MS 186.qxp
نویسندگان
چکیده
DIABETES IS AN INDEPENDENT RISK FACTOR FOR THE DEVELOPMENT OF CARDIOVASCULAR DISEASE (CVD),1,2 AND A GROWING BODY OF EVIDENCE SUGGESTS THAT sleep-disordered breathing (SDB) is associated with adverse CVD risk factors and outcomes, including hypertension and myocardial infarction.1-5 The prevalence of hypertension, atherosclerotic CVD, and myocardial infarction are elevated in individuals with diabetes and in individuals with sleep apnea.5-9 Oxidative stress has been implicated as an important pathophysiologic mechanism contributing to CVD.10 SDB is associated with an increase in oxidative stress that is due to repetitive episodes of hypoxia-reoxygenation.11 The severity of oxidative stress and the adaptation to reduce that stress may explain differential susceptibility to atherosclerotic CVD10,11 in individuals with SDB.12-14 For example, functional polymorphisms in genes encoding antioxidant enzymes or proteins may be of particular importance in explaining susceptibility to CVD in individuals with SDB. Haptoglobin is an abundant serum protein for which there are 2 common alleles in humans, denoted 1 and 2.15 Haptoglobin is an antioxidant as a direct result of its ability to prevent hemoglobin-driven oxidation, the potential for which may be increased in SDB due to hypoxia-reoxygenation injury to red blood cells. We and others have recently demonstrated that the antioxidant activity of haptoglobin differs between the different haptoglobin allelic variants.16-17 Haptoglobin type has recently been demonstrated to be a susceptibility gene for the development of CVD in individuals with diabetes, another disorder associated with increased oxidative stress.18 Moreover, we have recently found in a series of patients with obstructive sleep apnea (OSA) that there is an apparent association between sleep apnea, haptoglobin phenotype, and CVD in individuals younger than 55 years of age.19 We sought to confirm and extend these findings in the Sleep Heart Health Study (SHHS) by assessing the independent and joint effects of SDB and haptoglobin phenotype on the prevalence of cardiovascular disease.
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