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Carrero-Cardenal E, Vollmer-Torrubiano I, Torres-López M, Martín-Barrera G, Casanovas-Mateu G, Tercero-Machin FJ, Paez-Carpio A, Fábregas-Julià N, Valero-Castell R. Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial. Insights Imaging 2024; 15:153. [PMID: 38900225 PMCID: PMC11190131 DOI: 10.1186/s13244-024-01721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.
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Affiliation(s)
- Enrique Carrero-Cardenal
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Ivan Vollmer-Torrubiano
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marta Torres-López
- Centre for Biomedical Research in the Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Martín-Barrera
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Surgical Area Nursing Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Alfredo Paez-Carpio
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Neus Fábregas-Julià
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Clinical Quality and Safety Directorate, Surgical Area, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Valero-Castell
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Denis C, Jaussent I, Guiraud L, Mestejanot C, Arquizan C, Mourand I, Chenini S, Abril B, Wacongne A, Tamisier R, Baillieul S, Pepin JL, Barateau L, Dauvilliers Y. Functional recovery after ischemic stroke: Impact of different sleep health parameters. J Sleep Res 2024; 33:e13964. [PMID: 37338010 DOI: 10.1111/jsr.13964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Sleep disturbances after ischaemic stroke include alterations of sleep architecture, obstructive sleep apnea, restless legs syndrome, daytime sleepiness and insomnia. Our aim was to explore their impacts on functional outcomes at month 3 after stroke, and to assess the benefit of continuous positive airway pressure in patients with severe obstructive sleep apnea. Ninety patients with supra-tentorial ischaemic stroke underwent clinical screening for sleep disorders and polysomnography at day 15 ± 4 after stroke in a multisite study. Patients with severe obstructive apnea (apnea-hypopnea index ≥ 30 per hr) were randomized into two groups: continuous positive airway pressure-treated and sham (1:1 ratio). Functional independence was assessed with the Barthel Index at month 3 after stroke in function of apnea-hypopnea index severity and treatment group. Secondary objectives were disability (modified Rankin score) and National Institute of Health Stroke Scale according to apnea-hypopnea index. Sixty-one patients (71.8 years, 42.6% men) completed the study: 51 (83.6%) had obstructive apnea (21.3% severe apnea), 10 (16.7%) daytime sleepiness, 13 (24.1%) insomnia, 3 (5.7%) depression, and 20 (34.5%) restless legs syndrome. Barthel Index, modified Rankin score and Stroke Scale were similar at baseline and 3 months post-stroke in the different obstructive sleep apnea groups. Changes at 3 months in those three scores were similar in continuous positive airway pressure versus sham-continuous positive airway pressure patients. In patients with worse clinical outcomes at month 3, mean nocturnal oxygen saturation was lower whereas there was no association with apnea-hypopnea index. Poorer outcomes at 3 months were also associated with insomnia, restless legs syndrome, depressive symptoms, and decreased total sleep time and rapid eye movement sleep.
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Affiliation(s)
- Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | | | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Mestejanot
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Arquizan
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Isabelle Mourand
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Sofiène Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Beatriz Abril
- Sleep University, Carémeau Hospital, CHU, Nîmes, France
| | - Anne Wacongne
- Neurology Department, Carémeau Hospital, CHU, Nîmes, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Sébastien Baillieul
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Jean-Louis Pepin
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
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Rocha BR, Ribeiro VV, Tempaku PF, Tufik S, Poyares D, Behlau M. What is the Effect of CPAP Treatment With Humidifier on Vocal Quality? J Voice 2023:S0892-1997(23)00299-0. [PMID: 37867069 DOI: 10.1016/j.jvoice.2023.09.023] [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: 08/21/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Evaluate vocal quality in patients with OSA before and after continuous use of CPAP with a humidifier using subjective patient perception and clinical assessment. The hypothesis was that CPAP treatment with a humidifier would benefit voice quality. STUDY DESIGN Randomized, sham-controlled, blinded clinical trial. METHODS Forty-three natal males with obstructive sleep apnea for whom CPAP treatment was recommended following polysomnography were randomized into two therapy groups: CPAP and Sham-CPAP. Participants completed questionnaires on voice use, a voice self-assessment with the ten-item vocal handicap index (VHI-10), and complementary questionnaires: the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), reflux symptoms index (LPRSI) and oral dryness visual analog scale (DRY). Their voices were recorded at three different times: before CPAP therapy, and after 3 and 6 months of continuous CPAP use. The acoustic voice quality index (AVQI), and an auditory-perceptual judgment (APJ) were also applied before and after the CPAP and Sham treatments. RESULTS After 6 months of treatment, the CPAP group presented improvements in their sleep patterns; however, no statistically significant differences were observed between the groups in respect of the results of the voice-related questionnaires, the AVQI values, and the APJ of the voice quality. All of the participants had some degree of vocal deviation at baseline. CONCLUSIONS CPAP therapy with a humidifier did not improve vocal quality as evaluated by the clinician or patient self-assessment. However, it did not have any significant negative effects on voice quality, so can be considered safe to use in male OSA patients.
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Affiliation(s)
- Bruna R Rocha
- Department of Communication Disorders, Universidade Federal de São Paulo, São Paulo, Brazil; CEV, Centro de Estudos da Voz, São Paulo, Brazil.
| | | | - Priscila F Tempaku
- Department of Psychobiology, Escola Paulista de Medicina (EPM), Federal University of São Paulo, São Paulo, SP, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina (EPM), Federal University of São Paulo, São Paulo, SP, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Escola Paulista de Medicina (EPM), Federal University of São Paulo, São Paulo, SP, Brazil
| | - Mara Behlau
- Department of Communication Disorders, Universidade Federal de São Paulo, São Paulo, Brazil; CEV, Centro de Estudos da Voz, São Paulo, Brazil
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Hoff E, Zou D, Grote L, Stenlöf K, Hedner J. The placebo effect in pharmacological treatment of obstructive sleep apnea, a systematic review and meta-analysis. Sleep Med 2023; 106:1-7. [PMID: 37023489 DOI: 10.1016/j.sleep.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE New drug treatments are under development in obstructive sleep apnea (OSA). The placebo effect is well recognized in various conditions, but its relevance in OSA is debated. In the current study we determined the influence of a placebo effect in studies of drug therapy in OSA. METHODS A systematic review and meta-analysis (PROSPERO CRD42021229410) with searches in MEDLINE, Scopus, Web of Science and Cochrane CENTRAL from inception to 2021-01-19. Inclusion criteria were (i) RCTs of adults with OSA, (ii) drug intervention with placebo baseline and follow-up sleep study (iii) outcomes: apnea hypopnea index (AHI), mean oxygen saturation (mSaO2), oxygen desaturation index (ODI) and/or Epworth Sleepiness Scale (ESS). Risk-of-bias was assessed with Cochrane RoB 2. RESULTS 7436 articles were identified and 29 studies included (n = 413). Studies were generally small (median n = 14), with 78% men, baseline AHI range 9-74 events/h and treatment duration range 1-120 days. Meta-analyses were conducted for main outcomes. Mean change of the primary outcome, AHI, was -0.84 (95% CI -2.98 to 1.30); mSaO2 and ODI estimations were also non-significant. ESS showed a trend towards a reduction of -1 unit. Subgroup analysis did not show significant differences. Risk-of-bias assessment indicated mostly low risk but studies were small with wide confidence intervals. CONCLUSIONS In this meta-analysis we did not identify systematic placebo effects on the AHI, ODI or mSaO2 while ESS score showed a trend for a small reduction. These results have an impact on the design and interpretation of drug trials in OSA.
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Affiliation(s)
- Erik Hoff
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Södra Älvsborgs Hospital, Department of Infectious Diseases, Borås, Sweden.
| | - Ding Zou
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Ludger Grote
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Centre for Sleep Medicine, Department of Pulmonary Medicine, Gothenburg, Sweden.
| | - Kaj Stenlöf
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Jan Hedner
- Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Centre for Sleep Medicine, Department of Pulmonary Medicine, Gothenburg, Sweden.
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5
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Gravdahl GB, Aakerøy L, Stovner LJ, Engstrøm M, Müller KI, Bjørk MH, Tronvik E. Continuous positive airway pressure in cluster headache: A randomized, placebo-controlled, triple-blind, crossover study. Cephalalgia 2023; 43:3331024221128273. [PMID: 36620891 DOI: 10.1177/03331024221128273] [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: 01/10/2023]
Abstract
BACKGROUND Oxygen inhalation aborts cluster headache attacks, and case reports show the effect of continuous positive airway pressure. The aim of this study was to investigate the prophylactic effect of continuous positive airway pressure in chronic cluster headache. METHODS This was a randomized placebo-controlled triple-blind crossover study using active and sham continuous positive airway pressure treatment for chronic cluster headache. Patients entered a one month's baseline period before randomly being assigned to two months' active continuous positive airway pressure treatment followed by a four weeks' washout period and two months' sham continuous positive airway pressure or vice versa. Primary outcome measure was number of cluster headache attacks/week. RESULTS Of the 30 included participants (12 males, median age 49.5 years, min-max 20-66 years), 25 completed both treatment/sham cycles (two discontinued, three lost to follow-up). The median number of cluster headache attacks per week was reduced from 8.25 (0.75-89.75) attacks to 6.25 (0-56.00) attacks for active continuous positive airway pressure and to 7.50 (0.50-43.75) attacks for sham continuous positive airway pressure, but there was no difference in active versus sham (p = 0.904). One patient had a serious adverse event during active treatment, none occurred during sham treatment. CONCLUSIONS Continuous positive airway pressure treatment did not reduce the number of cluster headache attacks compared to sham treatment in chronic cluster headache patients. TRIAL REGISTRATION CLINICALTRIALS.GOV NCT03397563.
