The efficacy of antihypertensiye drugs in chronic intermittent hypoxia conditions

The authors would like to thank the Portuguese Fundacao para a Ciencia e a Tecnologia (FCT) and CEDOC (Chronic Diseases Research Centre, Lisbon, Portugal). Lucilia N. Diogo is supported by an FCT fellowship (SFRH/BD/48335/2008; PTDC/SAU-TOX/112264/2009).Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CRAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.publishersversionpublishe

Predicting the risk of ovarian hyperstimulation syndrome in women undergoing assisted reproductive technology treatments: a systematic review and quality assessment of prediction models

Importance: Ovarian hyperstimulation syndrome (OHSS) is a common iatrogenic complication of controlled ovarian stimulation (COS) in assisted conception. OHSS can be life-threatening and associated with significant morbidity. Several measures could help prevent OHSS; however, accurate risk prediction remains a challenge to enable early prevention. // Objective: To review available prediction models for OHSS in women undergoing assisted conception and to identify the best-performing models for their accuracy, generalizability, and applicability. // Evidence review: We searched electronic databases (MEDLINE, EMBASE, and CENTRAL) until October 2023. We included studies reporting on the development or evaluation of models predicting the risk of OHSS outcomes before or during COS among women undergoing assisted conception. We reported on models’ discrimination, calibration, type of validation, and any implementation tools for clinical practice. // Findings: We screened 5,699 citations and included 14 observational cohort studies reporting on 14 prediction models. The median sample size was 782 participants (range 105–256,381), and the majority of models were developed using logistic regression (13/14, 92.9%). The commonest predictor was maternal age (7/14, 50.0%), followed by number of antral and mature follicles (6/14, 42.9%). Six models were internally validated (6/14, 42.9%), and none were externally validated. Only one model had an implementation platform as a smartphone-based application (1/14, 7.1%). Most of the included studies had an unclear risk of bias (7/14, 50.0%), and only three studies were at low risk (3/13, 21.4%). // Conclusion and relevance: There are no clinically appropriate and validated prediction models for OHSS among women undergoing controlled ovarian stimulation. More research is needed to improve their generalizability and applicability into clinical practice. // PROSPERO: CRD4202450942

Predicting the risk of ovarian hyperstimulation syndrome in women undergoing assisted reproductive technology treatments: a systematic review and quality assessment of prediction models

Importance: Ovarian hyperstimulation syndrome (OHSS) is a common iatrogenic complication of controlled ovarian stimulation (COS) in assisted conception. OHSS can be life-threatening and associated with significant morbidity. Several measures could help prevent OHSS; however, accurate risk prediction remains a challenge to enable early prevention. Objective: To review available prediction models for OHSS in women undergoing assisted conception and to identify the best-performing models for their accuracy, generalizability, and applicability. Evidence review: We searched electronic databases (MEDLINE, EMBASE, and CENTRAL) until October 2023. We included studies reporting on the development or evaluation of models predicting the risk of OHSS outcomes before or during COS among women undergoing assisted conception. We reported on models’ discrimination, calibration, type of validation, and any implementation tools for clinical practice. Findings: We screened 5,699 citations and included 14 observational cohort studies reporting on 14 prediction models. The median sample size was 782 participants (range 105–256,381), and the majority of models were developed using logistic regression (13/14, 92.9%). The commonest predictor was maternal age (7/14, 50.0%), followed by number of antral and mature follicles (6/14, 42.9%). Six models were internally validated (6/14, 42.9%), and none were externally validated. Only one model had an implementation platform as a smartphone-based application (1/14, 7.1%). Most of the included studies had an unclear risk of bias (7/14, 50.0%), and only three studies were at low risk (3/13, 21.4%). Conclusion and relevance: There are no clinically appropriate and validated prediction models for OHSS among women undergoing controlled ovarian stimulation. More research is needed to improve their generalizability and applicability into clinical practice. PROSPERO: CRD42024509423</p