Obstructive sleep apnea in adults: relationship with cardiovascular and metabolic disorders
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Basel [u.a.]
Karger
2011
|
| Schriftenreihe: | Advances in Cardiology
46 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI, 271 S. Ill., graph. Darst. |
| ISBN: | 9783805596459 |
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CONTENTS
PREFACE XV
ACKNOWLEDGEMENTS XVI
CHAPTER 1
OBSTRUCTIVE SLEEP APNEA IN ADULTS: EPIDEMIOLOGY, CLINICAL PRESENTATION,
AND TREATMENT OPTIONS I 1 DEFINITIONS 3
2 PREVALENCE AND INCIDENCE OF OBSTRUCTIVE SLEEP APNEA 5
3 RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA 7
3.1 OVERWEIGHT, OBESITY, METABOLIC SYNDROME AND ALTERATIONS IN GLUCOSE
METABOLISM 7
3.2 AGE 8
3.3 GENDER 8
3.3.1 MENOPAUSE, A RISK FACTOR FOR OBSTRUCTIVE SLEEP APNEA 8
3.3.2 TESTOSTERONE LEVELS AND THE RISK OF OBSTRUCTIVE SLEEP APNEA 9
3.3.3 POLYCYSTIC OVARY SYNDROME AND THE RISK OF OBSTRUCTIVE SLEEP APNEA
9 3.4 CRANIOFACIAL ANATOMY 9
3.5 SMOKING AND ALCOHOL CONSUMPTION 10
3.6 FAMILIAL AND GENETIC PREDISPOSITION 10
4 OBSTRUCTIVE SLEEP APNEA SYMPTOMS AND SIGNS 11
4.1 DAYTIME SYMPTOMS 11
4.1.1 EXCESSIVE SLEEPINESS 11
4.1.2 EXCESSIVE SLEEPINESS IN THE GENERAL POPULATION AND IN PATIENTS
WITH OBSTRUCTIVE SLEEP APNEA 12
4.1.3 FATIGUE 14
4.2 SLEEP-RELATED SYMPTOMS 15
4.2.1 SNORING, WITNESSED APNEAS AND NOCTURNAL CHOKING 15
4.2.2 NOCTURIA 16
4.3 SEQUELAE 17
4.3.1 PSYCHOLOGICAL CHANGES AND PSYCHIATRIC SYMPTOMS 17
4.3.2 HEALTH-RELATED QUALITY OF LIFE 18
4.3.3 PERFORMANCE ALTERATIONS 19
5 CHARACTERISTIC CLINICAL FEATURES OF OBSTRUCTIVE SLEEP APNEA IN
PATIENTS WITH METABOLIC OR CARDIOVASCULAR DISORDERS 22
VII
BIBLIOGRAFISCHE INFORMATIONEN HTTP://D-NB.INFO/101196239X
DIGITALISIERT DURCH
IMAGE 2
6 A BRIEF PRESENTATION OF THE STRATEGIES AND TESTS TO IDENTIFY
OBSTRUCTIVE SLEEP APNEA AND TREATMENT OPTIONS ACCORDING TO THE AMERICAN
ACADEMY OF SLEEP MEDICINE GUIDELINES 22
6.1 GUIDELINES 22
6.2 DIAGNOSTIC TESTS 26
6.3 TREATMENT OPTIONS 26
6.3.1 POSITIVE AIRWAY PRESSURE ADMINISTRATION 26
6.3.2 ORAL APPLIANCES 28
6.3.3 WEIGHT LOSS 28
6.3.4 SURGERY 29
7 CONCLUSION 30
8 REFERENCES 31
CHAPTER 2
INFLAMMATION, OXIDATIVE STRESS, AND PROCOAGULANT AND THROMBOTIC ACTIVITY
IN ADULTS WITH OBSTRUCTIVE SLEEP APNEA 43
1 INFLAMMATORY RESPONSE TO CHRONIC INTERMITTENT HYPOXIA 45
1.1 INTERMITTENT HYPOXIA ACTIVATES TRANSCRIPTION FACTORS INVOLVED IN
INFLAMMATORY PROCESSES .45
