Obstructive sleep apnea and cardiovascular risk: Meta-analysis of prospective cohort studies

Dong, Jia-Yi; Zhang, Yonghong; Qin, Li–Qiang

doi:10.1016/j.atherosclerosis.2013.04.026

Cited by 264 publications

(190 citation statements)

References 37 publications

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“…We know that OSAS is accompanied by several complications such as arterial hypertension, coronary disease and cerebrovascular events [7,21,37,39], and it should be considered if the behavior of the gelatinases might play a role in the development of these vascular complications. Up to now, the literature data show a controversial relationship between gelatinases and pulse wave velocity, that reflects arterial stiffness: in subjects with isolated systolic hypertension [40] and in subjects with chronic kidney disease, with or without diabetes mellitus [5], a correlation between gelatinases and arterial stiffness was observed, but not in healthy individuals [34] and in type 2 diabetic subjects [25].…”

Section: Discussionmentioning

confidence: 99%

“…OSAS is independently associated with an increased risk of morbidity and mortality [28] considering that the most important complications are arterial hypertension, coronary artery disease, and cerebrovascular accidents [7,21,37,39]. Atherosclerosis is common in OSAS, and several studies have demonstrated that the elevated mortality in OSAS is associated with the severity of the atherosclerosis [33].…”

Section: Introductionmentioning

confidence: 99%

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Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Hopps¹,

Canino²,

Montana

et al. 2016

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Abstract. Obstructive sleep apnea syndrome (OSAS) is associated with an elevated risk of cardiovascular events and stroke. Matrix metalloproteinases (MMPs) are endopeptidases involved in extracellular matrix degradation and then in the development and progression of cardiovascular diseases. Our aim was to evaluate plasma levels of gelatinases (MMP-2 and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2) in a group of subjects with OSAS. We enrolled 48 subjects (36 men and 12 women; mean age 49.7 ± 14.68 yrs) with OSAS diagnosed with a 1-night cardiorespiratory study and then we subdivided these subjects into two subgroups according to the apnea/hypopnea index (AHI): Low (L = 21 subjects with AHI <30) and High (H = 27 subjects with AHI >30). We measured plasma concentration of the gelatinases and their inhibitors using ELISA kits. We observed a significant increase in plasma concentration of MMP-9, MMP-2, TIMP-1 and TIMP-2 in the entire group of OSAS subjects and in the two subgroups, with higher levels in the H in comparison with the L subgroup. In the whole group of OSAS subjects we also noted a significant decrease in MMP-9/TIMP-1 ratio in comparison with normal controls. Only MMP-9 was significantly correlated with the severity of the disease, expressed as AHI, with the oxygen desaturation index and also with the mean oxygen saturation. MMPs pattern is altered in OSAS and significantly influenced by the severity of the disease; it probably contributes to the vascular remodeling that leads to the atherosclerotic disease and cardiovascular complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Hopps¹,

Canino²,

Montana

et al. 2016

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“…In a recent meta-analysis of 17 prospective studies moderate-to-severe OSA carried an almost 2.5-fold risk of developing cardiovascular events and had a 2.0-fold risk of developing stroke [29].…”

Section: Osa and Cardiovascular Diseasementioning

confidence: 99%

Obstructive sleep apnea: one more target in cardiac rehabilitation

Rovere

Fanfulla

Febo

2015

Monaldi Arch Chest Dis

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Obstructive sleep apnea: one more target in cardiac rehabilitation. M.T. La Rovere, F. Fanfulla, O. Febo.Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder, often unrecognized and undiagnosed, in patients with established cardiovascular diseases. Considerable evidence is now available in support of a significant association between OSA and increased risk for cardiovascular disease morbidity. OSA has also been recognised as a potential public health issue associated with societal consequences including accidents and work economics. Treatment of OSA would reduce cardiovascular risk and the overall usage of health care resources. OSA might be a modifiable risk factor and screening for OSA should be implemented in cardiac rehabilitation settings.

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“…OSA has an estimated prevalence of 9-24% in middle-aged population (20,21) and has emerged as an important cardiovascular risk factor. In recent years, OSA has been linked to a higher relative risk for cardiovascular diseases, such as arterial hypertension, congestive heart failure, arrhythmias, and sudden cardiac death (22,23 duction in blood pressure and an initial inhibition of sympathetic drive, likely to and due to a mechanical stretching effect on cardiac vagal afferent fibers (Figure 1). Immediately after the cessation of the obstructive event, upper airways patency is associated with an increase in cardiac output which, superimposed to the preceding sympathetic vasoconstriction, determines a considerable increase in blood pressure, a consequent activation of baroreceptor and lung pulmonary inflation reflexes thus inducing a transient shutdown of sympathetic drive (25) (Figure 2).…”

Section: Sleep Breathing Disorders and Ansmentioning

confidence: 99%

Sympathovagal balance changes in sleep breathing disorders

Patruno¹

2014

sob

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SummaryThe autonomic nervous system (ANS) plays a leading role in controlling visceral functions and it is well known that the increase of sympathetic activity underlies most of cardiovascular diseases such as hypertension, heart failure, myocardial infarction and arrhythmias. On the other hand parasympathetic activity acts as protective factor against the above mentioned conditions. Sleep breathing disorders (SBD) are commonly divided in three syndromes: obstructive sleep apnoea syndrome, central sleep apnoea syndrome and Cheyne-Stokes breathing syndrome, the latter two both characterized by cyclic non-obstructive breathing patterns. Cheyne-Stokes Respiration is a form of periodic breathing characterized by a crescendo-decrescendo pattern of ventilation with (CSR-CSA) or without (CSR) central apnoea. Obstructive sleep apnea (OSA) is significantly associated with increased cardiovascular morbidity and mortality. OSA exerts strong modulatory effects on the autonomic nervous system through a number of mechanisms including central respiratory-cardiac coupling in the brain stem, chemo-reflex stimulation, baro-reflexes, and reflexes relating to lung inflation. EEG arousals, often related to apnea termination, also represent the final way of autonomic activation. CSR is common among patients with congestive heart failure, being present in 30-40% of the two largest reported. If CSR "per se" promotes an increase of sympathetic outflow during sleep is not really known.Several lines of argument would support the hypothesis that CSR may be a compensatory mechanism for severe HF.

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Obstructive sleep apnea and cardiovascular risk: Meta-analysis of prospective cohort studies

Cited by 264 publications

References 37 publications

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Gelatinases and their tissue inhibitors in a group of subjects with obstructive sleep apnea syndrome

Obstructive sleep apnea: one more target in cardiac rehabilitation

Sympathovagal balance changes in sleep breathing disorders

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