Recent weight gain in patients with newly diagnosed obstructive sleep apnea.

OBJECTIVE: Patients with obstructive sleep apnea are often obese. Obesity may contribute to both sleep apnea itself and to the cardiovascular risk associated with sleep apnea. Weight loss in obese patients with sleep apnea may alleviate symptoms and decrease the severity of sleep apnea. Whether patients with obstructive sleep apnea are indeed predisposed to recent weight gain, as compared with similarly obese subjects without sleep apnea, is not known. PATIENTS AND METHODS: We compared 1-year weight histories in 53 male and female patients newly diagnosed with obstructive sleep apnea, compared with 24 controls matched for gender, age, body mass index, and percent body fat. Sleep apnea patients had never been treated. Control subjects were proven to be free of sleep-disordered breathing by overnight polysomnography. RESULTS: Patients with obstructive sleep apnea (n = 53) had a significant recent weight gain of 7.4 +/- 1.5 kg compared with a weight loss of 0.5 +/- 1.7 kg (P = 0.001) in similarly obese controls (n = 24). Male patients with obstructive sleep apnea (n = 28) had a history of significant weight gain (6.8 +/- 2.3 kg) over the year preceding the study compared with male control subjects (n = 13), in whom average weight fell by 0.58 +/- 2.4 kg (P = 0.03). Female patients (n = 25) with obstructive sleep apnea had an 8.0 +/- 1.9 kg weight gain compared with female controls (n = 11) who had a history of weight loss of 0.46 +/- 2.6 kg (P = 0.02). CONCLUSION: These findings support the concept that patients with obstructive sleep apnea may be susceptible to increasing obesity in the period preceding the diagnosis of obstructive sleep apnea.     

Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome

The obstructive sleep apnoea syndrome (OSAS) results in excessive daytime sleepiness, impaired quality of life, and is associated with an increased risk of traffic accidents and cardiovascular disease. Nasal continuous positive airway pressure (CPAP), the standard treatment for OSAS provides immediate relief of symptoms and has only minor side effects. Nevertheless, an alternative treatment is needed if CPAP is not feasible for medical or psychological reasons. Removable oral appliances that advance the mandible when fitted to the teeth during sleep also improve nocturnal breathing disturbances, symptoms, quality of life, vigilance and blood pressure in OSAS patients. Their long-term effectiveness and side effects require further study. In morbidly obese patients suffering from OSAS bariatric surgery should be considered as a treatment that reduces obesity and at the same time improves OSAS. In selected patients including those with adeno-tonsillar hypertrophy, and cranio-facial malformations various surgical techniques that enlarge the upper airway may be a treatment option for OSAS.     

持续气道正压通气治疗阻塞性睡眠呼吸暂停相关性高血压的疗效观察

目的:评估持续气道正压通气(CPAP)对严重阻塞性睡眠呼吸暂停(OSA)合并Ⅱ~Ⅲ级高血压患者的疗效。方法:32名高血压合并严重OSA的患者(呼吸暂停低通气指数30),予以3联抗高血压药物(缬沙坦160 mg+氨氯地平5~10 mg+氢氯噻嗪25 mg),3周后将患者随机分为2组,治疗组给予有效CPAP治疗(压力4~15cm H2O),每晚4 h;对照组给予安慰剂CPAP治疗(压力4 cm H2O),治疗3周。分别在降压药物治疗前、后及CPAP治疗3周后测量每位患者的诊室血压、动态血压、动态动脉硬化指数(AASI)、主动脉压、颈-股动脉脉搏波传导速度(cf PWV)、收缩波增强指数。结果:降压药物治疗3周之后,诊室血压及中心动脉压均有明显下降(P0.05),有效CPAP治疗3周后,两指标均有进一步的下降(P0.05)。降压药物治疗之前有94%的患者cf PWV超过正常范围(脉搏波传导速度12 ms),降压治疗后cf PWV下降了[(1.9±1.0)ms,P0.01],有效CPAP治疗后cf PWV进一步下降了0.7 ms(P0.05)。降压药物+有效CPAP组有37.5%的患者PWV超过正常,单纯降压药物治疗患者中有56%的患者PWV超过正常,降压药物+安慰剂CPAP组有53%的患者PWV超过正常。只有降压药物和CPAP联合治疗才能获得增强指数和AASI的显著下降以及主动脉和肱动脉血压的进一步降低。结论:OSA合并Ⅱ~Ⅲ级高血压患者给予有效CPAP治疗3周,患者诊室血压、动态血压、中心血压有了进一步下降,同时动脉硬化参数,如cf PWV、AASI和增强指数有显著改善。     

Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea.

