[Show description][Hide description] DESCRIPTION: Glucose tolerance and cardiovascular risk biomarkers in nondiabetic nonobese obstructive sleep apnea patients: effects of long term continuous positive airway pressure
[Show abstract][Hide abstract] ABSTRACT: Most of patients suffering from resistant hypertension (HTN) have obstructive sleep apnea (OSA). Little data are available to confirm or not the efficacy of continuous positive airway pressure (CPAP) on blood pressure (BP) in resistant HTN.
We performed a multicentric, comparative (presence or not of OSA), randomized (sham CPAP then active CPAP versus active CPAP right away), simple blind study in patients with essential resistant HTN (confirmed by ABPM). OSA patients (apnea-hypopnea index, AHI, > 15 per hour) previously untreated for OSA received CPAP. Follow-up was of 6 (active CPAP group) or 9 (sham CPAP group) months.
61 patients were included, mean age 59.6 years, 77% of men, BMI 29.6 kg/m, daytime BP 145/85 mmHg, 3.7 antihypertensive drugs. The 36 OSA patients (59%, mean AHI 44.8) were predominantly men (86 vs 64%, p = 0.043), with metabolic syndrome (83 vs 60%, p = 0.042). After a period of 6 months under active CPAP, BP decreased by 3.4 (p = 0.161) and 2.8 (p = 0.068) mmHg over 24 hours, by 1.6 (ns) and 1.9 (ns) mmHg during the day and by 5.5 (p = 0.022) and 4.0 (p = 0.015) mmHg during the night, respectively for systolic and diastolic BP. Dipper profile was improved by active CPAP (64.5 vs 35.5 %, p = 0.047, for systolic BP, and 71 vs 58%, p = 0.084, for diastolic BP).
Not only OSA must be investigated in resistant HTN but also its treatment must be started. Indeed, besides its interest on sleepiness, CPAP is efficient to decrease nighttime BP in apneic patients suffering from resistant HTN. This explains in part the benefit of CPAP on morbidity-mortality of OSA patients.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its influence on second eye involvement is not well known.
To evaluate the prevalence of OSAS in patients with NAION and risk factors of second eye involvement.
In this cohort study, we examined 118 patients with anterior ischemic optic neuropathy referred to a tertiary care center from January 1, 2003, through December 31, 2010.
Patients underwent polysomnography to detect OSAS and were prospectively followed up to assess the risk of second eye involvement.
The prevalence of OSAS in patients with NAION and the risk of second eye involvement using survival analysis based on the presence of OSAS, indication for ventilation treatment with continuous positive airway pressure, and other potential ocular and systemic confounders.
In 89 patients with NAION who underwent polysomnography, 67 (75%) had OSAS. Second eye involvement was found in 10 (13.7%) of 73 patients at 3 years: 8 (15.4%) of 52 patients with OSAS at 3 years and 2 (9.5%) of 21 patients without OSAS at 3 years; P = .04. In multivariate analysis, nonadherence to ventilation treatment with continuous positive airway pressure in patients with severe OSAS increased the risk of second eye involvement (hazard ratio, 5.54; 95% CI, 1.13-27.11; P = .04).
These results suggest that OSAS is common in patients with NAION and that polysomnography should be considered in these patients. These findings also suggest that patients with severe OSAS who are nonadherent to ventilation treatment with continuous positive airway pressure have an increased risk of second eye involvement.
[Show abstract][Hide abstract] ABSTRACT: To assess whether daily variations in three parameters recorded by non-invasive ventilation (NIV) software (respiratory rate (RR), percentage of respiratory cycles triggered by the patient (%Trigg) and NIV daily use) predict the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD) treated by home NIV.
Patients completed the EXACT-Pro questionnaire daily to detect exacerbations. The 25th and 75th percentiles of each 24 h NIV parameter were calculated and updated daily. For a given day, when the value of any parameter was >75th or <25th percentile, the day was marked as 'abnormal value' ('high value' >75th, 'low value' <25th). Stratified conditional logistic regressions estimated the risk of exacerbation when ≥2 days (for RR and %Trigg) or ≥3 days (for NIV use) out of five had an 'abnormal value'.
Sixty-four patients were included. Twenty-one exacerbations were detected and medically confirmed. The risk of exacerbation was increased when RR (OR 5.6, 95% CI 1.4 to 22.4) and %Trigg (OR 4.0, 95% CI 1.1 to 14.5) were considered as 'high value' on ≥2 days out of five.
This proof-of-concept study shows that daily variations in RR and %Trigg are predictors of an exacerbation.
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