Aldosterone is Associated With New-onset Cerebrovascular Events in Patients With Hypertension and White Matter Lesions: A Cohort Study.

OBJECTIVE: White matter lesions (WMLs) increase the risk of stroke, stroke recurrence, and death. Higher plasma aldosterone concentration (PAC) increases the risk of stroke, acute myocardial infarction, and hypertension. The objective is to evaluate the relationship between PAC and cerebrovascular events in patients with hypertension and WMLs. METHODS: We conducted a retrospective cohort study that included 1041 participants hospitalized. The outcome was new-onset cerebrovascular events including intracerebral hemorrhage and stroke. A Cox regression model was used to evaluate the relationship between baseline PAC and the risk of cerebrovascular events. RESULTS: The mean age of participants was 60.9 ± 10.2 years and 565 (53.4%) were males. The median follow-up duration was 42 months (interquartile range: 25-67), and 92 patients experienced new-onset cerebrovascular events. In a multivariate-adjusted model, with PAC as a continuous variable, higher PAC increased the risk of cerebrovascular events; patient risk increased per 1 (hazard ratio [HR: 1.03], 95% confidence interval [CI]: 1.01-1.06, P < .01), per 5 (HR: 1.17, 95% CI: 1.06-1.31, P < .01), and per 10 ng/dL (HR: 1.41, 95%: 1.14-1.75, P < .01) increase in PAC. When PAC was expressed as a categorical variable (quartile: Q1-Q4), patients in Q4 (HR: 2.12, 95% CI: 1.18-3.79, P < .05) exhibited an increased risk of cerebrovascular events compared to Q1. Restrictive spline regression showed a linear association between PAC and the risk of new-onset cerebrovascular events after adjusting for all possible variables. CONCLUSIONS: Our study identified a linear association between PAC and the risk of new-onset cerebrovascular events in patients with hypertension and WMLs.

Associated lifestyle factors of elevated plasma aldosterone concentration in community population, gender-stratified analysis of a cross-sectional survey.

BACKGROUND: Aldosterone plays important parts in development of cardio-metabolic diseases as end product of renin-angiotensin-aldosterone system. However, factors elevating circulating aldosterone are not clear, and lifestyle-related factors are suggested to be involved, whereas less studied. Therefore, we aimed to explore the association of lifestyle factors with plasma aldosterone concentration (PAC) in community population. METHODS: In this cross-sectional study, we recruited participants using multistage random sampling from Emin China in 2019, and collected data and fasting blood samples. The considered lifestyle factors included obesity parameters (neck circumference, abdominal circumference), alcohol consumption, blood pressure (BP), physical activity, sleep duration, sleep quality, mental state (depression and anxiety), fasting blood glucose (FBG), and lipid profiles (total cholesterol and triglyceride). PAC was measured using radioimmunoassay. We performed sex-stratified linear and logistic regressions to explore associated factors of PAC. Component analysis was further performed to identify the main factors affecting PAC. RESULTS: Twenty-seven thousand four hundred thirty-six participants with 47.1% men were included. Obesity parameters (neck circumference, abdominal circumference), glucose metabolism (FBG), psychological status (anxiety status in men and women, depression status in men), BP, liver function (in men), lipid metabolism (TC and TG in men), sleep parameters (sleep quality in women), and renal function (in women) are the main factors associated with elevated PAC. CONCLUSION: lower physical activity, alcohol consumption, higher BP, fat accumulation, dyslipidemia, higher fasting blood glucose, and presence of depression and anxiety were the main factors associated with eleveated PAC.

The association between blood pressure control and long-term cardiovascular outcomes in Hypertension coexistent with obstructive sleep apnea.