1.1.1 THE NUCLEAR FACTOR KB PATHWAY 46
1.1.2 THE HYPOXIA-LNDUCIBLE FACTOR PATHWAY 48
1.1.3 TISSUE-SPECIFIC EFFECTS OF CHRONIC INTERMITTENT HYPOXIA 50
1.2 OXIDATIVE AND NITROSATIVE STRESS 51
1.2.1 SOURCES AND CELLULAR EFFECTS OF REACTIVE OXIDATIVE AND NITROSATIVE
SPECIES 51
1.2.2 OXIDATIVE AND NITROSATIVE STRESS IN OBSTRUCTIVE SLEEP APNEA 53
2 INFLAMMATORY RESPONSE TO SLEEP LOSS AND FRAGMENTATION 56
3 HYPERCOAGULABILITY AND THROMBOSIS 57
4 SYSTEMIC INFLAMMATION 58
5 CONCLUSIONS AND FUTURE PERSPECTIVES 59
6 REFERENCES 61
CHAPTER 3
METABOLIC DISORDERS ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA IN ADULTS 67
1 OBESITY AND OBSTRUCTIVE SLEEP APNEA 69
1.1 OBESITY IS THE MAJOR RISK FACTOR FOR OBSTRUCTIVE SLEEP APNEA 69
1.1.1 DEFINITION OF OBESITY 69
1.1.2 CLINICAL AND POPULATION STUDIES OF THE RELATIONSHIP BETWEEN
OBESITY AND THE RISK FOR OBSTRUCTIVE SLEEP APNEA 71
1.1.3 IMPACT OF TREATMENT FOR OBESITY ON OBSTRUCTIVE SLEEP APNEA
SEVERITY 72
1.1.4 GENDER DIFFERENCES IN BODY MASS INDEX AND THE RISK FOR OBSTRUCTIVE
SLEEP APNEA 73
VIII CONTENTS
IMAGE 3
1.2 VISCERAL OBESITY 74
1.2.1 VISCERAL OBESITY MAY AFFECT THE ANATOMY OF THE UPPER AIRWAY 75
1.2.2 OBESITY AND UPPER AIRWAY COLLAPSIBILITY 75
1.3 ADIPOSE TISSUE, AN ENDOCRINE ORGAN 81
1.3.1 LEPTIN 82
1.3.2 ADIPONECTIN 84
1.3.3 CYTOKINES 85
1.3.4 OTHER ADIPOKINES 86
1.3.5 IN SUMMARY 86
1.4 A POTENTIALLY VICIOUS CIRCLE 86
1.5 CONCLUSION 88
2 ALTERATIONS IN GLUCOSE METABOLISM AND OBSTRUCTIVE SLEEP APNEA 89 2.1
ASSESSMENT OF THE REGULATION OF GLUCOSE METABOLISM 89
2.1.1 INSULIN RESISTANCE 89
2.1.2 DIABETES MELIITUS 90
2.2 EVIDENCE FOR ALTERATIONS IN GLUCOSE METABOLISM IN OBSTRUCTIVE SLEEP
APNEA .. .91 2.2.1 CLINICAL AND EPIDEMIOLOGICAL STUDIES 91
2.2.2 THERAPEUTIC STUDIES 95
2.2.3 IN SUMMARY 99
2.3 POTENTIAL MECHANISMS FOR THE DEVELOPMENT OF GLUCOSE METABOLISM
ALTERATIONS IN OBSTRUCTIVE SLEEP APNEA 100
2.3.1 INFLAMMATORY DYSFUNCTION 100
2.3.2 CHRONIC INTERMITTENT HYPOXIA 102
2.3.3 SLEEP LOSS AND FRAGMENTATION 105
2.4 A POTENTIALLY VICIOUS CIRCLE 106
2.5 CONCLUSION 109
3 DYSLIPIDEMIA AND OBSTRUCTIVE SLEEP APNEA 110
3.1 POPULATION AND CLINICAL STUDIES OF THE LINK BETWEEN OBSTRUCTIVE
SLEEP APNEA AND DYSLIPIDEMIA 110
3.2 EFFECTS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ADMINISTRATION ON
DYSLIPIDEMIA I LL
3.3 CONCLUSION 112
4 METABOLIC SYNDROME AND OBSTRUCTIVE SLEEP APNEA 113
4.1 DEFINITION AND PREVALENCE OF METABOLIC SYNDROME 113
