Inflammation in sleep apnea: An update

Dileep Unnikrishnan1, Jonathan C. Jun1, Vsevolod Y. Polotsky1
1Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Rm 5B.81, Baltimore, MD, 21224, USA

Tóm tắt

Từ khóa


Tài liệu tham khảo

Gastaut H, Tassinari CA, Duron B. Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifestations of the Pickwick syndrome. Brain Res. 1966;1(2):167–86.

Young T et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

Peppard PE et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

Berry RB et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the american academy of sleep medicine. J Clin Sleep Med. 2012;8(5):597–619.

Somers VK et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–904.

Dempsey JA et al. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112.

Dempsey JA, Forster HV. Mediation of ventilatory adaptations. Physiol Rev. 1982;62(1):262–346.

Smith PL et al. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med. 1985;103(6(Pt 1):850–5.

Weaver TE. Adherence to positive airway pressure therapy. Curr Opin Pulm Med. 2006;12(6):409–13.

Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173–8.

Ng A et al. Oral appliance therapy for obstructive sleep apnea. Treat Respir Med. 2005;4(6):409–22.

Maurer JT. Surgical treatment of obstructive sleep apnea: standard and emerging techniques. Curr Opin Pulm Med. 2010;16(6):552–8.

Strollo Jr PJ et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139–49.

Mesarwi, O.A., et al., Metabolic dysfunction in obstructive sleep apnea: A critical examination of underlying mechanisms. Sleep Biol Rhythm, 2014: p. n/a-n/a.

Cassel W et al. Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. Eur Respir J. 1996;9(12):2606–11.

Montesi SB et al. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med. 2012;8(5):587–96.

Schein AS et al. Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients. J Hypertens. 2014;32(9):1762–73.

Fava C et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest. 2014;145(4):762–71.

Punjabi NM et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30.

Babu AR et al. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005;165(4):447–52.

Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia: implications for atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2010;17(2):161–5.

Punjabi NM et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.

Young T et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.

Peker Y et al. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med. 2002;166(2):159–65.

Hung J et al. Association of sleep apnoea with myocardial infarction in men. Lancet. 1990;336(8710):261–4.

Dyken ME et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996;27(3):401–7.

Latina JM, Estes 3rd NA, Garlitski AC. The relationship between obstructive sleep apnea and atrial fibrillation: a complex interplay. Pulm Med. 2013;2013:621736.

Marin JM et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.

Arnaud C et al. Obstructive sleep apnea, immuno-inflammation, and atherosclerosis. Semin Immunopathol. 2009;31(1):113–25.

Jun J, Polotsky VY. Metabolic consequences of sleep-disordered breathing. ILAR J. 2009;50(3):289–306.

Lavie L. Oxidative stress–a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis. 2009;51(4):303–12.

Lavie L. Intermittent hypoxia: the culprit of oxidative stress, vascular inflammation and dyslipidemia in obstructive sleep apnea. Expert Rev Respir Med. 2008;2(1):75–84.

McNicholas WT. Obstructive sleep apnea and inflammation. Prog Cardiovasc Dis. 2009;51(5):392–9.

Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685–95.

Liuzzo G et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331(7):417–24.

Biasucci LM et al. Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in-hospital coronary events. Circulation. 1999;99(16):2079–84.

Koenig W et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (monitoring trends and determinants in cardiovascular disease) Augsburg cohort study, 1984 to 1992. Circulation. 1999;99(2):237–42.

Haverkate F et al. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European concerted action on thrombosis and disabilities angina pectoris study group. Lancet. 1997;349(9050):462–6.

Ridker PM et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9.

Nordestgaard BG, Zacho J. Lipids, atherosclerosis and CVD risk: is CRP an innocent bystander? Nutr Metab Cardiovasc Dis. 2009;19(8):521–4.

Vasse M et al. Regulation of fibrinogen biosynthesis by cytokines, consequences on the vascular risk. Haemostasis. 1996;26 Suppl 4:331–9.