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Affiliation(s)
- Gøril Bruvik Gravdahl
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olav University Hospital, Trondheim, Norway.,NorHEAD, Norwegian Headache Research Centre, Norway
| | - Lars Aakerøy
- Department of Thoracic Medicine, St. Olav University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olav University Hospital, Trondheim, Norway.,NorHEAD, Norwegian Headache Research Centre, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Department of Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital
| | - Kai Ivar Müller
- Department of Neurology and National Neuromuscular Centre, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Marte Helene Bjørk
- NorHEAD, Norwegian Headache Research Centre, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olav University Hospital, Trondheim, Norway.,NorHEAD, Norwegian Headache Research Centre, Norway
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6
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A randomized sham-controlled trial on the effect of continuous positive airway pressure treatment on gait control in severe obstructive sleep apnea patients. Sci Rep 2021; 11:9329. [PMID: 33927278 PMCID: PMC8085224 DOI: 10.1038/s41598-021-88642-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
To determine the effect of continuous positive airway pressure (CPAP), the gold standard treatment for obstructive sleep apnea syndrome (OSAS), on gait control in severe OSAS patients. We conducted a randomized, double-blind, parallel-group, sham-controlled monocentric study in Grenoble Alpes University Hospital, France. Gait parameters were recorded under single and dual-task conditions using a visuo-verbal cognitive task (Stroop test), before and after the 8-week intervention period. Stride-time variability, a marker of gait control, was the primary study endpoint. Changes in the determinants of gait control were the main secondary outcomes. ClinicalTrials.gov Identifier: (NCT02345694). 24 patients [median (Q1; Q3)]: age: 59.5 (46.3; 66.8) years, 87.5% male, body mass index: 28.2 (24.7; 29.8) kg. m−2, apnea–hypopnea index: 51.6 (35.0; 61.4) events/h were randomized to be treated by effective CPAP (n = 12) or by sham-CPAP (n = 12). A complete case analysis was performed, using a mixed linear regression model. CPAP elicited no significant improvement in stride-time variability compared to sham-CPAP. No difference was found regarding the determinants of gait control. This study is the first RCT to investigate the effects of CPAP on gait control. Eight weeks of CPAP treatment did not improve gait control in severe non-obese OSAS patients. These results substantiate the complex OSAS-neurocognitive function relationship.
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7
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Sex-Specific Differential Responses of Circulating Biomarkers in Obstructive Sleep Apnea Treatment. A Post Hoc Analysis of a Randomized Controlled Trial. Ann Am Thorac Soc 2021; 17:605-613. [PMID: 31860326 DOI: 10.1513/annalsats.201908-593oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Knowledge of sex-specific changes of cardiovascular biomarkers in response to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) is limited.Objectives: We hypothesized a differential sex-specific cardiovascular biomarker response with CPAP therapy for OSA.Methods: Participants with moderate-severe OSA (apnea-hypopnea index, 15 events/h) were randomized to CPAP versus sham and completed polysomnography and collection of biomarkers of inflammation (myeloperoxidase, fibrinogen, paraoxonase, interleukin [IL]-6, IL-6 soluble receptor, aryl esterase, oxidized low-density lipoprotein, lipoprotein A, plasminogen activator inhibitor 1, and F2-isoprostane urine/creatinine ratio) and vascular measures at baseline and 8 weeks of therapy with either CPAP (n = 72) or sham treatment (n = 70). Post hoc secondary analyses of sex-study arm interaction relative to change in inflammatory biomarkers were evaluated via linear regression with adjustment for baseline biomarker value, age, race, body mass, index, waist circumference, and CPAP adherence. Interactions were further evaluated via sex-stratified analyses.Results: The study sample comprised a total of 149 participants aged 50.8 ± 11.7 years; 55% were male, and 55% were white. Participants had a median apnea-hypopnea index of 26.3 events per hour (interquartile range, 13-37). There were substantial interactions between study arm and sex for myeloperoxidase, paraoxonase, and fibrinogen (P = 0.03, P = 0.03, and P = 0.08, respectively). No significant interactions were found for the vascular measures. Estimates were similar but with decreased power in sex-stratified analyses, with decreased biomarkers in women and increased biomarkers in men.Conclusions: Differential sex-specific responses to CPAP therapy for OSA were observed for circulating inflammatory biomarkers, which persisted after adjustment for confounders. These findings set the stage for validation studies and, if confirmed, biochemical pathway elucidation to inform sex-specific personalized treatment approaches.Clinical trial registered with www.clinicaltrials.gov (NCT00607893).
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8
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Javaheri S, Gottlieb DJ, Quan SF. Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). J Sleep Res 2019; 29:e12943. [PMID: 31726485 DOI: 10.1111/jsr.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea is associated with hypertension, and short-term studies have demonstrated a modest reduction in blood pressure with continuous positive airway pressure therapy. We evaluated the effects of continuous positive airway pressure versus sham continuous positive airway pressure on blood pressure in 1,101 participants with obstructive sleep apnea from the Apnea Positive Pressure Long-term Efficacy Study, a randomized, sham-controlled double-blinded study designed to assess the impact of continuous positive airway pressure on neurocognition. Participants with apnea-hypopnea index ≥ 10 were randomly assigned to continuous positive airway pressure or sham continuous positive airway pressure. Blood pressures measured in the morning and evening at baseline, 2 months and 6 months were analysed post hoc using a mixed-model repeated-measures analysis of variance. The largest magnitude reduction was approximately 2.4 mmHg in morning systolic pressure that occurred at 2 months in the continuous positive airway pressure arm as compared with an approximate 0.5 mmHg reduction in the sham group (continuous positive airway pressure effect -1.9 mmHg, p = .008). At 6 months, the difference between groups was diminished and no longer statistically significant (continuous positive airway pressure effect -0.9 mmHg, p = .12). Sensitivity analysis with use of multiple imputation approaches to account for missing data did not change the results. Treatment with continuous positive airway pressure for obstructive sleep apnea reduces morning but not evening blood pressure in a population with well-controlled blood pressure. The effect was greater after 2 than after 6 months of treatment.
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Affiliation(s)
- Sogol Javaheri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Gottlieb
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Stuart F Quan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Asthma and Airways Disease Research Center, University of Arizona, Tucson, AZ, USA
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9
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Kim DJ, Choi BG, Cho JW, Mun SJ, Lee MW, Kim HW. Comparison for the Optimal Pressure between Manual CPAP and APAP Titration with Obstructive Sleep Apnea Patients. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2019. [DOI: 10.15324/kjcls.2019.51.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dae Jin Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byoung Geol Choi
- Research Institute of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Woo Lee
- Research Institute of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Joyeux-Faure M, Baguet JP, Barone-Rochette G, Faure P, Sosner P, Mounier-Vehier C, Lévy P, Tamisier R, Pépin JL. Continuous Positive Airway Pressure Reduces Night-Time Blood Pressure and Heart Rate in Patients With Obstructive Sleep Apnea and Resistant Hypertension: The RHOOSAS Randomized Controlled Trial. Front Neurol 2018; 9:318. [PMID: 29867728 PMCID: PMC5951941 DOI: 10.3389/fneur.2018.00318] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Most patients with resistant hypertension (RH) have obstructive sleep apnea (OSA). We aimed to determine the impact of OSA and continuous positive airway pressure (CPAP) treatment on the leptin profile and blood pressure (BP) in patients with RH. Methods After an initial case-control study (RH with and without OSA), we performed a randomized, single blind study in OSA + RH patients receiving either sham CPAP (3 months) followed by active CPAP (6 months) or 6 months of active CPAP. The primary outcome was the comparison of leptin levels between groups of RH patients with or without OSA. Secondary outcomes were the comparison of metabolic parameters, biomarkers of sympathetic activity, and BP indices between the two groups of RH patients with or without OSA. The same outcomes were then evaluated and compared before and after sham and effective CPAP intervention. Results Sixty-two patients (60 ± 10 years; 77% men) with RH (24-h daytime systolic BP (SBP)/diastolic BP: 145 ± 13/85 ± 10 mmHg, 3.7 antihypertensive drugs) were included. The 37 RH patients exhibiting OSA (60%) were predominantly men (87 vs 64% for non-OSA patients), with a greater prevalence of metabolic syndrome and higher creatininemia. Their leptin concentrations were significantly lower than in non-OSA patients [9 (6; 15) vs 17 (6; 29) ng/mL] but increased after 6 months of CPAP. Three months of effective CPAP significantly decreased night-time SBP by 6.4 mmHg and heart rate (HR) by 6.0 bpm, compared to sham CPAP. Conclusion The association between OSA and RH corresponds to a specific, predominately male phenotype with a higher burden of metabolic syndrome and higher creatininemia but there was no significant difference between OSA and non-OSA patients regarding BP indices, and the number of antihypertensive drugs used. Active CPAP could be efficient at decreasing night-time BP and HR, but there was no difference between CPAP and sham CPAP groups for all metabolic and SNS markers (NCT00746902 RHOOSAS).
