Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea

Narkiewicz, Krzysztof; Kato, Masahiko; Phillips, Brian N.; Pesek, Catherine A.; Davison, Diane E.; Somers, Virend K.

doi:10.1161/01.cir.100.23.2332

Cited by 430 publications

(263 citation statements)

References 40 publications

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“…The mechanism for improved LVEF with chronic CPAP therapy in patients with CHF and OSA likely relates to improved systolic function due to a favourable modification of the pathophysiology of left ventricular dysfunction. Previous investigators have documented excessive sympathetic nervous system activity in patients with OSA and CHF that can be attenuated by CPAP therapy (11,12,14,15,24,54,55). In this regard, we observed a relationship between baseline SVRI and the recovery of systolic function.…”

Section: Velocity (E) To Ea Ratio (Bottom) Ns Nonsignificantsupporting

confidence: 69%

“…In addition to restoring normal sleep architecture, CPAP therapy prevents the extremes of negative intrathoracic pressure and, thus, reduces left ventricular transmural pressure, prevents recurrent hypoxia, reduces sympathetic nervous system activity, decreases blood pressure and heart rate, and increases arterial baroreceptor sensitivity and daytime heart rate variability (1,7,(10)(11)(12)(13)(14)(15)(16). In the normal heart, initiation of CPAP therapy acutely increases intrathoracic pressure, decreases venous return and left ventricular filling, and results in decreased cardiac output (17)(18)(19).…”

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confidence: 99%

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Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure

Johnson

Beanlands

Yoshinaga

et al. 2008

Canadian Journal of Cardiology

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Section: Velocity (E) To Ea Ratio (Bottom) Ns Nonsignificantsupporting

confidence: 69%

mentioning

confidence: 99%

Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure

Johnson

Beanlands

Yoshinaga

et al. 2008

Canadian Journal of Cardiology

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“…These cycles may occur hundreds of times a night in a patient with moderate-to-severe OSAS (13,14). Hence, both ventricles are exposed to hemodynamic stress.…”

Section: Cpap Treatment and Ecg Findings In Osasmentioning

confidence: 99%

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Seyis¹,

Usalan²

2017

Curr Res Cardiol

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OBJECTIVE: This study aims to evaluate the effects of continuous positive airway pressure (CPAP) treatment on intrinsicoid deflection time (R wave peak time) and P wave discrimination in severe obstructive sleep apnea syndrome (OSAS). METHODS:Fifty-five patients with severe OSAS (apnea-hypopnea index ≥ 30) and a healthy control group were included. Baseline electrocardiography (ECG), echocardiography (ECHO), and polysomnography parameters were recorded. All patients received CPAP treatment. ECG and ECHO echocardiography tests were repeated after one-year of CPAP therapy. RESULTS:A total of 55 OSAS patients (36 M, 19 F) with a mean age of 56.9 ± 7.6 years and 54 healthy controls (31 M, 23 F) with a mean age of 56.6 ± 5.7 years were included. There was a significant improvement in terms of intrinsicoid deflection time in lead V1 (76.2 ± 8.3 vs. 59.8 ± 7.2) and lead V6 (58.5 ± 8.0 vs. 49.8 ± 7.1), and P-wave dispersion (95.2 ± 12.8 vs. 39.8 ± 6.4) after one-year CPAP treatment (p<0.001). Cardiac volumes and diameters improved significantly.CONCLUSION: CPAP treatment significantly decreases intrinsicoid deflection time in leads V1 and V6, and improves P-wave dispersion. The results of this study indicate that long-term CPAP treatment had a strong protective effect on right or left cardiac functions in severe OSAS patients without any cardiac and pulmonary disease. KeyWords: CPAP; Intrinsicoid deflection time; OSAS; P-wave dispersion; PolysomnographyO bstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It is caused by temporary collapse of the upper airway, which results in nocturnal hypoxia and sleep disturbance (1,2). Many vascular diseases including hypertension, coronary heart disease, heart failure, cardiac arrhythmias, and stroke have been found to be associated with OSAS (3). Cardiovascular morbidity and mortality have been reported as high as 70% in patients with OSAS (4).Many studies have shown that OSAS is associated with changes in cardiac structure such as myocardial hypertrophy or increased left ventricular mass, which can widen the QRS complex on the electrocardiogram (ECG) (5-7). On the other hand, prolonged QRS duration is an independent predictor of mortality and cardiovascular diseases (e.g., hypertension and heart failure) in OSAS patients. It has also been shown that severe OSAS patients (AHI ≥ 30) have a four-fold higher frequency of atrial fibrillation (AF) (8). Arrhythmia and its improvement with continuous positive airway pressure (CPAP) therapy in OSAS patients have been reported as well (8). However, the relationship between OSAS and intrinsicoid deflection (ID) (i.e., R-wave peak time) is unknown.Continuous positive airway pressure is used as first line treatment modality in patients with severe OSAS (9). Regular use of CPAP may lead to reduction in cardiovascular risk in patients with heart failure. A reduction of blood pressure, an increase in left ventricular ejection fraction, and a decrease in left ventricular hypertrophia, and an improvement in cardiovascular function h...

