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Letter by Tsuda Regarding Article, “Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation”

Letter by Tsuda Regarding Article, “Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic... Letter to the Editor Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 4 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. levels of proinflammatory cytokines in OSA subjects with higher Letter by Tsuda Regarding Article, apnea hypopnea index levels might be associated with impaired “Obstructive Sleep Apnea in Acute Stroke: endothelial function in the study of Ifergane et al. It would be A Role for Systemic Inflammation” important to assess more precisely the relationships among OSA, To the Editor: inflammation, and endothelial dysfunction, and their contribution We read with great interest the article by Ifergane et al deal- to the progression of cerebrovascular diseases in sleep-disordered ing with the relationship between obstructive sleep apnea (OSA) breathing. and biomarkers of inflammation and coagulability. The results of their study demonstrated that subjects with the greater apnea Disclosures hypopnea index had higher prevalence of recurrent stroke and atrial fibrillation in patients with OSA. The levels of biomark- None. ers, such as tumor necrosis factor, interleukin-6 and plasminogen Kazushi Tsuda, MD activator inhibitor-1, were higher in subjects with greater value Cardiovascular and Metabolic Research Center of apnea hypopnea index. The authors proposed that OSA was Kansai University of Health Sciences associated with significantly increased levels of inflammatory biomarkers, providing possible pathophysiological explanation Osaka, Japan of OSA-associated stroke risk. Current evidence indicates that impaired endothelial func- 1. Ifergane G, Ovanyan A, Toledano R, Goldbart A, Abu-Salame I, tion may strongly be related to the increased cardiovascular Tal A, et al. Obstructive sleep apnea in acute stroke: a role for sys- 2,3 3 risk associated with OSA. Kato et al demonstrated that endo- temic inflammation. Stroke. 2016;47:1207–1212. doi: 10.1161/ thelium-dependent vasodilation was significantly reduced in STROKEAHA.115.011749. patients with OSA, suggesting that nitric oxide bioavailability 2. Atkeson A, Yeh SY, Malhotra A, Jelic S. Endothelial function in obstruc- might be disturbed in OSA. On the contrary, it has been shown tive sleep apnea. Prog Cardiovasc Dis. 2009;51:351–362. doi: 10.1016/j. that a proinflammatory cytokine, tumor necrosis factor-α, might pcad.2008.08.002. induce asymmetrical dimethylarginine (an endogenous nitric 3. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, et al. Impairment of endothelium-dependent vasodilation of oxide synthase inhibitor) accumulation in both human umbili- resistance vessels in patients with obstructive sleep apnea. Circulation. cal vein endothelial cells and human coronary artery endothelial 2000;102:2607–2610. doi: 10.1161/01.CIR.102.21.2607. cells. In a study presented previously, we demonstrated that the 4. Eid HM, Lyberg T, Arnesen H, Seljeflot I. Insulin and adiponectin inhibit plasma high-sensitivity C-reactive protein levels (an index of the TNFα-induced ADMA accumulation in human endothelial cells: systemic inflammation) were inversely correlated with plasma the role of DDAH. Atherosclerosis. 2007;194:e1–e8. doi: 10.1016/j. nitric oxide metabolites in the overall analysis of hypertensive atherosclerosis.2006.11.008. and normotensive men. In this context, it is strongly suggested 5. Tsuda K. Associations between high-sensitivity c-reactive protein and that elevated inflammatory status might be accompanied by membrane fluidity of red blood cells in hypertensive elderly men: an the reduced nitric oxide production and endothelial dysfunc- Electron Spin Resonance study. Int J Hypertens. 2012;2012:292803. doi: tion. Therefore, we would like to know whether the increased 10.1155/2012/292803. (Stroke. 2016;47:e213. DOI: 10.1161/STROKEAHA.116.013914.) © 2016 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STROKEAHA.116.013914 e213 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Stroke Wolters Kluwer Health

Letter by Tsuda Regarding Article, “Obstructive Sleep Apnea in Acute Stroke: A Role for Systemic Inflammation”

Tsuda, Kazushi
Stroke , Volume 47 (8) – Aug 1, 2016
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References (5)

