Continuous positive airway pressure and diabetes risk in sleep apnea patients: A systemic review and meta-analysis

BackgroundThe study assessed the effect of continuous positive airway pressure (CPAP) therapy on the risk of developing type 2 diabetes by evaluating change in the homeostasis model assessment of insulin resistance (HOMA-IR) fasting blood glucose (FBG) and fasting insulin following CPAP treatment in non-diabetic patients and pre-diabetic with obstructive sleep apnea (OSA).MethodsMedline, PubMed, Cochrane, and EMBASE databases were searched until August 24, 2015. The analysis included randomized controlled trials (RCTs), two arm prospective studies, cohort studies, and retrospective studies. The primary outcome measure was change of HOMA-IR in pre-diabetic patients receiving CPAP treatment.ResultsTwenty-three studies were included with 965 patients who had OSA. Nineteen studies were prospective studies and four were RCTs. CPAP therapy resulted in a significant reduction in the pooled standard difference in means of HOMA-IR (− 0.442, P = 0.001) from baseline levels compared with the control group. Change in FBG and fasting insulin from baseline levels was similar for the CPAP and control groups. For RCT studies (n = 4), there was no difference in change in HOMA-IR or FBG levels from baseline between CPAP and control groups. The combined effect of RCTs showed that CPAP was associated with a significant reduction in change from baseline in fasting insulin than the control group (standardized diff. in means between groups = − 0.479, P value = 0.003).ConclusionThese findings support the use of CPAP in non-diabetic and pre-diabetic patients with OSA to reduce change of HOMA-IR and possibly reduce the risk of developing type 2 diabetes in this patient population.     

Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study

BackgroundThere is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE.MethodsMulti-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3–6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4 h/day) were compared with those with not adherent or those who had not been prescribed CPAP.ResultsValid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96–2.7; p = 0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07–15.1; p = 0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2–11.6; p = 0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05–1.02; p = 0.053).ConclusionsIn patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events.     

Weight loss and metabolic outcomes of bariatric surgery in men versus women — A matched comparative observational cohort study

BackgroundDespite the high prevalence of morbid obesity, the global frequency of bariatric surgery in men is significantly lower than in women. It is unclear if this is due to the perception of poorer outcomes in men.ObjectivesCompare weight loss and metabolic outcomes in men vs. women after bariatric surgery.SettingUniversity teaching hospital in North West England.MethodsWe performed an observational cohort analysis of 79 men matched to 79 women for baseline age (± 5 years), body mass index (BMI; ± 2 kg/m²), bariatric procedure (69 gastric bypass and 10 sleeve gastrectomy each), type 2 diabetes (33 each), and continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA; 40 each).ResultsOverall mean (95% confidence interval) reduction in BMI was 17.5 (15.7–19.4) kg/m² (P < 0.001) at 24 months. There was no significant difference between men and women in mean percentage excess BMI loss (65.8% vs. 72.9%) at 24 months. Likewise, there were significant reductions in blood pressure, glycosylated haemoglobin and total cholesterol-to-high density lipoprotein cholesterol overall but no significant gender differences. Postoperatively, 77.5% of men and 90.0% of women with OSA discontinued CPAP therapy (non-significant).ConclusionsWeight loss and metabolic outcomes after bariatric surgery are of similar magnitude in men compared to women. The use of bariatric surgery in eligible men should be encouraged.     

Long-term adherence to nasal continuous positive airway pressure therapy by hypertensive patients with preexisting sleep apnea

