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Altay S, Fırat S, Peker Y. A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist? J Clin Med 2023; 12:4144. [PMID: 37373837 DOI: 10.3390/jcm12124144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT.
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Affiliation(s)
- Servet Altay
- Department of Cardiology, Trakya University School of Medicine, Edirne 22030, Turkey
| | - Selma Fırat
- Department of Pulmonary Medicine, University of Health Sciences, Atatürk Sanatorium Education and Research Hospital, Ankara 06280, Turkey
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22002 Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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2
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Park JW, Almeida FR. Disparities in oxygen saturation and hypoxic burden levels in obstructive sleep apnea patient's response to oral appliance treatment. J Oral Rehabil 2022; 49:633-643. [PMID: 35274338 PMCID: PMC9322413 DOI: 10.1111/joor.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/23/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Background Oxygen saturation indices show a strong correlation with long‐term health outcomes. Nonetheless, evidence on the relationship between reduction in respiratory events and increase in oxygenation levels following oral appliance (OA) treatment is scarce. Objectives To verify the relationship between reduction in the apnoea‐hypopnoea index (AHI) and oxygen saturation levels following OA treatment, we have conducted an evaluation of polysomnography (PSG) and clinical parameters associated with the improvement of oxygen desaturation. Methods OSA patients (n = 48) who received an OA and had pre‐ and post‐treatment PSG were classified into three responder groups according to the change in AHI and min O2 post‐treatment: responderAHIonly (decrease in AHI of ≥50% but increase in min O2 level of <4% or decrease); responderMinO2only (increase in min O2 level of ≥4% but decrease in AHI <50% or increase) and responderCongruous (decrease in AHI of ≥50% and increase in min O2 level of ≥4%). Various demographic and PSG variables were statistically compared among groups. Results There were 26 (54.17%) responderAHIonly, 9 (18.75%) responderMinO2only and 13 (27.08%) responderCongruous. Pre‐treatment min O2 was significantly lower in responderMinO2only. A higher pre‐treatment min O2 showed a significant correlation with a smaller amount of change in mean O2 (r = −.486) and min O2 (r = −.764) with treatment. Pre‐treatment min O2 showed the strongest ability to predict those who would show a ≥4% min O2 increase following treatment. Conclusion Certain patients do not show sufficient decrease in hypoxaemia in spite of the improvement in AHI. Pre‐treatment min O2 should be considered in OA treatment planning regarding its close relation to improvements in oxygenation levels with treatment.
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Affiliation(s)
- Ji Woon Park
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea (ROK).,Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea (ROK)
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
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3
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Baran R, Grimm D, Infanger M, Wehland M. The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension. Int J Mol Sci 2021; 22:2300. [PMID: 33669062 PMCID: PMC7956605 DOI: 10.3390/ijms22052300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 01/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disease, with approximately 3-7% of men and 2-5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.
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Affiliation(s)
- Ronni Baran
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark;
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark;
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
| | - Manfred Infanger
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
| | - Markus Wehland
- Department for Microgravity Research and Translational Regenerative Medicine, Otto-von-Guericke University, D-39106 Magdeburg, Germany;
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Picard F, Panagiotidou P, Weinig L, Steffen M, Tammen AB, Klein RM. Effect of CPAP therapy on nocturnal blood pressure fluctuations, nocturnal blood pressure, and arterial stiffness in patients with coexisting cardiovascular diseases and obstructive sleep apnea. Sleep Breath 2020; 25:151-161. [DOI: 10.1007/s11325-020-02075-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022]
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5
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Liu C, Kang W, Zhang S, Qiao X, Yang X, Zhou Z, Lu H. Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Sci Rep 2020; 10:3394. [PMID: 32098974 PMCID: PMC7042252 DOI: 10.1038/s41598-020-60034-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/03/2020] [Indexed: 01/21/2023] Open
Abstract
Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4–6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.
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Affiliation(s)
- Chunyan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China.,Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA
| | - Wenjing Kang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Shilong Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Xing Qiao
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Xiuchun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University; Hebei Province, Shijiazhuang, China
| | - Zheng Zhou
- Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA.
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China.
