Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Hnatiak ◽  
O Ludka ◽  
L Batalik ◽  
P Winnige ◽  
F Dosbaba
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Rehabilitation ◽  
Public Institution ◽  
Moderate Intensity ◽  
Newly Diagnosed ◽  
Cpap Therapy ◽  
Phone Calls ◽  
Obstructive Sleep ◽  
Home Conditions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.

scholarly journals 0632 The Correlation Between Severity of Obstructive Sleep Apnea and Patient Compliance

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A241-A241
Author(s):  
A C Roberts ◽  
G Bastin
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patient Compliance ◽  
Compliance Rate ◽  
Newly Diagnosed ◽  
Cpap Therapy ◽  
Cpap Adherence ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Cpap Compliance

Abstract Introduction Obstructive sleep apnea (OSA) is a prevalent disorder affecting 9-38% of the global population and is linked to multiple health complications. Continuous Positive Airway Pressure (CPAP) is regarded as the gold standard treatment for OSA, but its efficacy is limited by poor patient compliance. Studies have linked many clinical and lifestyle factors to CPAP adherence, but have produced conflicting outcomes. Based on the current literature, it is assumed patients diagnosed with severe OSA are more likely to be compliant with CPAP due to a greater improvement in quality of life. The goal of this study is to compare the compliance rate of CPAP for patients with mild, moderate, and severe OSA, as well as identify other potential predictors of CPAP compliance. Methods This study is a retrospective chart review of 100 patients who were newly diagnosed with OSA and started on CPAP between January 1, 2017 and January 1, 2018. Baseline demographic data, past medical history, OSA severity, Epworth sleepiness scale, and compliance to CPAP therapy were recorded. Compliance was defined as CPAP usage greater than four hours per night for at least 21 days per month. Results Mean follow-up time after CPAP initiation was 3.19 months. Overall 77% of patients were compliant to CPAP therapy, of which 48% were males and 52% were females (P=0.48). CPAP compliance rates for mild OSA (79.3%), moderate OSA (73.7%), and severe OSA (78.8%) showed no significant difference for independence (P=0.83) or correlation with compliance (P=0.99). Only seasonal allergic rhinitis showed a positive association with CPAP adherence (P=0.031) and depression showed a negative association (P=0.027). Conclusion The level of OSA severity is not a significant predictor of short-term CPAP compliance among newly diagnosed patients. Support Parkview Physicians Group, Indiana School of Medicine - Fort Wayne, and the Dr. Luis and Anne B Schneider Foundation.

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

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.

scholarly journals Obstructive sleep apnea and CPAP therapy alter distinct transcriptional programs in subcutaneous fat tissue

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Sina A Gharib ◽  
Amanda L Hurley ◽  
Michael J Rosen ◽  
James C Spilsbury ◽  
Amy E Schell ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Subcutaneous Adipose Tissue ◽  
Subcutaneous Fat ◽  
Study Group ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Group 2 ◽  
Subcutaneous Adipose ◽  
Group 1

Abstract Obstructive sleep apnea (OSA) has been linked to dysregulated metabolic states, and treatment of sleep apnea may improve these conditions. Subcutaneous adipose tissue is a readily samplable fat depot that plays an important role in regulating metabolism. However, neither the pathophysiologic consequences of OSA nor the effects of continuous positive airway pressure (CPAP) in altering this compartment’s molecular pathways are understood. This study aimed to systematically identify subcutaneous adipose tissue transcriptional programs modulated in OSA and in response to its effective treatment with CPAP. Two subject groups were investigated: Study Group 1 was comprised of 10 OSA and 8 controls; Study Group 2 included 24 individuals with OSA studied at baseline and following CPAP. For each subject, genome-wide gene expression measurement of subcutaneous fat was performed. Differentially activated pathways elicited by OSA (Group 1) and in response to its treatment (Group 2) were determined using network and Gene Set Enrichment Analysis (GSEA). In Group 2, treatment of OSA with CPAP improved apnea-hypopnea index, daytime sleepiness, and blood pressure, but not anthropometric measures. In Group 1, GSEA revealed many up-regulated gene sets in OSA subjects, most of which were involved in immuno-inflammatory (e.g. interferon-γ signaling), transcription, and metabolic processes such as adipogenesis. Unexpectedly, CPAP therapy in Group 2 subjects was also associated with up-regulation of several immune pathways as well as cholesterol biosynthesis. Collectively, our findings demonstrate that OSA alters distinct inflammatory and metabolic programs in subcutaneous fat, but these transcriptional signatures are not reversed with short-term effective therapy.

scholarly journals Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea

2014 ◽  
Vol 4 ◽  
pp. 383-391 ◽  
Author(s):  
Rajesh Kumar ◽  
Salar Farahvar ◽  
Jennifer A. Ogren ◽  
Paul M. Macey ◽  
Paul M. Thompson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Newly Diagnosed ◽  
Volume Changes ◽  
Obstructive Sleep

Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome

2007 ◽  
Vol 293 (4) ◽  
pp. R1666-R1670 ◽  
Author(s):  
Walter T. McNicholas
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Cardiovascular Morbidity And Mortality ◽  
Apnea Syndrome ◽  
The Impact

Considerable evidence is now available of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease. The association is particularly strong for systemic arterial hypertension, but there is growing evidence of an association with ischemic heart disease and stroke. The mechanisms underlying cardiovascular disease in patients with OSAS are still poorly understood. However, the pathogenesis is likely to be a multifactorial process involving a diverse range of mechanisms, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation, and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. Therapy with continuous positive airway pressure (CPAP) has been associated with significant benefits to cardiovascular morbidity and mortality, both in short-term studies addressing specific aspects of morbidity, such as hypertension, and more recently in long-term studies that have evaluated major outcomes of cardiovascular morbidity and mortality. However, there is a clear need for further studies evaluating the impact of CPAP therapy on cardiovascular outcomes. Furthermore, studies on the impact of CPAP therapy have provided useful information concerning the role of basic cell and molecular mechanisms in the pathophysiology of OSAS.

scholarly journals Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment

2016 ◽  
Vol 12 (08) ◽  
pp. 1105-1111 ◽  
Author(s):  
Philippe Jaoude ◽  
Ashima Lal ◽  
Leah Vermont ◽  
Jahan Porhomayon ◽  
Ali A. El-Solh
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pain Intensity ◽  
Cpap Therapy ◽  
Opioid Treatment ◽  
Obstructive Sleep

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: 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. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> 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. Results: 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. <strong>Conclusions</strong><b>:</b> 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.

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