Improving Heart Rate Variability in Sleep Apnea Patients: Differences in Treatment with Auto-titrating Positive Airway Pressure (APAP) Versus Conventional CPAP |
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Authors: | Levent Karasulu P?nar Özkan Epöztürk Sinem Nedime Sökücü Levent Dalar Sedat Alt?n |
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Institution: | 1. Sleep Disorders Unit, Yedikule Chest Disease and Thoracic Surgery Research and Education Hospital, ?stanbul, Turkey 2. Yedikule G??üs Hastal?klar? Hastanesi Uyku Klini?i, Yedikule, 34303, ?stanbul, Turkey
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Abstract: | 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. |
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