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СPAP-therapy decrease arterial stiffness in patients with arterial hypertension and obstructive sleep apnea
Abstracts
Previous studies assumed inflammation participated in obstructive sleep apnea syndrome (OSAS) and hypertension. The fact that tumor necrosis factor α (TNF-α) was related to OSAS while neuropeptide Y (NPY) was related to hypertension was widely reported separately. To investigate the involvement of TNF-α and NPY simultaneously in hypertension accompanied with OSAS, 417 subjects who underwent the polysomnography and blood pressure measurement were consecutively selected. Plasma TNF-α and NPY levels were determined in normotensive with OSAS (n = 113), hypertensive without OSAS (n = 73), hypertensive with OSAS (n = 134) and those of controls (n = 97) respectively. Significant increase in TNF-α and NPY was observed simultaneously in hypertensive subjects with or without OSAS in the present cross-sectional study. Both of TNF-α and NPY besides neck circumference (NC) contributed to OSAS and hypertension as risk factors in logistic regression model. NC was impacted by apnea/ hypopnea index, mean diastolic blood pressure and TNF-α level, which was indicated via multiple linear regression model. These data suggested that complex interactions existed in TNF-α, NPY and hypertension and OSAS in Han population of Xinjiang. The highest levels of TNF-α and NPY were observed in OSAS with hypertension. Elevated concentration of plasma TNF-α and NPY potentiate the hypertension combined with OSAS. However, whether raised plasma TNF-α and NPY levels were the cause or the results of hypertension overlapping OSAS was not been determined. Further studies are needed to clarify the role of inflammation in the pathogenesis of OSAS with hypertension, in which NC should be entered as an independent factor. doi:10.1016/j.ijcard.2009.09.451
SL000133 Sleep duration and all cause-mortality: A meta-analysis of prospective studies FRANCESCO CAPPUCCIO, LANFRANCO D'ELIA, PASQUALE STRAZZULLO, MICHELLE MILLER University of Warwick, United Kingdom Background: An association between both short and long duration of habitual sleep with adverse health outcomes exists. Objectives: To assess the longitudinal evidence of a relationship between duration of sleep and all-cause mortality, to obtain an estimate of the risk. Methods: We performed a systematic search of publications using MEDLINE (1966–2009) and other sources. Included were prospective studies, follow up more than 3 years, assessment of duration of sleep at baseline and all-cause mortality as outcome. For each study relative risks (RR) and 95% C.I. were extracted and pooled using a random effect model. Sensitivity analysis was performed, heterogeneity and publication bias were also assessed. Results: 13 studies provided 23 independent cohorts. They included 1,376,393 male and female participants (follow-up 6 to 25 years), and 110,977 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep (21 cohorts from 12 studies) was associated with greater risk of death (RR: 1.13; 95% CI 1.07 to 1.19; p < 0.0001) with no evidence of publication bias (p = 0.48) but significant heterogeneity between studies (I2 = 44%, p = 0.0049). The effect was consistent in men (1.17 [1.04 to 1.31], p = 0.0067) and women (1.09 [1.04 to 1.14], p = 0.0002). Long duration of sleep (23 cohorts from 13 studies) was also associated with greater risk of death (1.28; [1.20 to 1.37; p < 0.0001) with no evidence of publication bias (p = 0.35) but significant heterogeneity between studies (I2 = 74%, p = 0.012). The effect was consistent in men (1.25 [1.10 to 1.43], p = 0.0008) and women (1.32 [1.19 to 1.45], p < 0.0001) and it appeared greater in studies carried out in East Asia. Conclusion: Both short and long duration of sleep are significant predictors of death in prospective
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population studies. The biological mechanisms underlying these associations are likely to differ and they require further study. doi:10.1016/j.ijcard.2009.09.452 SL000398 СPAP-therapy decrease arterial stiffness in patients with arterial hypertension and obstructive sleep apnea ZULFIA SUKMAROVA, ANATOLIY ROGOZA, ALEXANDR LITVIN, IRINA CHAZOVA Russian Cardiology Research Complex, Russian Federation Arterial stiffness (AS) is a risk factor of the damage of target organs and cardiovascular major events. The research of influence of Continuous Positive Airway Pressure (СРАР) in patients (pts) with arterial hypertension (AH) and obstructive sleep apnea (OSA) on AS has never been done. Aim: To investigate of СPAP-therapy in reduction of AS in pts with AH and OSA in prospective, randomized, double-blind, placebo-controlled, crosssectional study. Methods: Included 44 pts 55,8 ±9,4 y with AH II-III gr. and OSA