Hypoxic Burden Based on Automatically Identified Desaturations Is Associated with Adverse Health Outcomes

Esmaeili, N.; Labarca, Gonzalo; Hu, Wen-Hsin; Vena, Daniel; Messineo, Ludovico; Gell, L.; Hajipour, Mohammadreza; Taranto‐Montemurro, Luigi; Sands, Scott A.; Redline, Susan; Wellman, Andrew; Sehhati, Mohammadreza; Azarbarzin, Ali

doi:10.1513/annalsats.202303-248oc

Cited by 15 publications

(3 citation statements)

References 46 publications

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“…Moreover, it can be calculated from automatic analyses of the sleep studies, facilitating the work of clinicians and accelerating the diagnosis. A recent publication [ 41 ] has assessed the relationship between manual-scored HB and automatically-scored HB, showing a high correlation between them and with adverse CV outcomes in a similar way as reported. Thus, it could be used to contribute to reducing the underdiagnosis observed in this disease.…”

Section: Discussionmentioning

confidence: 86%

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The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review

Coso,

Solano-Pérez,

Romero-Peralta

et al. 2024

Rev. Cardiovasc. Med.

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Background: Obstructive sleep apnea (OSA) is a highly prevalent sleep-disordered breathing. It is associated with adverse co-morbidities, being the most scientific evidence of cardiovascular (CV) disease. Currently, OSA is measured through the apnea-hypopnea index (AHI), the total number of respiratory events per hour of sleep. However, different studies have questioned its utility in OSA management, highlighting the need to search for new parameters that better reflect the heterogeneity of the disease. Hypoxic burden (HB) has emerged as a novel biomarker that informs about the frequency, duration and depth of the desaturation related to the respiratory events. We conducted a systematic review in order to find publications about the heterogeneity of OSA measured by HB and its associations with future disease. Methods: Systematic review was conducted using PubMed and Web of Science. The terms “sleep apne” and “hypoxic burden” were used to look for publications from the date of inception to August 15, 2023. Inclusion criteria: articles in English published in peer-reviewed journals. Exclusion criteria: (1) not available publications; (2) duplicated articles; (3) letters, editorials, and congress communications; (4) articles not including information about HB as a specific biomarker of OSA. Results: 33 studies were included. The results were classified in 2 main sections: (1) HB implication in the CV sphere: HB showed to be a better predictor of CV risk in OSA patients than traditional measures such as AHI with possible clinical management implication in OSA. (2) HB response to OSA treatment: pharmacological and nonpharmacological treatments have demonstrated to be effective in improving hypoxia measured through the HB. Conclusions: HB could be a better and more effective parameter than traditional measurements in terms of diagnosis, risk prediction and therapeutic decisions in patients with OSA. This measure could be incorporated in sleep units and could play a role in OSA management, driving the clinic to a more personalized medicine.

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Section: Discussionmentioning

confidence: 86%

“…The main results were found in the CV sphere (Table 1 , Ref. [ 14 , 17 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]). These reviewed studies highlight that AHI may oversimplify the complexity of the disorder and do not optimally correlate with associated CV morbidity and mortality.…”

Section: Resultsmentioning

confidence: 97%

The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review

Coso,

Solano-Pérez,

Romero-Peralta

et al. 2024

Rev. Cardiovasc. Med.

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“…In recent studies, sleep apnea-specific intermittent hypoxemia, quantified by the hypoxic burden (HB), has been shown to predict cardiovascular disease-related mortality, with a new method based on automatically scored desaturations called oximetry-derived hypoxic burden (HBOxi) demonstrating strong correlation and associations with daytime sleepiness, hypertension, and cardiovascular disease mortality. 16 As the LVAD improves the underlying physiology causing CSA and Cheyne-Stokes respiration, it does not affect other parameters affecting OSA, such as obesity, neck circumference, oropharyngeal anatomy, or obstruction. Therefore, OSA may even worsen following LVAD implantation in some patients.…”

Section: Discussionmentioning

confidence: 99%

Ventricular assist devices and sleep‐disordered breathing—A mechanical heart stimulating a sleepy brain

Durland,

Angles,

Hoyland

et al. 2023

Artificial Organs

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Sleep‐disordered breathing, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is common in severe heart failure (HF) patients. There is limited data on the effect of left ventricular assist devices (LVAD) on sleep apnea. We performed a retrospective review of 350 durable LVAD patients and found 5 with a history of pre‐ and post‐LVAD sleep studies. All five patients had OSA, and three had concomitant CSA. We observed reduced apnea‐hypopnea index following LVAD placement. This was due to a near abolishment of CSA in three mixed sleep apnea patients—as seen by a central apnea index improvement from an average of 25.9 ± 13.1 to 1.4 ± 2.5 events per hour (p = 0.063). LVAD placement was associated with an increase in thermodilution cardiac output from 2.7 ± 0.6 to 4.1 ± 1.1 L/min (p = 0.014). These findings support chemoreception physiology seen in patients with poor circulation and the effect of restoring this circulation with LVAD support.

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The effect of supplemental oxygen and continuous positive airway pressure withdrawal on endocan levels

Turnbull,

Stradling,

Petousi

et al. 2024

Sleep Breath

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Purpose Endocan is a biomarker of endothelial dysfunction, which is a precursor to cardiovascular disease. Obstructive sleep apnoea (OSA) is associated with elevated endocan levels but the effects of treatment on endocan levels in OSA are not fully established. We aimed to determine whether endocan levels could be detected by immunoassay and to determine the effect of supplemental oxygen during continuous positive airway pressure (CPAP) withdrawal on circulating endocan levels. Methods We conducted an exploratory analysis from a randomised controlled crossover study which included participants with OSA. Participants stopped their CPAP therapy and were randomised to receive either supplemental oxygen or sham for 14 nights before crossing over. Supplemental oxygen blocked the rise in blood pressure seen in the sham group. We analysed plasma endocan levels by immunoassay at baseline and after 14 nights of intervention in both groups. Results Twenty-five participants were included, with a total of 100 samples. Endocan levels were detectable at all time points in 22 participants (88%), and in 93 (93%) samples. Supplemental oxygen had no effect on endocan levels compared to sham (+ 0.52 ng/ml, 95%CI -0.21 to + 1.25, p = 0.16), and there was no significant difference in endocan levels from baseline to follow-up in either the sham (-0.30 ng/ml, 95%CI -0.89 to + 0.30, p = 0.31) or supplemental oxygen (+ 0.22 ng/ml, 95%CI 0.00 to + 0.44, p = 0.05) arm. Conclusions We have shown that endocan levels are detectable before and after CPAP withdrawal. However, we found no effect of supplemental oxygen following CPAP withdrawal on circulating endocan levels. Trial registration and date ISRCTN 17,987,510 19/02/2015.

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Hypoxic Burden Based on Automatically Identified Desaturations Is Associated with Adverse Health Outcomes

Cited by 15 publications

References 46 publications

The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review

The Hypoxic Burden, Clinical Implication of a New Biomarker in the Cardiovascular Management of Sleep Apnea Patients: A Systematic Review

Ventricular assist devices and sleep‐disordered breathing—A mechanical heart stimulating a sleepy brain

The effect of supplemental oxygen and continuous positive airway pressure withdrawal on endocan levels

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