Background and objectiveAlthough positive screening for and treatment of obstructive sleep apnea (OSA) have been recommended for patients with cardiovascular problems, patient adherence to nasal continuous positive airway pressure (CPAP) therapy primarily for a cardiovascular concern is unknown. Therefore, this study aimed to determine the adherence to CPAP therapy by hypertensive patients with OSA after a screening test performed regardless of OSA-related symptoms.Subjects and methodsCPAP therapy was administered to 194 of the 1365 hypertensive patients who underwent the screening. The monthly dropout from CPAP therapy and the adequate use level (4 h every night, 70% days in a month) were assessed using the Kaplan–Meier analysis over a 3-year follow-up period.ResultsOf the patients, 106 (55%) refused or abandoned the therapy by the end of the follow-up period (adherence, 45%). An adequate use level was maintained by 76 patients (39%). Most of the patients’ background characteristics, including age, sex, Epworth sleepiness scale scores, and parameters obtained on polysomnography, were not related to adherence or adequate use level. The good-compliance level on the first visit after CPAP therapy introduction was most strongly related to adherence (95% CI, 0.05–0.32; p < 0.001) and adequate use level (95% CI, 0.06–0.33; p < 0.05). Fourth quartile of apnea hypopnea index value (greater than 67/h) was also related to adherence (95% CI, 0.21–0.98; p < 0.02) and adequate use level (95% CI, 0.19–0.88; p < 0.05).ConclusionsThe adherence and use level in this population may not be satisfactory but are comparable with those in previous sleep center reports treating symptomatic OSA patients. Thus, the present results would encourage hypertensive patients to undergo positive screening for OSA, regardless of OSA-related symptoms. However, an outcomes study with the same cohort is needed.     

Blood pressure changes after automatic and fixed CPAP in obstructive sleep apnea: relationship with nocturnal sympathetic activity

Treatment of obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) usually causes a reduction in blood pressure (BP), but several factors may interfere with its effects. In addition, although a high sympathetic activity is considered a major contributor to increased BP in OSA, a relationship between changes in BP and in sympathetic nervous system activity after OSA treatment is uncertain. This study was undertaken to assess if, in OSA subjects under no pharmacologic treatment, treatment by CPAP applied at variable levels by an automatic device (APAP) may be followed by a BP reduction, and if that treatment is associated with parallel changes in BP and catecholamine excretion during the sleep hours. Nine subjects underwent 24-h ambulatory BP monitoring and nocturnal urinary catecholamine determinations before OSA treatment and 2 months following OSA treatment by APAP (Somnosmart2, Weinmann, Hamburg, Germany). Eight control subjects were treated by CPAP at a fixed level. After APAP treatment, systolic blood pressure (SBP) decreased during sleep (p < 0.05), while diastolic blood pressure (DBP) decreased both during wakefulness (p < 0.05) and sleep (p < 0.02). Similar changes were observed in subjects receiving fixed CPAP. Nocturnal DBP changes were correlated with norepinephrine (in the whole sample: r = .61, p < 0.02) and normetanephrine (r = .71, p < 0.01) changes. In OSA subjects under no pharmacologic treatment, APAP reduces BP during wakefulness and sleep, similarly to CPAP. A reduction in nocturnal sympathetic activity could contribute to the reduction in DBP during sleep following OSA treatment.     

Effectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea

RationaleObesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity.ObjectiveTo determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups.MethodsPost hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI) ≥ 30 events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO₂ of 45–49.9 or ≥50 mmHg). Repeated measures of PaCO₂ and PaO₂ during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model.Results204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO₂ and PaO₂ were similar between CPAP and NIV based on the PaCO₂ severity subgroups.ConclusionIn ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO₂.     

Development and Validation of the OSA-CPAP Perceived Competence Evaluation Interview

IntroductionContinuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients’ levels of adherence with CPAP treatment.MethodsA questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated.Results5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r = .986; p < .001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173] = 8.097, p < .001); CPAP treatment information (t[173] = 15.170, p < .001); and CPAP use (t[173] = 14.642, p < .001). The final 12-item version was reliable (CRI = .793) and its internal structure was adequate (χ²[51] = 72.073; p = .027, CFI = .967, RMSEA = .020 [.000, .030]). Women had a better general knowledge of OSA (t[1,018] = 2.190, p = .029), CPAP treatment information (t[1,018] = 2.920, p = .004), and higher overall OSA-CPAP scores (t[1,018] = 3.093, p = .002). Scores were positively related to quality of life and motivation, adherence was positively related to CPAP use and monitoring, and the total score was negatively related to daytime sleepiness.ConclusionsThe interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.     