Wilhelmsen L et al. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med. 1984;311(8):501–5.

Gerner RR et al. Metabolic inflammation: role of cytokines in the crosstalk between adipose tissue and liver. Can J Physiol Pharmacol. 2013;91(11):867–72.

Arner P. The adipocyte in insulin resistance: key molecules and the impact of the thiazolidinediones. Trends Endocrinol Metab. 2003;14(3):137–45.

Yudkin JS et al. Low-grade inflammation may play a role in the etiology of the metabolic syndrome in patients with coronary heart disease: the HIFMECH study. Metabolism. 2004;53(7):852–7.

Visser M et al. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131–5.

Gottlieb DJ et al. CPAP versus oxygen in obstructive sleep apnea. N Engl J Med. 2014;370(24):2276–85.

Chirinos JA et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370(24):2265–75.

Craig SE et al. Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial. Thorax. 2012;67(12):1090–6.

Kohler M et al. CPAP improves endothelial function in patients with minimally symptomatic OSA: results from a subset study of the MOSAIC trial. Chest. 2013;144(3):896–902.

Stradling, J.R., et al., Markers of inflammation: data from the MOSAIC randomised trial of CPAP for minimally symptomatic OSA. Thorax, 2014.

Unuvar Dogan F et al. Relationships between obstructive sleep apnea syndrome, continuous positive airway pressure treatment, and inflammatory cytokines. Sleep Disord. 2014;2014:518920.

Kritikou I et al. Sleep apnoea, sleepiness, inflammation and insulin resistance in middle-aged males and females. Eur Respir J. 2014;43(1):145–55.

Shamsuzzaman AS et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002;105(21):2462–4.

Cheng TO. Could elevated C-reactive protein in patients with obstructive sleep apnea be due to obesity per se? Circulation. 2003;107(1):e9. author reply e9.

Yokoe T et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107(8):1129–34.

Kohler M et al. Effects of continuous positive airway pressure on systemic inflammation in patients with moderate to severe obstructive sleep apnoea: a randomised controlled trial. Thorax. 2009;64(1):67–73.

Guilleminault C, Kirisoglu C, Ohayon MM. C-reactive protein and sleep-disordered breathing. Sleep. 2004;27(8):1507–11.

Barcelo A et al. Effects of obesity on C-reactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med. 2004;117(2):118–21.

Ryan S et al. Cardiovascular risk markers in obstructive sleep apnoea syndrome and correlation with obesity. Thorax. 2007;62(6):509–14.

Sahlman J et al. The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea. J Sleep Res. 2010;19(2):341–8.

Ryan S, Taylor CT, McNicholas WT. Predictors of elevated nuclear factor-kappaB-dependent genes in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2006;174(7):824–30.

Gozal D et al. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci (Elite Ed). 2012;4:2410–22.

Kheirandish-Gozal L et al. Plasma C-reactive protein in nonobese children with obstructive sleep apnea before and after adenotonsillectomy. J Clin Sleep Med. 2006;2(3):301–4.

Ciccone MM et al. Correlation between inflammatory markers of atherosclerosis and carotid intima-media thickness in obstructive sleep apnea. Molecules. 2014;19(2):1651–62.

Bottazzi B et al. An integrated view of humoral innate immunity: pentraxins as a paradigm. Annu Rev Immunol. 2010;28:157–83.

Yasunaga T et al. Plasma pentraxin 3 is a more potent predictor of endothelial dysfunction than high-sensitive C-reactive protein. Int Heart J. 2014;55(2):160–4.

Kobukai, Y., et al., Morning Pentraxin3 levels reflect obstructive sleep apnea-related acute inflammation. J Appl Physiol (1985), 2014.

Oh IS et al. Identification of nesfatin-1 as a satiety molecule in the hypothalamus. Nature. 2006;443(7112):709–12.

Ramanjaneya M et al. Identification of nesfatin-1 in human and murine adipose tissue: a novel depot-specific adipokine with increased levels in obesity. Endocrinology. 2010;151(7):3169–80.

