Obstructive sleep apnea and CPAP therapyin different clinical scenarios

Authors: Magomedova N.M., Kazanovskaya S.N.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2018-12-4-353-365

For citation: Magomedova N.M., Kazanovskaya S.N. Obstructive sleep apnea and CPAP therapy in different clinical scenarios. Creative Cardiology. 2018; 12 (4): 353–65 (in Russ.). DOI: 10.24022/1997-3187-2018-12-4-353-365

Received / Accepted:  26.11.2018/05.12.2018

Keywords: obstructive sleep apnea continuous positive airway pressure coronary heart disease atrial fibrillation cardiovascular disease

Download
Full text:  

 

Abstract

The syndrome of obstructive sleep apnea (OSA) is a modifiable risk factor associated with the progression of different cardiovascular diseases and atrial fibrillation. Continuous positive airway pressure in OSA is successfully used to treat coronary heart disease, hypertension, heart rhythm disturbances, strokes, diabetes mellitus, pulmonary hypertension, heart failure. In this review, the data of modern studies are analyzed, the effectiveness of CPAP therapy in this category of patients is evaluated.

References

  1. Dempsey J., Khayat R., Javaheri S. et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J. Am. Coll. Cardiol. 2017; 69 (7): 841–58. DOI: 10.1016/j.jacc.2016.11.069
  2. Bravata D.M., Concato J., Fried T., Ranjbar N., Sadarangani T., McClain V. et al. Autotitrating CPAP for patients with Acute Transient Ischemic Atack: A randomized Feasibility Trial. Stroke. 2010; 41 (7): 1464–70. DOI: 10.1161/STROKEAHA.109.566745
  3. Магомедова Н.М., Голухова Е.З. Слип-апноэ и сердечно-сосудистые риски. Креативная кардиология. 2016; 10 (3): 210–9. DOI: 10.15275/kreatkard.2016.03.03 / Magomedova N.M., Golukhova E.Z. Obstructive sleep apnea and the risk of cardiovascular disease. Creative Cardiology. 2016; 10 (3): 210–9. DOI: 10.15275/kreatkard.2016.03.03 (in Russ.).
  4. Geovanini G.R., Wang R., Weng J., Jenny N.S., Shea S., Allison M. et al. Association between obstructive sleep apnea and cardiovascular risk factors-variation by age, sex and race: the Multi- Ethnic Study of Atherosclerosis (MESA). Ann. Am. Thorac. Soc. 2018. DOI: 10.1513/AnnalsATS.201802-121OC
  5. Bauters F., Rietzschel E.R., Hertegonne K.B., Chirinos J.A. The link between obstructive sleep apnea and cardiovascular disease. Curr. Atheroscler. Rep. 2016; 18: 1. DOI: 10.1007/s11883-015-0556-z
  6. Baltzis D., Bakker J.P., Patel S.R., Veves A. Obstructive sleep apnea and vascular diseases. Compr. Physiol. 2016; 6 (3): 1519–28. DOI: 10.1002/cphy.c150029
  7. . Xie X.M., Pan L., Ren D.Q., Du C.J., Guo Y.Z. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep. Med. 2013; 14 (11): 1139–50. DOI: 10.1016/j.sleep.2013.07.006
  8. Ning Y., Zhang T.S., Wen W.W., Li K., Yang Y.X., Qin Y.W. Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep. Breath. 2018; 22. DOI: 10.1007/s11325-018-1662-2
  9. Kohler M., Stoewhas A.C., Ayers L., Senn O., Bloch K.E., Russi E.W., Stradling J.R. Effects of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial. Am. J. Respir. Crit. Care. Med. 2011; 184 (10): 1192–99. DOI: 10.1164/rccm.201106-0964OC
  10. Gami A.S., Olson E.J., Shen W.K., Wright R.S., Ballman K.V., Hodge D.O. et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J. Am. Coll. Cardiol. 2013; 62: 610–6.
  11. Mazaki T., Kasai T., Yokoi H., Kuramitsu S., Yamaji K., Morinada H. et al. Impact of sleep-disordered breathing on long-term outcomes in patients with acute coronary syndrome who have undergone primary percutaneous coronary intervention. J. Am. Heart Assoc. 2016; 5 (6): e003270. DOI: 10.1161/JAHA.116.003270
  12. Wang X., Fan J.Y., Zhang Y., Nie S.P., Wei Y.X. Association of obstructive sleep apnea with cardiovascular outcomes after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97 (17): e0621. DOI: 10.1097/MD.0000000000010621
