Weeks Of Therapeutic Continuous Positive Airway Pressure Research Articles

Continuous Positive Airway Pressure Treatment in Patients with Alzheimer's Disease: A Systematic Review.

Background: Epidemiological studies have suggested a pathophysiological relationship between obstructive sleep apnea syndrome (OSAS) and Alzheimer’s disease (AD). The aim of this study is to evaluate the treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) in AD and its relationship with neurocognitive function improvement. Methods: Systematic review conducted following PRISMA’s statements. Relevant studies were searched in MEDLINE, PEDro, SCOPUS, PsycINFO, Web of Science, CINAHL and SportDicus. Original studies in which CPAP treatment was developel in AD patients have been included. Results: 5 studies, 3 RCTs (Randomized controlled trials) and 2 pilot studies. In all RCTs the CPAP intervention was six weeks; 3 weeks of therapeutic CPAP vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. The two pilot studies conducted a follow-up in which the impact on cognitive impairment was measured. Conclusions: CPAP treatment in AD patients decreases excessive daytime sleepiness and improves sleep quality. There are indications that cognitive deterioration function measured with the Mini Mental Scale decreases or evolves to a lesser extent in Alzheimer’s patients treated with CPAP. Caregivers observe stabilization in disease progression with integration of CPAP. More research is needed on the topic presented.

Obstructive Sleep Apnea and Cognition in Parkinson's disease

ObjectiveObstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD − OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. MethodsEighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. ResultsPatients with PD + OSA scored significantly lower than PD − OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p < 0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. ConclusionsFindings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.

Effects of continuous positive airway pressure on endothelial function and circulating progenitor cells in obstructive sleep apnoea: A randomised sham-controlled study

Obstructive sleep apnoea (OSA) is characterised by reoccurring apnoeas and hypopneas, causing repetitive hypoxia and reoxygenation, and is associated with endothelial dysfunction and reduced levels of circulating progenitor cells (CPCs). The potential to improve endothelial function and CPC levels in people with OSA by preventing hypoxic episodes with Continuous Positive Airway Pressure (CPAP) was investigated in a sham-controlled CPAP study. Men with moderate-to-severe OSA (mean ± SD: age=49 ± 12 y, apnoea hypopnea index (AHI)=37.6 ± 16.4 events/h, body mass index=31.5 ± 5.7 kg/m(2)) who were CPAP naïve without diabetes mellitus were randomised in a 12-week double-blind sham-controlled parallel group study to receive either active (n=25) or sham (n=21) CPAP. CPCs, isolated from blood, were measured by flow cytometry and by co-staining cultured cells (7 days) with acetylated low-density lipoprotein (acLDL) and lectin. Endothelial function was assessed by peripheral arterial tonometry (PAT). Compared to sham, CPAP significantly decreased AHI (mean between-group difference -36.0 events/h; 95%CI, -49.7 to -22.3, p<0.0001) after 12 weeks. Despite this improvement in AHI, CPAP had no effect on change in CPC levels (including CD34(+)/KDR(+) (565 cells/mL; -977 to 2106, p=0.45), CD34(+)/KDR(+)/CD45(-) (37.0 cells/mL; -17.7 to 85.7, p=0.13), acLDL(+)/lectin(+) (-43.1 cells/field, -247 to 161, p=0.67)) or change in endothelial function (0.27; -0.14 to 0.67, p=0.19) compared to sham therapy. Despite the improvement in OSA parameters and ablation of apnoeic events by CPAP, CPC counts and endothelial function in men with moderate-to-severe OSA were not significantly improved after 12 weeks of therapeutic CPAP when compared to sham control.

Effects of 8 weeks of continuous positive airway pressure on abdominal adiposity in obstructive sleep apnoea

The aim of the present study was to investigate the effect of continuous positive airway pressure (CPAP) treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea. Patients received both therapeutic and sham CPAP in a random order for 2 months each with an intervening 1-month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms. 38 eligible patients were randomly assigned to a treatment order, with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28.6 cm(3); p=0.49) or visceral (-16.8 cm(3); p=0.59) adipose tissue, intrahepatic lipid (-0.2%; p=0.21), or fasting glucose measurements (-0.1 mmol·L(-1); p=0.46) between treatment modalities. Alkaline phosphatase decreased (-3.1 U·L(-1); p=0.02) while on therapeutic CPAP compared with sham CPAP but other liver enzymes, including aspartate aminotransferase (0.3 U·L(-1); p=0.82), alanine aminotransferase (1.34 U·L(-1); p=0.59) and γ-glutamyltransferase (-2.3 U·L(-1); p=0.33), remained unchanged. In this first randomised, sham-controlled trial, there was no change in adipose tissue distribution after 8 weeks of therapeutic CPAP compared with 8 weeks of sham CPAP. Longer duration of CPAP use may be necessary to demonstrate a difference.

Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.

Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA); however, the impact of continuous positive airway pressure (CPAP) on fatigue remains unclear. Fifty-nine men and women with OSA were randomly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period. Four outcome measures were assessed: (1) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory--Short Form (MFSI-sf), the (2) fatigue and (3) vigor subscales of the Profile of Mood States--Short Form (POMS), and (4) the Epworth Sleepiness Scale (ESS). Data were analyzed using repeated-measures analysis of variance. Compared with patients receiving placebo CPAP, those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index, as well as decreases in both measures of fatigue and increases in vigor (P values < 0.05). The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset. Significant treatment effects in sleepiness scores were not observed in the entire sample (P > 0.05); however, in a subset of patients with excessive sleepiness at the onset of treatment, ESS scores were significantly reduced with use of therapeutic CPAP (P < 0.05). Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA. Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment.