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6
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Cardoso CRL, Roderjan CN, Cavalcanti AH, Cortez AF, Muxfeldt ES, Salles GF. Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial. J Sleep Res 2020; 29:e12990. [DOI: 10.1111/jsr.12990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Claudia R. L. Cardoso
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
| | - Christian N. Roderjan
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
| | - Aline H. Cavalcanti
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
| | - Arthur F. Cortez
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
| | - Elizabeth S. Muxfeldt
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
| | - Gil F. Salles
- Department of Internal Medicine School of Medicine University Hospital Clementino Fraga Filho Universidade Federal do Rio de Janeiro Rio de Janeiro Brasil
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7
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Joyeux-Faure M, Tamisier R, Borel JC, Millasseau S, Galerneau LM, Destors M, Bailly S, Pepin JL. Contribution of obstructive sleep apnoea to arterial stiffness: a meta-analysis using individual patient data. Thorax 2018; 73:1146-1151. [PMID: 30032122 DOI: 10.1136/thoraxjnl-2018-211513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness? METHODS Individual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid-femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis. RESULTS 893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m2 (30±7 kg/m2). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all p<0.01) as well as to dyslipidaemia (p=0.03) and an Epworth Sleepiness Scale score ≥9 (p=0.04), whereas it was not related to obesity (p=0.54), a severe Apnoea-Hypopnoea Index (p=0.14), mean nocturnal saturation (p=0.33) or sleep time with oxygen saturation below 90% (p=0.47). In multivariable analysis, PWV was independently associated with age, systolic blood pressure and diabetes (all p<0.01), whereas severe OSA was not significantly associated with PWV. CONCLUSION Our individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters.
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Affiliation(s)
- Marie Joyeux-Faure
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Renaud Tamisier
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Christian Borel
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Louis-Marie Galerneau
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Destors
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Louis Pepin
- Laboratoire HP2, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble Alpes University Hospital, Grenoble, France
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Suzuki S, Yoshihisa A, Sato Y, Watanabe S, Yokokawa T, Sato T, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Ishida T, Takeishi Y. Association between sleep-disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction. ESC Heart Fail 2018; 5:284-291. [PMID: 29460495 PMCID: PMC5933962 DOI: 10.1002/ehf2.12273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 12/04/2017] [Accepted: 01/09/2018] [Indexed: 01/16/2023] Open
Abstract
AIMS Sleep-disordered breathing (SDB) is associated with arterial stiffness, which may be one of the factors that lead to heart failure (HF). We examined the relationship between pulse wave velocity (PWV) and SDB in patients who have HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). METHODS AND RESULTS We measured the apnoea-hypopnoea index (AHI) by polysomnography, echocardiographic parameters, and PWV in 221 HF patients. Age, blood pressure, and PWV were higher in HFpEF (ejection fraction > 50%, n = 70) patients than in HFrEF (ejection fraction < 50%, n = 151) patients. All HF patients were divided into three groups according to AHI: none-to-mild SDB group (AHI < 15 times/h, n = 77), moderate SDB group (15 < AHI < 30 times/h, n = 59), and severe SDB group (AHI > 30 times/h, n = 85). Although blood pressure and echocardiographic parameters did not differ among the three groups, PWV was significantly higher in the severe SDB group than in the none-to-mild and moderate SDB groups (P = 0.002). When the HFrEF and HFpEF patients were analysed separately, PWV was significantly higher in the severe SDB group than in the none-to-mild and moderate SDB groups in patients with HFpEF (P = 0.002), but not in those with HFrEF (P = 0.068). In the multiple regression analysis to determine PWV, the presence of severe SDB was found to be an independent predictor of high PWV in HFpEF (β = 0.234, P = 0.005), but not in HFrEF patients. CONCLUSIONS Severe SDB is associated with elevated arterial stiffness and may be related to the pathophysiology of HF, especially in HFpEF patients.
