scholarly journals Coagulation and Fibrinolysis in Obstructive Sleep Apnoea

2021 ◽  
Vol 22 (6) ◽  
pp. 2834
Author(s):  
Andras Bikov ◽  
Martina Meszaros ◽  
Esther Irene Schwarz
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Systemic Inflammation ◽  
Sleep Apnoea ◽  
Future Research ◽  
Common Disease ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Coagulation And Fibrinolysis

Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.

scholarly journals Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

2019 ◽  
Vol 57 (9) ◽  
pp. 1406-1413
Author(s):  
Valeria Bisogni ◽  
Giuseppe Maiolino ◽  
Giulio Ceolotto ◽  
Martino F. Pengo ◽  
Rosario Marchese Ragona ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Plasma Catecholamines ◽  
Sleep Apnoea ◽  
Sleep Endoscopy ◽  
Upper Airways ◽  
Drug Induced ◽  
Chromatography Method ◽  
Plasma Aldosterone Concentration ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

scholarly journals Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

2020 ◽  
Vol 55 (4) ◽  
pp. 1901849 ◽  
Author(s):  
Samu Kainulainen ◽  
Brett Duce ◽  
Henri Korkalainen ◽  
Arie Oksenberg ◽  
Akseli Leino ◽  
...  
Keyword(s):  
Reaction Time ◽  
Obstructive Sleep Apnoea ◽  
Significant Risk ◽  
Sleep Apnoea ◽  
Type I ◽  
Median Reaction Time ◽  
Diagnostic Parameters ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Psychomotor Vigilance

Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance.We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea–hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression.A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20–1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26–1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21–6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05–1.07, p<0.01) and older age (ORrange 1.01–1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance.These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

scholarly journals Screening for obstructive sleep apnoea in professional drivers

Breathe ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 29364 ◽  
Author(s):  
Sophia E. Schiza ◽  
Izolde Bouloukaki
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Early Identification ◽  
Sleep Apnoea ◽  
Screening Tools ◽  
List Type ◽  
Objective Data ◽  
Sleep Study ◽  
Professional Drivers ◽  
Obstructive Sleep ◽  
Increased Risk

Professional drivers show a higher prevalence of obstructive sleep apnoea (OSA) compared with the general population. Furthermore, there is concern about the association between OSA and car crash risk given that drivers with OSA show an increased risk for car accidents. Despite this risk, OSA is often underdiagnosed and undertreated in this population, mainly due to lack of appropriate screening and sleep study referrals. Polysomnography (PSG), the gold standard test, is inappropriate for systematic screening because of its high expense, complexity and relative inaccessibility in this population. Therefore, there is a strong demand for good screening tools, including both subjective and objective data that may assist in early identification of possible OSA among professional drivers and, thus, aid in PSG examination referral and OSA management in an accredited sleep centre. However, there is considerable disagreement over screening methods and criteria for triggering a sleep study referral in different countries. There is also a strong need for further research in the area of OSA screening of commercial drivers in order to improve the diagnostic accuracy of screening tools and ensure that patients with OSA are accurately identified.Key pointsObstructive sleep apnoea (OSA) is often undiagnosed and undertreated in professional drivers.Professional drivers often under-report and are reluctant to report OSA symptoms.Barriers to OSA diagnosis include appropriate screening and sleep study referrals.Screening tools including both subjective and objective data may assist in early identification of possible OSA among professional drivers.Educational aimsTo evaluate screening instruments currently used to identify OSA risk in professional drivers.To provide guidance for developing an assessment strategy for OSA by professional driver medical examiners.

scholarly journals Obstructive sleep apnoea in a patient with chronic lymphocytic leukaemia

2019 ◽  
Vol 12 (7) ◽  
pp. e228763
Author(s):  
Gregory Paul Stimac ◽  
Asefa Jejaw Mekonnen
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Obstructive Sleep Apnoea ◽  
Lymphocytic Leukaemia ◽  
Oral Appliance ◽  
Sleep Apnoea ◽  
Caucasian Woman ◽  
Upper Airways ◽  
Airway Narrowing ◽  
Obstructive Sleep ◽  
Structural Abnormalities

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.

scholarly journals Upper airways sarcoidosis presenting as obstructive sleep apnoea

