Effect Of CPAP Treatment Research Articles

Effects of CPAP treatment on nocturnal desaturations in patients with Obstructive Sleep Apnea syndrome

Effects of CPAP treatment on nocturnal desaturations in patients with Obstructive Sleep Apnea syndrome

O053 Cardio-metabolic Health Effects of CPAP Treatment for Sleep Apnoea during Weight Loss: A Randomised Controlled Pilot Trial.

Abstract Introduction This study assessed whether the addition of CPAP during weight loss would enhance cardiometabolic health improvements in patients with obesity and OSA. Methods Patients with overweight or obesity, pre-diabetes and moderate-severe OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by OGTT. Trial registration: ANZCTRN 12617000823370. Results 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Mean CPAP compliance was 5.29 hrs/night. Participants lost ~12 kg which reduced OSA severity by ~45%. The primary analysis showed no between group differences for any of the assessed outcomes. Despite this, most outcomes improved with weight loss including insulin sensitivity (.000965 units, p=.008), wake diastolic BP (-4.3mmHg, p=.03), sleep systolic BP (-16.2 mmHg, p=.0003), sleep diastolic BP (-9.8 mmHg, p=0.02), and sleepiness (Epworth Sleepiness Score -3.2, p=.0003). Two-hour glucose levels did not improve (p=0.33), but the glucose area under the curve (AUC) was reduced (-230 units, p=.009). In addition, total (-0.86mmol/L, p=0.006) and LDL cholesterol (-0.58mmol/L, p=0.007), triglycerides (-0.75mmol/L, p=0.004), fat mass (-7.6kg, p<.0001) and abdominal fat (-310cm3, p<.0001) were all reduced. Conclusions We did not establish any cardio-metabolic benefit from CPAP therapy during weight loss. In contrast, weight loss had a robust positive effect on cardio-metabolic health. The magnitude of weight loss improvements far exceeded those from trials assessing the impact of CPAP alone, suggesting that weight loss should be the primary focus of treatment for patients with OSA and obesity.

What is the Effect of CPAP Treatment With Humidifier on Vocal Quality?

Evaluate vocal quality in patients with OSA before and after continuous use of CPAP with a humidifier using subjective patient perception and clinical assessment. The hypothesis was that CPAP treatment with a humidifier would benefit voice quality. Randomized, sham-controlled, blinded clinical trial. Forty-three natal males with obstructive sleep apnea for whom CPAP treatment was recommended following polysomnography were randomized into two therapy groups: CPAP and Sham-CPAP. Participants completed questionnaires on voice use, a voice self-assessment with the ten-item vocal handicap index (VHI-10), and complementary questionnaires: the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), reflux symptoms index (LPRSI) and oral dryness visual analog scale (DRY). Their voices were recorded at three different times: before CPAP therapy, and after 3 and 6 months of continuous CPAP use. The acoustic voice quality index (AVQI), and an auditory-perceptual judgment (APJ) were also applied before and after the CPAP and Sham treatments. After 6 months of treatment, the CPAP group presented improvements in their sleep patterns; however, no statistically significant differences were observed between the groups in respect of the results of the voice-related questionnaires, the AVQI values, and the APJ of the voice quality. All of the participants had some degree of vocal deviation at baseline. CPAP therapy with a humidifier did not improve vocal quality as evaluated by the clinician or patient self-assessment. However, it did not have any significant negative effects on voice quality, so can be considered safe to use in male OSA patients.

Evaluation of the effect of CPAP treatment on voice in obstructive sleep apnea with objective and subjective voice analyzes.

Obstructive sleep apnea (OSA) is a multifactorial disease that is the most common among sleep-related respiratory disorders. In our study, we aimed to compare the objective and subjective voice analysis results of the patients with CPAP treatment indication after polysomnography performed in the sleep disorders center before the start of CPAP treatment, the 1st month, and the 3rd month after the treatment. Patients were asked to say the vowels /ɑ:/ for 5 seconds, respectively for voice recording. MPT and S/Z ratios were also recorded. Using the Praat voice analysis program Jitter%, Shimmer%, HNR, f0 values were obtained. VHI-10 questionnaire was applied. The voice analysis results of the patients before and after the treatment were compared. 26 patients were included in the study. Since 8 of these patients did not come to the 3rd month evaluation, the study was completed with the data of 18 patients. In our study, at the end of the 3rd month, no difference was found in terms of the fundamental frequency, Shimmer%, HNR, and S/Z values. There was a statistically significant decrease in Jitter% at the 1st month after treatment and 3rd month after treatment compared to pre-treatment (p=0.05, p=0.018). There was a statistically significant decrease in MPT at the 1st month after treatment and 3rd month after treatment compared to pre-treatment (p<0.001, p<0.001). There was a statistically significant decrease in VHI-10 at the 1st month and 3rd month after treatment compared to pre-treatment. Furthermore, there was statistically significant difference between 3rd month after treatment compared to 1st month after treatment. (p=0.043, p=0.030, p=0.029). Our study showed that CPAP treatment had both objective and subjective positive effects on voice recovery in the OSA patient group.

