Bidirectional relationships of comorbidity with obstructive sleep apnoea

Abstract

Obstructive sleep apnoea (OSA) is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary and neuropsychiatric. There is considerable evidence that OSA is an independent risk factor for many of these comorbidities but, more recently, there is evidence that some of these comorbidities may predispose to the development of OSA. Thus, there is growing evidence of a bidirectional relationship between OSA and comorbidity, especially for heart failure, metabolic syndrome and stroke. Potential mechanisms of bidirectional relationships differ in individual comorbidities with fluid retention and redistribution being especially important in heart failure and end-stage renal disease, whereas neural mechanisms may be more important in diabetes mellitus and stroke. The evidence for other comorbidities, such as hypertension and atrial fibrillation, support these being more a consequence of OSA with limited evidence to support a bidirectional relationship. The present review explores the evidence for such bidirectional relationships with a particular perspective on comorbidities that may predispose to OSA. The impact of therapy in bidirectional relationships is also reviewed, which highlights the clinical importance of accurate diagnosis. This aspect is especially true of COPD, where the identification of co-existing OSA has important implications for optimum therapy.

Obstructive sleep apnea: transition from pathophysiology to an integrative disease model

“…Renal disease and OSA have a bi‐directional relationship (Gleeson & McNicholas, 2022). OSA is up to 10‐times more prevalent in patients with chronic kidney disease (CKD) than the general population (Hanly, 2004), and potential contributing factors include increased chemoreflex sensitivity, reduced clearance of uraemic toxins, and hypervolaemia (Abuyassin et al, 2015).…”

“…Obstructive sleep apnea is independently associated with many comorbidities, including cardiovascular, metabolic, renal, and neuropsychiatric (McNicholas, 2019). However, many studies were cross-sectional in design, which limits the ability to evaluate causality, and there is growing evidence of a bi-directional relationship between OSA and comorbidity (Gleeson & McNicholas, 2022). Furthermore, most reports evaluating links between OSA and comorbidity have used the AHI as the principal metric of OSA severity, and there is growing evidence that the relationship of OSA with comorbidity should take into account additional variables such as acute and chronic systemic effects (Randerath et al, 2018).…”

Screening the risk of obstructive sleep apnea by utilizing supervised learning techniques based on anthropometric features and snoring events

“…More precisely, some features such as craniofacial features, that vary among different ethnicities, may affect the AHI and OSA severity. 58 Other lifestyle habits, such as tobacco and alcohol usage 59 or one's personal health status (menopausal status, medication use, and comorbidities), 60 , 61 may also affect OSA severity. Some researchers proposed machine learning approaches by employing nocturnal oxygen saturation obtained by pulse oximetry and electrocardiogram signals for screening for OSA risk.…”

Identification of metabolic fingerprints in severe obstructive sleep apnea using gas chromatography–Mass spectrometry

“…The onset of OSA has been known to predispose individuals to comorbidities and metabolic disorders (Gleeson and McNicholas, 2022). We used log regression analysis with Metaboanalyst to validate the efficacy of our highlighted metabolites as metabolic biomarkers in severe OSA patients compared with controls.…”