Continuous Positive Airway Pressure Treatment In Patients Research Articles

0528 Effects of continuous positive airway pressure on white matter microstructure in patients with obstructive sleep apnea

Abstract Introduction Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests. Methods Twenty-two male patients with moderate to severe OSA were recruited and underwent DTI scanning before and 6-44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up MRI in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method. Results The TSSA analysis showed that FA values in the middle part of the right CST were increased after treatment in the CPAP group. No significant change in FA value was observed between baseline and post-scan in the untreated group. In the CPAP group, the post-treatment FA value in the anterior part of the right ATR was significantly correlated with durations of CPAP therapy after controlling for age, body mass index, and baseline FA value. Conclusion Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA. Support (if any)

Effects of Continuous Positive Airway Pressure on White Matter Microstructure in Patients With Obstructive Sleep Apnea

Background and Objective Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests.Methods Twenty-two male patients with moderate to severe OSA were recruited, and thepatients underwent DTI scanning before and 6–44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up magnetic resonance imaging in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method.Results The TSSA analysis showed that FA values in the middle part of the right corticospinal tract were increased after treatment in the CPAP group. In the untreated group, no significant change in FA value was observed between baseline and follow-up. In the CPAP group, the post-treatment FA value in the anterior part of the right anterior thalamic radiation was significantly correlated with the duration of CPAP therapy, after controlling for age, body mass index, and baseline FA value.Conclusions Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA.

Association between brain-derived neurotrophic factor levels and obstructive sleep apnea: a systematic review and meta-analysis.

Chronic intermittent hypoxia associated with obstructive sleep apnea (OSA) can affect neurons and glial cells, leading to cell stress and damage, and changes in brain-derived neurotrophic factor (BDNF) levels. This study investigated the relation between BDNF, OSA, and continuous positive airway pressure (CPAP) - the standard of care in patients withOSA. Five databases were searched for studies that evaluated BDNF serum and/or plasma levels in patients with OSA and controls or publications assessing the effect of CPAP treatment on BDNF levels. We used standardized mean difference (SMD) with its 95% confidence interval(CI) comparison between patients withOSA and controls. Ten studies were included in our study assessing the relation between BDNF levels, OSA, and CPAP treatment. Five studies of BDNF levels in OSA compared to controls showed no significant difference (SMD =  - 0.52, 95% CI [- 1.93; 0.89], p-value = 0.47). No statistically significant difference was found between CPAP treatment in patients with OSA and BDNF levels (SMD =  - 0.78, 95% CI [- 1.77; 0.21], p-value = 0.12). BDNF peripheral levels are not significantly altered in OSA or by its related treatment, preventing its use as a biomarker.

Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial.

BackgroundThe titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titration in patients with OSA.MethodsIn this randomized, controlled, and single-blind crossover trial, we compared the effects of 1-month CPAP treatment in patients with OSA with either DISE-guided CPAP titration or CSC CPAP titration. Twenty-four patients with OSA were recruited for the study. All patients underwent polysomnography, DISE-guided CPAP titration, and accommodation. Initially, patients were randomly assigned to receive either DISE-guided CPAP titration or CSC CPAP treatment for the first month. They were then switched to other treatments in the second month. The Epworth sleepiness scale (ESS) score was recorded at baseline, 1 and 2 months.ResultsThe upper limit of the pressure of DISE-guided titration and CSC CPAP titration was not significantly different (13.9 ± 0.7 vs. 13.5 ± 0.5 cm H2O; P = 0.92). The residual apnea-hypopnea index and compliance were also not significantly different between the groups. ESS score significantly improved from baseline to 1 month after CPAP treatment in both groups. Both epiglottis (anterior-posterior collapse) and tongue base collapse were significantly associated with 95% CPAP pressure (P = 0.031 and 0.038, respectively). After multivariate regression analyses, the epiglottis (anterior-posterior collapse) was an independent factor for 95% CPAP pressure. The incidence rate of bradycardia was 58.3%, which is a safety concern for DISE. Despite the high incidence of bradycardia, all patients with bradycardia recovered with proper management.ConclusionBoth modalities were comparable in terms of establishing the pressure settings required to treat patients. Further large-scale studies are required to confirm these results.Trial registrationhttps://clinicaltrials.gov/, NCT03523013.