4.2 OBSTRUCTIVE SLEEP APNEA AND THE RISK FOR METABOLIC SYNDROME 114
4.2.1 PREVALENCE OF METABOLIC SYNDROME IN OBSTRUCTIVE SLEEP APNEA
PATIENTS 114
4.2.2 EFFECTS OF OBSTRUCTIVE SLEEP APNEA ON THE EARLY SIGNS OF
ATHEROSCLEROSIS IN METABOLIC SYNDROME PATIENTS 116
4.2.3 EFFECTS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ADMINISTRATION ON
METABOLIC SYNDROME 116
4.3 METABOLIC SYNDROME AND THE RISK FOR OBSTRUCTIVE SLEEP APNEA 118 4.4
CONCLUSION 118
5 LIVER INJURY AND OBSTRUCTIVE SLEEP APNEA 118
5.1 CHARACTERISTICS OF NONALCOHOLIC FATTY LIVER DISEASE 118
5.2 THE TWO-HIT THEORY 119
CONTENTS IX
IMAGE 4
5.3 OBSTRUCTIVE SLEEP APNEA AND LIVER INJURY 119
5.3.1 HEPATIC ENZYME LEVELS IN OBSTRUCTIVE SLEEP APNEA 119
5.3.2 HISTOPATHOLOGICAL EVIDENCE LINKING OBSTRUCTIVE SLEEP APNEA AND
NONALCOHOLIC FATTY LIVER DISEASE 120
5.3.3 IS LIVER INJURY IN OBSTRUCTIVE SLEEP APNEA CONSISTENT WITH
THE TWO-HIT THEORY? 121
5.4 CONCLUSION 122
6 CONCLUSION AND FUTURE PERSPECTIVES 1 22
7 REFERENCES 123
CHAPTER 4
ENDOTHELIAL DYSFUNCTION IN ADULTS WITH OBSTRUCTIVE SLEEP APNEA 139
1 OBSTRUCTIVE SLEEP APNEA MAY ALTER VASCULAR STRUCTURE 142
1.1 ARTERIAL STRUCTURE AND ELASTIC PROPERTIES 142
1.2 CELL APOPTOSIS AND ENDOTHELIAL REPAIR CAPACITY 144
2 OBSTRUCTIVE SLEEP APNEA MAY ADVERSELY AFFECT ENDOTHELIAL REGULATION OF
THE PERIPHERAL VASOMOTOR TONE 147
2.1 ALTERATIONS IN NITRIC-OXIDE-DEPENDENTVASODILATOR MECHANISMS 147
2.1.1 VASCULAR REACTIVITY 147
2.1.2 NITRIC OXIDE AVAILABILITY 149
2.2 ALTERATIONS IN VASOCONSTRICTION MECHANISMS 152
2.2.1 DOWNREGULATION OF VASCULAR SYMPATHOADRENERGIC RECEPTORS 152 2.2.2
ENDOTHELIN 1 154
2.2.3 ANGIOTENSIN II 156
3 POTENTIAL MECHANISMS LEADING TO ENDOTHELIAL DYSFUNCTION IN OBSTRUCTIVE
SLEEP APNEA 158
3.1 CHRONIC INTERMITTENT HYPOXIA/REOXYGENATION 158
3.2 OXIDATIVE STRESS 158
3.3 ADIPOKINES 159
3.4 HYPERCOAGULABILITY 160
3.5 SLEEP LOSS AND FRAGMENTATION 160
3.6 CONFOUNDERS AND THE DEVELOPMENT OF ENDOTHELIAL DYSFUNCTION IN
OBSTRUCTIVE SLEEP APNEA 161
4 CONCLUSION 161
5 REFERENCES 163
CHAPTER 5
HEMODYNAMIC AND AUTONOMIE CHANGES IN ADULTS WITH OBSTRUCTIVE SLEEP APNEA
171
1 CONTROL OF CARDIOVASCULAR FUNCTION DURING NORMAL SLEEP STAGES 173 2
HEMODYNAMIC AND AUTONOMIE CHANGES DURING THE APNEA-VENTILATION
RESUMPTION CYCLE 177
2.1 HEMODYNAMIC CHANGES 177
2.1.1 HEART RATE AND BLOOD PRESSURE 177
2.1.2 PERIPHERAL RESISTANCE 177
2.1.3 STROKE VOLUME AND CARDIAC OUTPUT 178
CONTENTS
IMAGE 5
2.2 AUTONOMIE CHANGES 178