PURPOSE: The goal of blood pressure (BP) control will be lower when hypertensive patients have comorbidities that can affect the risk of cardiovascular diseases. But, the goal of BP control for hypertensive patients coexistent with obstructive sleep apnea (OSA) is not discussed, which is a special population at high risk of cardiovascular diseases. PATIENTS AND METHODS: Using data from a retrospective study(Urumqi Research on Sleep Apnea and Hypertension (UROSAH) study, we enrolled 3267 participants who were diagnosed with hypertension and performed polysomnography during 2011-2013 to explore the association between BP control and long-term major adverse cardiovascular and cerebrovascular event (MACCE). Outcomes of interest was the levels of BP control, MACCE, cardiac event and cerebrovascular event. Then we calculated the cumulative incidence of MACCE and performed Cox proportional hazards with stepwise models. RESULTS: 379 of 3267 patients experienced MACCE during a median follow-up of 7.0 years. After full risk adjustment, BP control of 120-139/80-89mmHg was associated with the lowest risk of cerebrovascular event (HR: 0.53, 95%CI:0.35-0.82) rather than MACCE and cardiac event in the total cohort. The association did not change much in patients with OSA. When the SBP and DBP were discussed separately, the SBP control of 120-139mmHg or < 120mmHg was associated with the decreased incidence of MACCE and cerebrovascular event. When DBP control < 80 mm Hg, the risk of cerebrovascular event showed 54% decrease [(HR:0.46, 95%CI: 0.25-0.88)] in patients with hypertension and OSA. CONCLUSION: In this retrospective study, antihypertensive-drug-induced office and home BP control at 120-139/80-89mmHg showed possible beneficial effect on incident MACCE. However, current results need to be verified in future studies.

Lower 24-h urinary potassium excretion is negatively associated with excessive daytime sleepiness in the general population.

OBJECTIVES: Uncertainty remains about the association of potassium (K) intake and sleepiness. Therefore, we aimed to explore the relationship between K excretion using 24-h urine samples and excessive daytime sleepiness (EDS) in the general population. METHODS: In a cross-sectional study, we used multi-stage proportional random sampling to obtain a study sample aged ≥ 18 years from Emin, China between March and June 2019. We collected timed 24-h urine specimens and conducted EDS assessments using the Epworth Sleepiness Scale (ESS) questionnaire. Subjects were divided into two groups by the median of 24-h urinary potassium (24-h UK). EDS was defined as ESS score ≥ 10. Multi-variable linear regression was used to examine the association between the 24-h UK and the odds of prevalent EDS. We performed a sensitivity analysis by excluding subjects under anti-hypertensive treatment and those with sleep disordered breathing by the NoSAS scale. RESULTS: A total of 470 participants with complete 24-h urine samples and ESS data (62% women, mean age 49.6 years, mean ESS score of 9.0 ± 5.2) were enrolled. The mean ESS score was significantly lower in the upper half of 24-h UK group than in the lower half (9.5 ± 5.3 vs 8.5 ± 5.1, P = 0.044), and accordingly, prevalent EDS was significantly greater in the lower half than in the higher half (49% vs 40%, P = 0.039). In further improving the propensity matching score, the results remained consistent with the overall results. In multiple linear regression, 24-h UK was negatively correlated with ESS score (ß = - 0.180 (- 0.276, - 0.085), < 0.001). Sensitivity analysis demonstrated augmented results in those without anti-hypertensive treatment. CONCLUSION: Lower potassium intake, as suggested by lower UK excretion, may be implicated in the presence of EDS in the general population.

Secondhand smoke is associated with poor sleep quality in self-reported never-smokers of Northwest China: a cross-sectional study.

OBJECTIVE: To investigate the relationship between secondhand smoke (SHS) exposure and sleep quality in never-smokers of Northwest China. METHODS: Never-smoking adults (≥ 15 years) from Xinjiang, Northwest China, were included in this cross-sectional survey between April and October 2019. SHS exposure in never-smokers was estimated using a structured questionnaire. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI), with PSQI score > 5 classified as poor sleep quality. Association of SHS exposure and frequency and duration of SHS exposure with poor sleep quality were analyzed by using a multivariate logistic regression after adjusting for potential confounding factors, including stratification by sex. RESULTS: The mean age of participants was 48.0 years, and 77% were females. Of 21,198 never-smokers, 13% (n = 2703) reported SHS exposure and 35% (n = 7390) reported poor sleep quality. In multivariate logistic regression analysis, a significant association was observed between SHS exposure and poor sleep quality (adjusted odds ratio (OR), 1.36; 95% confidence interval (CI) 1.24-1.48). Subgroup analysis showed a negative association of SHS exposure with sleep quality in both sexes. However, a significant dose-response relationship of frequency and duration of SHS exposure per week with poor sleep quality was observed only in females. Consistent results were also observed in the aged ≥ 18 years. CONCLUSION: Exposure to SHS is associated with poor sleep quality in never-smoking adults of Northwest China. A dose-response relationship between SHS exposure and poor sleep quality is found in women. Avoiding SHS exposure may have beneficial effects on sleep quality, especially for females.

Poor sleep quality is negatively associated with low cognitive performance in general population independent of self-reported sleep disordered breathing.

