Obstructive sleep apnoea (OSA) has been associated with disturbances in energy metabolism and insulin resistance, nevertheless, the links between OSA severity, resting energy expenditure (REE) and insulin resistance (homeostasis model assessment, HOMA-IR) remained unexplored. Therefore, we investigated the effects of OSA severity on REE, and relationships between REE and HOMA-IR in patients with OSA. Forty men [mean (SD) age 49.4 (11.4) years] underwent overnight polysomnography; REE was assessed using indirect calorimetry. REE adjusted for fat-free mass (FFM) was higher in patients with moderate-to severe OSA [n=24; body mass index (BMI) 31.1 (2.7) kg.m(-2); apnoea-hypopnoea index (AHI)>/=15 episodes.h(-1)] compared to participants with no clinically significant OSA (n=16; BMI 30.3 (2.2) kg.m(-2); AHI<15 episodes.h(-1)) [median (interquartile range) 30.4 (26.1-31.3) versus 25.8 (24.6-27.3) kcal.kg(-1).24 h(-1), p=0.005)]. AHI and oxygen desaturation index (ODI) were directly related to REE/FFM (p=0.001; p<0.001, respectively) and to HOMA-IR (p<0.001 for both). In stepwise multiple linear models, REE/FFM was independently predicted by ODI (p<0.001) and age (p=0.028) (R(2)=0.346); HOMA-IR was independently predicted by ODI only (p<0.001, R(2)=0.457). In conclusion, male patients with moderate-to severe OSA have increased REE paralleled by impaired insulin sensitivity. Severity of nocturnal intermittent hypoxia reflected by ODI is an independent predictor of REE/FFM and HOMA-IR.

• MeSH
• adipokiny krev   MeSH
• dospělí MeSH
• energetický metabolismus * MeSH
• glukosa metabolismus   MeSH
• index tělesné hmotnosti MeSH
• inzulinová rezistence * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepřímá kalorimetrie MeSH
• obezita komplikace   patofyziologie   MeSH
• obstrukční spánková apnoe metabolismus   patofyziologie   MeSH
• odpočinek MeSH
• polysomnografie MeSH
• senioři MeSH
• složení těla MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Increases in resting energy expenditure (REE) likely contribute to weight loss in various chronic diseases. In chronic obstructive pulmonary disease (COPD), relationships between the ventilatory impairment and increased REE, and between disturbances in adipokines and weight loss were previously described. Therefore, we investigated serum levels and adipose tissue expression of leptin and adiponectin, and their relationships to REE in patients with COPD. In 44 patients with stable COPD (38 male; age 62.3+/-7.2 years), REE was assessed using indirect calorimetry. Subcutaneous adipose tissue samples were analyzed using real-time PCR. From underweight [n=9; body mass index (BMI) <20.0 kg.m(-2)], to normal weight-overweight (n=24, BMI=20.0-29.9 kg.m(-2)) and obese patients (n=11; BMI>/=30 kg.m(-2)), REE adjusted for body weight decreased (32.9+/-6.1 vs. 26.2+/-5.8 vs. 23.9+/-6.6 kcal.kg(-1).24 h(-1), p=0.006), serum levels and adipose tissue expression of leptin increased (p<0.001 for both), and serum and adipose tissue adiponectin decreased (p<0.001; p=0.004, respectively). REE was inversely related to serum and adipose tissue leptin (R=-0.547, p<0.001; R=-0.458, p=0.002), and directly to serum adiponectin (R=0.316, p=0.039). Underweight patients had increased REE compared to normal weight-overweight patients, in association with reductions in serum and adipose tissue leptin, and increased serum adiponectin, suggesting a role of adipokines in energy imbalance in COPD-related cachexia.

