Sains Malaysiana 49(7)(2020): 1713-1718

http://dx.doi.org/10.17576/jsm-2020-4907-21

 

Role of Serum Asymmetric Dimethylarginine Level in Cardiovascular Diseases Early Prognostic in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

(Peranan Tahap Serum Asimetri Dimetilarginina pada Pesakit Prognostik Awal Penyakit Kardiovaskular dengan Sindrom Apnea-Hipopnea Tidur Obstruktif)

 

JINPING WANG1*, LIJIE YUAN2, HAIXIANG ZHANG3 & YONGGANG YUN1

 

1Department of ENT, Shaanxi Provincial People’s Hospital, Xi’an 710068, China

 

2Department of Medical Office Infection Management, Shaanxi Provincial People’s Hospital, Xi’an 710068, China

 

3Central Laboratory of Shaanxi Provincial People’s Hospital, Xi’an 710068, China

 

Received: 24 December 2019/Accepted: 22 March 2020

 

Abstract

The purpose of this paper was to investigate the role of serum asymmetric dimethylarginine (ADMA) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and identify its clinical significance in OSAHS related cardiovascular diseases. A total of 75 patients with OSAHS were enrolled and divided into mild (n=25), moderate (n=27), and severe group (n=23) according to their apnea hypopnea index (AHI) and minimal oxygen saturation (SaO2 min), respectively. Thirty healthy individuals were enrolled as normal control. Serum ADMA was measured with enzyme-linked immunosorbent assay (ELISA). Nitric oxide (NO) level was assayed with colorimetric method. Nasal continuous positive airway pressure (nCPAP) treatment was performed to the patients, and the follow up lasted for 2 months. Serum ADMA level increased with the severity of patients. Serum NO level decreased with severity of patients. A negative correlation was noticed between serum NO and mean SaO2 (SaO2 mean) and minimal SaO2 (SaO2 min). Serum ADMA was positively correlated with AHI, tSaO2<90%, and morbidity of cardiovascular diseases. After nCPAP therapy, the serum ADMA level was remarkably decreased and NO was remarkably increased in patients with OSAHS. Serum ADMA may be correlated with OSAHS and OSAHS related cardiovascular diseases. Reducing the plasma ADMA level by nCPAP therapy can reduce the morbidity of OSAHS-related cardiovascular diseases.

Keywords: Asymmetric dimethylarginine; nasal continuous positive airway pressure; nitric oxide; obstructive sleep apnea-hypopnea syndrome; SaO2

 

ABSTRAK

Kajian ini dijalankan untuk mengkaji peranan serum asimetri dimetilarginin (ADMA) pada pesakit dengan sindrom apnea-hipopnea tidur obstruktif (OSAHS) dan mengenal pasti keertian klinikal dalam penyakit kardiovaskular yang berkaitan dengan OSAHS. Seramai 75 pesakit OSAHS telah didaftarkan dan dibahagikan kepada kumpulan ringan (n=25), sederhana (n=27) dan kumpulan teruk (n=23) mengikut indeks apnea hipopnea (AHI) dan ketepuan oksigen minimum (SaO2 min), masing-masing. Tiga puluh individu yang sihat didaftarkan sebagai kawalan normal. Serum ADMA diukur dengan asai imunoserapan terangkai enzim (ELISA). Tahap oksida nitrat (NO) diuji dengan kaedah kolorimetri. Rawatan tekanan salur udara positif berterusan nasal (nCPAP) dijalankan pada pesakit, dan disusulkan berlangsung selama 2 bulan. Tahap ADMA serum meningkat dengan tahap keterukan pesakit. Tahap NO serum menurun dengan tahap keterukan pesakit. Hubungan negatif diperhatikan antara serum NO dan min SaO2 (SaO2 mean) dan minimum SaO2 (SaO2 min). Serum ADMA berkorelasi positif dengan AHI, tSaO2<90%, dan morbiditi penyakit kardiovaskular. Selepas terapi nCPAP, tahap ADMA serum menurun dan NO meningkat pada pesakit dengan OSAHS. ADMA serum mungkin berkorelasi dengan penyakit kardiovaskular yang berkaitan dengan OSAHS dan OSAHS. Pengurangan tahap ADMA plasma dengan terapi nCPAP dapat mengurangkan tahap penyakit kardiovaskular yang berkaitan dengan OSAHS.

Kata kunci: Asimetri dimetilarginina; nitrik oksida; SaO2; sindrom apnea-hipopnea tidur obstruktif; tekanan salur udara positif berterusan nasal

 

REFERENCES

Barcelo, A., Miralles, C., Barbe, F., Vila, M., Pons, S. & Agusti, A.G. 2000. Abnormal lipid peroxidation in patients with sleep apnoea. European Respiratory Journal 16(4): 644-647.

