) in a large clinical population of patients. Materials and Methods: A total of 2127 patients (mean age 55 years, 24% women) underwent diagnostic polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Athens Insomnia Scale (AIS), and the Beck Depression Inventory (BDI). We investigated the predictive value of OSA-associated symptoms for prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and co-morbidities. Results: Patients with OSA and CVD were older and had a higher Body Mass Index (BMI); the percentage of obese patients was also higher (83% vs. 70%, p < 0001). They also had greater neck, waist, and hip circumferences and a higher waist-to-hip ratio. Excessive daytime sleepiness (ESS ≥ 10) [odds ratio (95% CI) 1.112 (0.708–1.748), p = 0.64], insomnia symptoms (AIS ≥ 6) [odds ratio (95% CI) 0.748 (0.473–1.184), p = 0.21], frequent awakenings [odds ratio (95% CI) 1.599 (1.019–2.508), p = 0.06], and nocturia [odds ratio (95% CI) 1.359 (0.919–2.009), p = 0.124] were not associated with CVD after adjustment for the previous confounders. On the other hand, depressive symptoms (BDI ≥ 10) independently predicted prevalent CVD [odds ratio (95% CI) 1.476 (1.154–1.887), p = 0.002]. Further analysis in subgroups stratified by age, BMI, and gender demonstrated that depressive symptoms predicted prevalent CVD but only in the subgroup of younger (age group < 60 years), obese (BMI group ≥ 30), and male (OR = 1.959, 95% CI = 1.209–3.175, p = 0.006) OSA patients. Conclusions: OSA patients with CVD were more likely to complain of less typical OSA symptoms and depressive symptoms compared to patients without CVD in this large clinical patient cohort, supportingthecomplexity and heterogeneityof OSA. Full article
(This article belongs to the Special Issue Sleep Apnea and Cardiometabolic Health)
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10 pages, 601 KiB  
Article
Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome
by Athanasios Voulgaris, Kostas Archontogeorgis, Athanasia Pataka, Alexandros N. Flaris, Paschalis Ntolios, Maria R. Bonsignore, Sophia Schiza and Paschalis Steiropoulos
Medicina 2021, 57(11), 1201; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111201 - 04 Nov 2021
Cited by 9 | Viewed by 2053
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap [...] Read more.
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are usually associated with multi-morbidity. The aim of this study was to retrospectively investigate the prevalence of comorbidities in a cohort of patients with OSAS and COPD-OSAS overlap syndrome (OS) patients and to explore differences between these two groups. Materials and Methods: Included were consecutive OS patients and OSAS patients who had been referred to our sleep laboratory, and were matched in terms of sex, age, BMI, and smoking history. Presence of comorbidities was recorded based on their medical history and after clinical and laboratory examination. Results: The two groups, OS patients (n = 163, AHI > 5/h and FEV1/FVC < 0.7) and OSAS patients (n = 163, AHI > 5/h, and FEV1/FVC > 0.7), did not differ in terms of apnea hypopnea index (p = 0.346), and oxygen desaturation index (p = 0.668). Compared to OSAS patients, OS patients had lower average SpO2 (p = 0.008) and higher sleep time with oxygen saturation <90% (p = 0.002) during sleep, and lower PaO2 (p < 0.001) and higher PaCO2 (p = 0.04) in wakefulness. Arterial hypertension was the most prevalent comorbidity for both OS and OSAS, followed by dyslipidemia, cardiovascular disease (CVD) and diabetes. OS was characterized by a higher prevalence of total comorbidities (median (IQR):2 (1–3) vs. 2 (1–2), p = 0.033), which was due to the higher prevalence of CVD (p = 0.016) than OSAS. No differences were observed in other comorbidities. Conclusions: In OS patients, nocturnal hypoxia and impaired gas exchange in wakefulness are more overt, while a higher burden of CVD is observed among them in comparison to sex-, age- and BMI-matched OSAS patients. Full article
(This article belongs to the Special Issue Sleep Apnea and Cardiometabolic Health)
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13 pages, 342 KiB  
Article
Smoking and Obstructive Sleep Apnea: Is There An Association between These Cardiometabolic Risk Factors?—Gender Analysis
by Despoina Ioannidou, George Kalamaras, Serafeim-Chrysovalantis Kotoulas and Athanasia Pataka
Medicina 2021, 57(11), 1137; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111137 - 20 Oct 2021
Cited by 12 | Viewed by 3061
Abstract
Background and Objectives: Studies have tried to establish a relationship between Obstructive Sleep Apnea syndrome (OSA) and smoking but data still remain controversial. We aimed: 1. To evaluate the relationship between smoking and OSA; 2. To explore potential differences according to gender, [...] Read more.
