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Altintas N, Riha RL. Non-sleepy obstructive sleep apnoea: to treat or not to treat? Eur Respir Rev 2019; 28:28/154/190031. [PMID: 31871125 DOI: 10.1183/16000617.0031-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Abstract
Non-sleepy obstructive sleep apnoea (OSA) is thought to have a prevalence of around 20-25% in industrialised countries. However, the question of whether it should be routinely treated or not is controversial. This review collates the results from recent randomised controlled trials addressing OSA and examines whether treating the condition leads to improvements in quality of life and reduced cardiometabolic dysfunction, comorbidities generally attributed to untreated obstructive sleep apnoea/hypopnoea syndrome.
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Affiliation(s)
- Nejat Altintas
- Pulmonary and Sleep Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK .,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
Sleep disordered breathing (SDB), which causes sleep deprivation, intermittent hypoxia, and negative intrathoracic pressure swings, can be accompanied by other harmful pathophysiologies relating to cardiovascular diseases (CVD), including sudden death, atrial fibrillation, stroke, and coronary artery disease leading to heart failure. Continuous positive airway pressure (CPAP) therapy for SDB has been reported to provide favorable effects such as lowered systemic blood pressure and improved endothelial function. However, in recent randomized controlled trials, CPAP has failed to demonstrate its beneficial prognostic impact on the primary or secondary setting of CVD. In this review article, we describe the characteristics of SDB complicated with CVD, the prognostic impacts of SDB in CVD, and the beneficial effects of CPAP on CVD.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University
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Heart Rate Variability in the Diagnostics and CPAP Treatment of Obstructive Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1176:25-33. [PMID: 31073928 DOI: 10.1007/5584_2019_385] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obstructive sleep apnea (OSA) is the most common manifestation of sleep-related breathing disorders that are often accompanied by dysfunction of the autonomic nervous system. The main objective of the study was to assess the usefulness of heart rate variability (HRV) analysis in the diagnosis of patients with severe OSA and in the assessment of the effects of 3-month treatment with continuous positive airway pressure (CPAP). There were 54 patients enrolled in the study. The OSA group consisted of 39 patients suffering from severe OSA (apnea/hypopnea index >30/h), and the control group included 15 non-OSA patients with matched demographic characteristics and comorbidities. All patients underwent 24-h Holter electrocardiographic monitoring. HRV was analyzed using the time- and frequency-domains. We found that OSA patients had decreases in time-domains and increases in frequency-domains of HRV, compared to non-OSA controls, which strongly suggested a clinically disadvantageous shift in the balance of parasympathetic/sympathetic activity toward the latter. Further, CPAP treatment, partly, albeit significantly, reversed the OSA-induced changes in HRV. We conclude that HRV analysis may be of help in the diagnosis of OSA and in the monitoring of the effectiveness of treatment.
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Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, Neal B. Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. JAMA 2017; 318:156-166. [PMID: 28697252 PMCID: PMC5541330 DOI: 10.1001/jama.2017.7967] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear. OBJECTIVE To assess the association of PAP vs control with cardiovascular events and death in patients with sleep apnea. DATA SOURCES AND STUDY SELECTION MEDLINE, EMBASE, and the Cochrane Library were systematically searched from inception date to March 2017 for randomized clinical trials that included reporting of major adverse cardiovascular events or deaths. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data using standardized forms. Summary relative risks (RRs), risk differences (RDs) and 95% CIs were obtained using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES The main outcomes were a composite of acute coronary syndrome (ACS) events, stroke, or vascular death (major adverse cardiovascular events); cause-specific vascular events; and death. RESULTS The analyses included data from 10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266; mean age, 60.9 [range, 51.5 to 71.1] years; 5847 [80.5%] men; mean [SD] body mass index, 30.0 [5.2]. Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P = .19 and RD, -0.01 [95% CI, -0.03 to 0.01]; P = .23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P = .30 and RD -0.00 [95% CI, -0.02 to 0.02]; P = .87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08 and RD, 0.00 [95% CI, -0.01 to 0.01]; P = .51). The same was true for ACS, stroke, and heart failure. There was no evidence of different associations for CPAP vs ASV (all P value homogeneity >.24), and meta-regressions identified no associations of PAP with outcomes for different levels of apnea severity, follow-up duration, or adherence to PAP (all P values > .13). CONCLUSIONS AND RELEVANCE The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes.
