Cardiovascular Dısease Risk in Patients with Obstructıve Sleep Apnea Syndrome
PDF

Keywords

sleep apnea
cardiovascular disease
metabolic syndrome

How to Cite

Ölmez, H., & Arslan Işık, N. (2019). Cardiovascular Dısease Risk in Patients with Obstructıve Sleep Apnea Syndrome. Galician Medical Journal, 26(4). https://doi.org/10.21802/gmj.2019.4.4

Abstract

Obstructıve sleep apnea syndrome is a clinical syndrome characterized by recurrent partial or total obstruction of the upper respiratory tract. The main symptoms are snoring, excessive daytime sleepiness and witnessed apnea. It is a disease that affects 3% to 7% of the middle-aged population. Studies and meta-analyzes have shown that cardiovascular diseases are more common in patients with obstructıve sleep apnea syndrome. Comorbid conditions such as obesity, metabolic syndrome and smoking are higher in obstructıve sleep apnea syndrome patients than in the general population. In addition, hypoxia-reperfusion injury due to intermittent oxygen desaturation occurring in obstructıve sleep apnea syndrome patients, endothelial dysfunction, increased sympathetic system activity, platelet activation, monocyte increase, which play the main role in arteriosclerosis, decreased and increased low-density lipoprotein cholesterol may also be the reason for the frequent occurrence of cardiovascular diseases. The development of cardiovascular disease in obstructıve sleep apnea syndrome patients is an important cause of morbidity and mortality. Evaluating white blood cell neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, hematocrit, platelet distribution width, red cell distribution width, C-reactive protein, and monocyte/high-density lipoprotein cholesterol ratio in the follow-up of obstructıve sleep apnea syndrome patients may be helpful in predicting the development of cardiovascular diseases. Whether obstructıve sleep apnea syndrome patients have metabolic syndrome or smoking should be questioned. Obstructıve sleep apnea syndrome, obesity, smoking and depression are increasingly prevalent diseases worldwide, leading to significant mortality and morbidity. Therefore, multicentre studies involving different societies are needed.

https://doi.org/10.21802/gmj.2019.4.4
PDF

References

Durán J, Esnaola S, Rubıo R, Iztueta Á. Obstructive Sleep Apnea-Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr. Am J Respir Crit Care Med. 2001;163(3):685-689. DOI: https://doi.org/10.1164/ajrccm.163.3.2005065 [PMid:11254524]

Atan D, Kundi FCS, Özcan KM, Dere H. A New Predictor for Obstructive Sleep Apnea Syndrome: Monocyte to HDL Ratio. Indian J Otolaryngol Head Neck Surg. 2017;69(2):142-146. DOI: https://doi.org/10.1007/s12070-016-0980-6 [PMid:28607881 PMCid:PMC5446332]

Shamsuzzaman A, Gersh B. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906-1914. DOI: https://doi.org/10.1001/jama.290.14.1906 [PMid:14532320]

Takama N, Kurabayashi M. Influence of untreated sleep-disordered breathing on the long-term prognosis of patients with cardiovascular disease. Am J Cardiol. 2009;103(5):730-734. DOI: https://doi.org/10.1016/j.amjcard.2008.10.035 [PMid:19231343]

Imhof BA, Aurrand-Lions M. Angiogenesis and inflammation face off. Nat Med. 2006;12(2):171-172. DOI: https://doi.org/10.1038/nm0206-171 [PMid:16462798]

Naruko T, Ueda M, Haze K et al. Neutrophil Infiltration of Culprit Lesions in Acute Coronary Syndromes. Circulation. 2002;106(23):2894-2900. DOI: https://doi.org/10.1161/01.CIR.0000042674.89762.20 [PMid:12460868]

Lattanzi S, Brigo F, Silvestrini M. Blood pressure profile and nocturnal oxygen desaturation. J Clin Hypertens (Greenwich). 2018;20(4):656-658. DOI: https://doi.org/10.1111/jch.13259 [PMid:29569321]

Wang J, Shi X, Ma C et al. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease: a systematic review and meta-analysis. J Hypertens. 2017;35(1):10-17. DOI: https://doi.org/10.1097/HJH.0000000000001159 [PMid:27906836]

Ribeiro A, Lotufo P, Fujita A et al. Association between short-term systolic blood pressure variability and carotid intima-media thickness in ELSA-Brasil baseline. Am J Hypertens. 2017;30(10):954-960. DOI: https://doi.org/10.1093/ajh/hpx076 [PMid:28475663]

Dursunoğlu N, Dursunoğlu D. Obstructive sleep apnea syndrome, endothelial dysfunction and coronary atherosclerosis. Tuberk Toraks. 2005;53(3):299-306.

