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Siopi D, Steiropoulos P. The Influence of CPAP Therapy on Basal Metabolic Rate and Physical Activity in Obese Patients with Obstructive Sleep Apnea. Nutrients 2023; 15:4446. [PMID: 37892521 PMCID: PMC10609663 DOI: 10.3390/nu15204446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Energy balance in Obstructive Sleep Apnea (OSA), a disease closely related to obesity, is disturbed, and physical activity levels are impaired. The role of Continuous Positive Airway Pressure treatment (CPAP) in alleviating the disruptions mentioned above is questioned. The objective of this study is to explore changes in energy expenditure (EE) and physical activity (PA) in obese patients with OSA after CPAP treatment. METHODS An assessment of Basal Metabolic Rate (BMR) via indirect calorimetry (IC) was performed on 24 obese patients (male in the majority (87.5%), mean age of 52.4 ± 9.8 years), newly diagnosed with moderate-severe OSA by polysomnography, at 4-time points: at baseline, at CPAP titration, at the 1-month and the 3-month follow up. Physical activity levels were subjectively estimated using the International Questionnaire of Physical Activity (IPAQ) before and after 3 months of adherent CPAP application. RESULTS BMR significantly decreased after CPAP treatment (1926 ± 537.8 kcal/d at baseline, 1790 ± 493.7 kcal/d at CPAP initiation, 1680.3 ± 600.8 kcal/d at 1 month, and 1581.3 ± 478.9 kcal/d at 3 months follow up (p < 0.001)). No significant changes in IPAQ were observed over time: baseline median IPAQ: 3894 (1487.5-11,755.5) total MET·min·wk-1, 3-month median IPAQ: 3900 (1512-11,824.5) total MET·min·wk-1. CONCLUSIONS CPAP has an appreciable time effect on the BMR of obese patients with moderate-severe OSA. However, this change is not accompanied by a significant increase in physical activity levels.
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Affiliation(s)
- Dimitra Siopi
- Department of Pulmonology, General Hospital “G. Papanikolaou”, 57010 Thessaloniki, Greece
| | - Paschalis Steiropoulos
- MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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2
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Zota IM, Roca M, Leon MM, Cozma CD, Anghel L, Statescu C, Sascau R, Hancianu M, Mircea C, Ciocoiu M, Cumpat CM, Mitu F. Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension-A Pilot Prospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13081447. [PMID: 37189548 DOI: 10.3390/diagnostics13081447] [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: 03/25/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.
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Affiliation(s)
- Ioana Madalina Zota
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Maria Magdalena Leon
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Corina Dima Cozma
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Larisa Anghel
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Radu Sascau
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Monica Hancianu
- Department of Pharmacognosy, Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Cornelia Mircea
- Department of Pharmaceutical Sciences (II), Faculty of Pharmacy, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Morpho-Functional Sciences (Pathophysiology), Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Carmen Marinela Cumpat
- Department of Medical Specialties (III), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties (I), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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3
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Placebo response in objective and subjective measures of hypersomnia in randomized clinical trials on obstructive sleep apnea. A systematic review and meta-analysis. Sleep Med Rev 2023; 67:101720. [PMID: 36495752 DOI: 10.1016/j.smrv.2022.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
Sleepiness is one of the outcomes most used in randomized clinical trials (RCT) on the effect of treatments for obstructive sleep apnea (OSA). Furthermore, it is known that there is a placebo effect, especially in subjective measures. Therefore, given that sleepiness is a subjective measure, the objective of this systematic review with meta-analysis and three-level meta-regression was to assess the response to different placebos (pills and sham-CPAP) used in RCTs in OSA, both on subjective (Epworth Sleepiness Scale [ESS]) and objective (Multiple Sleep Latency Test [MSLT], Maintenance Wake Test [MWT], the Osler test and the Psychomotor Vigilance Task [PVT]). We observed a statistically significant placebo effect in both subjective and objective measures of hypersomnia, and in both sham-CPAP and pills. This placebo effect was greater, even clinically significant, in subjective measures (ESS: -2.84 points) and in those RCTs that used pills as a placebo. In the meta-regression, only a higher baseline value of the ESS and Osler test was related to the placebo effect.
