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Sleep and Breathing
Published in: Sleep and Breathing 3/2014

01-09-2014 | Original Article

Association of ACE I/D polymorphism with obstructive sleep apnea susceptibility: evidence based on 2,228 subjects

Authors: Hai Lin, Dong Lin, Chunquan Zheng, Jing Li, Lian Fang

Published in: Sleep and Breathing | Issue 3/2014

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Abstract

Background

Whether the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene increases susceptibility to obstructive sleep apnea (OSA) is controversial and still undetermined. Therefore, this meta-analysis was performed to systematically assess the possible association between them.

Methods

The OVID, Medline, Embase, Web of Science, CNKI, and Wangfang databases were searched to identify eligible studies focusing on the association between ACE polymorphism I/D and susceptibility to OSA.

Results

A total of 2,228 subjects from nine studies were subjected to meta-analysis. Overall, ACE polymorphism I/D had no statistically significant association with increased OSA risk under all genetic models (P > 0.05). In the subgroup analysis by ethnicity or study design, still no significant associations were found for all genetic models (P > 0.05). However, ACE polymorphism I/D was significantly associated with susceptibility to OSA with hypertension in Asians under heterozygous comparison and dominant model. The ID genotype carriers and D allele carriers (ID + DD) were about 53 % less likely (odds ratio (OR) = 0.47, 95 % confidence interval (CI) = 0.29–0.74; P = 0.001) and about 52 % less likely (OR = 0.48, 95 % CI = 0.24–0.99; P = 0.047), respectively, to have OSA with hypertension compared to carriers of the II genotype.

