Impact of Obstructive Sleep Apnea on Cardiac Troponin I: Comparisons of the Effects of Nasal O2 and Positive Airway Pressure on this Biomarker

Authors

1 Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

2 Baharloo Sleep Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

Abstract

Background: Sleep apnea is a common disorder and is known to impact myocardial stress and increase morbidity and mortality. The concentrations of cardiac highly sensitive troponin I (hs-TnI) are currently in clinical use as markers of myocardial injury. That obstructive sleep apnea (OSA) may lead to myocardial injury and elevated cardiac troponin levels suggests that the treatment of sleep apnea with positive airway pressure (PAP) should decrease myocardial injury. Methods: We studied 114 patients with a diagnosis of moderate-to-severe OSA who were referred to our cardiovascular department. None of the patients had a history of cardiovascular problems and diabetes. The mean age was 30.653.96 years. The patients were divided into 2 groups: the first group (the O2 group) received nasal O2 for 2 weeks, and the second group (the PAP group) received PAP for about 2 weeks. The concentrations of hs-TnI were measured in evening blood samples in ed patients. After 2 weeks of treatment with O2 or PAP, the serum hs-TnI level was rechecked and compared with the baseline and between the 2 groups. Results: The level of hs-TnI did not differ significantly between the 2 groups. No patients in either O2 or PAP group showed elevated troponin levels before the treatment. The cardiac biomarker, hs- TnI, was detectable (≥1 ng/L) in none of the patients in the O2 group before and after the treatment and only in 2 (3%) patients in the PAP group after treatment. There was no significant difference in the hs-TnI level before and after the treatment with nasal O2 (P=0.4). Conclusions: Although OSA is well known to impact myocardial stress, we did not find increased amounts of cardiac hs-TnI as a biomarker of myocardial damage even in the severe form of OSA. PAP did not cause any myocardial damage detectable with the hs-TnI level and it was somewhat more effective than was O2 in decreasing the baseline level of troponin.

