1
|
McNicholas WT, Arnardottir ES, Leppänen T, Schiza S, Randerath W. CPAP therapy for obstructive sleep apnoea: persisting challenges in outcome assessment. Eur Respir J 2023; 62:2300182. [PMID: 37474148 DOI: 10.1183/13993003.00182-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| | - Erna Sif Arnardottir
- The Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Sophia Schiza
- Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| |
Collapse
|
2
|
Pengo MF, Javaheri S, Sanchez-de-la-Torre M, Schwarz EI. What cardiologists should know about sleep. Eur Heart J 2022; 43:2911-2913. [PMID: 35818107 DOI: 10.1093/eurheartj/ehac349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Martino Francesco Pengo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan 20149, Italy
| | - Sogol Javaheri
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston 02130, MA, USA
| | - Manuel Sanchez-de-la-Torre
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida 25198, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid 28029, Spain
| | - Esther Irene Schwarz
- Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich 8091, Switzerland
| |
Collapse
|
3
|
McNicholas WT, Pevernagie D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. J Sleep Res 2022; 31:e13616. [PMID: 35609941 PMCID: PMC9539471 DOI: 10.1111/jsr.13616] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
Collapse
Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
4
|
Zagorski T, Arzt M, Stadler S. Obstruktive Schlafapnoe und arterielle Hypertonie. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Zusammenfassung
Hintergrund
In Deutschland leiden rund 19 Mio. Patienten an einer diagnostizierten arteriellen Hypertonie (aHT). Die Schnittmenge zwischen Menschen mit aHT und obstruktiver Schlafapnoe (OSA) ist groß. Aufwachreaktionen und Hypoxämie im Rahmen einer OSA können zu einem gesteigerten Sympathikotonus und endothelialer Dysfunktion und somit zu aHT führen.
Fragestellung
Der vorliegende Übersichtsartikel soll die Zusammenhänge zwischen OSA und aHT sowie Behandlungsmöglichkeiten darstellen.
Materialien und Methoden
Es erfolgte eine Literaturrecherche von Original- und Übersichtsartikeln, die bis 2021 in der PubMed-Datenbank veröffentlicht wurden.
Ergebnisse
Obstruktive Schlafapnoe kann sowohl die Entstehung als auch die Verschlechterung einer aHT verursachen. Betroffene profitieren von einer CPAP-Behandlung mit einer durchschnittlichen Senkung des systolischen Blutdrucks um −4,4 mm Hg sowie des diastolischen Blutdrucks um −2,9 mm Hg. Prädiktoren für eine Reduktion des Blutdrucks unter kontinuierlicher Positivdrucktherapie (CPAP) sind junges Alter, therapieresistente aHT, schwere OSA-bedingte Sauerstoffentsättigungen und ein „Non-Dipping-Blutdruckmuster“.
Schlussfolgerung
Die adäquate Behandlung einer aHT fordert häufig einen multimodalen Ansatz. Neben einer medikamentösen antihypertensiven Therapie und einer Modifikation des Lebensstils sollte auch die Diagnose und gegebenenfalls die Behandlung einer OSA berücksichtigt werden.
Collapse
|
5
|
Khan NNS, Todem D, Bottu S, Badr MS, Olomu A, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2022; 18:181-191. [PMID: 34270409 PMCID: PMC8807929 DOI: 10.5664/jcsm.9534] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES The aim of the Improving CPAP Adherence Program was to assess the impact of a multidimensional treatment framework based on shared decision-making, patient activation, and caregiver engagement on improving long-term positive airway pressure (PAP) adherence in patients newly diagnosed with obstructive sleep apnea. METHODS In this pilot study, patients aged ≥ 18 years with a new obstructive sleep apnea diagnosis who qualified for PAP treatment and lived with a caregiver were randomly assigned to receive either the multidimensional treatment (intervention, n = 28) or unrelated education (control group, n = 32). All patients and their caregiver participated in a group visit. The intervention group attended 4 structured sessions: interactive education, peer coaching, hands-on experience, and a semistructured motivational interview. The control group was educated on physical activity and lifestyle only. Objective PAP adherence data were obtained at baseline (day that they received PAP machine to group visit), group visit to 3 months, and 3-6 months. RESULTS In an age-adjusted model, the mean daily use of PAP increased significantly over the 3 time periods (P = .03). Intervention-arm participants gained a mean 1.23 hours (95% confidence interval, 0.33-2.13) in PAP mean daily use between 3 and 6 months vs those in the control arm (P = .008). We saw no difference in the percentage of PAP adherence across time between the 2 arms. CONCLUSIONS A multifaceted patient-centered intervention with caregiver engagement improved PAP adherence vs control levels, a beneficial effect sustained for the 6 months. Our findings suggest that caregivers, with the appropriate training, can improve patients' PAP adherence by providing a socially supportive environment. CITATION Khan NNS, Todem D, Bottu S, Badr MS, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2022;18(1):181-191.
