Genetic Associations with Obstructive Sleep Apnea Traits in Hispanic/Latino Americans.

RATIONALE Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic basis is still largely unknown. Prior genetic studies focused on traits defined using the apnea-hypopnea index, which contains limited information on potentially important genetically determined physiologic factors, such as propensity for hypoxemia and respiratory arousability. OBJECTIVES To define novel obstructive sleep apnea genetic risk loci for obstructive sleep apnea, we conducted genome-wide association studies of quantitative traits in Hispanic/Latino Americans from three cohorts. METHODS Genome-wide data from as many as 12,558 participants in the Hispanic Community Health Study/Study of Latinos, Multi-Ethnic Study of Atherosclerosis, and Starr County Health Studies population-based cohorts were metaanalyzed for association with the apnea-hypopnea index, average oxygen saturation during sleep, and average respiratory event duration. MEASUREMENTS AND MAIN RESULTS Two novel loci were identified at genome-level significance (rs11691765, GPR83, P = 1.90 × 10-8 for the apnea-hypopnea index, and rs35424364; C6ORF183/CCDC162P, P = 4.88 × 10-8 for respiratory event duration) and seven additional loci were identified with suggestive significance (P < 5 × 10-7). Secondary sex-stratified analyses also identified one significant and several suggestive associations. Multiple loci overlapped genes with biologic plausibility. CONCLUSIONS These are the first genome-level significant findings reported for obstructive sleep apnea-related physiologic traits in any population. These findings identify novel associations in inflammatory, hypoxia signaling, and sleep pathways.

[1]  E. Clambey,et al.  Hypoxia-inducible factor-1 alpha–dependent induction of FoxP3 drives regulatory T-cell abundance and function during inflammatory hypoxia of the mucosa , 2012, Proceedings of the National Academy of Sciences.

[2]  B. Edwards,et al.  A method for measuring and modeling the physiological traits causing obstructive sleep apnea. , 2011, Journal of applied physiology.

[3]  Suzette J. Bielinski,et al.  Phenome-wide association studies demonstrating pleiotropy of genetic variants within FTO with and without adjustment for body mass index , 2014, Front. Genet..

[4]  Robert J. Goodloe,et al.  A candidate gene study of obstructive sleep apnea in European Americans and African Americans. , 2010, American journal of respiratory and critical care medicine.

[5]  Christian Gieger,et al.  Seventy-five genetic loci influencing the human red blood cell , 2012, Nature.

[6]  Hee-Sup Shin,et al.  Genetic dissection of theta rhythm heterogeneity in mice. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[7]  J. Choi,et al.  Genetic and Metabolic Characterization of Insomnia , 2011, PloS one.

[8]  N. Schneiderman,et al.  Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. , 2012, JAMA.

[9]  H. Seo,et al.  Associations of Sleep Apnea, NRG1 Polymorphisms, Alcohol Consumption, and Cerebral White Matter Hyperintensities: Analysis with Genome-Wide Association Data. , 2015, Sleep.

[10]  S. Redline,et al.  Reliability of scoring respiratory disturbance indices and sleep staging. , 1998, Sleep.

[11]  Tetyana Kendzerska,et al.  Obstructive sleep apnea and incident diabetes. A historical cohort study. , 2014, American journal of respiratory and critical care medicine.

[12]  M. Stephens,et al.  Genome-wide Efficient Mixed Model Analysis for Association Studies , 2012, Nature Genetics.

[13]  I. Mills,et al.  Nuclear ARRB1 induces pseudohypoxia and cellular metabolism reprogramming in prostate cancer , 2014, The EMBO journal.

[14]  D. Altshuler,et al.  A map of human genome variation from population-scale sequencing , 2010, Nature.

[15]  L. Neyses,et al.  Endothelial nitric oxide synthase activity is inhibited by the plasma membrane calcium ATPase in human endothelial cells. , 2010, Cardiovascular research.

[16]  Lloyd E Chambless,et al.  Design and implementation of the Hispanic Community Health Study/Study of Latinos. , 2010, Annals of epidemiology.

[17]  Raanan Arens,et al.  Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos. , 2014, American journal of respiratory and critical care medicine.

[18]  J. Herman,et al.  Expression of the glucocorticoid-induced receptor mRNA in rat brain , 2005, Neuroscience.

[19]  P. Li,et al.  CD4+T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome , 2015, Pediatric Research.

[20]  Robert J. Goodloe,et al.  Association of Genetic Loci with Sleep Apnea in European Americans and African-Americans: The Candidate Gene Association Resource (CARe) , 2012, PloS one.

[21]  T. Bártfai,et al.  Downregulation of GPR83 in the hypothalamic preoptic area reduces core body temperature and elevates circulating levels of adiponectin. , 2012, Metabolism: clinical and experimental.

[22]  P. Donnelly,et al.  A Flexible and Accurate Genotype Imputation Method for the Next Generation of Genome-Wide Association Studies , 2009, PLoS genetics.

[23]  Yun Li,et al.  METAL: fast and efficient meta-analysis of genomewide association scans , 2010, Bioinform..

[24]  J. Harrow,et al.  A conditional knockout resource for the genome-wide study of mouse gene function , 2011, Nature.

[25]  N Risch,et al.  The Future of Genetic Studies of Complex Human Diseases , 1996, Science.

