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Postgraduate Education CornerContemporary Reviews in Sleep MedicineObstructive Sleep Apnea: An Emerging Risk Factor for Atherosclerosis
Section snippets
Atherosclerosis: Fundamental Concepts
In the past, atherosclerosis was considered a lipid storage disease. The current view is that atherosclerosis is a complex phenomenon involving chronic inflammation of the vascular wall.7 According to the American Heart Association, there are six identified histologic categories of atherosclerotic lesions.8 Atherosclerotic lesions begin with the fatty streaks composed of macrophages engulfing lipids (foam cells), T lymphocytes, and smooth muscle cells. Further accumulation of lipids results in
Mechanisms Linking OSA to Atherosclerosis
The mechanisms by which OSA may contribute to atherosclerosis progression comprise a cascade of multiple, interrelated, and not completely known mechanisms that are under investigation. Therefore, any attempt to simplify this entangled cascade of mediators may be misleading. Having this potential limitation in mind, Figure 1 summarizes several key mechanisms involved in the atherogenesis induced by OSA. The primary mechanisms that may link OSA to atherosclerosis are consequences of recurrent
Markers of Atherosclerosis in Patients With OSA
Performing a search in PubMed (search terms were “apnea,” “obstructive sleep apnea,” “sleep apnea syndromes,” “atherosclerosis,” “arteriosclerosis,” “intima-media thickness,” “plaque,” “catheterization,” “ultrasound,” “intravascular ultrasound,” and “coronary artery calcium”) for articles that evaluated atherosclerosis in patients with OSA (excluding studies that evaluated only endothelial function, arterial stiffness, and coronary flow), we found 36 studies from 1998 (the year of the first
Future Directions
As suggested by Figure 1, OSA can induce atherosclerosis via multiple mechanisms. As discussed in this review, there is a growing body of evidence from clinical studies and animal models suggesting that OSA contributes to the progression of atherosclerosis. However, the majority of human data is based on cross-sectional studies focused on the carotid bed. It must be stressed that increased markers of atherosclerosis were observed mainly in patients with moderate and severe OSA. These findings
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.
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2023, Biomedicine and PharmacotherapyCitation Excerpt :In addition, a previous study of OSA patients compared to non-OSA patients reported a profile of 65 proteins, highlighting a differentially expressed profile pattern of TFPI in patients with OSA [52]. These pathways have been previously described as targets of the pathophysiological consequences of OSA [37,40,50,53]. Specifically, these three proteins play a key role in regulating the inflammatory response and oxidative stress, together with an effect on endothelial dysfunction.
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Funding/Support: This study was funded by the National Institutes of Health [Grants R01 HL80105, 5P50HL084945]; Fundação Zerbini; Fundação de Amparo à Pesquisa do Estado de São Paulo [Research Fellowship Grant 2010/11681-0]; and the American Heart Association [Grant-in-Aid 10GRNT3360001].
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