Obstructive sleep apnea and cardiovascular comorbidity: modern discordance in assessing the effectiveness of CPAP-therapy against the pathogenetic mechanisms and cardiovascular diseases

2021 ◽  
Vol 31 (6) ◽  
pp. 799-807
Author(s):  
Mikhail V. Agaltsov ◽  
Lyudmila S. Korostovtseva
Keyword(s):  
Clinical Trials ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiovascular Diseases ◽  
Endothelial Dysfunction ◽  
Sympathetic Activity ◽  
Vascular Inflammation ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
First Choice

Sleep-disordered breathing (and obstructive sleep apnea, OSA) is a common pathology in the general population in economically developed countries. In the last decades, CPAP therapy (continuous positive airway pressure) became the first-choice treatment option in clinically relevant OSA.Objective. The review summarized available evidence about the effects of CPAP-therapy on the main pathogenetic pathways of OSA (sleep-related sympathetic activity, vascular inflammation, endothelial dysfunction, oxidative stress, and blood coagulation) and cardiovascular diseases (CVDs - hypertension, cardiac arrhythmias, heart failure, pulmonary hypertension, coronary heart disease, and combined cardiovascular outcomes, including cardiovascular mortality).Methods. We analyzed the data of the randomized observational cohort clinical trials and metaanalyses, which assessed the effects of CPAP-therapy on the pathophysiological mechanisms of OSA and the associated CVDs. We also analyzed current guidelines on the management of patients with CVDs and OAS. We searched the following databases: Scopus, Pubmed, Google Scholar, Russian Scientific Citation Index.Results. Despite the rather recent implementation of this method, the accumulated evidence shows its favorable impact on OSA pathogenesis (on sympathetic activity and, to some extent, on vascular inflammation and endothelial dysfunction) and CVDs (hypertension, in particular, resistant hypertension, and paroxysmal atrial fibrillation). The observational studies also demonstrate favorable outcomes regarding other CVDs. However, the data of the randomized clinical trials are limited or controversial, the samples are rather small, which leads to inconsistent conclusions.Conclusion. Currently, most of the researchers emphasize that the required CPAP-adherence level (regular use for at least 4 h nightly) is the main barrier to getting the high-level evidence of CPAP efficiency with regard to the cardiovascular risk. This factor becomes the biggest limitation in patients who are characterized by the low compliance because they are not prone to daytime sleepiness.

scholarly journals The effect of antihypertensive therapy and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea syndrome in association with arterial hypertension

2017 ◽  
Vol 14 (1) ◽  
pp. 37-40
Author(s):  
E M Elfimova ◽  
A V Rvacheva ◽  
M I Tripoten ◽  
O V Pogorelova ◽  
T V Balakhonova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Endothelial Dysfunction ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Adhesion Molecule ◽  
Severe Obstructive Sleep Apnea ◽  
Cpap Therapy ◽  
Obstructive Sleep

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

scholarly journals cardiovascular effects of oral appliances in obstructive sleep apnea

2018 ◽  
Vol 24 (4) ◽  
pp. 396-405
Author(s):  
M. V. Agaltsov
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiovascular Diseases ◽  
Oral Appliances ◽  
Upper Respiratory Tract ◽  
Cpap Therapy ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Custom Made

Oral  appliances  (ОА)  are  one  of  the  leading  methods  of  effective  treatment  of  sleep-related  breathing disorders. Obstructive sleep apnea (OSA) is a widespread disturbance in the general population. It is closely associated with many cardiovascular diseases (hypertension, cardiac arrhythmias, chronic heart failure, ischemic heart disease). Timely detection and treatment of OSA is an important task in the process of reducing the number of cardiac complications. Modern devices for the treatment of OSA are custom-made devices which allow to change the position of the mandible and its extension providing personalized treatment of snoring and sleep apnea. Changing the degree of the mandible extension, the ОА retains the upper respiratory tract in open position and indirectly stimulates the muscles, determining their tone. The effectiveness of the ОА is evaluated by the complete elimination of all respiratory events (snoring, upper airway resistance syndrome, OSA and hypopnea), as well as the influence on the sleep structure and the wakefulness functioning (excessive daytime sleepiness). The effects of ОА on cardiovascular diseases are of great importance, as they showed a decrease in both systolic and diastolic blood pressure, as well as a positive effect on the impaired endothelial function. Among all the treatment options, ОА take the leading positions, only slightly inferior in effectiveness to noninvasive ventilation, so called CPAP therapy. Regarding the long-term adherence to therapy (which is especially important in the cardiovascular prevention) оral appliances exceed CPAP therapy. Thus, the OA therapy is one of the leading therapeutic directions in modern sleep medicine for obstructive sleep-related breathing disorders.