Collapse
Affiliation(s)
- Nazia Naz S. Khan
- Department of Medicine, Michigan State University, East Lansing, Michigan,Address correspondence to: Nazia Naz S. Khan, MD, MS, Department of Medicine, Michigan State University, 788 Service Road, Clinical Center B-325, East Lansing, MI 48824; Office Tel: 517-353-3730; Office Fax: 517-432-1326;
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Shireesha Bottu
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - M. Safwan Badr
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, Harper University Hospital, Wayne State University School of Medicine, Detroit, Michigan
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Adesuwa Olomu
- Department of Medicine, Michigan State University, East Lansing, MI
| |
Collapse
|
6
|
Zhang L, Ko CY, Zeng YM. Immunoregulatory Effect of Short-Chain Fatty Acids from Gut Microbiota on Obstructive Sleep Apnea-Associated Hypertension. Nat Sci Sleep 2022; 14:393-405. [PMID: 35299627 PMCID: PMC8922759 DOI: 10.2147/nss.s354742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/27/2022] [Indexed: 12/12/2022] Open
Abstract
The intestine is the largest bacterial ecosystem and immune response organ of the human body. The microbiota regulates the metabolic and immune functions of the host through their metabolites. Short-chain fatty acids (SCFAs) are part of the metabolites of the gut microbiota (GM), providing energy to intestinal epithelial cells and regulating the immune system. A decrease in SCFA-producing bacteria, imbalanced effector T-helper cells (Th cells), and increasing corresponding inflammatory cytokine were found in both animal models and clinical patients with obstructive sleep apnea (OSA) and hypertension (HTN). Intervention with probiotics, prebiotics, or postbiotics in animal models simulating OSA-associated HTN restored blood pressure to normal, which allows the hypothesis that GM are involved in the pathophysiology of OSA-induced HTN patients through their metabolites' SCFAs; however, the exact regulatory mechanism is not completely clear. This review describes the potential mechanisms of SCFAs, a major metabolite of the GM, in the pathology of OSA-induced HTN, from the perspective of immune system regulation in the available studies.
Collapse
Affiliation(s)
- Li Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, People's Republic of China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, People's Republic of China
| | - Chih-Yuan Ko
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, People's Republic of China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, People's Republic of China.,Department of Clinical Nutrition, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, People's Republic of China.,School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, People's Republic of China
| | - Yi-Ming Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, People's Republic of China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, People's Republic of China
| |
Collapse
|
7
|
Effect of CPAP treatment on BP in resistant hypertensive patients according to the BP dipping pattern and the presence of nocturnal hypertension. Hypertens Res 2021; 45:436-444. [PMID: 34952953 DOI: 10.1038/s41440-021-00762-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022]
Abstract
High heterogeneity in the blood pressure (BP) response to continuous positive airway pressure (CPAP) exists in patients with resistant hypertension (RH). Only nondipper normotensive and hypertensive patients exhibited BP reductions when treated with CPAP; the baseline BP dipping pattern has been proposed as a predictor of BP response to CPAP but has never been explored in patients with RH. This study aimed to assess the effect of CPAP on BP in subjects with RH with respect to BP dipping pattern or nocturnal hypertension. This is an ancillary study of the SARAH study. RH subjects with an apnea/hypopnea index (AHI) ≥ 15/h and who received CPAP treatment for 1 year were included. Subjects underwent a sleep study and ambulatory BP monitoring (ABPM) at baseline and at the 1-year follow-up. Eighty-nine RH subjects were included. The subjects were mainly male (77.5%) and obese, with a mean age of 66 years (25th-75th percentile; 59.0; 70.0) and an AHI of 32.7/h (25th-75th percentile; 25.0; 54.7). A total of 68.5% of participants were nondippers, and 71.9% had nocturnal hypertension. After 1 year of CPAP, no significant differences in ABPM parameters were observed between dippers and nondippers. According to nighttime BP, subjects with nocturnal normotension did not show significant changes in ABPM parameters, while nocturnal hypertensive subjects achieved a significant reduction in mean nighttime BP of -4.38 mmHg (-7.10 to -1.66). The adjusted difference between groups was 3.04 (-2.25 to 8.34), which was not significant. This study shows that the BP response to CPAP in patients with RH does not differ according to the BP dipping pattern (dipper and nondipper) and suggests a differential response according to the presence of nocturnal hypertension (ClinicalTrials.gov: NCT03002558).
