Case report of new-onset obstructive sleep apnea after carbon monoxide poisoning

Obstructive sleep apnea (OSA) is characterized by repetitive intermittent oxygen desaturation during sleep. Carbon monoxide poisoning (COP) is the second most common cause of death among non-medicinal poisonings, and oxygen therapy is the current standard of treatment for COP. We herein report a case of a 50-year-old woman diagnosed with severe OSA associated with COP. Both the OSA and COP gradually resolved by automatic continuous positive airway pressure (CPAP) therapy. New OSA symptoms appeared following the development of delayed encephalopathy after acute COP (DEACMP) 3 weeks later. Severe OSA was diagnosed 76 days after COP with an apnea–hypopnea index of 66 events/hour, and CPAP therapy was immediately administered. The patient’s DEACMP symptoms and OSA both improved with CPAP therapy (her apnea–hypopnea index decreased to 32.4 and 16.5 events/hour at 161 and 204 days after COP, respectively). To our knowledge, this is the first case report of OSA caused by COP based on the occurrence and disappearance of OSA symptoms and laboratory findings associated with the emergence and improvement of DEACMP.

Download Full-text

1240 Obstructive Sleep Apnea Management in Weill-Marchesani Syndrome: A Case Report

SLEEP ◽

10.1093/sleep/zsaa056.1234 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A473-A473

Author(s):

Brittany Monceaux ◽

Megan Smalley ◽

Ugorji Okorie ◽

Edmond Roberts ◽

Cesar Liendo ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Case Report ◽

Sleep Apnea ◽

High Risk ◽

Fibrous Tissue ◽

Apnea Hypopnea Index ◽

Joint Movement ◽

Tonsillar Hypertrophy ◽

First Case ◽

Obstructive Sleep

Abstract Introduction Weill-Marchesani Syndrome (WMS) is a rare systemic genetic connective tissue disorder which usually presents with symptoms of short stature, limited joint movement, and eye problems such as glaucoma and microspherophakia. This genetic condition is associated with fibrous tissue hyperplasia. WMS is inherited as autosomal dominant or autosomal recessive patterns in families leading to a variability in presenting phenotype. Few papers have been written on airway management during anesthesia but as far as we know, this is the first case report on obstructive sleep apnea management in a patient with WMS. Report of Case A 9 year old boy with a past medical history of Methylene THF Reductase deficiency, von Willebrand’s Disease, seizure disorder, premature birth, developmental delays and Weill-Marchesani syndrome was referred to Sleep Medicine due to tonsillar hypertrophy (3+), snoring and witnessed apneas. Upon physical examination, patient had mid-facial hypoplasia, retropositioning of the mandible, high arched palate, Mallampti class IV, maxillary hypoplasia and mandibular hypoplasia. He had been evaluated by ENT which determined the patient to be too high risk due to his medical conditions for T&A. The patient had a polysomnogram in 2018 indicating OSA with an apnea-hypopnea index of 4.2 and a minimum oxygen saturation of 91%. After a CPAP titration study, the patient was started on Auto CPAP of 5-15 cmH2O and has shown improvement in symptoms based on subjective and objective compliance report. Patient has been able to tolerate PAP therapy well with 100% compliance greater than 4 hours per night. Conclusion This case is the first illustrating OSA in a patient with Weill-Marchesani Syndrome. In WMS, the causes of OSA are not only due to tonsillar hypertrophy, but multifactorial, including craniofacial abnormalities. Given the high risk of surgical complications in WMS patients, PAP therapy appears to be a reasonable option for OSA management.

Download Full-text

Relationship between obstructive sleep apnea and endogenous carbon monoxide

Journal of Applied Physiology ◽

10.1152/japplphysiol.00658.2016 ◽

2017 ◽

Vol 122 (1) ◽

pp. 104-111 ◽

Cited By ~ 2

Author(s):

Masanori Azuma ◽

Kimihiko Murase ◽

Ryo Tachikawa ◽

Satoshi Hamada ◽

Takeshi Matsumoto ◽

...

Keyword(s):

Oxidative Stress ◽

Carbon Monoxide ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Surrogate Marker ◽