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4
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Feltner C, Wallace IF, Aymes S, Cook Middleton J, Hicks KL, Schwimmer M, Baker C, Balio CP, Moore D, Voisin CE, Jonas DE. Screening for Obstructive Sleep Apnea in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1951-1971. [PMID: 36378203 DOI: 10.1001/jama.2022.18357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE Obstructive sleep apnea (OSA) is associated with adverse health outcomes. OBJECTIVE To review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force. DATA SOURCES PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022. STUDY SELECTION English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials. MAIN OUTCOMES AND MEASURES Test accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms. RESULTS Eighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, -2.33 [95% CI, -2.75 to -1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, -1.67 [95% CI, 2.09 to -1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg). CONCLUSIONS AND RELEVANCE The accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health-related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.
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Affiliation(s)
- Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Aymes
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Kelli L Hicks
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Manny Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Claire Baker
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Casey P Balio
- Center for Rural Health Research, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Daniel Moore
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
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5
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Imes CC, Bizhanova Z, Sereika SM, Korytkowski MT, Atwood CW, Burke LE, Kariuki J, Morris JL, Stansbury R, Strollo PJ, Chasens ER. Metabolic outcomes in adults with type 2 diabetes and sleep disorders. Sleep Breath 2022; 26:339-346. [PMID: 34105104 PMCID: PMC8655315 DOI: 10.1007/s11325-021-02408-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Insomnia is frequently co-morbid with obstructive sleep apnea (OSA); the effect of insomnia or co-morbid insomnia and OSA (OSA + I) on associated metabolic outcomes in adults with type 2 diabetes (T2D) remains unclear. This study in adults with T2D compared metabolic outcomes among persons with OSA, insomnia, or OSA + I. METHODS This study analyzed baseline data from the Diabetes Sleep Treatment Trial of persons recruited for symptoms of OSA or poor sleep quality. Home sleep studies determined OSA presence and severity. Insomnia was evaluated using the Insomnia Severity Index. Height and weight to calculate body mass index (BMI) and blood for laboratory values were obtained. Multivariate general linear models were used to examine the impact of the type of sleep disorder and sociodemographic, lifestyle, and sleep risk factors on metabolic outcomes. RESULTS Participants (N = 253) were middle-aged (56.3 ± 10.5 years), white (60.5%), obese (mean BMI of 35.3 ± 7.1 kg/m2), and male (51.4%) with poor glucose control (mean HbA1c of 8.0 ± 1.8%). Most participants had OSA + I (42.7%) or insomnia only (41.0%). HbA1c and BMI differed among the sleep disorder groups. In addition, in the adjusted models, having insomnia only, compared to OSA only, was associated on average with higher HbA1c levels (b = 1.08 ± 0.40, p < 0.007) and lower BMI (b = - 7.03 ± 1.43, p < 0.001). CONCLUSIONS Findings suggest that insomnia frequently co-exists with OSA, is independently associated with metabolic outcomes in adults with T2D, and should be considered in investigations of the effects of OSA in persons with T2D. TRIAL REGISTRATION Diabetes-Obstructive Sleep Apnea Treatment Trial (NCT01901055), https: Clinicaltrials.gov/ct2/show/NCT01901055; Registration date: July 17, 2013.
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Affiliation(s)
| | - Zhadyra Bizhanova
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan M. Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Charles W. Atwood
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lora E. Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacob Kariuki
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonna L. Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Stansbury
- School of Medicine, West Virginia University, Morgantown, WV, USA
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6
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Chasens ER, Atwood CW, Burke LE, Korytkowski M, Stansbury R, Strollo PJ, Sereika SM. Diabetes sleep treatment trial: Premise, design, and methodology. Contemp Clin Trials 2019; 76:104-111. [PMID: 30517889 PMCID: PMC6311443 DOI: 10.1016/j.cct.2018.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/16/2018] [Accepted: 11/30/2018] [Indexed: 02/01/2023]
Abstract
The Diabetes Sleep Treatment Trial (DSTT) is a multi-site, double-blinded, randomized, sham-controlled trial. The study objective is to test whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) treatment results in improved glycemic control and diabetes self-management behavior compared to participants on a sham-CPAP (sub-therapeutic) device in participants with type 2 diabetes mellitus (T2DM) and co-morbid OSA. The purpose of this paper is to describe the premise for the DSTT, the study design, and the methodology used in this on-going trial. The target enrollment is 210 randomly assigned participants recruited from two sites. The primary outcome for glucose control is HbA1C; additional outcomes for diabetes self-management include objectively measured steps walked and subjectively measured diabetes-related distress, diabetes empowerment, and diabetes knowledge. All participants receive individual diabetes education and counseling for 6 weeks over two individual sessions and three telephone calls. Participants are randomized to receive either sham or active CPAP for 12 weeks, after which, they "guess" their group assignment; this will assist in determining the success of blinding participants to treatment group assignment. Participants revealed to be on active CPAP will be encouraged to continue CPAP for an additional 12 weeks; participants who had been on sham devices will be encouraged to have a repeat CPAP titration study and to crossover to active CPAP treatment for 24 weeks. An intention-to-treat approach will be used for efficacy analyses. The trial is registered with Clinicaltrials.gov (NCT01901055).
