Background Obstructive sleep apnea （OSA） is the most common cause of resistant hypertension, which has been proposed to result from activation of the renin-angiotensin-aldosterone system （RAAS）. We meta-analyzed t...Background Obstructive sleep apnea （OSA） is the most common cause of resistant hypertension, which has been proposed to result from activation of the renin-angiotensin-aldosterone system （RAAS）. We meta-analyzed the effects of OSA on plasma levels of RAAS components. Methods Full-text studies published on MEDL1NE and EMBASE analyzing fasting plasma levels of at least one RAAS component in adults with OSA with or without hypertension. OSA was diagnosed as an apnea-hypopnea index or respiratory disturbance index 〉 5. Study quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity was assessed using the 12 statistic. Results from individual studies were synthesized using inverse variance and pooled using a random-effects model. Subgroup analysis, sensitivity analysis, and meta-regression were performed, and risk of publication bias was assessed. Results The meta-analysis included 13 studies, of which 10 reported results on renin （n = 470 cases and controls）, 7 on angiotensin II （AnglI, n = 384）, and 9 on aldosterone （n = 439）. AnglI levels were significantly higher in OSA than in controls [mean differences = 3.39 ng/L, 95% CI： 2.00-4.79, P 〈 0.00001], while aldosterone levels were significantly higher in OSA with hypertension than OSA but not with hypertension （mean differences = 1.32 ng/dL, 95% CI： 0.58-2.07, P = 0.0005）. Meta-analysis of all studies suggested no significant differences in aldosterone between OSA and controls, but a significant pooled mean difference of 1.35 ng/mL （95% CI： 0.88-1.82, P 〈 0.00001） emerged after excluding one small-sample study. No significant risk of publication bias was detected among all included studies. Conelusions OSA is associated with higher AnglI and aldosterone levels, espe- cially in hypertensive patients. OSA may cause hypertension, at least in part, by stimulating RAAS activity.展开更多
目的展现近10年来国内外早产儿呼吸暂停(AOP)药物治疗的研究现状,描绘研究趋势。方法以主题词"早产儿呼吸暂停"及"治疗"在CNKI数据库、以主题词"apnea of prematurity"及"treatment"在MEDLINE...目的展现近10年来国内外早产儿呼吸暂停(AOP)药物治疗的研究现状,描绘研究趋势。方法以主题词"早产儿呼吸暂停"及"治疗"在CNKI数据库、以主题词"apnea of prematurity"及"treatment"在MEDLINE数据库检索2006年1月至2015年12月的文献。筛选文献并提取关键词建立共现矩阵,使用Ucinet 6.2绘制知识图谱。结果共纳入中文关键词26个,英文关键词20个。中文关键词的共现网络图中居于核心位置的关键词为"早产儿""呼吸暂停""原发性呼吸暂停""纳洛酮"和"氨茶碱"。在英文关键词的共现网络图中,居于核心位置的关键词为"apnea(呼吸暂停)""preterm infants(早产儿)"和"caffeine(咖啡因)"。结论目前AOP的药物干预仍以甲基黄嘌呤类为主,国内主要为氨茶碱,而国外则采用咖啡因。其他药物如纳洛酮亦被应用于临床。展开更多
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most c...Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.展开更多
Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM...Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA.展开更多
文摘Background Obstructive sleep apnea （OSA） is the most common cause of resistant hypertension, which has been proposed to result from activation of the renin-angiotensin-aldosterone system （RAAS）. We meta-analyzed the effects of OSA on plasma levels of RAAS components. Methods Full-text studies published on MEDL1NE and EMBASE analyzing fasting plasma levels of at least one RAAS component in adults with OSA with or without hypertension. OSA was diagnosed as an apnea-hypopnea index or respiratory disturbance index 〉 5. Study quality was evaluated using the Newcastle-Ottawa Scale, and heterogeneity was assessed using the 12 statistic. Results from individual studies were synthesized using inverse variance and pooled using a random-effects model. Subgroup analysis, sensitivity analysis, and meta-regression were performed, and risk of publication bias was assessed. Results The meta-analysis included 13 studies, of which 10 reported results on renin （n = 470 cases and controls）, 7 on angiotensin II （AnglI, n = 384）, and 9 on aldosterone （n = 439）. AnglI levels were significantly higher in OSA than in controls [mean differences = 3.39 ng/L, 95% CI： 2.00-4.79, P 〈 0.00001], while aldosterone levels were significantly higher in OSA with hypertension than OSA but not with hypertension （mean differences = 1.32 ng/dL, 95% CI： 0.58-2.07, P = 0.0005）. Meta-analysis of all studies suggested no significant differences in aldosterone between OSA and controls, but a significant pooled mean difference of 1.35 ng/mL （95% CI： 0.88-1.82, P 〈 0.00001） emerged after excluding one small-sample study. No significant risk of publication bias was detected among all included studies. Conelusions OSA is associated with higher AnglI and aldosterone levels, espe- cially in hypertensive patients. OSA may cause hypertension, at least in part, by stimulating RAAS activity.
文摘目的展现近10年来国内外早产儿呼吸暂停(AOP)药物治疗的研究现状,描绘研究趋势。方法以主题词"早产儿呼吸暂停"及"治疗"在CNKI数据库、以主题词"apnea of prematurity"及"treatment"在MEDLINE数据库检索2006年1月至2015年12月的文献。筛选文献并提取关键词建立共现矩阵,使用Ucinet 6.2绘制知识图谱。结果共纳入中文关键词26个,英文关键词20个。中文关键词的共现网络图中居于核心位置的关键词为"早产儿""呼吸暂停""原发性呼吸暂停""纳洛酮"和"氨茶碱"。在英文关键词的共现网络图中,居于核心位置的关键词为"apnea(呼吸暂停)""preterm infants(早产儿)"和"caffeine(咖啡因)"。结论目前AOP的药物干预仍以甲基黄嘌呤类为主,国内主要为氨茶碱,而国外则采用咖啡因。其他药物如纳洛酮亦被应用于临床。
文摘Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
文摘Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA.
