The Impact of CPAP on Cardiovascular Biomarkers in Minimally Symptomatic Patients with Obstructive Sleep Apnea: A Pilot Feasibility Randomized Crossover Trial
| Autor: | Vikram R. Comondore, Sammy Chan, G.B. John Mancini, Rupi Cheema, Najib T. Ayas, C. Frank Ryan, Joel Fox, John A. Fleetham, Arsalan Butt |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Epinephrine medicine.medical_treatment Blood Pressure Pilot Projects law.invention Norepinephrine Catecholamines Randomized controlled trial Risk Factors law Diabetes mellitus Internal medicine medicine Albuminuria Humans Continuous positive airway pressure Sleep Apnea Obstructive Cross-Over Studies Continuous Positive Airway Pressure business.industry Sleep apnea Middle Aged medicine.disease Lipids Crossover study nervous system diseases respiratory tract diseases Obstructive sleep apnea C-Reactive Protein Blood pressure Cardiovascular Diseases Physical therapy Female business Hypopnea Biomarkers |
| Zdroj: | Lung. 187:17-22 |
| ISSN: | 1432-1750 0341-2040 |
| DOI: | 10.1007/s00408-008-9115-5 |
| Popis: | Previous, largely uncontrolled studies demonstrated the substantial effects of continuous positive airway pressure ventilation (CPAP) on a variety of physiologic and biochemical markers known to be risk factors for cardiovascular disease in patients with obstructive sleep apnea (OSA). In this pilot crossover study, we assessed (1) the feasibility of using CPAP in a group of minimally symptomatic patients with OSA, assessed through patient compliance and (2) CPAP therapy's effect on biomarkers in these patients.We studied patients with minimal daytime sleepiness who were referred to the University of British Columbia's Hospital Sleep Clinic with suspected OSA and an apnea-hypopnea index (AHI)15 events/h. Patients were randomized to either CPAP or no therapy for 4 weeks followed by a washout of 4 weeks, and then a crossover to the other intervention. Fasting morning blood and urine, 24-h blood pressure (BP) measurements, and endothelial function (peak flow-mediated dilation to nitroglycerin-mediated dilation ratio) were assessed before and after each study intervention.Nine adult male and four female patients were studied. Mean (SD) age was 55 (7) years, mean AHI = 27.9/h, mean Epworth Sleepiness Score = 6.8 (11/13 had a score10), and mean BMI = 31.1 kg/m(2). Mean compliance with CPAP therapy was 5.53 h/night. Compared to no therapy, potential improvements were observed with CPAP for urinary microalbumin, norepinephrine, and epinephrine to creatinine ratios (decreased by 3.51 mg/mmol, 1.70 nmol/mmol, and 0.95 nmol/mmol, respectively); 24-h BP (systolic decreased by 3.60 mmHg, diastolic by 0.70 mmHg); homeostasis model for insulin resistance score (decreased by 1.11); and endothelial function (increased by 7.4%). However, none of the above differences was significant (p0.10).In this pilot study there were potential improvements in a variety of cardiovascular biomarkers with CPAP. CPAP compliance was reasonably good even though patients were not particularly sleepy. Accordingly, larger randomized controlled trials in this area appear feasible and warranted. |
| Databáze: | OpenAIRE |
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