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“…8 Most changes might go back to normality once obstructive sleep apnea is treated and improved. 9,10 Sympathetic stimulation because of sustained hypoxemia is particularly insidious, 11 and although not directly measured, it is likely present also in the population sample of Avelar et al 4 as is suggested by the higher heart rate. Sympathetic hypertone can worsen insulin resistance and can modulate leptin expression in a way that facilitates the development of a vicious cycle, worsens obesity, and promotes the related comorbidities.…”

mentioning

confidence: 99%

Morbid Obesity and Left Ventricular Geometry

Simone

2007

Hypertension

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O besity is a condition encompassing a broad range of clinical presentations from a nearly normal status to a life-threatening disease. In the absence of a permeating campaign raising the level of attention to the problem of obesity, many obese individuals see their doctors only for esthetic reasons. A large number of subjects, in fact, seem to live quite well even with moderate or severe obesity. Others, albeit feeling healthy, look for dietary interventions not only to improve their body build but also to increase the level of their self-esteem. Some others, a minority, usually those in class III, 1 progressively develop symptoms and clinical signs that raise their level of attention and force them to see doctors.The latter type of obese subjects is usually more motivated and, therefore, tends to be more compliant with physicians' suggestions and indications. There is a proportion of these individuals who are considered to be at higher risk, and when their motivations are strong enough, they are sent to bariatric surgery. When examining those obese subjects, doctors and researchers need to be aware that they represent the tip of the iceberg, far away from the reality of obesity in general and from the real cardiovascular risk attributable to obesity in population. Because of the a priori selection, hypertension, diabetes, joint pain, and whatever comorbidity is limiting quality of life are very frequent in those patients. Their cardiovascular risk is higher than in obese patients without prevalent comorbidities, and, unsurprisingly, they also show high levels of left ventricular (LV) mass partly related to coexisting abnormalities consistent with findings in the setting of the metabolic syndrome. 2,3 Abnormalities of LV geometry get worse as the severity of morbid obesity increases.In this issue of the journal, Avelar et al 4 add another important observation by focusing their study on the effect of obstructive sleep apnea-hypopnea on levels of LV mass in obese patients with some compelling indications for bariatric surgery. The vast majority of these patients were women. Although the authors used a method of normalization of LV mass that minimizes the gender difference, there is, however, gender difference in the distribution of obstructive sleep apnea-hypopnea episodes and, most likely, in their severity, as also confirmed in recent works. 5,6 Although the effort of breathing is not necessarily different in men and women when lying the same, the physiology of breathing is different in men and women even in the presence of similar obstructive conditions, particularly when excessive abdominal fat compresses the diaphragm toward the chest.Even considering the potential gender-related limitations, the observation by Avelar et al 4 that the degree of sustained nocturnal hypoxemia, rather than the number of apneic and hypopneic episodes, contributes to the variance of LV mass index is interesting, because it indicates a real measurable biological characteristic potentially associated with LV mass. Focusing on hypo...

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Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea

Cited by 430 publications

References 40 publications

Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure

Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Morbid Obesity and Left Ventricular Geometry

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