Control Group ◽

Cpap Therapy ◽

Obstructive Sleep

Endogenous carbon monoxide (CO) levels are recognized as a surrogate marker for activity of heme oxygenase-1, which is induced by various factors, including hypoxia and oxidative stress. Few reports have evaluated endogenous CO in patients with obstructive sleep apnea (OSA). Whether OSA more greatly affects exhaled or blood CO is not known. Sixty-nine patients with suspected OSA were prospectively included in this study. Exhaled and blood CO were evaluated at night and morning. Blood and exhaled CO levels were well correlated both at night and morning ( r = 0.52, P < 0.0001 and r = 0.61, P < 0.0001, respectively). Although exhaled CO levels both at night and morning significantly correlated with total sleep time with arterial oxygen saturation < 90% (ρ = 0.41, P = 0.0005 and ρ = 0.27, P = 0.024, respectively), blood CO levels did not correlate with any sleep parameter. Seventeen patients with an apnea and hypopnea index (AHI) < 15 (control group) were compared with 52 patients with AHI ≥ 15 (OSA group). Exhaled CO levels at night in the OSA group were significantly higher than in the control group (3.64 ± 1.2 vs. 2.99 ± 0.70 ppm, P < 0.05). Exhaled CO levels at night decreased after 3 mo of continuous positive airway pressure (CPAP) therapy in OSA patients ( n = 36; P = 0.016) to become nearly the same level as in the control group ( P = 0.21). Blood CO levels did not significantly change after CPAP therapy. Exhaled CO was positively related to hypoxia during sleep in OSA patients, but blood CO was not. Exhaled CO might better correlate with oxidative stress associated with OSA than blood CO. NEW & NOTEWORTHY Endogenous carbon monoxide (CO) levels are recognized to be a surrogate marker of oxidative stress. No study has evaluated both exhaled and blood CO at the same time in obstructive sleep apnea (OSA) patients. Here we provide evidence that exhaled CO levels positively correlated with hypoxia during sleep in OSA patients, but blood CO levels did not, and that continuous positive airway pressure therapy significantly decreased exhaled CO levels in the OSA group, but did not significantly affect blood CO.

Download Full-text

Symptomatic response to CPAP in obstructive sleep apnea versus COPD- obstructive sleep apnea overlap syndrome: Insights from a large national registry

PLoS ONE ◽

10.1371/journal.pone.0256230 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256230

Author(s):

Dan Adler ◽

Sébastien Bailly ◽

Paola Marina Soccal ◽

Jean-Paul Janssens ◽

Marc Sapène ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

National Registry ◽

Overlap Syndrome ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Exertional Dyspnea ◽

Cpap Treatment ◽

Obstructive Sleep ◽

Design And Methods

Background The symptomatic response to continuous positive airway pressure (CPAP) therapy in COPD-obstructive sleep apnea overlap syndrome (OVS) compared to OSA syndrome (OSA) alone has not been well studied so far. The aim of this study is to explore main differences in the clinical response to CPAP treatment in OVS compared to OSA alone. Study design and methods Using prospective data from the French National Sleep Apnea Registry, we conducted an observational study among 6320 patients with moderate-to-severe OSA, available spirometry, and at least one follow-up visit under CPAP therapy. Results CPAP efficacy measured on the residual apnea-hypopnea index and median adherence were similar between OVS and OSA patients. In both groups, the overall burden of symptoms related to sleep apnea improved with CPAP treatment. In a multivariable model adjusted for age, gender, body mass index, adherence to treatment and residual apnea-hypopnea index, OVS was associated with higher odds for persistent morning headaches (OR: 1.37 [95% CI; 1.04; 1.79]; P = 0.02), morning tiredness (OR: 1.33 [95% CI: 1.12; 1.59]; P<0.01), daytime sleepiness (OR; 1.24 [95% CI: 1.4; 1.46]: P<0.01) and exertional dyspnea (OR: 1.26 [95% CI: 1.00;1.58]; P = 0.04) when compared with OSA alone. Interpretation CPAP therapy was effective in normalizing the apnea-hypopnea index and significantly improved OSA-related symptoms, regardless of COPD status. CPAP should be offered to patients with OVS on a trial basis as a significant improvement in OSA-related symptoms can be expected, although the range of response may be less dramatic than in OSA alone.

Download Full-text

Effect of obstructive sleep apnea and CPAP therapy on skeletal muscle lipid content in obese and non-obese male subjects

Journal of the Endocrine Society ◽

10.1210/jendso/bvab082 ◽

2021 ◽

Author(s):

Alexander M Koenig ◽

Ulrich Koehler ◽

Olaf Hildebrandt ◽

Hans Schwarzbach ◽

Lena Hannemann ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Magnetic Resonance ◽

