ABSTRACT
INTRODUCTION: Obstructive sleep apnea (OSA) and severe obesity share a common pathophysiological phenomenon, systemic and tissue hypoxia. Hypoxaemia modifies microRNA expression, particularly, extracellular vesicles microRNAs which are involved in the progression of cardiovascular diseases, metabolic syndrome and cancer. We aim to evaluate extracellular vesicle miRNAs among patients with severe obesity with and without OSA and the effect of OSA and severe obesity treatment: continuous positive airway pressure (CPAP) and bariatric surgery. METHODS: Patients were selected from the Epigenetics Modification in Morbid Obesity and Obstructive Sleep Apnea (EPIMOOSA) study (NCT03995836), a prospective observational study of patients undergoing bariatric surgery. Patients were divided into OSA (Apnea-hyponea index (AHI) > 10) and non-OSA (AHI < 10). Patients with OSA were treated with CPAP for 6 months. Then, all patients had bariatric surgery and re-evaluated 12 months later. At each visit, blood samples were obtained for biobanking. Subsequently, extracellular vesicles were extracted, and then, miRNA expression was analysed. RESULTS: 15 patients with OSA and 9 without OSA completed the protocol. At baseline, patients with OSA showed higher miR16, miR126 and miR320 (p < 0.05) and lower miR223 expression (p < 0.05) than those without OSA. In patients with severe obesity and OSA, after 6 months with CPAP, we observed a significant decrease in miR21 (p < 0.01), miR126 (p < 0.001) and miR320 (p < 0.001), with no changes in any miRNA in patients without OSA. No changes were detected in any miRNA after 6 months of bariatric surgery in patients with or without OSA. CONCLUSION: Co-existance of OSA and severe obesity alters the profile of extracellular vesicle miRNAs. Bariatric surgery and weight loss did not reverse this effect meanwhile the treatment with CPAP in patients with severe obesity and OSA showed a recovery outcome in those extracellular vesicle miRNAs. Those facts remark the need for OSA screening in patients with severe obesity. CLINICAL TRIAL REGISTRATION: The study has also been registered at ClinicalTrials.gov identifier: NCT03995836.
Subject(s)
Bariatric Surgery , MicroRNAs , Obesity, Morbid , Sleep Apnea, Obstructive , Humans , Obesity, Morbid/complications , Obesity, Morbid/surgery , Biological Specimen Banks , Continuous Positive Airway Pressure , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , Sleep Apnea, Obstructive/diagnosisABSTRACT
UNLABELLED: In order to assess bone loss in uremic renal osteodystrophy (URO), we have measured total and regional mineral bone density (TMBD and RMBD, respectively) by using bioenergetic radiographic absorptiometry (BRA) in a population of patients on hemodialysis (HD). Thirty one patients have been evaluated, with a mean age of 55 and a mean time on hemodialysis of 31 mo. (range 2-120 mo.). Bone absorptiometry consisted of measurement of total body (TMBD) and regional analysis of head, upper limb, lower limb, ribs, pelvis and spine (RMBD). TMBD inversely correlated with alkaline phosphatase and parathyroid hormone levels; it also correlated inversely with age, but only in females. TMBD showed significantly lower values in HD patients than in chronic renal failure patients and controls. All the regional parameters correlated inversely with alkaline phosphatase levels. CONCLUSION: BRA is a non invasive method which quantifies TMBD and RMBD with a very low radiologic exposure and correlates adequately with levels of alkaline phosphatase and parathyroid hormone in URO. TMBD measures total cortical bone of the skeleton with good accuracy, RMBD allows a selective analysis of regional bone changes and a evolutive control in these patients, given the nonuniform decrease of mineral density in the skeleton.