The Effects of Continuous Positive Airway Pressure Therapy for Secondary Cardiovascular Prevention in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis

Background: Obstructive sleep apnoea (OSA) is highly prevalent and significantly associated with major adverse cardiovascular events (MACEs). Continuous positive airway pressure (CPAP) treatment has a protective effect on cardiovascular events in OSA patients. However, whether CPAP therapy significant reduces the risk of recurrent cardiovascular (CV) events in OSA patients with established cardiovascular or cerebrovascular diseases remains disputed. We aim to evaluate the effect of CPAP on recurrent cardiovascular outcomes in moderate to severe OSA patients with previous cardiovascular or cerebrovascular diseases. Methods: We searched the electronic databases (PubMed, EMBASE, and Cochrane library) from their inception to August, 2021. Only randomized controlled trials (RCTs) that described the association of CPAP treatment in patients with cardiovascular or cerebrovascular disease and OSA were included in our analysis. The primary outcome of interest was major adverse cardiac or cerebral events (MACCEs), a composite endpoint of myocardial infraction (MI), non-fatal stroke, CV mortality; secondary outcomes included all-caused death, cardiac mortality, myocardial infraction, atrial fibrillation, heart failure, repeat revascularization, angina, stroke, and transient ischemic attack. In addition, subgroup analyses based on CPAP adherence were performed. Result: Six RCTs of 4493 participants were included in the analysis. Compared with usual care, CPAP therapy did not significantly reduce the risk of recurrent MACCEs odds ratio (OR) 0.94, 95% confidence interval (CI) 0.79–1.12, p = 0.5, CV mortality (OR 0.83, 95% CI [0.54–1.26], p = 0.37), myocardial infarction (OR 1.09, 95% CI [0.8–1.47], p = 0.6), heart failure (OR 0.94, 95% CI [0.66–1.33], p = 0.71), stroke (OR 0.9, 95% CI [0.67–1.23], p = 0.52), or all-cause death (OR 0.86, 95% CI [0.63–1.16], p = 0.32). However, the subgroup analyses revealed that CPAP can decrease the risk of CV mortality (OR 0.25, 95% CI [0.08–0.77], p = 0.02) and stoke (OR 0.39, 95% CI [0.15–0.97], p = 0.04) in patients who used it more than 4 hours. Conclusions: CPAP therapy was not associated with reduce the risk of MACCEs in OSA patients with a history of chronic cardiovascular disease who utilize CPAP <4 hours/night, although CPAP appeared to have a positive effect on CV mortality and stroke among those who used CPAP >4 hours. The correlation between CPAP and the prognosis of OSA patients warrants further study.

Differential effects of positive and negative upper airway pressure application on atrial electrophysiology: implications for CPAP-therapy in OSA-patients