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Affiliation(s)
- Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shunsuke Watanabe
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shu-Ichi Saitoh
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Mineiro MA, Silva PMD, Alves M, Papoila AL, Marques Gomes MJ, Cardoso J. The role of sleepiness on arterial stiffness improvement after CPAP therapy in males with obstructive sleep apnea: a prospective cohort study. BMC Pulm Med 2017; 17:182. [PMID: 29221483 PMCID: PMC5723049 DOI: 10.1186/s12890-017-0518-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/23/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk. This study aim to assess differences in changes in arterial stiffness of two groups of patients, defined as having daytime sleepiness or not, after continuous positive airway pressure (CPAP) treatment. METHODS A selected cohort of consecutive male patients, under 65 years old, with moderate to severe OSA and without great number of comorbidities was studied. The diagnosis was confirmed by home respiratory poligraphy. Sleepiness was considered with an Epworth Sleepiness Scale (ESS) > 10. An ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (cf-PWV) measurements were performed, before and after four months under CPAP. Compliant patients, sleepy and non-sleepy, were compared using linear mixed effects regression models. A further stratified analysis was performed with non-sleepy patients. RESULTS Thirty-four patients were recruited, with mean age 55.2 (7.9) years, 38.2% were sleepy, 79.4% with hypertension, 61.8% with metabolic syndrome and 82.4% with dyslipidaemia. In univariable analysis, cf-PWV was strongly related to systolic BP parameters and age, but also to antihypertensive drugs (p = 0.030), metabolic syndrome (p = 0.025) and daytime sleepiness (p = 0.004). Sleepy patients had a more severe OSA, with AHI 44.8 (19.0) vs 29.7 (15.7) events/h (p = 0.018), but sleep study parameters were not associated with cf-PWV values. On multivariable regression, a significant interaction between time (CPAP) and sleepiness (p = 0.033) was found. There was a weak evidence of a cf-PWV reduction after CPAP treatment (p = 0.086), but the effects of treatment differed significantly between groups, with no changes in non-sleepy patients, while in sleepy patients a significant decrease was observed (p = 0.012). Evaluating non-sleepy patients group under CPAP therapy, results showed that both higher pulse pressure (p = 0.001) and lower LDL-cholesterol levels (p = 0.015) at baseline were associated to higher cf-PWV changes. CONCLUSIONS Patients with daytime sleepiness had a more severe OSA and presented a greater arterial stiffness improvement after CPAP therapy, independently from age and BP. Besides sleepiness, cf-PWV reduction after CPAP therapy was mainly associated to CV risk factors, and less to sleep study parameters. TRIAL REGISTRATION Clinicaltrials.gov NCT02273089 23.10.2014 retrospectively registered.
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Affiliation(s)
- Maria Alexandra Mineiro
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Pedro Marques da Silva
- Arterial Investigation Unit, Internal Medicine Department IV, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal
| | | | - João Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal
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Abstract
Aortic stiffness (AS) is an important predictor of cardiovascular morbidity in humans. The present review discusses the possible pathophysiological mechanisms of AS and focuses on a survey of different therapeutic modalities for decreasing AS. The influence of several nonpharmacological interventions is described: decrease body weight, diet, aerobic exercise training, music, and continuous positive airway pressure therapy. The effects of different pharmacological drug classes on AS are also discussed: antihypertensive drugs-renin-angiotensin-aldosterone system drugs, beta-blockers, alpha-blockers, diuretics, and calcium channel blockers (CCBs)-advanced glycation end product cross-link breakers, statins, oral anti-diabetics, anti-inflammatory drugs, vitamin D, antioxidant vitamins, and endothelin-1 receptor antagonists. All of these have shown some effect in decreasing AS.
