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Obstructive sleep apnoea syndrome is associated with enhanced sub-clinical inflammation and asymmetric dimethyl-arginine levels in hypertensives

Journal of Human Hypertension volume 23, pages 65–67 (2009)Cite this article

In a cross-sectional study of middle aged hypertensives, those with obstructive sleep apnoea syndrome (OSAS) compared with those without OSAS, demonstrated increased levels of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), interleukin 18 (IL-18), tumour necrosis factor alpha (TNF-α) and asymmetric dimethyl-arginine (ADMA), at the same level of ambulatory pulsatile load and body size. Association of apnoea severity indices with the above-mentioned markers supports the incremental effect of OSAS on the cardiovascular risk duet of sub-clinical inflammation and endothelial dysfunction in the setting of hypertension.

Epidemiological evidence linking OSAS and hypertension is documented independently of confounding atherosclerotic factors and cardiovascular comorbidities.1 However, many studies designed to identify the involved pathogenetic mechanisms mainly suffer from inadequate control for confounders such as body mass index and blood pressure (BP).2 Diverse cytokines promote a wide range of atherogenic effects in various domains of the vasculature3 reflecting alternative pathways of inflammatory activation. Furthermore, ADMA has been characterized as the ‘uber marker’ of endothelial dysfunction in multiple clinical settings including hypertension.4 Repetitive upper airway collapses in OSAS result in hypoxia, hypercapnia and changes in intrathoracic pressure accompanied by a variety of autonomic, haemodynamic, humoral and cellular responses. We investigated the possible associations of OSAS with hs-CRP, IL-6, IL-18, TNF-α and ADMA in hypertensives.

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References

  1. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F et al. Sleep disordered breathing and cardiovascular disease. Cross sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163: 19–25.

    Article  CAS  Google Scholar 

  2. McNicholas WT, Bonsignore MR, and the Management Committee of EU COST ACTION B 26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 2007; 29 (1): 156–178.

    Article  CAS  Google Scholar 

  3. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon III RO, Criqui M et al. Markers of inflammation and cardiovascular disease. Application to clinical and public health practice: a statement for healthcare professionals from the Centres for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499–511.

    Article  Google Scholar 

  4. Cooke JP . Asymmetrical dimethylarginine: the Uber marker? Circulation 2004; 109: 813–818.

    Article  Google Scholar 

  5. Tsioufis C, Thomopoulos K, Dimitriadis K, Amfilochiou A, Tousoulis D, Alchanatis M et al. The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens 2007; 25 (1): 141–146.

    Article  CAS  Google Scholar 

  6. Ohayon M, Guilleminault C . Sleep disordered breathing and C reactive protein: a commentary. Sleep 2007; 30: 679.

    Article  Google Scholar 

  7. Punjami NM, Beamer BA . C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 2007; 30: 29–34.

    Article  Google Scholar 

  8. Shamsuzzaman AS, Winnicki M, Lafranchi P, Wolk R, Kara T, Accurso V et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002; 105: 2462–2464.

    Article  CAS  Google Scholar 

  9. Drager L, Bortolotto L, Lorenzi MC, Figueiredo A, Krieger E, Lorenzi-Filho G . Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172: 613–618.

    Article  Google Scholar 

  10. Miyazaki H, Matsuoka H, Cooke J, Usui M, Ueda S, Okuda S et al. Endogenous nitric oxide synthase inhibitor: a novel marker of atherosclerosis. Circulation 1999; 99: 1141–1146.

    Article  CAS  Google Scholar 

  11. Ohike Y, Kozaki K, Eto M, Kojima T, Ohga E, Santa T et al. Amelioration of vascular endothelial dysfunction in obstructive sleep apnea syndrome by nasal continuous positive airway pressure. Possible involvement of nitric oxide and asymmetric NG, NG-dimethylarginine. Circ J 2005; 69: 221–226.

    Article  CAS  Google Scholar 

  12. Tsioufis C, Stougiannos P, Kakkavas A, Toutouza M, Mariolis A, Vlasseros I et al. Relation of left ventricular concentric remodelling to the levels of C-reactive protein and serum amyloid-A in patients with essential hypertension. Am J Cardiol 2005; 96 (2): 252–256.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. First Cardiology Clinic, Hippokration Hospital, University of Athens, Athens, Greece

    C Thomopoulos, C Tsioufis, K Dimitriadis, D Tsiachris, D Tousoulis & C Stefanadis

  2. Department of Cardiology, Asklepieion Hospital, Athens, Greece

    A Manolis

  3. Department of Respiratory Medicine, Sotiria Hospital, University of Athens, Athens, Greece

    M Alchanatis

  4. Department of Cardiology, Hippokration Hospital, Athens, Greece

    I Kallikazaros

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  1. C Thomopoulos
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  2. C Tsioufis
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  4. D Tsiachris
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  5. D Tousoulis
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  6. A Manolis
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  7. M Alchanatis
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  9. C Stefanadis
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Correspondence to C Tsioufis.

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Thomopoulos, C., Tsioufis, C., Dimitriadis, K. et al. Obstructive sleep apnoea syndrome is associated with enhanced sub-clinical inflammation and asymmetric dimethyl-arginine levels in hypertensives. J Hum Hypertens 23, 65–67 (2009). https://doi.org/10.1038/jhh.2008.101

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