• MeSH
• adiponektin krev   metabolismus   MeSH
• chronická obstrukční plicní nemoc metabolismus   MeSH
• energetický metabolismus * MeSH
• leptin krev   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• odpočinek * MeSH
• tuková tkáň metabolismus   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Obštrukčné spánkové apnoe (OSA) je charakterizované opakovanými epizódami úplného alebo čiastočného kolapsu dýchacích ciest počas spánku prejavujúceho sa apnoickými alebo hypopnoickými pauzami. Artériová hypertenzia je najčastejšou kardiovaskulárnou (KVS) komorbiditou OSA pacientov. Opakované cykly desaturácií a reoxygenácií spojené so zvýšenou sympatikovou aktivitou, oxidačným stresom, aktiváciou renín-angiotenzín-aldosterónového systému a endotelovou dysfunkciou prispievajú k akútnym vzostupom tlaku krvi (TK) počas spánku a k fixácii tohto stavu aj počas dňa. Vysoká pravdepodobnosť prítomnosti OSA je medzi pacientmi s rezistentnou artériovou hypertenziou a pacientmi ktorí nevykazujú nočné poklesy TK (tzv. non-dippers). Súčasný výskyt hypertenzie a neliečeného OSA zvyšuje kardiovaskulárne riziko, preto je pri podozrení na OSA (anamnéza chrápania, apnoických páuz a nadmernej dennej spavosti) potrebné vyšetrenie v spánkovom laboratóriu. V kohorte 536 pacientov vyšetrených v Laboratóriu pre spánkové poruchy dýchania Kliniky pneumológie a ftizeológie LF UPJŠ v Košiciach bolo OSA ťažkého stupňa diagnostikované u 236 pacientov. Pacienti s OSA mali signifikantne častejšie zaznamenanú prítomnosť liečenej artériovej hypertenzie, ischemickej choroby srdca, prekonaného infarktu myokardu, dyslipidémie a diabetu 2. typu. Medzi pacientmi ktorí užívali viac ako dvojkombináciu antihypertenzív bolo 87 % zastúpenie pacientov s OSA (58 % s OSA ťažkého stupňa). Pri potvrdení OSA stredne ťažkého a ťažkého stupňa je indikovaná dlhodobá liečba pomocou neinvazívnej ventilácie, avšak na kontrolu hladín TK obvykle zostáva nutná aj farmakoterapia. Dokázaný bol synergický efekt liečby OSA neinvazívnou ventiláciou a užívania liečiv ovplyvňujúcich renín-angiotenzín-aldosterónový systém na zníženie hladín TK.

Obstructive sleep apnoea (OSA) is characterized by repeated episodes of total or partial upper airway occlusion during sleep resulting in apnoeic or hypopnoeic episodes. Arterial hypertension is the most prevalent cardiovascular comorbidity in OSA patients. Repetitive cycles of hypoxaemia and reoxygenation are accompanied by increased sympathetic activity, oxidative stress, activation of the renin-angiotensin-aldosterone system and endothelial dysfunction that contribute to acute rise in blood pressure (BP) during sleep as well as to the persistence of elevated BP during wakefulness. Patients with resistant hypertension and non-dippers have increased prevalence of OSA. Unrecognized OSA in the presence of poorly controlled hypertension increases the cardiovascular risk substantially. Therefore, in the presence of symptoms suggestive of OSA such as history of snoring, apnoeic pauses and excessive daytime sleepiness, examination in the sleep laboratory is strongly recommended. In the cohort of 536 patients examined in the Laboratory for Sleep Disordered Breathing, Department of Respiratory Medicine and Tuberculosis, Medical Faculty, PJ Safarik University in Kosice we diagnosed severe OSA in 236 cases. OSA was associated with increased prevalence of cardiovascular diseases, dyslipidaemia and diabetes type 2. Among patients who reported the use of more than 2 antihypertensive drugs the prevalence of OSA was 87 % (58 % for severe OSA). Long-time non-invasive ventilation represents golden standard for treatment of moderate and severe OSA. However, non-invasive ventilation per se is frequently not sufficient to achieve BP control, and therefore adequate antihypertensive medication is required. Recent data suggest synergic effects of non-invasive ventilation and aldosterone antagonists on BP in patients with OSA and concurrent arterial hypertension.