Original Articles
Hemodynamic and Inflammatory Markers of Sleep Apnea-Hypopnea Syndrome and Nocturnal Hypoxemia: Effects of Treatment With Nasal Continuous Positive Airway Pressure
Amparo Sáncheza,
, Alan R. Schwartzb, Pedro L. Sánchezc, José L. Fernándeza, Jacinto Ramosa, Francisco Martín-Herrerod, Rafael González-Celador, Ricardo Ruano, Irene Bregóna, Cándido Martín-Luengod, Francisco P. Gómeza
Corresponding author
arsanchez@nuevoiris.com
Correspondence: Dr A. Sánchez Servicio de Neumología, Hospital Universitario de Salamanca P.º de San Vicente, 58-182 37007 Salamanca, Spain
Correspondence: Dr A. Sánchez Servicio de Neumología, Hospital Universitario de Salamanca P.º de San Vicente, 58-182 37007 Salamanca, Spain
a Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca, Spain
b Johns Hopkins Sleep Disorders Center, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
c Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
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"apellidos" => "Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Johns Hopkins Sleep Disorders Center, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr A. Sánchez Servicio de Neumología, Hospital Universitario de Salamanca P.º de San Vicente, 58-182 37007 Salamanca, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-09-10" "fechaAceptado" => "2007-12-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155043" "palabras" => array:4 [ 0 => "Sleep apnea" 1 => "Hypoxemia" 2 => "ProBNP" 3 => "Inflammation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155044" "palabras" => array:4 [ 0 => "Apnea del sueño" 1 => "Hipoxemia" 2 => "ProBNP" 3 => "Inflamación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers.</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and <span class="elsevierStyleSup">99m</span>Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (<span class="elsevierStyleItalic">r</span>=0.37,<span class="elsevierStyleItalic">P</span>=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Investigamos los factores del síndrome de apneas-hipopneas durante el sueño (SAHS) que activan los mecanismos de riesgo cardiovascular, a través del estudio de las concentraciones plasmáticas del fragmento N-terminal del precursor del péptido natriurético cerebral (NTproBNP) y de la proteína C reactiva de alta sensibilidad (PCRas), así como el efecto que sobre ellos tiene el tratamiento con presión positiva continua de la vía aérea nasal (CPAPn).</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudió a 42 pacientes con SAHS (leve-moderado en 15 casos y grave en 27), comparados con 14 personas sin SAHS. No tomaban fármacos ni presentaban diabetes, hipertensión, dislipemia importante o enfermedad cardiovascular, que se descartó tanto clínicamente como por ecocardiografía y tomografía computarizada por emisión de fotón cínico-esfuerzo con<span class="elsevierStyleSup">99m</span>Tc-tetrofosmina. En los pacientes con SAHS grave se estudiaron los efectos de 6 meses con CPAPn.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Ajustando por edad, índice de masa corporal y tabaquismo, las medias de los biomarcadores no fueron significativamente más altas en los pacientes con SAHS grave que en aquéllos con SAHS leve-moderado o en los controles. Sin embargo, en los pacientes con SAHS el principal factor que influyó en las concentraciones de NTproBNP fue el porcentaje de tiempo con saturación arterial de oxígeno nocturna menor del 90% (r = 0,37; p = 0,017), sin que se encontrara ningún predictor de los valores séricos de la PCRas. La aplicación de CPAPn hizo descender, pero no significativamente, las concentraciones de los biomarcadores.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Mientras que la hipoxemia nocturna en el SAHS es la responsable de las variaciones en los valores del NTproBNP, derivado de la afectación cardíaca, el SAHS no parece estar asociado con el biomarcador inflamatorio PCRas, cuando se excluye a los pacientes con alteraciones cardíacas, factores de riesgo cardiovascular o en tratamiento farmacológico.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep-disordered breathing and cardiovascular disease: crosssectional results of the Sleep Heart Health Study" "autores" => array:1 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 7 | 11 |