index >30, treated with combination amlodipine 5–10 mg, valsartane 160 mg, hydrochlorthiaside 25 mg. After 3–9 week Antihypertensive Therapy (AT) the pts were randomized into 2 groups: additional received effective-eСРАР and CPAP-placebo. After 3 weeks on CPAP we carried out the crossover of groups. At each step of intervention we produced ABPM. AS was estimated by Ambulatory AS Index (AASI) and carotid-to-femoral pulse wave velocity (PWV) (Sfygmocor). Results: PWV demonstrated reduction of AS after AT and additional positive effect of eCPAP. Significantly reduction of AASI was detected only in combination of AT and eCPAP. The exchanges of parameters in AT and eCPAP: (M±STD) Initial →AT→AT+eCРАР; PWVcf (m/s): 15±3→12±3* →12±2*#; AASI: 0,55 ± 0,17 → 0,48 ±0,19 ns → 0,41 ± 0,18*ns; 24hBP mmHg: 157/96 ± 21/11 → 139/86 ± 11/10** → 137/81 ± 14/8*. * −p < 0,05 vs. initial, # − p < 0,05 vs. medication. Conclusion: The addition of the CPAP to the AT in pts with severe OSA and AH results in improvement of arterial elastic property's – according to the 24 h observe (ABPM) and standard diagnostic method – Applanation Tonometry. doi:10.1016/j.ijcard.2009.09.453 SL000631 Effects of obstructive sleep apnea–hypopnea syndrome on serum macrophage inflammatory protein-1α and high-sensitivity c-reactive protein levels and cardiac structure and function in patients with hypertension NAN ZHANG, DONGYING ZHANG, SHU QIN, YIPING YANG, QIONGZHEN DENG The First Affiliated Hospital of Chongqing Medical University, China Objective: To investigate the effect of OSAHS on serum macrophage inflammatory protein-1α (MIP-1α) and high-sensitivity c-reactive protein (hs-CRP) levels, and inquire its effect on cardiac function in hypertension patients. Design and methods: Eighty-six patients were recruited and divided into three groups: OSAHS group (n = 29); HT group (n = 27); OSAHS+ HT group (n = 30). Thirty healthy subjects were selected as control group (n = 30). Cardiac structure and function were measured by Doppler ultrasound. Serum MIP-1α and hs-CRP levels were detected by ELISA. Results: The BMI, neck circumference and waist to hip ratio in OSAHS and OSAHS+ HT groups were higher than control group's (P < 0.05). The systolic, diastolic blood pressure (SBP, DBP) and pulse pressure difference in HT and OSAHS + HT groups were higher than those in OSAHS group. No difference was found among four groups on left ventricular ejection fraction, left ventricular fraction shortening, sampling volume and cardiac output (P>0.05). Compared
Previous studies assumed inflammation participated in obstructive sleep apnea syndrome (OSAS) and hypertension. The fact that tumor necrosis factor α (TNF-α) was related to OSAS while neuropeptide Y (NPY) was related to hypertension was widely reported separately. To investigate the involvement of TNF-α and NPY simultaneously in hypertension accompanied with OSAS, 417 subjects who underwent the polysomnography and blood pressure measurement were consecutively selected. Plasma TNF-α and NPY levels were determined in normotensive with OSAS (n = 113), hypertensive without OSAS (n = 73), hypertensive with OSAS (n = 134) and those of controls (n = 97) respectively. Significant increase in TNF-α and NPY was observed simultaneously in hypertensive subjects with or without OSAS in the present cross-sectional study. Both of TNF-α and NPY besides neck circumference (NC) contributed to OSAS and hypertension as risk factors in logistic regression model. NC was impacted by apnea/ hypopnea index, mean diastolic blood pressure and TNF-α level, which was indicated via multiple linear regression model. These data suggested that complex interactions existed in TNF-α, NPY and hypertension and OSAS in Han population of Xinjiang. The highest levels of TNF-α and NPY were observed in OSAS with hypertension. Elevated concentration of plasma TNF-α and NPY potentiate the hypertension combined with OSAS. However, whether raised plasma TNF-α and NPY levels were the cause or the results of hypertension overlapping OSAS was not been determined. Further studies are needed to clarify the role of inflammation in the pathogenesis of OSAS with hypertension, in which NC should be entered as an independent factor. doi:10.1016/j.ijcard.2009.09.451
