Insulin resistance is associated with Sfrp5 in obstructive sleep apnea / Resistência à insulina está associada à Sfrp5 na apneia obstrutiva do sono

Abstract Introduction: Obstructive sleep apnea, a common disease, is usually complicated by insulin resistance and type 2 diabetes mellitus. Adipokine is considered to play an important role in the development of insulin resistance and type 2 diabetes mellitus in obstructive sleep apnea. Objective: To assess whether secreted frizzled-related protein 5, a new adipokine, is involved in untreated obstructive sleep apnea patients. Methods: Seventy-six subjects with obstructive sleep apnea and thirty-three control subjects without obstructive sleep apnea were recruited and matched in terms of body mass index and age. The fasting secreted frizzled-related protein 5 plasma concentration was tested using ELISA. In addition, the correlation between secreted frizzled-related protein 5 and the homeostasis model assessment of insulin resistance was obtained. Multiple linear regression analysis models with stepwise selection were performed to determine the independent associations between various factors and secreted frizzled-related protein 5. Results: Plasma secreted frizzled-related protein 5 levels were significantly lower in the obstructive sleep apnea group than in the control group (obstructive sleep apnea group: 28.44 ± 13.25 ng/L; control group: 34.16 ± 13.51 ng/L; p = 0.023). In addition, secreted frizzled-related protein 5 was negatively correlated with homeostasis model assessment of insulin resistance but positively correlated with the mean and lowest oxygen saturation with or without adjusting for age, gender, body mass index, neck circumference, waist circumference and waist-to-hip ratio. The multiple linear regression analysis showed there was an independent negative association between secreted frizzled-related protein 5 and homeostasis model assessment of insulin resistance. Conclusion: Secreted frizzled-related protein 5 was involved in obstructive sleep apnea and the decrease in secreted frizzled-related protein 5 was directly proportional to the severity of obstructive sleep apnea. There was an independent negative correlation between homeostasis model assessment of insulin resistance and secreted frizzled-related protein 5 in the obstructive sleep apnea group. Secreted frizzled-related protein 5 might be a therapeutic target for insulin resistance in obstructive sleep apnea.

Resumo Introdução: A apneia obstrutiva do sono, uma doença comum, é geralmente complicada com resistência à insulina e diabetes melito tipo 2. Acredita-se que a adipocina possa ter um papel importante no desenvolvimento de resistência à insulina e diabetes melito tipo 2 na apneia obstrutiva do sono. Objetivo: Avaliar se a proteína secretada relacionada ao receptor frizzled-5, uma nova adipocina, está envolvida em pacientes com apneia obstrutiva do sono não tratada. Método: Foram recrutados 76 indivíduos com apneia obstrutiva do sono e 33 indivíduos controle sem apneia obstrutiva do sono e pareados em relação a índice de massa corporal e idade. A concentração plasmática de proteína secretada relacionada ao receptor frizzled-5 foi testada em jejum com o teste Elisa. Além disso, obteve-se correlação entre a proteína secretada relacionada ao receptor frizzled-5 e o modelo de avaliação da homeostase de resistência à insulina. Modelos de análise de regressão linear múltipla com seleção stepwise foram feitos para determinar as associações independentes entre vários fatores e a proteína secretada relacionada ao receptor frizzled-5. Resultados: Os níveis plasmáticos de proteína secretada relacionada ao receptor frizzled-5 foram significativamente menores no grupo com apneia obstrutiva do sono do que no grupo controle (grupo com apneia obstrutiva do sono: 28,44 ± 13,25 ng/L; grupo controle: 34,16 ± 13,51 ng/L; p = 0,023). Além disso, a proteína secretada relacionada ao receptor frizzled-5 foi correlacionada negativamente com o modelo de avaliação da homeostase de resistência à insulina, mas se correlacionou positivamente com a média e a saturação mínima de oxigênio com ou sem ajuste para idade, gênero, índice de massa corporal, circunferência do pescoço, circunferência da cintura e relação cintura-quadril. A análise de regressão linear múltipla mostrou que houve uma associação negativa independente entre a proteína secretada relacionada ao receptor frizzled-5 e o modelo de avaliação da homeostase de resistência à insulina. Conclusões: A proteína secretada relacionada ao receptor frizzled-5 esteve envolvida na apneia obstrutiva do sono e sua diminuição foi diretamente proporcional à gravidade da apneia obstrutiva do sono. Houve uma correlação negativa independente entre o modelo de avaliação da homeostase de resistência à insulina e a proteína secretada relacionada ao receptor frizzled-5 no grupo da apneia obstrutiva do sono. A proteína secretada relacionada ao receptor frizzled-5 pode ser um alvo terapêutico para a resistência à insulina na apneia obstrutiva do sono.