Publisher
Wolters Kluwer Health
Copyright
© 2016 American Heart Association, Inc.
ISSN
0039-2499
eISSN
1524-4628
DOI
10.1161/STROKEAHA.116.013914
pmid
27387992
Publisher site
See Article on Publisher Site

Abstract

Letter to the Editor Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 4 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. levels of proinflammatory cytokines in OSA subjects with higher Letter by Tsuda Regarding Article, apnea hypopnea index levels might be associated with impaired “Obstructive Sleep Apnea in Acute Stroke: endothelial function in the study of Ifergane et al. It would be A Role for Systemic Inflammation” important to assess more precisely the relationships among OSA, To the Editor: inflammation, and endothelial dysfunction, and their contribution We read with great interest the article by Ifergane et al deal- to the progression of cerebrovascular diseases in sleep-disordered ing with the relationship between obstructive sleep apnea (OSA) breathing. and biomarkers of inflammation and coagulability. The results of their study demonstrated that subjects with the greater apnea Disclosures hypopnea index had higher prevalence of recurrent stroke and atrial fibrillation in patients with OSA. The levels of biomark- None. ers, such as tumor necrosis factor, interleukin-6 and plasminogen Kazushi Tsuda, MD activator inhibitor-1, were higher in subjects with greater value Cardiovascular and Metabolic Research Center of apnea hypopnea index. The authors proposed that OSA was Kansai University of Health Sciences associated with significantly increased levels of inflammatory biomarkers, providing possible pathophysiological explanation Osaka, Japan of OSA-associated stroke risk. Current evidence indicates that impaired endothelial func- 1. Ifergane G, Ovanyan A, Toledano R, Goldbart A, Abu-Salame I, tion may strongly be related to the increased cardiovascular Tal A, et al. Obstructive sleep apnea in acute stroke: a role for sys- 2,3 3 risk associated with OSA. Kato et al demonstrated that endo- temic inflammation. Stroke. 2016;47:1207–1212. doi: 10.1161/ thelium-dependent vasodilation was significantly reduced in STROKEAHA.115.011749. patients with OSA, suggesting that nitric oxide bioavailability 2. Atkeson A, Yeh SY, Malhotra A, Jelic S. Endothelial function in obstruc- might be disturbed in OSA. On the contrary, it has been shown tive sleep apnea. Prog Cardiovasc Dis. 2009;51:351–362. doi: 10.1016/j. that a proinflammatory cytokine, tumor necrosis factor-α, might pcad.2008.08.002. induce asymmetrical dimethylarginine (an endogenous nitric 3. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, et al. Impairment of endothelium-dependent vasodilation of oxide synthase inhibitor) accumulation in both human umbili- resistance vessels in patients with obstructive sleep apnea. Circulation. cal vein endothelial cells and human coronary artery endothelial 2000;102:2607–2610. doi: 10.1161/01.CIR.102.21.2607. cells. In a study presented previously, we demonstrated that the 4. Eid HM, Lyberg T, Arnesen H, Seljeflot I. Insulin and adiponectin inhibit plasma high-sensitivity C-reactive protein levels (an index of the TNFα-induced ADMA accumulation in human endothelial cells: systemic inflammation) were inversely correlated with plasma the role of DDAH. Atherosclerosis. 2007;194:e1–e8. doi: 10.1016/j. nitric oxide metabolites in the overall analysis of hypertensive atherosclerosis.2006.11.008. and normotensive men. In this context, it is strongly suggested 5. Tsuda K. Associations between high-sensitivity c-reactive protein and that elevated inflammatory status might be accompanied by membrane fluidity of red blood cells in hypertensive elderly men: an the reduced nitric oxide production and endothelial dysfunc- Electron Spin Resonance study. Int J Hypertens. 2012;2012:292803. doi: tion. Therefore, we would like to know whether the increased 10.1155/2012/292803. (Stroke. 2016;47:e213. DOI: 10.1161/STROKEAHA.116.013914.) © 2016 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STROKEAHA.116.013914 e213

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Stroke – Wolters Kluwer Health

Published: Aug 1, 2016

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