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        Sympathetic overactivity and nocturnal diuresis in obstructive sleep apnea alter the response to hypertension therapy

        Ziegler Michael G.,Milic Milos,Dimsdale Joel E.,Mills Paul J. 대한고혈압학회 2024 Clinical Hypertension Vol.30 No.-

        Obstructive sleep apnea (OSA) is associated with high blood pressure that responds poorly to usual antihypertensive therapy. Forty-one subjects with OSA had 25% higher plasma norepinephrine and 42% higher epinephrine measured every 2 h over 24 h than 20 control subjects. They also excreted more sodium during sleep. This suggested that that a sympatholytic would be a more successful antihypertensive than a diuretic. To test this hypothesis we treated a second group of 23 hypertensive apneics with placebo, 6 weeks of the sympatholytic guanfacine and 6 weeks of hydrochlorothiazide in a crossover study. Guanfacine lowered 24-hour blood pressure by 9.6/6.7 mmHg, more than the 5.4/2.9 mmHg effect of hydrochlorothiazide ( P  < 0.05). Nighttime systolic blood pressure dipping was poor at 6.6 ± 1.8%. Hydrochlorothiazide did not alter blood pressure dipping but guanfacine improved dipping to 9.1 ± 1.2%, a better result ( P  = 0.03) than from the diuretic. Central aortic pressure by pulse wave analysis was 120/84 mmHg on hydrochlorothiazide and 109/72 on guanfacine, ( P  < 0.05). Guanfacine, but not hydrochlorothiazide, improved baroreflex sensitivity, heart rate variability and flow mediated vascular dilation, suggesting that decreasing the elevated sympathetic nerve activity of obstructive sleep apnea returned vascular function toward normal. OSA is the most common condition associated with antihypertensive treatment failure. It increased sympathetic nerve activity day and night. Drugs that block sympathetic nerve function are not among the 4 most commonly recommended classes of antihypertensives but diuretics are. Sympatholytic therapy was superior to diuretic treatment for hypertension associated with sleep apnea. NCT, NCT02699125, Registered 26 February 2016 - Retrospectively registered, https://clinicaltrials.gov/study/NCT02699125 . Background Obstructive sleep apnea (OSA) is associated with high blood pressure that responds poorly to usual antihypertensive therapy. Methods and results Forty-one subjects with OSA had 25% higher plasma norepinephrine and 42% higher epinephrine measured every 2 h over 24 h than 20 control subjects. They also excreted more sodium during sleep. This suggested that that a sympatholytic would be a more successful antihypertensive than a diuretic. To test this hypothesis we treated a second group of 23 hypertensive apneics with placebo, 6 weeks of the sympatholytic guanfacine and 6 weeks of hydrochlorothiazide in a crossover study. Guanfacine lowered 24-hour blood pressure by 9.6/6.7 mmHg, more than the 5.4/2.9 mmHg effect of hydrochlorothiazide (P < 0.05). Nighttime systolic blood pressure dipping was poor at 6.6 ± 1.8%. Hydrochlorothiazide did not alter blood pressure dipping but guanfacine improved dipping to 9.1 ± 1.2%, a better result (P = 0.03) than from the diuretic. Central aortic pressure by pulse wave analysis was 120/84 mmHg on hydrochlorothiazide and 109/72 on guanfacine, (P < 0.05). Guanfacine, but not hydrochlorothiazide, improved baroreflex sensitivity, heart rate variability and flow mediated vascular dilation, suggesting that decreasing the elevated sympathetic nerve activity of obstructive sleep apnea returned vascular function toward normal. Conclusions OSA is the most common condition associated with antihypertensive treatment failure. It increased sympathetic nerve activity day and night. Drugs that block sympathetic nerve function are not among the 4 most commonly recommended classes of antihypertensives but diuretics are. Sympatholytic therapy was superior to diuretic treatment for hypertension associated with sleep apnea. Trial registration NCT, NCT02699125, Registered 26 February 2016 - Retrospectively registered, https://clinicaltrials. gov/study/NCT02699125.

      • Nonverbal Communication between Males and Females: Who is the Controlling Participant during communication?

        ( Nathan Ziegler ) 현대영미어문학회 2008 현대영미어문학회 추계학술대회 발표논문집 Vol.2008 No.-

        Studies of the communication between men and women have shown that males are usually the controlling participants during the communicative event when the other participant is a female. This study explores the possibility of the female being the dominant participant in the communicative event by correlating the nonverbal communicative behavior of both the male and the female with the outcome of the communicative event in a consumer based setting. The results are then discussed showing the participant who is in control of the communicative event.

