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Changes in Brachial and Central Blood Pressure after Short Term Continuous Positive Airway Pressure Treatment of Patients with Moderate-to-Severe obstructive sleep apnoea and Impaired Renal Function

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Open Journal of Nephrology 2019年第1期9卷 1-19页

作者： Bodil G.Hornstrup Pia H.Gjorup Jost Wessels Thomas G.Lauridsen Erling B.Pedersen Jesper N.Bech University Clinic in Nephrology and Hypertension Regional Hospital West Jutland and Aarhus UniversityAarhusDenmark Department of Medicine Regional Hospital West JutlandHolstebroDenmark

Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.

关键词： Chronic Kidney Disease Nocturnal Blood Pressure obstructive sleep apnoea Central Blood Pressure Continuous Positive Airway Pressure

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An Assessment of the Surgical Results of the Site-Directed Surgical Treatment in obstructive sleep apnoea Syndrome

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International Journal of Otolaryngology and Head & Neck Surgery 2020年第4期9卷 111-123页

作者： D. R. Kandel A. Thakar S. C. Sharma S. K. Sharma A. Trikha G. Shukla A. S. Bhalla R. Kumar R. C. Deka MS ENT and HNS Bharatpur Nepal

Background: obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. Aims and objectives: To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment. Methodology: Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. Result: 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgic

关键词： obstructive sleep apnoea Polysomnography Retroglossal apnoea Hypopnoea Index

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Screening and managing obstructive sleep apnoea in nocturnal heart block patients:An observational study

Screening and managing obstructive sleep apnoea in nocturnal...

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中国睡眠研究会第九届学术年会

作者： Xu Wu Zilong Liu Su Chi Chang Cuiping Fu Shanqun Li Department of Pulmonary Medicine Zhongshan Hospital Fudan University

Background:Nocturnal heart block often occurs in patients with obstructive sleep apnoea(OSA).It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep *** Questionnaire(BQ) is a highly reliable way to discover the risk factors of OSA,whereas the validity in sleep-related heart block patients is *** performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure(CPAP).Methods:Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan *** participantscompleted Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring.A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA,as well as to assess the diagnostic accuracy of the ***,subjects diagnosed with OSA(apnoea-hypopnoea index > 5) underwent 3consecutive days of CPAP *** the third day,patients repeated 24-hour Holter monitoring within the institution of ***:The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block(r = 0.306,0.226,respectively,p = 0.015,0.019) than syncope(r=0.134,p=0.282) and palpitations(r = 0.106,p= 0.119),which were prominent trait of our study *** sensitivity,specificity,positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0%,44.4%,91.07%and 25%.Nocturnal heart block does not appear to occur exclusively in severe sleep *** frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between *** therapy resulted in significant decrease in the average number of episodes of heart block,from 148.58 ±379.44 to 16.07 ±

关键词： obstructive sleep apnoea heart block Berlin Questionnaire continuous positive airway pressure

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Effects of nasal continuous positive airway pressure treatment on insulin resistance and ghrelin levels in non-diabetic apnoeic patients with coronary heart disease

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Chinese Medical Journal 2013年第17期126卷 3316-3320页

作者： YANG Dan LIU Zhi-hong ZHAO Qing LUO Qin State Key Laboratory of Cardiovascular Disease Fu Wai Hospital National Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background Obesity is a common risk factor for several diseases. Obesity related hormone and increased insulin resistance （IR） may contribute to the effects of obstructive sleep apnoea on cardiovascular consequences. We investigated ghrelin and IR in non-diabetic apnoeic patients with stable coronary heart disease and assessed the effects of continuous positive airway pressure （CPAP）. Methods Plasma ghrelin, glucose and insulin were measured in 22 patients with CPAP and 22 matched controls without CPAP at baseline and three months. Indexes including homeostasis model assessment IR （HOMA IR）, HOMA S and HOMA β were calculated for the assessment of IR, insulin sensitivity and pancreatic β cell function. Results At three months follow-up, plasma ghrelin levels and HOMA IR in CPAP group were significantly decreased （P=0.002 and 0.046, respectively） while those in control group increased significantly （P=0.012 and 0.009, respectively）. Significant moderate correlations were found between ghrelin vs. HOMA IR and ghrelin vs. HOMA S after CPAP, however, for those without CPAP, no significant associations were observed. Conclusions Short-term effective continuous positive airway pressure had a significant effect on lowering plasma ghrelin levels and IR, but not body fat. Further large scale and longer term studies are warranted to corroborate these findings.

关键词： obstructive sleep apnoea coronary heart disease continuous positive airway pressure homeostasis model assessment ghrelin

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High prevalence of positional OSA in sleep breathing disordered with ischemic stroke

High prevalence of positional OSA in sleep breathing disorde...

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中国睡眠研究会第7届全国学术年会暨2012金陵国际睡眠医学论坛

作者： Liu Hao Liying Deng Xueliang Zou The Second Affiliated Hospital To Nanchang University

Objective To explore the role of sleep position in the patients with obstrustive sleep apnea-hypopnea syndrome and acute cerebral *** Consecutive patients were enrolled,who have been confirmed by brain MRI and polysomnography(PSG) with acute cerebral infarction and *** were stratified in a group of positional patients(PP)(AHI supine≥2×AHI other positions) and a group of non-positional patients(NPP).Postural characteristics of sleep-disordered breathing,stroke risk factors,clinical features and characteristics of brain magnetic resonance imaging were compared between the two *** characteristics of sleep-disordered breathing,stroke risk factors were compared between OSAHS patients accompanied with and without acute cerebral infarction. Results In 122 patients with ischemic stroke,67.2%(82/122) was found to have sleep breathing *** them,87.8%(72/82) have OSAHS,3.7%(3/82) have CSA,8.5%(7/82 ) have MSA. OSAHS patients accompanied with ischemic stroke have higher prevalence of Hypertension,Diabetes, Hyperlipidemia and smoke than those without.(Psleep time percents was 55.6%.Those with non-positional OSAHS have supine AHI 19.66 and supine sleep time percents 45.2%(Psleep breathing disordered,.regardless of the PP group or NPP *** prevalence of positional patients in anterior circulation group is 75%,in posterior circulation group 51%,in all the circulation group 63.6%.The prevalence of positional patients in anterior circulation group is significantly different from posterior circulation *** prevalence of positional patients in lacunar infarction group is higher than in non-lacunar

关键词： ischemic stroke obstructive sleep apnoea positional obstructive sleep apnoea positional therapy

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