Time delay of baroreflex control and oscillatory pattern of sympathetic activity in patients with metabolic syndrome and obstructive sleep apnea

Toschi‐Dias, Edgar; Trombetta, Ivani C.; Silva, Valdo J. Dias da; Maki-Nunes, Cristiane; Cepeda, Felipe X.; Alves, Maria-Janieire N. N.; Drager, Luciano F.; Lorenzi-Filho, Geraldo; Negräo, Carlos Eduardo; Rondon, Maria Urbana Pinto Brandão

doi:10.1152/ajpheart.00848.2012

Cited by 29 publications

(32 citation statements)

References 40 publications

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“…This is attributed to the stimulation of peripheral chemoreceptors by the anoxia induced by nocturnal hypopneic-apnoeic episodes, and also to diminished arterial baroreflex sensitivity in OSA subjects (Narkiewicz et al, 1998b; Toschi-Dias et al, 2013). The prevalence of OSA in newly diagnosed metabolic syndrome subjects with similar clinical profile to our cohort, has been reported at 60% (Drager et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Neck Circumference Is Associated with Muscle Sympathetic Nerve Activity in Overweight and Obese Men but Not Women

et al. 2017

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Background: Neck circumference (NC) is a predictor of cardiometabolic risk. The objective of this study was to explore the relationship of NC to muscle sympathetic nerve activity (MSNA) within an overweight and obese population.Methods: The study design was a retrospective cross-sectional analysis. Un-medicated persons (72 men, 53 postmenopausal women) aged 56 ± 1 years (mean ± SEM) with body mass index (BMI) 32.8 ± 0.4 kg/m2, were studied. NC was measured together with traditional anthropometric measures, supine blood pressure, fasting blood lipids, insulin, and glucose. Insulin sensitivity was assessed by homeostasis model (HOMA-IR) and Matsuda Insulin Sensitivity Index (ISI) derived from 75-g oral glucose tolerance test. Resting multiunit MSNA was recorded by microneurography in the peroneal nerve and expressed as burst frequency and burst incidence.Results: Men within the highest tertile of NC had significantly higher fasting and post-glucose plasma insulin levels (insulin AUC0−120), HOMA-IR, non-esterified fatty acids, MSNA (45 ± 2 vs. 36 ± 2 bursts per min; 69 ± 3 vs. 58 ± 3 bursts per 100 hb) and heart rate, and lower Matsuda ISI compared to men in the lowest tertile (P all <0.05). In stepwise regression analyses, NC alone explained 12%, and together with insulin AUC0−120 it accounted for 22%, of the variance in MSNA in men. In women, NC was associated with anthropometric measures but not with MSNA or metabolic indices.Conclusions: Among overweight and obese men, NC was independently associated with elevated MSNA and hyperinsulinemia, and thus may be relevant to cardiometabolic risk prediction. The biological basis of gender differences merits further elucidation.

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Section: Discussionmentioning

confidence: 99%

Neck Circumference Is Associated with Muscle Sympathetic Nerve Activity in Overweight and Obese Men but Not Women

et al. 2017

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“…Age‐matched healthy individuals who were sedentary and had normal physical and clinical examinations were enrolled in the study as a control group. Approximately 70% of the studied patients also participated in other autonomic evaluation studies …”

Section: Methodsmentioning

confidence: 99%

The role of increased glucose on neurovascular dysfunction in patients with the metabolic syndrome

Rodrigues

Cepeda

Toschi‐Dias

et al. 2017

J of Clinical Hypertension

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Metabolic syndrome (MetS) causes autonomic alteration and vascular dysfunction. The authors investigated whether impaired fasting glucose (IFG) is the main cause of vascular dysfunction via elevated sympathetic tone in nondiabetic patients with MetS. Pulse wave velocity, muscle sympathetic nerve activity (MSNA), and forearm vascular resistance was measured in patients with MetS divided according to fasting glucose levels: (1) MetS+IFG (blood glucose ≥100 mg/dL) and (2) MetS‐IFG (<100 mg/dL) compared with healthy controls. Patients with MetS+IFG had higher pulse wave velocity than patients with MetS‐IFG and controls (median 8.0 [interquartile range, 7.2–8.6], 7.3 [interquartile range, 6.9–7.9], and 6.9 [interquartile range, 6.6–7.2] m/s, P=.001). Patients with MetS+IFG had higher MSNA than patients with MetS‐IFG and controls, and patients with MetS‐IFG had higher MSNA than controls (31±1, 26±1, and 19±1 bursts per minute; P<.001). Patients with MetS+IFG were similar to patients with MetS‐IFG but had higher forearm vascular resistance than controls (P=.008). IFG was the only predictor variable of MSNA. MSNA was associated with pulse wave velocity (R=.39, P=.002) and forearm vascular resistance (R=.30, P=.034). In patients with MetS, increased plasma glucose levels leads to an adrenergic burden that can explain vascular dysfunction.

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“…However, as PSG was not performed, apnoea frequency and sleep fragmentation could not be ruled out as additional factors [134]. Nocturnal hypoxaemia increases sympathetic activity and may contribute to cardiovascular complications of SDB such as hypertension and arrhythmias [135]. Oxygen supplementation might therefore be effective in improving symptoms and complications of sleep apnoea, even if it does not directly address the airway obstruction.…”

Section: Supplemental Oxygenmentioning

confidence: 99%

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

et al. 2016

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Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group. @ERSpublications An overview of the research in the field of and clinical guidelines for the treatment of SDB in elderly patients

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Time delay of baroreflex control and oscillatory pattern of sympathetic activity in patients with metabolic syndrome and obstructive sleep apnea

Cited by 29 publications

References 40 publications

Neck Circumference Is Associated with Muscle Sympathetic Nerve Activity in Overweight and Obese Men but Not Women

Neck Circumference Is Associated with Muscle Sympathetic Nerve Activity in Overweight and Obese Men but Not Women

The role of increased glucose on neurovascular dysfunction in patients with the metabolic syndrome

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

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