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Affiliation(s)
- Eileen R Chasens
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, United States.
| | - Charles W Atwood
- Veterans Administration Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA, United States
| | - Lora E Burke
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, United States
| | - Mary Korytkowski
- University of Pittsburgh School of Medicine, 3601 Fifth Ave, Room 550, Pittsburgh, PA, United States
| | - Robert Stansbury
- West Virginia University School of Medicine, 4th Floor HSCN Room, Morgantown, WV 4062, United States
| | - Patrick J Strollo
- University of Pittsburgh School of Medicine, NW 628 UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA, United States
| | - Susan M Sereika
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, United States
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7
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Feng Y, Maislin D, Keenan BT, Gislason T, Arnardottir ES, Benediktsdottir B, Chirinos JA, Townsend RR, Staley B, Pack FM, Sifferman A, Pack AI, Kuna ST. Physical Activity Following Positive Airway Pressure Treatment in Adults With and Without Obesity and With Moderate-Severe Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:1705-1715. [PMID: 30353806 DOI: 10.5664/jcsm.7378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the level of physical activity (PA) before and following positive airway pressure (PAP) treatment in adults who have obstructive sleep apnea (OSA) with obesity versus without obesity. METHODS Simultaneous waist accelerometer and wrist actigraphy recordings were obtained in 129 adults with obesity and 69 adults without obesity and who had OSA prior to and following 4 months of PAP therapy and in 52 patients in a control group. Primary PA measurements were average steps per day on waist accelerometry and average counts per minute (CPM) per day on wrist actigraphy. RESULTS At baseline, participants with obesity and OSA exhibited fewer steps per day on waist accelerometer and fewer CPM per day on wrist actigraphy compared to participants without obesity and with OSA (despite similar apnea-hypopnea index between groups). Following PAP treatment, participants with OSA had modestly increased CPM per day on wrist actigraphy (17.69 [95% confidence interval (CI), 5.67-29.71], P = .005) and increased light PA time (0.26 [95% CI, 0.07-0.44] hours, P = .008) on waist accelerometer. Participants without obesity and with OSA had greater improvements in PA measures on average compared to participants with obesity and OSA, although the differences were not statistically significant. Weight increased following PAP treatment in the participants with obesity and OSA (1.71 [95% CI, 0.41-3.02] kg, P = .010) but was unchanged in the group without obesity (0.93 [95% CI, -0.89 to 2.76] kg, P = .311). CONCLUSIONS Compared to study participants without obesity and with OSA, participants with obesity and OSA had reduced PA at baseline. PA increased significantly in participants without obesity, with OSA, and who were adherent to PAP treatment. Results indicate that treatment of OSA is unlikely to be associated with a change in PA in adults with obesity and OSA and help explain the absence of weight loss following PAP treatment in adults with OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, title: The Effects of Treating Obese and Lean Patients With Sleep Apnea (PISA), identifier: NCT01578031, URL: https://clinicaltrials.gov/ct2/show/NCT01578031.
