Response to CPAP Withdrawal in Patients with Mild Versus Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Young, Laura R.; Taxin, Zachary; Norman, Robert G.; Walsleben, Joyce A.; Rapoport, David M.; Ayappa, Indu

doi:10.5665/sleep.2460

Cited by 51 publications

(40 citation statements)

References 23 publications

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“…Across these studies, subjects also differed in OSA severity or had variable exposures to PAP; some studies were underpowered. Also, the effects of short‐term PAP withdrawal on cardiovascular measures only have been characterized in a few studies,19, 20 though its effects on sleep architecture and obstructive event rates indicate a rapid return to almost baseline values 21…”

Section: Introductionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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BackgroundThe cardiovascular effects of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients are not clear because of confounding by comorbid conditions.Methods and ResultsProspective interventional study of PAP therapy and withdrawal. Apnea Hypopnea Index (AHI; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (BPs), Aortic Augmentation Index (AAIx), and central (PWV c‐f) and peripheral pulse wave (PWV c‐r) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of PAP therapy, and 1 week after PAP withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5) AHI events/hour. After 4 weeks post‐PAP initiation and sustained after 12 weeks, subjects experienced decreases in central systolic BP (P=0.008), diastolic BP, mean BP, AAIx, and PWV c‐r, and brachial artery dilation (all P<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models, PAP use (hours/night) predicted reductions in diastolic BP (β=−0.65 [SE, 0.32] mm Hg/hour; P=0.045), AAIx (β=−0.53 [0.27] %/hour; P=0.049) and PWV c‐r (β=−0.13 [0.05] m·s−1/hour; P=0.007), and improved brachial artery flow‐mediated dilation (β=0.31 [0.14] %/hour use; P=0.015). After 1 week of PAP withdrawal, brachial diameter, diastolic BP, mean BP, AAIx, and heart rate increased (P≤0.05).Conclusions PAP therapy reduces arterial tone and improves endothelial and diastolic function in young to middle‐aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with PAP withdrawal.Clinical Trial RegistrationURL: https://clinicaltrials.gov/. Unique identifier: NCT01317329.

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Section: Introductionmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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“…3,4,28 Based on the evidence, even one night of missing CPAP usage may cause reoccurrence of more apneas and hypopneas and increased daytime sleepiness. 3,18 Reinforcement of teaching by a perioperative nurse on the day of surgery may have provided benefits. 16 This allowed the patient to hear the key points of the education again.…”

Section: Discussionmentioning

confidence: 99%

“…4,11 CPAP continuously blows air under pressure into the mask when the person breathes. 3,4,7,18 This prevents the collapse of the upper airway during sleep in patients with OSA. 3,7 There is high quality evidence that shows CPAP reduces AHI during sleep, improves daytime cognition, helps control systemic blood pressure and blood glucose, and increases quality of life.…”

Section: Background and Evidencementioning

confidence: 99%

Obstructive Sleep Apnea: Emphasis on Discharge Education After Surgery

Nazareno

Newsom²,

Lee³

et al. 2017

Journal of PeriAnesthesia Nursing

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In the United States, the prevalence of obstructive sleep apnea (OSA) in the adult population is increasing. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. The American Society of Perianesthesia Nurses recommends that discharge education (DCE) on OSA should be provided after surgery to patients diagnosed with OSA to promote continuous positive airway pressure (CPAP) compliance and self-care behaviors at home. However, CPAP adherence is poor. The purpose of this evidence-based practice project is to evaluate the effectiveness of DCE on OSA for increasing CPAP compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

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“…Apnea-hypopnea index (AHI4%) was obtained from the total of obstructive and central apneas and all hypopneas divided by the total sleep or sleep stage time. 33 We defined sleep-disordered breathing (SDB) as "mild" for AHI4% values between 5 and 15/h, as "moderate" for AHI4% values above 15/h and below 30/h, and as "severe" for AHI4% values above 30/h.…”

Section: Respiratory Eventsmentioning

confidence: 99%

“…30 We classified respiratory events as: 31 • Obstructive sleep apnea for airflow reduction of > 90% from baseline with continued or increased inspiratory effort 30,32 • Central sleep apnea for airflow reduction of > 90% from baseline without respiratory effort 30 • Hypopnea for any visible significant air flow reduction (> 30% decrease in airflow) associated with ≥ 4% desaturation ("preferred" AASM definition) 32,33 The apnea indices (total-AI, obstructive-oAI and central-cAI) and hypopnea index (HI) were obtained by the count of the respective apneas or hypopneas divided by total sleep or sleep stage time. Apnea-hypopnea index (AHI4%) was obtained from the total of obstructive and central apneas and all hypopneas divided by the total sleep or sleep stage time.…”

Section: Respiratory Eventsmentioning

confidence: 99%

Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia

Hilz

Moeller

Buechner

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives:In familial dysautonomia (FD) patients, sleep-disordered breathing (SDB) might contribute to their high risk of sleep-related sudden death. Prevalence of central versus obstructive sleep apneas is controversial but may be therapeutically relevant. We, therefore, assessed sleep structure and SDB in FD-patients with no history of SDB. Methods: 11 mildly affected FD-patients (28 ± 11 years) without clinically overt SDB and 13 controls (28 ± 10 years) underwent polysomnographic recording during one night. We assessed sleep stages, obstructive and central apneas (≥ 90% air flow reduction) and hypopneas (> 30% decrease in airflow with ≥ 4% oxygen-desaturation), and determined obstructive (oAI) and central (cAI) apnea indices and the hypopnea index (HI) as count of respective apneas/hypopneas divided by sleep time. We obtained the apnea-hypopnea index (AHI4%) from the total of apneas and hypopneas divided by sleep time. We determined differences between FD-patients and controls using the U-test and within-group differences between oAIs, cAIs, and HIs using the Friedman test and Wilcoxon test. Results: Sleep structure was similar in FD-patients and controls. AHI4% and HI were significantly higher in patients than controls. In patients, HIs were higher than oAIs and oAIs were higher than cAIs. In controls, there was no difference between HIs, oAIs, and cAIs. Only patients had apneas and hypopneas during slow wave sleep. Conclusions: In our FD-patients, obstructive apneas were more common than central apneas. These findings may be related to FD-specific pathophysiology. The potential ramifications of SDB in FD-patients suggest the utility of polysomnography to unveil SDB and initiate treatment. Commentary: A commentary on this article appears in this issue on page 1583. Keywords: familial dysautonomia, hereditary sensory and autonomic neuropathy type III, obstructive sleep apnea, sleep-disordered breathing Citation: Hilz MJ, Moeller S, Buechner S, Czarkowska H, Ayappa I, Axelrod FB, Rapoport DM. Obstructive sleep-disordered breathing is more common than central in mild familial dysautonomia.

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Response to CPAP Withdrawal in Patients with Mild Versus Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Abstract: Young LR; Taxin ZH; Norman RG; Walsleben JA; Rapoport DM; Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. SLEEP 2013;36(3):405-412.

Cited by 51 publications

References 23 publications

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Obstructive Sleep Apnea: Emphasis on Discharge Education After Surgery

Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia

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