Collapse
|
8
|
Sutherland K, Dissanayake HU, Trzepizur W, Gagnadoux F, Cistulli PA. Circadian blood pressure profile and blood pressure changes following oral appliance therapy for obstructive sleep apnoea. J Hypertens 2021; 39:2272-2280. [PMID: 34149014 DOI: 10.1097/hjh.0000000000002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Oral appliance therapy for obstructive sleep apnoea (OSA) reduces blood pressure (BP) but there is little information on relationship to circadian BP pattern (nocturnal BP dipping or non-dipping). The aims of this study were to determine whether nocturnal dipping pattern influences BP changes following oral appliance therapy, and to determine the effect of oral appliance therapy on circadian BP pattern. METHODS Participants in two randomized trials of oral appliance therapy (1-2 months) with 24-h ambulatory BP monitoring (ABPM) data were included (N = 152). Nocturnal BP Dippers (nocturnal/diurnal SBP ratio <0.9) and non-dippers were compared for BP changes following oral appliance therapy and the effect of oral appliance therapy on nocturnal BP dipping was assessed. RESULTS Of 152 participants, 64.5% were dippers. Dippers were on average younger and less likely to be hypertensive (42 vs. 82.7%, P < 0.001). Nondippers showed greater reduction in nocturnal BP measures, related to higher BP measures at baseline. There was no difference in the relationship between treatment effectiveness and BP changes between groups. Oral appliance therapy converted only 23% of baseline non-dippers to a nocturnal dipping profile. CONCLUSION Baseline circadian BP profile influenced the BP response to oral appliance therapy, largely because of higher baseline BP in the non-dipper subgroup. Oral appliance therapy did not convert OSA patients to a more favourable circadian BP profile. Further work is required to understand the effect of oral appliance therapy on circadian BP profile and of the individuals who will receive cardiovascular benefit from oral appliance therapy.
Collapse
Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Wojciech Trzepizur
- University of Angers, INSERM UMR 1063 'SOPAM'
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Frederic Gagnadoux
- University of Angers, INSERM UMR 1063 'SOPAM'
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| |
Collapse
|
9
|
Crinion SJ, Kleinerova J, Kent B, Nolan G, Taylor CT, Ryan S, McNicholas WT. Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy. ERJ Open Res 2021; 7:00338-2021. [PMID: 34409095 PMCID: PMC8365144 DOI: 10.1183/23120541.00338-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is strongly associated with systemic hypertension, but there are limited data on the relationship with blood pressure (BP) in normotensive subjects. Here, we examined the relationship of OSA with nocturnal BP in a documented diurnal normotensive cohort, explored potential intermediate pathways and assessed the effects on BP of continuous positive airways pressure (CPAP) therapy. Methods 65 males referred for assessment of possible OSA and normotensive on 24-hour BP monitoring underwent overnight inpatient polysomnography (age 41±7 years, body mass index (BMI) 34±6 kg·m−2, apnoea–hypopnoea index (AHI) 14 (interquartile range 5–26)). Urine and serum were assessed for markers of sympathetic activation, renin–angiotensin–aldosterone system activity, oxidative stress, endothelial function and systemic inflammation. In a subset of patients, 24-hour BP monitoring was repeated after CPAP therapy. Results Within this normotensive cohort, night-time systolic and diastolic BP and nocturnal BP dip were highest in the fourth OSA severity quartile (p<0.05). Nocturnal BP dip correlated with AHI (r=−0.327, p<0.05) and oxygen desaturation index (ODI) (r=−0.371, p<0.05), but only ODI was an independent predictor of BP dip (B=–0.351, p<0.01) and non-dipping status (B=0.046, p<0.05). Overnight urinary norepinephrine correlated with nocturnal systolic BP (r=0.387, p<0.01) with a trend towards correlation with systolic dipping (p=0.087). In 20 CPAP-treated patients, night-time systolic BP decreased (p<0.05) and mean nocturnal BP dip increased (p≤0.05). Conclusion In this normotensive cohort, OSA severity was associated with higher nocturnal BP, which improved following CPAP therapy, and intermittent hypoxia was the most important OSA-related variable in this relationship. There is a strong association in a normotensive cohort between OSA and nocturnal blood pressure, with intermittent hypoxia as an important mechanistic pathwayhttps://bit.ly/2SFvWiB
