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Changes in the Heart Rate Variability in Patients with Obstructive Sleep Apnea and Its Response to Acute CPAP Treatment  [PDF]
Ernesto Kufoy, Jose-Alberto Palma, Jon Lopez, Manuel Alegre, Elena Urrestarazu, Julio Artieda, Jorge Iriarte
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033769
Abstract: Introduction Obstructive Sleep Apnea (OSA) is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. Methods Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. Results 39 patients (15 females, 24 males) were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m2 (31.83 males, 35.95 females). Our results showed that HRV (SDNN) decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. Conclusions These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once.
Prediction of Effective CPAP Level in Obstructive Sleep Apnea Syndrome  [PDF]
Selda KORKMAZ,Sevda ?SMA?LO?ULLARI,Ay?e DUMAN,Murat AKSU
Journal of Neurological Sciences , 2012,
Abstract: Background: Prediction of effective CPAP level to treat obstructive sleep apnea syndrome (OSAS) before CPAP titration helps the effectiveness of titration. Several algorithms that predict the optimal continuous positive airways pressure (CPAP) level have been developed. However, a standard algorithm has not been composed.There are two aims of this study. First, to examine the factors that account for the variability in CPAP levels required to abolish apnea and hypopnea in patients with OSAS. Second, to obtain a formulation of predicting the lowest effective pressure from some anthropometric and polysomnographic variables for Turkish patients with OSAS.Methods: We retrospectively have evaluated 127 patients with mild-severe obstructive sleep apnea who were applied CPAP titration. Anthropometric (body mass index(BMI), age, gender) and polysomnographic (sleep efficacy, epworth sleepiness scale (ESS) score, multiple sleep latency test (MSLT) mean sleep latency, apnea hypopnea index, minimum O2 saturation) parameters in patients are determined. Then, we have evaluated the relationship between optimum CPAP level and those parameters.Results: We found a significant correlation between CPAP level and BMI (p<0.028) and AHI (p<0.001) and min O2sat (p<0.001). However, we did not find a correlation between CPAP level and BMI in presence of multiple variables. Also, there wasn't any correlation between CPAP level and sleep efficacy and ESS score and MSLT mean sleep latency.Conclusions: Predicting optimal CPAP level formulation: logCPAP=0.921-(0.002xminO2sat)+(0.001xAHI). According to this formulation, BMI is not a parameter that affect CPAP level. On the other hand, min O2sat and AHI are important that determine to CPAP level.
Childhood Obesity and Obstructive Sleep Apnea
Indra Narang,Joseph L. Mathew
Journal of Nutrition and Metabolism , 2012, DOI: 10.1155/2012/134202
Abstract: The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.
Obstructive Sleep Apnea Syndrome Implications on Health and Adherence to CPAP Treatment  [PDF]
Jesús Moo Estrella, Paulino Dzib Aguilar, Ricardo Castillo Ayuso, Rossana Cuevas Ferrera
Health (Health) , 2015, DOI: 10.4236/health.2015.75076
Abstract: Respiratory disorders during sleep have as a general characteristic the alteration of the respiratory cycle while sleeping. The most outstanding characteristic of Obstructive Sleep Apnea Syndrome (OSA) is the partial (hypopnea) or total (apnea) obstruction of the upper airway that occurs repeatedly during sleep. The OSA is global public health issue. When it is not treated, OSA represents a cost two or three times higher of the institutional resources for health. Studies conducted in different countries indicate that the prevalence of the OSA goes from 2% to 10% in general population. The OSA is a serious sleep disorder that has negative implications on multiple systems of the organism. It is associated with hypertension, diabetes and the metabolic syndrome. When OSA coexists with a heart disease or ischemic heart disease, it significantly raises the probability of a heart failure. The use of Continuous Positive Airway Pressure (CPAP) is so far the most effective method for OSA treatment. Intervention at different levels (physiological, educational and psychological intervention) appears to be important in adherence to CPAP treatment.
Obstructive sleep apnea syndrome and cognitive impairment: effects of CPAP  [cached]
Alessandra Giordano,Alessandro Cicolin,Roberto Mutani
Reviews in Health Care , 2011, DOI: 10.7175/rhc.5224209-227
Abstract: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep disorder characterised by repetitive episodes of upper airway obstruction (apnea) or reduced airflow (hypopnoea) despite persistent respiratory effort. Apnea is defined as the cessation of breathing for at least 10 seconds during sleep, while hypopnoea is defined as at least 30% reduction in airflow for 10 seconds associated with oxygen desaturation and sleep fragmentation. The presence in the general population is about 4%. The principal symptoms are: excessive daytime sleepiness (EDS), snoring, dry throat, morning headache, night sweats, gastro-esophageal reflux, and increased blood pressure. Long term complications can be: increased cardio-cerebrovascular risk and cognitive impairment such as deficiency in attention, vigilance, visual abilities, thought, speech, perception and short term memory. Continuous Positive Airway Pressure (CPAP) is currently the best non-invasive therapy for OSAS. CPAP guarantees the opening of upper airways using pulmonary reflexive mechanisms increasing lung volume during exhalation and resistance reduction, decreasing electromyografical muscular activity around airways. The causes of cognitive impairments and their possible reversibility after CPAP treatment have been analysed in numerous studies. The findings, albeit controversial, show that memory, attention and executive functions are the most compromised cognitive functions. The necessity of increasing the patient compliance with ventilotherapy is evident, in order to prevent cognitive deterioration and, when possible, rehabilitate the compromised functions, a difficult task for executive functions.