BACKGROUND: Sleep disordered breathing (SDB) plays a significant role in both sleep quality and cognition and whether it has an impact on the relationship between above two factors remains to be clear. The study aimed to explore the association between sleep quality and cognitive performance in general population by considering influence of sleep disordered breathing (SDB). METHODS: In this cross-sectional study, we enrolled subjects aged ≥ 18 years using a multi-stage random sampling method. Cognitive status was assessed using Mini Mental State Examination (MMSE) questionnaire, sleep quality using Pittsburgh Sleep Quality Index (PSQI) and SDB was assessed using No-SAS scale, respectively. Multi-variable logistic regression was applied to examine the association of sleep quality and cognitive performance. Subgroup analyses were performed in different age groups, and in those with and without SDB. RESULTS: Finally, 30,872 participants aged 47.5 ± 13.8 years with 53.5% women were enrolled, of whom 32.4% had poor sleep quality and 18.6% had low cognitive performance. Compared with good sleepers, subjects with poor sleep quality exhibited significantly higher presence of low cognitive performance (23.7% vs 16.2%, P < 0.001). Poor sleepers revealed 1.26 (95%CI: 1.16,1.36), 1.26 (1.08,1.46) and 1.25 (1.14,1.37) fold odds for low cognitive performance in general population and in subjects with and without self-reported SDB respectively. Stratified by age and SDB, the association was observed in young and middle-aged group without SDB (OR = 1.44, 95%CI: 1.30,1.59) and in the elderly group with SDB (OR = 1.30, 95%CI: 1.07,1.58). CONCLUSIONS: Sleep quality is in a negative association with cognitive performance in general population independent of SDB, implying improvement of sleep disturbances is a potential objective of intervention strategies for cognitive protection at population level.

Association of Hypertension with Mild Cognitive Impairment in Population from Less-Developed Areas of Multiethnic Northwest China.

BACKGROUND: Relationship between hypertension and mild cognitive impairment (MCI) remains undetermined in population from less-developed regions. We aimed to explore whether hypertension is associated with MCI in this specific population. METHODS: In this cross-sectional study, we enrolled subjects aged ≥18 years using multistage random sampling from Emin, China, in 2019. Participants underwent questionnaires and data collection including mini-mental state examination (MMSE) and blood pressure measurement. RESULTS: Finally, 31,329 subjects were included, with 11,270 hypertensives. Compared with normotensive subjects, hypertensives were characterized by significantly older age (55.19 ± 12.25 vs. 43.26 ± 12.71), more men (52.5% vs. 42.9%), low education attainment (≤primary education: 42.4% vs. 26.3%), more abdominal obesity (39.7% vs. 19.1%), poor sleep quality (39.1% vs. 28.7%), and chronic kidney disease (6.6% vs. 3.4%, p for all <0.001). Prevalence of MCI in hypertensives was significantly higher than that of normotensive subjects (24.3% vs. 15.6%, p < 0.001). Multivariate logistic regression analysis showed in a fully adjusted model that the odds for MCI were significantly increased in hypertensives than in normotensive population (OR = 1.19, 95% CI: 1.09, 1.30, p < 0.001) and independent of all the parameters studied including age, education level, and stroke. In the age-stratified regression model, presence of hypertension significantly increased the odds of MCI by 1.17-fold (95% CI: 1.03, 1.33, p = 0.020) and by 1.22-fold (95% CI: 1.04, 1.44, p = 0.016) in middle-aged and elderly population. Sensitivity analysis of excluding those with stroke history showed that hypertension was still a risk factor for MCI in total, middle-aged, and elderly population. CONCLUSION: Hypertension is in independent negative association with MCI in middle-aged and elderly population from underdeveloped regions.

Distribution characteristics of circulating homocysteine and folate and related factors in agriculture, stock-raising and urban populations: a cross-sectional survey.