Leivo-Korpela S et al. Adipokines NUCB2/nesfatin-1 and visfatin as novel inflammatory factors in chronic obstructive pulmonary disease. Mediat Inflamm. 2014;2014:232167.

Tang CH et al. The anti-inflammatory and anti-apoptotic effects of nesfatin-1 in the traumatic rat brain. Peptides. 2012;36(1):39–45.

Shen, P., et al., Decreased levels of serum nesfatin-1 in patients with obstructive sleep apnea syndrome. Sleep Breath, 2014.

Emerging Risk Factors, C et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012;367(14):1310–20.

Fibrinogen Studies C et al. Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies collaboration. Am J Epidemiol. 2007;166(8):867–79.

Shamsuzzaman, A., et al., Severity of obstructive sleep apnea is associated with elevated plasma fibrinogen in otherwise healthy patients. Sleep Breath, 2014.

Basoglu OK et al. Metabolic syndrome, insulin resistance, fibrinogen, homocysteine, leptin, and C-reactive protein in obese patients with obstructive sleep apnea syndrome. Ann Thorac Med. 2011;6(3):120–5.

Chin K et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1996;153(6 Pt 1):1972–6.

Kaditis AG et al. Morning levels of fibrinogen in children with sleep-disordered breathing. Eur Respir J. 2004;24(5):790–7.

Phillips CL et al. Effects of continuous positive airway pressure on coagulability in obstructive sleep apnoea: a randomised, placebo-controlled crossover study. Thorax. 2012;67(7):639–44.

Guardiola JJ et al. Hypercoagulability in patients with obstructive sleep apnea. Sleep Med. 2001;2(6):517–23.

Nizankowska-Jedrzejczyk A et al. Modulation of inflammatory and hemostatic markers in obstructive sleep apnea patients treated with mandibular advancement splints: a parallel, controlled trial. J Clin Sleep Med. 2014;10(3):255–62.

Nojgaard C et al. Serum levels of YKL-40 increases in patients with acute myocardial infarction. Coron Artery Dis. 2008;19(4):257–63.

Nielsen AR et al. Plasma YKL-40: a BMI-independent marker of type 2 diabetes. Diabetes. 2008;57(11):3078–82.

Kazakova M et al. Relationship between sonographic parameters and YKL-40 levels in rheumatoid arthritis. Rheumatol Int. 2013;33(2):341–6.

Letuve S et al. YKL-40 is elevated in patients with chronic obstructive pulmonary disease and activates alveolar macrophages. J Immunol. 2008;181(7):5167–73.

Wang X, Xing GH. Serum YKL-40 concentrations are elevated and correlated with disease severity in patients with obstructive sleep apnea syndrome. Scand J Clin Lab Invest. 2014;74(1):74–8.

Li W, Yu Z, Jiang C. Association of serum YKL-40 with the presence and severity of obstructive sleep apnea syndrome. Lab Med. 2014;45(3):220–5.

Oh DY et al. GPR120 is an omega-3 fatty acid receptor mediating potent anti-inflammatory and insulin-sensitizing effects. Cell. 2010;142(5):687–98.

Ichimura A et al. Dysfunction of lipid sensor GPR120 leads to obesity in both mouse and human. Nature. 2012;483(7389):350–4.

Gozal D et al. Obstructive sleep apnea and obesity are associated with reduced GPR 120 plasma levels in children. Sleep. 2014;37(5):935–41.

Dovizio M et al. Role of platelets in inflammation and cancer: novel therapeutic strategies. Basic Clin Pharmacol Toxicol. 2014;114(1):118–27.

Jun J et al. Effect of intermittent hypoxia on atherosclerosis in apolipoprotein E-deficient mice. Atherosclerosis. 2010;209(2):381–6.

Gautier-Veyret E et al. Intermittent hypoxia-activated cyclooxygenase pathway: role in atherosclerosis. Eur Respir J. 2013;42(2):404–13.

