Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial.

OBJECTIVE: It is well recognized that the most effective treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Different treatment possibilities comprise surgery, mandibular advancement, pulmonary rehabilitation, and oropharyngeal and facial exercises (PR program). However, these treatments showed inconsistent results. The purpose of the study was to compare the short-term effects of CPAP and the combination of PR program with CPAP on OSA severity, ventilatory functions, and changes in body characteristics in a newly diagnosed patient. METHODS: This study was a single-center, two-arm, parallel, randomized, controlled, open-label trial. Forty patients with OSA (20 men, 20 women, aged 54.2 ± 6.8 years) with moderate to severe obstructive sleep apnea were randomized to CPAP and CPAP + PR. The PR group underwent six weeks of 60-min twice-weekly individual PR programs. The primary outcome measure was apnea/hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale. The secondary outcome measures were a percentage of total sleep time with oxygen saturation below 90%, body mass index (BMI), vital capacity and forced expiratory volume in 1 s (% of predicted), neck, waist, and hip circumferences. RESULTS: Five patients with OSA did not complete the program. The comparison between baseline and final assessment was made in 15 patients in the CPAP + PR group and 20 patients in the control group with CPAP only. Although OSA severity was controlled with CPAP treatment in both groups, a significant reduction of neck, waist, and hip circumferences, BMI, and improvement of pulmonary function were confirmed only in the CPAP + PR group after treatment. CONCLUSION: Treatment with CPAP combined with the PR program improved OSA patients to a greater extent than only CPAP.

Ambulatory screening for obstructive sleep apnea in patients with resistant arterial hypertension.

OBJECTIVE: Obstructive sleep apnea (OSA) is one of the most common causes of secondary arterial hypertension. It is important to rule out OSA as a cause of resistant hypertension. The ApneaLink device is a simple and cost-efficient outpatient examination, but its usefulness in screening OSA in resistant hypertension has not yet been evaluated. METHODS: A total of 69 patients with resistant arterial hypertension were enrolled. Patients underwent a physical examination, including the use of ApneaLink, followed by respiratory polygraphy. The presence of OSA was assessed by the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean nocturnal desaturation (SpO2), and percentage of sleep time with SpO2 less than 90%. RESULTS: There was no significant difference between the values of AHI found during the use of ApneaLink and respiratory polygraphy (mean 30.4 ± 21.7 vs. 37.2 ± 20.9, P = 0.07). ApneaLink had 77.3% sensitivity and 100% specificity to diagnose OSA with the area under the ROC curve 0.866 (P < 0.001). We also found no significant difference in mean SpO2 (91.3 ± 2.5 vs. 90.9 ± 3.3%, P = 0.22). The ODI evaluated via ApneaLink was significantly lower than by the polygraphy (31.1 ± 18.3 vs. 43.9 ± 24.8, P < 0.001), while the measured percentage of sleep time with SpO2 less than 90% was higher (31.8 ± 23.7 vs. 23.3 ± 24.4, P = 0.001). The severity of OSA was correctly determined by ApneaLink in 50.7% of patients, underestimated in 23.2% and overestimated in 26.1%. CONCLUSIONS: The use of ApneaLink is a suitable method for screening the presence of OSA in patients with resistant hypertension, but to accurately assess the severity of OSA, respiratory polygraphy or polysomnography is required.

Depression and obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses. METHOD: The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life". RESULTS: After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms. CONCLUSIONS: It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

Cognitive function and depressivity before and after cpap treatment in obstructive sleep apnea patients.

OBJECTIVE: The target of the investigation was to find if there is any improvement of depressive symptoms and cognitive functioning after continuous positive airway pressure (CPAP) treatment in the severe obstructive apnea (OSA) patients. METHOD: The study included 59 patients treated with CPAP for OSA in the Sleep Laboratory of the Department of Respiratory Medicine. Thirty-eight patients were treated with CPAP for one month, and twenty-one patients were in a control group. We used the following methods: Test of Visual Memory (ViMe), Numeric Rectangle, d2 (test of attention), and the Beck Depression Inventory-II, respectively. RESULTS: Among the OSA patients, there were statistically significant improvements in all parameters: attention, working memory, and depressive symptoms after the treatment with CPAP. We found a statistically significant positive connection between the decrease in depressive symptoms and the improvement in attention. In the control group, there were no improvements in the investigated factors. CONCLUSIONS: According to our results, the patients with sleep apnoea improved their mood and cognitive functions during the treatment by the CPAP device.

Significant phenotype variability of congenital central hypoventilation syndrome in a family with polyalanine expansion mutation of the PHOX2B gene.

