scholarly journals Continuous positive airway pressure therapy reduces the levels of catecholamines and blood pressure in pseudophaeochromocytoma with coexisting obstructive sleep apnoea

2021 ◽  
Vol 10 ◽  
pp. 204800402199219
Author(s):  
Gie Ken-Dror ◽  
Michael Wood ◽  
David Fluck ◽  
Pankaj Sharma ◽  
Christopher H Fry ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Case Reports ◽  
Sleep Apnoea ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Urinary Noradrenaline ◽  
Catecholamine Levels

Background Stress from obstructive sleep apnoea (OSA) stimulates catecholamine release and consequently can exacerbate hypertension, even in the absence of a catecholamine-producing tumour (phaeochromocytoma). As such, a positive screening test for suspected phaeochromocytoma may be misleading. There exists only a handful case reports, and no controlled trials, how continuous positive airway pressure (CPAP) to treat OSA influences catecholamine levels. We examined changes to levels of urinary catecholamine and blood pressure in response to CPAP treatment. Methods We conducted a meta-analysis of data aggregated from published case reports of individual patient data up to April 2020. The quality of the reports was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. Results A total of 13 cases (seven men and six women) from seven reports met our search criteria. Patients had mean age of 49.1 years (range = 36–62) and body mass index of 37.4 kg/m2 (range = 27–56). Most had moderate to severe OSA with CPAP treatment. Nine cases had 24-hour urinary noradrenaline assessment before and after CPAP treatment. CPAP treatment led to a 21% reduction (104 nmol/24-hours, 95% credible interval =59 to 148) in 24-hour urinary noradrenaline to within reference ranges, and 25% reduction (from 131 to 100 mmHg) in mean arterial pressure. The risk of overall bias evaluated by the ROBINS-I tool was found to be low in the majority of reports. Conclusions Investigations of patients suspected of phaeochromocytoma, particularly obese individuals, should exclude OSA and treat this condition if present before performing screening tests to assess for catecholamine levels.

Continuous positive airway pressure improves blood pressure and serum cardiovascular biomarkers in obstructive sleep apnoea and hypertension

2021 ◽  
pp. 2003687
Author(s):  
Macy Mei-Sze Lui ◽  
Hung-Fat Tse ◽  
David Chi-Leung Lam ◽  
Kui-Kai Lau ◽  
Carmen Wing-Sze Chan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Myocardial Injury ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Control Group ◽  
Cpap Treatment ◽  
Obstructive Sleep

RationaleThe impact of treatment for obstructive sleep apnoea (OSA) on reduction of cardiovascular risk is unclear. This study aimed to examine the effect of continuous positive airway pressure (CPAP) on ambulatory blood pressure (BP) and subclinical myocardial injury in subjects with OSA and hypertension.MethodsSubjects with hypertension requiring at least three anti-hypertensive medications and moderate-severe OSA were enrolled. Eligible subjects were randomized (1:1) to receive either CPAP treatment or control (no CPAP) for eight weeks. Changes in ambulatory BP and serum biomarkers were compared. Stratified analysis according to circadian BP pattern was performed.Main resultsNinety two subjects (75% men; age, 51±8 years; apnoea-hypopnoea index 40±8 events·h−1, taking average of 3.4 anti-hypertensive drugs [range 3–6]) were randomised. The group on CPAP treatment, compared to the control group, demonstrated significant reduction in 24-h systolic BP (−4.4 mmHg, 95% CI −8.7 to −0.1, p=0.046), 24-h diastolic BP (−2.9 mmHg, 95% CI −5.5 to −0.2, p=0.032), daytime systolic BP (−5.4 mmHg, −9.7 to −1.0, p=0.016) and daytime diastolic BP (−3.4 mmHg, 95% CI −6.1 to −0.8, p=0.012). CPAP treatment was associated with significant BP lowering only in non-dippers, but not in dippers. Serum troponin I (mean difference −1.74 pg·mL−1, 95% CI −2.97 to −0.5, p=0.006) and brain natriuretic peptide (−9.1 pg·mL−1, 95% CI −17.6 to −0.6, p=0.036) were significantly reduced in CPAP compared to control group.ConclusionIn a cohort with OSA and multiple cardiovascular risk factors including difficult-to-control hypertension, short-term CPAP treatment improved ambulatory BP and alleviated subclinical myocardial injury and strain.