SL000133 Sleep duration and all cause-mortality: A meta-analysis of prospective studies FRANCESCO CAPPUCCIO, LANFRANCO D'ELIA, PASQUALE STRAZZULLO, MICHELLE MILLER University of Warwick, United Kingdom Background: An association between both short and long duration of habitual sleep with adverse health outcomes exists. Objectives: To assess the longitudinal evidence of a relationship between duration of sleep and all-cause mortality, to obtain an estimate of the risk. Methods: We performed a systematic search of publications using MEDLINE (1966–2009) and other sources. Included were prospective studies, follow up more than 3 years, assessment of duration of sleep at baseline and all-cause mortality as outcome. For each study relative risks (RR) and 95% C.I. were extracted and pooled using a random effect model. Sensitivity analysis was performed, heterogeneity and publication bias were also assessed. Results: 13 studies provided 23 independent cohorts. They included 1,376,393 male and female participants (follow-up 6 to 25 years), and 110,977 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep (21 cohorts from 12 studies) was associated with greater risk of death (RR: 1.13; 95% CI 1.07 to 1.19; p < 0.0001) with no evidence of publication bias (p = 0.48) but significant heterogeneity between studies (I2 = 44%, p = 0.0049). The effect was consistent in men (1.17 [1.04 to 1.31], p = 0.0067) and women (1.09 [1.04 to 1.14], p = 0.0002). Long duration of sleep (23 cohorts from 13 studies) was also associated with greater risk of death (1.28; [1.20 to 1.37; p < 0.0001) with no evidence of publication bias (p = 0.35) but significant heterogeneity between studies (I2 = 74%, p = 0.012). The effect was consistent in men (1.25 [1.10 to 1.43], p = 0.0008) and women (1.32 [1.19 to 1.45], p < 0.0001) and it appeared greater in studies carried out in East Asia. Conclusion: Both short and long duration of sleep are significant predictors of death in prospective
S133
population studies. The biological mechanisms underlying these associations are likely to differ and they require further study. doi:10.1016/j.ijcard.2009.09.452 SL000398 СPAP-therapy decrease arterial stiffness in patients with arterial hypertension and obstructive sleep apnea ZULFIA SUKMAROVA, ANATOLIY ROGOZA, ALEXANDR LITVIN, IRINA CHAZOVA Russian Cardiology Research Complex, Russian Federation Arterial stiffness (AS) is a risk factor of the damage of target organs and cardiovascular major events. The research of influence of Continuous Positive Airway Pressure (СРАР) in patients (pts) with arterial hypertension (AH) and obstructive sleep apnea (OSA) on AS has never been done. Aim: To investigate of СPAP-therapy in reduction of AS in pts with AH and OSA in prospective, randomized, double-blind, placebo-controlled, crosssectional study. Methods: Included 44 pts 55,8 ±9,4 y with AH II-III gr. and OSA index >30, treated with combination amlodipine 5–10 mg, valsartane 160 mg, hydrochlorthiaside 25 mg. After 3–9 week Antihypertensive Therapy (AT) the pts were randomized into 2 groups: additional received effective-eСРАР and CPAP-placebo. After 3 weeks on CPAP we carried out the crossover of groups. At each step of intervention we produced ABPM. AS was estimated by Ambulatory AS Index (AASI) and carotid-to-femoral pulse wave velocity (PWV) (Sfygmocor). Results: PWV demonstrated reduction of AS after AT and additional positive effect of eCPAP. Significantly reduction of AASI was detected only in combination of AT and eCPAP. The exchanges of parameters in AT and eCPAP: (M±STD) Initial →AT→AT+eCРАР; PWVcf (m/s): 15±3→12±3* →12±2*#; AASI: 0,55 ± 0,17 → 0,48 ±0,19 ns → 0,41 ± 0,18*ns; 24hBP mmHg: 157/96 ± 21/11 → 139/86 ± 11/10** → 137/81 ± 14/8*. * −p < 0,05 vs. initial, # − p < 0,05 vs. medication. Conclusion: The addition of the CPAP to the AT in pts with severe OSA and AH results in improvement of arterial elastic property's – according to the 24 h observe (ABPM) and standard diagnostic method – Applanation Tonometry. doi:10.1016/j.ijcard.2009.09.453 SL000631 Effects of obstructive sleep apnea–hypopnea syndrome on serum macrophage inflammatory protein-1α and high-sensitivity c-reactive protein levels and cardiac structure and function in patients with hypertension NAN ZHANG, DONGYING ZHANG, SHU QIN, YIPING YANG, QIONGZHEN DENG The First Affiliated Hospital of Chongqing Medical University, China Objective: To investigate the effect of OSAHS on serum macrophage inflammatory protein-1α (MIP-1α) and high-sensitivity c-reactive protein (hs-CRP) levels, and inquire its effect on cardiac function in hypertension patients. Design and methods: Eighty-six patients were recruited and divided into three groups: OSAHS group (n = 29); HT group (n = 27); OSAHS+ HT group (n = 30). Thirty healthy subjects were selected as control group (n = 30). Cardiac structure and function were measured by Doppler ultrasound. Serum MIP-1α and hs-CRP levels were detected by ELISA. Results: The BMI, neck circumference and waist to hip ratio in OSAHS and OSAHS+ HT groups were higher than control group's (P < 0.05). The systolic, diastolic blood pressure (SBP, DBP) and pulse pressure difference in HT and OSAHS + HT groups were higher than those in OSAHS group. No difference was found among four groups on left ventricular ejection fraction, left ventricular fraction shortening, sampling volume and cardiac output (P>0.05). Compared