scholarly journals 0650 Impact of Upper Airway Stimulation Therapy on 24 Hour Ambulatory Blood Pressure Monitoring

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A248-A248
Author(s):  
A De ◽  
J Bena ◽  
L Wang ◽  
J Aylor ◽  
R Bhambra ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Cleveland Clinic ◽  
Upper Airway ◽  
Repeated Measure ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
The Impact ◽  
Over Time

Abstract Introduction Upper airway stimulation (UAS) is recommended treatment for moderate to severe obstructive sleep apnea (OSA) in select patients. Existing data have not focused on gold standard 24 hour ambulatory blood pressure monitor (ABPM) to elucidate the impact of UAS. We hypothesize that UAS reduces ABPM indices characterized using objective sleep-wake from actigraphy data over 12-month follow-up period. Methods A prospective sub-study of the Inspire ® post-approval study at the Cleveland Clinic was designed to examine the effect of UAS on 24-hour ABPM measures post-implantation by examining blood pressure (BP) at baseline, and-2, 6, and 12 months follow-up. Actigraphy data was contemporaneously collected. Paired T-tests were used to evaluate BP changes over time. Repeated measure correlations measured within-patient associations between BP and actigraphy measures. Results Average age and BMI were 62.4 +/-12.9) years and 30.1 +/-3.3 kg/m2, 73.3% males and all Caucasian. The mean baseline systolic, diastolic and mean arterial pressure (MAP) were 119.7+/-12.9 mmHg, 74.3+/-7.4 mmHg and 89.3+/- 8.1 mmHg. There were no changes to number, type or dosage of BP medications. At 12 months, there were non-significant overall mean reduction in systolic [-0.55mmHg, p=0.75], diastolic [-0.73mmHg, p=0.63], and MAP [-0.55mmHg, p=0.71]. Mean sleeping systolic, diastolic and MAP changed by -4.36(p=0.34), -1.45 (p=0.57), -2.18 (p=0.50), respectively. Positive correlations above 0.25 (p<0.10) were observed between all dipping percentage measures and total sleep time. Negative correlations were seen between overall systolic, diastolic and MAP with sleep latency (-0.22, p=0.19, -0.35, p=0.031 and -0.29, p=0.075 respectively). No significant changes in BMI was observed, but average hours of usage decreased over time. Conclusion Although consistent reduction of BP measures were observed post-UAS implantation, findings were not statistically significant. It is unclear whether this is due to insufficient sample size or true lack of effect. Larger-scale clinical and mechanistic studies are needed to enhance understanding of UAS-related vascular influences. Support Funded: Inspire Medical Systems

scholarly journals The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽  
2021 ◽  
pp. 1-10
Author(s):  
Wei-Hsiu Chang ◽  
Hsien-Chang Wu ◽  
Chou-Chin Lan ◽  
Yao-Kuang Wu ◽  
Mei-Chen Yang
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea ◽  
Positional Dependency ◽  
Over Time

<b><i>Background:</i></b> Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. <b><i>Objectives:</i></b> The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). <b><i>Methods:</i></b> This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. <b><i>Results:</i></b> In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, <i>p</i> = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, <i>p</i> = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, <i>p</i> = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, <i>p</i> = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust <i>R</i><sup>2</sup> = 0.056, <i>p</i> = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. <b><i>Conclusions:</i></b> In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

scholarly journals The Impact of Upper Airway Stimulation on Swallowing Function

2019 ◽  
Vol 98 (8) ◽  
pp. 496-499 ◽  
Author(s):  
Colin Huntley ◽  
Adam Vasconcellos ◽  
Michael Mullen ◽  
David W. Chou ◽  
Haley Geosits ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Swallowing Function ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

Long-term follow-up of the German post-market study for upper airway stimulation for obstructive sleep apnea

2019 ◽  
Vol 24 (3) ◽  
pp. 979-984 ◽  
Author(s):  
Armin Steffen ◽  
Ulrich J. Sommer ◽  
Joachim T. Maurer ◽  
Nils Abrams ◽  
Benedikt Hofauer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
Post Market ◽  
Long Term Follow Up

