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Florentin J, O'Neil SP, Ohayon LL, Uddin A, Vasamsetti SB, Arunkumar A, Ghosh S, Boatz JC, Sui J, Kliment CR, Chan SY, Dutta P. VEGF Receptor 1 Promotes Hypoxia-Induced Hematopoietic Progenitor Proliferation and Differentiation. Front Immunol 2022; 13:882484. [PMID: 35634304 PMCID: PMC9133347 DOI: 10.3389/fimmu.2022.882484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Although it is well known that hypoxia incites unleashed cellular inflammation, the mechanisms of exaggerated cellular inflammation in hypoxic conditions are not known. We observed augmented proliferation of hematopoietic stem and progenitor cells (HSPC), precursors of inflammatory leukocytes, in mice under hypoxia. Consistently, a transcriptomic analysis of human HSPC exposed to hypoxic conditions revealed elevated expression of genes involved in progenitor proliferation and differentiation. Additionally, bone marrow cells in mice expressed high amount of vascular endothelial growth factor (VEGF), and HSPC elevated VEGF receptor 1 (VEGFr1) and its target genes in hypoxic conditions. In line with this, VEGFr1 blockade in vivo and in vitro decreased HSPC proliferation and attenuated inflammation. In silico and ChIP experiments demonstrated that HIF-1α binds to the promoter region of VEGFR1. Correspondingly, HIF1a silencing decreased VEGFr1 expression in HSPC and diminished their proliferation. These results indicate that VEGF signaling in HSPC is an important mediator of their proliferation and differentiation in hypoxia-induced inflammation and represents a potential therapeutic target to prevent aberrant inflammation in hypoxia-associated diseases.
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Affiliation(s)
- Jonathan Florentin
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Scott P O'Neil
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lee L Ohayon
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Afaz Uddin
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sathish Babu Vasamsetti
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anagha Arunkumar
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Samit Ghosh
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer C Boatz
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Justin Sui
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Corrine R Kliment
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen Y Chan
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Partha Dutta
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Zhao YY, Wang R, Gleason KJ, Lewis EF, Quan SF, Toth CM, Song Y, Morrical M, Rueschman M, Mittleman MA, Redline S. Effect of continuous positive airway pressure treatment on ambulatory blood pressures in high-risk sleep apnea patients: a randomized controlled trial. J Clin Sleep Med 2022; 18:1899-1907. [PMID: 35459446 PMCID: PMC9340589 DOI: 10.5664/jcsm.10012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The long-term effect of continuous positive airway pressure (CPAP) on 24-hour blood pressure (BP) in high-risk patients with obstructive sleep apnea (OSA) is uncertain. We aimed to determine the effect of CPAP treatment on ambulatory BP in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. METHODS In this randomized, controlled, parallel group study, 169 participants were randomly assigned to CPAP treatment or the control group. The primary outcome was the change in mean 24-hour systolic BP between groups from baseline to the average of 6 and 12 month measurements using mixed effect linear regression models. RESULTS The 24-hour systolic BP did not significantly differ by group, although there was a trend of decrease in the CPAP group (treatment effect -2.7 mm Hg [95% confidence interval -5.9 to 0.6]; P=0.105) compared with control. CPAP had the greatest effect on nighttime systolic BP (treatment effect -5.9 mm Hg [95% confidence interval -9.9 to -1.9]; P=0.004). Similar improvements in other nocturnal BP indices were observed. CONCLUSIONS In high risk patients with moderate-severe OSA without severe sleepiness, CPAP resulted in modest BP improvements over 6 to 12 months of follow-up, with possibly larger effects for nocturnal BP. Use of office blood pressure may under-estimate the effect of CPAP on BP profile in patients with OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Sleep Apnea Intervention for Cardiovascular Disease Reduction; Identifier: NCT01261390; URL: https://clinicaltrials.gov/ct2/show/NCT01261390.
