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Hypoxia and inflammation indicate significant differences in the severity of obstructive sleep apnea within similar apnea-hypopnea index groups

  • Neurology • Original Article
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Abstract

Purpose

We determined whether hypoxia parameters are associated with C-reactive protein (CRP), mean platelet volume (MPV), white matter hyperintensity (WMH), and the severity of obstructive sleep apnea (OSA), and also evaluated whether hypoxia parameters, CRP, MPV, and WMH differ in patients with similar apnea-hypopnea index (AHI) scores.

Methods

A total of 297 patients, who were evaluated using polysomnography, were assessed retrospectively. The measured hypoxia parameters included total sleep time with oxygen saturation <90% (ST90), percentage of cumulative time with oxygen saturation <90% (CT90), and lowest oxygen saturation (min SaO2). The patients were divided into subgroups according to their CT90 values, and patients with different AHI severities were divided into subgroups according to their ST90 and min SaO2 levels.

Results

Hypoxia parameters are associated with CRP, MPV, WMH, and the severity of OSA (P < 0.05). The hypoxia parameters differed in all subgroup analyses of similar AHI groups (P < 0.001), and CRP differed only in severe OSA (P < 0.008, P < 0.001). In subgroup analyses of similar AHI groups, MPV and WMH were not significantly different (P > 0.05). Above the hypoxia threshold (CT90 ≥ 10%) of CRP, MPV increased significantly and the presence of WMH increased twofold.

Conclusions

These data suggest that increased hypoxia severity may mediate increased inflammation and activation of platelets and contribute to the pathogenesis of WMH in patients with OSA. In addition, patients with severe OSA may show significant variability in inflammation and vascular risk. Further prospective data are needed.

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References

  1. Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, Vaughn BV, American Academy of Sleep Medicine (2015) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.2. Darien IL: American Academy of sleep medicine. J Clin Sleep Med 15(11):1253–1254

    Article  Google Scholar 

  2. Zhang XB, Zen HQ, Lin QC, Chen GP, Chen LD, Chen H (2014a) TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3044-0

    PubMed Central  Google Scholar 

  3. Kulkas A, Tiihonen P, Julkunen P, Mervaala E, Töyräs J (2013) Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea-hypopnea index. Med Biol Eng Comput. doi:10.1007/s11517-013-1039-4

    PubMed  Google Scholar 

  4. Bostanci A, Turhan M, Bozkurt S (2015) Factors influencing sleep time with oxygen saturation below 90% in sleep-disordered breathing. Laryngoscope. doi:10.1002/lary.24942

    PubMed  Google Scholar 

  5. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation scientific statement from the American Heart Association Council for high blood pressure research professional education committee, council on clinical cardiology, stroke council, and council on cardiovascular nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. doi:10.1161/CIRCULATIONAHA.107.189375

    PubMed  Google Scholar 

  6. Song D, Fang G, Greenberg H, Liu SF (2015) Chronic intermittent hypoxia exposure-induced atherosclerosis: a brief review. Immunol Res. doi:10.1007/s12026-015-8703-8

    Google Scholar 

  7. Ridker PM (2007) C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 49(21):2129–2138

    Article  CAS  PubMed  Google Scholar 

  8. Muraki I, Tanigawa T, Yamagishi K, Sakurai S, Ohira T, Imano H et al (2010) Nocturnal intermittent hypoxia and C reactive protein among middle-aged community residents: a cross-sectional survey. Thorax. doi:10.1136/thx.2009.128744

    PubMed  Google Scholar 

  9. Rahangdale S, Yeh SY, Novack V, Stevenson K, Barnard MR, Furman MI, Frelinger AL, Michelson AD, Malhotra A (2011) The influence of intermittent hypoxemia on platelet activation in obese patients with obstructive sleep apnea. J Clin Sleep Med 7(2):172–178

    PubMed  PubMed Central  Google Scholar 

  10. Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP (2009) Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost 9(3):177–190

    Article  Google Scholar 

  11. Martin JF, Shaw T, Heggie J, Penington DG (1983) Measurement of the density of human platelets and its relationship to volume. Br J Haematol 54(3):337–352

    Article  CAS  PubMed  Google Scholar 

  12. Varol E, Ozturk O, Gonca T, Has M, Ozaydin M, Erdogan D et al (2010) Mean platelet volume is increased with severe obstructive sleep apnea. Scand J Clin Lab Invest. doi:10.3109/00365513.2010.520733

    PubMed  Google Scholar 

  13. Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E et al (2012) Mean platelet volume and platelet distribution width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets. doi:10.3109/09537104.2011.632031

    PubMed  Google Scholar 

  14. Ovbiagele B, Saver JL (2006) Cerebral white matter hyperintensities on MRI: current concepts and therapeutic implications. Cerebrovasc Dis 22(2–3):83–90

    Article  PubMed  Google Scholar 

  15. Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F et al (1993) Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 43(9):1683–1689

    Article  CAS  PubMed  Google Scholar 

  16. Debette S, Markus HS (2010) The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systemic review and meta-analysis. BMJ 341:c3666. doi:10.1136/bmj.c3666