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Affiliation(s)
- Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Maislin
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thorarinn Gislason
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Erna S Arnardottir
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Julio A Chirinos
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond R Townsend
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bethany Staley
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis M Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Sifferman
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel T Kuna
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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8
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Liu T, Li W, Zhou H, Wang Z. Verifying the Relative Efficacy between Continuous Positive Airway Pressure Therapy and Its Alternatives for Obstructive Sleep Apnea: A Network Meta-analysis. Front Neurol 2017; 8:289. [PMID: 28701992 PMCID: PMC5487413 DOI: 10.3389/fneur.2017.00289] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/06/2017] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder, and continuous positive airway pressure (CPAP) therapy together with its alternatives has been developed to treat this disease. This network meta-analysis (NMA) was aimed to compare the efficacy of treatments for OSA. Cochrane Library, MEDLINE, and Embase were searched for eligible studies. A conventional and NMA was carried out to compare all therapies. Sleeping characteristics, including Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), arterial oxygen saturation, and arousal index (AI), and changes of blood pressure were selected as outcomes. A total of 84 studies were finally included after rigorous screenings. For the primary outcomes of AHI and ESS, the value of auto-adjusting positive airway pressure (APAP), CPAP, and oral appliance (OA) all showed statistically reduction compared with inactive control (IC). Similar observation was obtained in AI, with treatments of the three active interventions. A lower effect of IC in SaO2 was exhibited when compared with APAP, CPAP, and OA. Similar statistically significant results were presented in 24 h systolic blood pressure and 24 h DBP when comparing with CPAP. Our NMA identified CPAP as the most efficacious treatment for OSA patients after the evaluation of sleeping characteristics and blood pressures. In addition, more clinical trials are needed for further investigation due to the existence of inconsistency observed in this study.
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Affiliation(s)
- Tingwei Liu
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenyang Li
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui Zhou
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zanfeng Wang
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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9
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Shechter A. Effects of continuous positive airway pressure on energy balance regulation: a systematic review. Eur Respir J 2016; 48:1640-1657. [PMID: 27824596 PMCID: PMC5201109 DOI: 10.1183/13993003.00689-2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022]
Abstract
Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain.The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance.CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation.It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients.
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Affiliation(s)
- Ari Shechter
- Department of Medicine, Columbia University, New York, NY, USA
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10
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Chasens ER, Luyster FS. Effect of Sleep Disturbances on Quality of Life, Diabetes Self-Care Behavior, and Patient-Reported Outcomes. Diabetes Spectr 2016; 29:20-3. [PMID: 26912961 PMCID: PMC4755460 DOI: 10.2337/diaspect.29.1.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IN BRIEF Poor sleep quality and sleep disorders, particularly insomnia, obstructive sleep apnea, and restless legs syndrome, are prevalent among people with type 2 diabetes. Evidence suggests that coexisting diabetes and sleep disturbances are associated with decreases in quality of life, diabetes self-care behaviors, and patient-reported outcomes. Additional research is required to determine the effect of treatment of sleep disorders on patient-centered outcomes in people with type 2 diabetes.
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Chasens ER, Morris JL, Strollo PJ, Sereika SM, Burke LE, Korytkowski M. Gender Differences in the Response to Impaired Sleep in Adults with Diabetes. Behav Sleep Med 2016; 14:457-66. [PMID: 26406786 PMCID: PMC4808489 DOI: 10.1080/15402002.2015.1017100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study analyzed cross-sectional data to examine gender differences in the association of sleep quality and daytime sleepiness with mood and functional outcomes in adults with type 2 diabetes (T2DM). Measures included demographic and clinical data as well as scales that measured subjective daytime sleepiness, sleep quality, mood disturbances, and functional outcomes. The majority of the sample (N = 116) had poor sleep quality and was subjectively sleepy. We observed in males and females significantly different associative patterns between the predictor variables of daytime sleepiness and sleep quality and the outcome variables of mood and functional outcome. There was no significant difference in daytime sleepiness or impaired sleep quality between men and women with T2DM; however, there was a difference in the expression of impaired sleep on mood and functional outcomes between genders.