Colonna, V.D.G., Bianchi, M., Pascale, V., Ferrario, P., Morelli, F., Pascale, W., Tomasoni, L. & Turiel, M. 2009. Asymmetric dimethylarginine (ADMA): An endogenous inhibitor of nitric oxide synthase and a novel cardiovascular risk molecule. Medical Science Monitor 15(4): RA91-RA101.

De Backer, W. 2013. Obstructive sleep apnea/hypopnea syndrome. Panminerva Medica 55(2): 191-195.

Drager, L.F., Polotsky, V.Y. & Lorenzi-Filho, G. 2011. Obstructive sleep apnea: An emerging risk factor for atherosclerosis. Chest 140(2): 534-542.

Forstermann, U. & Munzel, T. 2006. Endothelial nitric oxide synthase in vascular disease: From marvel to menace. Circulation 113(13): 1708-1714.

Friedman, M., Vidyasagar, R., Bliznikas, D. & Joseph, N. 2005. Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome? The Laryngoscope 115(12): 2109-2113.

Hayashi, Y., Barron, G.J. & Almeida, A.A. 2008. Operative timing for absent pulmonary valve with obstructive sleep apnea. Asian Cardiovascular and Thoracic Annals 16(6): e52-e54.

Kielstein, J.T., Böger, R.H., Bode-Böger, S.M., Frölich, J.C., Haller, H., Ritz, E. & Fliser, D. 2002. Marked increase of asymmetric dimethylarginine in patients with incipient primary chronic renal disease. Journal of the American Society of Nephrology 13(1): 170-176.

Lavie, L. & Lavie, P. 2009. Molecular mechanisms of cardiovascular disease in OSAHS: The oxidative stress link. European Respiratory Journal 33(6): 1467-1484.

Lee, S.A., Amis, T.C., Byth, K., Larcos, G., Kairaitis, K., Robinson, T.D. & Wheatley, J.R. 2008. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep 31(9): 1207-1213.

Liu, X., Xu, X., Shang, R. & Chen, Y. 2018. Asymmetric dimethylarginine (ADMA) as an important risk factor for the increased cardiovascular diseases and heart failure in chronic kidney disease. Nitric Oxide 78: 113-120.

Monahan, K. & Redline, S. 2011. Role of obstructive sleep apnea in cardiovascular disease. Current Opinion in Cardiology 26(6): 541-547.

Perticone, F., Sciacqua, A., Maio, R., Perticone, M., Maas, R., Boger, R.H., Tripepi, G., Sesti, G. & Zoccali, C. 2005. Asymmetric dimethylarginine, L-arginine, and endothelial dysfunction in essential hypertension. Journal of the American College of Cardiology 46(3): 518-523.

Schäfer, H., Koehler, U., Ewig, S., Hasper, E., Tasci, S. & Lüderitz, B. 1999. Obstructive sleep apnea as a risk marker in coronary artery disease. Cardiology 92(2): 79-84.

Schulz, R., Mahmoudi, S., Hattar, K., Sibelius, U.L.F., Olschewski, H., Mayer, K., Seeger, W. & Grimminger, F. 2000. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea: Impact of continuous positive airway pressure therapy. American Journal of Respiratory and Critical Care Medicine 162(2): 566-570.

Sibal, L., Agarwal, S.C., Home, P.D. & Boger, R.H. 2010. The role of asymmetric dimethylarginine (ADMA) in endothelial dysfunction and cardiovascular disease. Current Cardiology Reviews 6(2): 82-90.

Sunnetcioglu, A., Asker, S., Alp, H.H. & Gunbatar, H. 2016. Increased asymmetric dimethylarginine and ischemia-modified albumin levels in obstructive sleep apnea. Respiratory Care 61(8): 1038-1043.

Turmel, J., Sériès, F., Boulet, L.P., Poirier, P., Tardif, J.C., Rodés-Cabeau, J., Larose, É. & Bertrand, O.F. 2009. Relationship between atherosclerosis and the sleep apnea syndrome: An intravascular ultrasound study. International Journal of Cardiology 132(2): 203-209.

Ueda, S., Yamagishi, S.I., Matsumoto, Y., Fukami, K. & Okuda, S. 2007. Asymmetric dimethylarginine (ADMA) is a novel emerging risk factor for cardiovascular disease and the development of renal injury in chronic kidney disease. Clinical and Experimental Nephrology 11(2): 115-121.

Yamauchi, M., Nakano, H., Maekawa, J., Okamoto, Y., Ohnishi, Y., Suzuki, T. & Kimura, H. 2005. Oxidative stress in obstructive sleep apnea. Chest 127(5): 1674-1679.

Yüksel, M., Okur, H.K., Pelin, Z. & Öztürk, L. 2014. Arginase activity and nitric oxide levels in patients with obstructive sleep apnea syndrome. Clinics 69(4): 247-252.

 

*Corresponding author; email: 306070789@qq.com

 

 

 

 

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