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Affiliation(s)
- Ying Y Zhao
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Department of Medicine, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Rui Wang
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J Gleason
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Stuart F Quan
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Claudia M Toth
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Yue Song
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michael Morrical
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Murray A Mittleman
- Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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3
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Tan J, Cui Q, Gu X, Xu S, Xue S, Yuan K, Chen W. [Efficacy of weight management combined with uvulopalatopharyngoplasty for obesityrelated obstructive sleep apnea-hypopnea syndrome]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1668-1672. [PMID: 33243742 DOI: 10.12122/j.issn.1673-4254.2020.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy of weight management combined with pharyngoplasty for treatment of obesity-related obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS Sixty obese patients with OSAHS were randomly assigned into the combined treatment group and control group (n=30) and received treatment with uvulopalatopharyngoplasty (UPPP) combined with cognitive-behavioral-psychological intervention for family weight management and uvulopalatopharyngoplasty with conventional management. At 3 and 6 months of the treatment, the patients were examined for changes in body mass index (BMI), neck circumference, waist circumference, Epworth Sleepiness Scale (ESS) scores, apnea-hypopnea index (AHI), the lowest oxygen saturation (LSaO2) and the percentage of time with oxygen saturation below 90% (CT90). RESULTS After 6 months of treatment, the patients receiving the combined treatment showed significant reductions of BMI, neck circumference and waist circumference as compared with the measurements before treatment and with those in the control group (P < 0.01); these parameters showed no significant changes in the control group (P > 0.05). In the combined treatment group, the ESS score, CT90, AHI, and LSaO2 at 6 months were all superior to those in the control group (P < 0.01) and differed significantly cross different time points during the treatment, and their improvements were the most obvious after 6 months (P < 0.01). After 6 months of treatment, the combined treatment group had a similar cure rate with the control group (6.6% vs 7.1%; χ2=1.66, P > 0.05) but a significantly higher good response (defined as an AHI < 20 h-1 and an AHI reduction by ≥50%) rate (60% vs 35.7%; χ2=8.71, P < 0.01) and a higher overall response (a AHI reduction ≥50%) rate (83.3% vs 53.6%; χ2=10.62, P < 0.01). CONCLUSIONS Weight management combined with uvulopalatopharyngoplasty can produce a good clinical efficacy for treatment of OSAHS with obesity, and the patients should have strengthened continuous family weight management while receiving surgical treatment.
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Affiliation(s)
- Jian Tan
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Qianbo Cui
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Xiang Gu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Shufang Xu
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Sha Xue
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Kun Yuan
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
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Langlois F, Suarez GM, Fleseriu M. Updates in rare and not-so-rare complications of acromegaly: focus on respiratory function and quality of life in acromegaly. F1000Res 2020; 9. [PMID: 32765836 PMCID: PMC7391012 DOI: 10.12688/f1000research.22683.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Acromegaly is a complex disease with excessive growth hormone and insulin-like growth factor 1 (IGF-1) causing multisystem effects, particularly cardiovascular, respiratory, and metabolic. Psychological concerns and poor quality of life (QoL) are also major disease consequences. This review is intended for clinicians and focuses on the latest developments related to respiratory and QoL effects of long-term growth hormone excess. Along with biochemical disease control, patient treatment satisfaction and outcomes have become major treatment objectives; current knowledge and tools to evaluate and manage this aspect of the disease are described. Sleep apnea syndrome and other derangements of lung function and apparatus, from pathophysiology to treatment, and evaluation tools and determinants of QoL in patients with acromegaly are discussed.
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Affiliation(s)
- Fabienne Langlois
- Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Gabriela M Suarez
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, CH8N, Portland, OR, 97239, USA
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, 3303 South Bond Avenue, CH8N, Portland, OR, 97239, USA
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5
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Reid ML, Gleason KJ, Bakker JP, Wang R, Mittleman MA, Redline S. The role of sham continuous positive airway pressure as a placebo in controlled trials: Best Apnea Interventions for Research Trial. Sleep 2020; 42:5497419. [PMID: 31116848 DOI: 10.1093/sleep/zsz099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The main objective of this study was to evaluate the role of sham continuous positive airway pressure (CPAP) compared to conservative medical therapy (CMT) as a control arm in the Best Apnea Interventions for Research (BestAIR) study by assessing differences in subjectively and objectively measured outcomes, adverse events, adherence, and retention rates. METHODS BestAIR is a clinical trial aimed to identify important design features for future randomized controlled trials of CPAP. Participants with obstructive sleep apnea were randomized to one of four groups; two control arms (CMT, sham-CPAP) and two active CPAP arms (with and without behavioral interventions). Blood pressure and health-related quality of life outcomes were assessed at baseline, 6 and 12 months. Study outcomes, retention, and adverse event rates were compared between the two control arms. Sham-CPAP adherence and self-efficacy were also compared to active-CPAP adherence (without behavioral intervention). RESULTS Our sample included 86 individuals in the control arms and 42 participants in the active-CPAP arm. There were no differences in longitudinal profiles in blood pressure, health-related quality of life outcomes, dropout rates, or adverse events in sham-CPAP group compared to CMT-only group (all ps > 0.05); standardized differences were generally small and with inconsistent directionality across measurements. When compared to active-CPAP, sham-CPAP was associated with 93 fewer minutes/night of usage over 12 months (p = 0.007) and lower outcome expectations (p < 0.05). CONCLUSION We observed no evidence of differences in objectively or subjectively measured outcomes with the use of sham-CPAP compared to CMT group. The lower adherence on sham-CPAP and poorer self-efficacy compared to active-CPAP may suggest differences in perceived benefit. REGISTRATION NCT01261390 Best Apnea Interventions for Research (BestAIR) www.clinicaltrials.gov.