Sudomotor dysfunction in moderate to severe obstructive sleep apnea syndrome and the effects of CPAP treatment

Sudomotor dysfunction in moderate to severe obstructive sleep apnea syndrome and the effects of CPAP treatment

Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment

BackgroundThere is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. We aimed to assess the...

Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after catheter ablation in patients with obstructive sleep apnea: A randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority OnBehalf OUH Background Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Studies have reported an association between OSA and increased AF burden, as well as increased recurrence of AF after catheter ablation. However, whether treatment with positive airway pressure (CPAP) can reduce the risk of AF recurrence after pulmonary vein isolation has still not been established. Purpose This is the first randomized study evaluating the effect of CPAP treatment on AF recurrence after pulmonary vein isolation in patients with AF and OSA. Methods Consecutive patients with AF referred for catheter ablation were included after being screened positive for OSA (apnea-hypopnea index [AHI] ≥ 15 events/h). All patients received an implantable loop recorder 6 months prior to ablation to quantify the arrhythmia burden. Patients were randomized to CPAP treatment or no treatment of OSA during five months before and 12 months after ablation. The primary end point was AF recurrence, defined as one episode of AF lasting longer than 30 seconds after catheter ablation, with an initial 90-day blanking period. We also compared AF burden measured in percent of time in AF and assessed five months before and 3-12 months after catheter ablation. Results We included 83 patients (65% male, age 61 ± 7.3 years), of which 37 patients were treated with CPAP and 46 controls. The mean baseline AHI in patients with CPAP was 26.7 ± 14.7 and in patients with usual care 26.3 ± 12.3. AF-burden prior to catheter ablation expressed as median [IQR] percent of time was 2.7 [0.9-9.1] in the CPAP-group compared to 1.8 [0.2-6.4] in the control group (p = 0.24). There was no signal to a difference in AF recurrence rate between patients with or without CPAP treatment. As shown in figure, we found overlapping curves with a final 21 patients [57%] vs. 26 patients (57%) presenting at least 30 seconds of AF. After catheter ablation and blanking period, patients with CPAP treatment had an AF burden of 0.0 [0.0-0.3] % compared to 0.0 [0.0-0.3] % in patients without CPAP (p = 0.64). Conclusion In this randomized study concomitant treatment with CPAP on top of pulmonary vein isolation had no added effect on the risk of AF recurrence in patients with OSA. Although several patients revealed at least 30 seconds of AF 3-12 months after ablation, there was a great reduction in percent AF burden after catheter ablation independent of CPAP treatment. Abstract Figure

Obstructive sleep apnea and atrial fibrillation: we need to go step by step.

Citation:Sanchez-de-la-Torre M, Lee C-H, Barbe F. Obstructive sleep apnea and atrial fibrillation: we need to go step by step. J Clin Sleep Med. 2021;17(5):869–870.

The Effect of CPAP Treatment on Uric Acid Levels in Obstructive Sleep Apnea Syndrome

The Effect of CPAP Treatment on Uric Acid Levels in Obstructive Sleep Apnea Syndrome

CPAP treatment in REM-related obstructive sleep apnea: a distinct clinical phenotype of sleep disordered breathing.

REM-related obstructive sleep apnea (REM-OSA), as defined using revised apnea-hypopnea index (AHI) criteria, might represent a specific OSA phenotype. However, there is a lack of data on outcomes of treatment in this population. This study evaluated the effects of CPAP treatment over 12months on clinical outcomes for patients with the polysomnography phenotype of REM-OSA. We conducted a prospective observational study with the following inclusion criteria: subjective sleepiness and diagnostic polysomnography demonstrating AHIREM≥15 events/h, AHINREM<5 events/h, and ≥30min of REM sleep. Clinical outcomes assessed included Epworth Sleepiness Scale (ESS), psychomotor vigilanc test reaction time (PVT-RT), and CPAP adherence at baseline, 1, 3, 6, and 12 months; Functional Outcomes of Sleep Questionnaire (FOSQ) and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3 and 12 months. The reason is the first 3 outcomes (ESS, PVT, adherence) were assessed at baseline, 1, 3, 6, and 12 months, while the next 2 outcomes (FOSQ, DASS) were assessed at baseline, 1, 3, and 12 months. The edited version is not as clear in separating these outcomes into 2 groups; Functional Outcomes of Sleep Questionnaire (FOSQ); and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3, and 12months. Linear mixed effects models were used to investigate the joint effects of time and average CPAP adherence on our outcomes of interest. Twenty participants completed a minimum of 1 month of CPAP treatment and were included for analysis. During the trial, 8 participants discontinued CPAP (4 before 3months, 1 before 6months, 3 before 12months), and 19 participants completed 12months of treatment. Baseline ESS was elevated at 12.6 units. Average CPAP usage for all 27 participants over 12months was 2.9 ±2.4h. There was a significant decrease in ESS and increase in FOSQ at all time points, and the decrease in ESS was only seen in the CPAP-adherent subgroup. Decreases in DASS-21 and PVT-RT were not sustained. CPAP treatment in sleepy patients with moderate to severe REM-OSA is associated with reduced sleepiness and improved quality of life. The trial was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12620000576921, 18/05/2020 (retrospectively registered).

Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome.

Microalbuminuria is an early marker of kidney damage and an early predictor and risk factor for cardiovascular diseases. We aimed to evaluate the association between albuminuria levels in different severity obstructive sleep apnea syndrome (OSAS) cases and to find out the efficacy of CPAP treatment on microalbuminuria. We conducted a prospective study on subjects who underwent polysomnography. The polysomnographic data were recorded to establish the presence and severity of OSAS. The blood and urine samples were taken both at the time of diagnosis and 3months after CPAP therapy. The relationship between the severity of OSAS and microalbuminuria and the effect of CPAP treatment on microalbuminuria were evaluated. The study population consisted of 449 subjects. Better compliance to CPAP was associated with significantly reduced levels of microlbuminuria. Urinary albumin/creatinine was increased in severe cases, but the difference was not statistically significant. In the non-compliant group, microalbumin/creatinine ratio was 25.24 prior to initiation of CPAP treatment and 28.36 at the third month control visit (p = 0.25). In the compliant group, microalbumin/creatinine ratio was 49.71 prior to initiation of CPAP treatment and 22.30 at the third month control visit (p = 0.04). Our study demonstrated that good compliance to CPAP therapy is associated with a decrease in microalbuminuria. Patients who used CPAP regularly had a significant decline in albumin/creatinine ratio after 3months of CPAP therapy.

1246 Resolution of Cyclical Ventricular Ectopy with ASV Therapy in a Patient with Cheyne-Stokes Respirations

Abstract Introduction Nocturnal cardiac arrhythmias, ranging from ventricular ectopy to heart blocks, have been commonly reported in patients with obstructive sleep apnea syndrome (OSAS). Potential mechanisms for these rhythm disturbances include OSA-associated hypoxemia, arousal trigger increased sympathetic activity and alterations in intrathoracic pressures leading to cardiac mechanical structural changes. A beneficial effect of CPAP treatment on rhythm abnormalities in patients with obstructive sleep apnea has also been demonstrated. However, the relationship of cardiac arrhythmias and central sleep apnea is not well established. Report of Case We report an 82-year-old male with CAD and Atrial fibrillation s/p PPM who presented for management of his sleep disordered breathing (SDB). Upon review, his original sleep studies performed at an outside facility revealed obstructive sleep apnea and central sleep apnea with Cheyne-Stokes Respirations. The patient presented to us on treatment with an auto-adjusting PAP (APAP) of 7-15 cmH2O with an average delivered pressure of 12 cmH2O. A re-titration study was recommended and demonstrated persistent central sleep apnea with Cheyne-Stokes breathing despite treatment with CPAP 12-18 cmH2O. During this time, EKG monitoring revealed an atrial paced rhythm with frequent premature ventricular beats (PVBs) which occurred in a cyclical pattern. After initiation of Adaptive Servo-Ventilation (ASV), periodic breathing was well controlled and cyclical ventricular ectopy had completely resolved. Conclusion Although CPAP therapy has been shown to improve nocturnal arrhythmias in patients with obstructive sleep apnea, the same relationship, to our knowledge, has not been reported in patients with central sleep apnea and Cheyne-Stokes breathing. This case demonstrates the improvement of cyclical ventricular ectopy with ASV therapy.

Effect of CPAP Treatment in Cognition in Adults With DS and OSA

Effect of CPAP Treatment in Cognition in Adults With DS and OSA

P4404Prognostic value of novel nocturnal oxygen saturation metrics in patients with obstructive sleep apnoea and high cardiovascular event risk

