Evaluation of Continuous Positive Airway Pressure Therapy on Renin–Angiotensin System Activity in Obstructive Sleep Apnea

Nicholl, David D M; Hanly, Patrick J.; Poulin, Marc J.; Handley, George B.; Hemmelgarn, Brenda R.; Sola, Darlene Y.; Ahmed, Sofia B.

doi:10.1164/rccm.201403-0526oc

Cited by 105 publications

(90 citation statements)

References 68 publications

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“…92 The investigators examined the role of the renin-angiotensin system in OSA-related loss of kidney function. Renal hemodynamics were measured at baseline and in response to angiotensin II infusion (3 or 6 ng/kg/min × 30 min), pre and post 1 month of continuous positive airway pressure (CPAP) therapy.…”

Section: Hypertensionmentioning

confidence: 99%

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Abuyassin

Sharma

Ayas

et al. 2015

Journal of Clinical Sleep Medicine

114

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Section: Hypertensionmentioning

confidence: 99%

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Abuyassin

Sharma

Ayas

et al. 2015

Journal of Clinical Sleep Medicine

114

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“…A week of nocturnal CPAP reduced glomerular hyperfiltration in 24 men with moderately severe OSA (100), while two studies involving ultrasonographic evaluation of the renal circulation in OSA subjects, showed a significant improvement in intra-renal haemodynamics after initiation of CPAP (101,102). These changes may be attributable to alterations in RAS activity following commencement of CPAP therapy; Nicholl et al measured changes in renal plasma flow response to infused angiotensin II as an indirect measure of the intrarenal RAS before and after one month of CPAP therapy in 20 patients, finding that CPAP use was associated with reduced circulating aldosterone levels and reduced overall intra-renal RAS activity (103). Overall, a growing body of evidence suggests that OSA may directly and indirectly contribute to the decline of kidney function, and that CPAP therapy may at least partially ameliorate this decline, although further interventional studies examining the effect of CPAP on longitudinal outcomes are required.…”

Section: Effect Of Cpap On Renal Functionmentioning

confidence: 99%

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Gildeh¹,

Drakatos²,

Higgins³

et al. 2016

J. Thorac. Dis.

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Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.

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“…38 Endothelial dysfunction is known to play a central role in the development of atherosclerosis and is associated with cardiovascular risk factors. 39 Nich-oll et al 40 reported that CPAP therapy had a correlation with down-regulation of renal renin-angiotensin system activity. A randomized controlled study also showed that CPAP significantly reduced plasma aldosterone concentration in subjects with OSA and hypertension.…”

Section: Possible Mechanism Of Cpap On Blood Pressurementioning

confidence: 99%

Beneficial Effects of Long-Term CPAP Treatment on Sleep Quality and Blood Pressure in Adherent Subjects With Obstructive Sleep Apnea

et al. 2015

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BACKGROUND: Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular diseases. Although CPAP is the first treatment choice for moderate-to-severe OSA, acceptance of and adherence to CPAP remain problematic. High CPAP adherence is generally defined as >4 h of use/night for >70% of the nights monitored. We investigated the long-term beneficial effects of CPAP on sleep quality and blood pressure in subjects with moderate-to-severe OSA according to high or low CPAP adherence. METHODS: We retrospectively analyzed 121 subjects with moderate-to-severe OSA from August 2008 to July 2012. These subjects were divided into 3 groups: (1) no CPAP treatment (n ‫؍‬ 29), (2) low CPAP adherence (n ‫؍‬ 28), and (3) high CPAP adherence (n ‫؍‬ 64). All subjects were followed up for at least 1 y. The 3 groups were compared regarding anthropometric and polysomnographic variables, presence of cardiovascular comorbidities, and blood pressure at baseline and at the last follow-up. RESULTS: The no-treatment group showed significant increases in oxygen desaturation index and blood pressure. The high-adherence group showed significant improvement in daytime sleepiness, apnea-hypopnea index (AHI), oxygen desaturation index, and blood pressure. Although the AHI was also significantly decreased after CPAP treatment in the lowadherence group, blood pressure remained unchanged. CONCLUSIONS: CPAP treatment had beneficial effects on both sleep quality and blood pressure only in subjects with OSA and high CPAP adherence who used CPAP for >4 h/night for >70% of nights monitored. Subjects with low CPAP adherence received beneficial effects on AHI, but not blood pressure.

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Evaluation of Continuous Positive Airway Pressure Therapy on Renin–Angiotensin System Activity in Obstructive Sleep Apnea

Abstract: CPAP therapy was associated with improved renal hemodynamics and down-regulation of renal RAS activity, suggesting a potential therapeutic benefit for kidney function.

Cited by 105 publications

References 68 publications

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer

Beneficial Effects of Long-Term CPAP Treatment on Sleep Quality and Blood Pressure in Adherent Subjects With Obstructive Sleep Apnea

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