Continuous positive airway pressure effectively ameliorates arrhythmias in patients with obstructive sleep apnea-hypopnea via counteracting the inflammation

Wang, Xiaoting; Yue, Zhiyong; Liu, Zhenhua; Han, Jie; Li, Jianfeng; Zhao, Yongjun; Wang, Fumin; Tang, Minglu; Zhao, Gang

doi:10.1016/j.amjoto.2020.102655

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…In contrast, hypertension, pulmonary disease, and arrythmias (with the exception of atrial fibrillation) were associated with increased rates of surgery. Considering that treating OSA with CPAP is known to reduce blood pressure 37 and recurrence of arrythmias, 33 our results suggest that surgery for sleep apnea may be performed in the interest of optimizing health and reducing cardiovascular and pulmonary risk factors. The association seen in several other variables is more difficult to explain.…”

Section: Discussionmentioning

confidence: 78%

“…Particularly over an extended period of follow‐up, time‐varying models can account for changes in a patient’s current condition and their effects on the outcome of interest (in this case, undergoing surgery for OSA relief). Medical treatment of OSA has been shown to reduce morbidity and mortality and/or improve biomarkers associated with these conditions; thus, a new diagnosis of OSA may indicate a need for earlier surgery 33–38 . We limited the time‐varying feature set to avoid increasing model complexity, which limits the model’s applicability to new data by overfitting on the existing data.…”

Section: Methodsmentioning

confidence: 99%

“…Medical treatment of OSA has been shown to reduce morbidity and mortality and/or improve biomarkers associated with these conditions; thus, a new diagnosis of OSA may indicate a need for earlier surgery. [33][34][35][36][37][38] We limited the time-varying feature set to avoid increasing model complexity, which limits the model's applicability to new data by overfitting on the existing data. The time interval for the analysis began at the date that patients met inclusion criteria.…”

Section: Statistical Analysesmentioning

confidence: 99%

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Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

Cohen¹,

Howard²,

Jin³

et al. 2022

OTO Open

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Objective Determine risk factors for failure to receive surgical treatment among patients with obstructive sleep apnea. Study Design Population-based observational longitudinal cohort study. Setting Population-based database. Methods Multivariate analysis of 500,792 individuals with obstructive sleep apnea from Optum’s deidentified Clinformatics Data Mart database (2004-2018). Results Black race, increased age, diabetes, atrial fibrillation, obesity, and congestive heart failure were independently associated with a decreased rate of surgery for obstructive sleep apnea. Asian race, hypertension, arrhythmias other than atrial fibrillation, pulmonary disease, and liver disease were independently associated with an increased rate of surgery for obstructive sleep apnea. Conclusion Racial disparities in health outcomes related to health care access and in economic resources have an enormous impact on public health and social equity. We found differences in rates of surgery for obstructive sleep apnea based on race. These data are consistent with others demonstrating disparities in medical treatment of sleep apnea with positive pressure and underline a need for a change in awareness and treatment in these populations.

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Section: Discussionmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

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Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

Cohen¹,

Howard²,

Jin³

et al. 2022

OTO Open

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“…To be noticed, we can only say that CPAP can slightly reduce inflammation levels, but cannot prove whether it can be reduced to normal levels. A possible explanation for the mild reduction in CRP after CPAP therapy may be the existence of comorbidities such as obesity, arterial hypertension and diabetes in our included patients [ 43–45 ], whereas an RCT which only collected OSA free of any comorbidities reported a significant reduction in CRP [ 46 ]. These results suggested that the contributors to abnormal inflammation in OSA maybe not only OSA itself but also some comorbidities, and the latter may even mask the decrease in CRP after CPAP treatment [ 44 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

The causal relationships between obstructive sleep apnea and elevated CRP and TNF-α protein levels

