Continuous Positive Airway Pressure Treatment

Abstract

The principal nocturnal GH peak normally coincides with the first episode of slow wave sleep (SWS). Obstructive sleep apnea (OSA) patients have low nocturnal GH levels which may be explained by their poor quality fragmented sleep but other factors are possibly involved. Obesity is frequently associated with OSA, and obese patients also manifest reduced GH secretion. The mechanisms reducing GH levels in obese subjects are not understood, but hyperinsulinaemia is a suggested factor. In this study nocturnal plasma and secretory GH profiles of OSA patients were examined in relation to the quality and quantity of sleep, together with plasma glucose and insulin levels. Eight OSA patients, (BMI 32.7 +/- 2.3 kg/m2), underwent 2 night studies. For one night no treatment was given and for the other continuous positive airway pressure (CPAP) treatment was administered for the first time. Blood was collected continuously throughout each night and plasma GH, insulin and glucose profiles established in 10 min interval samples. From the plasma data a deconvolution model was used to calculate GH secretion rates. Sleep was recorded during the studies. For the non-treatment night GH levels were low and increased significantly with treatment, p = 0.008 for plasma levels and p = 0.02 for secretion rates. Treatment significantly decreased the cumulative apnea duration and increased the quantity of SWS and Rapid Eye Movement (REM) sleep (p = 0.008), but the mean insulin and glucose profiles did not differ between the two nights. Individual GH plasma and secretion rates, on treatment, showed a tendency to correlate with the amount of SWS (p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

Sleep Apnea and Daytime Sleepiness and Fatigue: Relation to Visceral Obesity, Insulin Resistance, and Hypercytokinemia

“…The independent effects of these disturbances could be explained by microawakening-and/or hypoxia-related nocturnal increases in sympathetic system and hypothalamic-pituitary-adrenal axis activities. The fact that two previous studies showed no effect of treatment of apnea on insulin levels may be due either to the short term assessment of these effects (27,28) or to the fact that the currently available treatments for sleep apnea are not effective in reversing the metabolic manifestations of this disorder, particularly when the disorder has existed for several years and has led to an adverse and probably irreversible redistribution of fat.…”

The impact of sleep on age-related sarcopenia: Possible connections and clinical implications

“…In fact, OSA treatment with CPAP significantly increases GH release and IGF-1 levels (Cooper et al, 1995;Saini et al, 1993;Hoyos et al, 2014). However, the interaction between sleep and GH release may be bidirectional, with low somatotropic function having a negative impact on sleep.…”

The Roles of Time of Day and Sleep Quality in Modulating Glucose Regulation: Clinical Implications

“…Indeed, alterations in carbohydrate metabolism and insulin sensitivity may be aggravated in the presence of sleep apnea syndrome, a prevalent condition in the obese population [59, 60]. A few studies have examined nocturnal hormonal release in patients with obstructive apnea [61, 62] and showed a marked decrease in nocturnal GH release which may be partially reversed by treatment with continuous positive airway pressure. While the restoration of GH secretion in early sleep was not associated with significant changes in overnight glucose and insulin levels, the possibility of an improvement in daytime insulin sensitivity remains to be investigated.…”