Waking up to sleep-disordered breathing

In 1997 Wright and colleagues1 published a systematic review on the health effects of obstructive sleep apnoea syndrome (OSA) and the effectiveness of treatment with continuous positive airway pressure (CPAP). They concluded that there was limited evidence of increased mortality or morbidity in patients with OSA, and that the evidence linking the condition to cardiovascular risk factors and motor vehicle crashes was conflicting and inconclusive. They also concluded that, although CPAP had been shown to improve daytime sleepiness, there were insufficient data to determine its effect on quality of life, morbidity or mortality. This review generated much controversy, but was a wake-up call to investigators in this field that all were not convinced that OSA was an important condition that always warranted treatment.2 At that time, our understanding of OSA and the impact of CPAP treatment was at a similar stage to where we were with cardiovascular risk factors such as systemic hypertension, diabetes and hypercholesterolaemia several decades ago. Considerable progress has been made since this review, and many of the issues which it raised have subsequently been addressed in papers published in Thorax . Systemic hypertension has been reported in epidemiological and hospital-based studies of patients with OSA, and is independent of obesity and the other common risk factors for hypertension which are also frequently present in this patient population. There have been conflicting data as to whether nasal CPAP can effectively reduce blood pressure in patients with OSA. Hui and associates3 performed a randomised controlled study in 56 patients with moderate to severe OSA and daytime sleepiness which showed that 12 weeks of therapeutic CPAP reduced 24 h mean and diastolic blood pressure by 3.8 mmHg and 3.5 mmHg, respectively. No …

Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea

Objective Patients with Alzheimer’s disease (AD) and obstructive sleep apnea (OSA) experience disrupted sleep. This study examined the effect of continuous positive airway pressure (CPAP) on sleep parameters in AD patients with OSA. Methods A randomized placebo-controlled trial of 3 weeks of therapeutic CPAP (tCPAP) vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. Polysomnography data from screening after one night and after 3 weeks of treatment were analyzed. Records were scored for percent of each sleep stage, total sleep time (TST), sleep efficiency (SE), sleep period (SP), time in bed (TIB), sleep onset (SO), wake time after sleep onset (WASO), and arousals. A randomized design comparing one night of pCPAP to tCPAP and a paired analysis combining 3 weeks of tCPAP were performed. Results Fifty-two participants (mean age = 77.8 years, SD = 7.3) with AD and OSA were included. After one treatment night, the tCPAP group had significantly less % Stage 1 ( p = 0.04) and more % Stage 2 sleep ( p = 0.02) when compared to the pCPAP group. In the paired analysis, 3 weeks of tCPAP resulted in significant decreases in WASO ( p = 0.005), % Stage 1 ( p = 0.001), arousals ( p = 0.005), and an increase in % Stage 3 ( p = 0.006). Conclusion In mild to moderate AD patients with OSA, the use of tCPAP resulted in deeper sleep after just one night, with improvements maintained for 3 weeks.

Cognitive effects of treating obstructive sleep apnea in Alzheimer's disease: a randomized controlled study.

To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. Randomized double-blind placebo-controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks. General clinical research center. Fifty-two men and women with mild to moderate AD and OSA. CPAP. A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks. A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre- and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed. OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.

Effects of continuous positive airway pressure on systemic inflammation in patients with moderate to severe obstructive sleep apnoea: a randomised controlled trial

Background:Obstructive sleep apnoea syndrome (OSAS) has been associated with cardiovascular disease in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but the...

Continuous Positive Airway Pressure Reduces Subjective Daytime Sleepiness in Patients with Mild to Moderate Alzheimer's Disease with Sleep Disordered Breathing

Studies have reported that 33% to 70% of patients with Alzheimer's disease (AD) have sleep-disordered breathing (SDB). Continuous positive airway pressure (CPAP) treatment has been shown to reduce daytime sleepiness and improve health-related quality of life in nondemented older people with SDB. The effect of therapeutic CPAP treatment on daytime sleepiness in patients with mild-moderate AD with SDB was assessed. Randomized, double-blind, placebo-controlled trial. Patients' home and the University of California San Diego, General Clinical Research Center, J. Christian Gillin Laboratory of Sleep and Chronobiology. Thirty-nine community-dwelling elderly patients with mild-moderate probable AD with SDB. Patients were randomly assigned to receive 6 weeks of therapeutic CPAP or 3 weeks of sham CPAP followed by 3 weeks of therapeutic CPAP. Epworth Sleepiness Scale (ESS) was administered at baseline, 3 weeks, and 6 weeks. Changes in daytime sleepiness in subjects who received optimal therapeutic CPAP were compared with changes in the sham CPAP group. Within the therapeutic CPAP group, ESS scores were reduced from 8.89 during baseline to 6.56 after 3 weeks of treatment (P=.04) and to 5.53 after 6 weeks of treatment (P=.004). In the sham CPAP group, there was no significant difference after 3 weeks of sham CPAP but a significant decrease from 7.68 to 6.47 (P=.01) after 3 weeks of therapeutic CPAP. These data provide evidence of the effectiveness of CPAP in reducing subjective daytime sleepiness in patients with AD with SDB.