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Affiliation(s)
- Marie Joyeux-Faure
- HP2 Laboratory, INSERM, University Grenoble Alpes, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Jean-Philippe Baguet
- Cardiology Department, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Gilles Barone-Rochette
- Cardiology Department, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Patrice Faure
- HP2 Laboratory, INSERM, University Grenoble Alpes, Grenoble, France.,Biochemistry, Toxicology and Pharmacology Department, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Philippe Sosner
- Cardiology Department, Poitiers University Hospital (CHU de Poitiers) - La Millétrie, Poitiers, France
| | - Claire Mounier-Vehier
- Vascular Medicine and Hypertension Department, Lille University Hospital (CHU de Lille), Lille, France
| | - Patrick Lévy
- HP2 Laboratory, INSERM, University Grenoble Alpes, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM, University Grenoble Alpes, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM, University Grenoble Alpes, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital (CHU de Grenoble), Grenoble, France
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11
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May AM, Gharibeh T, Wang L, Hurley A, Walia H, Strohl KP, Mehra R. CPAP Adherence Predictors in a Randomized Trial of Moderate-to-Severe OSA Enriched With Women and Minorities. Chest 2018; 154:567-578. [PMID: 29684316 DOI: 10.1016/j.chest.2018.04.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/12/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Suboptimal CPAP adherence in OSA clinical trials involving predominantly white men limits interpretability and generalizability. We examined predictors of CPAP adherence in a clinical trial enriched with minorities. METHODS The Sleep Apnea Stress Study-a randomized, double-blind, sham-controlled trial of patients with moderate-to-severe OSA-included participants with complete 8-week adherence data (n = 138). Overnight 14-channel polysomnography, anthropometry, socioeconomic status, mood questionnaires, and week 1 CPAP adherence were analyzed via adjusted linear models relative to CPAP adherence (average minutes per night usage). RESULTS Overall, age was 51 ± 12 years, 55% of the patients were male, 55% were white, BMI was 36.7 ± 7.7 kg/m2, and median apnea-hypopnea index was 20 (interquartile range, 13-37). In univariate analyses adherence increased with randomization to active CPAP (81 min; 95% CI, 30-132), increasing age (35 min/decade; 95% CI, 13-57), white race (78 min, 95% CI, 26-129), and per hour of week 1 adherence (41 min, 95% CI, 32-51). Active CPAP (48 min, 95% CI, 6-91), increasing age (27 min/decade, 95% CI, 10-44), and higher 1-week adherence (36 min/h, 95% CI, 27-46) were significantly associated with improved adherence in multivariable analyses. Subgroup analyses showed stronger associations of adherence with treatment arm in whites and increasing age in minorities. Increasing age and white race were more strongly associated with adherence in women. CONCLUSIONS In this trial with near-even sex distribution and high ethnic minority representation, we identified CPAP assignment, increasing age, and early adherence to be associated with improved adherence in addition to sex-specific and race-specific adherence differences. These results can inform targeted clinical trial adherence optimization strategies. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00607893; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Anna M May
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
| | - Tarek Gharibeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Ahuja Medical Center, Cleveland, OH
| | - Lu Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Amanda Hurley
- Indiana Wesleyan University School of Nursing, Marion, IN
| | - Harneet Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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12
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Gupta A, Shukla G. Polysomnographic determinants of requirement for advanced positive pressure therapeutic options for obstructive sleep apnea. Sleep Breath 2017; 22:401-409. [DOI: 10.1007/s11325-017-1556-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 08/03/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
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13
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Yagihara F, Lorenzi-Filho G, Santos-Silva R. Nasal Dilator Strip is an Effective Placebo Intervention for Severe Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:215-221. [PMID: 27707442 DOI: 10.5664/jcsm.6450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate the effects of nasal dilator strip (NDS) as a placebo intervention compared with continuous positive airway pressure (CPAP) treatment in patients with severe obstructive sleep apnea (OSA). METHODS Patients were treated with both NDS and nasal CPAP. The sequence was randomized and interposed by 15 days of washout. Polysomnography was performed at baseline and on the first night of intervention with NDS and CPAP (titration). The Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Beck Depression Inventory (BDI) were completed at baseline and at the end of both interventions. A questionnaire on the comfort and satisfaction (0 = no to 10 = total) was completed at the end of each intervention. RESULTS Twenty-six patients with OSA were evaluated (19 male; age 46.3 ± 9.3 y; body mass index 33.2 ± 5.1 kg/m2; ESS 15.8 ± 4.1; apnea-hypopnea index 60.7 ± 25.2). Adherence was high in both NDS (98%) and CPAP interventions (94%; 5.8 ± 1.7 h/night). In contrast to the baseline values, NDS intervention had no significant effect on all polysomnographic parameters, but NDS improved somnolence (ESS 13.0 ± 5.4, p = 0.001) and depressive symptoms (BDI 7.7 ± 6.9, p = 0.005). Reported satisfaction was significantly higher for CPAP than for NDS (sleep quality 9.2 ± 0.8 vs. 6.1 ± 2.1; wake up at morning: 8.6 ± 1.2 vs. 6.0 ± 2.2; daily activities: 8.9 ± 1.4 vs. 5.8 ± 1.5; quality of life: 8.3 ± 2.1 vs. 3.8 ± 3.5, p < 0.001), but similar low levels of difficulty for both interventions were observed (1.3 ± 2.2 vs. 0.3 ± 1.3, p = 0.098). CONCLUSIONS Our data indicate that NDS is an attractive placebo intervention for randomized controlled trials evaluating the effects of CPAP in sleepy patients with OSA.
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Affiliation(s)
- Fabiana Yagihara
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil.,Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo, Brazil
| | - Rogerio Santos-Silva
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo, Brazil.,Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo, Brazil
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14
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Joyeux-Faure M, Naegelé B, Pépin JL, Tamisier R, Lévy P, Launois SH. Continuous positive airway pressure treatment impact on memory processes in obstructive sleep apnea patients: a randomized sham-controlled trial. Sleep Med 2016; 24:44-50. [PMID: 27810185 DOI: 10.1016/j.sleep.2016.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/20/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the changes in a large panel of memory processes after six weeks of continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. This randomized controlled trial compared the influence of effective CPAP to sham CPAP over six weeks on different memory processes in OSA patients. METHODS The study took place in a sleep laboratory and outpatient sleep clinic in a French tertiary-care university hospital. A total of 36 patients with OSA were randomized to receive either CPAP (n = 18) or sham CPAP (n = 18) for six weeks. Interventions were either effective CPAP or non-effective sham CPAP, for six weeks. All patients underwent an extensive battery of tasks evaluating three separate memory systems, before and after treatment. Verbal episodic memory was tested after forced encoding, procedural memory was tested using simplified versions of mirror drawing and reading tests, and working memory was examined with validated paradigms based on a theoretical model. RESULTS The study subjects were 55 ± 11 years of age and 72.2% were male. The mean body mass index was 29.5 ± 4.1 kg/m2 and the apnea-hypopnea index was 37.1 ± 16.3/h. Prior to treatment, memory performances of OSA patients were altered. In an intention-to-treat analysis, memory deficits were not significantly improved after six weeks of effective CPAP compared to sham CPAP treatment. Verbal episodic, procedural, and working memory scores were comparable between both groups. CONCLUSION Using cautious methodology in comparing effective CPAP to sham CPAP and a well-defined set of memory assessments, we did not find improvement in memory performance after six weeks of treatment.
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Affiliation(s)
- Marie Joyeux-Faure
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
| | - Bernadette Naegelé
- Neuro-Vascular Department, Grenoble University Hospital, Grenoble, France; Inserm U836, Grenoble Neurosciences Institut, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Sandrine H Launois
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
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15
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Isetta V, Montserrat JM, Santano R, Wimms AJ, Ramanan D, Woehrle H, Navajas D, Farré R. Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices. PLoS One 2016; 11:e0151530. [PMID: 26978077 PMCID: PMC4792477 DOI: 10.1371/journal.pone.0151530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/28/2016] [Indexed: 11/29/2022] Open
Abstract
Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients’ characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient’s night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.
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Affiliation(s)
- Valentina Isetta
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Josep M. Montserrat
- CIBERES, Madrid, Spain
- Sleep Laboratory, Pneumology Department, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Raquel Santano
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Daniel Navajas
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
- Institute for Bioengineering of Catalonia, IBEC, Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- * E-mail:
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16
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Harmell AL, Neikrug AB, Palmer BW, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Loredo JS, Ancoli-Israel S. Obstructive Sleep Apnea and Cognition in Parkinson's disease. Sleep Med 2016; 21:28-34. [PMID: 27448468 DOI: 10.1016/j.sleep.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. METHODS Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. RESULTS Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. CONCLUSIONS Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.
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Affiliation(s)
- Alexandrea L Harmell
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ariel B Neikrug
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Barton W Palmer
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Jose S Loredo
- Veterans Administration Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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17
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Jullian-Desayes I, Tamisier R, Zarski JP, Aron-Wisnewsky J, Launois-Rollinat SH, Trocme C, Levy P, Joyeux-Faure M, Pepin JL. Impact of effective versus sham continuous positive airway pressure on liver injury in obstructive sleep apnoea: Data from randomized trials. Respirology 2015; 21:378-85. [PMID: 26567858 DOI: 10.1111/resp.12672] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnoea (OSA) could be an independent risk factor for non-alcoholic fatty liver disease (NAFLD) occurrence and progression. The impact of continuous positive airway pressure (CPAP) treatment on non-invasive markers of NAFLD has not been studied. The aim of this study was to evaluate the effect of 6-12 weeks of effective CPAP on the FibroMax test (comprising components including the SteatoTest, NashTest and FibroTest) through three randomized sham controlled studies. METHODS The FibroMax test was performed in 103 obstructive sleep apnoea patients (apnoea + hypopnoea index > 15/h) enrolled in a randomized study comparing sham versus effective CPAP. RESULTS At baseline, 40.4% of patients in the sham CPAP group and 45.5% in the CPAP group exhibited liver steatosis. Furthermore, 39.6% of patients in the sham CPAP group and 58.4% in the CPAP group displayed borderline or possible non-alcoholic steatohepatitis (NASH). Six to twelve weeks of effective CPAP did not demonstrate any impact on reducing steatosis, NASH or liver fibrosis even after adjustment for gender, BMI, baseline apnoea + hypopnoea index and severity of liver injury. CONCLUSION A number of non-invasive markers of liver damage are increased in untreated obstructive sleep apnoea patients, potentially contributing to cardiometabolic risk, but they do not improve after 6-12 weeks of effective CPAP treatment. CLINICAL TRIAL REGISTRATION NCT01196845 (ADISAS), NCT00464659 (MneSAS) and NCT00669695 (StatinflaSAS) at ClinicalTrials.gov.