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11
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Drakatos P, Higgins S, Pengo MF, Kent BD, Muza R, Karkoulias K, Leschziner G, Williams A. Derived Arterial Stiffness is Increased in Patients with Obstructive Sleep Apnea and Periodic Limb Movements during Sleep. J Clin Sleep Med 2017; 12:195-202. [PMID: 26414977 DOI: 10.5664/jcsm.5484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) have been associated with increased risk of cardiovascular disease (CVD). OSA has also been linked to increased large arterial stiffness, which is considered an independent risk factor for CVD. We utilized a previously validated index of large artery stiffness (SIDVP) derived from the digital volume pulse (DVP) to seek comparison in patients with PLMS and OSA. METHODS Forty-nine adult male subjects, without known comorbidities that could affect arterial stiffness or on vasoactive medication, were retrospectively identified and categorized into controls (n = 8), PLMS (n = 13), OSA (n = 17), and OSA/PLMS (n = 11). The cutoff for PLMS was a periodic limb movement index (PLMI) > 15 events/h, and for OSA an apnea-hypopnea index (AHI) > 10 events/h. SIDVP was derived from the raw data of photoplethysmography of the nocturnal polysomnography, averaged for 2 min prior to sleep study initiation (baseline), after completion in the morning, and every half hour after sleep onset. RESULTS The groups were age/body mass index-matched. Controls showed lower baseline, morning, and overall SIDVP compared to the other groups (p < 0.01). Patients with PLMS (PLMI: 50.69 ± 9.7 events/h) and the OSA group (AHI: 29.7 ± 2 events/h) demonstrated similar overall SIDVP (6.78 ± 0.08 versus 6.94 ± 0.04, respectively, p = 0.5), whereas the OSA/PLMS (AHI: 29.35 ± 8, PLMI: 50.63 ± 7.2) group demonstrated the highest (7.40 ± 0.06, p < 0.001). CONCLUSIONS Based on an easily reproducible and applicable marker of large arterial stiffness, patients with significant PLMS had higher SIDVP when compared to controls and comparable to those with moderate/severe OSA. The OSA/PLMS group had the highest SIDVP, implying a possible additive effect of OSA and PLMS on arterial stiffness.
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Affiliation(s)
| | | | - Martino F Pengo
- Guy's and St Thomas' NHS Foundation Trust, UK.,University Hospital of Padova, Italy
| | | | - Rex Muza
- Guy's and St Thomas' NHS Foundation Trust, UK
| | | | - Guy Leschziner
- Guy's and St Thomas' NHS Foundation Trust, UK.,King's College, London, England
| | - Adrian Williams
- Guy's and St Thomas' NHS Foundation Trust, UK.,King's College, London, England
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12
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Sarinc Ulasli S, Sariaydin M, Ozkececi G, Gunay E, Halici B, Unlu M. Arterial stiffness in obstructive sleep apnoea: Is there a difference between daytime and night-time? Respirology 2016; 21:1480-1485. [PMID: 27381837 DOI: 10.1111/resp.12845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnoea syndrome (OSAS) is a common chronic systemic disease in the general population, with known associated cardiovascular outcomes. We aimed to investigate arterial stiffness in OSAS patients and compare daytime and night-time values with control subjects. METHODS A total of 104 patients undergoing investigation for OSAS with polysomnography also underwent pulse wave velocity (PWV) and augmentation index (AIx) measurements with Mobil-O-Graph for 24 h. Eighty-two patients were found to have OSAS and 22 did not have OSAS and acted as controls. RESULTS PWV values of the 82 OSAS patients during the 24-h period, both daytime and night-time, were significantly higher than that of the control subjects. Moreover, night-time levels of AIx were significantly higher in OSAS patients than control subjects (P = 0.025). PWV during night-time was higher than daytime measurements in OSAS patients (P = 0.012). Apnoea hypopnoea index (AHI) was significantly correlated with PWV and AIx over 24 h (P = 0.0001, r = 0.412; P = 0.002, r = 0.333, respectively). Positive correlations were also found between oxygen desaturation index (ODI) with PWV and AIx during the night (P = 0.0001, r = 0.480; P = 0.002, r = 0.325, respectively). However, daytime AIx was not significantly correlated with ODI (P = 0.052, r = 0.205). CONCLUSION OSAS patients, without known cardiovascular disease, have increased PWV, indicating an increased arterial stiffness, compared with control subjects and correlations between AHI and arterial stiffness indices suggest increased arterial stiffness with increased disease severity. Therefore, arterial stiffness should be considered as a possible cause for cardiovascular complications in OSAS patients.
