Impact of severity of obstructive sleep apnea (OSA) and body composition on redox status in OSA patients

Ivan Čekerevac; Vladimir Jakovljević; Vladimir Živković; Marina Petrović; Vojislav Ćupurdija; Ljiljana Novković

doi:10.2298/VSP161030041C

Ivan Čekerevac University in Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Vladimir Jakovljević University in Kragujevac, Faculty of Medical Sciences, Department of Physiology, Kragujevac, Serbia
Vladimir Živković University in Kragujevac, Faculty of Medical Sciences, Department of Physiology, Kragujevac, Serbia
Marina Petrović University in Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Vojislav Ćupurdija University in Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Ljiljana Novković University in Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP161030041C

Keywords: sleep apnea, obstructive;, oxidative stress;, nutritional status;, body composition.

Abstract

Background/Aim. There is an increasing number of studies on the existence of systemic oxidative stress in patients with obstructive sleep apnea (OSA) which is an important mechanism linking OSA and endothelial dysfunction with increased risk for cardiovascular diseases. Comorbidities must be also considered, especially obesity, as the most important source of oxidative stress independently of OSA. The aim of this paper was to show if OSA severity increases the level of markers of systemic oxidative stress and reduces antioxidant capacity, independently from body mass index (BMI) and nutritional status. Methods. One hundred and twenty-eight patients with OSA were included in the trial. Based on the results of a sleep study-polysomnography, the examinees were divided into two groups according to apnea-hypopnea index (AHI < 15 and AHI ≥ 15). Nutritional status was estimated by using the BMI and body composition. Body composition was determined by dual X-ray absorptiometry (DXA) whole-body scan. Redox status of patients with OSA was determined by measuring the concentration of NO in plasma and antioxidant capacity was evaluated using the plasma level of reduced glutathione (GSH) as a marker of antioxidant capacity. Results. Significantly higher mean values of NO were found in the group with AHI ≥ 15 in comparison to AHI < 15 group (1.269 ± 0.789 vs. 0.462 ± 0.373 nmol/mL, respectively; p = 0.001), while significantly higher levels of GSH were found in the group with AHI < 15 in comparison to AHI ≥ 15 group (238.08 ± 84.37 vs. 172.77 ± 83.88 mg/mL, respectively; p = 0.04). Independent predictors of plasma GSH level (multivariate regression analysis) were: desaturation index (ODI) [B = -0.157; 95% confidence intervals (CI): -0.262–0.053], mean SatO₂(B = -4.76; 95% CI: -9.21–0.306) and min SatO₂(B = 0.118; 95% CI: 0.03–0.206). ODI was singled out as an independent predictor of NO concentration in plasma (B = 0.038; 95% CI: 0.011–0.065). No significant statistical difference was found in mean values of BMI and body composition parameters in patients with AHI < 15 and AHI ≥ 15. None of the markers of systemic oxidative stress was associated with BMI and body composition assessment parameters. Conclusion. OSA severity is significantly associated with reduced antioxidant capacity and increased level of systemic oxidative stress. The degree of desaturation during sleep considerably affects systemic oxidative stress in patients with OSA independently from nutritional status and body composition.

References

Stradling JR, Chadwick GA, Frew AJ. Changes in ventilation and its components in normal subjects during sleep. Thorax 1985; 40(5): 364‒70.

Feng J, Zhang D, Chen B. Endothelial mechanisms of endothe-lial dysfunction in patients with obstructive sleep apnea. Sleep Breath 2012; 16(2): 283‒94.

Jelic S, Le Jemtel TH. Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Car-diovasc Med 2008; 18(7): 253‒60.

Keaney JF Jr, Larson MG, Vasan RS, Wilson PW, Lipinska I, Corey D, et al. Obesity and systemic oxidative stress: clinical correlates of oxidative stress in the Framingham Study. Arte-rioscler Thromb Vasc Biol 2003; 23(3): 434‒9.

Borrud LG, Flegal KM, Looker AC, Everhart JE, Harris TB, Shepherd JA. Body composition data for individuals 8 years of age and older: U.S. population, 1999–2004. Vital Health Stat 11 2010; (250): 1‒87.

Green LC, Wagner DA, Glogowski J, Skipper PL, Wishnok JS, Tannenbaum SR. Analysis of nitrate, nitrite, and [15N]nitrate in biological fluids. Anal Biochem 1982; 126(1): 131‒8.

Beutler E. Catalase. In: Beutler E, editor. Red cell metabolism, a manual of biochemical methods. 3rd ed. New York: Grune and Stratton; 1982. p. 105‒6.

Makris D, Ntalapascha M, Zakynthinos E. The association be-tween oxidative stress and obstructive sleep apnea syndrome. Sleep Breath 2013; 17(2): 451.

Ntalapascha M, Makris D, Kyparos A, Tsilioni I, Kostikas K, Gourgoulianis K, et al. Oxidative stress in patients with obstruc-tive sleep apnea syndrome. Sleep Breath 2013; 17(2): 549‒55.

Simiakakis M, Kapsimalis F, Chaligiannis E, Loukides S, Sitaras N, Alchanatis M. Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS) patients. PLoS One 2012; 7(6): e39172.

Svatikova A, Wolk R, Lerman LO, Juncos LA, Greene EL, McConnell JP, et al. Oxidative stress in obstructive sleep ap-noea. Eur Heart J 2005; 26(22): 2435‒9.

Fujita K, Nishizawa H, Funahashi T, Shimomura I, Shimabukuro M. Systemic oxidative stress is associated with visceral fat ac-cumulation and the metabolic syndrome. Circ J 2006; 70(11): 1437‒42.