Keywords


Kamasova M,Vaklavic J,Kocianova E,Taborsky M.Obstructive sleep apnea in outpatient care – What to do with? Cor et vasa 60(3), Oct 2017
Muraja-Murro A, Nieminen O, Julkunen P, Töyräs J, Laitinen T, Mervaala E Peri-apneic hemodynamic reactions in obstructive sleep apnea. Pathophysiology,2017 Sep;24(3):197-203.
Luciano F.Drager, R.DougEvoy,Ferran Barbe, Geraldo Lorenzi-Filho,Susan Redline.Sleep Apnea and Cardiovascular Disease. Ciculation . 2017:1840-1850.
Einvik G, Røsjø H, Randby A, Namtvedt SK, Hrubos-Strøm H, Brynildsen J, Somers VK, Omland  T.Severity of Obstructive Sleep Apnea is Associated with Cardiac Troponin I Concentrations in a Community-based Sample: Data the Akershus Sleep Apnea Project. Sleep. 2014 Jun 1;37(6).
Nalan Demir, Oğuz Köktürk, Tansu Ulukavak Ciftçi, Ozlem Gülbahar, Neslihan Celik Bukan, Kenan Köse The Association of Troponin I Levels with Severity of Obstructive Sleep Apnea Syndrome J Sleep Disorders Ther 2013, 2:1
Randby A, Namtvedt SK, Einvik G, Hrubos-Strøm H, Hagve TA, Somers VK, Omland T Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest 2012 Sep;142(3):639-646.
Gami AS, Svatikova A, Wolk R, Olson EJ, Duenwald CJ, Jaffe AS, Somers VK. Cardiac troponin T in obstructive sleep apnea. Chest  2004 Jun;125(6):2097-100.
Misa Valo, Annette Wons, Albert Moeller, and Claudius Teupe Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease, Pulmonary Medicine Volume 2015, Article ID 621450, 6 pages.
Vishesh K. Kapur,  Dennis H. Auckley, Susmita Chowd huri,David C. Kuhlmann,Reena Mehra  Kannan Ramar, Christopher G. Harrod, Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017 Mar 15; 13(3): 479–504.
Querejeta Roca G, Redline S, Punjabi N, Claggett B, Ballantyne CM, Solomon SD, Shah AM .Sleep apnea is associated with subclinical myocardial injury in the community. Am J Respir Crit Care Med. 2013 Dec 15;188(12).
Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71
Alchanatis M.  Tourkohoriti G. Kakouros S. Kosmas E. Podaras S. Jordanoglou J.B. Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea.The Effect of Continuous Positive Airway Pressure on Pulmonary Hemodynamics. Respiration 2001;68:566–572. 
Rubini Gimenez M, Twerenbold R, Reichlin T, Wildi K, Haaf P, Schaefer M, Zellweger C, Moehring B, Stallone F, Sou SM, Mueller M, Denhaerynck K, Mosimann T, Reiter M, Meller B, Freese M, Stelzig C, Klimmeck I, Voegele J, Hartmann B, Rentsch K, Osswald S, Mueller C.Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction. Eur Heart J. 2014 Sep 7;35(34):2303-11.
Antonio Barcelo,Cristina Esquinas,josep MiquelBauca, JavierPiérola, Mónicade la Peña, MeritxellArqué, ManuelSánchez –de-la-Torre, AlbertoAlonso-Fernández, FerranBarbé,Effect of CPAP treatment on plasma high sensitivity troponin levels in patients with obstructive sleep apnea. Respiratory Medicine Volume 108, Issue 7, July 2014, Pages 1060-1063.
Zhang XB, Zeng HQ, Du YP, Lyu Z, Zhan FF High-sensitivity cardiac troponin T in obstructive sleep apnea patients without cardiovascular diseases: Efficacy of CPAP treatment. Chron Respir Dis. 2018 May;15(2):157-164
Trygve Sørdahl Hall , Tobias Herrscher , Petr Jarolim , Morten W. Fagerland ,Torstein Jensen ,Jonas Hallén ,Stefan Agewall ,Dan Atar Obstructive sleep apnea: No independent association to troponins  Sleep And Breathing 18(2). September 2013.
Phillips BA, Schmitt FA, Berry DT, Lamb DG, Amin M, Cook YR .Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest 1990 Aug;98(2):325-30
Daniel J. Gottlieb., Naresh M. Punjabi, Reena Mehra, Sanjay R. Patel, Stuart F. Quan,., Denise C. Babineau, Russell P. Tracy, Michael Rueschman, Roger S. Blumenthal., Eldrin F. Lewis, Deepak L. Bhatt, Susan Redline. CPAP versus Oxygen in Obstructive Sleep Apnea. N Engl J Med 2014;370:2276-85.
Norman D, Loredo JS, Nelesen RA, Ancoli-Israel S, Mills PJ, Ziegler MG, Dimsdale JE.E ffects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure. Hypertension. 2006 May;47(5):840-5.
Atoosa Mostafavi, Leila Aliabadi, Khosro Sadeghniiat ,A. Hussein Tabatabaei.Comparison of the efficacy of continuous positive airway pressure and oxygen therapy in increasing heart rate variability in patients with obstructive sleep apnea. Iranian Heart Journal 2017; 18(4):34-41.
Barceló A, Esquinas C,  Bauçà JM , Piérola J, de la Peña M, Arqué M, Sánchez-de-la-Torre M, Alonso-Fernández A, Barbé F. Effect of CPAP treatment on plasma high sensitivity troponin levels in patients with obstructive sleep apnea. Respir Med. 2014 Jul;108(7):1060-3.
Obstructive Sleep Apnea: Effects of Continuous Positive Airway Pressure on Cardiac Remodeling as Assessed by Cardiac Biomarkers, Echocardiography, and Cardiac MR. Chest,Volume 141, Issue 3, March 2012, Pages 674-681.
Cifçi N, Uyar M, Elbek O, Süyür H, Ekinci E. Impact of CPAP treatment on cardiac biomarkers and pro-BNP in obstructive sleep apnea syndrome. Sleep Breath. 2010 Sep;14(3):241-4.