OBJECTIVE: To investigate homocysteine (Hcy) and folate levels, prevalence of hyperhomocysteinaemia (HHcy) and folate deficiency, which are affected by lifestyles in urban, agricultural and stock-raising populations. DESIGN: This is a cross-sectional study. SETTING: Urban, agricultural and stock-raising regions in Emin, China. PARTICIPANTS: Totally 1926 subjects - 885 (45·9 %) from urban, 861 (44·7 %) from agricultural and 180 (9·4 %) from stock-raising regions - were obtained using multistage stratified random sampling. Inclusion criteria encompassed inhabitants aged ≥15 years who resided at the current address for ≥6 months and agreed to participate in the study. Surveys on health behaviour questionnaires and physical examinations were conducted and blood samples collected. RESULTS: The folate level of subjects from the stock-raising region was the lowest, followed by those from the agricultural region, and the highest in those from the urban region (3·48 v. 6·50 v. 7·12 ng/ml, P < 0·001), whereas mean Hcy showed no significant difference across regions. The OR for HHcy in stock-raising regions was 1·90 (95 % CI 1·11, 3·27) compared with the urban region after adjusting for all possible covariates. The OR for folate deficiency in stock-raising and agriculture regions was 11·51 (95 % CI 7·09, 18·67) and 1·91 (95 % CI 1·30, 2·82), respectively, compared with the urban region after adjusting for all possible covariates. CONCLUSIONS: HHcy and folate deficiency are highly prevalent in stock-raisers, which is of important reference for HHcy control in Xinjiang, with a possibility of extension to others with approximate lifestyles.

Association between 24-h urinary sodium to potassium ratio and mild cognitive impairment in community-based general population.

OBJECTIVE: To explore the relationship between parameters of Na and K excretion using 24-h urine sample and mild cognitive impairment (MCI) in general population. DESIGN: This is a cross-sectional study. SETTING: Community-based general population in Emin China. PARTICIPANTS: Totally, 1147 subjects aged ≥18 years were selected to complete the study, with a multistage proportional random sampling method. Cognitive status was assessed with Mini Mental State Examination (MMSE) questionnaire and timed 24-h urine specimens were collected. Finally, 561 participants aged ≥35 years with complete urine sample and MMSE data were included for the current analysis and divided into groups by tertiles of 24-h urinary sodium to potassium ratio (24-h UNa/K) as lowest (T1), middle (T2) and highest (T3) groups. RESULTS: The MMSE score was significantly lower in T3, compared with the T1 group (26·0 v. 25·0, P = 0·002), and the prevalent MCI was significantly higher in T3 than in T1 group (11·7 % v. 25·8 %, P < 0·001). In multiple linear regression, 24-UNa/K (ß: -0·184, 95 % CI -0·319, -0·050, P = 0·007) was negatively associated with MMSE score. In multivariable logistic regression, compared with T1 group, 24-h UNa/K in the T2 and T3 groups showed 2·01 (95 % CI 1·03, 3·93, P = 0·041) and 3·38 (95 % CI 1·77, 6·44, P < 0·001) fold odds for presence of MCI, even after adjustment for confounders. More augmented results were demonstrated in sensitivity analysis by excluding individuals taking anti-hypertensive agents. CONCLUSIONS: Higher 24-h UNa/K is in an independent association with prevalent MCI.

Prevalence, awareness, treatment and control of hypertension in various ethnic groups (Hui, Kazakh, Kyrgyz, Mongolian, Tajik) in Xinjiang, Northwest China.

Purpose: Credible data is scarce in representative population aged ≥18 years, though hypertension is highly prevalent and poorly controlled in population aged ≥30 years in Xinjiang Northwest China. Therefore, we tried to provide data on hypertension status for reference.Materials and methods: We conducted a population-based cross-sectional survey between 2014 and 2015 using stratified multi-stage random sampling as part of a national survey. Hypertension is defined as systolic blood pressure (BP) ≥140 mmHg, and/or diastolic BP ≥90 mmHg and/or taking anti-hypertensive agents. We assessed prevalence, awareness, treatment and control rates of hypertension by rural and urban regions, by gender and by ethnicity, and related factors including agent prescription pattern.Results: Data for 6807 subjects ≥18 years with 79.2% rural and 52.0% women subjects are analyzed. Overall age-adjusted prevalence of hypertension in population aged ≥18 years is 22.2%, and shows no disparity between genders and regions. By ethnicity, the prevalence of hypertension was the highest in Tajik subjects (25.4%), followed by Mongolian (25.3%) and Kazakh (24.8%) subjects and the lowest in Kyrgyz (20.2%) subjects. Of the hypertensives, 55.5% have awareness, 43.9% receive anti-hypertensive treatment, whereas only 14.5% have their BP controlled. In different ethnic groups, the awareness, control and control in treatment rates showed no significant disparities, except for the treatment rate. It was the highest in Kazakh subjects (50.0%) and the lowest in Hui subjects (36.7%). The most common prescribed agent encompassed ACEI/ARBs (41.1%) and calcium channel blockers (30.4%). Over 87.2% of hypertensives were prescribed for single drug regimen.Conclusions: Hypertension is moderately prevalent in Xinjiang, whereas poorly controlled. Standardization of its treatment such as introducing treatment algorithm might be the priorities for future improvement, with healthy life promotion.