We used polysomnography, echocardiography and ventilatory measurements to study 50 patients suspected of having OSA to determine a link to RVH. Twenty-eight patients (56 percent) had OSA and 20 (71 percent) of those had isolated RVH. We evaluated patients with RVH and divided them into two groups, those with apnea and those without apnea. The patients with sleep apnea were younger, weighed more, had greater BSA and had lower average oxygen saturations during the sleep study period. We divided the group with apnea into those with RVH and those without it. Those patients with RVH had a higher AI, longer average apnea time, a greater duration of longest apnea and a lower average oxygen saturation for the period of the sleep study. In addition, those with RVH had a lower average oxygen saturation during each apneic episode with a p value equaling 0.09.     

持续气道正压通气治疗阻塞性睡眠呼吸暂停合并高血压的疗效观察

目的:评估持续气道正压通气(CPAP)对严重阻塞性睡眠呼吸暂停(OSA)合并Ⅱ~Ⅲ级高血压患者的疗效。方法:32名高血压合并严重OSA的患者(呼吸暂停低通气指数30),予以3联抗高血压药物(缬沙坦160 mg+氨氯地平5~10 mg+氢氯噻嗪25 mg),3周后将患者随机分为2组,治疗组给予有效CPAP治疗(压力4~15cm H2O),每晚4 h;对照组给予安慰剂CPAP治疗(压力4 cm H2O),治疗3周。分别在降压药物治疗前、后及CPAP治疗3周后测量每位患者的诊室血压、动态血压、动态动脉硬化指数(AASI)、主动脉压、颈-股动脉脉搏波传导速度(cf PWV)、收缩波增强指数。结果:降压药物治疗3周之后,诊室血压及中心动脉压均有明显下降(P0.05),有效CPAP治疗3周后,两指标均有进一步的下降(P0.05)。降压药物治疗之前有94%的患者cf PWV超过正常范围(脉搏波传导速度12 ms),降压治疗后cf PWV下降了[(1.9±1.0)ms,P0.01],有效CPAP治疗后cf PWV进一步下降了0.7 ms(P0.05)。降压药物+有效CPAP组有37.5%的患者PWV超过正常,单纯降压药物治疗患者中有56%的患者PWV超过正常,降压药物+安慰剂CPAP组有53%的患者PWV超过正常。只有降压药物和CPAP联合治疗才能获得增强指数和AASI的显著下降以及主动脉和肱动脉血压的进一步降低。结论:OSA合并Ⅱ~Ⅲ级高血压患者给予有效CPAP治疗3周,患者诊室血压、动态血压、中心血压有了进一步下降,同时动脉硬化参数,如cf PWV、AASI和增强指数有显著改善。     

Stage-matched intervention for adherence to CPAP in patients with obstructive sleep apnea: a randomized controlled trial

Purpose

The objective of the study was to evaluate the effectiveness of stage-matched intervention on adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome.

Methods

One hundred and ten Chinese patients with newly diagnosed obstructive sleep apnea syndrome were enrolled in this study. They were randomly assigned into stage-matched care (SMC) and standard care (SC) groups (55 patients in each group). Patients in the SMC group received stage-matched intervention at different stages of behavior changes, and the SC group received only routine care. The intervention was based on the health action process approach theory and included risk perception, outcome expectancy, and self-efficacy. Questionnaires included the Self-Efficacy Measure for Sleep Apnea, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and 1 and 3 months after home CPAP treatment, and hours of CPAP usage was also recorded at 1 and 3 months of follow-up.

Results

At 1 month, CPAP usage was 5.59?±?0.56 h/night (mean ± SD) vs 5.28?±?0.67 h/night in the SMC and SC groups, respectively (p?=?0.016). At 3 months, CPAP usage was 5.65?±?0.50 vs 5.26?±?0.82 h/night in the SMC and SC groups, respectively (p?=?0.006). Repeated ANOVA analysis demonstrated that risk perception, outcome expectancy, and self-efficacy in the SMC group were significantly higher than those of the SC group (p?<?0.05). Moreover, the time × group interaction was significant for outcome expectancy and self-efficacy, indicating that the groups differed significantly in changes in outcome expectancy and self-efficacy over the three time points. There was a significant difference between the SMC and SC groups in terms of improvement in ESS (p?<?0.001) and PSQI (p?=?0.013) after 3 months of CPAP treatment.

Conclusions

Stage-matched intervention could not only facilitate intention formation and enhance treatment self-efficacy but significantly improve CPAP adherence in OSA patients for the 3-month treatment.     

