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Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
2012 (English)In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 35, no 11, p. 1521-1527Article in journal (Refereed) Published
Abstract [en]

Study Objectives:

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. One contributory factor may be hemodynamic stress due to the negative intrathoracic pressure during each episode of apnea. Type B natriuretic peptide (BNP) is secreted by the cardiac ventricles in response to volume expansion and pressure load and the authors hypothesized that there would be an association between indices of OSA during the night and levels of BNP in the morning.

Setting:

Community-based in Uppsala, Sweden.

Participants:

There were 349 women who participated.

Measurements and Results:

Participants underwent full-night polysomnography and anthropometric measurements, and answered questionnaires about medical conditions and current medication. The morning after the polysomnography, blood samples were drawn for analysis of plasma BNP, C-reactive protein, creatinine, and hemoglobin. There was an increase in mean BNP as the severity of sleep apnea increased, increasing from a mean value of 8.5 ng/L among women with an apnea-hypopnea index (AHI) < 5 to 18.0 ng/L in women with an AHI = 30. Elevated BNP levels (= 20 ng/L) were found in 29.8% of the women, whereas 70.2% had normal levels. The odds ratio was 2.2 for elevated BNP levels for women with an AHI of 5-14.9 in relation to women with an AHI < 5, 3.1 for women with an AHI of 15-29.9, and 4.6 for women with an AHI = 30 after adjustment for age, body mass index, systolic blood pressure, antihypertensive drugs, and creatinine.

Conclusions:

There is a dose-response relationship in women between the severity of sleep apnea during the night and the levels of BNP in the morning.

Place, publisher, year, edition, pages
2012. Vol. 35, no 11, p. 1521-1527
Keywords [en]
Community-based, Epidemiology, Heart failure, Polysomnography, Sleep apnea
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-184929DOI: 10.5665/sleep.2202ISI: 000310578200013OAI: oai:DiVA.org:uu-184929DiVA, id: diva2:570489
Available from: 2012-11-19 Created: 2012-11-15 Last updated: 2019-04-09Bibliographically approved
In thesis
1. Sleep-disordered breathing in women: Associations with cardiovascular disease and the significance of sleep apnea during REM sleep
Open this publication in new window or tab >>Sleep-disordered breathing in women: Associations with cardiovascular disease and the significance of sleep apnea during REM sleep
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sleep-disordered breathing (SDB) is associated with an increased risk of cardiovascular disease, but it is unclear which elements of SDB that are most harmful to the cardiovascular system and whether the associations observed in men also apply to women.

Aim: To investigate associations between different aspects of SDB and cardiovascular disease in women

Methods and results: All four papers were based on participants in “Sleep and Health in Women” (SHE), a population-based cohort study of women.

Paper I is a cross-sectional study of 349 women with polysomnographic assessments of obstructive sleep apnea (OSA) and measurements of plasma BNP, clinically used as a marker of heart failure, in the morning. There was a dose-response relationship between the severity of OSA and levels of BNP.

In Paper II, with a study population of 5,990 women, questionnaire data on symptoms of obstructive sleep apnea were combined with register data from the Swedish National Patient Register regarding a diagnosis of heart failure (mean follow-up 11.4 years). Women with the combination of snoring and daytime sleepiness had a two-fold increase in the risk of incident heart failure after adjustment for confounding.

Paper III was based on 201 women without known cardiovascular disease, with a polysomnography at baseline, assessing OSA during REM sleep, and a carotid artery ultrasound with measurements of intima thickness at follow-up. Severe OSA during REM sleep was associated with a thicker carotid intima.

Paper IV comprised 253 women with polysomnographic data on severe OSA and severe OSA during REM sleep, as well as proteomic analyses of cardiac and inflammatory proteins. After adjustment for confounding and multiple testing, severe OSA during REM sleep was associated with decreased levels of Sirt2, LAP-TGF-β1 and Axin1, while there were no significant associations for OSA based on a whole night and protein levels.

Conclusions: Women with symptoms of OSA run an increased risk of developing heart failure and OSA is associated with increased levels of BNP. Severe OSA during REM sleep is associated with an early sign of atherosclerosis and reduced levels of proteins with anti-inflammatory effects linked to atherosclerosis and metabolic regulation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1567
Keywords
Obstructive sleep apnea, REM sleep, cardiovascular disease, heart failure
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-381416 (URN)978-91-513-0640-7 (ISBN)
Public defence
2019-06-05, Enghoffsalen, Akademiska sjukhuset, Ing 50 bv, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-05-15 Created: 2019-04-09 Last updated: 2019-06-18

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Ljunggren, MirjamLindahl, BertilTheorell-Haglöw, JennyLindberg, Eva
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