scholarly journals Obstructive sleep apnea syndrome in children: prerequisites for formation and possibilities of ultrasound diagnostics of structural and functional changes in the vascular system

2021 ◽  
Vol 12 (2) ◽  
pp. 65-72
Author(s):  
Svetlana E. Bolshakova ◽  
Irina M. Madaeva ◽  
Olga N. Berdina ◽  
Olga V. Bugun ◽  
Lyubov V. Rychkova
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiovascular Diseases ◽  
Endothelial Dysfunction ◽  
Vascular System ◽  
Reactive Hyperemia ◽  
Sleep Apnea Syndrome ◽  
Functional Changes ◽  
Obstructive Sleep ◽  
Ultrasound Diagnostics

Obstructive sleep apnea (OSA) in children are relatively frequent sleep disorder, with a prevalence of 15 %, in pediatrics population, as reported by different studies. The clinical consequences of OSA are daytime sleepiness, cognitive and behavioral disorders, and poor school performance. OSA has serious social implications given their correlations with cardiovascular diseases and obesity. The article reflects the mechanisms involved in the development of the pathologic changes in cardiovascular system in OSA patients, which remain completely unclear, which determines the need for further study of the problem. The role of endothelial dysfunction in children with OSA as the main marker of vascular damage is considered. The description of ultrasound methods for studying the vascular system in OSA pediatric patients is given. The work on the study of cerebral hemodynamics using transcranial duplex scanning of the vessels of the base of the brain and its changes caused by vascular remodeling in OSA are presented. This review discusses the possibility of ultrasound assessment of endothelium-dependent dilatation of the brachial artery in a test with reactive hyperemia as a functional method for diagnosing endothelial dysfunction in OSA children. The use of these methods will make it possible to timely identify the structural and functional changes in blood vessels, which will allow determining the vector of early prevention and pathogenetically substantiate innovative approaches to the treatment of various cardiovascular diseases in OSA children from the standpoint of sleep medicine.

A Pilot Study Of Aspirin Resistance In Obstructive Sleep Apnea Patients

2021 ◽  
Vol 44 (3) ◽  
pp. E55-63
Author(s):  
Maria Scinico ◽  
Oleg V. Sostin ◽  
Rakhee Agarwal ◽  
Amber D. Kapoor ◽  
Joann R. Petrini ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Phase 1 ◽  
Aspirin Resistance ◽  
Phase 2 ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
The Mean

Purpose: Obstructive sleep apnea (OSA) leads to endothelial dysfunction and platelet hyperactivity, which arelinked to increased risk of cardiovascular disease and implicated in the development of aspirin resistance. We  hypothesized that aspirin resistance is prevalent among OSA patients and aimed to explore effects of continuous positive airway pressure (CPAP) therapy on aspirin responsiveness. Methods: In Phase 1, prevalence of aspirin resistance was determined cross-sectionally in a group of OSA  patients (n=59) on daily low-dose aspirin (81 mg) taken before entering the study, for primary or secondary prevention. In Phase 2, aspirin responsiveness before and after initiation of CPAP therapy was compared and stratified by endothelial function in a cohort of aspirin-naïve patients with newly diagnosed OSA (n=18). Results: In Phase 1, prevalence of aspirin resistance was 17%; most patients (56%) were on CPAP therapy. In Phase 2, initiation of CPAP therapy was associated with significant improvement in endothelial function (p=0.03). The mean pre-CPAP aspirin resistance units (ARU) was 569 (SD=75). In subjects with endothelial dysfunction (44%), the mean decrease after initiation of CPAP therapy was 43 ARU (SD=81, p=0.18). In contrast, subjects with normal endothelial function experienced the mean decrease of 8 ARU (SD=116, p=0.83). Conclusion: Aspirin resistance may be prevalent among OSA patients. After initiation of CPAP therapy, we observed a trend towards improvement in aspirin responsiveness among patients with endothelial dysfunction. The role of endothelial dysfunction and aspirin resistance should be explored in further studies that focus on the effect of CPAP on cardiovascular outcomes.

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.

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