2.2.1 LEVELS OF PAO 2 AND PACO 2 179
2.2.2 LUNG INFLATION 180
2.2.3 BLOOD PRESSURE 180
2.3 PULMONARY ARTERIAL PRESSURE CHANGES DURING THE APNEA-VENTILATION
RESUMPTION CYCLE 181
3 CHRONIC AUTONOMIE CARDIOVASCULAR DYSFUNCTION 184
3.1 DAYTIME SYMPATHETIC OVERACTIVITY 184
3.2 DOWNREGULATION OF VASCULAR SYMPATHOADRENERGIC RECEPTORS 187 3.3
POLYMORPHISMS IN A- AND SS-ADRENERGIC RECEPTOR GENES 187
3.4 CHEMOREFLEX CHANGES 187
3.5 CARDIAC VAGAL DYSFUNCTION AND BAROREFLEX CHANGES 187
3.6 RELATIONSHIP BETWEEN NIGHTTIME CHRONIC INTERMITTENT HYPOXIA AND
DAYTIME AUTONOMIE AND BLOOD PRESSURE CHANGES 189
4 CONCLUSION 191
5 REFERENCES 191
CHAPTER 6
CARDIOVASCULAR DISORDERS ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA 197
1 LIMITATIONS OF STUDIES FOUND IN THE LITERATURE 199
2 OBSTRUCTIVE SLEEP APNEA AND THE RISK OF MORTALITY FROM CARDIOVASCULAR
CAUSES 200
2.1 CLINICAL AND EPIDEMIOLOGICAL STUDIES 200
2.2 DAY-NIGHT PATTERN OF DEATH IN OBSTRUCTIVE SLEEP APNEA PATIENTS 202
2.3 EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE TREATMENT ON MORTALITY
FROM CARDIOVASCULAR CAUSES 204
2.4 KEY POINTS 206
3 SYSTEMIC HYPERTENSION 206
3.1 CLINICAL AND EPIDEMIOLOGICAL STUDIES 206
3.2 BLOOD PRESSURE PROFILE ABNORMALITIES ASSOCIATED WITH AN INCREASED
RISK OF OBSTRUCTIVE SLEEP APNEA 210
3.3 EFFECTS OF TREATMENT FOR OBSTRUCTIVE SLEEP APNEA ON BLOOD PRESSURE
211 3.3.1 EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY 211
3.3.2 EFFECT OF A MANDIBULAR ADVANCEMENT DEVICE 213
3.4 EFFECTS OF ANTIHYPERTENSIVE DRUGS IN OBSTRUCTIVE SLEEP APNEA
PATIENTS 214 3.5 MECHANISMS POTENTIALLY INVOLVED IN THE DEVELOPMENT OF
SUSTAINED HYPERTENSION IN OBSTRUCTIVE SLEEP APNEA 214
3.6 KEY POINTS 215
4 HEART FAILURE 215
4.1 OBSTRUCTIVE SLEEP APNEA PREVALENCE IN PATIENTS WITH HEART FAILURE
215 4.2 CHARACTERISTIC CLINICAL FEATURES OF OBSTRUCTIVE SLEEP APNEA IN
PATIENTS WITH CHRONIC HEART FAILURE 216
4.3 EFFECTS OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY 218
4.4 MECHANISMS POTENTIALLY INVOLVED IN THE DEVELOPMENT OF HEART FAILURE
IN OBSTRUCTIVE SLEEP APNEA PATIENTS 219
4.4.1 INCREASED BLOOD PRESSURE AND OTHER CARDIAC DISORDERS 219
4.4.2 CHRONIC INTERMITTENT HYPOXIA 220
4.4.3 SYMPATHETIC OVERACTIVATION 221
CONTENTS XI
IMAGE 6
4.4.4 FLUID RETENTION AND OBSTRUCTIVE SLEEP APNEA SEVERITY 221
4.4.5 VENTRICULAR HYPERTROPHY 222
4.4.6 RECURRENT EXAGGERATED NEGATIVE INTRATHORACIC PRESSURE DURING
APNEA-VENTILATION RESUMPTION CYCLES 222