Background and Objectives: Studies have tried to establish a relationship between Obstructive Sleep Apnea syndrome (OSA) and smoking but data still remain controversial. We aimed: 1. To evaluate the relationship between smoking and OSA; 2. To explore potential differences according to gender, and 3. To analyze the prevalence of cardiovascular disease (CVD) co-morbidities according to gender and smoking status. Materials and Methods: This retrospective study included 3791 (70.6% males) adult patients who visited a Sleep Clinic. All participants underwent nocturnal polysomnography. Daytime somnolence and insomnia were assessed by using the Epworth Sleepiness Scale (ESS) and the Athens Insomnia Scale (AIS). Ever-smokers completed the Fagerstrom Test for Nicotine Dependence (FTND). Results: OSA was confirmed in 72.1% of participants with 62.2% suffering from moderate-to-severe disease. The number of cigarettes/day, Pack/Years, and FTND were significantly higher in patients with more severe OSA. The prevalence of current smokers was higher in those without OSA or with mild disease, whereas the prevalence of former smokers was higher in moderate and severe OSA. In univariate analysis, current smokers were found to be 1.2 times more likely to have OSA compared with never and former smokers combined and former smokers 1.49 times more likely compared with never smokers. In the multiple regression analysis, after adjusting for BMI, gender, age and number of alcoholic drinks per week, smoking was not found to be significantly associated with OSA. In gender stratified multivariate analyses, no significant associations were observed. CVD co-morbidities were more frequent in more severe OSA. Hypertension, coronary disease and diabetes were more prevalent in former smokers with AHI ≥ 15, compared with current smokers, especially in men. Conclusions: Even if an independent effect of smoking on OSA was not found, the number of cigarettes/day, Pack/Years, and FTND were higher in patients with more severe OSA with more prevalent CVD co-morbidities. Full article
(This article belongs to the Special Issue Sleep Apnea and Cardiometabolic Health)
8 pages, 570 KiB  
Article
Effect of Intermittent Hypoxia on Metabolic Syndrome and Insulin Resistance in the General Male Population
by Jung-Yup Lee, Chan-Won Kim, Kyung-Chul Lee, Jae-Hyuk Lee, Sung-Hun Kang, Sung-Won Li, Kyubo Kim and Seok-Jin Hong
Medicina 2021, 57(7), 668; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070668 - 29 Jun 2021
Cited by 4 | Viewed by 2311
Abstract
Background and objectives: Obstructive sleep apnea (OSA) is closely associated with insulin resistance (IR) and is an independent risk factor for incident type 2 diabetes mellitus (T2DM). Most studies evaluate the correlation between OSA and IR in only obese or T2DM patients. Therefore, [...] Read more.
Background and objectives: Obstructive sleep apnea (OSA) is closely associated with insulin resistance (IR) and is an independent risk factor for incident type 2 diabetes mellitus (T2DM). Most studies evaluate the correlation between OSA and IR in only obese or T2DM patients. Therefore, we tried to investigate the effect of OSA on metabolic syndrome and IR in the general healthy male population. Materials and Methods: 184 subjects who visited a preventive health examination program were recruited for this study. All subjects received overnight polysomnography by a portable device (Watch-PAT 200). We examined several metabolic parameters and a homeostasis model of assessment for insulin resistance index (HOMA-IR). The subjects were divided into three groups by AHI (Apnea-hyponea index): normal group (AHI < 5), mild OSA group (5 ≤ AHI < 15), and moderate-severe OSA group (AHI ≥ 15). They were also divided into two groups according to minimum oxygen saturation: low group, Min-SpO2 < 88%; and high group, Min-SpO2 ≥ 88%. Results: Parameters of metabolic syndrome, including waist circumference, systolic and diastolic blood pressure, triglyceride, and high-density lipoprotein cholesterol showed significant differences among the AHI groups. Furthermore, HOMA-IR showed significant differences among the AHI groups. Those parameters, including metabolic syndrome and HOMA-IR, also showed differences between Min-SpO2 groups. Conclusions: In summary, this study helps confirm that AHI is associated with HOMA-IR in the general male population. Furthermore, the severity of AHI correlated with the parameters of metabolic syndrome. Therefore, AHI might be an indicator for evaluating both T2DM and metabolic syndrome, even in the general male population. Full article
(This article belongs to the Special Issue Sleep Apnea and Cardiometabolic Health)
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