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

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.clini​caltr​ials.gov ; Unique identifier: NCT01156116.

Abstract 3722: Multimodality Cardiovascular Imaging Detects Improvment Of Subclinical Microvascular Dysfunction With Continuous Positive Airway Pressure Therapy In Obstructive Sleep Apnea Patients: A Prospective, Randomized, Double-blinded Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Chandra Katikireddy ◽  
Patricia Nguyen ◽  
Christine Won ◽  
Chia-Yu Cardell ◽  
Deborah Nichols ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cardiovascular Imaging ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Lv Mass ◽  
Subclinical Cardiovascular Disease ◽  
Double Blinded

Background: Several observational studies suggest that obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. However, there is little data on early subclinical development of cardiovascular disease in OSA patients. Hypothesis: We tested the hypothesis that continuous positive airway pressure (CPAP) improves subclinical cardiovascular disease in OSA patients. Methods: Sixteen consecutive patients diagnosed with moderate to severe OSA were recruited into a double-blinded, prospective study. Multimodality cardiovascular imaging (CVI) studies (cardiac MRI, echocardiography, and vascular ultrasound) were performed to assess LV mass, LV and RV ejection fraction (EF), adenosine stress myocardial perfusion reserve (MPR), nitroglycerin mediated coronary vasoreactivity, and flow-mediated vasodilatation (FMD) of the brachial artery. Patients were randomized to either CPAP or sham CPAP therapy and monitored for compliance during the entire period of treatment. After 3 months of therapy, they underwent follow-up CVI studies to assess development of subclinical cardiovascular disease. Results: MPR significantly improved (p=0.02) in patients with CPAP therapy compared to those without. Similarly, FMD of brachial artery improved significantly (p=0.04) following CPAP therapy. No significant differences were observed in LV mass (p=0.31), LV EF (p=0.17), RV EF (p=0.09), LV diastolic function (E/A) (p=0.67), and coronary vasoreactivity (p=0.25) between the two groups. Conclusions: Impairment of endothelial dependent FMD, and MPR, surrogate markers of microvascualr function, has been shown to be the subclinical cardiovascular effects in OSA patients. Our findings suggest that CPAP therapy may prevent the progression of subclinical cardiovascular disease in OSA patients.

Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension

Hypertension ◽  
2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Douglas A. Hettrick ◽  
Aleksander Prejbisz ◽  
Andrzej Januszewicz
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Renal Denervation ◽  
Positive Airway Pressure ◽  
Controlled Trials ◽  
Nocturnal Hypertension ◽  
Randomized Controlled ◽  
Obstructive Sleep

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.

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