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo nordisk foundation Background Obstructive sleep apnea (OSA) is closely associated with atrial fibrillation (AF) and OSA-treatment by continuous positive airway pressure (CPAP) is believed to reduce the AF burden in OSA-patients. While negative upper airway pressure during obstructive respiratory events have been shown to increase AF susceptibility, atrial electrophysiological effects of positive upper airway pressure during CPAP-therapy are unknown. Purpose In pigs, we investigated differential atrial electrophysiological effects of increasing levels of CPAP-applications compared to obstructive respiratory events. Methods In sedated and spontaneously breathing pigs, obstructive respiratory events were simulated by intermittent negative upper airway pressure (INAP) applied via a pressure device connected to the intubation tube. INAP was applied for 75 seconds with a 10 minute resting period in-between. After four INAP-applications, during which atrial electrophysiological responses to INAP were recorded, continuous positive airway pressure was applied in increasing pressure stages for a duration of 20 minutes for each pressure level (4, 8, 12 and 16 mbar). Atrial effective refractory periods (AERP) were recorded at the free wall of the right atrium (RA) and in the distal area of the coronary sinus (CS) before (Pre-INAP), during (INAP) and after (Post-) INAP and every 10 minutes throughout the stepwise increase of CPAP. Results AERP shortened due to INAP application in the RA (Pre-INAP 134±7ms vs. INAP 95±7ms; p=0.008, Fig.1.), but not in the CS (Pre-INAP 132±8ms vs. INAP 110±9ms; p=0.144, Fig.2). Stepwise increases of CPAP-application up until 12 mbar did neither result in changes of RA- nor CS-AERP. Only CPAP-application at 16 mbar (CPAP16) resulted in transiently shortened CS-AERP (CPAP-baseline 140±6ms versus CPAP16 115±10ms; p=0.0081, Fig.2.), but not RA-AERPs (p=0.31, Fig.1.). Conclusion While simulation of obstructive respiratory events by INAP were reproducibly associated with a predominantly right atrial shortening of refractoriness, high-pressure CPAP-application of 16 mbar was associated with an isolated moderate shortening of left atrial refractoriness. These findings may have important implications for CPAP treatment in patients with AF, which should be considered in the design of future clinical studies.

Changes of circulating biomarkers of inflammation and glycolipid metabolism by CPAP in OSA patients: a meta-analysis of time-dependent profiles.

Background:Continuous positive airway pressure (CPAP) is the first-line therapy for moderate-to-severe obstructive sleep apnea (OSA). Specifying timing of CPAP benefits on OSA-related biomarkers will help to assess the effectiveness of CPAP and to optimize the treatment strategies.Purpose:To explore the time-dependent changes of circulating biomarkers to CPAP treatment in patients with OSA, including inflammatory biomarkers [C-reactive protein (CRP) and tumor necrosis factor–α (TNF-α)] and glycolipid metabolic biomarkers [fasting blood glucose (FBG), fasting insulin (FINS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG)].Methods:Searches of PubMed and Embase database were completed. Two independent reviewers extracted data from 68 included studies. A meta-analysis was conducted using a random-effect (or fixed-effect) model and standardized mean difference (SMD) model. The timing profiles of circulating biomarkers changes of inflammation and glycolipid metabolism were analyzed based on different CPAP duration, that is, short-term (<3 months), mid-term (3–6 months), and long-term (⩾6 months).Results:Those first improved by short-term treatment include CRP [SMD: 0.73, 95% confidence interval (CI): 0.15–1.31; p = 0.014], TNF-α [SMD: 0.48 (95% CI: 0.10–0.86; p = 0.014)], FBG [SMD: 0.32 (95% CI: 0.07–0.57; p = 0.011)], and LDL [SMD: 0.40 (95% CI: 0.18–0.62; p = 0.000)]. Those first improved by the mid-term or long-term treatment include HDL [SMD: –0.20 (95% CI: –0.36 to –0.03; p = 0.018)] and TC [SMD: 0.20 (95% CI: 0.05–0.34; p = 0.007)]. There were insignificant changes for TG and FINS after short or long CPAP.Conclusion:Our results imply that changes of circulating biomarkers for patients with OSA under CPAP treatment have a time-dependent profile.

Telemedicine Strategy to Rescue CPAP Therapy in Sleep Apnea Patients with Low Treatment Adherence: A Pilot Study.

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study

BackgroundThere is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. MethodsMulti-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3•6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. ResultsValid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96•2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07•15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2•11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05•1.02; p=0.053). ConclusionsIn patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.

A visual analog scale for the assessment of mild sleepiness in patients with obstructive sleep apnea and healthy participants.