Trends in Lipids and Lipoproteins Among Adults in Northwestern Xinjiang, China, From 1998 Through 2015.

BACKGROUND: To examine trends in serum lipids in population in Northwestern Xinjiang between 1998 and 2015 and to provide clues for future prevention. METHODS: We enrolled 5,142 adults aged ≥30 years from seven independent cross-sectional studies conducted in 1998-2000, 2007-2008, and 2015. Blood lipid profiles, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were measured. RESULTS: The mean age was 48.5 years in 1998-2000, 47.9 years in 2007-2008, and 53.7 years in 2015. There was a declining trend in the prevalence of dyslipidemia among adults in northwestern Xinjiang. Mean LDL-C decreased during the same period, while mean HDL-C showed the opposite trend. Mean TC was 4.79 mmol/L in 1998-2000, 5.17 mmol/L in 2007-2008, and 4.59 mmol/L in 2015. The trend of mean TG was similar to that of TC. The prevalence of dyslipidemia was closely related with male gender, Mongolian ethnicity, hypertension, obesity, elevated fasting blood glucose, smoking, and drinking. CONCLUSION: Between 1998 and 2015, favorable trends in lipid levels have occurred among adults of Northwestern Xinjiang. However, further efforts are needed.

Influences of obstructive sleep apnea on blood pressure variability might not be limited only nocturnally in middle-aged hypertensive males.

PURPOSE: In this cross-sectional study, we analyzed the potential association between sleep measures and blood pressure variability. METHODS: Ninety-three middle-aged hypertensive males, who underwent polysomnography and 24-h ambulatory blood pressure monitoring, were enrolled. Blood pressure variability was assessed by blood pressure standard deviation. Obstructive sleep apnea (apnea hypopnea index ≥ 15) was diagnosed in 52 (55.91%) patients. Mean body mass index and age were 27.77 ± 3.11 kg/m2 and 44.05 ± 8.07 years, respectively. RESULTS: Hypertensive males with obstructive sleep apnea showed significantly higher 24-h, diurnal, and nocturnal diastolic blood pressure variability, compared to those without obstructive sleep apnea. While total cohort was further divided into two groups using the median of oxygen desaturation index, another indicator for severity of OSA, significant differences were also observed in 24-h, diurnal, and nocturnal diastolic blood pressure variability between two groups with higher and lower oxygen desaturation index. While subjects were also divided into two groups via the mean of sleep stage 1, hypertensive males with sleep stage 1 ≥ 8.1% showed significantly higher diurnal diastolic blood pressure variability than those with sleep stage 1 < 8.1%. Apnea hypopnea index was independently associated with 24-h and nocturnal diastolic blood pressure variability; oxygen desaturation index of 3% with 24-h diastolic, diurnal, and nocturnal diastolic blood pressure; and sleep stage 1 was with 24-h and with diurnal diastolic blood pressure variability in all study subjects. CONCLUSION: Effects of obstructive sleep apnea on blood pressure variability may not be limited nocturnally.

Elevated serum concentrations of lipopolysaccharide binding protein might prolong sleep stage one in middle-aged hypertensive males.

PURPOSE: Sleep architecture can be affected by alteration in circulating lipopolysaccaride and cytokines. However, still unknown are the effects of lipopolysaccaride-binding protein (LBP) on sleep architecture. Therefore, potential relationship between alteration in serum LBP concentrations and sleep architecture was analyzed. METHODS: This is a cross-sectional study. Consecutive 54 hypertensive males, aged 30-65 years. and with no obstructive sleep apnea via polysomnography, were recruited. Subjects were divided into two groups via the LBP median as hypertensives with higher and lower serum LBP (n = 27 and n = 27, respectively). Sleep architecture was assessed by polysomnography. Serum LBP, IL-1ß, IL-6, and TNF-α were measured by commercial laboratories using sandwich-type enzyme immunoassay kit. RESULTS: Hypertensive subjects with higher LBP showed significantly higher inflammatory status as assessed by IL-1ß (18.85 ± 3.71 vs 16.15 ± 4.00 ng/L, P = 0.009), IL-6 (67.64 ± 11.22 vs 58.94 ± 11.32 ng/L, P = 0.004), and TNF-α (322.27 ± 59.17 vs 283.89 ± 61.87 pg/ml, P = 0.024) than did those with lower LBP. Hypertensives with higher serum LBP also exhibited prolonged N1 % (7.63 ± 3.55 vs 4.98 ± 2.90 %, P = 0.002), the transition from wakefulness to other sleep stages or follows arousal during sleep, than did those with lower LBP. A significant positive correlation was observed between serum LBP concentrations and N1 % (r = 0.378, P = 0.005) via Spearman's correlation and remained significant even after adjusting for age, apnea-hypopnea index, and body mass index. CONCLUSION: Elevation in serum concentrations of LBP might prolong N1 % in this middle-aged hypertensive males, which needs to be confirmed further.

