Obstructive sleep apnea syndrome

Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
European Journal of Internal Medicine (Impact Factor: 2.89). 10/2012; 23(7):586-93. DOI: 10.1016/j.ejim.2012.05.013
Source: PubMed


Obstructive sleep apnea (OSA) syndrome is a common but often unrecognized disorder caused by pharyngeal collapse during sleep and characterized by frequent awakenings, disrupted sleep and consequent excessive daytime sleepiness. With the increasing epidemic of obesity, the most important risk factor for OSA, prevalence of the disease will increase over the coming years thus representing an important public-health problem. In fact, it is now recognized that there is an association between OSA and hypertension, metabolic syndrome, diabetes, heart failure, coronary artery disease, arrhythmias, stroke, pulmonary hypertension, neurocognitive and mood disorders. Diagnosis is based on the combined evaluation of clinical manifestations and objective sleep study findings. Cardinal symptoms include snoring, sleepiness and significant reports of sleep apnea episodes. Polysomnography represents the gold standard to confirm the clinical suspicion of OSA syndrome, to assess its severity and to guide therapeutic choices. Behavioral, medical and surgical options are available for the treatment. Continuous positive airway pressure (CPAP) represents the treatment of choice in most patients. CPAP has been demonstrated to be effective in reducing symptoms, cardiovascular morbidity and mortality and neurocognitive sequelae, but it is often poorly tolerated. The results of clinical studies do not support surgery and pharmacological therapy as first-line treatment, but these approaches might be useful in selected patients. A better understanding of mechanisms underlying the disease could improve therapeutic strategies and reduce the social impact of OSA syndrome.

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    • "OSAS is recognized as a chronic, complex disease related to metabolic syndrome, cardiovascular disease, neurocognitive and mood disorders [2]. With the rise in overweight and obesity, the prevalence of OSAS should increase, representing a serious public-health problem with substantial social and economic costs [3]. "
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    ABSTRACT: A consensus has not been reached regarding the association of several different gene polymorphisms and susceptibility to obstructive sleep apnea syndrome (OSAS). We performed a meta-analysis to better evaluate the associations between 5-HT2A, 5-HTT, and LEPR polymorphisms, and OSAS. 5-HT2A, 5-HTT, and LEPR polymorphisms and OSAS were identified in PubMed and EMBASE. The pooled odd rates (ORs) with 95%CIs were estimated using a fixed-effect or random-effect models. The associations between these polymorphisms and OSAS risk were assessed using dominant, recessive and additive models. Twelve publications were included in this study. The -1438 "A" allele of 5-HT2A was identified as a candidate genetic risk factor for OSAS (OR: 2.33, 95%CI 1.49-3.66). Individuals carrying the -1438 "G" allele had a nearly 70% reduced risk of OSAS when compared with AA homozygotes (OR: 0.30, 95%CI 0.23-0.40). There was no significant association between 5-HT2A 102C/T and OSAS risk, using any model. The "S" allele of 5-HTTLPR conferred protection against OSAS (OR: 0.80, 95%CI 0.67-0.95), while the "10" allele of 5-HTTVNTR contributed to the risk of OSAS (OR: 2.08, 95%CI: 1.58-2.73). The "GG" genotype of LEPR was associated with a reduced risk of OSAS (OR: 0.39, 95%CI 0.17-0.88). The meta-analysis demonstrated that 5-HTR-1438 "A" and 5-HTTVNTR "10" alleles were significantly associated with OSAS. The "S" allele of 5-HTTLPR and the "GG" genotype of LEPR conferred protection against OSAS. Further studies, such as Genome-Wide Association study (GWAS), should be conducted in a large cohort of OSAS patients to confirm our findings.
    Full-text · Article · Apr 2014 · PLoS ONE
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    • "Obstructive sleep apnoea (OSA) is a common condition affecting about 5–15% of adult population in developed countries. Prevalence is increasing with age, obesity, and chronic diseases [1, 2]. The main characteristics are repetitive apnoea or hypopnoea induced by narrowing of the upper airways during sleep. "
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    ABSTRACT: Unlabelled: The aim of the study was to evaluate whether obstructive sleep apnea (OSA) contributes directly to left ventricular (LV) diastolic and regional systolic dysfunction in newly diagnosed OSA with normal left ventricle ejection fraction. Methods: 125 consecutive patients were prospectively enrolled in the study. Control group consisted of 78 asymptomatic age-matched healthy subjects who did not have any cardiovascular and respiratory diseases. All patients had undergone overnight polysomnography and standard transthoracic and tissue Doppler imaging echocardiogram. Results: The E/A ratio and the peak E wave at mitral flow were significantly lower and the peak A wave at mitral flow was significantly higher in OSA patients compared with control subjects. Left ventricle isovolumetric relaxation time (IVRT) and mitral valve flow propagation (MVFP) were significantly longer in OSA patients than in controls. Tissue Doppler derived S' amplitude of lateral part at mitral valve (S'Lm) and E' wave amplitudes both at the lateral (E'Lm) and septal parts of the mitral valve (E'Sm) were significantly lower in OSA patients compared to controls. Conclusion: Newly diagnosed OSA patients with normal global LV function have significantly impaired diastolic function and regional longitudinal systolic function. OSA is independently associated with these changes in LV function.
    Full-text · Article · Feb 2014 · The Scientific World Journal
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    • "OSA is strongly associated with increasing obesity [3]. Whilst continuous positive airway pressure (CPAP) is the gold standard treatment for symptomatic adults with an apnoea-hypopnoea index (AHI) of 15–30 per hour (moderate OSA) or AHI > 30 per hour (severe OSA) [1], significant weight loss through bariatric surgery is well recognized to induce complete or partial remission of OSA in the long-term [2] [4]. However, to our knowledge there is no published research on the immediate effect of bariatric surgery on OSA. "
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    ABSTRACT: Obstructive sleep apnoea (OSA) is associated with obesity and frequently remits with significant weight loss.We report that bariatric surgery induces an immediate reduction in continuous positive airway pressure requirement.This implicates weight-independent mechanisms in resolution of OSA after bariatric surgery.
    Full-text · Article · Nov 2013 · European Journal of Internal Medicine
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