Acute effects of autoadjusting and fixed continuous positive airway pressure treatments on cardiorespiratory coupling in obese patients with obstructive sleep apnea

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• 作者：Vincenzo Patruno ; Eleonora Tobaldini ; Anna M. Bianchi ; Martin O. Mendez ; Orietta Coletti ; Giorgio Costantino ; Nicola Montano
• 关键词：AHI ; apnea&ndash ; hypopnea index ; APAP ; autoadjusting continuous positive airway pressure ; BMI ; body-mass index ; CPAP ; continuous positive airway pressure ; CT 90 ; cut-off time 90 (total sleep time with SaO2 < ;   ; 90%) ; DAP ; diastolic blood pressure ; ESS ; Epworth Sleepiness Scale ; HF ; high frequency ; HRV ; heart rate variability ; LF ; low frequency ; Mean-SaO2 ; mean oxygen saturation ; Nadir-SaO2 ; lower oxygen saturation ; ODI ; oxyhemoglobin desaturation index ; SAP ; systolic blood pressure
• 刊名：European Journal of Internal Medicine
• 出版年：February, 2014
• 年：2014
• 卷：25
• 期：2
• 页码：164-168
• 全文大小：414 K

文摘

Background

Treatment with positive airway pressure devices improved signs and symptoms of obstructive sleep apnea syndrome (OSA); however, auto-adjusting positive pressure (APAP) device was not as effective as continuous positive airway pressure (CPAP) in reducing arterial blood pressure and insulin resistance. The role played by autonomic cardiac regulation remains to be clarified.

We aimed to test the effects of CPAP and APAP on autonomic regulation and cardiorespiratory coupling during sleep.

Methods

We retrospectively analyzed full-night polysomnographic studies. 19 patients newly diagnosed with severe OSA (AHI > 30) and 7 obese subjects without OSA (CON) were enrolled. Each OSA subject was assigned to CPAP or APAP treatment and underwent a sleep study after 1 week of treatment. Spectral and cross-spectral analyses of heart rate variability (HRV) and respiration were performed to assess autonomic profile and coherence (K²) between respiration and HF oscillation during sleep in CPAP, APAP and CON groups.

Results

In CPAP and CON, LFnu and LF/HF, markers of sympathetic modulation, decreased from N2 to N3 and increased during REM sleep (p < 0.001), while in APAP group, sympathetic modulation was significantly higher compared with those of CPAP and CON during all sleep stages. K² values were lower in APAP compared with those in CPAP and CON.

Conclusion

APAP treatment was characterized by a greater sympathetic activation and it was associated with a lower cardio-respiratory coupling compared with CPAP. This might account for the different effects on cardiovascular risk factors induced by the two treatments.