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Affiliation(s)
- Jie Yu
- Department of Cardiology, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, People’s Republic of China
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Zien Zhou
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Craig S. Anderson
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- The George Institute China, Peking University Health Science Center, Beijing, People’s Republic of China
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Division of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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Johal A, Haria P, Manek S, Joury E, Riha R. Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial. J Clin Sleep Med 2017; 13:175-182. [PMID: 27784410 DOI: 10.5664/jcsm.6440] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 09/25/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To compare the effectiveness of a custom-made (MRDc) versus ready-made (MRDr) mandibular repositioning devices (MRD) in the management of obstructive sleep apnea (OSA). METHODS A randomized crossover trial design was adopted in which patients with a confirmed diagnosis of OSA were randomly allocated to receive either a 3-month period of ready-made or custom-made MRD, with an intervening washout period of 2 weeks, prior to crossover. Treatment outcomes included both objective sleep monitoring and patient-centered measures (daytime sleepiness, partner snoring and quality of life). RESULTS Twenty-five patients, with a mild degree of OSA (apnea-hypopnea index of 13.3 [10.9-25] events/h) and daytime sleepiness (Epworth Sleepiness Scale of 11 [6-16]), completed both arms of the trial. The MRDc achieved a complete treatment response in 64% of participants, compared with 24% with the MRDr (p < 0.001). A significant difference was observed in treatment failures, when comparing the MRDr (36%) with the MRDc (4%). Excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10) persisted in 33% (MRDc) and 66% (MRDr) of OSA subjects, following treatment. A statistically significant improvement was observed in quality of life scales following MRDc therapy only. Significant differences were observed in relation to both the number of nights per week (p = 0.004) and hours per night (p = 0.006) between the two different designs of device. CONCLUSIONS The study demonstrates the significant clinical effectiveness of a custom-made mandibular repositioning device, particularly in terms of patient compliance and tolerance, in the treatment of OSA.
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Affiliation(s)
- Ama Johal
- Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, UK
| | - Priya Haria
- Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, UK
| | - Seema Manek
- Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, UK
| | - Easter Joury
- Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, UK
| | - Renata Riha
- Sleep and Respiratory Medicine, Edinburgh Royal infirmary, UK
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Patel N, Donahue C, Shenoy A, Patel A, El-Sherif N. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol 2016; 228:967-970. [PMID: 27914359 DOI: 10.1016/j.ijcard.2016.11.137] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
There is a growing consensus in the scientific community that suggests a strong association between obstructive sleep apnea (OSA) and cardiovascular (CVD) conditions and events, including coronary artery disease, hypertension, arrhythmia, heart failure, and sudden cardiac death. We reviewed evidence on the relationship between OSA and arrhythmia. Our conclusion, based on our review of the literature, is that the evidence supports a strong link between OSA and cardiovascular mortality, which warrants treating OSA. Continuous positive airway pressure (CPAP) appears to reduce the CVD consequences of OSA. Future research is expected to clarify the benefits and optimal application of these treatment approaches.
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Affiliation(s)
- Nirav Patel
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States; Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States; The Henry Low Heart Center, Hartford Hospital, Connecticut, United States.