  13. Peker Y., Glantz H., Eulenburg C., Wegscheider K., Herlitz J., Thustrom E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 2016; 194 (5): 613–20. DOI: 10.1164/rccm.201601-0088OC м Mokhlesi B., Ayas N.T. Cardiovascular events in obstructive sleep apnea – can CPAP therapy SAVE lives? N. Engl. J. Med. 2016; 375: 994–96. DOI: 10.1056/NEJMe1609704
  14. Loffler K.A., Heeley E., Freed R., Anderson C.S., Brockway B., Corbett A., Chang C.L., James A. Effect of obstructive sleep apnea treatment on renal function in patients with cardiovascular disease. Am. J. Respir. Crit. Care Med. 2017; 196 (11): 1456–62. DOI: 10.1164/rccm.201703-0603OC
  15. Chirinos J.A., Gurubhagavatula I., Teff K. Rader D.J., Wadden T.A., Townsend R. et al. CPAP, weight loss, or both for obstructive sleep apnea. N. Engl. J. Med. 2014; 370 (24): 2265–75. DOI: 10.1056/NEJMoa1306187
  16. Pamidi S., Wroblewski K., Stepien M., Sharif-Sidi K., Kilkus J., Whitmore H., Tasali E. et al. Eight hours of nightly continuous positive airway pressure treatment of obstructive sleep apnea improves glucose metabolism in patients with prediabetes. A randomized controlled trial. Am. J. Respir. Crit. Care Med. 2015; 192 (1): 96–105.
  17. Weinstock T.G., Wang X., Rueschman M., Ismail- Beigi F., Aylor J., Babineau D.C. et al. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. Sleep. 2012; 35 (5): 617–25. DOI: 10.5665/sleep.1816
  18. Salord N., Fortuna A.M., Monasterio C., Gasa M., Perez A., Bonsignore M.R. et al. A randomized controlled trial of continuous positive airway pressure on glucose tolerance in obese patients with obstructive sleep apnea. Sleep. 2016; 39 (1): 35–41. DOI: 10.5665/sleep.5312
  19. Craig S., Pepperell J.C., Kohler M., Crosthwaite N., Davies R.J., Stradling J.R. et al. Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trial. J. Sleep. Res. 2009; 18 (3): 329–36. DOI: 10.1111/j.1365-2869.2008.00726.x
  20. Ryan C.M., Usui K., Floras J.S., Bradley T.D. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax. 2005; 60: 781–5. DOI: 10.1136/thx.2005.040972
  21. Mehra R., Benjamin E.J., Shahar E., Gottlieb D.J., Nawabit R., Kirchner H.L. et al. Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study. Am. J. Respir. Crit. Care Med. 2006; 173 (8): 910–16. DOI: 10.1164/rccm.200509-1442OC
  22. Mehra R., Stone K.L., Varosy P.D., Hoffman A.R., Marcus G.M., Blackwell T. et al. Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Arch. Intern. Med. 2009; 169 (12): 1147–55. DOI: 10.1001/archinternmed.2009.138
  23. Cintra F.D., Leite R.P., Storti L.J., Bittencourt L.A., Poyares D., de Siqueira Castro L. et al. Sleep apnea and nocturnal cardiac arrhythmia: a populational study. Arg. Bras. Cardiol. 2014; 103 (5): 368–74. DOI 10.5935/abc.20140142
  24. Holmqvist F., Guan N., Zhu Z., Kowey P.R., Allen L.A., Fonarow G.C. et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am. Heart J. 2015; 169 (5): 647–54. e2. DOI: 10.1016/j.ahj.2014.12.024
  25. Певзнер А.В., Байрамбеков Э.Ш., Литвин А.Ю., Елфимова Е.М., Ермишкин В.В., Соколов С.Ф., Голицын С.П. Результаты применения терапии с созданием положительного давления воздуха в верхних дыхательных путях при лечении больных с фибрилляцией предсердий и синдромом обструктивного апноэ во время сна. Российский кардиологический журнал. 2017; 7: 111–6. DOI: 10.15829/1560-4071-2017-7-111-116 / Pevzner A.V., Bayrambekov E.S., Litvin A.Yu., Elfimova E.M., Ermishkin V.V., Sokolov S.F., Golitsyn S.P. Results of continuous positive upper airway pressure treatment in patients with atrial fibrillation and obstructive sleep apnea. Russian Journal of Cardiology. 2017; 7: 111–6. DOI: 10.15829/1560-4071-2017-7-111-116 (in Russ.).
  26. Neilan T.G., Farhad H., Dodson J.A., Shah R.V., Abbasi S.A., Bakker J.P. et al. Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. J. Am. Heart. Assoc. 2013; 2 (6): e000421. DOI: 10.1161/JAHA.113.000421
  27. Qureshi W.T., Nasir U.B., Alqalyoobi S., O'Neal W.T., Mawri S., Sabbagh S. et al. Meta-analysis of continuous positive airway pressure as a therapy of atrial fibrillation in obstructive sleep apnea. Am. J. Cardiol. 2015; 116 (11): 1767–73. DOI: 10.1016/j.amjcard.2015.08.046