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Affiliation(s)
- Michelle L Reid
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA
| | - Kevin J Gleason
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA.,Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Jessie P Bakker
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, MA.,Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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6
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Liu Y, Gao L, Lv W, Lın L, Wang Y, Fıang F, Feng F. Pathologic and hemodynamic changes of common carotid artery in obstructive sleep apnea hypopnea syndrome in a porcine model. Turk J Med Sci 2019; 49:939-944. [PMID: 31195789 PMCID: PMC7018377 DOI: 10.3906/sag-1807-170] [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] [Indexed: 11/30/2022] Open
Abstract
Background/aim To prepare a porcine model of obstructive sleep apnea-hypopnea syndrome (OSAHS) and observe the pathological and hemodynamic changes in the common carotid artery. Materials and methods Twelve male miniature pigs were randomly divided into the model and control group (n = 6). Pigs in the model group were kept in an air-flow negative pressure chamber at 0.96 ± 0.01 kPa, and the air oxygen content, temperature, and humidity were kept at normal culture conditions in both groups. After pigs in the model group presented symptoms of OSAHS, changes in the hemodynamics and morphology of the carotid artery were analyzed using color Doppler, and light and electron microscopy. Results An animal model of OSAHS was successfully created. The internal diameter of the carotid artery of pigs in the model group was decreased, while the intima thickness, peak-systolic mean velocity, and resistance index were increased when compared to the control group (P < 0.05). The results of the light and electron microscopy revealed an incomplete elastic plate, increased media thickness, irregular morphology of the smooth muscle cells, increased collagen fiber bundles, partially disordered elastic fibers, and smooth muscle layers. The quantitative analysis showed significantly increased elastic fibers in the media of the carotid artery in the model group (P < 0.01). Conclusion Pathological changes in the tissue structure and hemodynamics in the negative pressure-induced pig OSAHS model were observed. We suggest that alterations in the upper airway pressure during OSAHS may lead to cardiovascular conditions through its pathological effects on the carotid artery.
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Affiliation(s)
- Yongyi Liu
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lu Gao
- Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Weinong Lv
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Lin Lın
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Yi Wang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Fıang
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China
| | - Fan Feng
- The Fourth Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China,Medical College of Jiangsu University, Jiangsu University, Zhenjiang, China,The Huishan District Second People’s Hospital of Wuxi City, Wuxi, China
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7
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Miech EJ, Bravata DM, Yaggi HK, Austin C, Tobias LA, Ferguson J, Matthias MS. Adapting Continuous Positive Airway Pressure Therapy to Where Patients Live: A Comparative Case Study. Cureus 2019; 11:e4078. [PMID: 31019856 PMCID: PMC6464984 DOI: 10.7759/cureus.4078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives Continuous positive airway pressure (CPAP) therapy has been demonstrated to effectively reverse the abnormal physiology of sleep apnea and improve a variety of patient outcomes, yet helping patients adapt and adhere to CPAP has proven to be a challenging issue in the effective treatment of obstructive sleep apnea (OSA). As a home-based intervention trial, the “Sleep Apnea in Transient Ischemic Attack and Stroke: Reducing Cardiovascular Risk with Positive Airway Pressure” (“sleep tight”) study was uniquely positioned to capture and evaluate challenges faced by patients over time during their introduction to CPAP therapy. Methods A comparative case study design was used to better understand the process whereby patients adapted CPAP therapy in order to fit their own personal set of circumstances. Cases were identified from patients enrolled in the “enhanced intervention” group of the sleep tight trial. Results These comparative case studies illustrated how adherence to CPAP therapy is an adaptive process where personal context matters. The case studies also demonstrated how some patients overcame challenges and barriers by themselves to integrate CPAP therapy into their own lives, while others required help from study staff to overcome these barriers and some were never able to successfully adapt CPAP therapy in order to fit their personal contexts, despite study staffs’ best efforts. Conclusions A major opportunity to improve CPAP adherence appears to exist in placing greater emphasis on supporting patients in adapting CPAP therapy for “where they live.”