Collapse
Affiliation(s)
- Sophie J Crinion
- Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, Canada.,Dept of Medicine, Queen's University, Kingston, Canada
| | - Jana Kleinerova
- Dept of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brian Kent
- Dept of Respiratory Medicine, St James' Hospital, Dublin, Ireland
| | - Geraldine Nolan
- Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Cormac T Taylor
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,These authors contributed equally
| | - Walter T McNicholas
- Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,These authors contributed equally
| |
Collapse
|
10
|
Tamura K, Uchida K, Ishigami T. An interesting link between quality of sleep and a measure of blood pressure variability. J Clin Hypertens (Greenwich) 2020; 23:331-333. [PMID: 33373081 PMCID: PMC8029662 DOI: 10.1111/jch.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kotaro Uchida
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
11
|
Recent advances in the management of secondary hypertension—obstructive sleep apnea. Hypertens Res 2020; 43:1338-1343. [DOI: 10.1038/s41440-020-0494-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/22/2022]
|
12
|
Staats R, Barros I, Fernandes D, Grencho D, Reis C, Matos F, Valença J, Marôco J, de Almeida AB, Bárbara C. The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients. Front Physiol 2020; 11:104. [PMID: 32231580 PMCID: PMC7082422 DOI: 10.3389/fphys.2020.00104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/28/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Obstructive sleep apnea (OSA) has been associated with non-dipping blood pressure (BP). The precise mechanism is still under investigation, but repetitive oxygen desaturation and arousal induced sleep fragmentation are considered the main contributors. Methods We analyzed beat-to-beat measurements of hemodynamic parameters (HPs) during a 25-min period of wake–sleep transition. Differences in the mean HP values for heart rate (HR), systolic BP (SBP), and stroke volume (SV) during wake and sleep and their standard deviations (SDs) were compared between 34 controls (C) and 22 OSA patients. The Student’s t-test for independent samples and the effect size by Cohen’s d (d) were calculated. HP evolution was investigated by plotting the measured HP values against each consecutive pulse wave. After a simple regression analysis, the calculated coefficient beta (SCB) was used to indicate the HP evolution. We furthermore explored by a hierarchical block regression which variables increased the prediction for the SCB: model 1 BMI and age, model 2 + apnea/hypopnea index (AHI), and model 3 + arousal index (AI). Results Between the two groups, the SBP increased in OSA and decreased in C resulting in a significant difference (p = 0.001; d = 0.92). The SV demonstrated a similar development (p = 0.047; d = 0.56). The wake/sleep variation of the HP measured by the SD was higher in the OSA group—HR: p < 0.001; d = 1.2; SBP: p = 0.001; d = 0.94; and SV: p = 0.005; d = 0.82. The hierarchical regression analysis of the SCB demonstrated in SBP that the addition of AI to AHI resulted in ΔR2: +0.163 and ΔF + 13.257 (p = 0.001) and for SV ΔR2: +0.07 and ΔF 4.83 (p = 0.003). The AI but not the AHI remained statistically significant in the regression analysis model 3—SBP: β = 0.717, p = 0.001; SV: β = 0.469, p = 0.033. Conclusion In this study, we demonstrated that in OSA, the physiological dipping in SBP and SV decreased, and the variation of all investigated parameters increased. Hierarchical regression analysis indicates that the addition of the AI to BMI, age, and AHI increases the prediction of the HP evolution following sleep onset for both SBP and SV and may be the most important variable.
