Management Committee of EU COST ACTION B26. Sleep apnea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities

Università degli Studi di Palermo, Palermo, Sicily, Italy
European Respiratory Journal (Impact Factor: 7.64). 02/2007; 29(1):156-78. DOI: 10.1183/09031936.00027406
Source: PubMed


Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death. The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies. Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder.

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    • "). Untreated OSAS is associated with the development and progression of various severe cardiovascular (McNicholas and Bonsigore, 2007) and metabolic comorbidities (Levy et al., 2009). Current research points towards a diverse spectrum of comorbid conditions being common complications of, or concurrences with, OSAS. "
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    ABSTRACT: Phenotyping obstructive sleep apnea syndrome's comorbidity has been attempted for the first time only recently. The aim of our study was to determine phenotypes of comorbidity in obstructive sleep apnea syndrome patients employing a data-driven approach. Data from 1472 consecutive patient records were recovered from our hospital's database. Categorical principal component analysis and two-step clustering were employed to detect distinct clusters in the data. Univariate comparisons between clusters included one-way analysis of variance with Bonferroni correction and chi-square tests. Predictors of pairwise cluster membership were determined via a binary logistic regression model. The analyses revealed six distinct clusters: A, 'healthy, reporting sleeping related symptoms'; B, 'mild obstructive sleep apnea syndrome without significant comorbidities'; C1 : 'moderate obstructive sleep apnea syndrome, obesity, without significant comorbidities'; C2 : 'moderate obstructive sleep apnea syndrome with severe comorbidity, obesity and the exclusive inclusion of stroke'; D1 : 'severe obstructive sleep apnea syndrome and obesity without comorbidity and a 33.8% prevalence of hypertension'; and D2 : 'severe obstructive sleep apnea syndrome with severe comorbidities, along with the highest Epworth Sleepiness Scale score and highest body mass index'. Clusters differed significantly in apnea-hypopnea index, oxygen desaturation index; arousal index; age, body mass index, minimum oxygen saturation and daytime oxygen saturation (one-way analysis of variance P < 0.0001). Binary logistic regression indicated that older age, greater body mass index, lower daytime oxygen saturation and hypertension were associated independently with an increased risk of belonging in a comorbid cluster. Six distinct phenotypes of obstructive sleep apnea syndrome and its comorbidities were identified. Mapping the heterogeneity of the obstructive sleep apnea syndrome may help the early identification of at-risk groups. Finally, determining predictors of comorbidity for the moderate and severe strata of these phenotypes implies a need to take these factors into account when considering obstructive sleep apnea syndrome treatment options.
    Journal of Sleep Research 09/2015; DOI:10.1111/jsr.12344 · 3.35 Impact Factor
    • "Bien que le trouble du rythme à type d'ESV soit fréquent, seulement 3 % présentent une TVNS [21]. Certaines équipes ont démontré la disparition de ces troubles du rythme ventriculaire chez les patients traités par CPAP [38]. Lanfranchi et al. ont étudié ces troubles chez des patients ayant un SAS avec dysfonction ventriculaire gauche et ils ont démontré que les troubles du rythme ventriculaire sont fréquents plutôt le matin que le soir et disparaissent sous CPAP [39]. "
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    ABSTRACT: Arrhythmia is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of arrhythmia in patients with sleep apnea syndrome and discuss the management of this arrhythmia. Reports published with the following search terms were searched: sleep apnea syndrome, atrial flutter, supraventricular arrhythmia, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsade de pointe, atrial fibrillation and sudden death. The investigation was restricted to reports published in English and French. The outcome of this analysis suggests that patients with untreated overt sleep apnea syndrome are at increased risk of arrhythmia. The timely recognition and effective treatment of sleep apnea syndrome in patients with arrhythmia are mandatory because the prognosis of arrhythmia may be improved with the appropriate treatment of sleep apnea syndrome. Copyright © 2015. Published by Elsevier Masson SAS.
    Revue de Pneumologie Clinique 07/2015; DOI:10.1016/j.pneumo.2015.03.007 · 0.25 Impact Factor
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    • "OSA is known to be associated with significant atrial structural remodeling, including atrial enlargement and significant conduction abnormalities [7] [8] [9]. It is thought that the electrical substrate for AF resulting from OSA is due to these structural changes, which result in increased sympathetic tone, systemic and pulmonary hypertension, intermittent hypoxia, and inflammation [10] [11] [12] [13] [14] [15] [16] [17]. "
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    ABSTRACT: Background: Obstructive Sleep Apnea (OSA) results in intermittent hypoxia leading to atrial remodeling, which, among other things, facilitates development of atrial fibrillation. While much data exists on the macrostructural changes in cardiac physiology induced by OSA, there is a lack of studies looking for histologic changes in human atrial tissue induced by OSA which might lead to the observed macrostructural changes. Methods: A case control study was performed. Patients undergoing coronary artery bypass grafting (CABG) were evaluated for OSA and categorized as high-risk or low-risk. The right atrial tissue samples were obtained during CABG and both microscopic histological analysis and Sirius Red staining were performed. Results: 18 patients undergoing CABG were included; 10 high-risk OSA and 8 low-risk OSA in evenly matched populations. No statistically significant difference between the two groups was observed in amount of myocytolysis ( p= 0.181), nuclear hypertrophy ( p= 0.671), myocardial inflammation ( p= n/a), amyloid deposition ( p= n/a), or presence of thrombi ( p= n/a), as measured through routine H&E staining. As well, no statistically significant difference in interstitial and epicardial collagen was observed, as measured by Sirius Red staining (for total tissue: p= 0.619: for myocardium: p= 0.776). Conclusions: In this pilot study there were no observable histological differences in human right atrial tissue from individuals at high- and low-risk for OSA. Further investigation would be required for more definitive results.
    03/2015; 6:71-75. DOI:10.1016/j.ijcha.2015.01.008
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