Conclusions

ACE polymorphism I/D had no statistically significant association with increased OSA risk, but the II genotype of ACE may be a risk factor for OSA with hypertension in Asians. OSA cases who develop hypertension may derive from a different mechanism compared to essential hypertension. Studies with large sample size and representative population are warranted to verify this finding.
Literature
1.
2.
3.
Jacobsen JH, Shi L, Mokhlesi B (2013) Factors associated with excessive daytime sleepiness in patients with severe obstructive sleep apnea. Sleep Breath 17(2):629–635PubMedCrossRef
4.
Varvarigou V, Dahabreh IJ, Malhotra A, Kales SN (2011) A review of genetic association studies of obstructive sleep apnea: field synopsis and meta-analysis. Sleep 34(11):1461–1468PubMedCentralPubMed
5.
Chen H, Hu K, Zhu J, Xianyu Y, Cao X, Kang J, He J, Zhao P, Mei Y (2013) Polymorphisms of the 5-hydroxytryptamine 2A/2C receptor genes and 5-hydroxytryptamine transporter gene in Chinese patients with OSAHS. Sleep Breath. doi:10.​1007/​s11325-013-0829-0
6.
de Carvalho TB, Suman M, Molina FD, Piatto VB, Maniglia JV (2013) Relationship of obstructive sleep apnea syndrome with the 5-HT2A receptor gene in Brazilian patients. Sleep Breath 17(1):57–62PubMedCrossRef
7.
Zhou TB, Ou C, Qin YH, Su LN, Lei FY, Huang WF, Zhao YJ, Pang YS, Yang KP (2011) Association of angiotensin converting enzyme insertion/deletion gene polymorphism with idiopathic nephrotic syndrome susceptibility in children: a meta-analysis. J Renin Angiotensin Aldosterone Syst 12(4):601–610PubMedCrossRef
8.
Bernstein KE, Ong FS, Blackwell WL, Shah KH, Giani JF, Gonzalez-Villalobos RA, Shen XZ, Fuchs S, Touyz RM (2013) A modern understanding of the traditional and nontraditional biological functions of angiotensin-converting enzyme. Pharmacol Rev 65(1):1–46PubMedCentralPubMedCrossRef
9.
Koyama RG, Drager LF, Lorenzi-Filho G, Cintra FD, Pereira AC, Poyares D, Krieger JE, Castro RM, Tufik S, de Mello MT, Pedrazzoli M (2009) Reciprocal interactions of obstructive sleep apnea and hypertension associated with ACE I/D polymorphism in males. Sleep Med 10(10):1107–1111PubMedCrossRef
10.
Song GG, Kim JH, Lee YH (2013) Associations between the insertion/deletion polymorphism of the angiotensin-converting enzyme and susceptibility to aortic aneurysms: a meta-analysis. J Renin Angiotensin Aldosterone Syst. doi:10.​1177/​ 1470320313485897​
11.
Huang Y, Li G, Lan H, Zhao G, Huang C (2013) Angiotensin-converting enzyme insertion/deletion gene polymorphisms and risk of intracerebral hemorrhage: a meta-analysis of epidemiologic studies. J Renin Angiotensin Aldosterone Syst. doi:10.​1177/​1470320313481838​
12.
Pawlik M, Mostowska A, Lianeri M, Oko A, Jagodzinski PP (2013) Association of aldosterone synthase (CYP11B2) gene -344T/C polymorphism with the risk of primary chronic glomerulonephritis in the Polish population. J Renin Angiotensin Aldosterone Syst. doi:10.​1177/​1470320313489588​ PubMed
13.
Gupta U, Mishra A, Rathore SS, Agarwal SK, Pande S, Garg N, Mittal B (2013) Association of angiotensin I-converting enzyme gene insertion/deletion polymorphism with rheumatic heart disease in Indian population and meta-analysis. Mol Cell Biochem. doi:10.​1007/​s11010-013-1719-2
14.
Yang J, Zhao Y, Hao P, Meng X, Dong M, Wang Y, Zhang Y, Zhang C (2013) Impact of angiotensin I converting enzyme insertion/deletion polymorphisms on dilated cardiomyopathy and hypertrophic cardiomyopathy risk. PLoS One 8(5):e63309PubMedCentralPubMedCrossRef
15.
Pei XH, Li HX (2012) Insertion/deletion (I/D) in the angiotensin-converting enzyme gene and breast cancer risk: lack of association in a meta- analysis. Asian Pac J Cancer Prev 13(11):5633–5636PubMedCrossRef
16.
Bostrom KB, Hedner J, Melander O, Grote L, Gullberg B, Rastam L, Groop L, Lindblad U (2007) Interaction between the angiotensin-converting enzyme gene insertion/deletion polymorphism and obstructive sleep apnoea as a mechanism for hypertension. J Hypertens 25(4):779–783PubMedCrossRef
17.
Li S, Cao J, Chen BY (2004) Investigation of the angiotensin-converting enzyme gene polymorphism in obstructive sleep apnea hypopnea syndrome. Chin J Respir Crit Care Med 3:350–353 (in Chinese)
18.