Beaudin AE et al. Cyclooxygenases 1 and 2 differentially regulate blood pressure and cerebrovascular responses to acute and chronic intermittent hypoxia: implications for sleep apnea. J Am Heart Assoc. 2014;3(3):e000875.

Akkaya, E., M. Gul, and M. Ugur, Platelet to lymphocyte ratio: A simple and valuable prognostic marker for acute coronary syndrome. Int J Cardiol, 2014.

Thomson SP, McMahon LJ, Nugent CA. Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood. Clin Immunol Immunopathol. 1980;17(4):506–14.

Nelson DH et al. Blood levels of 17-hydroxycorticosteroids following the administration of adrenal steroids and their relation to levels of circulating leukocytes. J Clin Invest. 1952;31(9):843–9.

Koseoglu, H.I., et al., Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis, 2014.

Kassi E et al. Role of vitamin D in atherosclerosis. Circulation. 2013;128(23):2517–31.

Kheirandish-Gozal L, Peris E, Gozal D. Vitamin D levels and obstructive sleep apnoea in children. Sleep Med. 2014;15(4):459–63.

Drager LF, Jun JC, Polotsky VY. Metabolic consequences of intermittent hypoxia: relevance to obstructive sleep apnea. Best Pract Res Clin Endocrinol Metab. 2010;24(5):843–51.

Jun J, Polotsky VY. Sleep disordered breathing and metabolic effects: evidence from animal models. Sleep Med Clin. 2007;2(2):263–77.

Jun, J.C., et al., Intermittent Hypoxia-Induced Glucose Intolerance is Abolished by Alpha-Adrenergic Blockade or Adrenal Medullectomy. Am J Physiol Endocrinol Metab, 2014: p. ajpendo 00373 2014.

Regazzetti C et al. Hypoxia decreases insulin signaling pathways in adipocytes. Diabetes. 2009;58(1):95–103.

Trayhurn P, Wang B, Wood IS. Hypoxia in adipose tissue: a basis for the dysregulation of tissue function in obesity? Br J Nutr. 2008;100(2):227–35.

Drager LF et al. Chronic intermittent hypoxia induces atherosclerosis via activation of adipose angiopoietin-like 4. Am J Respir Crit Care Med. 2013;188(2):240–8.

He Q et al. Regulation of HIF-1{alpha} activity in adipose tissue by obesity-associated factors: adipogenesis, insulin, and hypoxia. Am J Physiol Endocrinol Metab. 2011;300(5):E877–85.

Lee YS et al. Increased adipocyte O2 consumption triggers HIF-1alpha, causing inflammation and insulin resistance in obesity. Cell. 2014;157(6):1339–52.

Shin MK et al. The effect of adrenal medullectomy on metabolic responses to chronic intermittent hypoxia. Respir Physiol Neurobiol. 2014;203C:60–7.

Poulain L et al. Visceral white fat remodelling contributes to intermittent hypoxia-induced atherogenesis. Eur Respir J. 2014;43(2):513–22.

Barcelo A et al. Free fatty acids and the metabolic syndrome in patients with obstructive sleep apnoea. Eur Respir J. 2011;37(6):1418–23.

Jun J et al. Intermittent hypoxia has organ-specific effects on oxidative stress. Am J Physiol Regul Integr Comp Physiol. 2008;295(4):R1274–81.

Kanagy NL. Vascular effects of intermittent hypoxia. ILAR J. 2009;50(3):282–8.

Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation. 2005;112(17):2660–7.

Jun JC et al. Effects of sleep apnea on nocturnal free fatty acids in subjects with heart failure. Sleep. 2011;34(9):1207–13.

Sniderman AD, Cianflone K. Substrate delivery as a determinant of hepatic apoB secretion. Arterioscler Thromb. 1993;13(5):629–36.

Schaffer JE. Lipotoxicity: when tissues overeat. Curr Opin Lipidol. 2003;14(3):281–7.