Association of subclinical inflammation, glycated hemoglobin and risk for obstructive sleep apnea syndrome / Associação entre inflamação subclínica, hemoglobina glicada e risco de apneia obstrutiva do sono

ABSTRACT Objective To investigate the inter-relation between high sensitivity C-reactive protein and glycated hemoglobin in prediction of risk of obstructive sleep apnea. Methods We included all individuals participating in a check-up program at the Preventive Medicine Center of Hospital Israelita Albert Einstein in 2014. The Berlin questionnaire for risk of obstructive sleep apnea was used, and the high sensitivity C-reactive protein and glycated hemoglobin levels were evaluated. Results The sample included 7,115 participants (age 43.4±9.6 years, 24.4% women). The Berlin questionnaire showed changes in 434 (6.1%) individuals. This finding was associated with high sensitivity C-reactive protein and glycated hemoglobin levels (p<0.001). However, only the association between the Berlin questionnaire result and glycated hemoglobin remained significant in the adjusted multivariate analysis, for the traditional risk factors and for an additional model, including high-density lipoprotein cholesterol and triglycerides. Conclusion The glycated hemoglobin, even below the threshold for diagnosis of diabetes, is independently associated with obstructive sleep apnea syndrome, even after adjustment for obesity and C-reactive protein. These findings suggest a possible pathophysiological link between changes in insulin resistance and obstructive sleep apnea syndrome, independently from obesity or low-grade inflammation.

RESUMO Objetivo Investigar a inter-relação entre proteína C-reativa de alta sensibilidade e hemoglobina glicada na predição do risco de apneia obstrutiva do sono. Métodos Foram incluídos todos os indivíduos participantes do programa de check-up do Centro de Medicina Preventiva Hospital Israelita Albert Einstein em 2014. Foi aplicado o questionário de Berlin sobre risco de apneia do sono, e avaliadas as dosagens de hemoglobina glicada e proteína C-reativa de alta sensibilidade. Resultados Foram incluídos 7.115 participantes (idade 43,4±9,6 anos, 24,4% mulheres). A prevalência de alteração no questionário de Berlin foi de 434 (6,1%). A alteração do questionário de Berlin associou-se positivamente aos resultados da proteína C-reativa de alta sensibilidade e da hemoglobina glicada (p<0,001). No entanto, apenas a associação entre o resultado do questionário de Berlin e a hemoglobina glicada permaneceu significativa na análise multivariada ajustada tanto para fatores de risco tradicionais quanto para um modelo adicional, que incluiu também lipoproteína de alta densidade-colesterol (HDL-c) e triglicérides. Conclusão A hemoglobina glicada, mesmo em valores abaixo do critério diagnóstico para diabetes mellitus, está associada de forma independente ao risco para síndrome da apneia obstrutiva do sono, mesmo após ajuste para obesidade e proteína C-reativa. Estes achados sugerem possível ligação fisiopatológica entre alterações na resistência insulínica e a síndrome da apneia obstrutiva do sono, que independe da obesidade ou inflamação de baixo grau.

Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome

OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5≤AHI<15, (2) AHImid group: 15<AHI≤30, and (3) AHIhigh group: AHI>30. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (β=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (β=0.194, p=0.010). CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome. .

