Article

Microvascular endothelial function in obstructive sleep apnea: Impact of continuous positive airway pressure and mandibular advancement.

Département de Pneumologie, CHU, 4 Rue Larrey, 49033 Angers Cedex, France.
Sleep Medicine (Impact Factor: 3.1). 08/2009; 10(7):746-52. DOI: 10.1016/j.sleep.2008.06.013
Source: PubMed

ABSTRACT Endothelial dysfunction has been proposed as a potential mechanism implicated in the pathogenesis of cardiovascular complications of obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the microvascular endothelial function (MVEV) in OSAS and the impact on MVEF of 2 months of treatment with continuous positive airway pressure (CPAP) and mandibular advancement device (MAD).
Microvascular reactivity was assessed using laser Doppler flowmetry combined with acetylcholine (Ach) and sodium nitroprusside (SNP) iontophoresis in 24 OSAS patients and 9 control patients. In 12 of the 24 OSAS patients, microvascular reactivity was reassessed after 2 months of CPAP and MAD using a randomized cross-over design.
Ach-induced vasodilation was significantly lower in OSAS patients than in matched controls and correlated negatively with apnea hypopnea index (r=-0.49, p<0.025) and nocturnal oxygen desaturations (r=-0.63, p<0.002). Ach-induced vasodilation increased significantly with both CPAP and MAD. The increase in Ach-induced vasodilation under OSAS treatment correlated with the decrease in nocturnal oxygen desaturations (r=0.48, p=0.016).
Our study shows an impairment of MVEF in OSAS related to OSAS severity. Both CPAP and MAD treatments were associated with an improvement in MVEF that could contribute to improve cardiovascular outcome in OSAS patients.

0 Bookmarks
 · 
123 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor- α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.
    Mediators of Inflammation 01/2014; 2014:568951. · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endothelial dysfunction is characterized by impaired endothelium-dependant vasodilatation and is an independent predictor of adverse cardiovascular consequences. The ease with which endothelial function can be assessed has led to it becoming a useful marker of cardiovascular diseases in research studies. Obstructive sleep apnea (OSA) has been independently associated with endothelial dysfunction which may explain the increased risk for cardiovascular and all-cause mortality in this population. One possible mechanism for the development of endothelial dysfunction in OSA is through the cyclical pattern of hypoxia and re-oxygenation. This creates a haemostatic imbalance in which nitric oxide bio-availability is reduced and pro-inflammatory and pro-thrombotic forces prevail. Furthermore the repair capacity of the endothelium to protect itself against this increased damage is diminished. All of these pathways contribute to vascular disease which ultimately gives rise to adverse cardiovascular consequences. This review aims to provide a critical appraisal of the cross-sectional and interventional studies which have investigated micro- and macro-vascular endothelial dysfunction in OSA with emphasis on randomised controlled studies.
    Sleep Medicine Reviews 06/2014; 20. · 9.14 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Endothelial function can be assessed by acetylcholine (ACh) iontophoresis with single current application. The effect of inter-electrodes distance as well as electrical cutaneous resistance (ECR) on ACh dependent vasodilation have never been studied using single current application . The aims of this study are (i) to compare ACh-peak and ECR measured at different inter-electrodes distances, (ii) to assess the relationship between ACh-peak and ECR, (iii) to study the reproducibility of the ECR values. Fourteen healthy subjects were included. Using laser speckle contrast imaging, ACh-iontophoreses (0.1mA, 30s) were performed on the forearm at a 7-day interval with an inter-electrodes distance set at 5cm. Two other inter-electrodes distances were also evaluated: 10cm and 15cm. ECR was measured during each ACh-iontophoresis as well as the ACh-peak. No statistical difference was found between the ACh-peak values obtained at 5cm, 10cm and 15cm. ECRs were also not statistically different. An inverse relationship (r=-0.60) was found between the ACh-peak and ECR (p<0.05). The coefficient of variation of the inter-day reproducibility of the ECR values was 9.1% [6.5%-15.1%] with an intra-class-correlation coefficient of 0.93 [0.81-0.98]. Inter-electrodes distance ranging from 5cm to 15cm changes neither the ACh-peak value nor. ECR value. ECR impacts ACh-peak values.
    Microvascular Research 04/2014; · 2.43 Impact Factor