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Affiliation(s)
- Sevinc Sarinc Ulasli
- Faculty of Medicine, Department of Pulmonary Diseases, Hacettepe University, Ankara, Turkey.
| | - Muzaffer Sariaydin
- Faculty of Medicine, Department of Pulmonary Diseases, Afyon Kocatepe University, Afyon, Turkey
| | - Gulay Ozkececi
- Faculty of Medicine, Department of Cardiology, Afyon Kocatepe University, Afyon, Turkey
| | - Ersin Gunay
- Faculty of Medicine, Department of Pulmonary Diseases, Afyon Kocatepe University, Afyon, Turkey
| | - Bilal Halici
- Faculty of Medicine, Department of Pulmonary Diseases, Afyon Kocatepe University, Afyon, Turkey
| | - Mehmet Unlu
- Faculty of Medicine, Department of Pulmonary Diseases, Afyon Kocatepe University, Afyon, Turkey
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Sieminski M, Partinen M. Nocturnal systolic blood pressure is increased in restless legs syndrome. Sleep Breath 2016; 20:1013-9. [PMID: 26993341 PMCID: PMC5016545 DOI: 10.1007/s11325-016-1333-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/26/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Abstract
Purpose Restless legs syndrome (RLS) is a frequent sensorimotor disorder characterized by an urge to move the legs, with symptoms appearing during the night and disturbing nocturnal sleep. There is a growing body of evidence that RLS correlates with an increased risk of cardiovascular diseases and hypertension. The aim of this study was to test the hypothesis that patients with RLS have higher blood pressure (BP) during the night than people without RLS. Methods We have analyzed polysomnographic (PSG) recordings of 30 patients with RLS and 27 subjects without the sleep disorder. During PSG, beat-to-beat BP measurement was performed. Results Patients with RLS have higher nocturnal and sleep-time systolic blood pressure compared to controls (124.4 vs. 116.5 mmHg, p < 0.05; 123.5 vs. 116.1 mmHg, p < 0.05). There was no noticeable dip in the values of nocturnal systolic pressure of patients with RLS. Conclusions Our results support the hypothesis that RLS and hypertension are linked. Thus, we believe patients with RLS require close observation with regard to cardiovascular risk factors.
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Affiliation(s)
- Mariusz Sieminski
- Department of Adults' Neurology, Medical University of Gdansk, Debinki 7, 80-210, Gdansk, Poland.
| | - Markku Partinen
- Vitalmed Helsinki Sleep Clinic, Valimotie 21, 00380, Helsinki, Finland
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Paz Y Mar HL, Hazen SL, Tracy RP, Strohl KP, Auckley D, Bena J, Wang L, Walia HK, Patel SR, Mehra R. Effect of Continuous Positive Airway Pressure on Cardiovascular Biomarkers: The Sleep Apnea Stress Randomized Controlled Trial. Chest 2016; 150:80-90. [PMID: 26997243 DOI: 10.1016/j.chest.2016.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although existing research highlights the relationship of OSA and cardiovascular disease, the effect of OSA treatment on cardiovascular biomarkers remains unclear. We evaluated the effect of OSA treatment on oxidative stress/inflammation measures. METHODS We conducted a parallel, randomized controlled trial in moderate to severe OSA (apnea-hypopnea index ≥ 15) patients to examine effects of 2-month CPAP vs sham-CPAP on the primary outcome of oxidative stress/inflammation (F2-isoprostanes: ng/mg) and myeloperoxidase: pmol/L) and secondary oxidative stress measures. Exploratory secondary analyses included vascular and systemic inflammation markers. Linear models adjusted for baseline values examined effect of CPAP on biomarker change (least squares means, 95% CI) including secondary stratified analyses examining CPAP adherence and degree of hypoxia. RESULTS Of 153 participants, 76 were randomized to CPAP and 77 to sham-CPAP. In an intent-to-treat analyses, no significant change was observed in the sham and CPAP groups respectively: F2-isoprostanes (-0.02 [-0.12 to 0.10] vs -0.08 [-0.18 to 0.03]) or myeloperoxidase (-3.33 [-17.02 to 10.37] vs -5.15 [-18.65 to 8.35]), nor other oxidative markers; findings that persisted in analyses stratified by adherence and hypoxia. Exploratory analyses revealed percentage reduction of soluble IL-6 receptor (ng/mL) levels (-0.04 [-0.08 to -0.01] vs 0.02 [-0.02 to 0.06], P = .019) and augmentation index (%) (-6.49 [-9.32 to -3.65] vs 0.44 [-2.22 to 3.10], P < .001) with CPAP compared with sham, respectively. CONCLUSIONS In moderate to severe OSA, 2-month CPAP vs sham did not reduce oxidative stress despite consideration of a broad range of measures, positive airway pressure adherence, and hypoxia burden. These findings suggest that nonoxidative stress pathways primarily modulate OSA-related cardiovascular consequences. TRIAL REGISTRATION ClinicalTrials.govNCT00607893.