Arginase activity and nitric oxide levels in patients with obstructive sleep apnea syndrome

OBJECTIVE: Obstructive sleep apnea syndrome is characterized by repetitive obstruction of the upper airways, and it is a risk factor for cardiovascular diseases. There have been several studies demonstrating low levels of nitric oxide in patients with obstructive sleep apnea syndrome compared with healthy controls. In this study, we hypothesized that reduced nitric oxide levels would result in high arginase activity. Arginase reacts with L-arginine and produces urea and L-ornithine, whereas L-arginine is a substrate for nitric oxide synthase, which produces nitric oxide. METHODS: The study group consisted of 51 obstructive sleep apnea syndrome patients (M/F: 43/8; mean age 49±10 years of age) and 15 healthy control subjects (M/F: 13/3; mean age 46±14 years of age). Obstructive sleep apnea syndrome patients were divided into two subgroups based on the presence or absence of cardiovascular disease. Nitric oxide levels and arginase activity were measured via an enzyme-linked immunosorbent assay of serum samples. RESULTS: Serum nitric oxide levels in the control subjects were higher than in the obstructive sleep apnea patients with and without cardiovascular diseases (p<0.05). Arginase activity was significantly higher (p<0.01) in obstructive sleep apnea syndrome patients without cardiovascular diseases compared with the control group. Obstructive sleep apnea syndrome patients with cardiovascular diseases had higher arginase activity than the controls (p<0.001) and the obstructive sleep apnea syndrome patients without cardiovascular diseases (p<0.05). CONCLUSION: Low nitric oxide levels are associated with high arginase activity. The mechanism of nitric oxide depletion in sleep apnea patients suggests that increased arginase activity might reduce the substrate availability of nitric oxide synthase and thus could reduce nitric oxide levels. .

Big endotelina-1 e óxido nítrico em pacientes idosos hipertensos com e sem síndrome da apneia-hipopneia obstrutiva do sono / Big endothelin-1 and nitric oxide in hypertensive elderly patients with and without obstructive sleep apnea-hypopnea syndrome

FUNDAMENTO: O papel do estresse oxidativo em pacientes idosos hipertensos com síndrome de apneia-hipopneia obstrutiva do sono (SAHOS) é desconhecido. Objetivo: O objetivo foi avaliar os níveis de Big Endotelina-1 (Big ET-1) e Óxido Nítrico (NO) em pacientes idosos hipertensos com e sem SAHOS moderada a grave. MÉTODOS: Os voluntários permaneceram internados durante 24 horas. Obtivemos os seguintes dados: índice de massa corporal (IMC), Monitorização Ambulatorial da Pressão Arterial (MAPA) - 24 horas, e medicação atual. Sangue arterial foi coletado às 7:00 h e às 19:00 h para determinar níveis plasmáticos de NO e Big ET-1. A oximetria de pulso foi realizada durante o sono. A correlação de Pearson, Spearman e análise de variância univariada foram utilizadas para a análise estatística. RESULTADOS: Foram estudados 25 sujeitos com SAHOS (grupo 1) e 12 sem SAHOS (grupo 2), com idades de 67,0 ± 6,5 anos, 67,8 ± 6,8 anos, respectivamente. Não foram observadas diferenças significativas entre os grupos em IMC; no número de horas de sono; PA diastólica e sistólica em 24 h; PA de vigília; PA no sono; ou medicamentos usados para controlar a PA. Não foram detectadas diferenças nos níveis de NO e Big ET-1 plasmáticos às 19:00 h, mas às 7:00 h os níveis de de Big ET-1 foram mais altos (p = 0,03). No grupo 1, correlação negativa também foi observada entre a saturação de oxihemoglobina arterial média e a PA sistólica - 24 horas (p = 0,03, r = -0,44), e Big ET-1 (p = 0,04, r = 0,41). CONCLUSÕES: Na comparação entre idosos hipertensos com e sem SAHOS com PA e IMC semelhantes, observou-se níveis mais elevados de Big ET-1 após o sono no grupo SAHOS. Os níveis de NO não diferiram entre os pacientes hipertensos com ou sem SAHOS.