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim H, Yun CH, Thomas RJ, Lee SH, Seo HS, Cho ER et al (2013) Obstructive sleep apnea as a risk factor for cerebral white matter change in middle-aged and older general population. Sleep. doi:10.5665/sleep.2632

    Google Scholar 

  18. Nishibayashi M, Miyomoto M, Miyamoto T, Suzuki K, Hirata K (2008) Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions. J Clin Sleep Med 4(3):242–247

    PubMed  PubMed Central  Google Scholar 

  19. Zhang J, Li Y, Cao X, Xian J, Tan J, Dong J, Ye J (2014b) The combination of anatomy and physiology in predicting the outcomes of velopharyngeal surgery. Laryngoscope. doi:10.1002/lary.24510

    PubMed Central  Google Scholar 

  20. Guilleminault C, Kirisoglu C, Ohayon MM (2004) C-reactive protein and sleep-disordered breathing. Sleep 27(8):1507–1511

    Article  PubMed  Google Scholar 

  21. Taheri S, Austin D, Lin L, Nieto FJ, Young T, Mignot E (2007) Correlates of serum C-reactive protein (CRP)–no association with sleep duration or disordered breathing. Sleep 30(8):991–996

    Article  PubMed  PubMed Central  Google Scholar 

  22. Khera A, Vega GL, Das SR, Ayers C, McGuire DK, Grundy SM, de Lemos JA (2009) Sex differences in the relationship between C-reactive protein and body fat. J Clin Endocrinol Metab. doi:10.1210/jc.2008-2406

    PubMed  PubMed Central  Google Scholar 

  23. Kurt OK, Yildiz N (2013) The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis. doi:10.1097/MBC.0b013e32835d53d4

    Google Scholar 

  24. Davies CW, Crosby JH, Mullins RL, Traill ZC, Anslow P, Davies RJ et al (2001) Case control study of cerebrovascular damage defined by magnetic resonance imaging in patients with OSA and normal matched control subjects. Sleep 24(6):715–720

    Article  CAS  PubMed  Google Scholar 

  25. Ding J, Nieto FJ, Beauchamp NJ Jr, Harris TB, Robbins JA, Hetmanski JB et al (2004) Sleep-disordered breathing and white matter disease in the brainstem in older adults. Sleep 27(3):474–479

    Article  PubMed  Google Scholar 

  26. Wakita H, Tomimoto H, Akiguchi I, Matsuo A, Lin JX, Ihara M et al (2002) Axonal damage and demyelination in the white matter after chronic cerebral hypoperfusion in the rat. Brain Res 924(1):63–70

    Article  CAS  PubMed  Google Scholar 

  27. Turhan M, Bostanci A, Bozkurt S (2015) Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3311-0

    Google Scholar 

  28. Skelly JR, Bradford A, O'Halloran KD (2010) Intermittent hypoxia impairs pharyngeal dilator muscle function in male but not female rats. Adv Exp Med Biol 669:285–287. doi:10.1007/978-1-4419-5692-7_58

    Article  PubMed  Google Scholar 

  29. Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D (2001) Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 164(2):250–255

    Article  CAS  PubMed  Google Scholar 

  30. Bradford A, McGuire M, O'Halloran KD (2005) Does episodic hypoxia affect upper airway dilator muscle function? Implications for the pathophysiology of obstructive sleep apnoea. Respir Physiol Neurobiol. doi:10.1016/j.resp.2005.04.001

    Google Scholar 

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Authors’ contributions

A. Yilmaz Avci and S. Avci designed the study. A. Yilmaz Avci and H. Lakadamyali acquired and interpreted the data. A. Yilmaz Avci, S. Avci, and U. Can revised the manuscript for important intellectual content.

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Authors and Affiliations

  1. Department of Neurology, Baskent University, Ankara, Turkey

    Aynur Yilmaz Avci

  2. Department of Otolaryngology Head and Neck Surgery, Baskent University, Ankara, Turkey

    Suat Avci

  3. Department of Chest Disease, Baskent University, Ankara, Turkey

    Huseyin Lakadamyali

  4. Department of Neurology, Baskent University, Ankara, Turkey

    Ufuk Can

Authors
  1. Aynur Yilmaz Avci
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  2. Suat Avci
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  3. Huseyin Lakadamyali
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Correspondence to Aynur Yilmaz Avci.

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The authors declared that this study received no financial support.

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The authors declare that they have no conflict of interest.

Ethical approval

Because this was a retrospective study, no ethical committee approval was taken. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Oral informed consent was taken from all the participants.

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Yilmaz Avci, A., Avci, S., Lakadamyali, H. et al. Hypoxia and inflammation indicate significant differences in the severity of obstructive sleep apnea within similar apnea-hypopnea index groups. Sleep Breath 21, 703–711 (2017). https://doi.org/10.1007/s11325-017-1486-5

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  • DOI: https://doi.org/10.1007/s11325-017-1486-5

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