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Affiliation(s)
- Edward J Miech
- Internal Medicine, Roudebush VA Medical Center, Indianapolis, USA
| | - Dawn M Bravata
- Internal Medicine, Roudebush VA Medical Center, Indianapolis, USA
| | - H Klar Yaggi
- Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Charles Austin
- Internal Medicine, Roudebush VA Medical Center, Indianapolis, USA
| | - Lauren A Tobias
- Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Jared Ferguson
- Internal Medicine, Roudebush VA Medical Center, Indianapolis, USA
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Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci 2019; 20:ijms20030459. [PMID: 30678164 PMCID: PMC6387387 DOI: 10.3390/ijms20030459] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.
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9
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Bravata DM, Sico J, Vaz Fragoso CA, Miech EJ, Matthias MS, Lampert R, Williams LS, Concato J, Ivan CS, Fleck JD, Tobias L, Austin C, Ferguson J, Radulescu R, Iannone L, Ofner S, Taylor S, Qin L, Won C, Yaggi HK. Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease. J Am Heart Assoc 2018; 7:e008841. [PMID: 30369321 PMCID: PMC6201384 DOI: 10.1161/jaha.118.008841] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/06/2018] [Indexed: 01/16/2023]
Abstract
Background Obstructive sleep apnea ( OSA ) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for OSA among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes. Methods and Results This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of OSA versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced), OSA prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used; P=0.46) patients. In intention-to-treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as-treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, -0.6±2.9; some, -0.9±1.4; good, -0.3±1.0; P=0.0064) and improved modified Rankin Scale score (no/poor, -0.3±1.5; some, -0.4±1.0; good, -0.9±1.2; P=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0-1) versus 38% of controls ( P=0.038); absolute risk reduction was 21% (number needed to treat, 4.8). Conclusions Although changes in neurological functioning and functional status were similar across the groups in the intention-to-treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with OSA . Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT 01446913.
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10
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Han Q, Li G, Ip MS, Zhang Y, Zhen Z, Mak JC, Zhang N. Haemin attenuates intermittent hypoxia-induced cardiac injury via inhibiting mitochondrial fission. J Cell Mol Med 2018. [PMID: 29512942 PMCID: PMC5908095 DOI: 10.1111/jcmm.13560] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Obstructive sleep apnoea (OSA) characterized by intermittent hypoxia (IH) is closely associated with cardiovascular diseases. IH confers cardiac injury via accelerating cardiomyocyte apoptosis, whereas the underlying mechanism has remained largely enigmatic. This study aimed to explore the potential mechanisms involved in the IH‐induced cardiac damage performed with the IH‐exposed cell and animal models and to investigate the protective effects of haemin, a potent haeme oxygenase‐1 (HO‐1) activator, on the cardiac injury induced by IH. Neonatal rat cardiomyocyte (NRC) was treated with or without haemin before IH exposure. Eighteen male Sprague‐Dawley (SD) rats were randomized into three groups: control group, IH group (PBS, ip) and IH + haemin group (haemin, 4 mg/kg, ip). The cardiac function was determined by echocardiography. Mitochondrial fission was evaluated by Mitotracker staining. The mitochondrial dynamics‐related proteins (mitochondrial fusion protein, Mfn2; mitochondrial fission protein, Drp1) were determined by Western blot. The apoptosis of cardiomyocytes and heart sections was examined by TUNEL. IH regulated mitochondrial dynamics‐related proteins (decreased Mfn2 and increased Drp1 expressions, respectively), thereby leading to mitochondrial fragmentation and cell apoptosis in cardiomyocytes in vitro and in vivo, while haemin‐induced HO‐1 up‐regulation attenuated IH‐induced mitochondrial fragmentation and cell apoptosis. Moreover, IH resulted in left ventricular hypertrophy and impaired contractile function in vivo, while haemin ameliorated IH‐induced cardiac dysfunction. This study demonstrates that pharmacological activation of HO‐1 pathway protects against IH‐induced cardiac dysfunction and myocardial fibrosis through the inhibition of mitochondrial fission and cell apoptosis.