BACKGROUND: The role of oxidative stress in hypertensive elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is unknown. OBJECTIVE: The purpose was to evaluate the levels of big endothelin-1 (Big ET-1) and nitric oxide (NO) in elderly hypertensive patients with and without moderate to severe OSAHS. METHODS: Volunteers were hospitalized for 24 h. We obtained the following data: body mass index (BMI); 24-ambulatory blood pressure monitoring; and current medication. Arterial blood was collected at 7pm and 7am for determining plasma NO and Big ET-1 levels. Pulse oximetry was performed during sleep. Pearson's or Spearman's correlation and univariate analysis of variance were used for statistical analysis. RESULTS: We studied 25 subjects with OSAHS (group 1) and 12 without OSAHS (group 2) aged 67.0 ± 6.5 years and 67.8±6.8 years, respectively. No significant differences were observed between the groups in BMI; number of hours of sleep; 24-h systolic and diastolic BPs; awake BP, sleep BP and medications to control BP between groups. No differences were detected in plasma Big ET-1 and NO levels at 19:00 h, but plasma Big ET-1 levels at 7:00 h were higher in group 1 (p =0.03). In group 1, a negative correlation was also observed between the mean arterial oxyhemoglobin saturation level, 24-h systolic BP (p = 0.03, r = -0.44), and Big ET-1 (p = 0.04, r = -0.41). CONCLUSIONS: On comparing elderly hypertensive patients with and without OSAHS having similar BP and BMI, we observed higher Big ET-1 levels After sleep in the OSAHS group. NO levels did not differ between the hypertensive patients with or without OSAHS.

Influence of obstructive sleep apnea on serum butyrylcholinesterase activity and ischemia-modified albumin levels

OBJECTIVE: To investigate the effect of obstructive sleep apnea and continuous positive airway pressure treatment on serum butyrylcholinesterase activity and ischemia-modified albumin levels. METHODS: Thirty-two patients with obstructive sleep apnea and 30 age- and sex-matched controls were enrolled and underwent a diagnostic polysomnogram. The serum butyrylcholinesterase activity, ischemia-modified albumin levels, metabolic parameters, and polysomnography scores were detected and evaluated. Nine patients were studied before and after treatment with continuous positive airway pressure. RESULTS: The serum ischemia-modified albumin levels were significantly higher and the butyrylcholinesterase activity was significantly lower in patients with obstructive sleep apnea than in the controls (p<0.001). The continuous positive airway pressure treatment decreased the modified albumin levels and elevated the buthrylcholinesterase activity (p = 0.019 and p = 0.023, respectively). The modified albumin levels were positively correlated with the apnea-hypopnea index (r = 0.462, p = 0.008) at baseline. Elevated ischemia-modified albumin levels can be more accurate than butyrylcholinesterase activity at reflecting the presence of obstructive sleep apnea. Receiver operating characteristic curves revealed a significant difference between the areas under the curve 0.916 for ischemia-modified albumin and 0.777 for butyrylcholinesterase (z = 2.154, p = 0.031). CONCLUSION: The elevated ischemia-modified albumin level was significantly associated with obstructive sleep apnea and was more sensitive than butyrylcholinesterase activity in reflecting obstructive sleep apnea. The continuous positive airway pressure treatment helped to ameliorate the imbalance. .

Cognition and biomarkers of oxidative stress in obstructive sleep apnea

OBJECTIVES: The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS: This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old) with obstructive sleep apnea and 13 controls (37.3±6.9 years old). All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS: The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006), superoxide dismutase (p<0.001) and vitamin B11 (p<0.001), as well as higher concentrations of homocysteine (p<0.02). Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F = 15.9; p = 0.002) and this correlation remained after controlling for age and body mass index (F = 6.3, p = 0.01). A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F = 7.9; p = 0.01) was also observed. CONCLUSIONS: Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population. .

Comparação do perfil clínico de crianças não obesas com apneia do sono e ronco / Comparing the clinical profile of non obese children with sleep apnea and snoring

Poucos trabalhos na literatura estudam repercussões cardiovasculares e metabólicas da Síndrome da Apneia Obstrutiva do Sono (SAOS) em crianças. OBJETIVO: Avaliar o perfil metabólico de crianças não obesas com SAOS. MÉTODO: Foram incluídas 52 crianças (21 meninas e 31 meninos), divididas em dois grupos: SAOS (28 crianças) e Ronco (22 crianças) de acordo com a polissonografia. As crianças foram submetidas a exame otorrinolaringológico completo, medidas de peso e estatura e aferição da pressão arterial. Foram coletadas amostras de sangue para dosagem de hemoglobina, hematócrito, glicemia de jejum, insulina de jejum, triglicérides, colesterol total e frações, TSH e T4 livre. As variáveis foram comparadas entre os grupos e também dentro do grupo SAOS de acordo com o grau de gravidade da síndrome. RESULTADOS: Todas as crianças apresentaram índices de PA e exames de sangue não alterados. Porém percebemos que existe diferença estatística entres os grupos nos resultados de: Hemoglobina, Hematócrito, HDL e VLDL. Somente o VLDL apresenta valores maiores no grupo SAOS. Não existe diferença estatística entre as variáveis de acordo com a gravidade da SAOS. CONCLUSÃO: Não foram encontradas alterações nos exames metabólicos e nos índices de pressão arterial das crianças não obesas com SAOS.

