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

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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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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: Drager, Luciano F.
Togeiro, Sônia M.
Polotsky, Vsevolod Y.
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: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 377 d)
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 (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Pharmacology (medical) › 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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