Effect of Continuous Positive Airway Pressure on Glucose and Lipid Profiles in Patients With Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and aimContinuous Positive Airway Pressure (CPAP) is the most effective therapy for symptomatic obstructive sleep apnoea (OSA). However, uncertainty remains about the effectiveness of CPAP in improving OSA-related metabolic dysregulation. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments, could improve glucose or lipid metabolism in OSA patients.MethodsRelevant articles were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 6th Feb 2022 through specific search terms and selection criteria.ResultsFrom a total of 5553 articles, 31 RCTs were included. CPAP modestly improved insulin sensitivity as determined by mean fasting plasma insulin and Homeostasis Model Assessment of Insulin Resistance reduction of 1.33 mU/L and 0.287, respectively. In subgroup analyses pre-diabetic/type 2 diabetic patients as well as those with sleepy OSA showed a greater response to CPAP. Regarding lipid metabolism, CPAP was associated with a mean total cholesterol reduction of 0.064 mmol/L. In subgroup analyses, the benefit was higher in patients that showed more severe OSA and oxygen desaturations at the baseline sleep study as well as in younger and obese subjects. Neither glycated haemoglobin nor triglycerides, HDL- and LDL-cholesterol were reduced by CPAP.ConclusionCPAP treatment may improve insulin sensitivity and total cholesterol levels in OSA patients but with low effect size. Our results suggest that CPAP does not substantially improve metabolic derangements in an unselected OSA population, but the effect may be higher in specific subgroups of OSA patients.     

Intra- and Inter-Physician Agreement in Therapeutic Decision for Sleep Apnea Syndrome

BackgroundLarge variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making between different sleep physicians in patients with AHI<40 events/h.MethodsSix experienced senior sleep specialists from different sleep centers of Spain were asked to make a therapeutic decision (CPAP treatment) based on anonymized recordings of patients with suspected OSA that has previously performed a sleep study. The clinical data was shown in an online database and included anthropometric features, clinical questionnaires, comorbidities, physical examination and sleep study results. Intra- and inter-observer decision-making were analyzed by the Fleiss’ Kappa statistics (Kappa).ResultsA total of 720 medical decisions were taken to analyze the agreement between sleep professionals. Overall intra-observer evaluation reliability was almost perfect (Kappa = 0.83, 95% CI, 0.75–0.90, p < 0.001). However, overall inter-observer concordance decreased to moderate agreement (Kappa = 0.46, 95% CI, 0.42–0.51, p < 0.001). Nevertheless, it was especially low when considering AHI < 15 events/h.ConclusionsThis study demonstrates a good intra-observer concordance in the therapeutic decision-making of different sleep physicians treating patients with low/moderate OSA. However, when analyzing inter-observer agreement the results were considerably worse. These findings underline the importance of developing improved consensus management protocols.     

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

IntroductionObstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR).MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5 h^?1.ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2 ± 6.0 vs. 1.9 ± 2.7 h^?1, p = .069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p = .232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation< 90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index.ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.     

Improving Heart Rate Variability in Sleep Apnea Patients: Differences in Treatment with Auto-titrating Positive Airway Pressure (APAP) Versus Conventional CPAP

The effect of positive airway pressure treatments in different modalities on the cardiovascular consequences of the disease in sleep apnea patients is still unclear. We aimed to compare auto-titrating positive airway pressure (APAP) and conventional continuous positive airway pressure (CPAP) in terms of improving heart rate variability (HRV) in obstructive sleep apnea patients. This was a prospective study done in a tertiary research hospital. All patients underwent a manual CPAP titration procedure to determine the optimal pressure that abolishes abnormal respiratory events. Then patients underwent two treatment nights, one under APAP mode and one under conventional CPAP mode with a 1-week interval. Forty newly diagnosed obstructive sleep apnea patients were enrolled in the study. We compared heart rate variability analysis parameters between the APAP night and the CPAP night. This final analysis included the data of 28 patients (M/F: 22/6; mean age = 46 ± 10 years). Sleep characteristics were comparable between the two treatment nights, whereas all-night time domains of HRV analysis such as HF, nuLF, and LF/HF were different between APAP and CPAP nights (2.93 ± 0.31 vs. 3.01 ± 0.31; P = 0.041; 0.75 ± 0.13 vs. 0.71 ± 0.14; P = 0.027; and 4.37 ± 3.24 vs. 3.56 ± 2.07; P = 0.023, respectively). HRV analysis for individual sleep stages showed that Stage 2 LF, nuLF, nuHF, LF/HF parameters entirely improved under CPAP treatment whereas APAP treatment resulted in nonsignificant changes. These results suggest that despite comparable improvement in abnormal respiratory events with APAP or CPAP treatments, CPAP may be superior to APAP in terms of correcting cardiovascular alterations in sleep apnea patients.     

