Abstract
Study objectivesObstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep-related breathing disorder, characterized by excessive daytime sleepiness (EDS), paralleled by intermittent collapse of the upper airway. EDS may be the symptom of OSAHS per se but may also be due to the alteration of central circadian regulation. Irisin is a putative myokine and has been shown to induce BDNF expression in several sites of the brain. BDNF is a key factor regulating photic entrainment and consequent circadian alignment and adaptation to the environment. Therefore, we hypothesized that EDS accompanying OSAHS is reflected by alteration of irisin/BDNF axis.MethodsCase history, routine laboratory parameters, serum irisin and BDNF levels, polysomnographic measures and Epworth Sleepiness Scale questionnaire (ESS) were performed in a cohort of OSAHS patients (n = 69). Simple and then multiple linear regression was used to evaluate data.ResultsWe found that EDS reflected by the ESS is associated with higher serum irisin and BDNF levels; β: 1.53; CI: 0.35, 6.15; p = 0.012 and β: 0.014; CI: 0.0.005, 0.023; p = 0.02, respectively. Furthermore, influence of irisin and BDNF was significant even if the model accounted for their interaction (p = 0.006 for the terms serum irisin, serum BDNF and their interaction). Furthermore, a concentration-dependent effect of both serum irisin and BDNF was evidenced with respect to their influence on the ESS.ConclusionsThese results suggest that the irisin-BDNF axis influences subjective daytime sleepiness in OSAS patients reflected by the ESS. These results further imply the possible disruption of the circadian regulation in OSAHS. Future interventional studies are needed to confirm this observation.
Highlights
Obstructive sleep apnea hypopnea syndrome (OSAHS) is gaining increased attention given its profound societal and long-term, health related consequences
We found that excessive daytime sleepiness (EDS) reflected by the Epworth Sleepiness Scale questionnaire (ESS) is associated with higher serum irisin and brain-derived neurotrophic factor (BDNF) levels; β: 1.53; confidence interval (CI): 0.35, 6.15; p = 0.012 and β: 0.014; CI: 0.0.005, 0.023; p = 0.02, respectively
These results suggest that the irisin-BDNF axis influences subjective daytime sleepiness in OSAS patients reflected by the ESS
Summary
Obstructive sleep apnea hypopnea syndrome (OSAHS) is gaining increased attention given its profound societal and long-term, health related consequences. Adaptation to the daily fluctuation of light and dark periods is the most fundamental challenge for an organism, that basically determines its physiology and behavior. It is orchestrated by the hierarchically organized circadian system, the central master clock and peripheral slave clocks present in most tissues. The master clock resides in the suprachiasmatic nucleus (SCN) It has an intrinsic pacemaker activity with its free-running intrinsic circadian period being longer than the 24 h long environmental photoperiod [7]. The SCN is most readily entrained by light, in a brain-derived neurotrophic factor (BDNF) dependent manner, rendering BDNF the gatekeeper, regulating light’s ability to shift the phase of the master clock. Research denoting that peripheral signals, e.g. exercise and fasting, both known to be upstream regulators of irisin expression, are only able to shift the master clock if light input is simultaneously present further corroborate this presumption [21]
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