Advances and challenges in pursuing biomarkers for obstructive sleep apnea: Implications for the cardiovascular risk ?

被引:26
作者
Lebkuchen, Adriana [1 ]
Freitas, Lunara S. [2 ]
Cardozo, Karina H. M. [1 ]
Drager, Luciano F. [2 ,3 ]
机构
[1] Fleury Grp, Sao Paulo, Brazil
[2] Univ Sao Paulo, Med Sch, Heart Inst InCor, Hypertens Unit, Ave Dr Eneas de Carvalho Aguiar 44, BR-05403900 Sao Paulo, Brazil
[3] Univ Sao Paulo, Med Sch, Renal Div, Hypertens Unit, Sao Paulo, Brazil
关键词
Biomarkers; Cardiovascular disease; Prognosis; Sleep apnea; POSITIVE AIRWAY PRESSURE; NONDIPPING BLOOD-PRESSURE; RESISTANT HYPERTENSION; CIRCULATING MICRORNAS; INTERMITTENT HYPOXIA; POTENTIAL BIOMARKER; PLASMA HOMOCYSTEINE; METABOLOMICS; PROTEOMICS; DISEASE;
D O I
10.1016/j.tcm.2020.04.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Several challenges have been noted in the pursuit of a comprehensive knowledge base about the impact of OSA including: 1) the precise mechanisms by which OSA causes metabolic and cardiovascular consequences are not clear, which limits our current ability to address potential targets in OSA; 2) several patients with OSA, even with severe forms, present with no or mild daytime symptoms. Beyond the obvious challenges for obtaining good adherence for conventional OSA treatments, there is evidence that symptomatic vs. asymptomatic patients with OSA do not necessarily have the same metabolic and cardiovascular outcomes; and 3) the cardiovascular response to OSA treatment may vary even in those patients with good adherence. In this scenario, there is an obvious need to develop biomarkers in the OSA research area. This review focuses on describing the advances that have occurred so far in exploring potential OSA biomarkers with clear emphasis for the cardiovascular risk. Particular attention will be devoted to discuss molecular biomarkers including the potential role of microRNAs, proteomics and metabolomics. We also discuss the major challenges and perspectives in this growing research field. Obstructive sleep apnea (OSA) is a common clinical condition associated with increased cardiovascular morbidity and mortality. Recent evidence from clinical studies and animal models suggest that OSA can promote cardiovascular disease by inducing autonomic, hemodynamic, inflammatory and metabolic dysregulation. However, most of the evidence addressing hard endpoints in humans is derived from observational studies. Several challenges have been noted in the pursuit of a comprehensive knowledge base about the impact of OSA including: 1) the precise mechanisms by which OSA causes metabolic and cardiovascular consequences are not clear, which limits our current ability to address potential targets in OSA; 2) several patients with OSA, even with severe forms, present with no or mild daytime symptoms. Beyond the obvious challenges for obtaining good adherence for conventional OSA treatments, there is evidence that symptomatic vs. asymptomatic patients with OSA do not necessarily have the same metabolic and cardiovascular outcomes; and 3) the cardiovascular response to OSA treatment may vary even in those patients with good adherence. In this scenario, there is an obvious need to develop biomarkers in the OSA research area. This review focuses on describing the advances that have occurred so far in exploring potential OSA biomarkers with clear emphasis for the cardiovascular risk. Particular attention will be devoted to discuss molecular biomarkers including the potential role of microRNAs, proteomics and metabolomics. We also discuss the major challenges and perspectives in this growing research field. (c) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:242 / 249
页数:8
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