Li WQ, Xie MZ, Li CQ, Liao WS, Ke XQ, Chen SW, Hu QS (2006) Investigation of the angiotensin-converting enzyme gene polymorphism in obstructive sleep apnea hypopnea syndrome patients with blood stasis syndrome. Chin J Trad Med Sci Tech 13:75–79 (in Chinese)
19.
Li Y, Zhang W, Wang T, Lu H, Wang X, Wang Y (2004) Study on the polymorphism of angiotensin converting enzyme genes and serum angiotensin II level in patients with obstructive sleep apnea hypopnea syndrome accompanied hypertension. Lin Chuang Er Bi Yan Hou Ke Za Zhi 18(8):456–459 (in Chinese)PubMed
20.
21.
Barcelo A, Elorza MA, Barbe F, Santos C, Mayoralas LR, Agusti AG (2001) Angiotensin converting enzyme in patients with sleep apnoea syndrome: plasma activity and gene polymorphisms. Eur Respir J 17(4):728–732PubMedCrossRef
22.
Benjamin JA, Moller M, Ebden P, Bartle I, Lewis KE (2008) Serum angiotensin converting enzyme and the obstructive sleep apnea hypopnea syndrome. J Clin Sleep Med 4(4):325–331PubMedCentralPubMed
23.
Gu XQ, Liu DB, Wan GP (2006) Polymorphism of angiotensin converting enzyme genes in children with obstructive sleep apnea-syndrome. Zhonghua Er Ke Za Zhi 44(11):874–875 (in Chinese)PubMed
24.
Chmielewska I, Mlak R, Krawczyk P, Czukiewska E, Milanowski J (2013) Polymorphism of the ACE gene and the risk of obstructive sleep apnoea. Pneumonol Alergol Pol 81(3):207–213PubMed
25.
Lin L, Finn L, Zhang J, Young T, Mignot E (2004) Angiotensin-converting enzyme, sleep-disordered breathing, and hypertension. Am J Respir Crit Care Med 170(12):1349–1353PubMedCrossRef
26.
Ogus C, Ket S, Bilgen T, Keser I, Cilli A, Gocmen AY, Tosun O, Gumuslu S (2010) Insertion/deletion polymorphism and serum activity of the angiotensin-converting enzyme in Turkish patients with obstructive sleep apnea syndrome. Biochem Genet 48(5–6):516–523PubMedCrossRef
27.
Ping F, Zhao JC, Zhang XQ, Gao FQ, Su L, Ding JY, Rong CL (2001) Association of the polymorphism of angiotensin converting enzyme with OSAS and OSAS accompanied by hypertension. Chin Gen Pract 4:24–26 (in Chinese)
28.
Tong H, Zhang M, Dong JY, Wang S, Ge H, Bai SL (2011) Association between the angiotensin converting enzyme gene polymorphism and intermittent hypoxia during sleep with high blood pressure. Chin J Histochem Cytochem 20(2):148–152 (in Chinese)
29.
Xiao Y, Huang X, Qiu C, Zhu X, Liu Y (1999) Angiotensin I-converting enzyme gene polymorphism in Chinese patients with obstructive sleep apnea syndrome. Chin Med J (Engl) 112(8):701–704
30.
Yakut T, Karkucak M, Ursavas A, Gulten T, Burgazlioglu B, Gorukmez O, Karadag M (2010) Lack of association of ACE gene I/D polymorphism with obstructive sleep apnea syndrome in Turkish patients. Genet Mol Res 9(2):734–738PubMedCrossRef
31.
Zhang J, Zhao B, Gesongluobu, Sun Y, Wu Y, Pei W, Ye J, Hui R, Liu L (2000) Angiotensin-converting enzyme gene insertion/deletion (I/D) polymorphism in hypertensive patients with different degrees of obstructive sleep apnea. Hypertens Res 23(5):407–411PubMedCrossRef
32.
Zhang LQ, Yao WZ, He QY, Wang YZ, Ren B, Lin YP (2004) Association of polymorphisms in the angiotensin system genes with obstructive sleep apnea–hypopnea syndrome. Zhonghua Jie He He Hu Xi Za Zhi 27(8):507–510 (in Chinese)PubMed
33.
Ziegler MG, Milic M, Sun P (2011) Antihypertensive therapy for patients with obstructive sleep apnea. Curr Opin Nephrol Hypertens 20(1):50–55PubMedCrossRef
34.
Kabadou IA, Soualmia H, Jemaa R, Feki M, Kallel A, Souheil O, Taieb SH, Sanhaji H, Kaabachi N (2013) G protein beta3 subunit gene C825T and angiotensin converting enzyme gene insertion/deletion polymorphisms in hypertensive Tunisian population. Clin Lab 59(1–2):85–92PubMed
35.
Li Y (2012) Angiotensin-converting enzyme gene insertion/deletion polymorphism and essential hypertension in the Chinese population: a meta-analysis including 21,058 participants. Intern Med J 42(4):439–444PubMedCrossRef
36.
Metadata
Title
Association of ACE I/D polymorphism with obstructive sleep apnea susceptibility: evidence based on 2,228 subjects
Authors
Hai Lin
Dong Lin
Chunquan Zheng
Jing Li
Lian Fang
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Sleep and Breathing / Issue 3/2014
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-013-0912-6

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