MOTIVATION:Studies have shown poor clinical effectiveness of the Epworth Sleepiness Scale (ESS) due to its ambiguity of items and cultural applicability. This study aimed to investigate the efficacy of a Visual Analog Scale (VAS) to assess sleepiness, compared to ESS.METHODS:Thirty-two obstructive sleep apnea (OSA) patients and 32 healthy participants completed two visits, 1 month apart, during which they completed both ESS and VAS. Patients diagnosed with OSA were treated with Continuous positive airway pressure (CPAP) between visits. The agreement between the ESS and VAS scores in both patients with OSA and healthy participants was investigated using Pearson correlation and Area Under the receiver operating characteristics.RESULTS:The (mean ± standard deviation) Oxygen Desaturation Index for patients with OSA was 18.5 ± 5.7 events/hour and 1.7 ± 1.0 events/hour in the healthy participants. A reduction in sleepiness, following CPAP treatment occurred in patients with OSA, using the ESS (11.2 ± 5.5–4.7 ± 5.0 points, P < 0.001) and the VAS (50.2 ± 3.0–21.9 ± 26.5 mm, P < 0.001). There was no significant change in sleepiness, in healthy participants using the ESS (3.91 ± 3.14–3.34 ± 3.27 points (P < 0.48) or the VAS (15.58 ± 21.21–12.05 ± 14.75 mm, (P < 0.44). A Likert scale showed that the VAS was easier to use compared to ESS in visit 1 (VAS: 8.7 ± 1.9 points, ESS: 7.7 ± 2.6 points, (P < 0.001), and visit 2 (VAS: 9.5 ± 1.4 points, ESS: 8.6 ± 1.5 points, P < 0.001).CONCLUSION:These preliminary results suggest that the VAS can detect a change in sleepiness after CPAP treatment in patients with OSA and that the VAS was also easier to use compared to ESS.

Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂ peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O₂ peak, 2 studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

Serum copeptin is a new biomarker of continuous-positive-airway-pressure treatment in severe obstructive sleep apnea

Abstract Introduction Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker which has been reported to be increased in cardiovascular and cerebrovascular diseases, thus playing a role in predicting their prognosis. Patients with obstructive sleep apnea syndrome (OSA) have been demonstrated to have a high risk for developing these vascular diseases. However, there have been no authentic reports concerning the effect of continuous positive airway pressure (CPAP) on serum copeptin levels in OSA patients. Purpose We hypothesis that CPAP treatment substantially modifies copeptin levels in OSA patients. Methods A total of 60 OSA patients confirmed by polysomnographic examinations was divided into two groups: a mild-moderate OSA (apnea-hypopnea index: AHI &amp;lt;30/h) group and a severe OSA (AHI ≥30/h) group. Blood samples were collected early in the morning after overnight fasting, and serum copeptin and ADH levels were measured with an enzyme immunoassay method. In patients initiated with CPAP, hormone levels were measured before and after CPAP treatment. Results Twenty-one patients (age: 54.7±12.4 y, male: 17, NT-proBNP: 45.3±44.2 pg/mL) were diagnosed as having mild-moderate OSA (AHI: 16.5±8.4/h), while 39 patients (age: 57.8±11.4y, male: 29, NT-proBNP: 73.7±87.3 pg/mL) were diagnosed as severe OSA (AHI: 49.5±21.1/h). As a whole, there were no significant differences in copeptin and ADH levels between mild-moderate OSA and severe OSA groups (copeptin: 2.1±1.4 pmol/L vs. 1.9±1.4, ADH: 2.3±2.6 pg/dL vs. 2.0±0.7). In 26 severe OSA patients (age: 55.9±12.9y, male: 23, NT-proBNP: 63.3±85.2 pg/mL), these hormones were again evaluated after CPAP initiation. AHI was significantly improved after CPAP treatment (45.5±20.8/h vs. 5.0±5.0, P&amp;lt;0.01). Although the ADH level was changed from 1.85±0.77 pg/dL to 1.68±0.99, the difference did not reach the statistical significance. The copeptin level was certainly decreased after CPAP by 26% (2.29±2.63 pmol/L vs. 1.69±1.68, P&amp;lt;0.01) (Figure 1). Conclusions Serum copeptin levels decreased after CPAP treatment in patients with severe OSA. Copeptin, but not ADH, can be considered as a new biomarker for predicting cardio/cerebrovascular events in severe OSA patients. Figure 1 Funding Acknowledgement Type of funding source: None

Meta-analysis of changes in the levels of catecholamines and blood pressure with continuous positive airway pressure therapy in obstructive sleep apnea.