The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome

ObjectiveMetabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS.MethodsEighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) ≥15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters.ResultsFifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS?OSA). Compared with MS?OSA patients, MS+OSA patients had higher levels of IMT (661 ± 117 vs. 767 ± 140 μm), PWV (9.6 ± 1.0 vs. 10.6 ± 1.6 m/s), and CD (6705 ± 744 vs. 7811 ± 862 μm) (P < 0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R² = 0.42); AHI and systolic blood pressure (R² = 0.38); and AHI, age, abdominal circumference and systolic blood pressure (R² = 0.45), respectively. The R² of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively.ConclusionsOSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.     

Prevalence of masked and nocturnal hypertension in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is considered as a risk factor for the development and worsening of compensation of arterial hypertension and other cardiovascular diseases. Prevalence of masked and nocturnal hypertension can have a significant negative impact on these patients and these prevalences are not well known.AimTo evaluate the prevalence of masked and nocturnal hypertension in patients with OSA.Materials and methodsIn this study, 97 (88 men) patients were enrolled, average age 53.9 ± 9.7 years. OSA was diagnosed with polysomnography and the continuous positive airway pressure therapy has been indicated according to current guidelines. Then were evaluated parameters of OSA (apnea-hypopnea index (AHI), oxygen desaturation index (ODI), % of sleep time <90% SpO₂, average night SpO₂). Patients also underwent physical examination including office blood pressure measurement, 24 h blood pressure monitoring (ABPM) and measurement of anthropometric parameters.ResultsFollowing average values were present in OSA patients (mean value and standard deviation): AHI 54.6 ± 22.7, ODI 58.3 ± 24, % of sleep time < 90% SpO₂ 35.4 ± 25.1, average night SpO₂ 88.8 ± 5. Masked hypertension was present in 55 (56.7%) patients, nocturnal hypertension in 79 (81.4%) patients. Arterial hypertension was appropriately compensated in only 15 (15.5%) patients. Results have not shown any statistically significant correlation between prevalence of nocturnal hypertension and AHI (p = 0.059), % of sleep time <90% SpO₂ (p = 0.516), average night SpO₂ (p = 0.167). ODI was significantly higher in patients with nocturnal hypertension (p = 0.002). No correlation between prevalence of masked hypertension and AHI (p = 0.841), ODI (p = 0.137), average night SpO₂ (p = 0.991) and % of sleep time <90% SpO₂ (p = 0.896) has been present.ConclusionThis study has demonstrated high prevalence of masked and nocturnal hypertension in patients with OSA, which can considerably increase risks of cardiovascular diseases in these patients.     

Association between obstructive sleep apnea and premature supraventricular contractions

ObjectiveThe exact association between obstructive sleep apnea (OSA) and premature supraventricular contractions (PSVCs) has not been established.MethodsWe prospectively performed polysomnography together with 24-hour Holter electrocardiography in 431 patients who were clinically suspected of having OSA and examined the association between OSA severity and PSVCs during wakefulness and sleep. The patients were classified into 4 groups according to the apnea–hypopnea index (AHI) quartiles (Q1 = patients with AHI < 13.8, Q2 = those with 13.8 ≤ AHI < 28.8, Q3 = those with 28.8 ≤ AHI < 48.1, Q4 = those with AHI ≥ 48.1).ResultsThe number of PSVCs/hour during sleep differed significantly among the 4 groups, but the number of PSVCs/hour during wakefulness did not. The prevalence of PSVC ≥ 5/hour during sleep was significantly higher in Q4 (21.0%) than the other 3 groups (Q1, 9.0%; Q2, 8.0%; Q3, 6.0%; all p < 0.05 for Q4), but the prevalence of PSVC ≥ 5/hour during wakefulness did not differ among the 4 groups. A multivariate logistic regression analysis showed that the highest AHI quartile was significantly associated with PSVC ≥ 5/hour during sleep (odds ratio 3.04, 95% confidence interval 1.44–6.42, p = 0.004).ConclusionsSevere OSA can cause PSVCs during sleep, but its effect appears not to be strong. Further studies are needed to clarify the clinical significance of this small but significant increase in PSVCs during sleep in severe OSA patients.     