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Affiliation(s)
- Hugo L Paz Y Mar
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Russell P Tracy
- Departments of Biochemistry and Pathology, University of Vermont, Burlington, VT
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Lu Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Harneet K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Sanjay R Patel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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Lin X, Chen G, Qi J, Chen X, Zhao J, Lin Q. Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis. Eur Arch Otorhinolaryngol 2016; 273:4081-4088. [DOI: 10.1007/s00405-016-3914-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/30/2016] [Indexed: 11/29/2022]
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16
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Cicero AFG, Morbini M, Urso R, Rosticci M, Parini A, Grandi E, D'Addato S, Borghi C. Association between self-reported snoring and arterial stiffness: data from the Brisighella Heart Study. Intern Emerg Med 2016; 11:77-83. [PMID: 26415727 DOI: 10.1007/s11739-015-1310-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
The correlation of both obstructive sleep apnoea syndrome (OSAS) and snoring with cardiovascular risk is well known, but its investigation is complex and not suitable for studying large cohorts of subjects. Thus, we prospectively evaluated 1476 non-pharmacologically treated subjects selected from the last survey of the Brisighella Heart Study. Snoring and sleep apnoea were investigated asking the subjects if they were aware of snoring during the night, and if this was associated with episodes of apnoea. A full set of clinical and laboratory parameters were evaluated, while augmentation index (AIx), and pulse wave velocity (PWV) were recorded with the Vicorder(®) apparatus. A logistic regression analysis identifies as main independent predictors of AIx age (OR 1.058, 95% CI 1.043-1.065, p < 0.001), Body Mass Index (OR 1.046, 95% CI 1.014-1.079, p = 0.005), and apolipoprotein B (OR 1.014, 95% CI 1.004-1.023, p = 0.001). The main independent predictors of PWV are snoring (OR 1.215, 95% CI 1.083-1.390, p < 0.001), and snoring with apnoea (OR 1.351, 95% CI 1.135-1.598, p = 0.014), age (OR 1.078, 95% CI 1.052-1.089, p < 0.001), serum uric acid [SUA] (OR 1.093, 95% CI 1.026-1.151, p < 0.001) and mean arterial pressure (OR 1.042, 95% CI 1.024-1.056, p < 0.001). In conclusion, in our cohort of overall healthy subjects, self-reported snoring and sleep apnoea are independently associated with a higher PVW, and AIx is statistically significantly higher in snorers with or without sleep apnoea than in non-snorers. Body Mass Index and apolipoprotein B are associated with AIx, while SUA and mean arterial pressure are related to PWV.
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Affiliation(s)
- Arrigo F G Cicero
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.
| | - Martino Morbini
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Riccardo Urso
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Martina Rosticci
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Angelo Parini
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Elisa Grandi
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Sergio D'Addato
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Claudio Borghi
- Medical and Surgical Sciences Department, U.O. Medicina Interna Borghi, Sant'Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
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Jaén-Águila F, Vargas-Hitos JA, Mediavilla-García JD. Implications of Renal Denervation Therapy in Patients with Sleep Apnea. Int J Hypertens 2015; 2015:408574. [PMID: 26491559 PMCID: PMC4605362 DOI: 10.1155/2015/408574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/08/2015] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is a prevalent condition characterized by repeated episodes of obstruction of the upper airway, leading to intermittent hypoxemia and important endothelial and anatomical dysfunctions that cause cardiovascular and cerebrovascular disease. The finding of the relationship between OSA and hypertension, especially resistant hypertension (RHT), has increased the interest in therapeutic strategies that affect renal sympathetic activity in these patients. The observational studies published until now demonstrated that renal denervation therapy can reduce the severity of OSA syndrome. Renal sympathetic denervation (RDN) could be a future therapeutic possibility for conditions other than RHT, such as atrial fibrillation, heart failure, obesity, and OSA syndrome, where renal sympathetic system plays an important physiological role. The aim of this review was to elucidate the implications of renal sympathetic activity in OSA syndrome.