Peker Y, Hedner J, Kraıczı H, Löth S. Respiratory Disturbance Index. Am J Respir Crit Care Med. 2000;162(1):81-86. DOI: https://doi.org/10.1164/ajrccm.162.1.9905035 [PMid:10903224]

Turak O, Özcan F, İşleyen A et al. Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis. Can J Cardiol. 2013;29(12):1672-8. DOI: https://doi.org/10.1016/j.cjca.2013.05.005 [PMid:23916736]

de Jager CP, van Wijk PT, Mathoera RB et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192. DOI: https://doi.org/10.1186/cc9309 [PMid:21034463 PMCid:PMC3219299]

Nena E, Papanas N, Steiropoulos P et al. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with Obstructive Sleep Apnoea Syndrome: New indices of severity? Platelets. 2012;23(6):447-454. DOI: https://doi.org/10.3109/09537104.2011.632031 [PMid:22070405]

Lattanzi S, Cagnetti C, Provinciali L et al. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8(34):57489-57494. DOI: https://doi.org/10.18632/oncotarget.15423 [PMid:28915688 PMCid:PMC5593660]

Choi JB, Loredo JS, Norman D et al. Does obstructive sleep apnea increase hematocrit? Sleep Breath. 2006;10(3):155-160. DOI: https://doi.org/10.1007/s11325-006-0064-z [PMid:16770648]

Acanfora D, Gheorghiade M, Trojano L et al. Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure. Am Heart J. 2001;142(1):167-73. DOI: https://doi.org/10.1067/mhj.2001.115792 [PMid:11431674]

Ozsu S, Abul Y, Gulsoy A et al. Red cell distribution width in patients with obstructive sleep apnea syndrome. Lung. 2012;190(3):319-326. DOI: https://doi.org/10.1007/s00408-012-9376-x [PMid:22310880]

Svatikova A, Shamsuzzaman AS, Wolk R et al. Plasma brain natriuretic peptide in obstructive sleep apnea. Am J Cardiol. 2004;94(4):529-32. DOI: https://doi.org/10.1016/j.amjcard.2004.05.010 [PMid:15325948]

Taniguchi H, Momiyama Y, Ohmori R et al. Associations of plasma C-reactive protein levels with the presence and extent of coronary stenosis in patients with stable coronary artery disease. Atherosclerosis. 2005;178(1):173-1777. DOI: https://doi.org/10.1016/j.atherosclerosis.2004.08.012 [PMid:15585215]

Olivares R, Ducimetière P, Claude JR. Monocyte count: risk factor for coronary heart disease? Am J Epidemiol. 1993;137(1):49-53. DOI: https://doi.org/10.1093/oxfordjournals.aje.a116601 [PMid:8434572]

Prentice RL, Szatrowski TP, Fujikura T et al. Leukocyte counts and coronary heart disease in a Japanese cohort. Am J Epidemiol. 1982;116(3):496-509. DOI: https://doi.org/10.1093/oxfordjournals.aje.a113434 [PMid:7124717]

Weber C, Shantsila E, Hristov M et al. Role and analysis of monocyte subsets in cardiovascular disease. Thromb Haemost. 2016;116(10):626-637. DOI: https://doi.org/10.1160/TH16-02-0091 [PMid:27412877]

Gratchev A, Sobenin I, Orekhov A et al. Monocytes as a diagnostic marker of cardiovascular diseases. Immunobiology. 2012;217(5):476-82. DOI: https://doi.org/10.1016/j.imbio.2012.01.008 [PMid:22325375]

Ridker P, MacFadyen J, Thuren T et al. Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind. Lancet. 2017;390(10105):1833-1842. DOI: https://doi.org/10.1016/S0140-6736(17)32247-X

Ertem AG, Yayla C, Acar B et al. Relation between lymphocyte to monocyte ratio and short-term mortality in patients with acute pulmonary embolism. Clin Respir J. 2018;12(2):580-586. DOI: https://doi.org/10.1111/crj.12565 [PMid:27727508]