Abstract Aim To determine prognostic value of novel oximetry-derived metrics in patients with obstructive sleep apnoea (OSA) and high cardiovascular (CV) event risk. Methods and results Ancillary study of the Sleep Apnoea CV Endpoints (SAVE) randomised controlled trial, which investigated the effects of CPAP treatment on secondary CV event outcomes in 2687 participants with moderate-severe OSA and established CV disease. Associations between baseline characteristics, standard sleep and pulse oximetry-derived metrics, and CV outcomes were determined in Cox proportional hazards regression models stratified for treatment allocation. Metrics evaluated included: oxygen desaturation index, time below 90% oxygen saturation (SpO2), average SpO2across recordings (mean SpO2), across episodic desaturation events (desaturation SpO2), and baseline interpolated through episodic desaturation events (baseline SpO2); duration and desaturation/resaturation time ratio of episodic desaturation events; and mean and standard deviation of pulse rate. No SpO2 metric was associated with the composite outcome. Mean and baseline SpO2 were negatively associated with heart failure (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95; P=0.009 and 0.78, 0.67–0.90; P=0.001, respectively) and myocardial infarction risk (0.86, 0.77–0.95; P=0.003 and 0.81, 0.73–0.90; P&lt;0.001, respectively) and marginally positively associated with stroke risk (1.09, 1.00–1.20; P=0.065 and 1.13, 1.02–1.26; P=0.020, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted heart failure (area under the receiver-operating-characteristic curve 0.86, 95% CI 0.79–0.93). Conclusions Higher mean and baseline SpO2 were associated with reduced risk of heart failure and myocardial infarction, and small increases in stroke rate. Desaturation shape may have predictive utility for future CV events. Clinical trial registration: clinicaltrials (NCT00738179).

OSA and CPAP therapy: effect of gender, somnolence, and treatment adherence on health-related quality of life.

Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender. This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence. Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3 ± 9.6years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12). Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥ 4h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS > 10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p < 0.0001; r2 = 0.26). This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.

Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

The aim of this study was to compare olfactory functions pre- and post-CPAP treatment in patients with moderate to severe OSA, and to evaluate the factors that cause changes in olfactory functions. Twenty-two patients who had completed regular usage of CPAP treatment for 2months were included in this prospective study. Olfactory tests using Sniffin' Sticks were performed pre- and post-treatment. The mean age of the subjects was 47.6 ± 9.5years. We did not find a significant change in olfactory functions after 2months of CPAP treatment in our study group. When the patients were divided into two groups-those whose olfactory functions showed improvement and those whose functions did not-it was found that the mean age of the patients whose olfactory functions did not improve was significantly higher statistically. A significant adverse correlation was found between age and post-treatment olfactory functions, specifically in odour threshold and odour identification scores. Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

Incident Type 2 Diabetes in OSA and Effect of CPAP Treatment: A Retrospective Clinic Cohort Study

The relationship between OSA and glucose metabolism remains controversial. This retrospective study investigated the relationship between OSA and incident type 2 diabetes (T2D) in a clinic cohort of Chinese adults in Hong Kong, and the effect of long-term CPAP treatment. Data for diagnosis of incident T2D and CPAP usage were obtained from the territory-wide electronic health administration system and records of protocolized evaluation of CPAP adherence at the sleep clinic. The relationship between baseline OSA and incident T2D and the effect of CPAP therapy were examined by Cox regression models. Risk of incident T2D over the continuum of apnea-hypopnea index was examined with cubic spline analysis. Of 1,206 subjects with overnight sleep studies and clinical assessment in 2006 through 2013, 152 developed diabetes (median follow-up, 7.3 years). In fully adjusted models, untreated moderate or patients with severe OSA had higher risk of developing diabetes, hazard ratios 2.01 (95%CI, 1.06-3.81) and 2.62 (95%CI, 1.40-4.93) respectively, with a trend to plateau in those with severe OSA. No interaction was demonstrated between OSA and obesity. Regular CPAP use, which was attained in about one-third of subjects with moderate-severe OSA, was associated with reduction of diabetes incidence from 3.41 to 1.61 per 100 person-years, and of adjusted hazard risk to that of non-OSA. OSA severity independently predicted incident diabetes. Regular long-term CPAP use was associated with reduced risk of incident T2D, after adjustment for various baseline metabolic risk factors and subsequent body weight change.

Patients With OSA Are Perceived as Younger Following Treatment With CPAP

The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA. Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1month. The sequence was interposed by 15days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients' conditions. Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7h per night on 94%of the nights and the placebo intervention on 98%of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) (P< .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation< 90%were predictors of a decreased age rating following CPAP treatment. Patients with severe OSA had a younger appearance following 1month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management. ClinicalTrials.gov; No.: NCT02117271; URL: www.clinicaltrials.gov.

The Effect of CPAP Treatment on Cognitive Functions, Anxiety, and Affective Symptoms

The Effect of CPAP Treatment on Cognitive Functions, Anxiety, and Affective Symptoms

Beneficial Effects of CPAP Treatment in High-risk Subgroups of OSA Patients: Some Evidence, at Last

Beneficial Effects of CPAP Treatment in High-risk Subgroups of OSA Patients: Some Evidence, at Last