Metabolic syndrome and sympathetic nervous system: is obstructive sleep apnea a key to understanding?

Česká verzia

Authors: T. Kára ¹; M. Souček ³; Š. Kárová ¹; J. Vítovec ²; V. K. Somers ¹
Authors place of work: Division of Cardiovascular Diseases and Hypertension, Mayo Clinic, Rochester, MN, USA, přednosta prof. David L. Hayes, M. D. ¹; I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC ²; II. interní klinika Lékařské fakulty MU a FN u sv. Anny, Brno, přednosta doc. MUDr. Miroslav Souček, CSc. ³
Published in the journal: Vnitř Lék 2005; 51(1): 53-61
Category: Reviews

Summary

Chronically increased sympathetic nervous system activity may contribute to the onset and progression of the metabolic syndrome. However, the primary cause of increased sympathetic activity in patients with this syndrome remains unclear. Obstructive sleep apnea has a high incidence in the general population and may be a significant independent risk factor for some cardiovascular diseases. Despite these considerations, obstructive sleep apnea remains generally underestimated phenomenon in both clinical practice as well as research. Data from clinical and basic research suggest that obstructive sleep apnea is associated with, and may contribute to, a significant increase in sympathetic activity, body weight and body fat, and systemic blood pressure. Obstructive sleep apnea is also associated with insulin and leptin resistance. Moreover, obstructive sleep apnea is linked with systemic inflammation, endothelial dysfunction, oxidative stress and a protrombotic state. Similarities in regulatory and metabolic abnormalities in obstructive sleep apnea and the metabolic syndrome, as well as the high prevalence of both metabolic syndrome and obstructive sleep apnea in the general population, suggest that obstructive sleep apnea may contribute to the pathophysiology and progression of the metabolic syndrome.

Key words:
metabolic syndrome – nervous system sympathetic – sleep apnea obstructive – sleep – syndrome X

Zdroje

1. Bray GA, York DA, Fisler JS. Experimental obesity: a homeostatic failure due to defective nutrient stimulation of the sympathetic nervous system. Vitam Horm 1989; 45: 1–125.

2. Chin K, Shimizu K, Nakamura T et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation 1999; 100(7): 706–712.

3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 (19): 2560–2572.

4. Considine RV, Sinha MK, Heiman ML et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 1996; 334(5): 292–295.

5. Dimsdale JE, Coy T, Ziegler MG et al. The effect of sleep apnea on plasma and urinary catecholamines. Sleep 1995; 18(5): 377–381.

6. Eisensehr I, Ehrenberg BL, Noachtar S et al. Platelet activation, epinephrine, and blood pressure in obstructive sleep apnea syndrome. Neurology 1998; 51(1): 188–195.

7. Elmasry A, Lindberg E, Berne C et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population– based study. J Intern Med 2001; 249(2): 153–161.

8. Grassi G, Seravalle G, Cattaneo BM et al. Sympathetic activation in obese normotensive subjects. Hypertension 1995; 25(4 Pt 1): 560–563.

8a. Harsch IA, Schahin, SP, Radespiel- Troger M et al. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patient with obstructive sleep aponea syndrome. Am J Respir Crit Care Med 2004; 169(2): 156–162.

9. Holden C. Wake–up call for sleep research. Science 1993; 259(5093): 305.

10. Ip MS, Lam B, Ng MM et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002; 165(5): 670–676.

11. Jenšovský J. Kardiovaskulární důsledky neurohumorální odpovědi na stres. Kardiol Rev 1999; 2: 63–66.

12. Jialal I, Devaraj S. Role of C–reactive protein in the assessment of cardiovascular risk. Am J Cardiol 2003; 91(2): 200–202.

13. Kára T, Souček M. Autonomní nervový systém. In: Souček M, Kára T. Klinická patofyziologie hypertenze. Praha: Grada 2002: 37–99.

14. Kára, T, Souček M. Společné působení patofyziologických faktorů při vzniku esenciální arteriální hypertenze. In: Souček, M, Kára T. Klinická patofyziologie hypertenze. Praha: Grada Publishing 2002: 290–309.

15. Kára T, Souček M, Jurák P et al. Regulační mechanizmy krevního tlaku. In: Souček M, Kára T. Klinická patofyziologie hypertenze. Praha: Grada 2002: 235–289.

16. Kára T, Souček M, Orban M. Ostatní humorální regulační faktory. In: Souček M, Kára T. Klinická patofyziologie hypertenze. Praha: Grada , 2002, 154–189

17. Kuczmarski RJ, Flegal KM. Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr 2000; 72(5): 1074–1081.

18. Lanfranco F, Gianotti L, Pivetti S et al. Obese patients with obstructive sleep apnoea syndrome show a peculiar alteration of the corticotroph but not of the thyrotroph and lactotroph function. Clin Endocrinol (Oxf) 2004; 60(1): 41–48.

