Consequences of Comorbid Sleep Apnea in the Metabolic Syndrome-Implications for Cardiovascular Risk


Autoria(s): TROMBETTA, Ivani C.; SOMERS, Virend K.; MAKI-NUNES, Cristiane; DRAGER, Luciano F.; TOSCHI-DIAS, Edgar; ALVES, Maria Janieire N. N.; FRAGA, Raffael F.; RONDON, Maria Urbana P. B.; BECHARA, Malta G.; LORENZI-FILHO, Gerado; NEGRAO, Carlos E.
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2010

Resumo

Study Objectives: Metabolic syndrome (MetSyn) increases overall cardiovascular risk. MetSyn is also strongly associated with obstructive sleep apnea (OSA), and these 2 conditions share similar comorbidities. Whether OSA increases cardiovascular risk in patients with the MetSyn has not been investigated. We examined how the presence of USA in patients with MetSyn affected hemodynamic and autonomic variables associated with poor cardiovascular outcome. Design: Prospective clinical study. Participants: We studied 36 patients with MetSyn (ATP-III) divided into 2 groups matched for age and sex: (1) MetSyn+OSA (n = 18) and (2) MetSyn-OSA (n = 18). Measurements: USA was defined by an apnea-hypopnea index (AHI) > 15 events/hour by polysomnography. We recorded muscle sympathetic nerve activity (MSNA - microneurography), heart rate (HR), and blood pressure (BP - Finapres). Baroreflex sensitivity (BRS) was analyzed by spontaneous BP and HR fluctuations. Results: MSNA (34 +/- 2 vs 28 +/- 1 bursts/min, P = 0.02) and mean BP (111 +/- 3 vs. 99 +/- 2 mm Hg, P = 0.003) were higher in patients with MetSyn+OSA versus patients with MetSyn-USA. Patients with MetSyn+OSA had lower spontaneous BRS for increases (7.6 +/- 0.6 vs 12.2 +/- 1.2 msec/mm Hg, P = 0.003) and decreases (7.2 +/- 0.6 vs 11.9 +/- 1.6 msec/mm Hg, P = 0.01) in BP. MSNA was correlated with AHI (r = 0.48; P = 0.009) and minimum nocturnal oxygen saturation (r = -0.38, P = 0.04). Conclusion: Patients with MetSyn and comorbid USA have higher BP, higher sympathetic drive, and diminished BRS, compared with patients with MetSyn without USA. These adverse cardiovascular and autonomic consequences of USA may be associated with poorer outcomes in these patients. Moreover, increased BP and sympathetic drive in patients with MetSyn+OSA may be linked, in part, to impairment of baroreflex gain.

Conselho Nacional de Pesquisa (CNPq)[476385/2006-7]

Conselho Nacional de Pesquisa (CNPq)[304304/2004-2]

Conselho Nacional de Pesquisa (CNPq)[305159/2005-4]

Conselho Nacional de Pesquisa (CNPq)[306931/2006-0]

Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)[2005/59740-7]

Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)[2008/03714-6]

Fundacao Zerbini

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)

National Institutes of Health (NIH)[HL65176]

National Center for Research Resources (NCRR)[1 UL1 RR024150]

NIH Roadmap for Medical Research

Identificador

SLEEP, v.33, n.9, p.1193-1199, 2010

0161-8105

http://producao.usp.br/handle/BDPI/22970

http://apps.isiknowledge.com/InboundService.do?Func=Frame&product=WOS&action=retrieve&SrcApp=EndNote&UT=000281473600011&Init=Yes&SrcAuth=ResearchSoft&mode=FullRecord

Idioma(s)

eng

Publicador

AMER ACAD SLEEP MEDICINE

Relação

Sleep

Direitos

restrictedAccess

Copyright AMER ACAD SLEEP MEDICINE

Palavras-Chave #Cardiovascular risk #sleep apnea #metabolic syndrome #sympathetic activation #baroreflex control #MUSCLE METABOREFLEX CONTROL #SYMPATHETIC-NERVE ACTIVITY #HEART-FAILURE #BAROREFLEX SENSITIVITY #BLOOD-PRESSURE #SCIENTIFIC STATEMENT #DAILY-LIFE #HYPERTENSION #ACTIVATION #DISEASE #Clinical Neurology #Neurosciences
Tipo

article

original article

publishedVersion