[Cardiovascular consequences of obstructive sleep apnea syndrome]

Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea

PURPOSE

Prevalence of glaucoma is higher in obstructive sleep apnea (OSA) patients. The gold standard technique to treat OSA is continuous positive airway pressure (CPAP) therapy. The influence of long-term CPAP therapy on intraocular pressure (IOP), blood pressure, ocular perfusion pressure (OPP), and glaucoma progression in primary open-angle glaucoma (POAG) patients was evaluated.

DESIGN

Prospective study.

MATERIALS AND METHODS

In this study, we enrolled 12 eyes from six POAG patients aged >35 years, with newly diagnosed OSA and with indication for CPAP therapy. The CPAP was performed for 12 months. We monitored the IOP every 3 months. Visual field was determined at baseline and 12 months.

RESULTS

The mean IOP after CPAP therapy for 12 months was significantly higher than the mean baseline IOP (average IOP 3 months before CPAP therapy) (19.08 ± 3.47 vs 17.83 ± 2.88 mm Hg; p = 0.006). The IOP rising rate was 0.69 ± 0.47/years (p = 0.138) before CPAP therapy and increased to 1.13 ± 0.47/years (p = 0.016) after CPAP therapy. The OPP after 12 months of CPAP was significantly lower than the baseline (42.21 ± 5.29 vs 45.24 ± 7.09 mm Hg; p = 0.06). Results showed that the pattern standard deviation (PSD) value of 24-2 short wavelength automated perimetry (SWAP) visual field was reduced from 5.34 ± 3.92 to 4.77 ± 3.73 (p = 0.025). Antiglaucoma medication was administered to a patient due to increased IOP without glaucoma progression evidence.

CONCLUSION

The POAG and OSA patients demonstrated significant IOP rising after CPAP therapy but did not show progression of glaucomatous damage. Mean deviation (MD), PSD, and visual field index (VFI) were not significantly different after CPAP therapy.

PRÉCIS

Prospective study of POAG and OSA patients demonstrated significant IOP rising after CPAP therapy for a year. The study did not show progression of glaucomatous damage.

HOW TO CITE THIS ARTICLE

Hirunpatravong P, Kasemsup T, Ayudhya WN, et al. Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea. J Curr Glaucoma Pract 2019;13(3):94-98.

[Sleep disorders, anxiety and depressive symptoms and cardiovascular risk among black African hypertensive: cross-sectional study of 414 hypertensive followed as outpatients at the University Hospital of Ouagadougou (Burkina Faso)]

Introduction

Dans le but de déterminer la fréquence des troubles du sommeil, de l'anxiété et de la dépression, et de rechercher l'existence d'une relation entre ces troubles et le risque cardio-vasculaire global chez les hypertendus noirs africains, nous avons réalisé une étude transversale de mai 2010 à mars 2011 à l'unité de consultation externe du service de cardiologie du CHU-Yalgado Ouédraogo de Ouagadougou qui a inclut 414 hypertendus adultes suivis en ambulatoire. Après un examen clinique à la recherche des facteurs de risque cardio-vasculaire, deux auto-questionnaires ont été administrés.

Méthodes

Le questionnaire de l’«European Sleep Center » pour la recherche des troubles du sommeil et, l’échelle «Hospital Anxiety and Depression Scale » de Zigmond et Snaith pour la recherche de l'anxiété et la dépression. Le diagnostic du syndrome d'apnée du sommeil était clinique et basé sur la présence des 4 symptômes principaux: hypersomnolence diurne, éveils nocturnes fréquents avec nycturie, asthénie matinale avec ou sans céphalées et ronflements importants. Le risque cardio-vasculaire global était calculé grâce à l’équation d'Anderson tirée de l’étude de Framingham. L'analyse des données a été réalisée par le logiciel SPSS version 17. La comparaison des variables a été effectuée grâce au test de Khi 2 pour les variables qualitatives et au test «t» de Student pour les variables quantitatives. Le seuil de signification a été fixé à 5%.