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Affiliation(s)
- Eileen R. Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonna L. Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Susan M. Sereika
- School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lora E. Burke
- School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Korytkowski
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Comparison of the effects of continuous positive airway pressure and mandibular advancement devices on sleepiness in patients with obstructive sleep apnoea: a network meta-analysis. THE LANCET RESPIRATORY MEDICINE 2015; 3:869-78. [PMID: 26497082 DOI: 10.1016/s2213-2600(15)00416-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Excessive daytime sleepiness is the most important symptom of obstructive sleep apnoea and can affect work productivity, quality of life, and the risk of road traffic accidents. We aimed to quantify the effects of the two main treatments for obstructive sleep apnoea (continuous positive airway pressure and mandibular advancement devices) on daytime sleepiness and to establish predictors of response to continuous positive airway pressure. METHODS We searched MEDLINE and the Cochrane Library from inception to May 31, 2015, to identify randomised controlled trials comparing the effects of continuous positive airway pressure, mandibular advancement devices or an inactive control (eg, placebo or no treatment) on the Epworth Sleepiness Scale (ESS, range 0-24 points) in patients with obstructive sleep apnoea. We did a network meta-analysis using multivariate random-effects meta-regression to assess the effect of each treatment on ESS. We used meta-regression to assess the association of the reported effects of continuous positive airway pressure versus inactive controls with the characteristics of trials and their risk of bias. FINDINGS We included 67 studies comprising 6873 patients in the meta-analysis. Compared with an inactive control, continuous positive airway pressure was associated with a reduction in ESS score of 2·5 points (95% CI 2·0-2·9) and mandibular advancement devices of 1·7 points (1·1-2·3). We estimated that, on average, continuous positive airway pressure reduced the ESS score by a further 0·8 points compared with mandibular advancement devices (95% CI 0·1-1·4; p=0·015). However, there was a possibility of publication bias in favour of continuous positive airway pressure that might have resulted in this difference. We noted no evidence that studies reporting higher continuous positive airway pressure adherence also reported larger treatment effects (p=0·70). INTERPRETATION Continuous positive airway pressure and mandibular advancement devices are effective treatments for reducing daytime sleepiness in patients with obstructive sleep apnoea. Continuous positive airway pressure seemed to be a more effective treatment than mandibular advancement devices, and had an increasingly larger effect in more severe or sleepier obstructive sleep apnoea patients when compared with inactive controls. However, mandibular advancement devices are an effective alternative treatment should continuous positive airway pressure not be tolerated. FUNDING Swiss National Science Foundation and the University of Zurich Clinical Research Priority Program Sleep and Health.
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Park H, Park C, Quinn L, Fritschi C. Glucose control and fatigue in type 2 diabetes: the mediating roles of diabetes symptoms and distress. J Adv Nurs 2015; 71:1650-60. [PMID: 25690988 DOI: 10.1111/jan.12632] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to examine the mediating influence of diabetes health characteristics (diabetes distress, depression symptoms and diabetes symptoms) on the relationship between glucose control and fatigue in adults with type 2 diabetes. BACKGROUND In patients with type 2 diabetes, fatigue is common and can affect diabetes self-management behaviours. Although long thought to result from hyperglycaemia, little evidence supports a relationship between fatigue and glucose control. DESIGN A cross-sectional, descriptive study design was used. METHOD Data were combined from two studies conducted at a large urban university in the Midwestern United States, resulting in a total sample of 155 urban-dwelling adults with type 2 diabetes. Data were collected over the course of 6 days from 2013-March 2014. Fatigue and related biological and psychological phenomena were measured to perform path analyses using structural equation modelling methods. The STATA software was used to analyse the data. FINDINGS In patients with A1C less than or equal to 7%, fatigue was related to diabetes distress and diabetes symptoms, but not to A1C directly or indirectly. In the group with A1C greater than 7%, fatigue was indirectly related to A1C; this relationship was mediated through diabetes symptoms, depression and diabetes distress. CONCLUSION Our findings suggest that fatigue is indirectly related to glucose control, but only in patients who have elevated A1C levels. In those with adequate glucose control, fatigue is mainly influenced by the presence of diabetes symptoms and distress. In both groups, the number and severity of diabetes symptoms were the strongest predictors of fatigue, regardless of blood glucose control.
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Affiliation(s)
- Hanjong Park
- College of Nursing Science, Kyung Hee University, Seoul, South Korea
| | - Chang Park
- Department of Health Systems Science, University of Illinois at Chicago, College of Nursing Chicago, Illinois, USA
| | - Laurie Quinn
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Cynthia Fritschi
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
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Kline CE. The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement. Am J Lifestyle Med 2014; 8:375-379. [PMID: 25729341 DOI: 10.1177/1559827614544437] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Exercise has long been associated with better sleep, and evidence is accumulating on the efficacy of exercise as a nonpharmacologic treatment option for disturbed sleep. Recent research, however, has noted that poor sleep may contribute to low physical activity levels, emphasizing a robust bidirectional relationship between exercise and sleep. This article will briefly review the evidence supporting the use of exercise as a nonpharmacologic treatment for sleep disturbance, outline future research that is needed to establish the viability of exercise as a behavioral sleep treatment, describe recent research that has emphasized the potential influence of poor sleep on daytime activity levels, and discuss whether improving sleep may facilitate adoption and/or better adherence to a physically active lifestyle. With poor sleep and physical inactivity each recognized as key public health priorities, additional research into the bidirectional relationship between exercise and sleep has significant implications for facilitating greater exercise adherence and improving sleep in society.
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