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Cited by 888Obstructive Sleep Apnea ResearchSleep and related disordersApelin-related biomedical research

Obstructive Sleep Apnea

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Drager, Luciano F., Togeiro, Sônia M., Polotsky, Vsevolod Y., Lorenzi-Filho, Geraldo·2013·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2013.05.045PMC PMC4461232
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Abstract

Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.

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  • An increased risk of cardiopulmonary disease and mortality has been established for clinically relevant OSA (AHI ≥ 15).

    “where an increased risk of cardiopulmonary disease and mortality has been established (true positive)432–434”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [432]

    The paper’s Abstract (page unavailable) reports that cohort studies consistently associate OSA with increased cardiovascular mortality, and its section on independent cardiometabolic effects reports an association with cardiovascular events. It defines moderate-to-severe OSA as AHI ≥15, but does not establish that threshold specifically for the reported risks or address pulmonary disease risk. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Central adiposity is linked to the development of both obstructive sleep apnea and metabolic syndrome, with both sharing similar pathophysiological features such as systemic inflammation and endothelial dysfunction.

    “Central adiposity is linked to the development of both OSA and the metabolic syndrome, with both sharing similar pathophysiological features (eg, systemic inflammation, endothelial dysfunction).47”

    From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [47]

    The review’s Abstract links obesity to OSA and reports systemic inflammation and endothelial dysfunction in obese patients with OSA. Its discussion of why OSA is common in obesity and metabolic syndrome also describes a role for abdominal fat in airway narrowing. However, the cited passages do not establish that central adiposity contributes to the development of metabolic syndrome or that both conditions share the two named features. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Intermittent hypoxia of adipose tissue, sympathetic activation, induction of adipocytokines, and oxidative stress may promote the development of metabolic risk factors.

    “In addition, intermittent hypoxia of adipose tissue, sympathetic activation, induction of adipocytokines, and oxidative stress may promote the development of metabolic risk factors.47”

    From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [47]

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Research works printed but not linked: 1

  1. [60]60. Pedrosa RP, Krieger EM, Lorenzi-Filho G, Drager LF. Recent advances of the impact of obstructive sleep apnea on systemic hyper- tension. Arq Bras Cardiol 2011;97:e40-7.

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Authors
Drager, L. F., Togeiro, S. M., Polotsky, V. Y., & Lorenzi-Filho, G.
Affiliations
  • Universidade de São Paulo (BR)
  • Universidade Federal de São Paulo (BR)
  • Johns Hopkins University (US)
Corresponding author
Drager, Luciano F.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2013-08
Volume
62
Issue
7
Pages
569-576
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2013.05.045
PMC
PMC4461232
OpenAlex
W82112906
Semantic Scholar
d934a572c944ea22e897140990fef8af7b39baa3
Cited by
886
References
87
Citations by year
2026: 103 · 2025: 106 · 2024: 77 · 2023: 56 · 2022: 71 · 2021: 80 · 2020: 82 · 2019: 50 · 2018: 49 · 2017: 37 · 2016: 58 · 2015: 63 · 2014: 47 · 2013: 7
FWCI
40.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Funders
National Heart, Lung, and Blood Institute (R01HL080105)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pharmacology › Apelin-related biomedical research
Keywords
obstructive sleep apnea, obesity, metabolic syndrome, intermittent hypoxia, insulin resistance, non-alcoholic fatty liver disease, cardiovascular risk, continuous positive airway pressure, arterial stiffness, atherosclerosis, cardiovascular mortality, endothelial dysfunction, systemic inflammation, sympathetic activation
MeSH terms
Adult, Aged, Cardiovascular Diseases, Female, Humans, Hypertension, Insulin Resistance, Male, Middle Aged, Obesity, Prognosis, Comorbidity, Body Mass Index, Incidence, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Cross-Over Studies, Sleep Apnea, Obstructive, Metabolic Syndrome, Continuous Positive Airway Pressure

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