Résultats

L’échantillon était composé de 414 patients dont 248 femmes (59,9%). L’âge moyen était de 54,6 ± 9,3 ans. Les troubles du sommeil étaient retrouvés dans 72,2% des cas. Ils étaient dominés par l'insomnie (49,2%), le syndrome d'apnée du sommeil (33,5%) et le syndrome des jambes sans repos (25,8%). L'anxiété était retrouvée dans 37,1% des cas et la dépression dans 16,6% des cas. Le risque cardio-vasculaire global était faible dans 21,0%, modéré dans 33,6%, élevé dans 24,4% et très élevé dans 21,0% des cas. Le syndrome d'apnée du sommeil (p=0,033), le syndrome des jambes sans repos (p=0,005), l'anxiété (p=0,0021) et la dépression (p=0,0001) étaient significativement associés à un risque cardio-vasculaire élevé à très élevé.

Conclusion

Les troubles du sommeil, l'anxiété et la dépression sont fréquents chez les hypertendus noirs africains. Ils sont liés à un niveau de risque cardio-vasculaire élevé. Leur dépistage devrait être intégré à la prise en charge des hypertendus.

Atorvastatin protects against deleterious cardiovascular consequences induced by chronic intermittent hypoxia

Chronic intermittent hypoxia (IH), a major component of obstructive sleep apnea (OSA), contributes to the high risk of cardiovascular morbidity. We have previously demonstrated that IH-induced oxidative stress is involved in the hypertension and in the hypersensitivity to myocardial infarction. However, the mechanisms underlying these cardiovascular alterations are still unclear, as well as the role of potential protective treatment. Atorvastatin has pleiotropic actions, including increasing nitric oxide (NO) bioavailability and reducing inflammation and oxidative damage. The aim of this study was to evaluate the beneficial effect of a two time course of this treatment against the deleterious cardiovascular consequences of IH. Rats were divided into two groups subjected to chronic IH or normoxic (N) exposure. IH consisted of repetitive one-minute cycles (with only 30 s of a 5% inspired O2 fraction) and was applied for eight hours during daytime, for 14 (simultaneous protocol) or 28 d (delayed protocol). Atorvastatin (10 mg/kg/ d) or its vehicle was administered during the 14 d simultaneous protocol or the last 14 d of the delayed protocol. For both protocols, systolic arterial pressure was significantly increased by 14 d IH exposure. Atorvastatin prevented this deleterious effect in the simultaneous protocol. Carotid artery compliance and endothelial function were significantly altered after 28 d but not after 14 d of IH exposure. Delayed atorvastatin administration preserved these vascular parameters. IH also increased hypersensitivity to myocardial infarction after 14 d exposure, and atorvastatin abolished this deleterious effect. IH also enhanced cardiac NADPH expression and decreased aortic superoxide dismutase activity after 14 d exposure. Atorvastatin significantly restored these activities. In conclusion, whereas IH rapidly increased blood pressure, myocardial infarction hypersensitivity and oxidative stress, compliance, endothelial function and the structural wall of the carotid artery were only altered after a longer IH exposure. Atorvastatin prevented all these deleterious cardiovascular effects, leading to a potentially novel pharmacological therapeutic strategy for OSA syndrome.

[Night cardiac rhythm and conduction disturbances revealing obstructive sleep apnoea syndrome]

There is a strong prevalence of sleep apnoea syndrome in general population. Cardiac arrhythmia and conduction disturbances during sleep may complicate this syndrome. We report the case of a 73-year-old patient to whom the sleep apnoea syndrome was diagnosed after varied heart blocks during the sleep. A treatment by continuous positive airway pressure (CPAP) permitted to correct these conduction disturbances and to avoid pacemaker implantation.

Association of obstructive sleep apnea with urinary albumin excretion in essential hypertension: a cross-sectional study

BACKGROUND

Microalbuminuria reflects a state of widespread vascular dysfunction, whereas obstructive sleep apnea (OSA) further promotes atherosclerotic damage in hypertension.

STUDY DESIGN

Cross-sectional.

SETTING & PARTICIPANTS

In an outpatient hypertensive unit, 62 untreated hypertensive patients (aged 48 +/- 7 years; office blood pressure [BP], 151 +/- 8/97 +/- 7 mm Hg) with OSA and 70 hypertensive patients without OSA (apnea hypopnea index [AHI] < or = 5) matched for age, sex, smoking status, body mass index, and 24-hour pulse pressure were studied.