Few studies in the literature have looked into the cardiovascular and metabolic effects of Obstructive Sleep Apnea Syndrome (OSAS) in children. OBJECTIVE: This study aims to evaluate the metabolic profile of non-obese children with OSAS. METHODS: Fifty-two children were enrolled in this study, 21 girls and 31 boys. Patients were divided into two groups: OSAS (28 children) and Snore (22 children) according to polysomnographic evaluation. All children were submitted to ENT examination, measurements of weight, height and blood pressure. Blood samples were tested for hemoglobin, hematocrit, fasting glucose, fasting insulin, triglycerides, total cholesterol, HDL, LDL, VLDL, TSH and T4. The gathered data sets were compared between groups and also within the OSAS group according to the severity of the syndrome. RESULTS: The children from both groups had no alterations in blood pressure levels. The results of the blood tests were normal for both groups. Results of hemoglobin, hematocrit, and HDL were all significantly higher in the Snore group when compared to the OSAS group; by their turn, VLDL levels were higher in the OSAS group. There was no statistical difference between the groups based on OSAS severity. CONCLUSION: Non-obese children with OSAS present no significant alterations in metabolic tests or blood pressure levels.

Oxidative stress and quality of life in elderly patients with obstructive sleep apnea syndrome: are there differences after six months of Continuous Positive Airway Pressure treatment?

OBJECTIVES: This study evaluated the effect of Continuous Positive Airway Pressure treatment on oxidative stress parameters and the quality of life of elderly patients with obstructive sleep apnea syndrome. METHODS: In total, 30 obstructive sleep apnea syndrome patients and 27 subjects without obstructive sleep apnea syndrome were included in this study. Both groups underwent quality of life and oxidative stress evaluations at baseline and after six months. Polysomnography was performed in both groups at baseline and a second time in the obstructive sleep apnea syndrome group after six months of Continuous Positive Airway Pressure treatment. All of the variables were compared between the control and obstructive sleep apnea syndrome groups in this prospective case-control study. RESULTS: The baseline concentrations of the antioxidant enzyme catalase were higher in the obstructive sleep apnea syndrome group than the control group. After Continuous Positive Airway Pressure treatment, the obstructive sleep apnea syndrome group exhibited a reduction in the level of oxidative stress, as indicated by a decrease in the level of lipid peroxidation measured by the malondialdehyde (MDA) concentration [pre: 2.7 nmol malondialdehyde/mL (95% 1.6-3.7) vs. post: 1.3 nmol MDA/mL (0.7-1.9), p<0.01]. Additionally, improvements were observed in two domains covered by the SF-36 questionnaire: functional capacity [pre: 77.4 (69.2-85.5) vs. post: 83.4 (76.9-89.9), p = 0.002] and pain [pre: 65.4 (52.8-78.1) vs. post: 77.8 (67.2-88.3), p = 0.004]. CONCLUSION: Our study demonstrated that the use of Continuous Positive Airway Pressure to treat obstructive sleep apnea syndrome in elderly patients reduced oxidative stress and improved the quality of life.

Avaliação dos níveis séricos de testosterona em pacientes com síndrome da apneia obstrutiva do sono / Evaluation of testosterone serum levels in patients with obstructive sleep apnea syndrome

