Regional differences in sympathetic activation in lean and obese normotensive individuals with obstructive sleep apnoea

Seravalle, Gino; Brambilla, Gianmaria; Buzzi, S; Volpe, Massimo; Cesana, Francesca; Mancia, Giuseppe

doi:10.1097/hjh.0000000000000034

Cited by 24 publications

(14 citation statements)

References 29 publications

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“…In the present subjects, sympathetic burst frequency and incidence were lower in control conditions than in untreated OSA patients previously described and, in fact, were comparable in magnitude to values reported for control subjects without OSA (Carlson et al., ; Donadio et al., ; Goya et al., ; Grassi et al., ; Henderson et al., ; Imadojemu et al., ; Narkiewicz et al., ; Waradekar, Sinoway, Zwillich, & Leuenberger, ). Excessive daytime sleepiness, which is associated with sympathetic hyperactivity (Donadio et al., ) and cardiovascular morbidity (Feng, He, Zhang, & Chen, ) in patients with OSA, was absent in the majority of our subjects.…”

Section: Discussionsupporting

confidence: 86%

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Morgan

Teodorescu

Pegelow

et al. 2018

Experimental Physiology

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Chemoreflex sensitization produced by chronic intermittent hypoxia in rats is attenuated by angiotensin II type 1 receptor (AT R) blockade. Both AT R blockade and xanthine oxidase inhibition ameliorate chronic intermittent hypoxia-induced endothelial dysfunction. We hypothesized that treatment with losartan and allopurinol would reduce chemoreflex sensitivity and improve hypoxic vasodilatation in patients with obstructive sleep apnoea. Eighty-six hypertensive patients with apnoea-hypopnoea index ≥25 events h and no other cardiovascular, pulmonary, renal or metabolic disease were randomly assigned to receive allopurinol, losartan or placebo for 6 weeks. Treatment with other medications and/or continuous positive airway pressure remained unchanged. Tests of chemoreflex sensitivity and hypoxic vasodilatation were performed during wakefulness before and after treatment. Ventilation (pneumotachography), muscle sympathetic nerve activity (microneurography), heart rate (electrocardiography), arterial oxygen saturation (pulse oximetry), blood pressure (sphygmomanometry), forearm blood flow (venous occlusion plethysmography) and cerebral flow velocity (transcranial Doppler ultrasound) were measured during eupnoeic breathing and graded reductions in inspired O tension. Losartan and allopurinol lowered arterial pressure measured during eupnoeic breathing and exposure to acute hypoxia. Neither drug altered the slopes of ventilatory, sympathetic or cardiovascular responses to acute hypoxia. We conclude that losartan and allopurinol are viable pharmacotherapeutic adjuncts for achieving blood pressure control in hypertensive obstructive sleep apnoea patients, even those who are adequately treated with continuous positive airway pressure.

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Section: Discussionsupporting

confidence: 86%

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Morgan

Teodorescu

Pegelow

et al. 2018

Experimental Physiology

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“…Several studies showed an increased sympathetic activity in obese subjects, as assessed by direct recordings of muscle sympathetic nerve activity (MSNA) [56,57,58,59,60]. Grassi et al showed that both heart rate and MSNA baroreflex changes were attenuated in hypertensive obese subjects compared to normotensive subjects.…”

Section: Mechanisms Linking Obesity To Hypertensionmentioning

confidence: 99%

Weight Loss and Hypertension in Obese Subjects

et al. 2019

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Arterial hypertension is strongly related to overweight and obesity. In obese subjects, several mechanisms may lead to hypertension such as insulin and leptin resistance, perivascular adipose tissue dysfunction, renal impairment, renin-angiotensin-aldosterone-system activation and sympathetic nervous system activity. Weight loss (WL) seems to have positive effects on blood pressure (BP). The aim of this review was to explain the mechanisms linking obesity and hypertension and to evaluate the main studies assessing the effect of WL on BP. We analysed studies published in the last 10 years (13 studies either interventional or observational) showing the effect of WL on BP. Different WL strategies were taken into account—diet and lifestyle modification, pharmacological intervention and bariatric surgery. Although a positive effect of WL could be identified in each study, the main difference seems to be the magnitude and the durability of BP reduction over time. Nevertheless, further follow-up data are needed: there is still a lack of evidence about long term effects of WL on hypertension. Hence, given the significant results obtained in several recent studies, weight management should always be pursued in obese patients with hypertension.

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“…Obesity also is associated with a marked sympathetic activation: MSNA of young normotensive D r a f t obese individuals is approximately double that of their non-obese control counterparts even in the absence of coexisting sleep apnea (Grassi et al, 2014).…”

Section: R a F Tmentioning

confidence: 99%

Muscle sympathetic activity in resting and exercising humans with and without heart failure

Notarius

Millar

Floras

2015

Appl. Physiol. Nutr. Metab.

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The sympathetic nervous system is critical for coordinating the cardiovascular response to various types of physical exercise. In a number of disease states, including human heart failure with reduced ejection fraction (HFrEF), this regulation can be disturbed and adversely affect outcome. The purpose of this review is to describe sympathetic activity at rest and during exercise in both healthy humans and those with HFrEF and outline factors, which influence these responses. We focus predominately on studies that report direct measurements of efferent sympathetic nerve traffic to skeletal muscle (muscle sympathetic nerve activity; MSNA) using intraneural microneurographic recordings. Differences in MSNA discharge between subjects with and without HFrEF both at rest and during exercise and the influence of exercise training on the sympathetic response to exercise will be discussed. In contrast to healthy controls, MSNA increases during mild to moderate dynamic exercise in the presence of HFrEF. This increase may contribute to the exercise intolerance characteristic of HFrEF by limiting muscle blood flow and may be attenuated by exercise training. Future investigations are needed to clarify the neural afferent mechanisms that contribute to efferent sympathetic activation at rest and during exercise in HFrEF.

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Regional differences in sympathetic activation in lean and obese normotensive individuals with obstructive sleep apnoea

Cited by 24 publications

References 29 publications

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Weight Loss and Hypertension in Obese Subjects

Muscle sympathetic activity in resting and exercising humans with and without heart failure

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