What role do adrenoreceptor polymorphisms play in modifying cardiovascular responses in obstructive sleep apnoea?

2005 ◽  
Vol 110 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Nigel Mcardle
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Risk ◽  
Diastolic Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Cardiovascular Responses ◽  
Sleep Apnoea ◽  
Cpap Treatment ◽  
Obstructive Sleep

OSA (obstructive sleep apnoea) is a common condition that is strongly associated with cardiovascular disease. It is remains unclear what role OSA plays in determining cardiovascular risk. The immediate physiological changes that occur during upper airway obstruction are potential contributors to cardiovascular risk in OSA. These changes include increased sympathetic activity, which is responsive to treatment of OSA with CPAP (continuous positive airway pressure). In this issue of Clinical Science, the possible role of a common polymorphism in the β1-adrenoreceptor [R389G (Arg389Gly)] has been investigated by Börgel and co-workers. Measurements of heart rate and blood pressure in untreated OSA patients were not related to the R389G polymorphism. There were changes in heart rate and diastolic blood pressure with CPAP treatment that were related to this polymorphism. Reduction in heart rate with CPAP treatment was associated with the R389R genotype. By contrast, a reduction in diastolic blood pressure was associated with the Gly389 carriers. These findings are intriguing, but difficult to fully explain. Further study is needed to determine if there is an important role of the R389G polymorphism in modifying cardiovascular responses among OSA patients.

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

scholarly journals Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges

2019 ◽  
Vol 8 (11) ◽  
pp. 1872 ◽  
Author(s):  
Grace Oscullo ◽  
Gerard Torres ◽  
Francisco Campos-Rodriguez ◽  
Tomás Posadas ◽  
Angela Reina-González ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Current Knowledge ◽  
Reduce Blood Pressure ◽  
Sleep Apnoea ◽  
Refractory Hypertension ◽  
Hypertensive Patients ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Clinically Significant

Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin–angiotensin–aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients’ varying response to CPAP treatment.

scholarly journals Role of hypoxia on increased blood pressure in patients with obstructive sleep apnoea.

Thorax ◽  
1995 ◽  
Vol 50 (1) ◽  
pp. 28-34 ◽  
Author(s):  
S Okabe ◽  
W Hida ◽  
Y Kikuchi ◽  
O Taguchi ◽  
H Ogawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep

Abstract 5430: Obstructive Sleep Apnoea Exacerbates Muscular Sympathetic Nervous Activity in Patients with Metabolic Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ivani C Trombetta ◽  
Cristiane M Nunes ◽  
Luciano F Drager ◽  
Raffael F Fraga ◽  
Maria Janieire N Alves ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Sympathetic Nervous Activity ◽  
Obstructive Sleep ◽  
Sympathetic Nervous

Obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) independently increases muscular sympathetic nervous activity (MSNA). Unknown is whether OSA has an additive effect on MSNA in patients with MetS. We tested the hypothesis that: OSA would have an additive effect on MSNA in patients with MetS. In addition, we studied whether the increase in MSNA in patients with MetS is associated with alteration in arterial baroreflex sensitivity (BRS). Twenty four patients with MetS diagnosed according ATP-III were divided in two groups: MetS+OSA (n=14) and MetS (n=10). They were matched for age, body mass index, waist circumference, and metabolic profile: OSA was defined by an apnoea/hypopnoea index (AHI)>15 events/hour by polysonography. MSNA was recorded directly from the peroneal nerve using the technique of microneurography. Blood pressure (BP) was monitored on a beat-by-beat basis (Finapress) and heart rate by ECG. BRS was analyzed by spontaneous BP and heart rate fluctuations. AHI was higher (42±9 vs. 7±1 events/h, P =0.0001) and minimum oxygen saturation lower (77±2 vs. 87±1 %, P =0.001) in MetS+OSA patients. Patients MetS+OSA had higher MSNA (55±3 vs. 43±2 bursts/100 beats, P =0.01) and systolic BP (158±4 vs.144±3 mmHg, P =0.01) when compared with patients with MetS without OSA. Further analysis showed that AHI and minimum oxygen saturation have significant correlation with MSNA (r=0.65; P =0.001 and r=−0.48; P =0.017, respectively). Patients with MetS+OSA had lower BRS for increases (7.8±0.9 vs. 13.4 ± 1.4 msec/mmHg, P =0.01) and decreases (7.2±0.9 vs. 13.2 ± 2.0 msec/mmHg, P =0.03) in blood pressure than patients with MetS without OSA. MSNA significantly correlated with BRS during spontaneous increases in blood pressure (r=−0.56, P =0.01). OSA exacerbates MSNA in patients with MetS. In addition, the augmented MSNA in patients with MetS+OSA is associated with reduced BRS. These findings suggest that OSA increases the risk for cardiovascular disease in patients with MetS.

scholarly journals Blood pressure response to CPAP treatment in subjects with obstructive sleep apnoea: the predictive value of 24-h ambulatory blood pressure monitoring