4.5 DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH HEART FAILURE
223 4.6 KEY POINTS 223
5 STROKE 223
5.1 PREVALENCE OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH STROKE 223
5.1.1 CLINICAL STUDIES 223
5.1.2 POPULATION STUDIES 224
5.1.3 META-ANALYSIS OF THE FREQUENCY OF SLEEP APNEA IN STROKE AND
TRANSIENT ISCHEMIE ATTACK 226
5.2 EFFECTS OF OBSTRUCTIVE SLEEP APNEA ON STROKE OUTCOME 226
5.2.1 EFFECTS OF UNTREATED OBSTRUCTIVE SLEEP APNEA ON STROKE OUTCOME 226
5.2.2 EFFECTS OF TREATED OBSTRUCTIVE SLEEP APNEA ON STROKE OUTCOME 226
5.3 CHARACTERISTIC CLINICAL FEATURES OF OBSTRUCTIVE SLEEP APNEA IN
PATIENTS WITH STROKE: DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA IN THE
POSTSTROKE PERIOD 228
5.4 KEY POINTS 229
6 CORONARY ARTERY DISEASE 230
6.1 CLINICAL AND EPIDEMIOLOGICAL STUDIES 230
6.2 DAY-NIGHT PATTERN OF MYOCARDIAL ISCHEMIA AND INFARCTION IN
OBSTRUCTIVE SLEEP APNEA PATIENTS 230
6.2.1 MYOCARDIAL ISCHEMIA 230
6.2.2 MYOCARDIAL INFARCTION 231
6.3 CORONARY ARTERY CALCIFICATION IN OBSTRUCTIVE SLEEP APNEA PATIENTS
231 6.4 EFFECT OF OBSTRUCTIVE SLEEP APNEA TREATMENT ON NONFATAL CORONARY
EVENTS 234
6.5 MECHANISMS POTENTIALLY LINKING OBSTRUCTIVE SLEEP APNEA AND CORONARY
ARTERY DISEASE 235
6.6 ASSESSMENT OF OBSTRUCTIVE SLEEP APNEA IN CORONARY ARTERY DISEASE
PATIENTS 235
6.7 KEY POINTS 235
7 PULMONARY HYPERTENSION AND RIGHT VENTRICULAR DYSFUNCTION 236 7.1
PULMONARY HYPERTENSION 236
7.1.1 DEFINITION OF PULMONARY HYPERTENSION 236
7.1.2 CLINICAL STUDIES 236
7.1.3 THERAPEUTIC STUDIES 237
7.2 RIGHT VENTRICULAR DYSFUNCTION 238
7.2.1 CLINICAL STUDIES 238
7.2.2 THERAPEUTIC STUDIES 238
7.3 POTENTIAL MECHANISMS THAT MAY LEAD TO PULMONARY HYPERTENSION AND
RIGHT VENTRICULAR DYSFUNCTION IN OBSTRUCTIVE SLEEP APNEA 239 7.4 KEY
POINTS 240
8 ARRHYTHMIAS 240
8.1 ATRIAL FIBRILLATION 240
8.1.1 CLINICAL, EPIDEMIOLOGICAL AND THERAPEUTIC STUDIES 240
8.1.2 MECHANISMS POTENTIALLY LINKING OBSTRUCTIVE SLEEP APNEA WITH ATRIAL
FIBRILLATION 243
8.1.3 KEY POINTS 246
XII CONTENTS
IMAGE 7
8.2 VENTRICULAR ARRHYTHMIAS 246
8.2.1 CLINICAL, EPIDEMIOLOGICAL AND THERAPEUTIC STUDIES 246
8.2.2 KEY POINTS 247
8.3 BRADYARRHYTHMIAS 247
8.3.1 CLINICAL, EPIDEMIOLOGICAL AND THERAPEUTIC STUDIES 247
8.3.2 ATRIAL PACING AND TREATMENT OF OBSTRUCTIVE SLEEP APNEA 248
8.3.3 KEY POINTS 249
9 CONCLUSIONS AND FUTURE DIRECTIONS 249
10 REFERENCES 249
SUBJECT INDEX 267
CONTENTS XIII
