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Obstructive Sleep Apnea Endocrine effects

Obstructive Sleep Apnea Endocrine effects. A. Valipour, MD, FCCP Department of Respiratory and Critical Care Medicine Otto-Wagner-Hospital Vienna. Prevalence: ~2-4% of population Risk Factors: Obesity Male Gender Anatomic Risk Factors Symptoms:

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Obstructive Sleep Apnea Endocrine effects

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  1. Obstructive Sleep ApneaEndocrine effects A. Valipour, MD, FCCP Department of Respiratory and Critical Care Medicine Otto-Wagner-Hospital Vienna

  2. Prevalence: ~2-4% of population • Risk Factors: • Obesity • Male Gender • Anatomic Risk Factors • Symptoms: • Excessive Sleepiness • Snoring/Apneas/Choking • Cognitive Dysfunction • Cardiovascular Morbidity and Mortality

  3. OSA and Endocrinedisorders Spiegel K, Nature RevEndocrinol 2009

  4. ObstructiveApnea: EndocrineEffects • Prevalence of endocrine/metabolic disease • Mechanism of action • Effects of treatment

  5. ObstructiveApnea: EndocrineEffects • Prevalence of endocrine/metabolicdisease • Mechanism of action • Effects of treatment

  6. Kiely JL et al., EurRespir J 2000

  7. Börgel J, Eur Respir J 2006

  8. Glucose- und Insulin levelsincreasewithseverity of OSA Punjabi NM et al., Am J Respir Crit Care Med 2002

  9. McArdle N, AJRCCM 2007

  10. Reichmuth KJ et al., Am J RespirCritCareMed 2005

  11. Reichmuth KJ et al., Am J RespirCritCareMed 2005

  12. Obesity + Hyperlipidemia + Hypertension + Impaired Glucose Tolerance ↓ Metabolic Syndrome Coughlin SR, EurHeart J 2004 Kono M et al., Chest 2007

  13. Redline S et al., AJRCCM 2007

  14. Metabolic Syndrome „Z“ Parish JM, Chest 2009

  15. Meston N, J Intern Med 2003

  16. ObstructiveApnea: EndocrineEffects • Prevalence of endocrine/metabolicfactors • Mechanism of action • Effects of treatment

  17. ObstructiveApnea: Consequences Flow Sympathetic activation Intermittent Hypoxia Sleep fragmentation ↓ Endocrine Effects Apnea Apnea Thorax Abdomen SaO2

  18. OSA: Mechanism of impairedglucosetolerance Punjabi NM et al., J ApplPhysiol 2005

  19. Alteredglucosemetabolism as a consequence of sleepfragmentation Resultsfromintravenousglucose-tolerancetests in healthy individuals when fully rested and after sleepmanipulations Spiegel K, Nature RevEndocrinol 2009

  20. Leptin: satietyhormoneGhrelin: appetite-stimulating hormone Spiegel K, Nature RevEndocrinol 2009

  21. Intermittent hypoxia can cause acute insulin resistance in lean, healthy animals, and the response is associated with decreased glucose utilization of oxidative muscle fibers, but occurs independently of activation of the ANS Iiyori N, AJRCCM 2007

  22. Intermittent hypoxia does not exacerbate pre-existing hyperlipidemia and metabolic disturbances in leptin-deficient obesity Li J et al., Circ Res 2005

  23. 12 male obeseleptin-deficientmice Standard diet 12 Weeks intermittent 5% FiO2 Upregulation of genes encoding: Cholesterol Fattyacidbiosynthesis Triglyceridesynthesis Sterolregualtorybindingelementprotein Li J et al., J ApplPhysiol 2005

  24. FactorsassociatedwiththeMetabolic Syndrome: Clinicaldata Redline S et al., AJRCCM 2007

  25. ObstructiveApnea: EndocrineEffects • Prevalence of endocrine/metabolic factors • Mechanism of action • Effects of treatment

  26. All the lipids/lipoproteins improved significantly in patients with initial pathological levels. Börgel J, Eur Respir J 2006

  27. Harsch et al., Am J RespirCritCareMed 2004

  28. At 12 weeks, improvement in Insulin Resistance was seen in subjects with BMI > 25sqm , but not in the subjects with BMI< 25 kg/sqm or the entire group. Lam JCM, EurRespir J 2010

  29. Babu AR, Arch Intern Med 2005

  30. Babu AR, Arch Intern Med 2005

  31. CVD-Risk Score: sex, age, total cholesterol, HDL cholesterol, systolicbloodpressure, smoking and diabetes Dorkova Z, Chest 2008

  32. Conclusions • High prevalence of metabolic syndrome in OSA • Mechanisms: • Intermittent Hypoxia • Sleep Fragmentation • CPAP treatment reduces metabolic/cardiovascular risk

  33. Thank you for your attention

  34. Vgontzas AN et al., J Intern Med 2003

  35. Weightloss CPAP Chin K et al, Circulation 1999

  36. Meston N, J Intern Med 2003

  37. Steatosishepatis in obesenon-OSA Steatosis and Inflammation in OSA Polotsky VY, AJRCCM 2008

  38. Polotsky VY, AJRCCM 2008

  39. Kapur VK, AJRCCM 1998

  40. Babu AR, Arch Intern Med 2005

  41. Wolk R et al., Exp Physiol 2007

  42. Vgontzas AN et al., J EndocrinolMetab 2000

  43. Kiely JL et al., EurRespir J 2000

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