Figure - available from: Journal of Clinical Medicine (JCM)
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Comparison in terms of diastolic blood pressure (DBP) between two groups. The follow-up period was 12 months. Results are expressed as mean ± SD.
Source publication
Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospe...
Citations
... Betablockers and angiotensin-converting enzyme (ACE) inhibitors, by lowering sympathetic overactivity and enhancing cardiovascular function, may indirectly support better respiratory outcomes (Strauss et al., 2021). PAP therapy, which is fundamental for managing OHS, not only alleviates hypercapnia and hypoxemia but also reduces cardiac preload and afterload, positively influencing heart failure outcomes (Kalaydzhiev et al., 2024;Kato et al., 2014;Sanders et al., 2008). Additionally, newer agents such as SGLT2 inhibitors have demonstrated cardiopulmonary benefits, including improvements in left ventricular function and reductions in systemic inflammation, which may hold promise for a subset of patients with OHS and coexisting heart failure (Chen et al., 2024;Fatima et al., 2023). ...
Obesity hypoventilation syndrome (OHS) is a multifaceted condition characterized by significant respiratory, cardiovascular, and psychological consequences. Positive airway pressure (PAP) therapy remains the cornerstone treatment, improving respiratory function, neurocognition, and mental health disorders such as depression and anxiety. However, its long-term impact on quality of life, physical activity, and broader health outcomes is not fully understood. Challenges such as residual apnoea/hypopnea index, reduced physical activity, and impaired quality of life persist despite high adherence rates. Factors like hypercapnia and daytime respiratory symptoms play a pivotal role in patient outcomes, underscoring the need for strategies beyond adherence alone. This review explores the interplay between OHS, heart failure, and sleep dysfunction, advocating for personalized PAP settings, targeted management of residual respiratory events, and enhanced patient education. Digital health technologies, including remote monitoring and feedback systems, present promising tools to optimize care delivery and foster holistic management. By integrating physiological, psychological, and digital health perspectives, this narrative review aims to advance understanding and improve outcomes for patients with OHS and other complex sleep-disordered breathing conditions.
... Some studies have shown that CPAP has obvious benefits for patients with OSA with or without MS; the reversibility of MS was higher after CPAP treatment and left ventricular systolic function was increased in CPAP-treated patients. [25][26][27][28] Hence we will further study this group of patients in the future. Finally, we did not control for the use of medications, which might have affected our results to a certain extent. ...
Purpose
The effect of metabolic factors on cardiovascular risk in obstructive sleep apnea (OSA) is unclear. This study aimed to investigate the effect of metabolic factors on the left ventricular diastolic function in patients with OSA.
Patients and Methods
This cross-sectional study included a total of 478 patients with OSA from September 2018 to September 2023. After propensity score matching, wherein 193 patients with OSA with metabolic syndrome (MS) were 1:1 matched to patients with OSA without MS by sex and age, data from 386 patients were ultimately analyzed. Furthermore, all patients were divided into mild, moderate, and severe OSA groups according to their sleep apnea-hypopnea index (AHI). Measurements included nocturnal polysomnography, biochemical testing, and transthoracic echocardiography data.
Results
The AHI in the MS group was higher (30.24±21.69 vs 23.19±17.65, p<0.001) and the lowest oxygen saturation at night was lower (77.67±9.23 vs 80.59±9.26, p<0.001) than those in the non-MS group. Additionally, the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), end-diastolic ventricular septal thickness (IVST), left ventricular end-diastolic posterior wall thickness (LVPWT), left atrial internal diameter (LAD), and E peak to A peak velocity ratio (E/A) in the MS group were higher than those in the non-MS group (P<0.05). The E peak to e’ peak velocity ratio (E/e’) in the MS group was higher than that in the non-MS group (12.02±3.68 vs 11.13±3.12, P=0.011) and was positively correlated with the diagnosis of MS and metabolic factors (r=0.115, p=0.024; r=0.131, p=0.010, respectively). Patients with five metabolic factors had a significantly higher risk of E/e’ elevation than patients in the non-MS group (odds ratio=4.238, p=0.007).
Conclusion
MS may be related to OSA severity and left ventricular diastolic dysfunction. An increase in metabolic factors may increase the risk of diastolic dysfunction. Among metabolic factors, blood pressure may be the most important.
... Left ventricular hypertrophy, myocardial dysfunction, and overall cardiac remodeling significantly increase the risk of cardiovascular morbidity and mortality in OSA patients. While CPAP therapy partially reverses LV hypertrophy and improves left ventricle ejection fraction, the impact of MADs on LV remodeling remains unclear [59,60]. Studies show that although MAD therapy did not significantly alter blood pressure or LV function, it reduced interventricular septal thickness in MADs responders, indicating a reversal of LV hypertrophy [26]. ...
Background: Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive review aimed to explore the effects of MAD therapy on oxidative stress, inflammation, endothelial function, and its impact on the cardiovascular risk in OSA patients. Results: MAD therapy significantly reduces the apnea-hypopnea index (AHI), improves serum nitric oxide (NOx) concentrations, reduces oxidative stress markers, and enhances endothelial function. Animal studies indicated that MAD reduces myocardial fibrosis and attenuates inflammatory markers. While both CPAP and MADs improve endothelial function and heart rate variability, CPAP is more effective in reducing OSA severity. Nevertheless, MAD has higher compliance, contributing to its positive impact on cardiovascular function. Moreover, CPAP and MADs have similar effectiveness in reducing cardiovascular risk. Conclusions: MAD therapy is an effective alternative to CPAP, particularly for patients with mild to moderate OSA as well as those intolerant to CPAP. It offers significant improvements in endothelial function and oxidative stress. Further studies are needed to assess MAD therapy in comprehensive OSA management.
