Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications

Abstract

R Re ed du uc ct ti io on n i in n s sy ym mp pa at th he et ti ic c a ac ct ti iv vi it ty y a af ft te er r l lo on ng g--t te er rm m C CP PA AP P t tr re ea at tm me en nt t i in n s sl le ee ep p a ap pn no oe ea a: : c ca ar rd di io ov va as sc cu ul la ar r i im mp pl li ic ca at ti io on ns s It is concluded that obstructive sleep apnoea is associated with high sympathetic activity both during sleep and waking periods. Urinary metanephrine excretion seemed to reflect blood pressure, but neither daytime nor night-time catecholamine excretion was directly related to disease severity in patients with severe obstructive sleep apnoea. In spite of a marked reduction of catecholamine excretion at followup, BP and cardiac structure remained unchanged. Although increased sympathetic activity may act as a contributory trigger for cardiovascular disease in sleep apnoea, a reduction of activity after nasal CPAP is not associated with changes in blood pressure or cardiac structure.

Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity

“…Several experimental and clinical studies have shown that nocturnal hypopnea induces increases in blood pressure levels 6,19 and the progression of arterial stiffness. 18,19 Endothelial dysfunction 4,[20][21][22] and disturbances of sympathetic activity 5,23 are recognized clinical features in OSA patients that increase vascular tone and accelerate the progression of arterial stiffness. 7 Chronic intermittent hypoxia causes dyslipidaemia and initiates the development of atherosclerosis, both of which contribute to arterial stiffness.…”

“…1,2 Atherosclerosis is a progressive disease that is also a pivotal risk factor for these cardiovascular disorders. OSA induces systemic HT, inflammation, 3 endothelial dysfunction 4 and disturbances in sympathetic activity, 5 all of which are known to accelerate the development of atherosclerosis. It has been shown that continuous positive airway pressure (CPAP) treatment improves these risk factors for atherosclerosis.…”

“…It has been shown that continuous positive airway pressure (CPAP) treatment improves these risk factors for atherosclerosis. [3][4][5][6] Arterial stiffness, an indicator of worsening atherosclerosis, has been shown in OSA patients, with the degree of arterial stiffness correlated with the severity of OSA. 7,8 Pulse wave velocity (PWV) reflects arterial stiffness associated with cardiac events, and thus the severity of atherosclerosis.…”

Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

“…In addition, many retrospective 4,6, 11 and which will not. 31 and most [22][23][24][25] but not all 21,26,27 prospective trials of Another less popular method of treating OSA is by therapy of OSA have demonstrated that its successavoiding sleeping in the supine position (positional ful treatment is associated with a fall in awake, therapy). 33 As shown by others, 34,35 and more sleeping and 24-h blood pressure (BP).…”

“…In addition, many retrospective 4,6,11 and which will not. 31 and most [22][23][24][25] but not all 21,26,27 prospective trials of Another less popular method of treating OSA is by therapy of OSA have demonstrated that its successavoiding sleeping in the supine position (positional ful treatment is associated with a fall in awake, therapy addition, the severity of these episodes; ie, their Polysomnographic (PSG) evaluations length, the magnitude of both the oxygen desatuAll the patients were referred to the Sleep Disorders rations and the arousal-related responses are usually Unit at the Loewenstein Rehabilitation Center worsened by sleeping on the back. 37 By avoiding the because of snoring complaints and/or a suspicion of supine position, these patients can relieve these dis-OSA.…”