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Affiliation(s)
- Ingrid Jullian-Desayes
- HP2; INSERM, U1042, University Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble, France
| | - Renaud Tamisier
- HP2; INSERM, U1042, University Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble, France
| | | | - Judith Aron-Wisnewsky
- Endocrinology and Nutrition Department, AP-HP, La Pitié-Salpétrière, Hospital, Paris, France.,Nutriomic Department, INSERM, UMRS 872, University Pierre and Marie Curie-Paris 6, Paris, France
| | | | - Candice Trocme
- Biochemistry, Toxicology and Pharmacology Department, CHU Grenoble, Grenoble, France
| | - Patrick Levy
- HP2; INSERM, U1042, University Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble, France
| | - Marie Joyeux-Faure
- HP2; INSERM, U1042, University Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble, France
| | - Jean-Louis Pepin
- HP2; INSERM, U1042, University Grenoble Alpes, Grenoble, France.,Laboratoire EFCR, Grenoble, France
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18
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Antic NA, Heeley E, Anderson CS, Luo Y, Wang J, Neal B, Grunstein R, Barbe F, Lorenzi-Filho G, Huang S, Redline S, Zhong N, McEvoy RD. The Sleep Apnea cardioVascular Endpoints (SAVE) Trial: Rationale, Ethics, Design, and Progress. Sleep 2015; 38:1247-57. [PMID: 25669180 DOI: 10.5665/sleep.4902] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/22/2014] [Indexed: 01/13/2023] Open
Abstract
ABSTRACT The Sleep Apnea cardioVascular Endpoints (SAVE) study is an ongoing investigator-initiated and conducted, international, multicenter, open, blinded endpoint, randomized controlled trial that was designed to determine whether treatment of obstructive sleep apnea (OSA) with continuous positive airways pressure (CPAP) can reduce the risk of serious cardiovascular (CV) events in patients with established CV disease (clinical trial registration NCT00738179). The results of this study will have important implications for the provision of health care to patients with sleep apnea around the world. The SAVE study has brought together respiratory, sleep, CV and stroke clinicians-scientists in an interdisciplinary collaboration with industry and government sponsorship to conduct an ambitious clinical trial. Following its launch in Australia and China in late 2008, the recruitment network expanded across 89 sites that included New Zealand, India, Spain, USA, and Brazil for a total of 2,717 patients randomized by December 2013. These patients are being followed until December 2015 so that the average length of follow-up of the cohort will be over 4 y. This article describes the rationale for the SAVE study, considerations given to the design including how various cultural and ethical challenges were addressed, and progress in establishing and maintaining the recruitment network, patient follow-up, and adherence to CPAP and procedures. The assumptions underlying the original trial sample size calculation and why this was revised downward in 2012 are also discussed. CLINICAL TRIALS REGISTRATION NUMBER NCT00738179. AUSTRALIA NEW ZEALAND CLINICAL TRIALS REGISTRY NUMBER ACTRN12608000409370.
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Affiliation(s)
- Nick A Antic
- The Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia.,School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Emma Heeley
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,The George Institute for Global Health, The University of Sydney, New South Wales, Australia
| | - Craig S Anderson
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,The George Institute for Global Health, The University of Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiguang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai, China
| | - Bruce Neal
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,The George Institute for Global Health, The University of Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Imperial College, London, United Kingdom
| | - Ron Grunstein
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Centre for Integrated Research and Understanding of Sleep Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Ferran Barbe
- School of Medicine at the University of Lleida Barcelona, Spain
| | | | | | - Susan Redline
- Department of Medicine and Division of Sleep, Brigham and Women's Hospital and Beth Israel Medical Center, Boston, MA
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia.,School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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19
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de Oliveira AC, Martinez D, Massierer D, Gus M, Gonçalves SC, Ghizzoni F, Steinhorst AM, Moreira LB, Fuchs SC, Fuchs FD. The antihypertensive effect of positive airway pressure on resistant hypertension of patients with obstructive sleep apnea: a randomized, double-blind, clinical trial. Am J Respir Crit Care Med 2014; 190:345-7. [PMID: 25084263 DOI: 10.1164/rccm.201403-0479le] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ana Claudia de Oliveira
- 1 Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
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20
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Prilipko O, Huynh N, Thomason ME, Kushida CA, Guilleminault C. An fMRI study of cerebrovascular reactivity and perfusion in obstructive sleep apnea patients before and after CPAP treatment. Sleep Med 2014; 15:892-8. [PMID: 24916094 DOI: 10.1016/j.sleep.2014.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cerebrovascular reactivity is impaired in patients suffering from obstructive sleep apnea syndrome (OSAS) as demonstrated by transcranial Doppler studies. We use magnetic resonance imaging techniques to investigate the anatomical distribution of cerebrovascular reactivity changes in patients with OSAS, as well as their evolution after therapeutic and sham continuous positive airway pressure (CPAP) treatment. METHODS Twenty-three men with moderate or severe obstructive sleep apnea were compared to a healthy control group (n=7) using a breath-holding functional magnetic resonance imaging task and the flow-sensitive alternating inversion recovery (FAIR) imaging before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment. RESULTS Significantly higher cerebrovascular reactivity was found in healthy controls as compared to patients in bilateral cortical and subcortical brain regions. Cerebrovascular reactivity increased with therapeutic CPAP in the thalamus and decreased with sham CPAP in medial frontal regions in OSAS patients. Duration of nocturnal hypoxemia and body mass index negatively correlated with cerebrovascular reactivity, particularly in the medial temporal lobe structures, suggesting a possible pathophysiological mechanism for hippocampal injury. There was no difference in perfusion between patients and control group, and no effect of CPAP or sham-CPAP treatment on perfusion in patients. CONCLUSIONS Observed cerebrovascular reactivity changes were neither homogeneous throughout the brain nor followed vascular territories, but rather corresponded to underlying neuronal networks, establishing a relationship between cerebrovascular reactivity and surrounding neuronal activity.
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Affiliation(s)
- Olga Prilipko
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA.
| | - Nelly Huynh
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA
| | - Moriah E Thomason
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA
| | - Clete A Kushida
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA
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Huynh NT, Prilipko O, Kushida CA, Guilleminault C. Volumetric Brain Morphometry Changes in Patients with Obstructive Sleep Apnea Syndrome: Effects of CPAP Treatment and Literature Review. Front Neurol 2014; 5:58. [PMID: 24808886 PMCID: PMC4010762 DOI: 10.3389/fneur.2014.00058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/07/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a frequent breathing disorder occurring during sleep that is characterized by recurrent hypoxic episodes and sleep fragmentation. It remains unclear whether OSAS leads to structural brain changes, and if so, in which brain regions. Brain region-specific gray and white matter volume (GMV and WMV) changes can be measured with voxel-based morphometry (VBM). The aims of this study were to use VBM to analyze GMV and WMV in untreated OSAS patients compared to healthy controls (HC); examine the impact of OSAS-related variables (nocturnal hypoxemia duration and sleep fragmentation index) on GMV and WMV; and assess the effects of therapeutic vs. sham continuous positive airway pressure (CPAP) treatment. We discuss our results in light of previous findings and provide a comprehensive literature review. METHODS Twenty-seven treatment-naïve male patients with moderate to severe OSAS and seven healthy age- and education-matched HC were recruited. After a baseline fMRI scan, patients randomly received either active (therapeutic, n = 14) or sham (subtherapeutic, n = 13) nasal CPAP treatment for 2 months. RESULTS Significant negative correlations were observed between nocturnal hypoxemia duration and GMV in bilateral lateral temporal regions. No differences in GMV or WMV were found between OSAS patients and HC, and no differences between CPAP vs. sham CPAP treatment effects in OSAS patients. CONCLUSION It appears that considering VBM GMV changes there is little difference between OSAS patients and HC. The largest VBM study to date indicates structural changes in the lateral aspect of the temporal lobe, which also showed a significant negative correlation with nocturnal hypoxemia duration in our study. This finding suggests an association between the effect of nocturnal hypoxemia and decreased GMV in OSAS patients.
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Affiliation(s)
- Nelly T Huynh
- Stanford Centre for Sleep Sciences and Medicine, Stanford University , Redwood City, CA , USA ; Faculty of Dental Medicine, University of Montreal , Montreal, QC , Canada
| | - Olga Prilipko
- Stanford Centre for Sleep Sciences and Medicine, Stanford University , Redwood City, CA , USA
| | - Clete A Kushida
- Stanford Centre for Sleep Sciences and Medicine, Stanford University , Redwood City, CA , USA
| | - Christian Guilleminault
- Stanford Centre for Sleep Sciences and Medicine, Stanford University , Redwood City, CA , USA
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Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, Maugeri A, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep 2014; 37:177-85. [PMID: 24470706 DOI: 10.5665/sleep.3332] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. DESIGN This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. SETTING Sleep laboratory. PARTICIPANTS Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). INTERVENTION Continuous positive airway pressure. MEASUREMENTS PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). RESULTS There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). CONCLUSIONS Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.