| | | | - Abhishek Shenoy
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States
| | - Arpan Patel
- Windsor School of Medicine, St. Kitts, Saint Kitts and Nevis
| | - Nabil El-Sherif
- Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States
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Cetinkaya EA, Turker M, Kiraz K, Gulkesen HK. Er:Yag Laser Treatment of Simple Snorers in an Outpatient Setting. ORL J Otorhinolaryngol Relat Spec 2016; 78:70-6. [PMID: 26967167 DOI: 10.1159/000443510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Snoring occurs as a result of soft tissue vibration caused by a partial upper airway collapse during sleep. This study evaluated the effectiveness and potential adverse side effects associated with the use of a nonsurgical, erbium-doped yttrium aluminum garnet (Er:YAG) laser treatment for patients with snoring conditions. MATERIALS AND METHODS In total, 33 patients with different degrees of snoring were analyzed retrospectively. All patients received three NightLase™ Er:YAG laser treatments. Results were measured using a follow-up questionnaire and then statistically analyzed. Any effects that occurred during the first year after treatment (i.e., short-term effects) were followed up with interviews. RESULTS Laser treatment effectively reduced patients' snoring and achieved a 65% satisfaction rate after three treatments. The greatest improvement and satisfaction were experienced by patients aged ≥50 years. Patients reported additional benefits from this treatment including easier breathing, higher alertness, and increased focus. CONCLUSION Nonsurgical Er:YAG laser treatment is an effective and minimally invasive procedure to reduce patient snoring and other sleep-disordered breathing symptoms. Patients reported minimal disadvantages including minor discomfort and a low risk of side effects.
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Hu X, Fan J, Chen S, Yin Y, Zrenner B. The role of continuous positive airway pressure in blood pressure control for patients with obstructive sleep apnea and hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich) 2015; 17:215-22. [PMID: 25582849 DOI: 10.1111/jch.12472] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/15/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to review the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and hypertension. Biomedical databases were searched for randomized controlled trials (RCTs) comparing CPAP with control among these patients. Seven RCTs reporting 24-hour ambulatory BP were identified for meta-analysis. CPAP was associated with significant reductions in 24-hour ambulatory systolic blood pressure (SBP) (-2.32 mm Hg; 95% confidence interval [CI], -3.65 to -1.00) and diastolic blood pressure (DBP) (-1.98 mm Hg; 95% CI, -2.82 to -1.14). CPAP led to more significant improvement in nocturnal SBP than that in diurnal SBP. Subgroup analysis showed that patients with resistant hypertension or receiving antihypertensive drugs benefited most from CPAP. Meta-regression indicated that CPAP compliance, age, and baseline SBP were positively correlated with decrease in 24-hour DBP, but not reduction in 24-hour SBP.
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Affiliation(s)
- Xinyu Hu
- Department of Cardiology, the Chongqing Cardiac Arrhythmias Service Center, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Finsterer J, Wahbi K. CNS-disease affecting the heart: brain-heart disorders. J Neurol Sci 2014; 345:8-14. [PMID: 25034054 DOI: 10.1016/j.jns.2014.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/27/2014] [Accepted: 07/01/2014] [Indexed: 01/09/2023]
Abstract
There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain-heart disorders). The most well-known of these CNS-disorders are epilepsy, stroke, subarachanoid bleeding, bacterial meningitis, and head injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest as arrhythmias, cardiomyopathy, or autonomic dysfunction. Rarer cardiac complications of CNS disorders include heart failure, systolic or diastolic dysfunction, myocardial infarction, arterial hypertension, or pulmonary hypertension. Cardiomyopathy induced by hereditary CNS disease mainly include stress-induced myocardial dysfunction, known as Takotsubo syndrome (TTS). CNS disease triggering TTS includes epilepsy, ischemic stroke, subarachnoid bleeding, or PRES syndrome. Arrhythmias induced by hereditary CNS disease include supraventricular or ventricular arrhythmias leading to palpitations, dizziness, vertigo, fainting, syncope, (near) sudden cardiac death, or sudden unexplained death in epilepsy (SUDEP). Appropriate management of cardiac involvement in CNS-disorders is essential to improve outcome of affected patients.
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Affiliation(s)
| | - Karim Wahbi
- Paris-Descartes, Sorbonne Paris Cite University, 75006 Paris, France; AP-HP, Cardiology Department, Cochin Hospital, Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
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Zhong Y, Wang N, Xu H. Is there a dynamic change in ischemia-modified albumin in patients with obstructive sleep apnea, which often leads to ischemic diseases? Clinics (Sao Paulo) 2013; 68:1474. [PMID: 24270962 PMCID: PMC3812552 DOI: 10.6061/clinics/2013(11)15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yigang Zhong
- Department of Cardiology, Hangzhou First People's Hospital, Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
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