Effect of continuous positive airway pressure on soluble CD40 ligand in patients with obstructive sleep apnea syndrome
ABSTRACT Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for atherosclerosis. CD40-CD40 ligand interaction promotes several proinflammatory mediators and plays a pivotal role in the various stages of atherosclerotic diseases. The present study examines whether CD40 ligation contributes to outcomes in patients with OSAS.
The study population comprised OSAS patients with an apnea hypopnea index (AHI) > or = 30 (n = 35) and control subjects (AHI < 5; n = 16). We measured serum levels of soluble CD40 ligand (sCD40L), tumor necrosis factor (TNF)-alpha, and hypersensitive C-reactive protein (hsCRP) before and after nasal continuous positive airway pressure (nCPAP) therapy for 3 months.
Baseline levels of sCD40L were significantly higher in patients with OSAS (6.93 +/- 4.64 ng/mL) [mean +/- SD] than in control subjects (3.43 +/- 2.11 ng/mL, p < 0.01). Baseline levels of sCD40L positively correlated with TNF-alpha but not with hsCRP. The elevation of sCD40L was improved for 1 night after nCPAP therapy (3.83 +/- 2.78 ng/mL, p < 0.001). Even though patients with severe OSAS did not receive any other medication to control atherosclerotic risk factors for 3 months, nCPAP was continued to reduce the levels of sCD40L.
The present study suggested that sCD40L is a key factor that links OSAS and atherosclerotic progression.
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ABSTRACT: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. The sleep fragmentation and the accompanying hypoxemia lead to many negative consequences including cardiovascular diseases, cognitive impairment, daytime sleepiness, fatigue, and depressive symptoms (Parish and Somers 2004; Reimer and Flemons 2003). Originally viewed as an interesting but rare malady, OSA is now recognized as a common disorder that is associated with major morbidity and mortality (Newman et al. 2001).12/2006: pages 257-274;
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ABSTRACT: Sleep is undoubtedly disturbed during pregnancy. The disturbances include an increase in nocturnal awakenings and greater periods of time spent awake during the night, as well as complaints of fatigue during the day. Although nausea (i.e., morning sickness) is most commonly expected in the first trimester, an increase in fatigue, which is often a consequence of disturbed sleep, is actually the first symptom of pregnancy (Lee 2006). Various contributors have been suggested or implicated in the magnitude of sleep disturbances in pregnancy, including hormonal, physiologic, physical (Baratte-Beebe and Lee 1999), and behavioral changes (Buster and Carson 2003; Challis and Lye 2003). As pregnancy progress, other symptoms contribute to sleep disturbances, some of them being fetal movements, leg cramps, shortness of breath, and an inability to get comfortable (Baratte-Beebe et al. 1999). This review will extend beyond the description of how sleep patterns change during pregnancy to suggest that there is an important relationship between pregnancy-associated sleep disturbances and cytokine and hormone changes that may have relevance to maternal and fetal health. Discussion will include how disturbances experienced during pregnancy are associated with cytokine alterations and hormonal changes, and how these relationships could add to a woman’s risk for developing pregnancy complications or experiencing poor pregnancy outcomes.12/2006: pages 207-225;