Zhao

Tan

et al. 2022

Annals of Medicine

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Background Obstructive sleep apnea (OSA) and inflammation are closely related. This study aimed to evaluate the associations and causal effect between C-reactive protein (CRP) and tumour necrosis factor-alpha (TNF-α) levels andOSA. Methods Pooled analysis was conducted to compare the expression differences of CRP and TNF-α between OSA patients with different severity and controls, and between continuous positive airway pressure (CPAP) and non-CPAP interventions for OSA patients. Using published GWAS summary statistics, we conducted a bidirectional two-sample Mendelian Randomization (MR) to estimate the causal relationships between CRP and TNF-α levels and OSA risk. Effect estimates were evaluated using inverse-variance weighted (IVW) as primary method, and several other MR methods as sensitivity analysis. Results Both TNF-α (WMD [95%CI] = 5.86 [4.80–6.93] pg/ml, p < .00001) and CRP (WMD [95%CI] = 2.66 [2.15–3.17] mg/L, p < .00001), showed a significant increase in OSA patients compared with controls and this increasing trend was associated with OSA severity. Besides, compared to blank control (non-CPAP), CPAP treatment can reduce high TNF-α (WMD [95%CI]= −4.44 [−4.81, −4.07]pg/ml, p < .00001) and CRP (WMD [95%CI]= −0.91 [−1.65, −0.17] mg/l, p = .02) in OSA. Moreover, the primary MR analysis by IVW showed that OSA was the genetically predicted cause of elevated CRP (estimate: 0.095; 95% CI, [0.010–0.179]; p = .029) using six SNPs as the instrument variable, which were repeated by weighted median (estimate: 0.053; 95% CI, [0.007, 0.100]; p =.024) and MR RAPS (estimate: 0.109; 95% CI, [0.079, 0.140]; p = 1.98x10 −12 ). Besides, the causal effect from elevated CRP on increased OSA risk was almost significant by IVW (OR:1.053; 95% CI, [1.000, 1.111]; p = .053). However, there were no causal associations between TNF-α and OSA from both directions. Conclusions Increased CRP and TNF-α were associated with OSA severity and sensible to CPAP treatment. Also, OSA had a suggestive causal effect on elevated CRP.

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“…The relative risk of sudden cardiac death in OSA patients, especially untreated patients, is higher than in the general population [23,50]. It is caused by the influence of hypoxia on the induction of inflammatory reaction (activation of the transcription of pro-inflammatory factors: CRP, IL-6, TNF-a) and also by activation of the sympathetic system and the induction of oxidative stress, which affects the functioning of the circulatory system [51,52]. Up to 50% of patients with OSA may suffer from various types of arrhythmias, which include almost all types of supraventricular and ventricular arrhythmias [53].…”

Section: Discussionmentioning

confidence: 99%

The effect of CPAP therapy on heart rate variability in patients with obstructive sleep apnea

Grzęda-Hałon

Poręba

Gut

et al. 2022

Sleep Biol. Rhythms

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The aim of this study was to analyze the relationship between the initiation of CPAP therapy and HRV in patients with OSA. The study group consisted of 37 patients, aged 34–79 (mean 54.95 years) with OSA treated with CPAP. Two subgroups of patients were distinguished: less than severe (AHI < 30, n = 16) and severe OSA (AHI ≥ 30, n = 21). The second study was carried out around a month after the initiation of therapy. CPAP therapy caused the improvement in polysomnographic parameters, however, in most parameters in time and frequency analysis, there were no significant positive changes in parasympathetic tone. Moreover, in HRV time analysis, the reduced rMSSD and pNN50 parameters in the hours of night rest and rMSSD and SDSD during the 15-min N3 sleep period were noted. Especially, in the group with AHI ≥ 30, we observed significant decreases in rMSSD and pNN50 for the entire time. The changes were mainly for the night periods including the N3 sleep period, which is especially connected with sleep apnea (parameters: rMSSD, SDSD, and pNN50). In spectral analysis, the decrease in HF from the 15-min daily activity period and the N3 sleep period was observed. Inverse correlations were seen between the maximum, median, and mean positive airway pressure (PAP) and the change in rMSSD, SDNN, and SDSD, mainly during night hours and the N3 sleep period. Only in patients with AHI < 30 the increase in SDNN was observed in 15-min N3 sleep period. The beneficial increase in SDNN parameter from time analysis was observed only in one sleep period in less ill patients with OSA. The lack of significant changes was observed in the majority of the parameters of heart rate variability after initiation of CPAP therapy in a short observational time; however, the shift towards reduced HRV was observed in patients with AHI > 30, so the response to CPAP therapy may depends on the severity of the apnea. The results may suggest that a longer observational period is needed in such studies, and the problem is still not fully elucidated.

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Continuous positive airway pressure effectively ameliorates arrhythmias in patients with obstructive sleep apnea-hypopnea via counteracting the inflammation

Cited by 8 publications

References 14 publications

Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

Racial Disparities in Surgical Treatment of Obstructive Sleep Apnea

The causal relationships between obstructive sleep apnea and elevated CRP and TNF-α protein levels

The effect of CPAP therapy on heart rate variability in patients with obstructive sleep apnea

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