Homens com síndrome da apneia obstrutiva do sono (SAOS) podem apresentar diminuição dos níveis de testosterona devido à hipóxia. OBJETIVOS: Relacionar os níveis séricos da testosterona, em pacientes com SAOS, com parâmetros clínico-laboratoriais. MATERIAL E MÉTODOS: Foram revisados 103 prontuários de pacientes com SAOS, entre os anos de 2002 e 2009, e coletados os seguintes dados: idade à época da realização da polissonografia, valores do Hematócrito e Hemoglobina, nível sérico da testosterona total, IMC, índice de apneia/hipopneia(IAH) e SatO2. FORMA DO ESTUDO: Estudo de casos retrospectivo em corte transversal. RESULTADOS: 79 pacientes (77 por cento) não apresentaram alteração hormonal e 24 (23 por cento) apresentaram níveis séricos inferiores. Dos pacientes com testosterona normal 70 por cento estavam com sobrepeso, enquanto que 63 por cento com testosterona alterada apresentaram obesidade grau I (p<0,05). Os pacientes com testosterona alterada apresentaram as dosagens médias do Ht e da Hb e dos níveis médios do andrógeno significantemente inferiores aos dos pacientes sem alteração androgênica. A média do IMC dos pacientes com alteração hormonal foi significativamente maior que a média daqueles sem alteração. CONCLUSÃO: A relação entre o perfil sérico da testosterona matinal e a obesidade e, em menor grau, a idade, o IAH e a hipóxia, podem ser responsáveis pela supressão central da testosterona nesses pacientes. A queda dos valores hematimétricos pode ser relacionada aos baixos níveis circulantes da testosterona.

Males with obstructive sleep apnea syndrome (OSAS) may present decreased testosterone serum levels because of hypoxemia. AIM: To correlate testosterone levels in OSAS patients with laboratory parameters. MATERIAL AND METHODS: 103 registries of OSAS patients were reviewed from 2002 to 2009. The following data collected: age when polysomnography was done, hematocrit and hemoglobin levels, total testosterone serum levels, BMI, apnea/hypopnea index (AHI), and O2 saturation. STUDY DESIGN: A cross-sectional retrospective case study. RESULTS: 79 patients (77 percent) had no hormonal changes, and 24 patients (23 percent) had decreased serum levels. In patients with normal testosterone levels, 70 percent were overweight; 63 percent with altered testosterone levels had obesity grade I (p<0.05). Patients with altered testosterone levels had significantly lower average doses of Ht, Hb and androgen compared to patients without altered androgen levels. The average BMI of patients with altered hormone levels was significantly higher compared to patients with normal hormone levels. CONCLUSIONS: The relationship between morning testosterone levels and obesity, and to a lesser degree age, AHI and hypoxemia may be the cause of central suppression of testosterone in these patients. Decreased blood HT and HB levels may be related to lower levels of circulating testosterone.

Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome

The prevalence of obstructive sleep apnea syndrome [OSAS] and metabolic syndrome is increasing worldwide, in part linked to epidemic of obesity. The purposes of this study were to establish the rate of metabolic syndrome and to compare fibrinogen, homocysteine, high-sensitivity C-reactive protein [hsCRP], leptin levels, and homeostasis model assessment insulin resistance [HOMA-IR] in the obese patients with and without OSAS. The study population included 36 consecutive obese patients with OSAS [23 males; mean age, 50.0 +/- 19.7 years], and 34 obese patients without OSAS [17 males; mean age, 49.7 +/- 11.1 years] were enrolled as control group. Metabolic syndrome was investigated; fibrinogen, homocysteine, CRP, and leptin levels were measured, and IR was assessed. Metabolic syndrome was found in 17 [47.2%] obese OSAS patients, whereas only 29.4% of obese subjects had metabolic syndrome [P > 0.05]. Obese patients with OSAS had significantly higher mean levels of triglyceride [P< 0.001], total-cholesterol [P = 0.003], low-density lipoprotein-cholesterol [P = 0.001], fasting glucose [P = 0.01], HOMA-IR [P<0.001], thyroid-stimulating hormone [P = 0.03], fibrinogen [P < 0.003], hsCRP [P <0.001], and leptin [P = 0.03] than control group. Besides, leptin level was positively correlated with waist [r = 0.512, P = 0.03] and neck circumferences [r = 0.547, P = 0.03], and fasting glucose [r = 0.471, P = 0.04] in OSAS patients, but not in obese subjects. This study demonstrated that obese OSAS patients may have an increased rate of metabolic syndrome and higher levels of serum lipids, fasting glucose, IR, leptin, fibrinogen, and hsCRP than obese subjects without sleep apnea. Thus, clinicians should be encouraged to systematically evaluate the presence of metabolic abnormalities in OSAS and vice versa

Estudio piloto de marcadores inflamatorios en el sindrome de apnea obstructiva del sueño / Pilot study of inflammatory markers in the syndrome of obstructive sleep apnea

