Circadian rhythms in blood pressure, heart rate, hormones, and on polysomnographic parameters in severe obstructive sleep apnea syndrome patients

Scholtze, Joachim; Schmitt, Julian

doi:10.1097/mbp.0000000000000173

Cited by 22 publications

(21 citation statements)

References 52 publications

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“…For the red luminance significant differences were found for all tested luminances. secretion, [22][23][24]76 but our results did not find reduced melanopsin-driven responses in OSA patients. Moreover, in this study, the OSA group presented an enhanced but not statistically significant ipRGC response to PLR compared with controls ( Fig.…”

Section: Discussioncontrasting

confidence: 90%

“…7,[19][20][21] This thinning of the RNFL in OSA may lead to a dysfunction of the retinal ganglion cells (RGC). In fact, a disrupted circadian rhythm and abnormal melatonin secretion pattern in OSA patients have been reported, [22][23][24] and it is known that the RGC subpopulation of intrinsically photosensitive ganglion cells (ipRGCs) is involved in circadian photoentrainment and in the regulation of melatonin secretion. These RGCs, also known as the third class of photoreceptor, 25,26 contain the melanopsin photopigment and are known to mediate nonimage-forming visual functions, which include a wide range of responses to light-circadian photoentrainment, sleep regulation, pupillary light response (PLR), and modulation of mood and learning.…”

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confidence: 99%

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Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea

Duque-Chica

Gracitelli

Moura

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Duque-Chica GL, Gracitelli CPB, Moura ALA, et al. Contributions of the melanopsin-expressing ganglion cells, cones, and rods to the pupillary light response in obstructive sleep apnea. Invest Ophthalmol Vis Sci. 2019;60:3002-3012. https://doi.org/ 10.1167/iovs.19-26944 PURPOSE. To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR).METHODS. Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at À3, À2, À1, 0, 1, 2, and 2.4 log cd/m 2 . Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used.RESULTS. OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at À3, À2, À1, 1 log cd/m 2 and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (À2, 0, 2, 2.4 log cd/m 2 ) and red stimuli (À2, 0 log cd/m 2 ; P < 0.040). No significant difference was found in the melanopsin-mediated PLR.CONCLUSIONS. This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.

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Section: Discussioncontrasting

confidence: 90%

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confidence: 99%

Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea

Duque-Chica

Gracitelli

Moura

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…Finally, a decrease in wrist-actigraphy derived physical activity during the night, indicative of reduced movement arousals during sleep, was reported in patients after 2 months of CPAP versus baseline [74]. These findings are in accordance with a reduced AHI, and may be functionally related to the aforementioned findings of reduced SMR [26].…”

Section: Resultsmentioning

confidence: 78%

Effects of continuous positive airway pressure on energy balance regulation: a systematic review

Shechter

2016

Eur Respir J

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Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain. The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance. CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation. It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients.

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“…106 Seventeen men with obstructive sleep apnea syndrome had elevated plasma levels of norepinephrine but attenuated melatonin nocturnal elevations; these changes were reversed by continuous positive airway pressure along with the enhancement in the number of dippers. 107 Consistent with these observations, the sympatholytic effect of melatonin would be expected to attenuate nondipping HR or the nocturnal HR increase if applied at bedtime; such a study is warranted.…”

Section: Effect Of Melatonin On Nocturnal Hr and On Nondipping Phenmentioning

confidence: 68%

Elevated heart rate and nondipping heart rate as potential targets for melatonin: a review

Šimko¹,

Baka²,

Paulis³

et al. 2016

Journal of Pineal Research

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Elevated heart rate is a risk factor for cardiovascular and all‐cause mortalities in the general population and various cardiovascular pathologies. Insufficient heart rate decline during the night, that is, nondipping heart rate, also increases cardiovascular risk. Abnormal heart rate reflects an autonomic nervous system imbalance in terms of relative dominance of sympathetic tone. There are only a few prospective studies concerning the effect of heart rate reduction in coronary heart disease and heart failure. In hypertensive patients, retrospective analyses show no additional benefit of slowing down the heart rate by beta‐blockade to blood pressure reduction. Melatonin, a secretory product of the pineal gland, has several attributes, which predict melatonin to be a promising candidate in the struggle against elevated heart rate and its consequences in the hypertensive population. First, melatonin production depends on the sympathetic stimulation of the pineal gland. On the other hand, melatonin inhibits the sympathetic system in several ways representing potentially the counter‐regulatory mechanism to normalize excessive sympathetic drive. Second, administration of melatonin reduces heart rate in animals and humans. Third, the chronobiological action of melatonin may normalize the insufficient nocturnal decline of heart rate. Moreover, melatonin reduces the development of endothelial dysfunction and atherosclerosis, which are considered a crucial pathophysiological disorder of increased heart rate and pulsatile blood flow. The antihypertensive and antiremodeling action of melatonin along with its beneficial effects on lipid profile and insulin resistance may be of additional benefit. A clinical trial investigating melatonin actions in hypertensive patients with increased heart rate is warranted.

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Circadian rhythms in blood pressure, heart rate, hormones, and on polysomnographic parameters in severe obstructive sleep apnea syndrome patients

Cited by 22 publications

References 52 publications

Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea

Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea

Effects of continuous positive airway pressure on energy balance regulation: a systematic review

Elevated heart rate and nondipping heart rate as potential targets for melatonin: a review

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