Fiber Type ◽

Subcutaneous Fat ◽

Apnea Hypopnea Index ◽

Resonance Spectroscopy ◽

Vastus Lateralis Muscle ◽

Cpap Therapy ◽

Obstructive Sleep

Abstract Obstructive sleep apnea (OSA), independently of obesity (OBS), predisposes to insulin resistance (IR) for largely unknown reasons. Since OSA-related intermittent hypoxia triggers lipolysis, overnight increases in circulating free fatty acid (FFA) including palmitic acid (PA) may lead to ectopic intramuscular lipid accumulation potentially contributing to IR. Using 3-T-1H-magnetic-resonance-spectroscopy, we therefore compared intra- and extra-myocellular lipid (IMCL and EMCL) in vastus lateralis muscle at ~7:00 a.m. between 26 male patients with moderate-to-severe OSA (17 obese, 9 non-obese) and 23 healthy male controls (12 obese, 11 non-obese). Fiber type composition was evaluated by muscle biopsies. Moreover, we measured fasted FFA including PA, HbA1c, thigh subcutaneous fat volume (ScFAT, 1.5-T-magnetic-resonance-tomograpphy) and maximal oxygen uptake (VO2max). 14 patients were reassessed after continuous-positive-airway-pressure (CPAP) therapy. Total FFA and PA were significantly by 178% and 166% higher in OSA patients vs. controls and correlated with the apnea-hypopnea index (AHI) (r≥0.45, P<0.01). Moreover, IMCL and EMCL were 55% (P<0.05) and 40% (P<0.05) higher in OSA patients, i.e. 114% and 103% in non-obese, 24.4% and 8.4% in obese subjects (with higher control levels). Overall, PA, FFA (minus PA) and ScFAT significantly contributed to IMCL (multiple r=0.568, P=0.002). CPAP significantly decreased EMCL (-26%) and, by trend only, IMCL, total FFA and PA. Muscle fiber composition was unaffected by OSA or CPAP. Increases in IMCL and EMCL are detectable at ~7:00 a.m. in OSA patients and partly attributable to overnight FFA excesses and high ScFAT or BMI. CPAP decreases FFAs and IMCL by trend but significantly reduces EMCL.

Download Full-text

Obstructive Sleep apnea Therapy

Journal of Dental Research ◽

10.1177/154405910808700917 ◽

2008 ◽

Vol 87 (9) ◽

pp. 882-887 ◽

Cited By ~ 78

Author(s):

A. Hoekema ◽

B. Stegenga ◽

P.J. Wijkstra ◽

J.H. van der Hoeven ◽

A.F. Meinesz ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Confidence Interval ◽

Severe Disease ◽

Lower Boundary ◽

Oral Appliance ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Oral Appliance Therapy ◽

Obstructive Sleep

In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded −25%. The lower boundary of the confidence interval was −21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea.

Download Full-text

Is sleep apnea-hypopnea index relevant for impaired brain perfusion and desaturation in patients with severe obstructive sleep apnea syndromes?

10.1101/2020.10.14.20212639 ◽

2020 ◽

Author(s):

Zhongxing Zhang ◽

Ming Qi ◽

Gordana Hügli ◽

Ramin Khatami

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cerebral Hemodynamics ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Hemodynamic Changes ◽

Cerebral Hemodynamic ◽

Respiratory Events ◽

Cpap Titration ◽

Obstructive Sleep

AbstractBackgroundObstructive sleep apnea syndrome (OSAS) is a common sleep disorder with the prevalence of 9-38% in the general population. Severe OSAS defined as apnea-hypopnea index (AHI) ≥ 30/h is a major risk factor for developing cerebro-cardiovascular diseases like stroke. Treatments such as continuous positive airway pressure (CPAP) therapy are recommended for those patients because untreated OSA can cause tremendous medical expenses and economic burden. Understanding the mechanisms of how repetitive sleep apneas/hypopneas induce changes in cerebral hemodynamics in severe OSAS is crucial for the understanding of disease severity, disease progression in brain damage and the treatment efficacy. However, these mechanisms and the association between AHI and the induced changes in cerebral hemodynamics in severe OSAS are essentially unknown. Using a stepwise incremental CPAP titration protocol we aim to identify the most relevant physiological factors including AHI and their quantitative contributions to cerebral hemodynamic changes before and during CPAP treatment in severe OSAS patients.Methods and findings29 newly diagnosed severe OSAS patients underwent incremental CPAP titration during polysomnography recordings: 1-h sleep without CPAP served as self-controlled baseline followed by stepwise increments of 1-cmH2O pressure per-hour starting from 5-8 cmH2O individually. Frequency-domain near-infrared spectroscopy measured the changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) during more than 2000 respiratory events were predicted by various predictors including AHI using linear mixed-effect models, respectively. The best predictors were automatically selected by stepwise regression. Surprisingly, AHI was excluded from the final selected models. Longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate (HR) during the events trigger smaller changes in CV-BV and de-StO2. CPAP pressures attenuate the changes in CV-BV and de-StO2.ConclusionsIn severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral vascular damage. Thus both, length and type of respiratory events should be considered as predictors of cerebro-cardiovascular events in future epidemiological studies and in clinical practice. OSAS patients with profound long apnea events need to pay special attention and quickly treated with CPAP therapy as it can restore the induced cerebral hemodynamic changes.

