Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

Abstract 5430: Obstructive Sleep Apnoea Exacerbates Muscular Sympathetic Nervous Activity in Patients with Metabolic Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ivani C Trombetta ◽  
Cristiane M Nunes ◽  
Luciano F Drager ◽  
Raffael F Fraga ◽  
Maria Janieire N Alves ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Sympathetic Nervous Activity ◽  
Obstructive Sleep ◽  
Sympathetic Nervous

Obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) independently increases muscular sympathetic nervous activity (MSNA). Unknown is whether OSA has an additive effect on MSNA in patients with MetS. We tested the hypothesis that: OSA would have an additive effect on MSNA in patients with MetS. In addition, we studied whether the increase in MSNA in patients with MetS is associated with alteration in arterial baroreflex sensitivity (BRS). Twenty four patients with MetS diagnosed according ATP-III were divided in two groups: MetS+OSA (n=14) and MetS (n=10). They were matched for age, body mass index, waist circumference, and metabolic profile: OSA was defined by an apnoea/hypopnoea index (AHI)>15 events/hour by polysonography. MSNA was recorded directly from the peroneal nerve using the technique of microneurography. Blood pressure (BP) was monitored on a beat-by-beat basis (Finapress) and heart rate by ECG. BRS was analyzed by spontaneous BP and heart rate fluctuations. AHI was higher (42±9 vs. 7±1 events/h, P =0.0001) and minimum oxygen saturation lower (77±2 vs. 87±1 %, P =0.001) in MetS+OSA patients. Patients MetS+OSA had higher MSNA (55±3 vs. 43±2 bursts/100 beats, P =0.01) and systolic BP (158±4 vs.144±3 mmHg, P =0.01) when compared with patients with MetS without OSA. Further analysis showed that AHI and minimum oxygen saturation have significant correlation with MSNA (r=0.65; P =0.001 and r=−0.48; P =0.017, respectively). Patients with MetS+OSA had lower BRS for increases (7.8±0.9 vs. 13.4 ± 1.4 msec/mmHg, P =0.01) and decreases (7.2±0.9 vs. 13.2 ± 2.0 msec/mmHg, P =0.03) in blood pressure than patients with MetS without OSA. MSNA significantly correlated with BRS during spontaneous increases in blood pressure (r=−0.56, P =0.01). OSA exacerbates MSNA in patients with MetS. In addition, the augmented MSNA in patients with MetS+OSA is associated with reduced BRS. These findings suggest that OSA increases the risk for cardiovascular disease in patients with MetS.

CPAP therapy prevents increase in blood pressure after upper airway surgery for obstructive sleep apnoea

2013 ◽  
Vol 17 (4) ◽  
pp. 1289-1299 ◽  
Author(s):  
Maria Teresa Martins de Araújo ◽  
Nazaré Sousa Bissoli ◽  
Sônia Alves Gouvêa ◽  
Maria Christina Thomé Pacheco ◽  
Bernard Meyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Upper Airway Surgery ◽  
Airway Surgery ◽  
Obstructive Sleep

What role do adrenoreceptor polymorphisms play in modifying cardiovascular responses in obstructive sleep apnoea?

2005 ◽  
Vol 110 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Nigel Mcardle
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Risk ◽  
Diastolic Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Cardiovascular Responses ◽  
Sleep Apnoea ◽  
Cpap Treatment ◽  
Obstructive Sleep

OSA (obstructive sleep apnoea) is a common condition that is strongly associated with cardiovascular disease. It is remains unclear what role OSA plays in determining cardiovascular risk. The immediate physiological changes that occur during upper airway obstruction are potential contributors to cardiovascular risk in OSA. These changes include increased sympathetic activity, which is responsive to treatment of OSA with CPAP (continuous positive airway pressure). In this issue of Clinical Science, the possible role of a common polymorphism in the β1-adrenoreceptor [R389G (Arg389Gly)] has been investigated by Börgel and co-workers. Measurements of heart rate and blood pressure in untreated OSA patients were not related to the R389G polymorphism. There were changes in heart rate and diastolic blood pressure with CPAP treatment that were related to this polymorphism. Reduction in heart rate with CPAP treatment was associated with the R389R genotype. By contrast, a reduction in diastolic blood pressure was associated with the Gly389 carriers. These findings are intriguing, but difficult to fully explain. Further study is needed to determine if there is an important role of the R389G polymorphism in modifying cardiovascular responses among OSA patients.

scholarly journals Blood pressure response to CPAP treatment in subjects with obstructive sleep apnoea: the predictive value of 24-h ambulatory blood pressure monitoring

2017 ◽  
Vol 50 (4) ◽  
pp. 1700651 ◽  
Author(s):  
Anabel L. Castro-Grattoni ◽  
Gerard Torres ◽  
Montserrat Martínez-Alonso ◽  
Ferran Barbé ◽  
Cecilia Turino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Response ◽  
Blood Pressure Monitoring ◽  
Sleep Apnoea ◽  
Clinical Predictors ◽  
Night Time ◽  
Nocturnal Hypertension ◽  
Obstructive Sleep

The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea–hypopnoea index 42 events·h−1) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (−2 mmHg) and norepinephrine (−109.5 nmol·day-1) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (−3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (<68 bpm) and BP dipper profile were associated with increased night-time BP and new diagnosis of nocturnal hypertension.Our results suggest that nocturnal hypertension, circadian BP pattern and night-time heart rate could be clinical predictors of BP response to CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies.

