Cardiovascular Benefit of Continuous Positive Airway Pressure in Adults with Coronary Artery Disease and Obstructive Sleep Apnea without Excessive Sleepiness

Azarbarzin, Ali; Zinchuk, Andrey; Wellman, Andrew; Labarca, Gonzalo; Vena, Daniel; Gell, L.; Messineo, Ludovico; White, David P.; Gottlieb, Daniel J.; Redline, Susan; Peker, Yüksel; Sands, Scott A.

doi:10.1164/rccm.202111-2608oc

Cited by 45 publications

(22 citation statements)

References 26 publications

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“…In this context, a dual increase of tPA and PAI-1 has been found to predict stroke [ 31 ], and they are further elevated post stroke [ 32 , 33 ], suggesting these to be possible mediators of the important association of stroke with sleep apnea. This may also explain the protective effect of CPAP in patients with OSA [ 34 , 35 ], whereby the present study identified significant reductions in PAI-1 and tPA, along with sE-Selectin, TrATPase, and CRP, after at least two weeks on CPAP/PAP. This suggests that treatment with CPAP/PAP reduces the hypoxic burden associated with sleep apnea, thereby reducing fibrinolysis, blood coagulation, plasminogen activation, and inflammatory responses.…”

Section: Discussionsupporting

confidence: 55%

Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response

Cederberg

Hanif

Sempere

et al. 2022

IJMS

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Obstructive sleep apnea (OSA), a disease associated with excessive sleepiness and increased cardiovascular risk, affects an estimated 1 billion people worldwide. The present study examined proteomic biomarkers indicative of presence, severity, and treatment response in OSA. Participants (n = 1391) of the Stanford Technology Analytics and Genomics in Sleep study had blood collected and completed an overnight polysomnography for scoring the apnea–hypopnea index (AHI). A highly multiplexed aptamer-based array (SomaScan) was used to quantify 5000 proteins in all plasma samples. Two separate intervention-based cohorts with sleep apnea (n = 41) provided samples pre- and post-continuous/positive airway pressure (CPAP/PAP). Multivariate analyses identified 84 proteins (47 positively, 37 negatively) associated with AHI after correction for multiple testing. Of the top 15 features from a machine learning classifier for AHI ≥ 15 vs. AHI < 15 (Area Under the Curve (AUC) = 0.74), 8 were significant markers of both AHI and OSA from multivariate analyses. Exploration of pre- and post-intervention analysis identified 5 of the 84 proteins to be significantly decreased following CPAP/PAP treatment, with pathways involving endothelial function, blood coagulation, and inflammatory response. The present study identified PAI-1, tPA, and sE-Selectin as key biomarkers and suggests that endothelial dysfunction and increased coagulopathy are important consequences of OSA, which may explain the association with cardiovascular disease and stroke.

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Section: Discussionsupporting

confidence: 55%

Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response

Cederberg

Hanif

Sempere

et al. 2022

IJMS

View full text Add to dashboard Cite

show abstract

“…7 Heart rate response, measured by a change in heart rate after a respiratory event, also predicts cardiovascular morbidity and mortality, as well as response to CPAP. 8,9 Prognostic biomarkers for OSA may serve to improve cardiovascular risk stratification and direct treatment.…”

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confidence: 99%

“…2,5,18 Thus, studies showing that stratification by PRV, or other physiologic markers, can impact CPAP therapy outcomes are needed. 9 In addition, the benefits of these biomarkers in older adults with multiple comorbidities need to be proven. Existing literature suggests that older adults with OSA may not suffer the same health consequences as middle-aged adults, 1 and at least one report suggests biomarkers may be less strongly associated with cardiovascular outcomes in persons over 65 years of age.…”

mentioning

confidence: 99%

“…Hypoxic burdens, the area under the curve of desaturation resulting from an OSA‐related respiratory event (apnea or hypopnea), predicts cardiovascular morbidity and mortality 7 . Heart rate response, measured by a change in heart rate after a respiratory event, also predicts cardiovascular morbidity and mortality, as well as response to CPAP 8,9 . Prognostic biomarkers for OSA may serve to improve cardiovascular risk stratification and direct treatment.…”

mentioning

confidence: 99%

“…A clear pattern in the literature is that OSA is associated with a host of risks for cardiovascular and neurocognitive outcomes in observational studies; however, with few exceptions (e.g., hypertension), the RCTs of OSA treatment fail to show mitigation of that risk 2,5,18 . Thus, studies showing that stratification by PRV, or other physiologic markers, can impact CPAP therapy outcomes are needed 9 . In addition, the benefits of these biomarkers in older adults with multiple comorbidities need to be proven.…”

mentioning

confidence: 99%

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