Adherence to CPAP therapy for sleep apnea in patients aged over 70 years old

Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy. Results: 33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. −1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients. Conclusions: In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes.

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Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

10.2337/figshare.11996421 ◽

2020 ◽

Author(s):

Kelly A. Loffler ◽

Emma Heeley ◽

Ruth Freed ◽

Rosie Meng ◽

Lia R. Bittencourt ◽

...

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Usual Care ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Serum Glucose ◽

Cpap Therapy ◽

Obstructive Sleep

<b>Objective</b><div> <div>Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA.</div><div><strong>Research Design and Methods</strong></div><div>Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded.</div><div><b>Results</b></div><div>Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable.</div><div><strong>Conclusions</strong></div><div>Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.</div></div>

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Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

10.2337/figshare.11996421.v2 ◽

2020 ◽

Author(s):

Kelly A. Loffler ◽

Emma Heeley ◽

Ruth Freed ◽

Rosie Meng ◽

Lia R. Bittencourt ◽

...

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Usual Care ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Serum Glucose ◽

Cpap Therapy ◽

Obstructive Sleep

<b>Objective</b><div> <div>Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA.</div><div><strong>Research Design and Methods</strong></div><div>Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded.</div><div><b>Results</b></div><div>Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable.</div><div><strong>Conclusions</strong></div><div>Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.</div></div>

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The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension

International Journal of Molecular Sciences ◽

10.3390/ijms22052300 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2300

Author(s):

Ronni Baran ◽

Daniela Grimm ◽

Manfred Infanger ◽

Markus Wehland

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Common Disease ◽

Cpap Therapy ◽

Pressure Therapy ◽

Airway Patency ◽

Obstructive Sleep

Obstructive sleep apnea (OSA) is a common disease, with approximately 3–7% of men and 2–5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.

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Association between sleep disordered breathing in early pregnancy and glucose metabolism

SLEEP ◽

10.1093/sleep/zsab281 ◽

2022 ◽

Author(s):

Laura Sanapo ◽

Margaret H Bublitz ◽

Alice Bai ◽

Niharika Mehta ◽

Geralyn M Messerlian ◽

...

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Glucose Metabolism ◽

Early Pregnancy ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

Respiratory Event

Abstract Study Objectives To examine the association between maternal sleep disordered breathing (SDB) and glucose metabolism in early gestation. Methods Women with body mass index (BMI) ≥27 kg/m2 and singleton pregnancies underwent in-home sleep study (HSAT) and homeostatic model assessment (HOMA) in early pregnancy. Insulin resistance (HOMA-IR) and β-cell function (HOMA %B) were derived. Exclusion criteria included pregestational diabetes, use of continuous positive airway pressure and chronic steroid therapy. We performed linear regression analyses to evaluate the association between continuous measures of SDB (respiratory event index (REI), and oxygen desaturation index (ODI)) and glucose metabolism parameters (HOMA-IR and HOMA %B). Analyses were adjusted for a set of a priori selected variables which included gestational age, maternal age, BMI, ethnicity, race, and parity. Results One hundred and ninety-two pregnant women with median (interquartile range) BMI of 35.14 (8.30) kg/m2 underwent HSAT and HOMA assessment at 11.14 (3) and 15.35 (4.14) gestational weeks, respectively. REI and ODI, as continuous values, were associated with HOMA-IR after adjusting for covariates. OSA (obstructive sleep apnea) diagnosis (REI > 5 events per hour) was not associated with HOMA-IR after adjusting for BMI (p ≥ 0.05). None of the parameters were associated with HOMA %B (p > 0.07). Conclusions SDB and insulin resistance are associated in early pregnancy, with a dose response association between respiratory event index severity and insulin resistance. Further studies are needed to establish if pregnant women with overweight and obesity may benefit from early SDB screening to improve glucose metabolic outcome. Clinical trials: NCT02412696, Positive Airway Pressure, Sleep Apnea, and the Placenta (PAP-SAP) https://clinicaltrials.gov/ct2/show/NCT02412696?term=Bourjeily&draw=2&rank=2 and NCT02917876, Predictors of De-novo Development of Obstructive Sleep Apnea in Pregnancy (Predictors) https://clinicaltrials.gov/ct2/show/NCT02917876?term=Bourjeily&draw=2&rank=1

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Effect of Positive Airway Pressure Therapy on Body Mass Index in Obese Patients With Obstructive Sleep Apnea Syndrome

American Journal of Therapeutics ◽

10.1097/mjt.0000000000000072 ◽

2016 ◽

Vol 23 (2) ◽

pp. e422-e428 ◽

Cited By ~ 3

Author(s):

Muhammad Adeel Rishi ◽

Ahmet Sinan Copur ◽

Rashid Nadeem ◽

Ashok Fulambarker

Keyword(s):

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnea Syndrome ◽

Obese Patients ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Apnea Syndrome

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430 Outcome of Sleep-Wake Pattern in Obstructive Sleep Apnea Patients after Positive Airway Pressure Therapy using Actigraphy

SLEEP ◽

10.1093/sleep/zsab072.429 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A170-A170

Author(s):

Narumol Luekitinun ◽

Kanlaya Panjapornpon ◽

Pattharaphong Plurksathaporn ◽

Rungaroon Tangsrikertikul ◽

Wanlana Tongkien ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Matched Pair ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Before And After ◽

Sleep Parameters

Abstract Introduction The initial phase of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) may affect sleep parameters and PAP compliance. Actigraphy is a validated method using accelerometer to objectively measure sleep parameters in patients with a range of sleep disorders, including OSA, particularly to follow-up after treatment. We compare sleep parameters from actigraphy, sleep log, sleep diary, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients before and after CPAP therapy for 1 week. Methods This pilot study have been prospectively performed at Central Chest Institute of Thailand (CCIT) since June to November 2020. Adult OSA patients, diagnosed by ICSD-3 criteria and achieved optimal or good CPAP pressure titration from split-night polysomnography (PSG), were informed and consent to wear actigraphy before and after CPAP therapy each for 1 week. Clinical and sleep parameters were recorded and analyzed using Wilcoxon matched-pair signed-rank and Mann Whitney U test. P-value < 0.05 was considered to have statistical significance. Results All 11 OSA patients participated in this study. Most patients were male (63.6%), hypertension (54.5%) and dyslipidemia (45.4%). Means of age, body mass index (BMI), ESS, PSQI, apnea hypopnea index (AHI), nadir SpO2, and CPAP usage were 45.5 ± 15.9 years, 29.1 ± 5.2 kg/m2, 10.8 ± 3.9, 7.7 ± 2.9, 65.2 ± 37.7 events/h, 82.3 ± 10.8 % and 9.5 ± 3.1 cmH2O, respectively. Comparing before and after 1-week CPAP therapy, an average number of wake bouts ((NWB), 48.4 vs 38 events, p=0.010), ESS (11 vs 9, p=0.035) and PSQI (8 vs 4, p=0.005) were significantly decrease. Additionally, when comparing between poor and good CPAP compliance group, NWB (55.1 vs 36.3 events, p=0.036) and the difference of wake after sleep onset (WASO, 10.5 vs -0.11 min, p=0.035) were significantly decrease. Conclusion OSA patients treated with CPAP for 1-week experienced marked improvement in sleepiness, sleep quality and nighttime awakening. Support (if any):

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