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      Obstructive sleep apnea and comorbidities: a dangerous liaison

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          Abstract

          Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

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          Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

          K Alberti, Robert H. Eckel, Scott M. Grundy … (2009)
          A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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            Insulin sensitivity: modulation by nutrients and inflammation.

            Simon Schenk, Maziyar Saberi, Jerrold Olefsky (2008)
            Insulin resistance is a major metabolic feature of obesity and is a key factor in the etiology of a number of diseases, including type 2 diabetes. In this review, we discuss potential mechanisms by which brief nutrient excess and obesity lead to insulin resistance and propose that these mechanisms of action are different but interrelated. We discuss how pathways that "sense" nutrients within skeletal muscle are readily able to regulate insulin action. We then discuss how obesity leads to insulin resistance via a complex interplay among systemic fatty acid excess, microhypoxia in adipose tissue, ER stress, and inflammation. In particular, we focus on the hypothesis that the macrophage is an important cell type in the propagation of inflammation and induction of insulin resistance in obesity. Overall, we provide our integrative perspective regarding how nutrients and obesity interact to regulate insulin sensitivity.
            Article 0 comments Cited 323 times – based on 0 reviews     Review now
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              Obstructive sleep apnoea syndrome.

              Patrick Levy, Malcolm Kohler, Walter McNicholas … (2015)
              Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.
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                Author and article information

                Contributors
                Maria R. Bonsignore:
                ORCID: http://orcid.org/0000-0002-4875-7796
                marisa@ibim.cnr.it
                Pierpaolo Baiamonte: maiden59.mail@libero.it
                Emilia Mazzuca: emilia88@inwind.it
                Alessandra Castrogiovanni: alecastro.pneumo@gmail.com
                Oreste Marrone: oreste.marrone@ibim.cnr.it
                Journal
                Journal ID (nlm-ta): Multidiscip Respir Med
                Journal ID (iso-abbrev): Multidiscip Respir Med
                Title: Multidisciplinary Respiratory Medicine
                Publisher: BioMed Central (London )
                ISSN (Print): 1828-695X
                ISSN (Electronic): 2049-6958
                Publication date (Electronic): 14 February 2019
                Publication date PMC-release: 14 February 2019
                Publication date Collection: 2019
                Volume: 14
                Electronic Location Identifier: 8
                Affiliations
                [1 ]ISNI 0000 0004 1762 5517, GRID grid.10776.37, Division of Respiratory Medicine, Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), , University Hospital Paolo Giaccone, University of Palermo, ; Piazza delle Cliniche, 2, 90100 Palermo, Italy
                [2 ]ISNI 0000 0004 1760 9517, GRID grid.419470.f, National Research Council (CNR), , Institute of Biomedicine and Molecular Immunology (IBIM), ; Palermo, Italy
                [3 ]ISNI 0000 0004 0630 8065, GRID grid.489371.0, Clinic for Pneumology und Allergology, Center of Sleep Medicine and Respiratory Care, , Bethanien Hospital, ; Solingen, Germany
                Author information
                http://orcid.org/0000-0002-4875-7796
                Article
                Publisher ID: 172
                DOI: 10.1186/s40248-019-0172-9
                PMC ID: 6374907
                PubMed ID: 30809382
                SO-VID: fd9c179d-dbaf-40f8-aff9-0151cb5a024a
                Copyright © © The Author(s). 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 21 November 2018
                Date accepted : 20 January 2019
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Respiratory medicine
                Keywords: mortality,prognosis,cardiovascular disease,diabetes,asthma,copd,cancer
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: mortality, prognosis, cardiovascular disease, diabetes, asthma, copd, cancer

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