What can impulse oscillometry and pulmonary function testing tell us about obstructive sleep apnea: a case-control observational study?

PURPOSE: This study aims to determine whether functional residual capacity (FRC) in obese patients with obstructive sleep apnea (OSA) decreases more than in patients without OSA because of decreased outward recoil from chest wall mass loading as well as increased lung inward recoil. METHODS: Subjects who were overweight and obese to various degrees with normal spirometric values underwent overnight polysomnography to determine the presence or absence of OSA and were labeled as cases or controls. Lung volume and respiratory mechanical properties were measured by plethysmograph and impulse oscillometry, respectively. RESULTS: A total of 76 men and 31 women were diagnosed with OSA (cases); 64 men and 33 women without OSA were confirmed as controls. Expiratory reserve volume and FRC were significantly decreased in cases compared with controls. Respiratory impedance and resistance at 5 Hz were significantly higher in cases than in controls, although reactance at low frequencies was significantly lower in cases than in controls. Reactance at 5 Hz (Xrs5) was found to be independently highly correlated with the severity of OSA as defined by the Apnea-Hypopnea Index and was significantly correlated with FRC. CONCLUSIONS: FRC is significantly decreased in overweight or obese patients with OSA compared with those without OSA, which may be attributed to an increase in lung elastic recoil. The stronger correlation between Xrs5 and OSA severity might indicate upper airway stenosis, and abnormally increased lung elastic recoil may contribute to OSA.

What do changes in concentrations of serum surfactant proteins A and D in OSA mean?

PURPOSE: Previous studies have shown that surfactant proteins are affected by oxygen concentration and mechanic stretches, although the alteration of serum surfactant proteins in individuals with obstructive sleep apnea (OSA) is still unclear. Therefore, the aim of this study is to examine whether serum concentrations of surfactant proteins A and D are altered and related to hypopnea index (HI) in OSA. METHODS: This is a cross-sectional study. Consecutive 140 males, suspicious of OSA, were studied. OSA was determined by PSG and polysomnographic data examined. Subjects with HI ≥ 10.1/h were classified as higher HI group and those with HI < 10.1/h as lower HI group. Hs-CRP, HbA1C, and FBG were determined by standard methods and Krebs von den Lungen-6 (KL-6), surfactant protein-A (SP-A), and surfactant protein-D (SP-D) by ELISA. RESULTS: OSA was diagnosed in 110 patients (78.5%). Mild, moderate, and severe OSA constitutes 26.4, 27.8, and 24.3%, respectively. Mean age was 44.6 ± 7.65 years. Subjects with higher HI had lower SP-A (139.54. ± 32.94 vs 158.2 ± 38.9 ng/L, p = 0.005) and SP-D (16.54 ± 3.67 vs 18.10 ± 3.48 ng/L, p = 0.014) compared to those with lower HI. Nocturnal HI was strongly correlated with serum levels of SP-A (r = 0.343, p = 0.012) and SP-D (r = 0.504, p < 0.001) and are inversely associated with circulating SP-A and SP-D levels, even after adjusting for age and body mass index in nonsmoking subjects. CONCLUSIONS: Circulating SP-A and SP-D levels are decreased in some individuals with higher HI in OSA, possibly reflecting severity of hypoxia in OSA.