scholarly journals Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252915
Author(s):  
Michael S. H. Chou ◽  
Natasha C. H. Ting ◽  
Nicole El-Turk ◽  
Zinta Harrington ◽  
Claudia C. Dobler
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Lifestyle Changes ◽  
Treatment Burden ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep

Background Little is known about the treatment burden experienced by patients with obstructive sleep apnoea (OSA) who use continuous positive airway pressure (CPAP) therapy. Participants 18 patients (33.3% males, mean age 59.7±11.8 years) with OSA who use CPAP therapy were interviewed. Methods Patients treated with CPAP for OSA at a tertiary hospital outpatient clinic in Sydney, Australia, were invited to participate in an interview in person or via phone. Semi-structured interviews were used to explore the treatment burden associated with using CPAP. The interviews were recorded, transcribed, and analysed using NVivo 12 qualitative analysis software. Results Four categories of OSA-specific treatment burden were identified: healthcare tasks, consequences of healthcare tasks, exacerbating and alleviating factors of treatment burden. Participants reported a significant burden associated with using CPAP, independently of how frequently they used their device. Common sources of their treatment burden included attending healthcare appointments, the financial cost of treatment, lifestyle changes, treatment-related side effects and general discomfort. Conclusions This study demonstrated that there is a significant treatment burden associated with the use of CPAP, and that treatment non-adherence is not the only consequence of treatment burden. Other consequences include relationship burden, stigma and financial burden. It is important for physicians to identify other negative impacts of treatment burden in order to optimise the patient experience.

scholarly journals Predictors of sleepiness in obstructive sleep apnoea at baseline and after 6 months of continuous positive airway pressure therapy

2017 ◽  
Vol 50 (5) ◽  
pp. 1700348 ◽  
Author(s):  
Rohit Budhiraja ◽  
Clete A. Kushida ◽  
Deborah A. Nichols ◽  
James K. Walsh ◽  
Richard D. Simon ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Controlled Trial ◽  
Sleep Apnoea ◽  
Positive Pressure ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep

We evaluated factors associated with subjective and objective sleepiness at baseline and after 6 months of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnoea (OSA).We analysed data from the Apnoea Positive Pressure Long-term Efficacy Study (APPLES), a prospective 6-month multicentre randomised controlled trial with 1105 subjects with OSA, 558 of who were randomised to active CPAP. Epworth sleepiness scale (ESS) scores and the mean sleep latency (MSL) on the maintenance of wakefulness test at baseline and after 6 months of CPAP therapy were recorded.Excessive sleepiness (ESS score >10) was present in 543 (49.1%) participants. Younger age, presence of depression and higher apnoea–hypopnoea index were all associated with higher ESS scores and lower MSL. Randomisation to the CPAP group was associated with lower odds of sleepiness at 6 months. The prevalence of sleepiness was significantly lower in those using CPAP >4 h·night−1versususing CPAP ≤4 h·night−1. Among those with good CPAP adherence, those with ESS >10 at baseline had significantly higher odds (OR 8.2, p<0.001) of persistent subjective sleepiness.Lower average nightly CPAP use and presence of sleepiness at baseline were independently associated with excessive subjective and objective sleepiness after 6 months of CPAP therapy.

scholarly journals P074 Night-to-night variability in obstructive sleep apnoea severity is associated with hypertension and high misdiagnosis rates

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A45-A45
Author(s):  
B Lechat ◽  
G Naik ◽  
A Reynolds ◽  
A Aishah ◽  
H Scott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
The Novel ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Important Health ◽  
The Mean ◽  
Single Night ◽  
The Impact

Abstract Introduction The impact of night-to-night variability in obstructive sleep apnoea (OSA) severity on important health outcomes such as blood pressure is unknown. This study aimed to determine the effects of night-to-night variability in the apnoea/hypopnoea index (AHI) on hypertension risk and OSA misdiagnoses. Methods In-home nightly monitoring of 67,278 participants from 151 countries, over ~170 nights per participant between July 2020 to March 2021 using a validated under mattress sleep analyser. Blood pressure measurements were available in 12,295 participants. OSA was defined as a mean nightly AHI &gt;15events/h. Night-to-night variability was assessed as the standard deviation of AHI across nights. Results 22.6% (95% CI: 20.9–24.3) of the cohort (13% of women, 25% of men) had an average AHI&gt; 15 events/h sleep. The average nightly AHI variability ranged from 3±1 in people without OSA to 14±6 in people with severe OSA. Higher mean AHI (OR [95% CI], 1.44 [1.29, 1.61]) and greater nightly variability in AHI (1.57 [1.39, 1.76]) were associated with hypertension. In people with a mean AHI of ≥5 events/h, high night-to-night AHI variability was associated with a ~30% increased risk in hypertension, independent of OSA severity category. Likelihood of misdiagnosis of OSA based on a single night compared to the mean across all nights was ~20%; this decreased with more monitoring nights. Conclusions These findings highlight the novel, important information that simple multi-night monitoring of OSA can yield. This includes the potential importance of night-to-night variation and its contribution to hypertension and increased confidence of OSA diagnoses.

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