Analysis of arterial hypertension pharmacotherapy in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is often connected with arterial hypertension and it could also be a cause of secondary hypertension. Treatment of arterial hypertension and optimal blood pressure level are important for prevention of cardiovascular complications. It is not well known how to treat patients with OSA and arterial hypertension. Also many patients with OSA suffer from metabolic syndrome which worsen their prognosis.AimThe aim of our study was to assess arterial hypertension compensation in patients with metabolic syndrome and moderate to severe OSA and to analyze used pharmacotherapy.Materials and methods85 hypertensive patients (75 men) with metabolic syndrome, average age 53.6 ± 9.3 years, were evaluated using overnight sleep study with diagnosis of OSA, average apnea–hypopnea index (AHI) 56.3 ± 23. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and their current pharmacotherapy data were obtained. Appropriate combinations of antihypertensive drugs (patients with metabolic syndrome) were derived from ESH/ESC 2013 guidelines.ResultsArterial hypertension was well compensated in only 11.8% of the patients. 24.7% patients were treated according to current guidelines. Fisher's exact test with analysis of adjusted residues has found higher rate of blood pressure subcompensation in patients treated with triple+ combination of drugs (p = 0.035, 51.4% vs 10%).ConclusionOnly a small number of patients had optimal blood pressure level and were treated according to current ESH/ESC guidelines. We have to constantly appeal to all physicians to perform ABPM in patients with OSA.     

Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study

IntroductionNon invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild–moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC + CPAP initiates early lower mortality and endotracheal intubation (ETI) rates.MethodsSubjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC + CPAP (first 24 h, EHC group) and Delayed HFNC + CPAP (after 24 h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables.ResultsThe median age of the 760 included patients was 57 (IQR 47–66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1–3) and 46.8% were obese. The median PaO₂/FiO₂ upon IRCU admission was 95 (IQR 76–126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p = 0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p = 0.002).ConclusionsParticularly in the first 24 h after IRCU admission, the HFNC + CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.     

Current child,but not maternal,snoring is bi-directionally related to adiposity and cardiometabolic risk markers: A cross-sectional and a prospective cohort analysis

PurposeObstructive sleep apnea (OSA), typically manifested as snoring, is closely associated with obesity. However, the directionality of associations of OSA with cardiometabolic risk markers is unclear, as obesity increases risk for OSA, and OSA results in excess weight gain and its metabolic consequences. Less is known about how obesity and OSA may relate in children and adolescents and whether maternal OSA may influence the development of obesity and cardiometabolic dysfunction in offspring.Basic ProceduresAmong 1078 children from the Project Viva cohort, we examined cross-sectionally and prospectively associations of parent-reported child or maternal snoring with cardiometabolic outcomes, including adiposity, adipokines, and insulin resistance.Main FindingsCross-sectionally, child snoring was related to adiposity and metabolic risk, particularly body mass index (BMI; β 0.61 kg/m², 95% CI 0.33, 0.89; p < 0.001), trunk fat mass index (β 0.23 kg/m², CI 0.12, 0.34; p < 0.001), high-density lipoprotein cholesterol (β − 1.47 mg/dL, CI − 2.69, − 0.25; p = 0.02), and metabolic risk z-score (β 0.08, CI 0.02, 0.14; p = 0.01) after correction for covariates. Prospectively, adiposity (BMI, trunk fat, fat mass, and waist circumference) and cardiometabolic (leptin, HOMA-IR, CRP, and global metabolic risk) measures at mid-childhood (~ 7 y) were associated with child snoring at the early teen visit (~ 12 y) after correction for covariates. Child snoring at ~ 9 y was related to changes in adiposity between mid-childhood and early teen visits.ConclusionsChild but not maternal snoring, was related to child adiposity and cardiometabolic outcomes. Adiposity and child snoring are associated with each other cross-sectionally and are each predictive of the other among children/adolescents prospectively. These results suggest similar mechanisms in pediatric/adolescent populations as in adults for the development of sleep-disordered breathing and sleep apnea that will need to be confirmed in randomized clinical trials. Importantly, this research points to the need to target both sleep and obesity in order to break this vicious cycle.     