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Affiliation(s)
- Ariel B Neikrug
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lianqi Liu
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Julie A Avanzino
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA
| | - Lenette Bradley
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Alex Maugeri
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | - Barton W Palmer
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
| | - Jose S Loredo
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Sonia Ancoli-Israel
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
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Walterspacher S, Walker DJ, Kabitz HJ, Windisch W, Dreher M. The Effect of Continuous Positive Airway Pressure on Stair-Climbing Performance in Severe COPD Patients. COPD 2013; 10:193-9. [DOI: 10.3109/15412555.2012.734872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simpson PJL, Hoyos CM, Celermajer D, Liu PY, Ng MKC. Effects of continuous positive airway pressure on endothelial function and circulating progenitor cells in obstructive sleep apnoea: a randomised sham-controlled study. Int J Cardiol 2013; 168:2042-8. [PMID: 23453448 DOI: 10.1016/j.ijcard.2013.01.166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/18/2012] [Accepted: 01/13/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea (OSA) is characterised by reoccurring apnoeas and hypopneas, causing repetitive hypoxia and reoxygenation, and is associated with endothelial dysfunction and reduced levels of circulating progenitor cells (CPCs). The potential to improve endothelial function and CPC levels in people with OSA by preventing hypoxic episodes with Continuous Positive Airway Pressure (CPAP) was investigated in a sham-controlled CPAP study. METHODS Men with moderate-to-severe OSA (mean ± SD: age=49 ± 12 y, apnoea hypopnea index (AHI)=37.6 ± 16.4 events/h, body mass index=31.5 ± 5.7 kg/m(2)) who were CPAP naïve without diabetes mellitus were randomised in a 12-week double-blind sham-controlled parallel group study to receive either active (n=25) or sham (n=21) CPAP. CPCs, isolated from blood, were measured by flow cytometry and by co-staining cultured cells (7 days) with acetylated low-density lipoprotein (acLDL) and lectin. Endothelial function was assessed by peripheral arterial tonometry (PAT). RESULTS Compared to sham, CPAP significantly decreased AHI (mean between-group difference -36.0 events/h; 95%CI, -49.7 to -22.3, p<0.0001) after 12 weeks. Despite this improvement in AHI, CPAP had no effect on change in CPC levels (including CD34(+)/KDR(+) (565 cells/mL; -977 to 2106, p=0.45), CD34(+)/KDR(+)/CD45(-) (37.0 cells/mL; -17.7 to 85.7, p=0.13), acLDL(+)/lectin(+) (-43.1 cells/field, -247 to 161, p=0.67)) or change in endothelial function (0.27; -0.14 to 0.67, p=0.19) compared to sham therapy. CONCLUSIONS Despite the improvement in OSA parameters and ablation of apnoeic events by CPAP, CPC counts and endothelial function in men with moderate-to-severe OSA were not significantly improved after 12 weeks of therapeutic CPAP when compared to sham control.
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Affiliation(s)
- Philippa J L Simpson
- Translational Research Group, the Heart Research Institute, Sydney 2042, Australia; University of Sydney, Sydney 2006, Australia
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von Känel R, Natarajan L, Ancoli-Israel S, Mills PJ, Wolfson T, Gamst AC, Loredo JS, Dimsdale JE. Effect of continuous positive airway pressure on day/night rhythm of prothrombotic markers in obstructive sleep apnea. Sleep Med 2013; 14:58-65. [PMID: 23036264 PMCID: PMC3540139 DOI: 10.1016/j.sleep.2012.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/02/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) has been associated with an increased risk of atherothrombotic events. A prothrombotic state might partially explain this link. This study investigated OSA patients' day/night rhythm of several prothrombotic markers and their potential changes with therapeutic continuous positive airway pressure (CPAP). METHODS The study included 51 OSA patients [apnea hypopnea index (AHI) ⩾10] and 24 non-OSA controls (AHI<10). Of the 51 OSA patients, 25 were randomized to CPAP and 26 to placebo-CPAP. Twelve blood samples were collected over a 24h period to measure prothrombotic markers. For the apneic patients these samples were collected before treatment and after 3weeks of treatment with either CPAP or placebo-CPAP. Day/night variation in prothrombotic markers was examined using a cosinor analysis. RESULTS Compared with controls, OSA patients showed lower mesor (mean) and amplitude (difference between maximum and minimum activity) of D-dimer. In unadjusted (but not in adjusted) analysis, patients showed higher mesor of plasminogen activator inhibitor-1 (p<0.05 in all cases). No significant group differences were seen in mesor and amplitude for either soluble tissue factor or von Willebrand factor, or the acrophase (time of the peak) and periodic pattern for any prothrombotic markers. There were no significant differences in changes of periodic pattern and in day/night rhythm parameters of prothrombotic markers pre- to post-treatment between the CPAP and placebo condition. CONCLUSIONS There may be altered day/night rhythm of some prothrombotic markers in OSA patients compared with controls. CPAP treatment for 3weeks did not affect day/night rhythm of prothrombotic markers in OSA patients differently from placebo-CPAP.
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Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland
- Department of Psychiatry, University of California, San Diego, USA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California, San Diego, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, USA
- Department of Medicine, University of California, San Diego, USA
| | - Paul J. Mills
- Department of Psychiatry, University of California, San Diego, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory, San Diego, Supercomputer Center University of California, San Diego, USA
| | - Anthony C. Gamst
- Computational and Applied Statistics Laboratory, San Diego, Supercomputer Center University of California, San Diego, USA
| | - José S. Loredo
- Department of Medicine, University of California, San Diego, USA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California, San Diego, USA
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Prilipko O, Huynh N, Schwartz S, Tantrakul V, Kushida C, Paiva T, Guilleminault C. The effects of CPAP treatment on task positive and default mode networks in obstructive sleep apnea patients: an fMRI study. PLoS One 2012; 7:e47433. [PMID: 23227139 PMCID: PMC3515559 DOI: 10.1371/journal.pone.0047433] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP) treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS) considering Task Positive and Default Mode networks (TPN and DMN). METHODS An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment. RESULTS Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back. CONCLUSION OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the disease may prevent or slow down the occurrence of irreversible impairment.
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Affiliation(s)
- Olga Prilipko
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | - Nelly Huynh
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | | | - Visasiri Tantrakul
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | - Clete Kushida
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | | | - Christian Guilleminault
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
- * E-mail:
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Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, Simon RD, Guilleminault C, White DP, Goodwin JL, Schweitzer PK, Leary EB, Hyde PR, Hirshkowitz M, Green S, McEvoy LK, Chan C, Gevins A, Kay GG, Bloch DA, Crabtree T, Dement WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 2012. [PMID: 23204602 DOI: 10.5665/sleep.2226] [Citation(s) in RCA: 277] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). DESIGN, SETTING, AND PARTICIPANTS The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures. INTERVENTION Active or sham CPAP MEASUREMENTS: THREE NEUROCOGNITIVE VARIABLES, EACH REPRESENTING A NEUROCOGNITIVE DOMAIN: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F]) RESULTS The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test. CONCLUSIONS CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship. CLINICAL TRIAL INFORMATION Registered at clinicaltrials.gov. Identifier: NCT00051363. CITATION Kushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602.
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Chasens ER, Drumheller OJ, Strollo PJ. Success in blinding to group assignment with sham-CPAP. Biol Res Nurs 2012; 15:465-9. [PMID: 23034539 DOI: 10.1177/1099800412461711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the success of sham-continuous positive airway pressure (CPAP) as a placebo in a 4-week clinical trial of adults with sleep apnea. Participants (n = 23) were previously undiagnosed for obstructive sleep apnea, had no one in their household on sleep apnea therapy, and were willing to be randomly assigned to either active or sham-CPAP. Before final debriefing, participants were asked to "guess" their group assignment. When questioned, 10 of the 23 participants (44%) were incorrect in their guess of group assignment; 2 of these participants stated that their guess was "random." The active CPAP group's average usage was significantly longer when compared to participants on the sham device (293 ± 117 min/day vs. 188 ± 110 min/day, p = .046). The results suggest that participants remained blinded to group assignment and that sham-CPAP is an appropriate placebo control device. Participants' lower adherence to the sham device may be a potential problem that requires attention in the use of sham-CPAP as a placebo during clinical trials.
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Affiliation(s)
- Eileen R Chasens
- 1School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Stepnowsky CJ, Mao WC, Bardwell WA, Loredo JS, Dimsdale JE. Mood Predicts Response to Placebo CPAP. SLEEP DISORDERS 2012; 2012:404196. [PMID: 23470990 PMCID: PMC3581114 DOI: 10.1155/2012/404196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/30/2012] [Accepted: 08/02/2012] [Indexed: 11/18/2022]
Abstract
Study Objectives. Continuous positive airway pressure (CPAP) therapy is efficacious for treating obstructive sleep apnea (OSA), but recent studies with placebo CPAP (CPAP administered at subtherapeutic pressure) have revealed nonspecific (or placebo) responses to CPAP treatment. This study examined baseline psychological factors associated with beneficial effects from placebo CPAP treatment. Participants. Twenty-five participants were studied with polysomnography at baseline and after treatment with placebo CPAP. Design. Participants were randomized to either CPAP treatment or placebo CPAP. Baseline mood was assessed with the Profile of Mood States (POMS). Total mood disturbance (POMS-Total) was obtained by summing the six POMS subscale scores, with Vigor weighted negatively. The dependent variable was changed in apnea-hypopnea index (ΔAHI), calculated by subtracting pre- from post-CPAP AHI. Negative values implied improvement. Hierarchical regression analysis was performed, with pre-CPAP AHI added as a covariate to control for baseline OSA severity. Results. Baseline emotional distress predicted the drop in AHI in response to placebo CPAP. Highly distressed patients showed greater placebo response, with a 34% drop (i.e., improvement) in AHI. Conclusion. These findings underscore the importance of placebo-controlled studies of CPAP treatment. Whereas such trials are routinely included in drug trials, this paper argues for their importance even in mechanical-oriented sleep interventions.
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Affiliation(s)
- Carl J. Stepnowsky
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
- Health Services Research & Development Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Wei-Chung Mao
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Wayne A. Bardwell
- Health Services Research & Development Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - José S. Loredo
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
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Amaro ACS, Duarte FHG, Jallad RS, Bronstein MD, Redline S, Lorenzi-Filho G. The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure. Clinics (Sao Paulo) 2012; 67:469-74. [PMID: 22666791 PMCID: PMC3351249 DOI: 10.6061/clinics/2012(05)11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/27/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/ females = 8/4, age = 52 ± 8 ys, body mass index = 33.5 ± 4.6 Kg/m(2), apnea-hypopnea index = 38 ± 14 events/h) who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips. CONCLUSION The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.
