BACKGROUNDObstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. METHODSAfter a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-tosevere obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. RESULTSMost of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P = 0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. 920T h e ne w e ngl a nd jou r na l o f m e dicine O bstructive sleep apnea causes episodic hypoxemia and nocturnal sympathetic nervous system activation 1 and elevates blood pressure 2 and markers of oxidative stress, inflammation, and hypercoagulation. 3,4

Background-The purpose of this study was to determine the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for the development of left ventricular diastolic abnormalities. Moreover, we tested the hypothesis that nasal continuous positive airway pressure (nCPAP) improves such alterations in OSAS patients by eliminating apneic events. Methods and Results-In this prospective, randomized, placebo-controlled, double-blind crossover study, 27 consecutive newly diagnosed middle-aged OSAS men with neither controllable factors nor conditions affecting left ventricular diastolic function and 15 healthy control subjects were selected. OSAS patients were randomized to 12 weeks on sham nCPAP and 12 weeks on effective nCPAP application. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, an abnormal left ventricular filling pattern was present in 15 of the 27 OSAS patients and only in 3 of the 15 control subjects (Pϭ0.020). Impaired relaxation was by far the most common abnormal pattern in both groups (11 and 3 patients, respectively). In OSAS patients, 12 weeks on effective nCPAP induced a significant increase in E/A ratio (PϽ0.01), as well as reductions in mitral deceleration (PϽ0.01) and isovolumic relaxation (PϽ0.05) times. Conclusions-OSAS

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Daily physical activity of patients with COPD is mainly associated with dynamic hyperinflation, regardless of severity classification.

Excessive daytime sleepiness (EDS) is not invariably present in patients with obstructive sleep apnoea syndrome (OSAS). The aim of the present study was to investigate polysomnographic determinants of EDS in patients with OSAS.EDS was assessed using the Epworth Sleepiness Scale (ESS) and the multiple sleep latency test (MSLT). Patients showed EDS whenever the ESS score was .10 and the MSLT score ,5 min. Absence of EDS was defined as having an ESS score of ,10 and an MSLT score of .10 min.In total, 23 male patients with EDS (mean¡SD ESS and MSLT score 17¡3 and 4¡1 min, respectively) and 17 without EDS (ESS and MSLT score 5¡2 and 16¡3 min, respectively), were studied. Both groups exhibited a similar apnoea/hypopnoea index (62¡18 versus 60¡20 events?h The mechanisms whereby some patients with OSAS complain of EDS, whereas others do not, are unclear. Some authors have related it to the abnormal sleep structure of these patients (as assessed by the number of arousals during sleep) [2,7,8], but this has not been confirmed by others [9]. Likewise, studies that investigated a potential relationship between EDS and several indices of nocturnal oxygenation also yielded controversial findings [10,11].The aim of the present study was to investigate potential mechanisms of EDS in patients with OSAS. Contrary to previous studies, however, no attempt was made to establish relationships between all of these variables in patients with varying degrees of EDS. Instead, several polysomnographic variables were compared in two groups of patients demonstrating either the absolute absence or clear presence of EDS. It was reasoned that excluding patients with intermediate levels of EDS might help to unravel the nocturnal determinants of EDS in OSAS. METHODS SubjectsConsecutive male patients (n565) who attended the sleep unit of the Respiratory Dept of Son Dureta University Hospital (Palma de Mallorca, Spain) and were found, by full polysomonography, to have an apnoea/hypopnoea index (AHI) of .20 events?h -1 were initially included in the present study. In these subjects, the presence of EDS was diagnosed by considering the results of

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OSAHS patients with normal resting left ventricular systolic function and no hypertension had a worse cardiac response to exercise than healthy subjects. In these patients, 3 months of CPAP improved both Qt and SV responses to exercise.