Impact of obstructive sleep apnea in recruitment of coronary collaterality during inaugural acute myocardial infarction

BackgroundObstructive sleep apnea (OSA) may lead to myocardial preconditioning by increasing coronary collateral vessel recruitment in patients with acute coronary occlusion.AimTo determine the relationship between the severity of obstructive sleep apnea and coronary collaterality during acute myocardial infarction.MethodsThis study prospectively included 71 patients with an inaugural myocardial infarction who had undergone a coronary angiography within 24 h of onset. All patients underwent an overnight polygraph before discharge and were classified according to the apnea–hypopnea index (AHI). Coronary collaterals were scored by visual analyses and according to the Rentrop grading system.ResultsMean age was 59 ± 11 years and 83% of patients were men. All patients had complete or subtotal occlusion of the infarct-related artery. After the sleep study, patients were divided into two groups: 25 were suffering from OSA (AHI > 15/h). Patients with OSA showed better collateral vessel development (Rentrop score ≥ 1) compared to non-OSA patients (68 vs. 41%, P = 0.032). AHI was significantly higher in patients with developed coronary collaterals (Rentrop ≥ 1) compared to those without collaterality (17.74 ± 13.2 vs. 12.24 ± 10.9, P = 0.025).ConclusionCoronary collateral development may be increased in OSA patients who are presenting with a first myocardial infarction.     

阻塞性睡眠呼吸暂停患者持续正压通气治疗前后自主神经 …

目的 研究阻塞性睡眠呼吸暂停（ＯＳＡ）患者夜间睡眠时自主神经功能的状态，以及有效的持续正压通气治疗对自主神经张力的影响。方法 对５６例重度ＯＳＡ患者持续正压通气（ＣＰＡＰ）治疗前和治疗中进行夜间７小时多导睡眠图（ＰＳＧ）及动态心电图监测，另择３０名正常受试者作为对照。采用心率功率谱分析法（ＨＲＰＳＡ）定量分析ＯＳＡ患者治疗前后夜间自主神经功能的变化。结果 ＯＳＡ组夜间睡眠时伴随着反复的呼吸暂停和低     

Prevalence of obstructive sleep apnoea in acute coronary syndrome: Routine screening in intensive coronary care units

IntroductionIncreased evidence has shown that, despite the maximum care afforded to patients admitted with acute coronary syndromes (ACS), a residual risk of mortality remains, in which obstructive sleep apnoea (OSA) appears to be a largely undiagnosed factor, particularly in the intensive cardiac care unit (ICCU). The purpose of this study is to determine whether the systematic screening for sleep-disordered breathing (SDB) is feasible and may be recommended. The aims of our study are to determine: (1) The estimated prevalence of OSA in patients admitted to the ICCU for ACS determined by a validated, user-friendly portable screening device; (2) The feasibility of the screening in this context; (3) To assess any negative impact of OSA on the severity of ACS.Patients and methodsThis is an observational study of 101 patients admitted to the ICCU for ACS showing no clinical evidence of heart failure (HF). In the 24–72 hours following admission, they underwent an overnight sleep study using a 3-channel portable screening device with automatic analysis.ResultsSixty-two out of the 101 patients proved positive to the screening test, and its feasibility was acceptable. OSA patients tended to have greater peak levels of hs-cTnT (3685 ± 3576 ng/L versus 2830 ± 3333 ng/L, P = 0.08) than the non-OSA group. Compared with the non-OSA group, OSA patients presented more severe ACS, with a greater average GRACE score at admission of 112.2 ± 26.3 (versus 98.4 ± 19.2, P < 0.001). In the OSA group, we found a statistically significant inverse correlation between the apnoea-hypopnea index (AHI) and the left ventricular ejection fraction (LVEF) in the linear regression analysis (r = −0.26; P = 0.037).ConclusionsA systematic screening of patients in the ICCU is acceptable. OSA is frequently found in the acute phase of ischaemic heart disease and its presence is associated with more severe ACS and a poorer left ventricle systolic function.