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138 Determining risk factors for cardiovascular diseases
Abstracts / Sleep Medicine 7 (2006) S1–S127 1
Center of Sleep Disorders, National Taiwan University Hospital, Taiwan 2 Department of Otolaryngology, National Taiwan University Hospital, Taiwan 3 Department of Family Medicine, National Taiwan University Hospital, Taiwan 4 Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taiwan Objectives: This study was to prove our hypothesis that the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) without daytime sleepiness is as good as in OSA patients with daytime sleepiness. Study design: Prospective observational study. Study population: From October 2003 to October 2006, 465 patients were referred consecutively to sleep lab for sleep apnea and 302 were diagnosed with suspected obstructive sleep apnea (OSA). From 302 patients, we recruited 28 patients with daytime sleepiness (ESS 6 11) into this study. These two-group patients were matched in age, sex, body-mass index (BMI) and AHI. Material and methods: Patients: All 40 patients were treated with CPAP and received regular out-patient follow-up one month after CPAP use. All 40 patients used CPAP for more than 5 h/night. The symptoms related to snore, ESS score, fatigue score, SF-36, 24 hr ambulatory blood pressure, serum levels of epinephrine, norepinephrine, IL-6, IL-8 and TNF-a were evaluated before and 1 month after CPAP treatment. The baseline and changes of these parameters were compared in these two-group patients. The category parameters were analyzed and continuous variables were analyzed with v2 test and Student’s test, respectively. Results: OSA patients with daytime sleepiness has lower minimal SpO2 (p = 0.022) than patients without. However, the baseline levels of serum epinephrine (p = 0.707), norepinephrine (p = 0.618), CRP (p = 0.489), IL-6 (p = 0.216), IL-8 (p = 0.56), and TNF-a (p = 0.588) were similar in two groups. In OSA patients without daytime sleepiness, levels of CRP (p = 0.012) and IL-8 (p = 0.049), systolic and diastolic pressure were lower after 1-month CPAP treatment. However, the BMI did not change (p = 0.314). In OSA patients with daytime sleepiness, IL-8 (p = 0.043), epinephrine (p = 0.003), norepinephrine (p = 0.004), CRP (p = 0.001), systolic and diastolic pressure and BMI (p = 0.038) were lower after one-month CPAP treatment. The changes of symptoms, hypersomnolence, fatigue, quality of life, blood pressure and serum levels of epinephrine, norepinephrine, IL-6, IL-8 and TNF-a were similar in these two-groups.
S17
Conclusion: The CPAP treatment of OSA patients without daytime sleepiness is as effective as that of patients with daytime sleepiness. doi:10.1016/j.sleep.2006.07.041
138 Determining risk factors for cardiovascular diseases Terry Young * University of Wisconsin-Madison, Department of Health Sciences, WI, USA doi:10.1016/j.sleep.2006.07.042
139 Blood pressure as an endpoint Anreas Jerrentrup *, Heinrich F. Becker Philipps-University, Department of Respiratory Medicine, Marburg, Germany There is compelling epidemiological and experimental evidence that obstructive sleep apnoea (OSA) is an independent risk factor for arterial hypertension. However, only two out of eight controlled studies published so far demonstrated a significant reduction of mean blood pressure. How can these discrepant results be explained? Presence of hypertension: The most important problem in the negative studies is the low percentage of hypertensives included. In the study that showed the largest effect, 66% of patients were hypertensive. Severity of OSA: The subgroup analysis in two studies demonstrated a reduction in blood pressure in patients with more than 33 desaturations per hour or >20 desaturations/h of at least 4%, whereas this was not the case in less severe OSA. Compliance, duration and effectivity of treatment: In some studies, CPAP compliance was low and in one the treatment period was only 1 week. In the only two papers that reported the effect of treatment on AHI there was a substantial decrease in AHI in the ‘‘sham’’ group. Therefore, in the sham group of other studies there may well have been a treatment effect, leading to blood pressure reduction in the control group. Number of patients treated/statistical power: All negative studies did not perform a statistical power analysis, whereas both studies that included a power analysis showed a significant blood pressure reduction with treatment. Is there an effect of CPAP on arterial hypertension and what is the effect size? Actually, most studies did not show an effect of CPAP on blood pressure. However, all of the negative studies had the limitations that patients were mainly or exclusively normotensive and that treatment duration was too short or compliance inadequate.