Stress from obstructive sleep apnea (OSA) stimulates catecholamine release consequently exacerbating hypertension. However, different studies have shown a conflicting impact of continuous positive airway pressure (CPAP) treatment in patients with OSA on catecholamine levels and blood pressure. We aimed to examine changes to catecholamine levels and blood pressure in response to CPAP treatment. We conducted a meta‐analysis of data published up to May 2020. The quality of the studies was evaluated using standard tools for assessing the risk of bias. Meta‐analysis was conducted using RevMan (v5.3) and expressed in standardized mean difference (SMD) for catecholamines and mean difference (MD) for systolic (SBP) and diastolic blood pressure (DBP). A total of 38 studies met our search criteria; they consisted of 14 randomized control trials (RCT) totaling 576 participants and 24 prospective cohort studies (PCS) of 547 participants. Mean age ranged between 41 and 62 year and body mass index between 27.2 and 35.1 kg/m2. CPAP treatment reduced 24‐hour urinary noradrenaline levels both in RCT (SMD = −1.1; 95% confidence interval (CI): −1.63 to − 0.56) and in PCS (SMD = 0.38 (CI: 0.24 to 0.53). SBP was also reduced by CPAP treatment in RCT (4.8 mmHg; CI: 2.0‐7.7) and in PCS (7.5 mmHg; CI: 3.3‐11.7). DBP was similarly reduced (3.0 mmHg; CI: 1.4‐4.6) and in PCS (5.1 mmHg; CI: 2.3‐8.0). In conclusion, CPAP treatment in patients with OSA reduces catecholamine levels and blood pressure. This suggests that sympathetic activity plays an intermediary role in hypertension associated with OSA‐related stress.

Efficacy of continuous positive airway pressure on subcutaneous adipose tissue in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials.

It remains inconclusive whether continuous positive airway pressure (CPAP) therapy can significantly reduce subcutaneous adipose tissue (SAT) in patients with obstructive sleep apnea (OSA). This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the impact of CPAP treatment on SAT in patients with OSA. We searched Pubmed, Cochrane, Web of Science, and Embase for RCTs, which investigated the effectiveness of CPAP treatment in reducing SAT among patients with OSA. Following the PRISMA guidelines, we extracted information on the study and patient characteristics, and pre- and post-CPAP measures of SAT. We then calculated the overall effects using the standardized mean difference (SMD) with a 95% confidence interval (CI). A total of 5 RCTs (comprising 153 patients) met inclusion criteria for the meta-analysis. We found that the SAT did not change before and after CPAP treatment in patients with OSA (SMD = - 0.02, 95% CI - 0.25 to 0.2, z = 0.19, p = 0.85). Subgroup analyses indicated that the outcome was not affected by age, CPAP therapy duration, baseline body mass index, and measure utilized. This meta-analysis of RCTs suggests that CPAP therapy does not significantly decrease the level of SAT among patients with OSA. Further large-scale, and high-quality randomized controlled trials are needed to better address this issue.

Effects on obstructive sleep apnea severity following a tailored behavioral sleep medicine intervention aimed at increased physical activity and sound eating: an 18-month follow-up of a randomized controlled trial.