El síndrome de Apnea Obstructiva del Sueño (SAOS), consiste en la aparición repetida de episodios de obstrucción faríngea durante el sueño como consecuencia de un colapso de la vía respiratoria. La respuesta fisiológica a la hipoxia intermitente crónica es la generación de una respuesta inflamatoria local y sistémica. Se han evidenciado cambios importantes a nivel cardiovascular en pacientes con SAOS; sin embargo, se desconocen cuáles marcadores séricos y genéticos pudieran ser de utilidad. En el presente estudio, se presentan 15 marcadores séricos y 3 genéticos (IL-6, IL-1β y TNF-α) en un grupo de cinco pacientes para determinar cuáles pueden ser los marcadores de interés en la aparición y en el desarrollo de esta patología respiratoria. Se proponen como marcadores los niveles séricos: proteína C reactiva, TNFα, IL-6, el receptor soluble de TNF I, sCD62, sCD154, nitrotirosina y anti-oxLDL. Los niveles de IL-1 β, el receptor de TNF soluble II, sCD25, sCD54, nitritos y nitratos no parecieran ser buenos marcadores en SAOS. Los estudios genéticos no fueron concluyentes.

Obstructive sleep apnea syndrome (OSAS) is a repeated sequences of pharynx obstruction during sleep as a consequence of airway collapse. The physiological response to the desaturation is the generation of a local and systemic inflammatory immune response. Important changes at cardiovascular levels in patients with OSAS have been observed; however, it is not know which serum or genetic parameters could be useful. In the present study, we present 15 serum and 3 genetic (IL-6, IL-1β y TNF-α) markers in a group of five patients in order to determine which marker could be useful to study the genesis and progression of this respiratory pathology. The proposed serum markers are C reactive proteín, TNFα, IL-6, soluble de TNF receptor I, sCD62, sCD154, nitrotirosine and anti-oxLDL. The levels of IL-1 β, soluble TNF receptor II, sCD25, sCD54, nitrite y nitrate do not seem to be good markers for OSAS. The genetic studies were not conclusive.

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme / Prevalence of obstructive sleep apnea in children and adolescents with sickle cell anemia

OBJETIVO: Estimar a prevalência da síndrome da apneia obstrutiva do sono (SAOS) em crianças e adolescentes com anemia falciforme (AF) e investigar a possível correlação entre hemoglobina anual média e tempo total de sono com SpO2 < 90 por cento e tempo total de sono com SpO2 < 80 por cento, assim como investigar a possível correlação entre o índice de apneia-hipopneia (IAH) e episódios de crise álgica. MÉTODOS: Participaram 85 pacientes com AF, que responderam a um questionário, foram avaliados por um pediatra e um otorrinolaringologista, e submetidos a estudo polissonográfico. O diagnóstico de SAOS foi definido como IAH > 1. RESULTADOS: A prevalência da SAOS foi 10,6 por cento. Observou-se uma correlação negativa entre hemoglobina anual média e tempo total de sono com SpO2 < 90 por cento (r = µ0,343; p = 0,002) e tempo total de sono com SpO2 < 80 por cento (r = µ0,270; p = 0,016). Não foi observada associação entre IAH e episódios de crise álgica. CONCLUSÕES: A prevalência da SAOS nesta população foi alta (10,6 por cento). Portanto, é importante identificar precocemente os sinais de SAOS e avaliar hemoglobina anual média, devido à correlação inversa entre essa e o tempo total de sono com SpO2 < 90 por cento ou < 80 por cento.

OBJECTIVE: To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90 percent, as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80 percent; and to investigate the possible correlation between apnea-hypopnea index (AHI) and painful crisis. METHODS: The study involved 85 patients with SCA. The patients completed a questionnaire, were submitted to polysomnography and underwent clinical evaluation (by a pediatrician and an otolaryngologist). An AHI > 1 was considered indicative of a diagnosis of OSAS. RESULTS: The prevalence of OSAS was 10.6 percent. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90 percent (r = µ0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80 percent (r = µ0.270; p = 0.016). There was no association between AHI and painful crisis. CONCLUSIONS: The prevalence of OSAS in this population was high (10.6 percent). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO2 < 90 percent or < 80 percent.