Impact of Acetazolamide and CPAP on Cortical Activity in Obstructive Sleep Apnea Patients  [PDF]
Katrin Stadelmann, Tsogyal D. Latshang, Yvonne Nussbaumer-Ochsner, Leila Tarokh, Silvia Ulrich, Malcolm Kohler, Konrad E. Bloch, Peter Achermann
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093931
Abstract: Study Objectives 1) To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS). 2) To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP) therapy. Design Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed. Setting Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m. Patients Study 1: 39 OSAS patients. Study 2: 41 OSAS patients. Interventions Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500–750 mg) or placebo at moderate altitudes. Measurements and Results An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10%) and increased spindle activity (approximately 10%) during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5–10%) and increase in beta activity (approximately 25%). Conclusions The higher evening dose of 500 mg acetazolamide showed the “spectral fingerprint” of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality.
PREVALENCE AND FACTORS AFFECTING REM AND SLOW WAVE SLEEP REBOUND ON CPAP TITRATION STUDY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Osuna S,Edgar; Siddiqui,Fouzia; Vanegas,Marco A; Walters,Arthur S; Chokroverty,Sudhansu;
Revista Facultad de Medicina de la Universidad Nacional de Colombia , 2008,
Abstract: background. in patients with obstructive sleep apnea syndrome (osas) treatment with cpap results in an increase of rem sleep and slow wave sleep, but there is limited information about the prevalence of rem rebound in patients with osas and possible factors related to the rebound. objective. rem rebound (rr) and slow wave sleep rebound (swsr) has been described as a frequent phenomenon that occurs during cpap titration, but the quantity that qualify for rr has not been mentioned in literature. the objective of our study was to determine the prevalence of rem rebound and slow wave sleep rebound in our sleep disorders center, to attempt to define rr and look for factors that may affect rr and swsr on the first night of cpap titration. materials and methods. we included patients who had both baseline polysomnogram (bpsg) and cpap polysomnogram (cpsg) studies done in the same laboratory. we included 179 patients>18 years with apnea hypopnea index (ahi)>10/hr on the baseline study, with an adequate cpap titration study. we compared the percentages of rem sleep and slow wave sleep during bpsg and cpsg. we analyzed the frequency of presentation and looked for the factors affecting rr and swsr. results. 179 patients were enrolled (m/f:118/61), with a mean age of 48.6±4 for men, and 51.6±12.9 for women. the mean interval between the bpsg and cpsg was 45 days. the mean rem percentage during the bpsg was 15.55 percent and during cpsg study it was 21.57 percent. we took 6 percent as our differential point as the results became statistically significant at this point (p:0001). we therefore present our data by dividing our patients population with rr<6% and rr>6%. the mean sws percentage during the bpsg was 8.11±9.68 and during the cpsg was 13.17±10, with a p:0.35 which is not statistically significant. the multiple regression model showed that the variables that contribute more to the rem change are: rem sleep during bpsg (-0.56), bahi (0.24) and the body mass index (0.081). con
Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program  [cached]
La Piana GE,Scartabellati A,Chiesa L,Ronchi L
Patient Preference and Adherence , 2011,
Abstract: Giuseppe Emanuele La Piana1, Alessandro Scartabellati1, Lodovico Chiesa1, Luca Ronchi1, Paola Raimondi1, Miriam A Carro1, Silvia Zibetti1, Stefano Aiolfi2 1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; 2Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy Background: Lack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term. Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year. Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation. Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful. Keywords: adherence, continuous positive airway pressure, obstructive sleep apnea syndrome, educational program
Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program
La Piana GE, Scartabellati A, Chiesa L, Ronchi L, Raimondi P, Carro MA, Zibetti S, Aiolfi S
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S24018
Abstract: ng-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program Methodology (3300) Total Article Views Authors: La Piana GE, Scartabellati A, Chiesa L, Ronchi L, Raimondi P, Carro MA, Zibetti S, Aiolfi S Published Date November 2011 Volume 2011:5 Pages 555 - 562 DOI: http://dx.doi.org/10.2147/PPA.S24018 Giuseppe Emanuele La Piana1, Alessandro Scartabellati1, Lodovico Chiesa1, Luca Ronchi1, Paola Raimondi1, Miriam A Carro1, Silvia Zibetti1, Stefano Aiolfi2 1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; 2Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy Background: Lack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term. Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year. Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation. Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful.
Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP
Rodrigues, Raimundo Nonato Delgado;Rodrigues, Aída Alexandra Alvim de Abreu e Silva;Pratesi, Riccardo;Gomes, Marília Miranda Fortes;Vasconcelos, Ana Maria Nogales;Erhardt, Christine;Krieger, Jean;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000100012
Abstract: background & purpose: the association of obstructive sleep apnea syndrome (osas) and restless legs syndrome (rls) has been reported in the literature for many years. both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. the primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (cpap) treatment in osas patients with and without rls. method: a prospective and comparative study between a group of 13 patients with osas and a group of 17 patients with osas+rls. laboratory blood tests and polysomnography were performed at baseline. the epworth sleepiness scale (ess) and the pichot?s questionnaire of fatigue/depression (pic) were applied before and after 3 months of cpap treatment. results were compared. results: no significant differences were found on psg and laboratory results at baseline. both groups had similar ess and pic scores at baseline (p=0.73 and 0.08, respectively). after n-cpap, osas+rls patients showed higher ess and pic scores (p=0.017 and 0.03, respectively). conclusions: despite a favorable general response, n-cpap seemed less effective in treating fatigue and sleepiness in the osas+rls group.
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