19. Marrone O, Riccobono L, Salvaggio A et al. Catecholamines and blood pressure in obstructive sleep apnea syndrome. Chest 1993; 103(3): 722–727.

20. Moráň M, Siegelová J, Kadaňka Z. Circadian variability of blood pressure and heart rate in patients with sleep apnoea syndrome. Česk Slov Neurol 2000; 63: 147–151.

21. Narkiewicz K, Kato M, Phillips BG et al. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 1999; 100(23): 2332–2335.

22. Narkiewicz K, Montano N, Cogliati C et al. Altered cardiovascular variability in obstructive sleep apnea. Circulation 1998; 98(11): 1071–1077.

23. Narkiewicz K, van de Borne PJ, Cooley RL et al. Sympathetic activity in obese subjects with and without obstructive sleep apnea. Circulation 1998; 98(8): 772–776.

24. Peppard PE, Young T, Palta M et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284(23): 3015–3021.

25. Phillips BG, Hisel TM, Kato M et al. Recent weight gain in patients with newly diagnosed obstructive sleep apnea. J Hypertens 1999; 17(9): 1297–1300.

26. Phillips BG, Kato M, Narkiewicz K et al. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 2000; 279(1): H234–H237.

26a. Pohanka M, Kaňovský P. Nové pohledy na patofyziologii erektilní dysfunkce. Vnitř. Lék., v tisku.

26b. Pohanka M, Kaňovský P. Erectile Dysfunction and Obstructive Sleep Apnea. Scripta Medica, v tisku.

27. Punjabi NM, Sorkin JD, Katzel LI et al. Sleep-disordered breathing and insulin resistance in middle–aged and overweight men. Am J Respir Crit Care Med 2002; 165(5): 677–682.

28. Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation 2001; 103(13): 1813–1818.

29. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107(3): 363–369.

30. Ridker PM, Buring JE, Cook NR et al. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation

2003; 107(3): 391–397.

31. Ridker PM, Rifai N, Pfeffer MA et al. Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1999; 100(3): 230–235.

32. Rosolová H. Sympatický nervový systém a kardiovaskulární riziko. Praha: Maxdorf Jesenius 2000.

33. Rumantir MS, Vaz M, Jennings GL et al. Neural mechanisms in human obesity–related hypertension. J Hypertens 1999; 17(8): 1125–1133.

34. Sanner BM, Konermann M, Tepel Met al. Platelet function in patients with obstructive sleep apnoea syndrome. Eur Respir J 2000; 16(4): 648–652.

35. Scherrer U, Randin D, Tappy L et al. Body fat and sympathetic nerve activity in healthy subjects. Circulation 1994; 89(6): 2634–2640.

36. Shamsuzzaman AS, Winnicki M, Lanfranchi P et al. Elevated C–reactive protein in patients with obstructive sleep apnea. Circulation 2002; 105(21): 2462–2464.

36a. Shamsuzzaman AS, Winnicki M, Wolk R et al. Independent association between plasma leptin and C–reactive protein in healthy humans. Circulation 2004; 109(18): 2181–2185.

37. Somers VK, Dyken ME, Clary MP et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96(4): 1897–1904.

38. Souček M, Kára T. Stresem indukovaná hypertenze a diabetes mellitus. Vnitř Lék 2001; 47(5): 315–319.

39. Spraul M, Ravussin E, Fontvieille AM et al. Reduced sympathetic nervous activity. A potential mechanism predisposing to body weight gain. J Clin Invest 1993; 92(4): 1730–1735.

39a. Svatikova A, Wolk R, Shamsuzzaman AS et al. Serum amyloid a in obstructive sleep apnea. Circulation 2003; 108(12): 1451–1454.

40. Tassone F, Lanfranco F, Gianotti L et al. Obstructive sleep apnoea syndrome impairs insulin sensitivity independently of anthropometric variables. Clin Endocrinol (Oxf) 2003; 59(3): 374–379.

41. Tishler PV, Larkin EK, Schluchter MD et al. Incidence of sleep–disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003; 289(17): 2230–2237.

42. Vgontzas AN, Papanicolaou DA, Bixler EO et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab

2000; 85(3): 1151–1158.

43. Vgontzas AN, Tan TL, Bixler EO et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994; 154(15): 1705–1711.

44. Wilcox I, McNamara SG, Collins FL et al. „Syndrome Z“: the interaction of sleep apnoea, vascular risk factors and heart disease. Thorax 1998; 53 (Suppl 3): S25–S28.

45. Wolk R, Kara T, Somers VK. Sleep-disordered breathing and cardiovascular disease. Circulation 2003; 108(1): 9–12.

46. Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension 2003; 42(6): 1067–1074.

47. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328(17): 1230–1235.