FC08-04 - Trajectories of depressive episodes and hypertension over 24 years: the whitehall II prospective cohort study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1855-1855
Author(s):  
H. Nabi ◽  
J.-F. Chanstang ◽  
T. Lefèvre ◽  
A. Dugravot ◽  
M. Melchior ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Health Questionnaire ◽  
Antidepressant Medication ◽  
Estimating Equation ◽  
Depression Subscale ◽  
Medical Examinations ◽  
Depressive Episodes ◽  
The Impact ◽  
Over Time

IntroductionProspective data on depressive symptoms and blood pressure (BP) are scarce, and the impact of age on this association is poorly understood.ObjectivesThe present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time.MethodsParticipants were 6,889 men and 3,413 women London based civil servants followed for 24 years between 1985 and 2009. The age of participants over the follow-up ranged from 35 to 80 years. Depressive episode (defined as scoring 4 or more on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure ≥ 140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at five medical examinations.ResultsIn longitudinal logistic regression analyses based on Generalized-Estimating-Equation using age as the time scale, participants with depression trajectory characterised by increasing depressive episodes overtime had a greater increase in the likelihood for hypertension with advancing age; an adjusted-excess increase of 7% (95% CI 3-12, p < 0.001) for each five-year increase in age compared to those with a low/stable depression trajectory. In a model adjusted for relevant confounders, a higher risk of hypertension in the first group of participants did not become evident before age 55. A similar pattern of association was observed in men and women although the association was stronger in men.ConclusionsThis study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and materializes in later adulthood.

scholarly journals Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Hypertension ◽  
2021 ◽  
Author(s):  
Hugues de Courson ◽  
Loïc Ferrer ◽  
Antoine Barbieri ◽  
Phillip J. Tully ◽  
Mark Woodward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Cox Model ◽  
Positive Association ◽  
Vascular Risk Factor ◽  
Stroke Recurrence ◽  
The Impact ◽  
Over Time

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV.

scholarly journals Review the Impact of Mandibular Setback Surgery for the Correction of Class III Malocclusion on the Upper Airway Space

2021 ◽  
Vol 9 (F) ◽  
pp. 644-649
Author(s):  
Dareen Aljehani
Keyword(s):  
Upper Airway ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Eligibility Criteria ◽  
Pharyngeal Airway ◽  
Mandibular Setback ◽  
Obstructive Sleep ◽  
Mandibular Setback Surgery ◽  
The Impact

AIM: This study aimed to review the scientific evidence related to the effect of mandibular setback surgery for the correction of Class III malocclusion on the changes in volume and anatomical structures’ positions of the upper airway within at least 1 year follow-up. METHODS: An electronic research was conducted on PubMed, Google scholar, and Elsevier up to April 20, 2021, the inclusion criteria were prospective or retrospective studies aiming to compare the changes in upper airway space following isolated mandibular setback through at least 1 year of follow-up. RESULTS: A total of 84 studies were retrieved, only 12 studies met the eligibility criteria. Their methods of measurement were using lateral cephalometry, CT, or Cone-beam computed tomography. Most of them showed narrowing in the Pharyngeal airway space, with some variability within the follow-up periods. Impact on the possibility of obstructive sleep apnea (OSA) was discussed in most of the included studies. CONCLUSION: Narrowing of upper airway volume is associated with isolated mandibular setback surgeries within 1 year of follow-up. However, OSA was not necessarily a consequence. Any predisposing factors for OSA should be considered before isolated mandibular setback surgery.

Trajectory of ambulatory blood pressure after adenotonsillectomy in children with obstructive sleep apnea: comparison at three- and six-month follow-up

2020 ◽  
Vol 65 ◽  
pp. 127-133
Author(s):  
Kun-Tai Kang ◽  
Shuenn-Nan Chiu ◽  
Che-Yi Lin ◽  
Wen-Chin Weng ◽  
Pei-Lin Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Ambulatory Blood Pressure ◽  
Obstructive Sleep
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