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Central sleep apnea in obese children with sleep disordered breathing.

Int J Obes (Lond). 2013 Sep 19;

Authors: Chou CH, Kang KT, Weng WC, Lee PL, Hsu WC

Abstract
Objectives:In contrast to obstructive sleep apnea (OSA), central sleep apnea (CSA) has received lesser attention in the obese children. Because pediatric CSA is more prevalent than expected and adversely impacts health, this study aims to elucidate the major factors associated with central apnea index (CAI), and compare CSA between obese and non-obese children.Methods:Retrospective analysis was performed in a tertiary referral medical center. Children with sleep disordered breathing (SDB) ranging from 2 to 18 years old were enrolled. All participants completed history taking, otolaryngological examination, and overnight polysomnography. CSA was defined as having CAI exceeding 1/hr. CAI and the prevalence of CSA were analyzed in children of different age groups, weight statuses, and adenotonsillar sizes.Results:A total of 487 cases were included. The prevalence of CSA was 13.3% (65/487). CAI was negatively correlated with age (r=-0.32, P<0.001). Obese children had a significantly lower CAI than that of non-obese ones (0.20±0.36/hr vs 0.48±0.82/h, P<0.001). Multiple linear regression analysis demonstrated a relationship among CAI, age, and obesity by 'CAI=0.883-0.055 × Age -0.22 × (Obesity)'.Conclusions:In children with SDB, younger ones have a significantly higher CAI than older ones. Additionally, obese children had a lower CAI than non-obese ones.International Journal of Obesity accepted article preview online, 19 September 2013. doi:10.1038/ijo.2013.184.

PMID: 24048143 [PubMed - as supplied by publisher]

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Obstructive Sleep Apnea Syndrome, Vascular Pathology, Endothelial Function and Endothelial Cells and Circulating Microparticles.

Arch Med Res. 2013 Sep 16;

Authors: Stiefel P, Sánchez-Armengol MA, Villar J, Vallejo-Vaz A, Moreno-Luna R, Capote F

Abstract
Accelerated atherosclerosis and increased cardiovascular risk are frequently reported in patients with obstructive sleep apnea (OSA) syndrome. In this article the authors attempt a review of the current understanding of the relationship between vascular risk and OSA syndrome based on large cohort studies that related the disease to several cardiovascular risk factors and vascular pathologies. We also discuss the pathophysiological mechanisms that may be involved in this relationship, starting with endothelial dysfunction and its mediators. These include an increased oxidative stress and inflammation as well as several disorders of coagulation and lipid metabolism. Moreover, circulating microparticles from activated leukocytes (CD62L_ MPs) are higher in patients with OSA and there is a positive correlation between circulating levels of CD62L_ MPs and nocturnal hypoxemia severity. Finally, circulating level of endothelial microparticles and circulating endothelial cells seem to be increased in patients with OSA. Also, endothelial progenitor cells are reduced and plasma levels of the vascular endothelial growth factor are increased.

PMID: 24051041 [PubMed - as supplied by publisher]

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Enhanced cardiorespiratory coupling in patients with obstructive sleep apnea following continuous positive airway pressure treatment.

Sleep Med. 2013 Aug 3;

Authors: Chang JS, Lee SD, Ju G, Kim JW, Ha K, Yoon IY

Abstract
BACKGROUND: Weak cardiorespiratory coupling (CRC) has been suggested in patients with obstructive sleep apnea (OSA), but the effects of continuous positive airway pressure (CPAP) on CRC remain unclear. We investigated the effects of CPAP treatment on CRC in patients with severe OSA to examine possible reversibility of altered CRC.
METHODS: High-resolution electrocardiograms (ECGs) and respiratory signals were simultaneously recorded for 13 never-treated OSA patients at baseline and after CPAP treatment. The analyses were performed on a 15-min daytime recording of ECG and respiration. Heart rate variability (HRV) indices were extracted from ECGs. After computing the sample entropy (SampEn) to quantify the regularity of both heart rate (SampEnRR) and respiration rhythm (SampEnresp), cross-sample entropy (cross-SampEn) was calculated to measure the interaction between the two signals. Cross-SampEn denotes asynchrony between heart rate and respiration, and thus negatively correlates with CRC.
RESULTS: Lower SampEnRR and higher cross-SampEn as well as a shift toward sympathetic dominance were found in OSA patients compared with age- and gender-matched controls. CPAP treatment was associated with improved sympathovagal balance, increased SampEnRR, and enhanced CRC, corresponding to a decrease in the cross-SampEn value from 0.71±0.08 to 0.49±0.06 (P<.001). The effect sizes for the CPAP-induced changes in sympathovagal balance, SampEnRR, and cross-SampEn were medium to large (0.54-0.90).
CONCLUSIONS: The findings of our study indicate reduced CRC in untreated OSA patients and suggest that CPAP treatment may reverse this abnormality.

PMID: 24051114 [PubMed - as supplied by publisher]

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Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: A meta-analysis.

Sleep Med. 2013 Aug 14;

Authors: Xie X, Pan L, Ren D, Du C, Guo Y

Abstract
OBJECTIVES: Our meta-analysis was performed to estimate the effect of continuous positive airway pressure (CPAP) therapy on systemic inflammation in patients with obstructive sleep apnea (OSA).
METHODS: A comprehensive literature search of PubMed and EMBASE was performed for literature published up to January 2013. Standardized mean difference (SMD) was calculated to estimate the treatment effects of pre- and post-CPAP therapy.
RESULTS: A total of 35 studies involving 1985 OSA patients were included in the meta-analysis. Each study investigated one or more inflammatory markers: 24 studies on C-reactive protein (CRP), 16 studies on IL-6, 3 studies on IL-8, and 12 studies on tumor necrosis factor α (TNF-α). The results showed that the SMD (95% confidence interval [CI]) for CRP, IL-6, IL-8, and TNF-α were 0.452 (95% CI, 0.252-0.651), 0.299 (95% CI, 0.001-0.596), 0.645 (95% CI, 0.362-0.929), and 0.478 (95% CI, 0.219-0.736) in pre- and post-CPAP therapy, respectively. The subgroup analyses seemed to support better benefits with therapy duration of ⩾3months and more adequate compliance (⩾4h/night).
CONCLUSIONS: CPAP therapy could partially suppress systemic inflammation in OSA patients, and substantial differences were present among the various inflammatory markers.

PMID: 24054505 [PubMed - as supplied by publisher]