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Effect of three weeks of continuous positive airway pressure treatment on mood in patients with obstructive sleep apnoea: a randomized placebo-controlled study. Sleep Med 2011; 13:161-6. [PMID: 22172966 DOI: 10.1016/j.sleep.2011.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 09/16/2011] [Accepted: 09/17/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with obstructive sleep apnoea (OSA) commonly have mood symptoms such as depression and anxiety. However, the results of randomized controlled trials on the therapeutic effect of CPAP on mood symptoms have been inconsistent. The present study examined whether three weeks of CPAP treatment had specific therapeutic effects on mood symptoms in patients with OSA compared with placebo. METHODS A double-blind, parallel, randomized controlled trial using therapeutic and placebo CPAP was performed in 71 patients newly diagnosed with OSA (apnoea-hypopnoea index [AHI]⩾10). Mood was assessed by the Center for Epidemiologic Studies-Depression (CES-D) Scale, the Profile of Mood States (POMS), and the Brief Symptom Inventory (BSI) before and after three weeks of treatment. AHI was used to assess the severity of apnoea. The two groups were compared using a simple comparison of the changes within each arm and repeated measures analysis of variance. RESULTS Fifty-six subjects completed the study: 26 in the CPAP group and 30 in the placebo group. The two groups were well matched at baseline, with no significant differences in demographic, mood and apnoea variables. Both groups had severe apnoea, mild depression, and anxiety at baseline. After three weeks of treatment, AHI decreased significantly in the CPAP group. The mean change in AHI was -30.7 (standard deviation [SD] 23.1) in the CPAP group and -5.8 (SD 18.3) in the placebo group (difference between groups P<0.001). However, after three weeks of treatment, there were no significant time by treatment effects in relation to mood, as assessed by the CES-D, POMS Depression, POMS Tension, BSI Depression, or BSI Anxiety (all P>0.05). CONCLUSION In conclusion, three weeks of CPAP treatment did not show a specific therapeutic effect on mood symptoms in patients with OSA.
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Lee IS, Bardwell WA, Kamat R, Tomfohr L, Heaton RK, Ancoli-Israel S, Loredo JS, Dimsdale JE. A Model for Studying Neuropsychological Effects of Sleep Intervention: The Effect of 3-week Continuous Positive Airway Pressure Treatment. ACTA ACUST UNITED AC 2011; 8:147-154. [PMID: 22140396 DOI: 10.1016/j.ddmod.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE: Patients with obstructive sleep apnea (OSA) commonly have cognitive complaints. There are few randomized studies that have examined neuropsychological effects of continuous positive airway pressure (CPAP) treatment in patients with OSA. In this double-blind trial, we examined if a 3-week CPAP treatment compared with placebo CPAP treatment has specific therapeutic effects on cognitive impairments in patients with OSA and if there are specific domains of cognitive impairments sensitive to 3-week CPAP treatment. SUBJECTS AND METHODS: Thirty-eight newly diagnosed patients with untreated OSA underwent neuropsychological testing before and after 3-weeks CPAP or Placebo CPAP treatment. The two treatment groups (therapeutic CPAP, and placebo-CPAP) were compared using repeated measures analysis of variance (ANOVA). RESULTS AND CONCLUSION: Impairments in neuropsychological functioning ranged from 2.6% to 47.1% before treatment. In response to 3 weeks of treatment, there was no significant time by treatment interaction for a global deficit score of neuropsychological functioning. Only the Stroop Color (number correct) test showed significant improvement specific to CPAP treatment. The study demonstrates the importance of further randomized placebo controlled studies in this area.
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Affiliation(s)
- In-Soo Lee
- Department of Psychiatry, University of California San Diego
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Brown DL, Chervin RD, Kalbfleisch JD, Zupancic MJ, Migda EM, Svatikova A, Concannon M, Martin C, Weatherwax KJ, Morgenstern LB. Sleep apnea treatment after stroke (SATS) trial: is it feasible? J Stroke Cerebrovasc Dis 2011; 22:1216-24. [PMID: 21784661 DOI: 10.1016/j.jstrokecerebrovasdis.2011.06.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 06/14/2011] [Accepted: 06/16/2011] [Indexed: 12/16/2022] Open
Abstract
Sleep apnea affects more than half of patients with acute ischemic stroke and is associated with poor stroke outcome. This pilot study assessed the feasibility of a randomized, sham-controlled continuous positive airway pressure (CPAP) trial in subjects with acute ischemic stroke. Subjects identified with sleep apnea based on an apnea-hypopnea index≥5 on overnight polysomnography or portable respiratory monitoring within 7 days of onset of stroke symptoms were randomized to receive active or sham CPAP for a 3-month period. Objective usage was ascertained by compliance data cards. Subjects, treating physicians, and outcome assessors were masked to intervention allocation. Among 87 subjects who provided consent, 74 were able to complete sleep apnea screening, 54 (73%) of whom had sleep apnea. Thirty-two subjects agreed to randomization. Of the 15 subjects who commenced active titration, 11 (73%) took the device home, and 8 (53%) completed the 3-month follow-up. Of the 17 subjects who commenced sham titration, 11 (65%) took the sham device home and completed the 3-month follow-up. The median cumulative usage hours over the 90 days were similar in the active group (53 hours; interquartile range, 22-173 hours) and the sham group (74 hours; interquartile range, 17-94 hours), and blinding to subject condition was successfully maintained. This first-ever randomized, sham-controlled trial of CPAP in patients with recent stroke and sleep apnea demonstrates that sham treatment can be an effective placebo.
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Affiliation(s)
- Devin L Brown
- Stroke Program, The Cardiovascular Center-Stroke Program, University of Michigan, Ann Arbor, Michigan.
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Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep 2011; 34:121-6. [PMID: 21203367 PMCID: PMC3001790 DOI: 10.1093/sleep/34.1.121] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA); however, the impact of continuous positive airway pressure (CPAP) on fatigue remains unclear. METHODS Fifty-nine men and women with OSA were randomly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period. Four outcome measures were assessed: (1) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory--Short Form (MFSI-sf), the (2) fatigue and (3) vigor subscales of the Profile of Mood States--Short Form (POMS), and (4) the Epworth Sleepiness Scale (ESS). Data were analyzed using repeated-measures analysis of variance. RESULTS Compared with patients receiving placebo CPAP, those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index, as well as decreases in both measures of fatigue and increases in vigor (P values < 0.05). The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset. Significant treatment effects in sleepiness scores were not observed in the entire sample (P > 0.05); however, in a subset of patients with excessive sleepiness at the onset of treatment, ESS scores were significantly reduced with use of therapeutic CPAP (P < 0.05). CONCLUSIONS Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA. Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment.
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Affiliation(s)
- Lianne M Tomfohr
- San Diego State University & University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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Rodway GW, Weaver TE, Mancini C, Cater J, Maislin G, Staley B, Ferguson KA, George CF, Schulman DA, Greenberg H, Rapoport DM, Walsleben JA, Lee-Chiong T, Kuna ST. Evaluation of sham-CPAP as a placebo in CPAP intervention studies. Sleep 2010; 33:260-6. [PMID: 20175410 PMCID: PMC2817913 DOI: 10.1093/sleep/33.2.260] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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 To evaluate the use of sham-continuous positive airway pressure (CPAP) treatment as a placebo intervention. DESIGN AND SETTING Analysis of polysomnograms performed in fixed order without sham-CPAP and on the first night of the sham-CPAP intervention in participants in the CPAP Apnea Trial North American Program (CATNAP), a randomized, placebo controlled trial evaluating the effects of CPAP treatment on daytime function in adults with newly diagnosed mild to moderate obstructive sleep apnea (apnea hypopnea index (AHI) 5-30). PARTICIPANTS The first 104 CATNAP participants randomized to the sham-CPAP intervention arm. MEASUREMENTS AND RESULTS Compared to the polysomnographic measures without sham-CPAP, the study on the first night with sham-CPAP had statistically significant differences that suggested a decrease in sleep quality: decreased sleep efficiency, increased arousal index, increased time in stage 1 NREM sleep, and prolonged latency to REM sleep. However, all of these differences had a relatively small effect size. Compared to the polysomnogram without sham-CPAP, the number of hypopneas on the sham-CPAP polysomnogram was significantly increased and the number of apneas significantly decreased. Relatively minor differences in AHI with and without sham-CPAP were present and were dependent on the criteria used to score hypopneas. CONCLUSION Comparison of polysomnograms with and without sham-CPAP revealed differences that, although statistically significant, were small in magnitude and had relatively low effect sizes suggesting minimal clinical significance. The results support the use of sham-CPAP as a placebo intervention in trials evaluating the effects of CPAP treatment in patients with obstructive sleep apnea. CLINICAL TRIAL INFORMATION This paper was a secondary analysis of clinical trial data. CATNAP: CPAP Apnea Trial North American Program, the trial from which the data were obtained, is registered with clinicaltrial.gov. Registration #NCT00089752.
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Affiliation(s)
- George W. Rodway
- University of Utah College of Nursing and School of Medicine, Salt Lake City, UT
| | - Terri E. Weaver
- Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing, Philadelphia, PA
- Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Cristina Mancini
- Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing, Philadelphia, PA
| | | | - Greg Maislin
- Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
- Biostatistical Consulting, Wynnewood, PA
| | - Bethany Staley
- Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kathleen A. Ferguson
- Division of Respirology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Charles F.P. George
- Division of Respirology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - David A. Schulman
- Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA
| | - Harly Greenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, NY
| | - David M. Rapoport
- Division of Pulmonary and Critical Care Medicine Department of Medicine, New York University School of Medicine, New York, NY
| | - Joyce A. Walsleben
- Division of Pulmonary and Critical Care Medicine Department of Medicine, New York University School of Medicine, New York, NY
| | | | - Samuel T. Kuna
- Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
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West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: A randomised controlled trial. Sleep Med 2009; 10:1056-8. [DOI: 10.1016/j.sleep.2008.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 10/30/2008] [Accepted: 11/01/2008] [Indexed: 11/30/2022]
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Cooke JR, Ancoli-Israel S, Liu L, Loredo JS, Natarajan L, Palmer BS, He F, Corey-Bloom J. Continuous positive airway pressure deepens sleep in patients with Alzheimer's disease and obstructive sleep apnea. Sleep Med 2009; 10:1101-6. [PMID: 19699148 DOI: 10.1016/j.sleep.2008.12.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/11/2008] [Accepted: 12/22/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with Alzheimer's disease (AD) and obstructive sleep apnea (OSA) experience disrupted sleep. This study examined the effect of continuous positive airway pressure (CPAP) on sleep parameters in AD patients with OSA. METHODS A randomized placebo-controlled trial of 3 weeks of therapeutic CPAP (tCPAP) vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. Polysomnography data from screening after one night and after 3 weeks of treatment were analyzed. Records were scored for percent of each sleep stage, total sleep time (TST), sleep efficiency (SE), sleep period (SP), time in bed (TIB), sleep onset (SO), wake time after sleep onset (WASO), and arousals. A randomized design comparing one night of pCPAP to tCPAP and a paired analysis combining 3 weeks of tCPAP were performed. RESULTS Fifty-two participants (mean age=77.8 years, SD=7.3) with AD and OSA were included. After one treatment night, the tCPAP group had significantly less % Stage 1 (p=0.04) and more % Stage 2 sleep (p=0.02) when compared to the pCPAP group. In the paired analysis, 3 weeks of tCPAP resulted in significant decreases in WASO (p=0.005), % Stage 1 (p=0.001), arousals (p=0.005), and an increase in % Stage 3 (p=0.006). CONCLUSION In mild to moderate AD patients with OSA, the use of tCPAP resulted in deeper sleep after just one night, with improvements maintained for 3 weeks.
