The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study

There is a bidirectional, causal relationship between obstructive sleep apnea (OSA) and hypertension. OSA-related hypertension is characterized by high rates of masked hypertension, elevated nighttime blood pressure, a nondipper pattern of nocturnal hypertension, and abnormal blood pressure variability. Hypoxia/hypercapnia-related sympathetic activation is a key pathophysiological mechanism linking the 2 conditions. Intermittent hypoxia also stimulates the renin-angiotensin-aldosterone system to promote hypertension development. The negative and additive cardiovascular effects of OSA and hypertension highlight the importance of effectively managing these conditions, especially when they coexist in the same patient. Continuous positive airway pressure is the gold standard therapy for OSA but its effects on blood pressure are relatively modest. Furthermore, this treatment did not reduce the cardiovascular event rate in nonsleepy patients with OSA in randomized controlled trials. Antihypertensive agents targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in comorbid hypertension and OSA, but current evidence is limited and combination strategies are often required in drug resistant or refractory patients. The key role of sympathetic nervous system activation in the development of hypertension in OSA suggests potential for catheter-based renal sympathetic denervation. Although long-term, randomized controlled trials are needed, available data indicate sustained and relevant reductions in blood pressure in patients with hypertension and OSA after renal denervation, with the potential to also improve respiratory parameters. The combination of lifestyle interventions, optimal pharmacological therapy, continuous positive airway pressure therapy, and perhaps also renal denervation might improve cardiovascular risk in patients with OSA.

Download Full-text

EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE IN VERY ELDERLY WITH MODERATE-TO-SEVERE OBSTRUCTIVE SLEEP APNEA Pooled results from two multicenter randomized controlled trials

Sleep Medicine ◽

10.1016/j.sleep.2021.11.009 ◽

2021 ◽

Author(s):

M.A. Martinez-Garcia ◽

G. Oscullo ◽

S. Ponce ◽

E. Pastor ◽

B. Orosa ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Controlled Trials ◽

Severe Obstructive Sleep Apnea ◽

Very Elderly ◽

Randomized Controlled ◽

Obstructive Sleep

Download Full-text

Long-term obstructive sleep apnea therapy: a 10-year follow-up of mandibular advancement device and continuous positive airway pressure

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8204 ◽

2020 ◽

Vol 16 (3) ◽

pp. 353-359 ◽

Cited By ~ 4

Author(s):

Julia A. M. Uniken Venema ◽

Michiel H. J. Doff ◽

Dilyana Joffe-Sokolova ◽

Peter J. Wijkstra ◽

Johannes H. van der Hoeven ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Obstructive Sleep

Download Full-text

Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial

SLEEP ◽

10.1093/sleep/zsz145 ◽

2019 ◽

Vol 42 (10) ◽

Cited By ~ 9

Author(s):

Francisco Campos-Rodriguez ◽

Maria Isabel Asensio-Cruz ◽

Jose Cordero-Guevara ◽

Bernabe Jurado-Gamez ◽

Carmen Carmona-Bernal ◽

...

Keyword(s):

Antioxidant Activity ◽

Randomized Controlled Trial ◽

Obstructive Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Controlled Trial ◽

Cpap Therapy ◽

Randomized Controlled ◽

Obstructive Sleep

AbstractStudy ObjectivesThe effect of continuous positive airway pressure (CPAP) on mediators of cardiovascular disease and depression in women with obstructive sleep apnea (OSA) is unknown. We aimed to assess the effect of CPAP therapy on a variety of biomarkers of inflammation, antioxidant activity, and depression in women with OSA.MethodsWe conducted a multicenter, randomized controlled trial in 247 women diagnosed with moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15). Women were randomized to CPAP (n = 120) or conservative treatment (n = 127) for 12 weeks. Changes in tumor necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were assessed. Additional analyses were conducted in subgroups of clinical interest.ResultsWomen had a median (25th–75th percentiles) age of 58 (51–65) years, body mass index 33.5 (29.0–38.3) kg/m2, and AHI 33.3 (22.8–49.3). No differences were found between groups in the baseline levels of the biomarkers. After 12 weeks of follow-up, there were no changes between groups in any of the biomarkers assessed. These results did not change when the analyses were restricted to sleepy women or to those with severe OSA. In women with CPAP use at least 5 hours per night, only TNFα levels decreased compared to the control group (−0.29 ± 1.1 vs −0.06 ± 0.53, intergroup difference −0.23 [95% CI = −0.03 to −0.50]; p = 0.043).ConclusionsTwelve weeks of CPAP therapy does not improve biomarkers of inflammation, antioxidant activity, or depression compared to conservative treatment in women with moderate-to-severe OSA.Trial RegistrationNCT02047071.

Download Full-text

Optimal Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Reduces Daytime Resting Heart Rate in Prediabetes: A Randomized Controlled Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016871 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Sushmita Pamidi ◽

Florian Chapotot ◽

Kristen Wroblewski ◽

Harry Whitmore ◽

Tamar Polonsky ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Obstructive Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Randomized Controlled Study ◽

Controlled Study ◽

Resting Heart Rate ◽

Randomized Controlled ◽

Obstructive Sleep

Background It has been widely recognized that obstructive sleep apnea (OSA) is linked to cardiovascular disease. Yet, randomized controlled studies failed to demonstrate a clear cardiovascular benefit from OSA treatment, mainly because of poor adherence to continuous positive airway pressure (CPAP). To date, no prior study has assessed the effect of CPAP treatment on daytime resting heart rate, a strong predictor of adverse cardiovascular outcomes and mortality. Methods and Results We conducted a randomized controlled study in 39 participants with OSA and prediabetes, who received either in‐laboratory all‐night (ie, optimal) CPAP or an oral placebo for 2 weeks. During daytime, participants continued daily activities outside the laboratory. Resting heart rate was continuously assessed over 19 consecutive days and nights using an ambulatory device consisting of a single‐lead ECG and triaxis accelerometer. Compared with placebo, CPAP reduced daytime resting heart rate (treatment difference, −4.1 beats/min; 95% CI, −6.5 to −1.7 beats/min; P =0.002). The magnitude of reduction in daytime resting heart rate after treatment significantly correlated with the magnitude of decrease in plasma norepinephrine, a marker of sympathetic activity ( r =0.44; P =0.02), and the magnitude of decrease in OSA severity (ie, apnea‐hypopnea index [ r =0.48; P =0.005], oxygen desaturation index [ r =0.50; P =0.003], and microarousal index [ r =0.57; P <0.001]). Conclusions This proof‐of‐concept randomized controlled study demonstrates, for the first time, that CPAP treatment, when optimally used at night, reduces resting heart rate during the day, and therefore has positive cardiovascular carry over effects. These findings suggest that better identification and treatment of OSA may have important clinical implications for cardiovascular disease prevention. Registration URL: https:/// www.clinicaltrials.gov ; Unique identifier: NCT01156116.

Download Full-text