Collapse
Affiliation(s)
- Richard Staats
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Barros
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Dina Fernandes
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Dina Grencho
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Cátia Reis
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CENC - Sleep Medicine Center, Lisbon, Portugal
| | - Filipa Matos
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - João Valença
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Marôco
- William James Centre for Research, ISPA-IU, Lisbon, Portugal
| | | | - Cristina Bárbara
- Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Sapiña-Beltrán E, Torres G, Benítez I, Santamaría-Martos F, Durán-Cantolla J, Egea C, Sánchez-de-la-Torre M, Barbé F, Dalmases M. Differential blood pressure response to continuous positive airway pressure treatment according to the circadian pattern in hypertensive patients with obstructive sleep apnoea. Eur Respir J 2019; 54:13993003.00098-2019. [PMID: 31097515 DOI: 10.1183/13993003.00098-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/21/2019] [Indexed: 01/08/2023]
Abstract
Continuous positive airway pressure (CPAP) has a heterogeneous effect on blood pressure (BP) in hypertensive patients. However, the effect of CPAP on BP in hypertensive subjects regarding circadian BP pattern has never been explored. This study aimed to assess the effect of CPAP on BP, taking into consideration the circadian BP pattern in untreated hypertensive patients.This study is a post hoc analysis of the Spanish Cohort for the Study of the Effect of CPAP in Hypertension (CEPECTA), a multicentre, randomised trial of CPAP versus sham-CPAP in patients with new-onset systemic hypertension and an apnoea-hypopnoea index >15 events·h-1 We included patients for whom 24-h ambulatory BP monitoring (ABPM) data were available at baseline and 12 weeks after the intervention. Subjects were classified based on the dipping ratio (dipper/non-dipper). We evaluated the effect of CPAP on ABPM parameters after 12 weeks of treatment.Overall, 272 hypertensive subjects were included in the analysis (113 dippers and 159 non-dippers). Baseline clinical and polysomnographic variables were similar between the groups. CPAP treatment in non-dipper patients was associated with reductions in 24-h ambulatory BP variables and night-time ambulatory BP measurements. However, a nonsignificant effect was reported in the dipper group. The differential effects of CPAP between the groups were -2.99 mmHg (95% CI -5.92-- -0.06 mmHg) for the mean 24-h ambulatory BP and -5.35 mmHg (95% CI -9.01- -1.69 mmHg) for the mean night-time ambulatory BP.Our results show a differential effect of CPAP treatment on BP in hypertensive patients depending on the circadian pattern. Only non-dipper patients benefited from CPAP treatment in terms of BP reduction.
Collapse
Affiliation(s)
- Esther Sapiña-Beltrán
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gerard Torres
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain
| | - Iván Benítez
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Fernando Santamaría-Martos
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain
| | - Joaquín Durán-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Bioaraba Research Institute, OSI Araba University Hospital, Dept of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unidad Funcional de Sueño, Bioaraba Research Institute, OSI Araba University Hospital, Dept of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Manuel Sánchez-de-la-Torre
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferrán Barbé
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Mireia Dalmases
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRB Lleida, Universitat de Lleida, Lleida, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | |
Collapse
|
15
|
Marrone O, Bonsignore MR. Decrease in blood pressure during continuous positive airway pressure treatment for obstructive sleep apnoea: still searching for predictive factors. Eur Respir J 2019; 54:54/1/1901219. [DOI: 10.1183/13993003.01219-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
|
16
|
Disturbed Sleep as a Mechanism of Race Differences in Nocturnal Blood Pressure Non-Dipping. Curr Hypertens Rep 2019; 21:51. [DOI: 10.1007/s11906-019-0954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Serinel Y, Hoyos C, Qasem A, Yee BJ, Grunstein RR, Wong KH, Phillips CL. Diurnal changes in central blood pressure and pulse pressure amplification in patients with obstructive sleep apnoea. Int J Cardiol Hypertens 2019; 1:100002. [PMID: 33447736 PMCID: PMC7803064 DOI: 10.1016/j.ijchy.2019.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Recent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA). METHODS In this observational study, patients with moderate to severe OSA underwent 24 h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times. RESULTS 36 patients were screened, 31 had successful testing (mean (SD) age 45 ± 10 years, AHI 58 ± 27 events/hr, Office BP 136/89 ± 10.7/9.5 mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (-3.2 mmHg, p < 0.001), whereas the central PP remained unchanged (0.124 mmHg, NS), causing a significant reduction in PPA overnight (-10.7%, p < 0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 mmHg, p < 0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by -3.3%, p = 0.004). CONCLUSIONS In moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.
Collapse
Affiliation(s)
- Yasmina Serinel
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Derby St, Penrith NSW 2750, Australia
| | - Camilla Hoyos
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad Qasem
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Place, NSW 2109 Australia
| | - Brendon J. Yee
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Ronald R. Grunstein
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Keith H. Wong
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Craig L. Phillips
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Reserve Rd, St Leonards, Sydney, NSW 2065, Australia
| |
Collapse
|
18
|
Abstract
Substantial evidence points to a benefit with CPAP on cardiovascular and metabolic outcomes in asymptomatic patients with moderate-to-severe obstructive sleep apnoea http://ow.ly/FUxN30nkTqU.
Collapse
Affiliation(s)
- Silke Ryan
- Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, The Conway Institute, University College Dublin, Dublin, Ireland
| |
Collapse
|