Measurement of mask leakage during CPAP in patients with obstructive sleep apnea

To improve the compliance of patients with obstructive sleep apnoea tight fitting nasal masks are necessary. It would be very useful to to measure the mask leakage during the recommended pressure for the treatment at home. We studied therefore the influence of different sizes and types of masks on the air leaks during the adaptation procedure. We investigated 20 patients, mean age 60.8 +/- 11.9 years, AHI 31 +/- 17, lowest oxygen saturation 81 +/- 10.3% mean CPAP-9.9 +/- 1.6. Randomized cross over we applied CPAP with different masks during wakefulness. The pressure was increased from 6 to 13 mbar by steps of 1 mbar. The mask leak was measured by Autoset. RESULTS: Using the best mask (selected from different sizes and different brands) the mask leak was 0.11 +/- 0.9 L/sec. If the patient used a mask (only one brand but selected from different sizes) or one standard mask the mask leak doubled respectively tripled. To reduce side effects and improve compliance we recommend therefore quantification of the mask leak to find the best fitting mask.     

Influence of longterm CPAP therapy on CO(2) drive in patients with obstructive sleep apnea

According to recent publications, the values of the hypercapnic ventilatory responses (HCVR) in normocapnic obstructive sleep apnea (OSA) patients are highly variable, but they are usually within the normal range. In our study, CPAP therapy during 1 month did not seem to influence the HCVR [Verbraecken, J., De Backer, W., Willemen, M., De Cock, W., Wittesaele, W., Van de Heyning, P., 1995. Respir. Physiol. 101, 279-287]. It is, however, not well studied whether long term (1 year) CPAP therapy can influence HCVR in normocapnic patients. Therefore, we evaluated the effect of 1 year CPAP therapy on CO(2) drive in 20 OSA patients. The slope of HCVR (SHCVR) changed from 2.35+/-0.21 L min(-1) mmHg(-1) (control) to 1.66+/-0.16 L min(-1) mm Hg(-1) (P=0.04), but the mean within subject coefficient of variation in repeated measurements of SHCVR in treated and untreated OSA patients was not statistically different. Pa(O(2)) increased from 72+/-2 mm Hg to 80+/-2 (1 year) mm Hg. We conclude that CPAP therapy improves daytime gas exchange in normocapnic OSA and may possibly decrease CO(2) drive (slope) after a treatment period of 1 year.     

Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA

Nasal CPAP is presently accepted as first-line therapy for obstructive sleep apnea, but a significant minority of patients do not tolerate nasal CPAP. The purpose of this study was to compare the benefits of nasal CPAP, nasal oxygen (O2), and placebo (air) using patients as their own controls. We studied eight men, aged 33 to 72 (mean 57 years), who had mild obstructive sleep apnea. To be eligible for study, patients had to have an apnea plus hypopnea index greater than or equal to 5, plus one or more of the following: blood pressure greater than 150/95 mm Hg, multiple sleep latency test mean score less than or equal to 10 minutes, or significant nocturnal cardiac ectopy. After a baseline study, patients received a month each of nocturnal O2 at 4 LPM and air at 4 LPM, presented in random order. The third month of treatment consisted of nasal CPAP (range 2.5 to 12.5 cm H2O). Patients underwent evaluation at baseline and after each month of treatment. It was concluded that oxygen was more effective in improving oxygenation and hypopneas than is nasal CPAP. However, oxygen did not reduce apneas or improve daytime hypersomnolence as well as nasal CPAP in patients with mild OSA. Oxygen might be considered as an alternate form of treatment for patients who are not hypersomnolent, or as an adjunct to nasal CPAP.     

The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome

The objective of this study was to compare continuous positive airway pressure (CPAP) use, functional status, and client satisfaction in obstructive sleep apnea syndrome (OSAS) patients randomized to either telemedicine support or traditional care. In our university-affiliated sleep disorders center, patients with OSAS who were initiating CPAP therapy were randomized to receive telemedicine support vs traditional follow-up care for 30 days. The telemedicine group received a “Health Buddy” computer that provided daily Internet-based informational support and feedback for problems experienced with CPAP use. At 30 days, there were no significant differences in the hours of CPAP use between groups receiving traditional care (M=4.22, SD±2.05) and telemedicine support (M=4.29, SD±2.15), p=0.87, or in the proportion of nights with CPAP use between the traditional (M=50%±33.8) and telemedicine groups (M=47%±34.2), p=0.61. No significant differences were found between groups in functional status (M=2.27±4.56 vs M=2.03±3.88, respectively, p=0.76) or client satisfaction (M=28.0±3.51 vs M=28.5±3.05, p=0.43). Patients in the telemedicine and traditional groups had similar CPAP use, functional status, and client satisfaction. The data suggest that telemedicine support as provided by our model compares favorably with traditional care. As a provider-extender, telemedicine support for patients initiating use of CPAP may allow for greater practice efficiency while maintaining quality of care. Disclosure Statement: Supported by the Telemedicine Directorate, Walter Reed Army Medical Center, Washington, DC.     

Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status

Purpose

Obstructive sleep apnea (OSA) is an increasingly common sleep disorder, especially among obese adults. Early identification of adults at risk for OSA would be of substantial benefit; however, the magnitude of the obesity epidemic requires that screening be performed judiciously. The study’s aim was to utilize questionnaires that assess OSA risk and symptoms to test the hypothesis that the most insulin-resistant subset of obese individuals is at highest risk for OSA.

Methods

Nondiabetic, overweight to obese volunteers underwent direct quantification of insulin sensitivity by measuring steady-state plasma glucose concentrations during the insulin suppression test. Insulin-sensitive and insulin-resistant individuals were administered the Berlin and STOP questionnaires to determine OSA risk status, and Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Fasting insulin and lipid/lipoprotein measurements were performed.

Results

Insulin-mediated glucose disposal differed threefold (p?<?0.001) between equally obese, insulin-resistant (n?=?22) and insulin-sensitive (n?=?14) individuals, associated with higher fasting insulin and triglyceride and lower high-density lipoprotein cholesterol (HDL-C) concentrations in insulin-resistant individuals. Fourteen (64 %) insulin-resistant as compared with 2 (14 %) insulin-sensitive individuals were found to be at high risk for OSA by both questionnaires (p?<?0.01). Whereas half of insulin-resistant individuals met the ESS criteria for excessive daytime sleepiness, only one insulin-sensitive individual did (p?=?0.011).

Conclusions

High risk for OSA and excessive daytime sleepiness is prevalent among the insulin-resistant subgroup of obese individuals. Surrogate estimates of insulin resistance based on fasting insulin, triglycerides, and/or HDL-C can be used to help identify those obese adults who would benefit most from OSA screening and referral for polysomnography.     

经鼻持续气道内正压通气与咽手术治疗阻塞性睡眠呼吸暂停综合征对比观察

目的对比观察经鼻持续气道内正压通气（ＣＰＡＰ）与悬雍垂腭咽成形术（ＵＰＰＰ）治疗阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的疗效及对睡眠呼吸参数的影响，评价二者在ＯＳＡＳ治疗中的地位。方法６０例ＯＳＡＳ患者，ＣＰＡＰ治疗组３６例，手术治疗组２４例。治疗前后作整夜多导睡眠图（ＰＳＧ）监测。结果两组呼吸紊乱指数减少，夜间低氧血症改善，ＣＰＡＰ组患者优于手术组（Ｐ＜０．０１）。有效率ＣＰＡＰ组为９７％，手术组为４６％（Ｐ＜０．０１），最长暂停时间ＣＰＡＰ组缩短，手术组改变不显著，１０例延长。结论ＣＰＡＰ疗效肯定，优于ＵＰＰＰ，适应证广，可作为ＯＳＡＳ首选治疗     

Indications for treatment of obstructive sleep apnea in adults

Obstructive sleep apnea is associated with significant daytime sleepiness, reduced quality of life, insulin resistance, motor vehicle crashes, vascular morbidity and mortality. Current evidence supports the belief that all these parameters can be impacted favorably by treatment. Medical therapy with positive pressure eliminates snoring and favorably affects daytime sleepiness, driving risk, vascular function, vascular risk, and quality of life. Treatment may be difficult to accept or adhere to, and some treatment options are not uniformly effective. The long-term impact of treatment is uncertain.     

持续气道正压通气对老年阻塞性睡眠呼吸暂停患者心脑血管事件的影响

目的 探讨持续气道正压通气(CPAP)治疗对老年阻塞性睡眠呼吸暂停综合征(OSAS)患者心脑血管事件的远期作用.方法 采用前瞻性队列研究对2000至2006年间诊断为中重度OSAS的老年患者进行随访,共纳入106例患者,其中男91例(85.8%),女 15 例(14.2%),年龄60～86岁,平均(73±6)岁,其中坚持进行CPAP治疗者34例,对照组72例,比较CPAP治疗与未治疗2组的心脑血管事件发生率.结果 全部受访的老年中重度OSAS患者接受随访平均观察时间3.5年,到随访结束,CPAP治疗组心脑血管事件的发生率为12%(4/34),对照组为47%(34/72),差别有统计学意义(P<0.001).经Kaplan-Meier生存分析结果显示,随访时间越长,对照组发生心脑血管事件的风险明显高于治疗组(χ2=17.0,P<0.01),是否接受CPAP治疗与心脑血管事件发生呈正相关.结论 合并中重度OSAS的老年心血管疾病患者在接受基础疾病治疗的同时,采用CPAP治疗睡眠呼吸暂停,可以减少心脑血管事件发生的风险,从而利于改善预后.     

CPAP treatment in REM-related obstructive sleep apnea: a distinct clinical phenotype of sleep disordered breathing

Sleep and Breathing - REM-related obstructive sleep apnea (REM-OSA), as defined using revised apnea-hypopnea index (AHI) criteria, might represent a specific OSA phenotype. However, there is a lack...     

Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment

Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.