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Affiliation(s)
- Fernando Jaén-Águila
- Cardiovascular Risk Unit, Department of Internal Medicine, University Hospital Complex City of Granada, Avenida Fuerzas Armadas 2, 18014 Granada, Spain
| | - José Antonio Vargas-Hitos
- Cardiovascular Risk Unit, Department of Internal Medicine, University Hospital Complex City of Granada, Avenida Fuerzas Armadas 2, 18014 Granada, Spain
| | - Juan Diego Mediavilla-García
- Cardiovascular Risk Unit, Department of Internal Medicine, University Hospital Complex City of Granada, Avenida Fuerzas Armadas 2, 18014 Granada, Spain
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Use of continuous positive airway pressure for sleep apnea in the treatment of hypertension. Curr Opin Nephrol Hypertens 2015; 23:462-7. [PMID: 24992567 DOI: 10.1097/mnh.0000000000000047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) and hypertension are highly prevalent and treatable conditions that often coexist and both contribute to an increased cardiovascular risk. The ability of continuous positive airway pressure (CPAP) to improve blood pressure in hypertensive patients with OSA is debated. This review highlights findings from recent studies that have investigated the impact of CPAP on blood pressure in patients with OSA. RECENT FINDINGS Comparing the results of various studies is complicated by important methodological differences among them. In hypertensive patients with OSA, treatment with CPAP improves blood pressure to a smaller degree than that derived from antihypertensive medication. Patients with more severe OSA and with greater adherence to CPAP are likely to gain the most benefit from the therapy. SUMMARY CPAP should be used in combination with antihypertensive medications in hypertensive patients with OSA. CPAP has the additional benefits of restoring nocturnal dipping and improving arterial stiffness, thus potentially influencing cardiovascular morbidity in these high-risk patients.
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Genta-Pereira DC, Pedrosa RP, Lorenzi-Filho G, Drager LF. Sleep Disturbances and Resistant Hypertension: Association or Causality? Curr Hypertens Rep 2014; 16:459. [DOI: 10.1007/s11906-014-0459-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Shantha GPS, Pancholy SB. Effect of renal sympathetic denervation on apnea-hypopnea index in patients with obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2014; 19:29-34. [PMID: 24839239 DOI: 10.1007/s11325-014-0991-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/17/2014] [Accepted: 04/23/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent evidence associates sympathetic tone with severity of obstructive sleep apnea (OSA). Renal sympathetic denervation (RDN), by decreasing sympathetic tone, has the potential to decrease OSA severity. Small observational studies that assessed this hypothesis lacked precision. Hence, in this meta-analysis, we have attempted to pool available data from studies that have assessed the effect of RDN on OSA severity in patients with OSA. METHODS Medline, Embase, Cochrane central, Ovid, Cinahl, web of science, and conference abstracts were searched for eligible citations by two independent reviewers using key words "renal denervation," "hypertension," and "obstructive sleep apnea." From a total of 2,863 identified citations, using meta-analysis of observational studies in epidemiology method, five studies were assessed eligible and included in the meta-analysis. RESULTS All five studies followed an observational study design, involved patients with OSA and HTN, and reported an apnea-hypopnea index (AHI) 6 months post-RDN. Four were "before and after" studies and one compared continuous positive airway pressure with RDN. In the pooled analysis, involving 49 patients, RDN was associated with a significant reduction in mean AHI [weighted mean difference -9.61 (95 % CI -15.43 to -3.79, P = 0.001)] 6 months post-RDN. One study also reported improvement in oxygen desaturation index and Epworth sleepiness scale score 6 months post-RDN. CONCLUSIONS RDN is associated with significant improvement in OSA severity. However, our results need validation in RCTs that assess effect of RDN in patients with OSA, which can potentially broaden the clinical applicability of RDN.
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