Zhou S et al. Deletion of metallothionein exacerbates intermittent hypoxia-induced oxidative and inflammatory injury in aorta. Oxid Med Cell Longev. 2014;2014:141053.

Cai L et al. Metallothionein in radiation exposure: its induction and protective role. Toxicology. 1999;132(2–3):85–98.

Badran M et al. Chronic intermittent hypoxia causes endothelial dysfunction in a mouse model of diet-induced obesity. Sleep Med. 2014;15(5):596–602.

Kaur C et al. Increased vascular permeability and nitric oxide production in response to hypoxia in the pineal gland. J Pineal Res. 2007;42(4):338–49.

Hung MW et al. Melatonin ameliorates endothelial dysfunction, vascular inflammation, and systemic hypertension in rats with chronic intermittent hypoxia. J Pineal Res. 2013;55(3):247–56.

Totoson P et al. Atorvastatin protects against deleterious cardiovascular consequences induced by chronic intermittent hypoxia. Exp Biol Med (Maywood). 2013;238(2):223–32.

Smith SM, Friedle SA, Watters JJ. Chronic intermittent hypoxia exerts CNS region-specific effects on rat microglial inflammatory and TLR4 gene expression. PLoS One. 2013;8(12):e81584.

Trotta T et al. Biological role of Toll-like receptor-4 in the brain. J Neuroimmunol. 2014;268(1–2):1–12.

Gozal E et al. Proteomic analysis of CA1 and CA3 regions of rat hippocampus and differential susceptibility to intermittent hypoxia. J Neurochem. 2002;83(2):331–45.

Guven SF et al. The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma. Asian Pac J Allergy Immunol. 2014;32(2):153–9.

Lu, Y., et al., [Treatment of obstructive sleep apnea-hypopnea syndrome for children refractory asthma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2014. 49(6): p. 462–7.

Reinke C et al. Chronic intermittent hypoxia induces lung growth in adult mice. Am J Physiol Lung Cell Mol Physiol. 2011;300(2):L266–73.

Philippe, C., et al., Airway cell involvement in intermittent hypoxia-induced airway inflammation. Sleep Breath, 2014.

Dancey DR et al. Impact of menopause on the prevalence and severity of sleep apnea. Chest. 2001;120(1):151–5.

Bixler EO et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.

Gottlieb DJ et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352–60.

Campos-Rodriguez F et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99–105.

Torres M et al. Effect of ovariectomy on inflammation induced by intermittent hypoxia in a mouse model of sleep apnea. Respir Physiol Neurobiol. 2014;202:71–4.

Somers VK, Abboud FM. Chemoreflexes–responses, interactions and implications for sleep apnea. Sleep. 1993;16(8 Suppl):S30–3.

Somers VK et al. Contrasting effects of hypoxia and hypercapnia on ventilation and sympathetic activity in humans. J Appl Physiol (1985). 1989;67(5):2101–6.

Stamatakis KA, Punjabi NM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest. 2010;137(1):95–101.

Deibert DC, Defronzo RA. Epinephrine-induced insulin resistance in man. J Clin Invest. 1980;65(3):717–21.

Halberg N et al. Hypoxia-inducible factor 1alpha induces fibrosis and insulin resistance in white adipose tissue. Mol Cell Biol. 2009;29(16):4467–83.

Chinen I et al. Vascular lipotoxicity: endothelial dysfunction via fatty-acid-induced reactive oxygen species overproduction in obese Zucker diabetic fatty rats. Endocrinology. 2007;148(1):160–5.

Imrie H, Abbas A, Kearney M. Insulin resistance, lipotoxicity and endothelial dysfunction. Biochim Biophys Acta. 2010;1801(3):320–6.

Chouchou F et al. Sympathetic overactivity due to sleep fragmentation is associated with elevated diurnal systolic blood pressure in healthy elderly subjects: the PROOF-SYNAPSE study. Eur Heart J. 2013;34(28):2122–31. 2131a.