Positive effects have been reported following a behavioral sleep medicine (BSM) intervention targeting physical activity and eating behavior in addition to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). Long-term follow-up remains to be explored. The aim was to examine the long-term effects of a tailored BSM intervention addressing physical activity and eating behavior in addition to CPAP treatment in patients with moderate to severe OSA combined with overweight and physical inactivity. Further, the aim was to identify variables at baseline, associated with treatment success regarding OSA severity. Sixty participants (body mass index: 34.5 ± 5.0 kg/m²; apnea-hypopnea index [AHI]: 43.7 ± 21.2 events/h) completed the randomized controlled trial with a follow-up at 18 months. The participants were randomized to either a control group treated with CPAP or an experimental group treated with CPAP and a BSM intervention targeting physical activity and eating behavior changes. OSA was categorized as mild (AHI: 5 to <14.9 events/h), moderate (AHI: 15 to <29.9 events/h), or severe (AHI ≥30 events/h). Being in the experimental group was associated with a larger improvement (B = -9.353, P = .029) in AHI at the 18-month follow-up compared with being in the control group when adjusting for baseline AHI and body mass index. Improvement in OSA category occurred more frequently in the experimental group participants (n = 11; 36.7%) compared with the control group (n = 2; 6.7%). Deterioration in OSA category was found in 1 (3.3%) participant in the experimental group and 3 (10%) in the control group. The importance of a BSM intervention as an adjunct treatment in patients with OSA is emphasized due to its long-term benefits. Registry: ClinicalTrials.gov; Name: Lifestyle changes in obstructive sleep apnea; Identifier: NCT01102920.

Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study

BackgroundThere is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. MethodsMulti-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3–6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. ResultsValid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96–2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07–15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2–11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05–1.02; p=0.053). ConclusionsIn patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.

0958 Effects of CPAP On EEG Delta Frequency In Patients with RBD: A Descriptive Case Series

Obstructive sleep apnea (OSA) and idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) have been associated with increased risk for mild cognitive impairment (MCI) and dementia. We are interested in identifying the electroencephalographic (EEG) changes in patients with iRBD and OSA when they are treated with continuous positive airway pressure (CPAP). We hypothesized that there would be less delta activity in REM sleep with CPAP treatment. Our future goal is to identify the benefits of CPAP treatment in patients with iRBD and OSA and how this may help in the delay of onset or decrease progression of neurodegeneration. 3 patients diagnosed with iRBD and OSA based on the clinical history and nocturnal polysomnography findings, underwent CPAP titration. Six well-defined (without any artifact, arousals and respiratory events) REM sleep epochs (10 seconds each) were identified for each patient during the diagnostic and titration studies. The delta frequency band (0.4-3.6 Hz) in these portions was analyzed with spectral analysis. The discrete fast Fourier transform was used to calculate the EEG power spectrum. Spectral analysis showed a decrease in the mean delta power in two patients. In patient 1, mean Delta frequency decreased from 82.33 (95% CI: 76.69-87.97, SD: 9.9) to 72.66 (95% CI: 66.13-79.2; SD: 11.54). In patient 2, mean Delta frequency decreased from 72.41 (95% CI: 66.12-78.70, SD: 11.11) to 43.66 (95% CI: 36.87-50.45; SD: 11.99). Patient 3 has less delta activity at baseline {26.91 (95% CI: 20.6-33.23, SD 11.16)} and did not decrease with CPAP {41.25 (95% CI 30.83-51.66, SD 18.4)}. Our findings suggest that there are significant EEG changes in patients with IRBD and OSA with the treatment of CPAP. The overall increase in delta wave frequency in REM sleep stage might be indicative of encephalopathy with possible cognitive consequences in these patients. Subsequent decrease in delta frequency might be due to the beneficial effect of CPAP. Further studies with larger samples are required to validate the preliminary results presented here. None

Efficacy of continuous positive airway pressure (CPAP) preventing type 2 diabetes mellitus in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and insulin resistance: a systematic review and meta-analysis

