Impaired intestinal barrier in patients with obstructive sleep apnea
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Impaired intestinal barrier in patients with obstructive sleep apnea Qianjun Li 1,2 & Ting Xu 1 & Hai Zhong 3 & Wenhui Gao 4 & Chuan Shao 5,6 & Lijie Feng 1 & Taoping Li 1 Received: 26 March 2020 / Revised: 15 August 2020 / Accepted: 21 August 2020 # Springer Nature Switzerland AG 2020
Abstract Background Obstructive sleep apnea (OSA) is often associated with multisystem damage. The gut is a pivotal organ that initiates the pathophysiological processes of multisystem diseases. Intermittent hypoxia resulting from OSA may impair the intestinal barrier prior to the induction of systemic inflammation. We hypothesize that the intestinal barrier markers D-lactic acid (D-LA) and intestinal fatty acid–binding protein (I-FABP) levels would be higher in patients with OSA. Methods Consecutive snoring and nonsnoring adults were included in this study and were grouped based on their apneahypopnea index (AHI) scores: the control group (AHI < 5) and the OSA group (AHI ≥ 5). Plasma D-LA and I-FABP levels were measured using colorimetry and ELISA, respectively. Other parameters, such as fasting levels of lipids, routine blood tests, and glucose were also assessed. Results Of 76 participants, patients in the OSA group accounted for 73% (55/76). Plasma D-LA and I-FABP levels were significantly higher in patients with OSA [7.90 (7.42) (IQR) vs. 0.88 (2.79) (IQR) mmol/L, p < 0.001 and 1851.99 ± 754.23 (SD) vs. 1131.98 ± 383.38 pg/mL, p < 0.001, respectively]. Increased glucose, triglycerides (TGs), leukocytes, neutrophils, and monocytes but decreased high density lipoprotein (HDL) were also found in patients with OSA. It was also observed that the increase in D-LA and I-FABP exhibited the strongest positive association with AHI (r = 0.443, p < 0.001; r = 0.645, p < 0.001), followed by the lowest SaO2 (p ≤ 0.001), BMI (p ≤ 0.017), glucose (p ≤ 0.011), and TGs (p ≤ 0.025). Moreover, multivariate regression analysis showed that D-LA (B = 0.823, p < 0.001) and I-FABP (B = 0.002, p = 0.017) were independently associated with OSA. Conclusions The systemic expression of D-LA and I-FABP is dramatically higher in OSA patients, suggesting that hypoxia resulting from OSA might have the capacity to impair the intestinal barrier prior to the induction of multisystem dysfunction. Keywords Obstructive sleep apnea . D-lactic acid (D-LA) . Intestinal fatty acid . binding protein (I-FABP) . Intestinal barrier
Introduction Qianjun Li and Ting Xu contributed equally to this work. * Taoping Li [email protected]; [email protected] 1
Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
2
Department of Respiratory and Critical Care Medicine, Yinzhou No.2 Hospital, Ningbo, China
3
Department of Cardiothoracic Surgery, Yinzhou No.2 Hospital, Ningbo, China
4
Department of Cardiovascular, Hangzhouwan Hospital, Ningbo, China
5
Department of Pulmonary and Critical Care Medicine, Medical Center Lihuili Hospital, Ningbo, China
6
Department of Special Procurement War
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