Contribuição da apnéia obstrutiva do sono para o estresse oxidativo da obesidade / Obstructive sleep apnea contribution to oxidative stress in obesity

OBJETIVO: O objetivo do trabalho foi verificar a influência da apnéia obstrutiva do sono (AOS) sobre o estresse oxidativo da obesidade e o efeito do pressão positiva de vias aéreas (CPAP) nestes pacientes. MÉTODOS: Os pacientes com IMC > 30 kg/m² foram divididos em: a) grupo 1: dez indivíduos sem AOS; b) grupo 2: dez portadores de AOS que não fizeram o uso do CPAP; e c) grupo 3: nove portadores de AOS que fizeram uso do CPAP durante dois meses. RESULTADOS: O grupo 3 apresentou, após o uso do CPAP, redução na produção de superóxido (SO) [13,2 (10,3-19,6) versus 10,5 (5,8-11,8) nmoles O2-/2×10(6) PMN] e aumento na síntese de nitritos e nitratos séricos [24,5 (16,7-33,5) versus 49,5 (39,3-58,1) µM]. Também foi verificada correlação positiva entre o índice apnéia-hipopnéia (IAH) e a produção de SO (r = 0,726) e negativa entre o IAH e os níveis de nitritos e nitratos séricos (r = -0,867). CONCLUSÕES: O estresse oxidativo presente na obesidade é exacerbado pela AOS e o uso do CPAP promove aumento nos níveis de nitritos e nitratos séricos, bem como reduções na produção de SO neste pacientes.

OBJECTIVE: The aim of this paper was to check the influence of obstructive sleep apnea (OSA) on obesity oxidative stress and CPAP (Continuous Positive Airway Pressure) effect on oxidative stress and in these patients. METHODS: Twenty nine male patients considered obese (BMI > 30kg/m²) were divided into 3 groups: a) Group I: 10 OSA free patients (apnea-hipopnea index (AHI) < 5); b) Group 2: 10 with moderate to serious OSA (AHI > 20); c) Group 3: 9 with OSA from moderate to serious (AHI > 20) using CPAP,, minimum 4 hours/night for 2 months. RESULTS: Significant differences before and after CPAP usage were observed in group 3 in the following variables: reduction of superoxide (SO) production [13,2 (10,3-19,6) vs. 10,5 (5,8-11,8) nmoles O2- /2x10(6) PMN] and increase in serum nitrite/nitrates levels [24,5 (16,7-33,5) vs. 49,5 (39,3-58,1) µM]. Positive correlation between Apnea-Hypopnea Index (AHI) and SO (r = 0,726) and negative correlation was observed between AHI and serum nitrite/nitrates levels (r = - 0,867). CONCLUSIONS: In conclusion, oxidative stress present in obesity is elevated by OSA and CPAP treatment can rise the levels of SO and can decrease serum nitrite/nitrates present in obese patients with OSA.

O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono / The effect of adenotonsillectomy on oxygen saturation in children with sleep disordered breathing

OBJETIVO: Realizar uma avaliação do efeito da adenotonsilectomia na saturação de oxigênio medida por oximetria de pulso noturna em crianças com distúrbios respiratórios do sono. MÉTODOS: Foi realizado um estudo tipo antes e após a intervenção cirúrgica, utilizando a oximetria de pulso noturna como método de avaliação. Foram avaliadas 31 crianças com suspeita de distúrbios respiratórios do sono e indicação clínica de adenotonsilectomia. RESULTADOS: Vinte e sete crianças completaram o estudo. A idade média foi de 5,2 ± 1,8 anos. Dezoito eram do sexo masculino (66,7 por cento). Vinte e três (85,2 por cento) crianças apresentavam, no exame físico, hiperplasia das tonsilas palatinas graus 3 e 4. Houve melhora significativa no índice de dessaturação de oxigênio (IDO) pós-operatório quando comparado com o pré-operatório (p < 0,001). CONCLUSÃO: A adenotonsilectomia melhorou significativamente a saturação de oxigênio, medida pela oximetria de pulso noturna em crianças com distúrbios respiratórios do sono.

OBJECTIVE: To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. METHODS: A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. RESULTS: A total of 27 children completed the study. The mean age was 5.2 ± 1.8 years, and 18 (66.7 percent) of them were male. Upon physical examination, 23 (85.2 percent) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95 percent CI: 0.5-1.3 vs. OR = 1.63; 95 percent CI: 1.1-2.4; p < 0.001). CONCLUSION: Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.