CPAP Therapy Delays Cardiovagal Reactivation and Decreases Arterial Renin-Angiotensin System Activity in Humans With Obstructive Sleep Apnea.

Autor: Nicholl DDM; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada., Hanly PJ; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada., Zalucky AA; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada., Mann MC; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada., MacRae JM; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.; Alberta Kidney Disease Network, Canada., Poulin MJ; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.; Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.; Faculty of Kinesiology, University of Calgary, Alberta, Canada., Handley GB; Healthy Heart Sleep Company, Calgary, Alberta, Canada., Sola DY; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada., Ahmed SB; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.; Alberta Kidney Disease Network, Canada.
Jazyk: angličtina
Zdroj: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2018 Sep 15; Vol. 14 (9), pp. 1509-1520. Date of Electronic Publication: 2018 Sep 15.
DOI: 10.5664/jcsm.7326
Abstrakt: Study Objectives: Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk. The effect of OSA treatment with continuous positive airway pressure (CPAP) on the cardiovascular response to a stressor is unknown. We sought to determine the effect of CPAP therapy on heart rate variability (HRV) and arterial stiffness, at baseline, in response to, and recovery from a physiological stressor, Angiotensin II (AngII), in humans with OSA.
Methods: Twenty-five incident healthy subjects (32% female; 49 ± 2 years) with moderate-severe OSA and nocturnal hypoxia were studied in high-salt balance, a state of maximal renin-angiotensin system (RAS) suppression, before CPAP, and after 4 weeks of effective CPAP therapy (usage > 4 h/night) in a second identical study day. HRV was calculated by spectral power and time domain analysis. Aortic augmentation index (AIx) and carotid-femoral pulse-wave velocity (PWV cf ) were measured by applanation tonometry. HRV and arterial stiffness were measured at baseline and in response to AngII challenge (3 ng/ kg/min·30 minutes, 6 ng/kg/min·30 minutes, recovery·30 minutes). The primary outcome was the association between CPAP treatment and HRV and arterial stiffness responses to, and recovery from, AngII challenge. In an exploratory analysis subjects were stratified by sex.
Results: CPAP corrected OSA and nocturnal hypoxemia. CPAP treatment was associated with increased sensitivity and delayed recovery from AngII (Δln HF [high frequency; recovery: -0.09 ± 0.19 versus -0.59 ± 0.17 ms 2 , P = .042; ΔrMSSD [root mean successive differences; recovery: -0.4 ± 2.0 versus -7.2 ± 1.9 ms, P = .001], ΔpNN50 [percentage of normal waves differing ≥ 50 ms compared to the preceding wave; AngII: 1.3 ± 2.3 versus -3.0 ± 2.4%, P = .043; recovery: -0.4 ± 1.4 versus -6.0 ± 1.9%, P = .001], all values pre-CPAP versus post-CPAP treatment). No differences were observed by sex. There was increased AIx sensitivity to AngII after CPAP among men (8.2 ± 1.7 versus 11.9 ± 2.2%, P = .046), but not women (11.4 ± 1.5 versus 11.6 ± 2.1%, P = .4). No change in PWV cf sensitivity was observed in either sex.
Conclusions: CPAP therapy was associated with delayed cardiovagal reactivation after a stressor and down-regulation of the arterial RAS. These findings may have important implications in mitigating cardiovascular risk in both men and women with OSA.
(© 2018 American Academy of Sleep Medicine.)
Databáze: MEDLINE
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