CPAP and Hypertension in Nonsleepy Patients.
University of Kentucky, Lexington, KY.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 02/2013; 9(2):181-182. DOI: 10.5664/jcsm.2426
QUESTION: Is continuous positive airway pressure (CPAP) therapy better than no therapy in reducing the incidence of hypertension or cardiovascular (CV) events in a cohort of nonsleepy patients with obstructive sleep apnea (OSA)? DESIGN: Randomized, controlled trial; no placebo CPAP used. ClinicalTrials.gov Identifier: NCT00127348. ALLOCATION: Randomization was performed using a computer generated list of random numbers in the coordinating center and results were mailed to participating centers in numbered opaque envelopes. BLINDING: Primary outcome was evaluated by individuals not involved in the study and who were blinded to patient allocation. Patients, investigators, and the statistician were not blinded. FOLLOW-UP PERIOD: median 4 (interquartile range, 2.7-4.4) years. SETTING: 14 academic medical centers in Spain. SUBJECTS: 725 adults (mean age 51.8 y, 14% women) who were diagnosed with OSA with apnea hypopnea index (AHI) ≥ 20 events per hour and Epworth sleepiness score (ESS) ≤ 10 were randomized. Subjects with previous CV events were excluded. However, patients with a history of hypertension were not excluded (50% of the sample were hypertensive at baseline). INTERVENTION: Patients were randomized to receive CPAP treatment or no active intervention. All participants received dietary counseling and advice about sleep hygiene. OUTCOMES: The primary outcome was the incidence of either systemic hypertension (among participants who were normotensive at baseline) or CV events (among all participants). The secondary outcome was the association between the incidence of hypertension or CV events (nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for unstable angina or arrhythmia, heart failure, and CV death) and the severity of OSA assessed by the AHI and oxygen saturation. The sample size was calculated assuming that the incidence of hypertension or new CV event in this population over a period of 3 years would be 10% annually; 345 patients per group were needed to detect a 60% reduction in incidence of new hypertension or CV events (90% power, 2-sided α = 0.05, assuming 10% study dropout). PATIENT FOLLOW-UP: 83% complete (only patients who received the allocated intervention were included in analysis of primary outcome). MAIN RESULTS: A total of 147 patients with new hypertension and 59 cardiovascular events were identified (Table). In the CPAP group, there were 68 patients with incident hypertension and 28 CV events. Of the 357 participants in the CPAP group, 127 used CPAP < 4 hours/night (36%). In the control group, there were 79 patients with new hypertension and 31 CV events. There was no statistically significant difference between the groups in the primary outcome. TableRisk for incident hypertension or cardiovascular event CONCLUSION: In adults with moderate to severe OSA and no symptoms of daytime sleepiness, CPAP therapy did not reduce incident hypertension or CV event compared with no active therapy. SOURCES OF FUNDING: Instituto de Salud Carlos III (PI 04/0165) (Fondo de Investigaciones Sanitarios, Ministerio de Sanidad y Consumo, Spain), Spanish Respiratory Society (SEPAR) (Barcelona), Resmed (Bella Vista, Australia), Air Products-Carburos Metalicos (Barcelona), Respironics (Murrysville, Pennsylvania), and Breas Medical (Madrid, Spain). FOR CORRESPONDENCE: Ferran Barbe, M.D., Email: email@example.com.