2017 ◽  
Vol 50 (4) ◽  
pp. 1700651 ◽  
Author(s):  
Anabel L. Castro-Grattoni ◽  
Gerard Torres ◽  
Montserrat Martínez-Alonso ◽  
Ferran Barbé ◽  
Cecilia Turino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Response ◽  
Blood Pressure Monitoring ◽  
Sleep Apnoea ◽  
Clinical Predictors ◽  
Night Time ◽  
Nocturnal Hypertension ◽  
Obstructive Sleep

The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea–hypopnoea index 42 events·h−1) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (−2 mmHg) and norepinephrine (−109.5 nmol·day-1) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (−3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (<68 bpm) and BP dipper profile were associated with increased night-time BP and new diagnosis of nocturnal hypertension.Our results suggest that nocturnal hypertension, circadian BP pattern and night-time heart rate could be clinical predictors of BP response to CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies.

scholarly journals The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial

2019 ◽  
Vol 54 (2) ◽  
pp. 1900518 ◽  
Author(s):  
Silvia Ponce ◽  
Esther Pastor ◽  
Belen Orosa ◽  
Grace Oscullo ◽  
Pablo Catalán ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Elderly Patients ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Life Domains ◽  
Cpap Treatment ◽  
Neurocognitive Tests ◽  
Obstructive Sleep

The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with nonsevere obstructive sleep apnoea (OSA) is controversial. The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA in terms of clinical, quality-of-life and neurocognitive measures.This was an open-label, randomised, multicentre clinical trial in 145 elderly patients (≥70 years old) with confirmed moderate OSA (apnoea–hypopnoea index 15–29.9 events·h−1) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary end-point was the Epworth Sleepiness Scale (ESS) score, and the secondary end-points included quality of life (Quebec Sleep Questionnaire (QSQ) domain scores), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests. The analysis was performed according to the intention-to-treat principle.Mean±sd age was 74.9±4.6 years. The CPAP group achieved a greater improvement in the ESS score (adjusted difference of 2.6 (95% CI 3.6–1.6) points; effect size 1) in some sleep-related symptoms and in some dimensions of the QSQ questionnaire (nocturnal symptoms: −0.7 (95% CI −0.3–−1.0) points; p<0.0001 and emotions: −0.4 (95% CI −0.1–−0.7) points; p=0.023). However, CPAP did not demonstrate any effect on either neurocognitive tests (including anxiety and depression) or blood pressure levels. There was a positive correlation between the effect of CPAP and the improvement in ESS scores and quality of life domains.CPAP treatment resulted in a significant improvement in diurnal hypersomnia and some sleep-related symptoms and quality of life domains in elderly patients with moderate OSA.

Continuous positive airway pressure improves blood pressure and serum cardiovascular biomarkers in obstructive sleep apnoea and hypertension

2021 ◽  
pp. 2003687
Author(s):  
Macy Mei-Sze Lui ◽  
Hung-Fat Tse ◽  
David Chi-Leung Lam ◽  
Kui-Kai Lau ◽  
Carmen Wing-Sze Chan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Myocardial Injury ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Control Group ◽  
Cpap Treatment ◽  
Obstructive Sleep

RationaleThe impact of treatment for obstructive sleep apnoea (OSA) on reduction of cardiovascular risk is unclear. This study aimed to examine the effect of continuous positive airway pressure (CPAP) on ambulatory blood pressure (BP) and subclinical myocardial injury in subjects with OSA and hypertension.MethodsSubjects with hypertension requiring at least three anti-hypertensive medications and moderate-severe OSA were enrolled. Eligible subjects were randomized (1:1) to receive either CPAP treatment or control (no CPAP) for eight weeks. Changes in ambulatory BP and serum biomarkers were compared. Stratified analysis according to circadian BP pattern was performed.Main resultsNinety two subjects (75% men; age, 51±8 years; apnoea-hypopnoea index 40±8 events·h−1, taking average of 3.4 anti-hypertensive drugs [range 3–6]) were randomised. The group on CPAP treatment, compared to the control group, demonstrated significant reduction in 24-h systolic BP (−4.4 mmHg, 95% CI −8.7 to −0.1, p=0.046), 24-h diastolic BP (−2.9 mmHg, 95% CI −5.5 to −0.2, p=0.032), daytime systolic BP (−5.4 mmHg, −9.7 to −1.0, p=0.016) and daytime diastolic BP (−3.4 mmHg, 95% CI −6.1 to −0.8, p=0.012). CPAP treatment was associated with significant BP lowering only in non-dippers, but not in dippers. Serum troponin I (mean difference −1.74 pg·mL−1, 95% CI −2.97 to −0.5, p=0.006) and brain natriuretic peptide (−9.1 pg·mL−1, 95% CI −17.6 to −0.6, p=0.036) were significantly reduced in CPAP compared to control group.ConclusionIn a cohort with OSA and multiple cardiovascular risk factors including difficult-to-control hypertension, short-term CPAP treatment improved ambulatory BP and alleviated subclinical myocardial injury and strain.

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