Download Full-text

Morning pentraxin3 levels reflect obstructive sleep apnea–related acute inflammation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00237.2014 ◽

2014 ◽

Vol 117 (10) ◽

pp. 1141-1148 ◽

Cited By ~ 3

Author(s):

Yusuke Kobukai ◽

Takashi Koyama ◽

Hiroyuki Watanabe ◽

Hiroshi Ito

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Acute Inflammation ◽

High Sensitivity ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Reactive Protein ◽

Obstructive Sleep ◽

Before And After ◽

Hs Crp

This study investigated morning levels of pentraxin3 (PTX3) as a sensitive biomarker for acute inflammation in patients with obstructive sleep apnea (OSA). A total of 61 consecutive patients with OSA were divided into two groups: non-to-mild ( n = 20) and moderate-to-severe ( n = 41) OSA based on their apnea-hypopnea index (AHI) score. Those patients with moderate-to-severe OSA were further divided into continuous positive airway pressure (CPAP) treated ( n = 21) and non-CPAP-treated ( n = 20) groups. Morning and evening serum PTX3 and high-sensitivity (hs) C-reactive protein (CRP) levels were measured before and after 3 mo of CPAP therapy. The baseline hs-CRP and PTX3 levels were higher in patients with moderate-to-severe OSA than in those with non-to-mild OSA. Moreover, the serum PTX3 levels, but not the hs-CRP levels, were significantly higher after than before sleep in the moderate-to-severe OSA group (morning PTX3, 1.96 ± 0.52; evening PTX3, 1.71 ± 0.44 ng/ml). OSA severity as judged using the AHI was significantly correlated with serum PTX3 levels but not hs-CRP levels. The highest level of correlation was found between the AHI and morning PTX3 levels ( r = 0.563, P < 0.001). CPAP therapy reduced evening and morning serum hs-CRP and PTX3 levels in patients with moderate-to-severe OSA; however, the reduction in PTX3 levels in the morning was greater than that in the evening (morning −29.8 ± 16.7% vs. evening −12.6 ± 26.8%, P = 0.029). Improvement in the AHI score following CPAP therapy was strongly correlated with reduced morning PTX3 levels( r = 0.727, P < 0.001). Based on these results, morning PTX3 levels reflect OSA-related acute inflammation and are a useful marker for improvement in OSA following CPAP therapy.

Download Full-text

Efficacy and adherence of auto-CPAP therapy in patients with obstructive sleep apnea: a prospective study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2020.468 ◽

2020 ◽

Vol 15 ◽

Author(s):

Hang Dinh-Thi-Dieu ◽

Anh Vo-Thi-Kim ◽

Huong Tran-Van ◽

Sy Duong-Quy

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Congestion ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Short Term ◽

Arousal Index ◽

Obstructive Sleep ◽

A Prospective Study

Introduction: The use of auto-continuous positive airway pressure (auto-CPAP) therapy has been recommended for subjects with moderate-to-severe obstructive sleep apnea (OSA) without significant comorbidities. This study is aimed at evaluating the efficacy and adherence of auto-CPAP therapy in subjects with OSA. Methods: It was a perspective and descriptive study. All study subjects who had apnea-hypopnea index (AHI) >30/h, measured by polysomnography, were included. They were treated with auto-CPAP and followed-up for 6 months for evaluating the effect of CPAP-therapy on clinical and biological features and treatment adherence. Results: One hundred and thirty-nine subjects with severe OSA were accepted for auto-CPAP therapy at inclusion. BMI was 28.4±3.8 kg/m2; neck and abdomen circumferences were 38.2±6.4 and 85.7±11.6. Epworth and Pichot scores were 18.4±6.3 and 28.3±4.5, respectively; AHI was 39±7/h and arousal index was 39±13/hour. At 6th month, 96.4% of study subjects continued to use auto-CPAP-therapy within 6.5±2.4 hours/night. There was a significant correlation between the modification (Δ) of Epworth scores and (Δ) AHI after 3 and 6 months of auto-CPAP-therapy (R=0.568 and P=0.003; R=0.745 and P=0.002; respectively). At 6th month follow-up, the main side effects of auto-CPAP were difficult sleeping, dry mouth or nose, skin marks or rashes, discomfortable breathing, and nasal congestion (36.1%, 32.0%, 20.8%, 16.0%, and 11.9%; respectively). Conclusion: Auto-CPAP is effective in treatment of Vietnamese patients with severe OSA in short-term follow-up.

Download Full-text

BLOOD PRESSURE AND ARTERIAL STIFFNESS DYNAMICS DEPENDING ON THE DURATION OF CPAP NIGHT SESSIONS IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-4-280-289 ◽

2019 ◽

Vol 9 (4) ◽

pp. 280-289

Author(s):

M. V. Gorbunova ◽

S. L. Babak ◽

T. V. Adasheva ◽

A. G. Malyavin

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Stiffness ◽

Resistant Hypertension ◽

Apnea Hypopnea Index ◽

Severe Obstructive Sleep Apnea ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Target Values

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

Download Full-text