Yayla Ç, Akboğa MK, Gayretli Yayla K et al. A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio. Biomark Med. 2016;10(5):485-493. DOI: https://doi.org/10.2217/bmm-2016-0022 [PMid:27089433]

Tamakı S, Yamauchı M, Fukuoka A et al. Nocturnal hypoxic stress activates invasive ability of monocytes in patients with obstructive sleep apnoea syndrome. Respirology. 2009;14(5):689-694. DOI: https://doi.org/10.1111/j.1440-1843.2009.01540.x [PMid:19476600]

Nadeem R, Singh M, Nida M et al. Effect of obstructive sleep apnea hypopnea syndrome on lipid profile: a meta-regression analysis. J Clin Sleep Med. 2014;10(5):475-89. DOI: https://doi.org/10.5664/jcsm.3690

Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302(18):1993-2000. DOI: https://doi.org/10.1001/jama.2009.1619 [PMid:19903920 PMCid:PMC3284229]

Adedayo AM, Olafiranye O, Smith D et al. Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism. Sleep Breath. 2014;18(1):13-18. DOI: https://doi.org/10.1007/s11325-012-0760-9 [PMid:22903801 PMCid:PMC4805366]

Ganjali S, Momtazi A, Banach M et al. HDL abnormalities in familial hypercholesterolemia: Focus on biological functions. Prog Lipid Res. 2017;67:16-26. DOI: https://doi.org/10.1016/j.plipres.2017.05.001 [PMid:28506805]

Tani S, Matsumoto M, Anazawa T et al. Development of a model for prediction of coronary atherosclerotic regression: evaluation of high-density lipoprotein cholesterol level and peripheral blood monocyte count. Heart Vessels. 2012;27(2):143-150. DOI: https://doi.org/10.1007/s00380-011-0130-8 [PMid:21416115]

Pirillo A, Norata GD, Catapano AL. High-density lipoprotein subfractions-what the clinicians need to know. Cardiology. 2013;124(2):116-125. DOI: https://doi.org/10.1159/000346463 [PMid:23428644]

Canpolat U, Aytemir K, Yorgun H et al. The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation. Europace. 2015;17(12):1807-1815. DOI: https://doi.org/10.1093/europace/euu291 [PMid:25995388]

Zhang Y, Li S, Guo Y-L et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Ann Med. 2016;48(5):305-312. DOI: https://doi.org/10.3109/07853890.2016.1168935 [PMid:27087382]

Murphy A, Chin-Dusting JP, Sviridov D et al. The anti inflammatory effects of high density lipoproteins. Curr Med Chem. 2009;16(6):667-675. DOI: https://doi.org/10.2174/092986709787458425 [PMid:19199930]

Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation. Clin Exp Pharmacol Physiol. 2009;37(7):710-718. DOI: https://doi.org/10.1111/j.1440-1681.2009.05338.x [PMid:19930423]

Kuvin J, Rämet M, Patel A et al. A novel mechanism for the beneficial vascular effects of high-density lipoprotein cholesterol: enhanced vasorelaxation and increased endothelial nitric oxide synthase. Am Heart J. 2002;144(1):165-72. DOI: https://doi.org/10.1067/mhj.2002.123145 [PMid:12094204]

Börgel J, Sanner B, Bittlinsky A et al. Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels. Eur Respir J. 2006;27(1):121-127. DOI: https://doi.org/10.1183/09031936.06.00131304 [PMid:16387944]

Cicero AFG, Colletti A, Bajraktari G et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev. 2017;75(9):731-767. DOI: https://doi.org/10.1093/nutrit/nux047 [PMid:28938795]

Sahebkar A, Serban M, Gluba-Brzózka A et al. Lipid-modifying effects of nutraceuticals: an evidence-based approach. Nutrition. 2016;32(11-12):1179-1192. DOI: https://doi.org/10.1016/j.nut.2016.04.007 [PMid:27324061]

Kanbay M, Solak Y, Unal HU et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46(8):1619-1625. DOI: https://doi.org/10.1007/s11255-014-0730-1 [PMid:24853998]

Karataş M, Çanga Y, Özcan K et al. Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention. Am J Emerg Med. 2016;34(2):240-244. DOI: https://doi.org/10.1016/j.ajem.2015.10.049 [PMid:26585199]