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Affiliation(s)
- Jana R Cooke
- Department of Medicine, University of California San Diego, La Jolla, Ca 92093-0733, USA
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Gruis KL, Brown DL, Weatherwax KJ, Feldman EL, Chervin RD. Evaluation of sham non‐invasive ventilation for randomized, controlled trials in ALS. ACTA ACUST UNITED AC 2009; 7:96-9. [PMID: 16753973 DOI: 10.1080/14660820600640604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive positive pressure ventilation (NIV) treatment of advanced respiratory insufficiency prolongs survival in ALS. To investigate the critical question of whether earlier initiation of NIV might provide additional benefit, a randomized trial with an appropriate placebo is needed. This study evaluated sub-therapeutic (sham) continuous positive airway pressure as a potential placebo. In a single-blind design, 40 ALS patients with forced vital capacity>50% were randomized to receive 30 seconds (s) of either active NIV, with 8 cm H2O inspiratory and 4 cm H2O expiratory pressure, or sham NIV with<1 cm of H2O continuous positive airway pressure at the mask. A questionnaire was then used to assess whether subjects thought that they had received a "real" or "pretend" treatment trial. The subjects' median age was 60.5 years, and 38% were female. Twelve of 20 subjects (60%) who received active NIV and 7 (35%) of the 20 subjects who received sham thought that they had tried the active treatment (p = 0.11). Only 8 (20%) of all subjects were confident about their determination that they had received "real" or "pretend" NIV. Thus, sub-therapeutic (sham) continuous positive airway pressure is a promising placebo control for NIV trials in ALS.
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Affiliation(s)
- Kirsten L Gruis
- University of Michigan Health System, Department of Neurology, 1324 Taubman Center, 032221-500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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Ancoli-Israel S, Palmer BW, Cooke JR, Corey-Bloom J, Fiorentino L, Natarajan L, Liu L, Ayalon L, He F, Loredo JS. Cognitive effects of treating obstructive sleep apnea in Alzheimer's disease: a randomized controlled study. J Am Geriatr Soc 2008; 56:2076-81. [PMID: 18795985 PMCID: PMC2585146 DOI: 10.1111/j.1532-5415.2008.01934.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. DESIGN Randomized double-blind placebo-controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks. SETTING General clinical research center. PARTICIPANTS Fifty-two men and women with mild to moderate AD and OSA. INTERVENTION CPAP. MEASUREMENTS A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks. RESULTS A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre- and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed. CONCLUSION OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.
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Affiliation(s)
- Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Jana R. Cooke
- Veterans Affairs San Diego Healthcare System
- Department of Medicine, University of California, San Diego
| | - Jody Corey-Bloom
- Veterans Affairs San Diego Healthcare System
- Department of Neurosciences, University of California, San Diego
| | | | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Liat Ayalon
- Department of Psychiatry, University of California, San Diego
| | - Feng He
- Department of Family and Preventative Medicine, University of California, San Diego
| | - Jose S. Loredo
- Veterans Affairs San Diego Healthcare System
- Department of Medicine, University of California, San Diego
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Farré R, Montserrat JM, Navajas D. Assessment of upper airway mechanics during sleep. Respir Physiol Neurobiol 2008; 163:74-81. [DOI: 10.1016/j.resp.2008.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 06/16/2008] [Accepted: 06/18/2008] [Indexed: 11/26/2022]
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Almendros I, Acerbi I, Vilaseca I, Montserrat JM, Navajas D, Farré R. Continuous positive airway pressure (CPAP) induces early nasal inflammation. Sleep 2008; 31:127-31. [PMID: 18220086 DOI: 10.1093/sleep/31.1.127] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To assess whether noninvasive application of nCPAP is a mechanical stimulus inducing early nasal inflammation. DESIGN Prospective controlled animal study. SETTING University laboratory. PATIENTS OR PARTICIPANTS 32 male Sprague-Dawley rats (250-300 g). INTERVENTIONS The rats were anesthetized and subjected to nCPAP=10 cm H2O and sham-CPAP through a mask for 3 h and 5 h (n=8 each). MEASUREMENTS AND RESULTS After nCPAP or sham, nasal scraping was carried out to detect neutrophils, and septum and dorsal nasal concha were excised to assess gene expression of inflammatory markers by real time PCR. Percentage of neutrophils in nucleated cells in the nasal scrapings was significantly (P = 0.006) higher after 5 h of nCPAP (3.51% +/- 0.73%; m +/- SEM) than in the sham group (1.12% +/- 0.39%). When compared with sham, the mRNA of macrophage inflammatory protein-2 (MIP-2) in nasal tissue was significantly overexpressed after both 3 h (2.28-fold +/- 0.43-fold; P = 0.034) and 5 h (5.56-fold +/-1.88-fold; P = 0.002) of nCPAP=10 cm H2O. No significant changes were found in the gene expressions of tumor necrosis factor-alpha, nerve growth factor and tachykinin-1 receptor. CONCLUSIONS The compression applied by nCPAP (10 cm H2O, 5 h) on the nasal wall of healthy rats is a mechanical stimulus that triggers an early inflammatory process mediated by MIP-2, resulting in neutrophil extravasation.
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Affiliation(s)
- Isaac Almendros
- Unitat de Biofisica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona - IDIBAPS, Barcelona, Spain
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Parish JM, Miller BW, Hentz JG. Autotitration positive airway pressure therapy in patients with obstructive sleep apnea who are intolerant of fixed continuous positive airway pressure. Sleep Breath 2007; 12:235-41. [DOI: 10.1007/s11325-007-0158-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 10/10/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
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Egea CJ, Aizpuru F, Pinto JA, Ayuela JM, Ballester E, Zamarrón C, Sojo A, Montserrat JM, Barbe F, Alonso-Gomez AM, Rubio R, Lobo JL, Duran-Cantolla J, Zorrilla V, Nuñez R, Cortés J, Jiménez A, Cifrián J, Ortega M, Carpizo R, Sánchez A, Terán J, Iglesias L, Fernández C, Alonso ML, Cordero J, Roig E, Pérez F, Muxi A, Gude F, Amaro A, Calvo U, Masa JF, Utrabo I, Porras Y, Lanchas I, Sánchez E. Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study. Sleep Med 2007; 9:660-6. [PMID: 17904420 DOI: 10.1016/j.sleep.2007.06.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 06/21/2007] [Accepted: 06/21/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Continuous positive airway pressure (CPAP) is an effective treatment for sleep apnea (SA), although the evidence for improving chronic heart failure (CHF) is inconclusive. Our aim was to evaluate the effect of CPAP treatment on the left ventricle ejection fraction (LVEF) among other cardiological variables in a randomized, multicenter, placebo (sham-CPAP)-controlled study. METHODS After the selection procedure, 60 patients with CHF with LVEF<45% and SA with an apnea-hypopnea index (AHI)>10/h were evaluated at baseline, and after 3 months of treatment with optimal CPAP or sham-CPAP. The assessment was based on the LVEF, hypertension, daytime sleepiness (Epworth sleepiness scale [ESS]), quality of life (SF-36), New York Heart Scale (NYHA score), dyspnea (by using the Borg scale) and exercise tolerance (6-min walk test). RESULTS The mean AHI was normalized in the optimal CPAP group but not in the sham-CPAP group. The LVEF showed a significant improvement in the group of patients treated with CPAP (2.5; 95% CI: 0.6 to 4.3), which was not observed in the sham-CPAP group (0.0; 95% CI: -2.1 to 2.1). However, the change in the LVEF from baseline to 3 months was not significantly greater in the whole group (obstructive and Cheyne-Stokes events) treated with CPAP than in the control group (p: 0.07). In patients with only obstructive sleep apnea (OSA), who account for 83% of the total population, there was a significant improvement in the LVEF in the group of patients treated with CPAP but no such improvement in the sham-CPAP group. In this OSA group, the change in the LVEF from baseline to 3 months was significantly greater in the group treated with CPAP than in the sham-CPAP group (p: 0.03). The other variables studied were not modified. When the patients were divided according to the severity of the LVEF (a LVEF cut-off of 30%), improvement was observed in those with a LVEF>30. No changes were found in the other cardiological variables. CONCLUSIONS CPAP therapy proved to be useful in patients with associated sleep-disordered breathing and CHF. The improvement was more marked in patients with a LVEF>30%. However, the increased LVEF in the CPAP group was not accompanied by changes in the other cardiological variables.
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Abstract
Continuous positive airway pressure (CPAP) has become the treatment of choice for obstructive sleep apnea syndrome. Successful therapy with CPAP depends greatly on individual patient acceptance and compliance. Current indications for CPAP, including those for mild obstructive sleep apnea, will need to be revisited when results from the longitudinal follow-up of the Wisconsin Cohort and the Sleep Heart Health Study are made available.