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| physical | XVI, 271 S. Ill., graph. Darst. |
| publishDate | 2011 |
| publishDateSearch | 2011 |
| publishDateSort | 2011 |
| publisher | Karger |
| record_format | marc |
| series | Advances in Cardiology |
| series2 | Advances in Cardiology |
| spelling | Lurie, Alain Verfasser aut Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders Alain Lurie Basel [u.a.] Karger 2011 XVI, 271 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Advances in Cardiology 46 Schlafapnoe (DE-588)4137452-6 gnd rswk-swf Stoffwechselstörung (DE-588)4057701-6 gnd rswk-swf Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Schlafapnoe (DE-588)4137452-6 s Kardiovaskuläre Krankheit (DE-588)4024666-8 s Stoffwechselstörung (DE-588)4057701-6 s DE-604 Advances in Cardiology 46 (DE-604)BV000000197 46 DNB Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024456743&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Lurie, Alain Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders Advances in Cardiology Schlafapnoe (DE-588)4137452-6 gnd Stoffwechselstörung (DE-588)4057701-6 gnd Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd |
| subject_GND | (DE-588)4137452-6 (DE-588)4057701-6 (DE-588)4024666-8 (DE-588)4143413-4 |
| title | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders |
| title_auth | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders |
| title_exact_search | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders |
| title_full | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders Alain Lurie |
| title_fullStr | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders Alain Lurie |
| title_full_unstemmed | Obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders Alain Lurie |
| title_short | Obstructive sleep apnea in adults |
| title_sort | obstructive sleep apnea in adults relationship with cardiovascular and metabolic disorders |
| title_sub | relationship with cardiovascular and metabolic disorders |
| topic | Schlafapnoe (DE-588)4137452-6 gnd Stoffwechselstörung (DE-588)4057701-6 gnd Kardiovaskuläre Krankheit (DE-588)4024666-8 gnd |
| topic_facet | Schlafapnoe Stoffwechselstörung Kardiovaskuläre Krankheit Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024456743&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000000197 |
| work_keys_str_mv | AT luriealain obstructivesleepapneainadultsrelationshipwithcardiovascularandmetabolicdisorders |