BACKGROUND: Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder resulting from mutations in the PHOX2B gene located on chromosome 4p12.3, characterized by hypoventilation secondary to missing responses to both hypercapnia and hypoxia. CASE REPORT: Proband. A girl, hospitalised 5 times for respiratory failure from 6 weeks old, presented at 4 years of age severe cyanosis related to pneumonia. Tracheostomy was done, and she was discharged home using a portable positive pressure ventilator during sleep. Proband's father: The father was retrospectively found out to suffer from severe headache and excessive daytime sleepiness. Molecular genetic evaluation of PHOX2B gene was performed and casual polyalanine repeat expansion mutation c.741_755dup15 in exon 3 was found both in proband and her father in heterozygous form. The proband's grandmother died of respiratory failure after administration of benzodiazepine at the age of fifty years. Considering the grandmother's history, she is highly suspected of having had CCHS as well. CONCLUSION: Repeated respiratory failure of girl was explained by PHOX2B mutation and Ondina curse. Proband´s father has incompletely penetrated PHOX2B heterozygous mutation as well and proband´s grandmother died probably from the consequences of drug interaction with PHOX2B mutated background as well. Both daughter and father currently require overnight mechanical ventilatory support. Although most PHOX2B mutations occur de novo, our case is a rare three generation family affected by autosomal dominant inheritance with incomplete penetrance manifested as the late-form of CCHS and proven PHOX2B mutation in two generations.

Serum adiponectin level in obstructive sleep apnea: Relation of adiponectin to obesity and long-term continuous positive airway pressure therapy.

PURPOSE: The study aimed to determine the effect of OSA and obesity on the plasma levels of adiponectin and the long-term effect of CPAP on its plasma levels and obesity parameters. MATERIAL/METHODS: A prospective observational study included 159 newly diagnosed OSA patients. The cohort was divided into CPAP treated (n=82) and control group (n=77). Both groups were examined at the beginning and a year later. The CPAP-treated patients were additionally tested after a month of therapy. The examinations included Epworth Sleepiness Scale questionnaire, anthropometric and polysomnographic measurements, and blood serum tests. Changes in the studied parameters of OSA, obesity, and adiponectin obtained at the beginning and after follow-up period were compared in each group. RESULTS: In CPAP group, all studied OSA parameters improved already after a month of CPAP therapy. Contrarily, obesity parameters (except of neck and waist circumference) remained unchanged after CPAP therapy. Serum adiponectin levels dropped during CPAP therapy. In the control group, both obesity and OSA parameters did not show changes. The only exceptions were deteriorated mean SpO2 and decreased hip circumference. Adiponectin remained unchanged in this group. In neither group, the Spearman correlation analyses showed any association of serum adiponectin levels with obesity or OSA parameters, except of mean SpO2. CONCLUSIONS: Only correlation found was between adiponectin and mean SpO2. Although CPAP therapy improves all OSA parameters, it did not change most obesity parameters. Additionally in the CPAP group, there was a significant drop in adiponectin levels, suggesting its protective role in this group of patients.

Total and High Molecular Weight Adiponectin Levels and Prediction of Cardiovascular Risk in Diabetic Patients.

The study aimed at assessing the potential use of lower total and HMW adiponectin levels for predicting cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). Concentrations of total adiponectin or high molecular weight (HMW) adiponectin decrease in association with the development of metabolic dysfunction such as obesity, insulin resistance, or T2DM. Increased adiponectin levels are associated with a lower risk for coronary heart disease. A total of 551 individuals were assessed. The first group comprised metabolically healthy participants (143 females, and 126 males) and the second group were T2DM patients (164 females, and 118 males). Both total adiponectin and HMW adiponectin in diabetic patients were significantly lower when compared with the group of metabolically healthy individuals. There was a weak monotonic correlation between HMW adiponectin levels and triglycerides levels. Binary logistic regression analysis, gender adjusted, showed a higher cardiovascular risk in diabetic persons when both total adiponectin (OR = 1.700) and HMW adiponectin (OR = 2.785) levels were decreased. A decrease in total adiponectin levels as well as a decrease in its HMW adiponectin is associated with a higher cardiovascular risk in individuals with T2DM. This association suggests that adiponectin levels may be potentially used as an epidemiological marker for cardiovascular risk in diabetic patients.

[Research of relations among sleep disorders, obstructive sleep apnoea, hypertension onset and hypertensive treatment - current or long-term trend?]. / Studium souvislostí poruch spánku, obstrukcní spánkové apnoe a vzniku a lécby arteriální hypertenze - módní vlna nebo dlouhodobý trend?

