Nasal CPAP reduces systemic blood pressure in patients with obstructive sleep apnoea and mild sleepiness (original) (raw)
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Journal of clinical and diagnostic research : JCDR, 2016
Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1(st) month of CPAP use. To observe both, short-term (one month) and long-term (three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) ≥15 were categorised as having moderate to severe ...
P395 Clinical experience of auto-CPAP therapy among supine/REM OSA patients
Sleep Medicine, 2006
tinuous positive airway pressure (CPAP) attenuates such increases in sympathetic activity. However, previous studies on antihypertensive effects of CPAP therapy have yielded inconsistent results. We postulated that good CPAP compliance is needed for BP reduction. Objective: To examine the effect of CPAP on BP in OSAHS patients and compare the outcomes based on CPAP compliance. Methods: A retrospective review of patients diagnosed to have OSAHS during the period September 2003 to June 2005 was performed. These patients were divided into two groups based on CPAP compliance. Consistent users (CG) reported daily CPAP usage while intermittent users (IG) skipped CPAP use one or more nights each week. Daytime systolic (SBP), diastolic (DBP) and mean arterial BP (MAP) were measured before and after 11 months' CPAP use. Hypertensive patients were excluded if their anti-hypertensive regimens were changed. Paired T test was used to test for differences. Data are presented as mean values ± SD. Results: Forty patients were consistent CPAP users while 34 used CPAP intermittently (3.7 ± 1.9 days per week). Among CG patients, SBP decreased significantly from 138 ± 17.9 mm Hg to 127 ± 15.6 mm Hg (p < 0.01), DBP reduced from 83.2 ± 11.4 mm Hg to 76.5 ± 9.9 mm Hg (p < 0.01) and MAP reduced from 101 ± 12.6 mm Hg to 93.6 ± 10.7 mm Hg (p < 0.01). Among IG patients, SBP remained unchanged (133 ± 15.1 mmHg at baseline and 130 ± 15 mm Hg after CPAP, p = 0.35), DBP decreased significantly from 85.1 ± 9.4 mmHg to 81.1 ± 8.1 mm Hg (p = 0.01) and MAP decreased from 101 ± 9.8 mm Hg to 97.6± 9.8 mm Hg (p = 0.03). SBP reduction was significantly greater among CG patients compared to IG patients (p = 0.02). Conclusion: This retrospective review showed that daytime DBP and MAP of OSAHS patients were reduced after 11 months' CPAP usage in both groups of patients while SBP was reduced among consistent CPAP users. Regularity of CPAP usage was the sole criterion for good compliance in this study as hours of CPAP usage might be overestimated in subjective reporting. Prospective studies using objective monitoring of hours of CPAP used at effective pressure are needed to further evaluate the importance of CPAP compliance on BP reduction.
2010
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) that is characterized by intermittent complete or partial collapse of the upper airway. This pattern of breathing has been considered a cause for several cardiovascular diseases, such as systemic hypertension, heart failure, arrhythmias, myocardial infarction, and pulmonary hypertension. The prevalence of OSA in the middle-aged population was first estimated in 1993 by the ongoing population-based Wisconsin Sleep Cohort Study [1] in a sample of 625 employed adults. The investigators found that 9% of women and 24% of men had at least five or more apneas or hypopneas per hour of sleep . When the presence of extreme daytime sleepiness was included as a criterion, the prevalence was estimated to be 2% in women and 4% in men [1]. The incidence of SDB is independently influenced by age, sex, waist-hip ratio, and body mass index (BMI). The correlation between OSA and cardiovascular diseases has been well studied, and a linear relationship between severity of OSA and the comorbidities has been reported [2, 3]. The famous Sleep Heart Health Study revealed that the relative odds of heart failure, stroke, and coronary artery disease (CAD) (upper vs. lower apnea-hypopnea index [AHI] quartile) were 2.38, 1.58, and 1.27, respectively . In this chapter, we review the best-available evidence supporting the use of continuous positive airway pressure (CPAP) in OSA patients with hypertension, CAD, heart failure, pulmonary hypertension, and stroke.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2014
Objective: Evaluation of the long-term effects of continuous positive airway presure (CPAP) on mean heart rate and left ventricular systolic and diastolic parameters in obstructive sleep apnea syndrome (OSAS) using conventional and tissue Doppler techniques. Methods: This prospective cohort study is designed to evaluate the long-term effects of CPAP treatments in normotensive OSAS patients. Initially 40 patients aged from eighteen to fifty five with documented OSAS syndrome were evaluated within one month of CPAP treatment. All had high self-reported compliance with treatment. From the latter, 21 patients with uninterrupted CPAP therapy (for at least 5 years, 5 hours per day) were included in the study and further evaluated with treatment. The left ventricular systolic function was assessed on apical four-chamber view using modified Simpson method and diastolic function was evaluated with classic transmitral pulsed and tissue Doppler techniques. Paired t test and Wilcoxon signed rank test had been used to compare the clinical and echocardiography data before and after treatment period. Results: A comparison of values assessed after one month and after 5 years of CPAP therapy, revealed a significant increase in the acceleration time(AT) Em/Am ratio and ejection time (ET) (AT: p=0.04; Em/Am ratio p=0.03 ET: p=0.04) while a significant decrease was observed on deceleration time (DT), isovolumetric relaxation time (IRT), myocardial performance index (MPI), mitral regurgitation (MR) and 24 hour mean heart rate (HR) in all subjects (DT: p=0.02; IVRT: p=0,04; MPI: p=0,01; MR: p≤0.001; HR: p=0.004). Conclusion: We observed a significant improvement in the left ventricular systolic and diastolic function and a significant decrease of 24-hour heart rate and mitral regurgitation with unchanged ejection fraction of the left ventricle with long-term CPAP treatment similar to short-term treatment studies. The long-term maintenance of the beneficial effect of CPAP throughout the 5 year long-term treatment can be one of the pathophysiologic mechanisms that may explain the decrease of cardiovascular mortality observed with long-term CPAP therapy in OSAS patients.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2015
Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients. Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured. Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (-1.0 cm2, 95%CI -2.6 to +0.6,...