Thorax ◽  
1998 ◽  
Vol 53 (3) ◽  
pp. 232-233 ◽  
Author(s):  
R N H Shah ◽  
P R Mills ◽  
P J M George ◽  
J A Wedzicha
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Upper Airways ◽  
Obstructive Sleep

scholarly journals Obstructive Sleep Apnoea and Type 2 Diabetes

2010 ◽  
Vol 10 (1) ◽  
pp. 43 ◽  
Author(s):  
Abd A Tahrani ◽  
Asad Ali ◽  
◽  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Obstructive Sleep Apnoea ◽  
Medical Condition ◽  
Diabetes Type 2 ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnoea (OSA) is a very common medical condition that is associated with increased risk of cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycaemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycaemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

scholarly journals Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

2022 ◽  
Vol 8 ◽  
Author(s):  
Miuni Athauda Arachchige ◽  
Joerg Steier
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Team Approach ◽  
Cpap Therapy ◽  
Management Options ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Increased Risk

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

Exercise capacity, obesity and systemic inflammation in severe obstructive sleep apnoea

2017 ◽  
Author(s):  
Carmen C. Stroescu ◽  
Stefan Dumitrache-Rujinski ◽  
Ionela Erhan ◽  
Carmen Gigea ◽  
Irina Pele ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Obstructive Sleep Apnoea ◽  
Systemic Inflammation ◽  
Sleep Apnoea ◽  
Obstructive Sleep

scholarly journals Atherogenic Index of Plasma in Obstructive Sleep Apnoea

2021 ◽  
Vol 10 (3) ◽  
pp. 417
Author(s):  
Andras Bikov ◽  
Martina Meszaros ◽  
Laszlo Kunos ◽  
Alina Gabriela Negru ◽  
Stefan Marian Frent ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Disease Severity ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Atherogenic Index ◽  
Clinical Value ◽  
Sleep Study ◽  
Atherogenic Index Of Plasma ◽  
Obstructive Sleep ◽  
Cardiovascular Morbidity And Mortality

Background: Dyslipidaemia is well recognised in obstructive sleep apnoea (OSA) and could contribute to the development of cardiovascular disease (CVD). Atherogenic index of plasma (AIP) predicts cardiovascular morbidity and mortality better than the individual lipid levels. The aim of this study was to investigate the AIP in patients with OSA in relation with disease severity. Methods: Four hundred sixty-one patients with OSA and 99 controls participated in this study. AIP was assessed in the morning following a diagnostic sleep study. The association between lipid values and OSA were adjusted for age, gender, and body mass index. Results: Patients with OSA had higher AIP and triglyceride, and lower high-density lipoprotein cholesterol (HDL-C) levels (all p < 0.05). AIP significantly correlated with the Epworth Sleepiness Scale score (ρ = 0.19), the apnoea-hypopnoea index (ρ = 0.40) and oxygen desaturation index (ρ = 0.43, all p < 0.05). However, there was no relationship between the AIP and markers of sleep quality such as total sleep time, sleep period time, sleep efficiency, arousal index or percentage of REM sleep (all p > 0.05). AIP was not a better predictor for self-reported cardiovascular disease or diabetes than HDL-C. Conclusions: AIP is elevated in OSA and is related to disease severity. However, it does not seem to have an additional clinical value compared to HDL-C.

scholarly journals New frontiers in obstructive sleep apnoea

2014 ◽  
Vol 127 (4) ◽  
pp. 209-216 ◽  
Author(s):  
Najib T. Ayas ◽  
Allen A. J. Hirsch ◽  
Ismail Laher ◽  
T. Douglas Bradley ◽  
Atul Malhotra ◽  
...  
Keyword(s):  
Animal Models ◽  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Sleep Fragmentation ◽  
Current Evidence ◽  
Respiratory Disorder ◽  
Negative Consequences ◽  
Obstructive Sleep ◽  
Increased Risk

OSA (obstructive sleep apnoea), the most common respiratory disorder of sleep, is caused by the loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. This results in recurrent nocturnal asphyxia. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxaemia, which leads to poor quality sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Furthermore, patients with untreated sleep apnoea are at an increased risk of hypertension, stroke, heart failure and atrial fibrillation. Although there are many predisposing risk factors for OSA, including male gender, endocrine disorders, use of muscle relaxants, smoking, fluid retention and increased age, the strongest risk factor is obesity. The aim of the present review is to focus on three cutting-edge topics with respect to OSA. The section on animal models covers various strategies used to simulate the physiology or the effects of OSA in animals, and how these have helped to understand some of the underlying mechanisms of OSA. The section on diabetes discusses current evidence in both humans and animal models demonstrating that intermittent hypoxia and sleep fragmentation has a negative impact on glucose tolerance. Finally, the section on cardiovascular biomarkers reviews the evidence supporting the use of these biomarkers to both measure some of the negative consequences of OSA, as well as the potential benefits of OSA therapies.

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