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Affiliation(s)
- Qian Han
- State Key Laboratory, Guangzhou Institute of Respiratory Health, Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guihua Li
- State Key Laboratory, Guangzhou Institute of Respiratory Health, Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mary SiuMan Ip
- Li Kashing Faculty of Medicine, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuelin Zhang
- Li Kashing Faculty of Medicine, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Zhe Zhen
- Li Kashing Faculty of Medicine, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Judith ChoiWo Mak
- Li Kashing Faculty of Medicine, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nuofu Zhang
- State Key Laboratory, Guangzhou Institute of Respiratory Health, Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Festic N, Alejos D, Bansal V, Mooney L, Fredrickson PA, Castillo PR, Festic E. Sleep Apnea in Patients Hospitalized With Acute Ischemic Stroke: Underrecognition and Associated Clinical Outcomes. J Clin Sleep Med 2018; 14:75-80. [PMID: 29198297 DOI: 10.5664/jcsm.6884] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. METHODS A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. RESULTS Of 989 patients, 190 (19%) were considered to have sleep apnea. Only 42 patients (22%) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1% versus 5.6% in patients without sleep apnea (odds ratio [OR] 0.18; 95% confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95% CI 1.01-1.11, P = .01 and OR 0.61, 95% CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95% CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95% CI 0.01-0.52; P = .01). CONCLUSIONS Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.
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12
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Lam AS, Collop NA, Bliwise DL, Dedhia RC. Validated Measures of Insomnia, Function, Sleepiness, and Nasal Obstruction in a CPAP Alternatives Clinic Population. J Clin Sleep Med 2017. [PMID: 28633723 DOI: 10.5664/jcsm.6692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVES Although efficacious in the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) can be difficult to tolerate, with long-term adherence rates approaching 50%. CPAP alternatives clinics specialize in the evaluation and treatment of CPAP-intolerant patients; yet this population has not been studied in the literature. To better understand these patients, we sought to assess insomnia, sleep-related functional status, sleepiness, and nasal obstruction, utilizing data from validated instruments. METHODS After approval from the Emory University Institutional Review Board, a retrospective chart review was performed from September 2015 to September 2016 of new patient visits at the Emory CPAP alternatives clinic. Patient demographics and responses were recorded from the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), Epworth Sleepiness Scale, and Nasal Obstruction Symptom Evaluation questionnaires. RESULTS A total of 172 patients were included, with 81% having moderate-severe OSA. Most of the patients demonstrated moderate-severe clinical insomnia and at least moderate nasal obstruction. FOSQ-10 scores indicated sleep-related functional impairment in 88%. However, most patients did not demonstrate excessive daytime sleepiness. CONCLUSION This patient population demonstrates significant symptomatology and functional impairment. Because of the severity of their OSA, they are at increased risk of complications. In order to mitigate the detrimental effects of OSA, these significantly impacted patients should be identified and encouraged to seek CPAP alternatives clinics that specialize in the treatment of this population.