scholarly journals 0053 Effect of Changes in Intracellular Adhesion Molecule-1 on Measures of Sleepiness and 24-hour Ambulatory Blood Pressure After 4 Months of Continuous Positive Airway Pressure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A21-A21
Author(s):  
V M Pak ◽  
D Maislin ◽  
B T Keenan ◽  
R Townsend ◽  
S B Dunbar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Adhesion Molecule ◽  
Ambulatory Blood Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Treatment ◽  
Arterial Blood ◽  
Obstructive Sleep

Abstract Introduction Previous studies have shown that continuous positive airway pressure (CPAP) therapy of adults with obstructive sleep apnea (OSA) reduces circulating levels of intercellular adhesion molecule 1 (ICAM-1). ICAM-1 levels may affect daytime sleepiness and elevated blood pressure associated with OSA. Our goals were to explore associations between changes in ICAM-1 and objective and subjective measures of sleepiness, as well as 24-hour ambulatory blood pressure monitor (ABPM) parameters in adults with OSA following 4 months of CPAP treatment. Methods We identified 140 adults with newly diagnosed OSA in the Penn Icelandic Sleep Apnea (PISA) Study, with a mean (±SD) body mass index (BMI) of 31.5±4.2 kg/m2 and apnea-hypopnea index (AHI) of 36.8±15.3 events/hour; 83.3% were males. Plasma ICAM-1 levels, 24-hour ABPM, Epworth Sleepiness Scale (ESS), and Psychomotor Vigilance Task (PVT) measures were obtained at baseline and after 4 months of CPAP treatment. Associations between changes in natural log ICAM-1 and both sleepiness and 24-hour mean arterial blood pressure (MAP) were assessed using multivariate regression models, controlling for a priori baseline covariates of age, sex, BMI, race, site, smoking status, physical activity, use of anti-hypertensive medications, AHI and hours/night of CPAP usage. Results Overall, there was no significant change in ICAM-1 from baseline to follow-up among all participants after 4 months (0.027 ng/ml, p=0.52). There were no statistically significant associations between the change in ICAM-1 and change in sleepiness measures (all p>0.05) or 24-hour MAP (1.124 mm Hg, p=0.07). A nominal association between increased ICAM-1 and increased daytime MAP after 4 months was observed (1.39 mm Hg, p=0.033), although this result was not significant after correction for multiple comparisons. Conclusion Our results do not support changes in ICAM-1 as the biological pathway linking changes in sleepiness or ABPM following CPAP treatment of adults with OSA. Support P01-HL094307 (NHLBI, PI: Pack AI)

scholarly journals Continuous positive airway pressure treatment for obstructive sleep apnoea: Maori, Pacific and New Zealand European experiences

2014 ◽  
Vol 6 (3) ◽  
pp. 221 ◽  
Author(s):  
Jessie Bakker ◽  
Karyn O’Keeffe ◽  
Alister Neill ◽  
Angela Campbell
Keyword(s):  
New Zealand ◽  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Role Models ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Cpap Adherence ◽  
Cpap Treatment ◽  
Obstructive Sleep

INTRODUCTION: Continuous positive airway pressure (CPAP) is an effective treatment of obstructive sleep apnoea (OSA), but can be limited by poor adherence. In New Zealand (NZ), ethnicity has been shown to be a predictor of CPAP adherence. This study aimed to explore Maori, Pacific and NZ European patients’ experience of CPAP treatment. METHODS: Patients identifying as Maori, Pacific, or NZ European ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group, using an interview template. Thematic analysis was applied to the discussion transcripts independently by two investigators, following published guidelines. FINDINGS: Five Maori, five Pacific, and eight NZ Europeans participated (mean age 47, range 30–71 years, mean ± standard deviation CPAP adherence 6.32 ±1.25 hours/night). Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All groups identified barriers to treatment (both at the CPAP initiation phase and long term), reported feelings of being ‘overwhelmed’ with information during the initial CPAP education session, and discussed the importance of successful role models. Family and friends were generally reported as being supportive of CPAP therapy. CONCLUSION: The three groups all reported similar initial CPAP experiences, highlighting access barriers to publicly funded assessment and treatment pathways, and sleep health knowledge as key issues. Educational resources to improve access, enable self-management, and increase community awareness of OSA would help overcome some of the issues identified in this study. KEYWORDS: Continuous positive airway pressure; obstructive sleep apnea; ethnic groups; focus groups

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