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Affiliation(s)
- Susmita Chowdhuri
- Department of Medicine (11M), John D. Dingell Veterans Affairs Medical Center and Wayne State University, 4646 John R, Detroit, MI, USA.
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Kasasbeh A, Kasasbeh E, Krishnaswamy G. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex--a hypothetical review. Sleep Med Rev 2007; 11:47-58. [PMID: 17198758 DOI: 10.1016/j.smrv.2006.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obstructive sleep apnea (OSA) and asthma are potentially linked at several levels. The pathophysiology of these two conditions seems to overlap significantly, as airway obstruction, inflammation, obesity, and several other factors are implicated in the development of both diseases. Gastroesophageal reflux disease (GERD), cardiovascular complications, obesity itself, and the underlying inflammatory processes are all complex contributory factors that provide hypothetical links. Furthermore, a collateral rise in prevalence of both OSA and asthma has been noticed during the past few years, occurring in association with the emerging epidemic of obesity, a common risk factor for both conditions. OSA and asthma share many other risk factors as well. We propose a hypothetical OSA-asthma relationship that has implications on the diagnosis and management of patients presenting with either condition singly. Clinicians should be aware that OSA might complicate asthma management. Based on this hypothesis, we suggest that the treatment of the individual patient who experiences both asthma and OSA needs to be multidisciplinary and comprehensive. This hypothetical association of asthma and OSA, though described anecdotally, has not been systematically studied. In particular, the influence of continuous positive airway pressure therapy (for sleep apnea) on asthma outcomes (such as quality of life, steroid utilization, emergency room visits) and fatality needs to be studied further.
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Affiliation(s)
- Aiman Kasasbeh
- Division of Allergy and Immunology, Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614-0622, UK.
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Hsu PP, Tan AKL, Tan BYB, Gan EC, Chan YH, Blair RL, Lu PKS. Uvulopalatopharyngoplasty outcome assessment with quantitative computer-assisted videoendoscopic airway analysis. Acta Otolaryngol 2007; 127:65-70. [PMID: 17364332 DOI: 10.1080/00016480600672659] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSION Quantitative digital imaging upper airway analysis enables surgeons to assess the pre- and postoperative upper airway morphology quantitatively, objectively and accurately, and to correlate these changes in surgical parameters with improvement of obstructive sleep apnea. OBJECTIVE This was a prospective study using a new method of quantitative computer-assisted digital-imaging videoendoscopic upper airway analysis to quantify objectively and correlate the changes in surgical parameters with improvement of obstructive sleep apnea following uvulopalatopharyngoplasty. PATIENTS AND METHODS Nineteen male patients underwent uvulopalatopharyngoplasty for obstructive sleep apnea after continuous positive airway pressure trial. All had undergone pre- and postoperative digital imaging upper airway examination, Epworth scores, and polysomnographic studies. Postoperative static and dynamic changes in upper airway parameters were compared, analyzed and correlated with improvement of the apnea-hypopnea index (AHI) by statistical regression. RESULTS There were 65.12% and 64.37% improvements in the AHI and Epworth scales, respectively, after uvulopalatopharyngoplasty. Retropalatal areas measured were significantly correlated with improvement of the AHI. A 1 cm2 increase in retropalatal area during Mueller's maneuver in the supine position resulted in an improvement of 32.65 in the AHI; a 1 cm increase in the transverse diameter of the retropalatal area in the erect position resulted in an improvement of 31.83 in the AHI.
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Affiliation(s)
- Pon Poh Hsu
- Division of Otolaryngology, Changi General Hospital, Singapore, Republic of Singapore
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Norman D, Loredo JS, Nelesen RA, Ancoli-Israel S, Mills PJ, Ziegler MG, Dimsdale JE. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension 2006; 47:840-5. [PMID: 16585412 DOI: 10.1161/01.hyp.0000217128.41284.78] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension. Prior studies have been limited, however, in their ability to show reduction in blood pressure after continuous positive airway pressure (CPAP) therapy, and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated. We performed a randomized, double-blind, placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA. We found that 2 weeks of CPAP therapy resulted in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic, mean, and diastolic blood pressure (all Ps <0.05). Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation, it did not affect blood pressure. We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA, perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation.
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Affiliation(s)
- Daniel Norman
- Department of Medicine, School of Medicine, University of California, San Diego, CA, USA.
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von Känel R, Loredo JS, Ancoli-Israel S, Dimsdale JE. Association between sleep apnea severity and blood coagulability: treatment effects of nasal continuous positive airway pressure. Sleep Breath 2006; 10:139-46. [PMID: 16565866 DOI: 10.1007/s11325-006-0060-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A prothrombotic state may contribute to the elevated cardiovascular risk in patients with obstructive sleep apnea (OSA). We investigated the relationship between apnea severity and hemostasis factors and effect of continuous positive airway pressure (CPAP) treatment on hemostatic activity. We performed full overnight polysomnography in 44 OSA patients (mean age 47+/-10 years), yielding apnea-hypopnea index (AHI) and mean nighttime oxyhemoglobin saturation (SpO2) as indices of apnea severity. For treatment, subjects were double-blind randomized to 2 weeks of either therapeutic CPAP (n = 18), 3 l/min supplemental nocturnal oxygen (n = 16) or placebo-CPAP (<1 cm H2O) (n = 10). Levels of von Willebrand factor antigen (VWF:Ag), soluble tissue factor (sTF), D-dimer, and plasminogen activator inhibitor (PAI)-1 antigen were measured in plasma pre- and posttreatment. Before treatment, PAI-1 was significantly correlated with AHI (r = 0.47, p = 0.001) and mean nighttime SpO2 (r = -0.32, p = 0.035), but these OSA measures were not significantly related with VWF:Ag, sTF, and D-dimer. AHI was a significant predictor of PAI-1 (R2 = 0.219, standardized beta = 0.47, p = 0.001), independent of mean nighttime SpO2, body mass index (BMI), and age. A weak time-by-treatment interaction for PAI-1 was observed (p = 0.041), even after adjusting for age, BMI, pre-treatment AHI, and mean SpO2 (p = 0.046). Post hoc analyses suggested that only CPAP treatment was associated with a decrease in PAI-1 (p = 0.039); there were no changes in VWF:Ag, sTF, and D-dimer associated with treatment with placebo-CPAP or with nocturnal oxygen. Apnea severity may be associated with impairment in the fibrinolytic capacity. To the extent that our sample size was limited, the observation that CPAP treatment led to a decrease in PAI-1 in OSA must be regarded as tentative.
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Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, University Hospital Bern, Bern, Switzerland
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Arias MA, García-Río F, Alonso-Fernández A, Martínez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure. Eur Heart J 2006; 27:1106-13. [PMID: 16497687 DOI: 10.1093/eurheartj/ehi807] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We tested the hypothesis that: (i) obstructive sleep apnoea (OSA) by itself originates pulmonary hypertension (PH); and (ii) the application of continuous positive airway pressure (CPAP) can reduce pulmonary pressure. METHODS AND RESULTS In this randomized and cross-over trial, 23 middle-aged OSA (apnoea-hypopnoea index, 44.1 +/- 29.3 h(-1)) and otherwise healthy patients and 10 control subjects were included. OSA patients randomly received either sham or effective CPAP for 12 weeks. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, OSA patients had higher pulmonary artery systolic pressure than control subjects (29.8 +/- 8.8 vs. 23.4 +/- 4.1 mmHg, respectively, P = 0.036). Ten out of 23 patients [43%, (95% CI: 23-64%)] and none of the control subjects had PH at baseline (P = 0.012). Two patients were removed from the study because of inadequate CPAP compliance. Effective CPAP induced a significant reduction in the values for pulmonary systolic pressure (from 28.9 +/- 8.6 to 24.0 +/- 5.8 mmHg, P < 0.0001). The reduction was greatest in patients with either PH or left ventricular diastolic dysfunction at baseline. CONCLUSION Severe OSA is independently associated with PH in direct relationship with disease severity and presence of diastolic dysfunction. Application of CPAP reduces pulmonary systolic pressure levels.
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Affiliation(s)
- Miguel A Arias
- Servicios de Cardiología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Spain
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Alonso-Fernández A, García-Río F, Arias MA, Mediano O, Pino JM, Martínez I, Villamor J. Obstructive sleep apnoea–hypoapnoea syndrome reversibly depresses cardiac response to exercise. Eur Heart J 2005; 27:207-15. [PMID: 16267074 DOI: 10.1093/eurheartj/ehi621] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate cardiac response to exercise in middle-aged normotensive obstructive sleep apnoea-hypoapnoea syndrome (OSAHS) adults with normal resting left ventricular systolic function and to test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy might improve cardiac performance during exercise. METHODS AND RESULTS We performed a prospective, randomized, double-blind, placebo-controlled, cross-over clinical trial including 31 consecutive newly diagnosed OSAHS patients and 15 healthy subjects. Cardiopulmonary exercise testing with cardiac output measurement, blood pressure (BP) recordings, and urinary excretion of catecholamine levels were obtained at baseline and after 3 months on both effective and sham CPAP. OSAHS subjects had higher systolic and mean nocturnal BP and higher nocturnal levels of catecholamines. In contrast, they had lower increments in cardiac output (Qt) and in stroke volume (SV) in response to exercise than control subjects. CPAP therapy was associated with highly significant improvements in all the indices of left ventricular systolic performance response during exercise, whereas with sham CPAP, all of them remained unchanged. CONCLUSION OSAHS patients with normal resting left ventricular systolic function and no hypertension had a worse cardiac response to exercise than healthy subjects. In these patients, 3 months of CPAP improved both Qt and SV responses to exercise.
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Affiliation(s)
- Alberto Alonso-Fernández
- Servicio de Neumología, Hospital Universitario La Paz, Alfredo Marqueríe 11, 28034 Madrid, Spain
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