[26]  Sandipan Chatterjee,et al.  Identification of Novel Genes and Pathways Regulating SREBP Transcriptional Activity , 2009, PloS one.

[27]  L. Real,et al.  Genetic analysis of candidate SNPs for metabolic syndrome in obstructive sleep apnea (OSA). , 2013, Gene.

[28]  J. Goldstein,et al.  Insig-2, a second endoplasmic reticulum protein that binds SCAP and blocks export of sterol regulatory element-binding proteins , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[29]  A. Newman,et al.  Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure: The Sleep Heart Health Study , 2010, Circulation.

[30]  C. Nievergelt,et al.  Genetic variants associated with sleep disorders , 2014, Sleep medicine.

[31]  S. Ryu,et al.  Phospholipase C isozymes selectively couple to specific neurotransmitter receptors , 1997, Nature.

[32]  E. Eisenstein,et al.  The Treg/Th17 Cell Balance: A New Paradigm for Autoimmunity , 2009, Pediatric Research.

[33]  Michael Boehnke,et al.  LocusZoom: regional visualization of genome-wide association scan results , 2010, Bioinform..

[34]  Alvar Agusti,et al.  Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study , 2005, The Lancet.

[35]  W J Schull,et al.  Diabetes among Mexican Americans in Starr County, Texas. , 1983, American journal of epidemiology.

[36]  Manolis Kellis,et al.  HaploReg: a resource for exploring chromatin states, conservation, and regulatory motif alterations within sets of genetically linked variants , 2011, Nucleic Acids Res..

[37]  L. Neyses,et al.  Regulation of Vascular Tone in Animals Overexpressing the Sarcolemmal Calcium Pump* , 2003, Journal of Biological Chemistry.

[38]  S. Redline Genetics of Obstructive Sleep Apnea , 2005 .

[39]  Manolis Kellis,et al.  FTO Obesity Variant Circuitry and Adipocyte Browning in Humans. , 2015, The New England journal of medicine.

[40]  F. Powell Adaptation to chronic hypoxia involves immune cell invasion and increased expression of inflammatory cytokines in rat carotid body. , 2009, American journal of physiology. Lung cellular and molecular physiology.

[41]  Qutayba Hamid,et al.  Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. , 2004, American journal of respiratory and critical care medicine.

[42]  T. Stauffer,et al.  Tissue distribution of the four gene products of the plasma membrane Ca2+ pump. A study using specific antibodies. , 1995, The Journal of biological chemistry.

[43]  S. Redline,et al.  Shared genetic basis for obstructive sleep apnea and adiposity measures , 2008, International Journal of Obesity.

[44]  R. Berry,et al.  Respiratory arousal from sleep: mechanisms and significance. , 1997, Sleep.

[45]  Ross M. Fraser,et al.  Defining the role of common variation in the genomic and biological architecture of adult human height , 2014, Nature Genetics.

[46]  R. Kronmal,et al.  Multi-Ethnic Study of Atherosclerosis: objectives and design. , 2002, American journal of epidemiology.

[47]  N. Schneiderman,et al.  Prevalence of Diabetes Among Hispanics/Latinos From Diverse Backgrounds: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) , 2014, Diabetes Care.

[48]  A. Malhotra,et al.  Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. , 2013, American journal of respiratory and critical care medicine.

[49]  D. Bennett,et al.  Prader Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. , 2014, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[50]  R. Geffers,et al.  Inflammation in vivo is modulated by GPR83 isoform-4 but not GPR83 isoform-1 expression in regulatory T cells , 2010, Genes and Immunity.

[51]  Jianguo Li,et al.  Effect of deficiency in SREBP cleavage-activating protein on lipid metabolism during intermittent hypoxia. , 2007, Physiological genomics.

[52]  R. Zhong,et al.  The Association of 5-HT2A, 5-HTT, and LEPR Polymorphisms with Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis , 2014, PloS one.

[53]  S. Yin,et al.  A Systematic Review and Meta-Analysis of the Association between Serotonergic Gene Polymorphisms and Obstructive Sleep Apnea Syndrome , 2014, PloS one.

[54]  S. Tufik,et al.  Influence of genetic ancestry on the risk of obstructive sleep apnoea syndrome , 2010, European Respiratory Journal.

[55]  M. Conomos Inferring, Estimating, and Accounting for Population and Pedigree Structure in Genetic Analyses , 2014 .

[56]  M. Daly,et al.  Genome-wide association studies for common diseases and complex traits , 2005, Nature Reviews Genetics.

[57]  R. Arens,et al.  Hypercapnic arousal responses in Prader-Willi syndrome. , 1995, Chest.

[58]  A. Malhotra,et al.  A review of genetic association studies of obstructive sleep apnea: field synopsis and meta-analysis. , 2011, Sleep.

[59]  S. Woods,et al.  The orphan receptor Gpr83 regulates systemic energy metabolism via ghrelin-dependent and ghrelin-independent mechanisms , 2013, Nature Communications.

[60]  Y. Yazaki,et al.  Enhanced phosphoinositide hydrolysis via overexpression of phospholipase C beta1 or delta1 inhibits stimulus-induced insulin release in insulinoma MIN6 cells. , 1999, Biochemical and biophysical research communications.