This paper is discussing recent findings about links between obstructive sleep apnea syndrome and arterial hypertension. It describes diagnostic approaches and also therapy of patients. It is describing options of pharmacological treatment and the influence of continuous positive airway pressure therapy on blood pressure level.

The effect of continuous positive airway pressure therapy on the prevalence of masked hypertension in obstructive sleep apnea patients.

BACKGROUND AND AIM: Obstructive sleep apnea (OSA) is a common cause of secondary arterial hypertension. Masked hypertension (MH) is defined as normal office blood pressure and abnormal results in 24 h ambulatory blood pressure monitoring (ABPM). The aim of this study was to evaluate the effect of CPAP therapy on the prevalence of MH in patients with OSA. METHODS: 43 patients (40 men) were included, average age 54.2±10.5 years. All underwent sleep study (PG or PSG) with a diagnosis of OSA indicated for CPAP treatment, average apnea-hypopnea index (AHI) 60.6±23.6. Patients were treated with CPAP for one year. Ambulatory blood pressure monitoring was performed before and after one year of treatment. RESULTS: Masked hypertension was initially present in 25 (58.1%) and in 26 (60.5%) patients after one year of CPAP therapy. However, there was a statistically significant improvement in BP for all evaluated intervals of ABPM with the exception of systolic pressure during the daytime. CONCLUSIONS: Masked hypertension was very prevalent in these patients with OSA. The CPAP treatment for one year however had no affect on prevalence of masked hypertension although there was a positive effect of CPAP treatment on blood pressure for all assessed intervals of ABPM with the exception of systolic BP during daytime.

Treatment of obstructive sleep apnea with continuous positive airway pressure decreases adipocyte fatty acid-binding protein levels.

AIM: Obstructive sleep apnea (OSA) can be associated with the metabolic syndrome. Adipocyte fatty acid-binding protein (A-FABP) may play a role in OSA. The aim of this study was to determine whether continuous positive airway pressure (CPAP) treatment results in decreased serum A-FABP levels. SUBJECTS AND METHODS: 81 patients (70 males, a mean age of 53.9±10.3 years) were evaluated by polysomnography, diagnosed with OSA and indicated for CPAP treatment. Anthropometric, clinical and laboratory investigations were carried out and repeated after 1 month/ 1 year of CPAP treatment. The data were analyzed using the SPSS Statistics 15 software (SPSS Inc., Chicago, USA). RESULTS: Patients had significantly decreased A-FABP levels (34.4 ng/ml, 31.2 ng/ml, 24.8 ng/ml, P=0.048, P=0.001) and improved OSA parameters: AHI (53.9, 5.0, 5.6, P<0.0001), mean nocturnal oxygen saturation (91%, 93%, 94%, P<0.0001), ODI (55, 9, 8, P<0.0001), and percentage of sleep time with oxygen saturation below 90% (28.2, 0.2, 0, P<0.0001). BMI, waist, neck circumference, and blood pressure did not statistically significantly change. CONCLUSION: CPAP therapy in OSA patients has a positive effect on A-FABP levels. Decreased A-FABP levels play an important role in regulating glucose metabolism and affect the regulation of lipid metabolism and thus may contribute to decrease in the cardiovascular complications of OSA.

Complicated course of ischemic heart disease in a patient with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) can activate pathological routes which can lead to insulin resistance, development of atherosclerosis and hypertension. The combination of hypertension and OSA has an additive effect on the development of atherosclerosis. As a number of studies have revealed, that the incidence of OSA in patients with myocardial infarction is likely to be high. METHODS AND RESULTS: We present a patient with acute myocardial infarction and no classical coronary artery disease risk factors: non-smoker, normal blood pressure, normal total and low-density lipoprotein cholesterol levels, borderline high-density lipoprotein cholesterol level, with good physical activity, no diabetes mellitus, no abdominal obesity, a negative family history. The only risk factor was untreated obstructive sleep apnea. The course of disease was complicated by subsequent in-stent restenosis and progression of atherosclerotic plaques, which led to the need for acute coronary artery bypass graft surgery complicated by consecutive in-anastomosis stenosis despite maximum cardiovascular therapy. One year of continuous positive airway pressure treatment was needed to stabilize his health condition, which is now stable for up to two years. CONCLUSIONS: Given the complicated course of ischemic heart disease in patients with OSA, we believe that OSA diagnosis would be advisable each time these patients with symptoms of myocardial infarction, ischemic heart disease and OSA are examined. Even more important, however, is proper treatment of the OSA when it is present.