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Affiliation(s)
- Austin S Lam
- Emory University School of Medicine, Atlanta, Georgia
| | - Nancy A Collop
- Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Donald L Bliwise
- Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Raj C Dedhia
- Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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13
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Campo F, Sanabria-Arenas F, Hidalgo-Martinez P. Tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) con presión positiva en la vía aérea (PAP). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Para el tratamiento de cualquier enfermedad es necesario un adecuado manejo multidisciplinar e involucrar al paciente en la mejor opción que se requiera a largo plazo; la falta de tratamiento de los pacientes implica una enorme carga para el sistema sanitario y la sociedad. En la actualidad, existen diferentes tratamientos para los pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS); el de mayor elección, después de descartar anomalías anatómicas susceptibles de cirugía, es el PAP (presión positiva en vía aérea). Las indicaciones para terapia con PAP incluyen pacientes con índice de apnea-hipopnea (IAH) ≥15 eventos/hora o ≥5 y ≤14 eventos/hora y quejas de somnolencia diurna excesiva, deterioro cognitivo, trastorno del afecto o insomnio, hipertensión arterial documentada, enfermedad arterial coronaria o historia de evento cerebrovascular. Es importante recordar que el IAH debe basarse en sueño ≥2 horas de registro polisomnográfico. Hay diferentes modalidades de tratamiento con PAP y se debe intervenir para buscar mejorar la adherencia al dispositivo, principal limitante para alcanzar la eficacia en el tratamiento. El impacto del tratamiento del SAHOS ha sido investigado, pero la mayoría de los estudios reportados son de carácter observacional.
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14
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Pietrock C, von Haehling S. Sleep-disordered breathing in heart failure: facts and numbers. ESC Heart Fail 2017; 4:198-202. [PMID: 28772039 PMCID: PMC5542721 DOI: 10.1002/ehf2.12193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/12/2022] Open
Abstract
Sleep‐disordered breathing has a high prevalence in the general population, but is especially prominent in patients with heart failure (HF). HF and sleep‐disordered breathing share a bidirectional relationship, with sleep‐disordered breathing being both cause and effect of poor cardiac functioning. The high inter‐individual variability of symptom presentation can impede the clinical diagnostic process. Polysomnography is the gold‐standard method of diagnosing sleep‐disordered breathing. Therapy of sleep‐disordered breathing should always consist of optimizing the treatment of the underlying disorder of HF. Additional therapeutic measures include continuous positive airway pressure ventilation therapy. New therapeutic options using neurostimulation are yielding promising results; however, long‐term benefits still need to be confirmed.
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Affiliation(s)
- Charlotte Pietrock
- Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Charité Medical School, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
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15
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Parsons C, Allen S, Parish J, Mookadam F, Mookadam M. The efficacy of continuous positive airway pressure therapy in reducing cardiovascular events in obstructive sleep apnea: a systematic review. Future Cardiol 2017. [DOI: 10.2217/fca-2017-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prospective studies show an association between obstructive sleep apnea and cardiovascular disease. Continuous positive airway pressure (CPAP) is the treatment of choice and effectively reduces subjective sleepiness and apneic and hypopneic events. However, randomized trials have not shown a reduction in cardiovascular outcomes with CPAP therapy. We review the past 10 years of randomized trial evidence regarding the therapeutic efficacy of CPAP on cardiovascular outcomes and mortality in adults with obstructive sleep apnea. The majority of studies found no significant improvement in cardiovascular outcomes with CPAP, although many noted nonsignificant benefits. Adjusted analysis in several trials showed significant cardiovascular benefit in those patients with higher CPAP compliance. Existing trials may lack sufficient follow-up and CPAP compliance, among other limitations.
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Affiliation(s)
- Christine Parsons
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Sorcha Allen
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - James Parish
- Department of Sleep Disorders & Pulmonology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 EShea Blvd, Scottsdale, AZ 85259, USA
| | - Martina Mookadam
- Department of Family Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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16
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Zhao YY, Wang R, Gleason KJ, Lewis EF, Quan SF, Toth CM, Morrical M, Rueschman M, Weng J, Ware JH, Mittleman MA, Redline S. Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial. Sleep 2017; 40:3737623. [PMID: 28419387 PMCID: PMC5806548 DOI: 10.1093/sleep/zsx040] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objectives The long-term effect of continuous positive airway pressure (CPAP) on health-related quality of life (HRQOL) in patients with high cardiovascular disease risk and obstructive sleep apnea (OSA) without severe sleepiness is uncertain. We aimed to determine the effect of CPAP treatment on HRQOL in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. Methods In this randomized, controlled, parallel group study, 169 participants were assigned to treatment with CPAP or the control group (conservative medical therapy [CMT] or CMT with sham CPAP). Analyses were based on an intention-to-treat approach. Linear mixed effect models were fitted to compare the changes in the Medical Outcomes Study Short Form-36 (SF-36) and in subjective sleepiness (Epworth Sleepiness Scale [ESS]) between groups from baseline to the average of 6- and 12-month measurements. Results CPAP improved several domains of HRQOL including bodily pain (treatment effect 9.7 [95% confidence interval, CI 3.9 to 15.4]; p = .001), vitality (5.7 [95% CI 1.5 to 9.9]; p = .008), general health (8.2 [95% CI 3.7 to 12.7]; p < .001), physical functioning (5.5 [95% CI 1.1 to 10.0]; p = .016), and the physical health summary score (3.3 [95% CI 1.4 to 5.3]; p = .001). CPAP also resulted in less daytime sleepiness (mean change in ESS -1.0 point [95% CI -2.0 to -0.0]; p = .040). Conclusions In patients with moderate-severe OSA at high risk of cardiovascular events and without severe sleepiness, CPAP improved daytime sleepiness and multiple domains of HRQOL over 6 to 12 months of follow-up, with the largest improvement observed for bodily pain.
