[Show abstract][Hide abstract] ABSTRACT: To evaluate whether nasal continuous positive airway pressure (nCPAP) reduces oxidative stress in patients with severe obstructive sleep apnea (OSA) syndrome.
Forty-six patients with severe OSA (AHI> or =30) requiring nasal CPAP treatment and 46 controls (subjects without OSA and with mild OSA as defined by an AHI<15) were enrolled. Oxidative stress was evaluated in blood samples with a commercially available automated spectrophotometric assay (D-ROMs test, Diacron, Grosseto, Italy). Blood samples were collected the evening before (10:00 p.m.) and the morning after (07:00 a.m.) a diagnostic polysomnography. Patients with severe OSA syndrome were subsequently submitted to a second polysomnography with nasal CPAP titration the following night. Using the same schedule we collected blood samples from the patients the morning after the nCPAP titration and after two months of nCPAP treatment.
Patients with severe OSA presented higher levels of oxidative stress than patients with AHI<15 in the evening and in the morning (357.57+/-13.07 UCarr vs. 319.28+/-12.66 UCarr, p=0.038, and 371.83+/-12.83 UCarr vs. 328.09+/-11.76 UCarr, p=0.014, respectively). Patients with severe OSA presented a significant reduction the levels of oxidative stress the morning after the nCPAP titration study (371.83+/-12.83 UCarr vs. 298.21+/-9.62 UCarr, p=0.001) and this reduction was further preserved after a period of two months of nCPAP treatment (293.72+/-6.55 UCarr, p=0.001 vs. baseline). Statistically significant correlations were observed between levels of oxidative stress and nocturnal polysomnography (NPSG) markers as oxygen desaturation index (ODI), arousal index (AI), lowest oxygen saturation of hemoglobin, and mean oxygen saturation of hemoglobin.
Patients with severe OSA syndrome presented increased systemic oxidative stress. A single night of nCPAP treatment significantly reduced the levels of oxidative stress in patients with severe OSA syndrome, and this reduction was maintained at least after two months of nCPAP treatment.
[Show abstract][Hide abstract] ABSTRACT: Current guidelines suggest the use of non-invasive ventilation (NIV) in hypercapnic chronic obstructive pulmonary disease (COPD) exacerbations in patients presenting with a pH of 7.25-7.35. The aim of this study was to investigate the role of NIV in COPD patients with chronic hypercapnic respiratory failure admitted to the hospital with acute exacerbations and an arterial pH of 7.35 or higher.
Forty-seven COPD patients with chronic hypercapnic respiratory failure admitted for exacerbations and with a pH of 7.35 or higher were randomized to receive standard medical therapy (control group) or medical therapy plus NIV (NIV group). Arterial blood gases were measured at baseline, after 1 h, 6 h, 12 h, 24 h, 48 h, and at discharge. Need for admission to intensive care unit (ICU), death, and duration of hospitalization were recorded. The final analysis included 42 patients (21 controls and 21 NIV patients).
NIV resulted in a shorter hospital stay (5.5+/-2.6 vs 10.1+/-4.4 days for controls, p=0.0004). Two patients from the control group were admitted to the ICU and one eventually died, whereas all NIV patients were successfully discharged. The NIV group showed a faster improvement in PaCO(2) and pH. At discharge, the NIV group had a lower PaCO(2) (6.5+/-0.6 kPa vs 7.5+/-1.1 kPa, p=0.01) but a comparable pH (7.43+/-0.03 vs 7.43+/-0.04, p=0.93). PaO(2) and PaO(2)/FiO(2) levels showed similar improvement in both groups at discharge.
Early administration of NIV in COPD patients with chronic hypercapnic respiratory failure admitted for acute exacerbations with a pH of 7.35 or higher results in a reduced hospital stay and faster improvement of arterial blood gases.
No preview · Article · Dec 2007 · European Journal of Internal Medicine