PREDICTOR VARIABLE

Hypertension and OSA compared with hypertension without OSA. OSA defined as AHI greater than 5, documented by polysomnography.

OUTCOME VARIABLE

Albuminuria assessed by urinary albumin-creatinine ratio (ACR).

MEASUREMENTS

Participants underwent polysomnography, ambulatory BP monitoring, echocardiography, routine metabolic profile assessment, and glomerular filtration rate estimation, whereas ACR was measured from 2 nonconsecutive morning spot urine samples.

RESULTS

Hypertensive patients with OSA compared with those without OSA showed increased 24-hour diastolic BP (87 +/- 7 versus 85 +/- 7 mm Hg; P = 0.03) and nighttime pulse pressure (50 +/- 10 versus 45 +/- 10 mm Hg; P = 0.008), but did not differ regarding metabolic profile and estimated glomerular filtration rate. Albuminuria was greater by 57% in patients with OSA compared with those without OSA: log(10)ACR, 1.1 +/- 0.2 versus 0.7 +/- 0.4 mg/g; P < 0.001). In the entire study population, log10(ACR) correlated with log10(AHI) (r = 0.35; P < 0.001), minimum oxygen saturation during sleep (r = -0.33; P < 0.001), 24-hour pulse pressure (r = 0.38; P < 0.001), and nighttime pulse pressure (r = 0.21; P =0 .01). In a multivariable linear regression model, independent predictors of ACR were AHI (beta = 0.36; P < 0.001) and 24-hour pulse pressure (beta = 0.25; P = 0.01).

LIMITATIONS

Cross-sectional study.

CONCLUSIONS

Albuminuria increases within the normal range in hypertensive individuals with OSA compared with those without OSA proportionally to OSA severity independently of confounders. The association of upper-airway dysfunction with albuminuria and pulsatile hemodynamic load may provide an explanatory mechanism for the OSA-related risk in hypertension.

Alteraciones ecocardiográficas asociadas al síndrome de apnea-hipopnea del sueño en función de su gravedad

INTRODUCTION AND OBJECTIVES

Sleep apnea-hypopnea syndrome (SAHS) is a prevalent condition that has well-known cardiovascular repercussions. However, few published echocardiographic studies have investigated the abnormalities present at SAHS diagnosis or their relationship with syndrome severity. Our objective was to evaluate myocardial structural, functional and performance parameters in these patients.

METHODS

In total, 110 consecutive patients diagnosed with SAHS between June 2005 and 2006 who required treatment with continuous positive airway pressure were divided into two groups according to SAHS severity. Baseline echocardiography was carried out to evaluate structural and functional variables. Findings in the two groups were compared by univariate and multivariate analysis.

RESULTS

The patients' mean age was 54 (13) years, their body mass index was 32 (6), 51% had comorbidities, and 74% were male. Patients with severe SAHS (i.e., apnea-hypopnea index [AHI] > or = 30) smoked and drank alcohol more and had larger neck circumferences. There was no significant difference in any structural parameter between the two groups. Functionally, patients with severe SAHS had shorter aortic (AHI<30 277 [4] ms vs AHIé30 263 [4] ms; P=.02) and pulmonary (AHI < 30 287 +/- 5 ms vs. AHI > or = 30 268 +/- 5 ms; P=.01) ejection times, and a higher Tei index (Left: AHI<30 0.51 [0.01] vs AHIé30 0.57 [0.02] [P=.04]; Right: AHI<30 0.38 [0.02] vs AHIé30 0.49 [0.03] [P=.02]). There were correlations between SAHS severity and the right Tei index, and aortic and pulmonary ejection times (P=.0001, P=.01, and P=.0001, respectively). The pulmonary ejection time was an independent predictor of SAHS severity (odds ratio: 0.98, 95% confidence interval, 0.97-0.99; P=.01).

CONCLUSIONS

Myocardial performance is poorer in patients with SAHS. The Tei index and ejection times are all associated with SAHS severity. The pulmonary ejection time is an independent predictor of disease severity.