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Affiliation(s)
- Ying Y Zhao
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rui Wang
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kevin J Gleason
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Eldrin F Lewis
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Stuart F Quan
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Claudia M Toth
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael Morrical
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jia Weng
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - James H Ware
- Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Murray A Mittleman
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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17
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Parsons C, Mookadam F, Mookadam M. The effect of obstructive sleep apnea treatment on cardiovascular outcomes. Future Cardiol 2017; 13:5-8. [DOI: 10.2217/fca-2016-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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18
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Grigg-Damberger MM. Wake-up Call to Identify Obstructive Sleep Apnea in Patients with Ischemic Strokes. J Clin Sleep Med 2016; 12:463-5. [PMID: 26951406 DOI: 10.5664/jcsm.5664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Madeleine M Grigg-Damberger
- University of New Mexico School of Medicine, Department of Neurology, University of New Mexico, Albuquerque, NM
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19
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Bakker JP, Wang R, Weng J, Aloia MS, Toth C, Morrical MG, Gleason KJ, Rueschman M, Dorsey C, Patel SR, Ware JH, Mittleman MA, Redline S. Motivational Enhancement for Increasing Adherence to CPAP: A Randomized Controlled Trial. Chest 2016; 150:337-45. [PMID: 27018174 DOI: 10.1016/j.chest.2016.03.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/19/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Motivational enhancement (ME) shows promise as a means of increasing adherence to CPAP for OSA. METHODS We performed an open-label, parallel-arm, randomized controlled trial of CPAP only or CPAP + ME, recruiting individuals 45 to 75 years with moderate or severe OSA without marked sleepiness and with either established cardiovascular disease (CVD) or at risk for CVD. All participants received standardized CPAP support from a sleep technologist; those randomly assigned to CPAP + ME also received standardized ME delivered by a psychologist during two appointments and six phone calls over 32 weeks. Mixed-effect models with subject-specific intercepts and slopes were fitted to compare objective CPAP adherence between arms, adjusting for follow-up duration, randomization factors, and device manufacturer. All analyses were intention-to-treat. RESULTS Overall, 83 participants (n = 42 CPAP only; n = 41 CPAP + ME) contributed 14,273 nights of data for 6 months. Participants were predominantly male (67%) and had a mean ± SD age of 63.9 ± 7.4 years, a BMI of 31.1 ± 5.2 kg/m(2), and an apnea-hypopnea index of 26.2 ± 12.9 events/h. In our fully adjusted model, average nightly adherence for 6 months was 99.0 min/night higher with CPAP + ME compared with CPAP only (P = .003; primary analysis). A subset of 52 participants remained in the study for 12 months; modeling these data yielded a consistent difference in adherence between arms of 97 min/night (P = .006) favoring CPAP + ME. CONCLUSIONS ME delivered during brief appointments and phone calls resulted in a clinically significant increase in CPAP adherence. This strategy may represent a feasible approach for optimizing management of OSA. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01261390; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jessie P Bakker
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Rui Wang
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | - Jia Weng
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark S Aloia
- National Jewish Health, Denver, CO; Philips Respironics, Murrysville, PA
| | - Claudia Toth
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael G Morrical
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kevin J Gleason
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael Rueschman
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Sanjay R Patel
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James H Ware
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard TH Chan School of Public Health and Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Redline
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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