| 2024 October | 37 | 23 | 60 |
| 2024 September | 26 | 23 | 49 |
| 2024 August | 48 | 33 | 81 |
| 2024 July | 27 | 24 | 51 |
| 2024 June | 35 | 28 | 63 |
| 2024 May | 50 | 36 | 86 |
| 2024 April | 19 | 26 | 45 |
| 2024 March | 28 | 20 | 48 |
| 2024 February | 18 | 26 | 44 |
| 2023 March | 3 | 4 | 7 |
| 2023 February | 22 | 21 | 43 |
| 2023 January | 22 | 27 | 49 |
| 2022 December | 22 | 25 | 47 |
| 2022 November | 22 | 27 | 49 |
| 2022 October | 32 | 34 | 66 |
| 2022 September | 22 | 23 | 45 |
| 2022 August | 23 | 46 | 69 |
| 2022 July | 24 | 46 | 70 |
| 2022 June | 19 | 35 | 54 |
| 2022 May | 18 | 27 | 45 |
| 2022 April | 17 | 24 | 41 |
| 2022 March | 19 | 51 | 70 |
| 2022 February | 12 | 35 | 47 |
| 2022 January | 12 | 34 | 46 |
| 2021 December | 18 | 47 | 65 |
| 2021 November | 20 | 56 | 76 |
| 2021 October | 29 | 53 | 82 |
| 2021 September | 30 | 74 | 104 |
| 2021 August | 23 | 33 | 56 |
| 2021 July | 17 | 27 | 44 |
| 2021 June | 36 | 41 | 77 |
| 2021 May | 14 | 28 | 42 |
| 2021 April | 19 | 40 | 59 |
| 2021 March | 33 | 24 | 57 |
| 2021 February | 10 | 22 | 32 |
| 2021 January | 12 | 14 | 26 |
| 2020 December | 15 | 19 | 34 |
| 2020 November | 23 | 14 | 37 |
| 2020 October | 11 | 6 | 17 |
| 2020 September | 12 | 7 | 19 |
| 2020 August | 13 | 11 | 24 |
| 2020 July | 18 | 19 | 37 |
| 2020 June | 5 | 3 | 8 |
| 2020 May | 21 | 14 | 35 |
| 2020 April | 28 | 21 | 49 |
| 2020 March | 14 | 14 | 28 |
| 2020 February | 22 | 21 | 43 |
| 2020 January | 18 | 17 | 35 |
| 2019 December | 18 | 15 | 33 |
| 2019 November | 17 | 10 | 27 |
| 2019 October | 7 | 14 | 21 |
| 2019 September | 9 | 9 | 18 |
| 2019 August | 16 | 16 | 32 |
| 2019 July | 10 | 18 | 28 |
| 2019 June | 10 | 7 | 17 |
| 2019 May | 22 | 11 | 33 |
| 2019 April | 21 | 15 | 36 |
| 2019 March | 16 | 15 | 31 |
| 2019 February | 16 | 14 | 30 |
| 2019 January | 11 | 7 | 18 |
| 2018 December | 12 | 12 | 24 |
| 2018 November | 30 | 19 | 49 |
| 2018 October | 19 | 15 | 34 |
| 2018 September | 12 | 11 | 23 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 11 | 10 | 21 |
| 2018 March | 5 | 4 | 9 |
| 2018 February | 5 | 9 | 14 |
| 2018 January | 4 | 11 | 15 |
| 2017 December | 8 | 8 | 16 |
| 2017 November | 5 | 4 | 9 |
| 2017 October | 10 | 10 | 20 |
| 2017 September | 7 | 9 | 16 |
| 2017 August | 17 | 9 | 26 |
| 2017 July | 18 | 10 | 28 |
| 2017 June | 17 | 10 | 27 |
| 2017 May | 11 | 10 | 21 |
| 2017 April | 7 | 2 | 9 |
| 2017 March | 9 | 2 | 11 |
| 2017 February | 3 | 2 | 5 |
| 2017 January | 3 | 2 | 5 |
| 2016 December | 9 | 7 | 16 |
| 2016 November | 11 | 7 | 18 |
| 2016 October | 25 | 12 | 37 |
| 2016 September | 10 | 9 | 19 |
| 2016 August | 6 | 4 | 10 |
| 2016 July | 7 | 2 | 9 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 72 | 11 | 83 |
| 2015 September | 75 | 6 | 81 |
| 2015 August | 72 | 11 | 83 |
| 2015 July | 46 | 6 | 52 |
| 2015 June | 33 | 4 | 37 |
| 2015 May | 53 | 9 | 62 |
| 2015 April | 39 | 7 | 46 |
| 2015 March | 31 | 3 | 34 |
| 2015 February | 51 | 4 | 55 |
| 2015 January | 37 | 9 | 46 |
| 2014 December | 49 | 9 | 58 |
| 2014 November | 41 | 8 | 49 |
| 2014 October | 50 | 13 | 63 |
| 2014 September | 37 | 8 | 45 |
| 2014 August | 36 | 12 | 48 |
| 2014 July | 35 | 9 | 44 |
| 2014 June | 43 | 7 | 50 |
| 2014 May | 52 | 8 | 60 |
| 2014 April | 47 | 5 | 52 |
| 2014 March | 49 | 9 | 58 |
| 2014 February | 50 | 6 | 56 |
| 2014 January | 35 | 11 | 46 |
| 2013 December | 39 | 9 | 48 |
| 2013 November | 29 | 6 | 35 |
| 2013 October | 39 | 9 | 48 |
| 2013 September | 33 | 8 | 41 |
| 2013 August | 34 | 7 | 41 |
| 2013 July | 40 | 11 | 51 |
| 2013 June | 36 | 9 | 45 |
| 2013 May | 35 | 5 | 40 |
| 2013 April | 17 | 7 | 24 |
| 2013 March | 9 | 1 | 10 |
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