Center of Sleep Disorders, National Taiwan University Hospital, Taiwan 2 Department of Otolaryngology, National Taiwan University Hospital, Taiwan 3 Department of Family Medicine, National Taiwan University Hospital, Taiwan 4 Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taiwan Objectives: This study was to prove our hypothesis that the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) without daytime sleepiness is as good as in OSA patients with daytime sleepiness. Study design: Prospective observational study. Study population: From October 2003 to October 2006, 465 patients were referred consecutively to sleep lab for sleep apnea and 302 were diagnosed with suspected obstructive sleep apnea (OSA). From 302 patients, we recruited 28 patients with daytime sleepiness (ESS 6 11) into this study. These two-group patients were matched in age, sex, body-mass index (BMI) and AHI. Material and methods: Patients: All 40 patients were treated with CPAP and received regular out-patient follow-up one month after CPAP use. All 40 patients used CPAP for more than 5 h/night. The symptoms related to snore, ESS score, fatigue score, SF-36, 24 hr ambulatory blood pressure, serum levels of epinephrine, norepinephrine, IL-6, IL-8 and TNF-a were evaluated before and 1 month after CPAP treatment. The baseline and changes of these parameters were compared in these two-group patients. The category parameters were analyzed and continuous variables were analyzed with v2 test and Student’s test, respectively. Results: OSA patients with daytime sleepiness has lower minimal SpO2 (p = 0.022) than patients without. However, the baseline levels of serum epinephrine (p = 0.707), norepinephrine (p = 0.618), CRP (p = 0.489), IL-6 (p = 0.216), IL-8 (p = 0.56), and TNF-a (p = 0.588) were similar in two groups. In OSA patients without daytime sleepiness, levels of CRP (p = 0.012) and IL-8 (p = 0.049), systolic and diastolic pressure were lower after 1-month CPAP treatment. However, the BMI did not change (p = 0.314). In OSA patients with daytime sleepiness, IL-8 (p = 0.043), epinephrine (p = 0.003), norepinephrine (p = 0.004), CRP (p = 0.001), systolic and diastolic pressure and BMI (p = 0.038) were lower after one-month CPAP treatment. The changes of symptoms, hypersomnolence, fatigue, quality of life, blood pressure and serum levels of epinephrine, norepinephrine, IL-6, IL-8 and TNF-a were similar in these two-groups.
S17
Conclusion: The CPAP treatment of OSA patients without daytime sleepiness is as effective as that of patients with daytime sleepiness. doi:10.1016/j.sleep.2006.07.041
138 Determining risk factors for cardiovascular diseases Terry Young * University of Wisconsin-Madison, Department of Health Sciences, WI, USA doi:10.1016/j.sleep.2006.07.042
139 Blood pressure as an endpoint Anreas Jerrentrup *, Heinrich F. Becker Philipps-University, Department of Respiratory Medicine, Marburg, Germany There is compelling epidemiological and experimental evidence that obstructive sleep apnoea (OSA) is an independent risk factor for arterial hypertension. However, only two out of eight controlled studies published so far demonstrated a significant reduction of mean blood pressure. How can these discrepant results be explained? Presence of hypertension: The most important problem in the negative studies is the low percentage of hypertensives included. In the study that showed the largest effect, 66% of patients were hypertensive. Severity of OSA: The subgroup analysis in two studies demonstrated a reduction in blood pressure in patients with more than 33 desaturations per hour or >20 desaturations/h of at least 4%, whereas this was not the case in less severe OSA. Compliance, duration and effectivity of treatment: In some studies, CPAP compliance was low and in one the treatment period was only 1 week. In the only two papers that reported the effect of treatment on AHI there was a substantial decrease in AHI in the ‘‘sham’’ group. Therefore, in the sham group of other studies there may well have been a treatment effect, leading to blood pressure reduction in the control group. Number of patients treated/statistical power: All negative studies did not perform a statistical power analysis, whereas both studies that included a power analysis showed a significant blood pressure reduction with treatment. Is there an effect of CPAP on arterial hypertension and what is the effect size? Actually, most studies did not show an effect of CPAP on blood pressure. However, all of the negative studies had the limitations that patients were mainly or exclusively normotensive and that treatment duration was too short or compliance inadequate.