Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea

Patruno, Vincenzo; Aiolfi, S; Costantino, Giorgio; Murgia, R.; Selmi, Carlo; Malliani, Alberto; Montano, Nicola

doi:10.1378/chest.06-2192

Cited by 115 publications

(83 citation statements)

References 35 publications

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“…Indeed, several cross-sectional and prospective observational studies have yielded conflicting results on the association between CRP and sleep-disordered breathing as well as on the effect of c-PAP therapy on CRP levels (13,(23)(24)(25)(26). Similarly to our results, in a double-blind randomized controlled trial comparing therapeutic and subtherapeutic c-PAP, effective correction of CIH in obese subjects with moderate-to-severe OSA did not significantly change CRP levels from baseline (27).…”

Section: L I N I C a L M E D I C I N Esupporting

confidence: 56%

Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea

Perrini¹,

Cignarelli²,

Quaranta³

et al. 2017

JCI Insight

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Section: L I N I C a L M E D I C I N Esupporting

confidence: 56%

Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea

Perrini¹,

Cignarelli²,

Quaranta³

et al. 2017

JCI Insight

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“…Numerous clinical studies have reported high proportions (17-29%) of under-treated patients on autoCPAP and fixedpressure CPAP therapy [8,9,20,21]. It is possible that this occult residual OSA may explain some of the variable clinical outcomes associated with autoCPAP [6,22,23].…”

Section: Sleep-related Disordersmentioning

confidence: 99%

Residual sleep-disordered breathing during autotitrating continuous positive airway pressure therapy

Denotti¹,

Wong²,

Dungan³

et al. 2011

Eur Respir J

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Obstructive sleep apnoea (OSA) is often treated with autotitrating continuous positive airway pressure (autoCPAP) devices. Clinical and bench tests of these devices have suggested performance limitations. These studies do not indicate whether this is a failure to detect or a failure to respond to airway obstruction.In this randomised, crossover trial, 34 patients with moderate-to-severe OSA underwent polysomnography on two laboratory visits. The autoCPAP device was randomly set to a fixed subtherapeutic pressure (detection assessment) or autotitrating mode (response assessment). Airflow was measured both from the autoCPAP (autoCPAP flow) and directly from the nasal mask, and recorded on polysomnography. Apnoea/hypopnoea indices (AHIs) measured at the two sites and from the autoCPAP download report were compared.Regarding detection, the AHI measured from the nasal mask showed good agreement with the autoCPAP flow AHI, but agreement was lower with the autoCPAP report AHI. In autotitrating mode, there was significant misclassification of those with and without OSA (AHI o10 events?h -1

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“…One study looking at CPAP versus APAP in 40 patients showed that CPAP resulted in reductions in blood pressure and a measure of insulin resistance (HOMA-IR) while APAP did not [29]. A follow-up study by Patruno et al suggests that APAP results in greater sympathetic activation and lower cardiorespiratory coupling than CPAP [30].…”

Section: Apap As Treatment For Osamentioning

confidence: 99%

Advanced Positive Airway Pressure Modalities

Bierer¹,

Ryden

Aysola³

2015

Curr Sleep Medicine Rep

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Auto-adjusting positive airway pressure (PAP) devices are increasingly becoming the first line treatment for obstructive sleep apnea (OSA). More complex sleepdisordered breathing such as Cheyne-Stokes respirations and central sleep apnea related to heart failure as well as complex sleep-disordered breathing related to chronic hypoventilation syndromes may require the use of advanced positive airway pressure modalities such as automated servo ventilation (ASV) and volume targeted pressure limited ventilation. Identifying patients with complex sleep-disordered breathing that will benefit from treatment with advanced modalities remains an area of active investigation. A recent and surprising development found ASV to be associated with an increased risk of sudden cardiac death when used to treat central sleep apnea in patients with symptomatic systolic heart failure and an ejection fraction less than 45 %. The optimal treatment of central sleep apnea in heart failure and the role of ASV are currently in question. The following chapter is intended to provide the clinician with a description of newer PAP modalities; a review of evidence supported indications for use as well as provide a framework for managing patients with advanced positive airway pressure therapy.

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Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea

Cited by 115 publications

References 35 publications

Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea

Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea

Residual sleep-disordered breathing during autotitrating continuous positive airway pressure therapy

Advanced Positive Airway Pressure Modalities

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