Can Nasal Continuous Positive Airway Pressure Decrease Clinic Blood Pressure in Patients with Obstructive Sleep Apnea?

Tun, Ye; Hida, Wataru; Okabe, Shinichi; Ogawa, Hiroyasu; Kikuchi, Yoshihiro; Oikawa, Manami; Kitamuro, Tomomi; Shirato, Kunio

doi:10.1620/tjem.201.181

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…Although it has been reported that intubation presents a greater difficulty in patients with a high BMI (Voyagis et al 1998;Mansharamani et al 2000;MacIntyre et al 2001;Wong et al 2004), respiratory complications (Asai et al 1998) and obstructive sleep apnea (Tun et al 2003) are observed more frequently, and the mortality rate is higher (Tremblay and Bandi 2003). To the best of our knowledge, the relationship between BMI and the CLT has not been pointed out in previous studies.…”

Section: Discussionmentioning

confidence: 84%

High Body Mass Index and Long Duration of Intubation Increase Post-Extubation Stridor in Patients with Mechanical Ventilation

Erginel

Uçgun

Yıldırım

et al. 2005

Tohoku J. Exp. Med.

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Approximately 20% of mechanically ventilated patients experience post-extubation stridor (PES) and reintubation, which subsequently may lead to an increased risk of morbidity and mortality. The risk of PES development is significantly higher in obese patients. Low air leakage between the endotracheal tube and the trachea, following cuff deflation, may indicate a higher risk for the development of PES. The aim of this study is to identify the relationship between body mass index (BMI) and PES using the cuff-leak test in patients intubated in the respiratory intensive care unit. A total of 67 consecutive intubations on 56 different ventilated patients were included in this study. The mean age was 63.6 ± 12.1 years and 84% of the patients were male. PES developed in seven patients (10.4%). The mean cuffleak volume was 395 ± 187 ml in non-PES patients and 240 ± 93 ml in PES patients (p = 0.023). The mean BMI was 36 ± 13 kg/m 2 in PES patients and 24 ± 7 kg/m 2 in non-PES patients (p = 0.046). BMI > 26.5 kg/m 2 (OR: 1.2), low cuff-leak volume (< 283 ml) and mechanical ventilation required for more than 5 days (OR: 0.9) were independent variables for PES occurrence. We therefore suggest that non-obese patients, short-term intubated patients and those having a high air leakage around the endotracheal tube could be extubated without much difficulty.intensive care unit; cuff-leak test; body mass index; post-extubation stridor; reintubation

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Section: Discussionmentioning

confidence: 84%

High Body Mass Index and Long Duration of Intubation Increase Post-Extubation Stridor in Patients with Mechanical Ventilation

Erginel

Uçgun

Yıldırım

et al. 2005

Tohoku J. Exp. Med.

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“…However, the approach of this study was similar to previous investigations [1,10], using sphygmomanometer-obtained clinic BP readings. In one study, a significant reduction in BP was found regardless of antihypertensive medication use in a group of 46 OSA patients (21 normotensive and 25 hypertensive) followed for 1 year.…”

Section: Discussionmentioning

confidence: 77%

“…This decrease in BP has been rather small [1][2][3][4][5][6] or rather substantial [7][8][9][10][11][12]. In addition, some studies showed an isolated decrease in systolic (SBP) [13,14,15] or diastolic blood pressure (DBP) [1-3, 11, 16].…”

Section: Introductionmentioning

confidence: 99%

Variables affecting the change in systemic blood pressure in response to nasal CPAP in obstructive sleep apnea patients

2007

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We hypothesized that an improvement in systemic blood pressure (BP) during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) would be related to severity of hypertension (HTN), morphometric parameters such as body mass index, and level of CPAP adherence. We tested this hypothesis with a retrospective review of 85 consecutive OSA patients who had completed diagnostic and CPAP titration polysomnograms and were equipped with a CPAP-adherence monitoring system for a minimum of 1 month of observation. Sphygmomanometer-obtained BP readings were compared at baseline and after 4-6 weeks of CPAP therapy. Presentation BP was significantly and strongly associated with the change in BP seen with treatment. Those with an elevated systolic and diastolic BP and those with an elevation of either systolic or diastolic BP showed a significant fall in BP on CPAP. Those with a BP below the hypertensive range of 140/90 on presentation did not have a significant drop in BP with CPAP. There were no significant changes in systolic, diastolic, or mean BP when patients were categorized by the severity of HTN, as determined by the number of antihypertensive medications prescribed or if they were categorized by the degree of CPAP adherence, objectively determined by the average use of more or less than 4 h/night. We conclude that HTN at initial presentation is among the most important indicators of potential benefit of CPAP administration on BP.

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“…In addition, it was shown that the cingulate cortex in subjects with OSA was less active than that in healthy subjects (35). Several studies have reported a reduction in nocturnal cardiac ischemic episodes and an improvement in daytime blood pressure levels and left ventricular function with long-term nasal CPAP (nCPAP) treatment (30,54). Furthermore, it has been shown that the treatment of OSA with an OA results in a significant reduction in hypertension (18), which is similar to that reported with nCPAP.…”

Section: Deactivation In Cortical and Subcortical Regions Associated mentioning

confidence: 99%

Effects of mandibular advancement on brain activation during inspiratory loading in healthy subjects: a functional magnetic resonance imaging study

Hashimoto¹,

Ono²,

Honda³

et al. 2006

Journal of Applied Physiology

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. Effects of mandibular advancement on brain activation during inspiratory loading in healthy subjects: a functional magnetic resonance imaging study. J Appl Physiol 100: 579 -586, 2006. First published September 29, 2005 doi:10.1152/japplphysiol.00169.2005.-Oral appliances have been a popular treatment option for subjects with obstructive sleep apnea. However, little information is available on how brain activation induced by respiratory challenge is modulated by mandibular advancement with these appliances. We hypothesized that the brain activation caused by respiratory stress may be alleviated by mandibular advancement. Respiratory stress was induced in 12 healthy subjects by resistive inspiratory loading. The effects of mandibular advancement during resistive inspiratory loading were assessed subjectively by using a visual analog scale. These effects were also evaluated objectively by using blood oxygenation level-dependent functional magnetic resonance imaging. The score for the visual analog scale significantly decreased with mandibular advancement. Cortical deactivation, in association with mandibular advancement, was localized to several specific regions, including the left cingulate gyrus and the bilateral prefrontal cortexes. These regions are known to be involved in respiratory control. Our results suggest that mandibular advancement with an oral appliance appears to be useful for reducing respiratory stress, based on both subjective and neuronal criteria.

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Can Nasal Continuous Positive Airway Pressure Decrease Clinic Blood Pressure in Patients with Obstructive Sleep Apnea?

Cited by 14 publications

References 25 publications

High Body Mass Index and Long Duration of Intubation Increase Post-Extubation Stridor in Patients with Mechanical Ventilation

High Body Mass Index and Long Duration of Intubation Increase Post-Extubation Stridor in Patients with Mechanical Ventilation

Variables affecting the change in systemic blood pressure in response to nasal CPAP in obstructive sleep apnea patients

Effects of mandibular advancement on brain activation during inspiratory loading in healthy subjects: a functional magnetic resonance imaging study

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