Association of glucose transporter 4 genetic polymorphisms with obstructive sleep apnea syndrome in Han Chinese general population: a cross-section study.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is strongly associated with the increasing prevalence of cerebrovascular events and metabolic syndrome. A growing number of studies have shown OSAS is an independent factor for insulin resistance, glucose intolerance and type2 diabetes. However, relationship of OSAS with dysglycemia is complex and still remains poorly understood. Glucose transporter 4 (GLUT4) gene is Human and rodents' main glucose transporter sensitive to insulin, and therefore confirmation of candidate gene polymorphisms and association with OSAS is needed. Aim of our study was to assess whether GLUT4 gene polymorphisms are associated with OSAS. METHODS: Patients hospitalized at People's Hospital of Xinjiang were selected from January to December 2010. A total of 568 Han subjects who possibly exist OSAS base on a history and physical examination were completed the polysomnography, 412of whom (72.5%) were diagnosed with OSAS, and 156 individuals were confirmed without OSAS (27.5%). 96 severe OSAS patients chosen from OSAS were used for DNA sequencing in functional domain. Blood samples were collected from all subjects and genotyping was performed on DNA extracted from blood cells. RESULTS: We performed GLUT4 genome sequencing, found 4 mutated sites. And finally selected three mutated sites such as rs5415, rs4517 and rs5435, according to principle of linkage disequilibrium (r2 > 0.8) and minimum gene allele frequency > 5%. All SNPs satisfied HEW (P > 0.05). Our study demonstrated a significant association of GLUT4 SNPrs5417 allele with OSAS, compared with controls (P < 0.05). Haplotype H1 (TCC) and H3 (CCC) defined as SNPrs5415, rs4517 and rs5435 are marginally associated with OSAS (P < 0.05). Frequencies of C haplotype of rs5417 in OSAS were higher than in controls. After adjustment for confounding factors, (AC + AA) genotype significantly reduces prevalence of OSAS, compared with CC genotype. Level of awake blood oxygen and lowest blood oxygen of (AA + AC) genotype was significantly superior to those of CC genotype. CONCLUSIONS: Our study demonstrates GLUT4 gene SNPrs5417 is associated with OSAS in hypertensive population. Carriers of AA + AC have less prevalence of obstructive sleep apnea syndrome than that of CC carriers.

Correlation between plasma aldosterone concentration and bone mineral density in middle-aged and elderly hypertensive patients: potential impact on osteoporosis and future fracture risk.

Background: Previous studies have suggested that aldosterone may play a major role in calcium-phosphorus homeostasis and bone metabolism. However, the relationship between plasma aldosterone concentrations (PAC) and bone mineral density (BMD) in middle-aged and elderly hypertensive patients remains unclear. Therefore, this study sought to investigate the relationship between PAC levels and BMD and explore PAC's potential impact on osteoporosis and future fracture risk in hypertensive patients. Methods: Our study included a total of 1430 participants. Associations are tested using multiple linear and logistic regression models. Nonlinearity was investigated using the restricted cubic spline (RCS). We also performed mediating analyses to assess mediating factors mediating the relationship between PAC and osteoporosis. Results: The multiple linear regression showed a negative correlation between PAC and BMD and was generally positively associated with FRAX scores. Meanwhile, logistic regression analyses indicated that osteoporosis was highly correlated with PAC levels. In addition, a clear non-linear dose-response relationship was also shown in the constructed RCS model. Finally, mediation analyses showed that serum potassium played an important role in the development of osteoporosis. Conclusion: This study demonstrates that elevated PAC levels are strongly associated with decreased BMD, increased prevalence of osteoporosis, and the risk of future fractures in middle-aged and elderly hypertensive patients. Further studies are needed to confirm this relationship and reveal its underlying mechanisms.

Increased stress hyperglycemia ratio at hospital admission in stroke patients are associated with increased in-hospital mortality and length of stay.

OBJECTIVE: Recently, the stress hyperglycemia ratio (SHR) has been introduced as a metric to signify relative hyperglycemia. This study aimed to investigate the relationship between SHR and in-hospital mortality and length of stay occurring during hospitalization in stroke patients. METHODS: The retrospective cohort study comprised a total of 4,018 patients diagnosed with acute stroke. The SHR is expressed by the formula: SHR = ABG (mmol/L) / [1.59 × HbA1c (%) - 2.59]. Outcomes included in-hospital mortality and length of stay. Multivariable logistic and linear regression analyses were conducted. Receiver operating characteristic (ROC) analysis was performed to distinguish between the variables, and the area under the ROC curve (AUC) was compared. RESULTS: In this analysis, a total of 4,018 individuals participated, including 2,814 male patients, accounting for 70.0%. Overall, in-hospital mortality and length of stay tended to rise as SHR increased. A higher prevalence of in-hospital mortality was observed with each standard deviation (SD) increase of the SHR (odds ratio [OR]: 1.26, 95% confidence interval [CI]: 1.05-1.52). Moreover, after considering the confounders, a significant positive association between SHR levels and length of stay was observed (ß = 0.70, 95% CI: 0.40-1.00). ROC analysis showed that among stroke patients, SHR (AUC = 0.693) was more effective than admission blood glucose (ABG) (AUC = 0.646) and glycosylated hemoglobin (HbA1c) (AUC = 0.523), which were more predictive of in-hospital mortality. CONCLUSIONS: Elevated SHR levels are associated with increased in-hospital mortality and prolonged length of stay in stroke patients.