      • Wide Bandwidth Current Sensors and the Influence on the Switching Loss Characterization

        Philipp Ziegler,Jan Linzmaier,Jorg Haarer,Philipp Marx,Mattea Eckstein,Jorg Roth-Stielow 전력전자학회 2023 ICPE(ISPE)논문집 Vol.2023 No.-

        Due to their outstanding properties, wide bandgap semiconductor devices enable better performance and efficiency in power electronic circuits compared to silicon devices. However, characterizing the switching loss of such devices is even more challenging. The limits of measurement equipment, especially for the current measurement, are reached due to the fast rise and fall times. Ideal characterization requires a non-invasive, infinite bandwidth current sensor. This paper presents a galvanically isolated current sensor that combines magnetic field sensors and a printed circuit board integrated Rogowski coil. The insertion inductance of the hybrid current sensor is compared to a commercial coaxial shunt and a low inductance SMD shunt approach. The influence of the different current measurement devices on the switching loss characterization is investigated.

      • SSCISCOPUSKCI등재
      • KCI등재

        RUSSIA AND GREAT-POWER POLITICS Russia in Central Asia: The Dynamics of Great-Power Politics in a Volatile Region

        Charles E. Ziegler 경남대학교 극동문제연구소 2014 ASIAN PERSPECTIVE Vol.38 No.4

        With US and North Atlantic Treaty Organization (NATO) forcespoised for a major drawdown from Afghanistan in 2014, and Russiadetermined to strengthen its influence in the “near abroad,” newuncertainties face the volatile post-Soviet Central Asian states. Changing power alignments in the region will pose new challengesfor the United States, Russia, China, and the European Union. Thisarticle assesses the evolving direction of great-power interactionand influence in Central Asia, focusing on Moscow’s growing assertivenessin the region. Using a neoclassical realist framework, Iargue that geographic, historical, and cultural ties; a military presence;and developing economic institutions favor Russia over theshort term, although China is best poised to expand regional influenceover the long run. US war weariness, budget constraints, anddistance suggest that—barring new major terrorist threats emanatingfrom the region—Washington’s presence and influence willgradually diminish.

      • KCI등재

        Competing for Markets and Influence: Asian National Oil Companies in Eurasia

        Charles E. Ziegler 경남대학교 극동문제연구소 2008 ASIAN PERSPECTIVE Vol.32 No.1

        This article discusses the asset acquisitions of Asian national oil companies (NOCs) in the energy-rich states of Russia and Central Asia, and considers the implications for economic and geopolitical stability. Asian NOC investment in these countries is analyzed in terms of state-level political and economic relations, as well as the regional and local impact of NOC activity on the host country. Asian NOCs, and the governments that support them, face few political obstacles in dealing with Eurasia’s authoritarian regimes. Asian companies operate in business cultures similar to those in Eurasia, and have fewer reservations about engaging in bribery or corruption than their Western counterparts. These advantages are offset by the entrenched position of Western and Russian oil companies, and a strong commitment of the host states to political and economic independence. This article discusses the asset acquisitions of Asian national oil companies (NOCs) in the energy-rich states of Russia and Central Asia, and considers the implications for economic and geopolitical stability. Asian NOC investment in these countries is analyzed in terms of state-level political and economic relations, as well as the regional and local impact of NOC activity on the host country. Asian NOCs, and the governments that support them, face few political obstacles in dealing with Eurasia’s authoritarian regimes. Asian companies operate in business cultures similar to those in Eurasia, and have fewer reservations about engaging in bribery or corruption than their Western counterparts. These advantages are offset by the entrenched position of Western and Russian oil companies, and a strong commitment of the host states to political and economic independence.

      • KCI등재

        Formulation and Shelf Life of a Nutritional Supplement for Undernourished Elderly People

        Fabiane La Flor Ziegler,Jose de Assis Faria,Valdemiro Carlos Sgarbieri 한국식품과학회 2008 Food Science and Biotechnology Vol.17 No.2

        A nutritional supplement was developed aiming at correcting the most common nutrient and caloric deficiencies encountered in elderly people (≥60 years old). The protein source was a mixture of whey protein isolates (WPI) and bovine collagen hydrolysate (BCH) with high nutritional and functional qualities making up 12% of the formulation. The carbohydrate fraction was composed of sucrose, inulin (soluble fiber), and fructo-oligosaccharide (prebiotic). The most commonly deficient essential minerals and vitamins were also included. Acceptance of the product was good according to both an elderly panel and a laboratory panel composing of both sexes and various ages. The stability of the formulations was evaluated and the estimated shelf life at room temperature (ca. 27℃) was approximately 4 months.

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