BackgroundObstructive sleep apnea/hypopnea syndrome (OSAHS) is a very common, yet undiagnosed, breathing disorder that has many more implications besides disrupted sleep. Its role as an independent risk factor for metabolic abnormalities such as insulin resistance (IR) and impaired glucose tolerance is becoming increasingly recognized. The main treatment for OSAHS is continuous positive airway pressure (CPAP), however the impact of CPAP on IR and glucose metabolism is still debated. ObjectivesCompile all available evidence regarding the effect of CPAP on IR in non-diabetic OSA patients. MethodsA literature search in Medline, Epistemonikos and the Cochrane Controlled Trial Register were searched through March 2018. We included Randomized Controlled Trials (RCTs) comparing CPAP treatment with sham CPAP, placebo or no treatment in non-diabetic adults with OSAHS. Risk of Bias was evaluated using Cochrane tool and a meta-analysis evaluating the efficacy of CPAP in both HOMA index and fasting glucose was done. Certain of evidence was rated using GRADE approach. ResultsNine studies consisting of 443 participants were included. CPAP treatment significantly improved HOMA index (Mean difference = −0.39 Ui (CI, −0.69 to −0.08), p < 0.05. I2 = 57% (GRADE = LOW). However, CPAP showed no significant changes in fasting glucose (GRADE = LOW). ConclusionThis systematic review and meta-analysis shows evidence that metabolic disturbances could be halted and regressed with CPAP treatment in patients with insulin resistance and OSAHS. In conclusion, treatment with CPAP could improve HOMA IR index.

Cardiac effects of CPAP treatment in patients with obstructive sleep apnea and atrial fibrillation.

Obstructive sleep apnea (OSA) has been recognized as an independent risk factor for the development and progression of atrial fibrillation (AF). We aimed to investigate the changes in heart rate and atrial and ventricular ectopy after continuous positive airway pressure (CPAP) treatment in patients with OSA and AF. Consecutive patients with AF underwent ambulatory sleep monitoring, and OSA was defined as an Apnea-Hypopnea-Index (AHI) ≥ 5/h. Treated patients completed in-laboratory CPAP titration study. A 24-h ECG Holter was performed at baseline and at 3 and 6months after CPAP treatment. One hundred patients (70% males) with AF were included in the final analysis. OSA was diagnosed in 85% of patients. There were no significant changes in mean 24-h heart rate in patients with paroxysmal or permanent AF at 3 and 6months of treatment compared to baseline. In patients with paroxysmal AF (n = 29), atrial and ventricular ectopy counts/24h significantly decreased at 3months compared to baseline (median (IQR) 351 (2049) to 57 (182), P = 0.002; 68 (105) to 16 (133), P = 0.01 respectively). At 6months follow-up, the atrial ectopy count/24h significantly decreased in patients with paroxysmal AF compared to baseline (median (IQR) 351 (2049) to 31 (113), P = 0.016, n = 14). In patients with permanent AF (n = 15), there was a significant reduction in ventricular ectopy count/24h at 3months compared to baseline (median (IQR) 100 (1116) to 33 (418), P = 0.02). There is a significant decrease in atrial and ventricular ectopy count/24h in patients with AF and OSA at 3 and 6months of CPAP treatment compared to baseline.

Factors influencing adherence to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure – a national registry-based cohort study

ObjectivesAdherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) is crucial. Our aim was to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy. MethodsThis was a registry-based cohort study from 37 centers across Sweden with OSA patients on CPAP in the Swedevox Swedish national registry between July 2010 and March 2017. ResultsIn 16,425 patients (70.8% men) with complete follow-up data after 1.2 ± 0.8 years the adjusted relative risk ratio (aRRR) for the discontinuation of CPAP was 0.57 (95% confidence interval (CI) 0.50–0.65) for use of humidifier, 0.87 (95% CI 0.82–0.92) for increasing age per 10 years, 0.80 (95% CI 0.77–0.83) for increasing apnea hypopnea index (AHI) per 5 units/hour, and 0.96 (95% CI 0.95–0.97) per increased unit on the Epworth Sleepiness Scale (ESS). Increasing BMI was associated with increased adherence up to BMI 35. Women and patients with hypertension ran an increased risk of discontinuing CPAP treatment, aRRR 1.28 (95% CI 1.12–1.46) and 1.24 (95% CI 1.12–1.42) respectively. The adjusted hazard ratio (HR) for mortality was 1.74 (95% CI 1.32–2.28) among those who did not adhere to CPAP (median follow-up period 2.4 years after the one year adherence evaluation). ConclusionUse of humidifier is associated with greater adherence to CPAP treatment. Other factors predicting adherence are increasing age, more severe OSA and overweight up to BMI 35, whereas female gender and coexisting hypertension are risk factors for discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.