Diurnal Cortisol Features and Type 2 Diabetes Risk in Patients With Hypertension and Obstructive Sleep Apnea: A Cohort Study.

CONTEXT: The hypothalamic-pituitary-adrenal (HPA) axis may be associated with type 2 diabetes (T2D); however, whether HPA axis dysfunction is associated with incident T2D remains unclear in patients with hypertension and obstructive sleep apnea (OSA). OBJECTIVE: To investigate the relationship between the diurnal cortisol features and the risk of incident T2D in patients with hypertension and OSA. METHODS: Participants with cortisol rhythm test at baseline in the Urumqi Research on Sleep Apnea and Hypertension cohort were enrolled. The Cox regression model was used to evaluate the relationship between ln-transformed diurnal cortisol features and T2D risk. Stratified and sensitivity analyses were also performed. RESULTS: A total of 1478 patients with hypertension and OSA were enrolled in this study. During a median follow-up of 7.0 years, 196 participants developed T2D. Overall, a steep diurnal cortisol slope (DCS) was significantly associated with decreased T2D risk (per SD increase, HR 0.88, 95% CI 0.79-0.97, P = .014). Midnight cortisol was positively associated with increased T2D risk (per SD increase, HR 1.25, 95% CI 1.08-1.45, P = .003). Sensitivity analyses showed similar results. Neither DCS nor midnight cortisol was associated with incident T2D in the women's subgroup or participants with mild OSA. CONCLUSION: Steeper DCS and higher midnight cortisol levels are associated with lower and higher T2D risks in patients with hypertension and OSA, respectively, at least in men or participants with moderate to severe OSA. Diurnal cortisol features may represent an early prevention target for diabetes in this population.

Relationship Between Plasma Aldosterone Concentrations and Non-Alcoholic Fatty Liver Disease Diagnosis in Patients with Hypertension: A Retrospective Cohort Study.

Objective: To investigate the association between plasma aldosterone concentration (PAC) and non-alcoholic fatty liver disease (NAFLD) diagnosis in Chinese hypertensive patients. Methods: We conducted a retrospective study of all patients diagnosed with hypertension between January 1, 2010, and December 31, 2021. We included 3713 hypertensive patients based on the criteria for inclusion and exclusion. PAC measurement was performed using a radioimmunoassay. NAFLD was diagnosed using abdominal ultrasonography. Cox regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for univariable and multivariable models. A generalized additive model was used to identify nonlinear relationships between PAC and NAFLD diagnosis. Results: A total of 3713 participants were included in the analysis. Over a median follow-up of 30 months, 1572 hypertensive individuals developed new-onset NAFLD. When PAC was used as a continuous variable, the risk of NAFLD increased by 1.04 and 1.24-fold for each 1 ng/dL and 5 ng/dL increase in PAC, respectively. When PAC was considered a categorical variable, the HR for tertile 3 was 1.71 (95% CI, 1.47-1.98, P < 0.001) compared to tertile 1. Overall, there was a J-shaped relationship between PAC and new-onset NAFLD. By fitting a two-piecewise linear regression model and using a recursive algorithm, we identified a PAC inflection point at 13 ng/dL (log-likelihood ratio test, P = 0.005). In adjusted model 3, for PAC ≥ 13 ng/dL, a 5 ng/dL increase in PAC was associated with a 30% increase in the risk of new-onset NAFLD (95% CI, 1.25-1.35, P < 0.001). Conclusion: The study revealed a non-linear relationship between elevated PAC levels and the incidence of NAFLD in hypertensive patients. Notably, the risk of new-onset NAFLD was significantly increased when PAC levels were ≥13 ng/dL. Larger, prospective studies are necessary to confirm these findings.