Obstructive Sleep Apnea Clinical Trial
Official title:
Endothelial Damage and Atherosclerosis in Obstructive Sleep Apnea: the Role of Advanced Glycation End-products
The investigators hypothesize that obstructive sleep apnea (OSA) may lead to increased
formation/accumulation of advanced glycation ends (AGEs), and that the increase in AGEs is
contributed in part by increased insulin resistance. The investigators further hypothesize
that AGEs contribute to vascular endothelial damage and ultimately atherosclerosis in OSA.
The objectives of this study are:
1. To explore the relationship between insulin resistance and AGEs in OSA
2. To study the relationship between AGE and vascular endothelial dysfunction in OSA
3. To study the relationship between AGE and early atherosclerosis in OSA
There is growing evidence to suggest that pathophysiology of OSA may lead to
atherosclerosis, independent of confounding variables which are often present in these
subjects with OSA. Many mechanisms have been reported to contribute to vasculopathy in OSA,
but whether increased AGEs formation contribute significantly to the pathogenesis of
cardiovascular morbidity in OSA remains to be determined.
Advanced glycation product is formed by non-enzymatic reaction of reducing sugars such as
glucose with the amino groups of proteins, and subsequent glycoxidation. AGEs can form on
long-lived extracellular proteins as well as short-lived molecules, cytoplasmic proteins and
nuclear acids. AGEs cause a number of adverse cellular events and they have been
demonstrated in fatty streaks and atherosclerotic plaques. The formation and tissue
accumulation of AGE is shown to be enhanced by hyperglycemia and/or increased oxidative
stress. There is increasing evidence to support this as an important mechanism of vascular
and other end organ damage in diabetes and some other diseases. In OSA, there is evidence to
support an increased insulin resistance and excessive oxidative stress, both of which may
predispose to AGE formation. We have preliminary data to suggest increased levels of
circulating AGE in non-diabetic OSA subjects. Since insulin resistance with elevated blood
glucose levels, albeit not up to diabetic thresholds, may partially contribute to increase
in AGE.
Many potential mechanisms of atherosclerosis have been reported, but direct evidence for
atherosclerosis is still lacking. Subjects with OSA also have comorbidities which may give
rise to atherosclerosis. With the advancement of non-invasive techniques for detection of
vascular endothelial damage and early atherosclerosis, it is possible to detect early
vascular abnormalities in otherwise healthy OSA subjects. This hypothesis underlies our
objectives to explore the relationship between AGE and the markers of endothelial
dysfunction and early atherosclerosis. Some of these early changes, especially at
endothelial level, may be reversible if the insult of OSA is removed. Thus a longitudinal
comparison of OSA-treated and OSA-untreated subjects on such changes would further help to
clarify the issue.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment
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