Yılmaz M, Kayançiçek H. A new inflammatory marker: elevated monocyte to HDL cholesterol ratio associated with smoking. J Clin Med. 2018;7(4). pii: E76. DOI: https://doi.org/10.3390/jcm7040076 [PMid:29642607 PMCid:PMC5920450]

Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea. Am J Respir Crit Care Med. 2008;177(4):369-375. DOI: https://doi.org/10.1164/rccm.200608-1190PP [PMid:17975198 PMCid:PMC2258438]

Inonu Koseoglu H, Pazarli AC, Kanbay A et al. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb. 2018;24(1):139-144. DOI: https://doi.org/10.1177/1076029616677803 [PMid:27837155 PMCid:PMC6714621]

Akboga MK, Balci KG, Maden O et al. Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease. Biomark Med. 2016;10(4):375-383. DOI: https://doi.org/10.2217/bmm-2015-0050 [PMid:26999570]

Açıkgöz S, Açıkgöz E, Şensoy B et al. Monocyte to high-density lipoprotein cholesterol ratio is predictive of in-hospital and five-year mortality in ST-segment elevation myocardial infarction. Cardiol J. 2016;23(5):505-512. DOI: https://doi.org/10.5603/CJ.a2016.0026 [PMid:27296159]

Ganjali S, Gotto AM, Ruscica M et al. Monocyte‐to‐HDL‐cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol. 2018;233(12):9237-9246. DOI: https://doi.org/10.1002/jcp.27028 [PMid:30076716]

Bolayir A, Gokce S, Cigdem B et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol. 2018;52(2):150-155. DOI: https://doi.org/10.1016/j.pjnns.2017.08.011 [PMid:28864326]

Xanthoudaki M, Nena E, Manidou M et al. 016. Prevalence of metabolic syndrome between patients with obstructive sleep apnea. J Thorac Dis. 2015;7(Suppl 1).

Zimmet P, Magliano D, Matsuzawa Y et al. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb. 2005;12(6):295-300. DOI: https://doi.org/10.5551/jat.12.295 [PMid:16394610]

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-31421. DOI: https://doi.org/10.1161/circ.106.25.3143 [PMid:12485966]

Mottillo S, Filion K, Genest J et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113-1132. DOI: https://doi.org/10.1016/j.jacc.2010.05.034 [PMid:20863953]

Ridker PM, Buring JE, Cook NR et al. C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events. Circulation. 2003;107(3):391-397. DOI: https://doi.org/10.1161/01.CIR.0000055014.62083.05 [PMid:12551861]

Kounis NG, Soufras GD, Tsigkas G et al. White Blood Cell Counts, Leukocyte Ratios, and Eosinophils as Inflammatory Markers in Patients With Coronary Artery Disease. Clin Appl Thromb. 2015;21(2):139-143. DOI: https://doi.org/10.1177/1076029614531449 [PMid:24770327]

Khan I, Pokharel Y, Dadu R et al. Postprandial monocyte activation in individuals with metabolic syndrome. J Clin Endocrinol Metab. 2016;101(11):4195-4204. DOI: https://doi.org/10.1210/jc.2016-2732 [PMid:27575945 PMCid:PMC5095236]

Varol Y, Anar C, Tuzel OE et al. The impact of active and former smoking on the severity of obstructive sleep apnea. Sleep Breath. 2015;19(4):1279-1284. DOI: https://doi.org/10.1007/s11325-015-1159-1 [PMid:25801280]

Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease. J Am Coll Cardiol. 2004;43(10):1731-1737. DOI: https://doi.org/10.1016/j.jacc.2003.12.047 [PMid:15145091]

Li H, Srinivasan S, Chen W, Xu J et al. Vascular abnormalities in asymptomatic, healthy young adult smokers without other major cardiovascular risk factors: the Bogalusa Heart Study. Am J Hypertens. 2005;18(3):319-24. DOI: https://doi.org/10.1016/j.amjhyper.2004.10.005 [PMid:15797647]

Zhou M-S, Chadipiralla K, Mendez AJ et al. Nicotine potentiates proatherogenic effects of oxLDL by stimulating and upregulating macrophage CD36 signaling. Am J Physiol Circ Physiol. 2013;305(4):H563-H574. DOI: https://doi.org/10.1152/ajpheart.00042.2013 [PMid:23748423 PMCid:PMC3891251]

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.