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ABSTRACT: There are a number of recent studies evaluating sleep disordered breathing and its treatment in the context of blood pressure control. In addition, total sleep time and subjective sleep complaints may also be related to hypertension; these will be reviewed. Recent findings in original articles document that sleep disordered breathing and decreased total sleep time, if chronic, may contribute to an increased risk for development of hypertension. Treatment of sleep apnea with either continuous positive airway pressure (CPAP) or oral devices are reasonable treatment approaches for obstructive sleep apnea (OSA), but the data on the effect on blood pressure remain unclear. In summary, treatment of sleep disordered breathing may help reduce blood pressure or decrease development of incident hypertension.Current Cardiology Reports 11/2013; 15(11):415. DOI:10.1007/s11886-013-0415-x · 1.93 Impact Factor
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ABSTRACT: Prior studies show that adaptive servoventilation (ASV) is initially more effective than continuous positive airway pressure (CPAP) for patients with complex sleep apnea syndrome (CompSAS), but choosing therapies has been controversial because residual central breathing events may resolve over time in many patients receiving chronic CPAP therapy. We conducted a multicenter, randomized, prospective trial comparing clinical and polysomnographic outcomes over prolonged treatment of patients with CompSAS, with CPAP versus ASV. Qualifying participants meeting criteria for CompSAS were randomized to optimized CPAP or ASV treatment. Clinical and polysomnographic data were obtained at baseline and after 90 days of therapy. We randomized 66 participants (33 to each treatment). At baseline, the diagnostic apnea-hypopnea index (AHI) was 37.7 ± 27.8 (central apnea index [CAI] = 3.2 ± 5.8) and best CPAP AHI was 37.0 ± 24.9 (CAI 29.7 ± 25.0). After second-night treatment titration, the AHI was 4.7 ± 8.1 (CAI = 1.1 ± 3.7) on ASV and 14.1 ± 20.7 (CAI = 8.8 ± 16.3) on CPAP (P ≤ 0.0003). At 90 days, the ASV versus CPAP AHI was 4.4 ± 9.6 versus 9.9 ± 11.1 (P = 0.0024) and CAI was 0.7 ± 3.4 versus 4.8 ± 6.4 (P < 0.0001), respectively. In the intention-to-treat analysis, success (AHI < 10) at 90 days of therapy was achieved in 89.7% versus 64.5% of participants treated with ASV and CPAP, respectively (P = 0.0214). Compliance and changes in Epworth Sleepiness Scale and Sleep Apnea Quality of Life Index were not significantly different between treatment groups. Adaptive servoventilation (ASV) was more reliably effective than CPAP in relieving complex sleep apnea syndrome. While two thirds of participants experienced success with CPAP, approximately 90% experienced success with ASV. Because both methods produced similar symptomatic changes, it is unclear if this polysomnographic effectiveness may translate into other desired outcomes. Clinicaltrials.Gov NCT00915499. Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934.Sleep 05/2014; 37(5):927-934. DOI:10.5665/sleep.3662 · 4.59 Impact Factor
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ABSTRACT: Introduction Obstructive sleep apnea (OSA) was associated with increased incidence of all cancers. We aimed to determine the risk for primary central nervous system (CNS) cancers in patients with sleep apnea syndrome. Methods A total of 23,055 incident cases of newly diagnosed sleep apnea syndrome (sleep apnea group) were identified between 2000 and 2003 in the medical claims database of Taiwan’s National Health Institute (NHI) program and were matched by age and gender to patients without OSA (comparison group) in the same period. The occurrence of primary malignant CNS cancers was measured 2 years after the index date over a 10-year period. Results The incidence density of primary CNS cancers (per 10,000 individual-years) was 2.14 and 1.28, respectively, for the OSA and comparison groups. The overall risk for developing primary CNS cancers was significantly higher in the OSA group (adjusted hazard ratio [HR], 1.54; P=.046) after adjusting for age, gender, and obesity, among other variables. Subgroup analysis revealed a significantly higher risk for primary brain cancers but not primary spinal cord cancers in the OSA subgroup (adjusted HR, 1.71; P=.027). The analysis also revealed a significantly higher risk for primary CNS cancers in the insomnia with OSA subgroup (adjusted HR, 2.20; P=.001) and in the OSA without surgical treatment subgroup (adjusted HR, 1.831; P=.003). Conclusions OSA, especially with insomnia, may increase the risk for primary CNS cancer development, though surgical treatment may reduce this risk in participants with OSA.Sleep Medicine 07/2014; 15(7). DOI:10.1016/j.sleep.2013.11.782 · 3.15 Impact Factor
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