  28. Shukla А., Aizer A., Holmes D., Fowler S., Park D.S., Bernstein S. et al. Effect of obstructive sleep apnea treatment on atrial fibrillation recurrence. A meta-analysis. JACCCEP. 2015; 1 (1): 41–51. DOI: 10.1016/j.jacep.2015.02.014
  29. Yadava M., Hughey A.B., Crawford T.C. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Cardiol. Clin. 2014; 32 (4): 627–36. DOI: 10.1016/j.ccl.2014.07.002
  30. Horwich P., Buth K.J., Légaré J.-F. New onset postoperative atrial fibrillation is associated with a long-term risk for stroke and death following cardiac surgery. J. Card. Surg. 2013; 28 (1): 8–13. DOI: 10.1111/jocs.12033
  31. Zhao L.-P., Kofidis T., Lim T.W., Chan S.P., Ong T.H., Tan H.C., Lee C.H. Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting. J. Crit. Care. 2015; 30 (6): 1418.e1–5.
  32. Wong J.K., Maxwell B.G., Kushida C.A., Sainani K.L., Lobato R.L., Joseph Woo Y., Pearl R.G. Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2015; 29: 1140–7.
  33. Ding F., Wong J.K., Whittemore A.S., Kushida C.A. Effect of postoperative positive airway pressure on risk of postoperative atrial fibrillation after cardiac surgery in patients with obstructive sleep apnea: a retrospective cohort study. Sleep Sci. Pract. 2017; 1: 5. DOI: 10.1186/s41606-016-0004-1
  34. Arias M.A., F. García-Río, A. Alonso-Fernández, Mediano O., Martinez I., Villamor J. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005; 112: 375–83.
  35. Kaneko Y., Floras J.S., Usui K., Plante J., Tkacova R., Kubo T. et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N. Engl. J. Med. 2003; 348 (13): 1233–41. DOI: 10.1056/NEJMoa022479
  36. Медведева Е.А., Коростовцева Л.С., Сазонова Ю.В., Бочкарёв М.В., Свиряев Ю.В., Конради А.О. Синдром обструктивного апноэ во сне при хронической сердечной недостаточности: взгляд кардиолога. Российский кардиологический журнал. 2018; (1): 78-82. DOI: 10.15829/1560-4071-2018-1-78-82/Medvedeva E.A., Korostovtseva L.S., Sazonova Y.V., Bochkarev M.V., Sviryaev Yu.V., Konradi A.О. Obstructive sleep apnea syndrome in congestive heart failure: cardiologist perspective. Russian Journal of Cardiology. 2018; (1): 78–82. DOI: 10.15829/1560-4071-2018-1-78-82 (in Russ.).
  37. Javaheri S. Heart failure. M.H. Kryger, T. Roth, W.C. Dement (Eds.). Principles and practices of sleep medicine. 6th ed. Elsevier: Philadelphia; 2017: 1271–85.
  38. Nieto F.J., Young T.B., Lind B.K., Shahar E., Samet J.M., Redline S. et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000; 283 (14): 1829–36.
  39. Peppard P.E., Young T., Palta M., Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. New Eng. J. Med. 2000; 342 (19): 1378–84. DOI: 10.1056/NEJM200005113421901
  40. Barbe F., Durán-Cantolla J., Capote F., de la Pena M., Chiner E., Masa J.F. et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am. J. Respir. Crit. Care Med. 2010; 181 (7): 718–26. DOI: 10.1164/rccm.200901-0050OC
  41. Martínez-García M.A., Capote F., Campos- Rodríguez F., Lloberes P., Díaz de Atauri M.J., Somoza M. et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: The HIPARCO randomized clinical trial. JAMA. 2013; 310 (22): 2407–15. DOI: 10.1001/jama.2013.281250
  42. Thunström E., Manhem K., Rosengren A., Peker Y. Blood pressure response to losartan and continuous positive airway pressure in hypertension and obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 2016; 193 (3): 310–20. DOI: 10.1164/rccm.201505-0998OC
  43. Chirinos J.A., Gurubhagavatula I., Teff K., Rader D.J., Wadden T.A., Townsend R. et al. CPAP, weight loss, or both for obstructive sleep apnea. N. Engl. J. Med. 2014; 370 (24): 2265–75. DOI: 10.1056/NEJMoa1306187
  44. Pepin J.L., Tamisier R., Barone-Rochette G., Launois S.H., Levy P., Baguet J.P. Comparison of continuous positive airway pressure and valsartan in hypertensive patients with sleep apnea. Am. J. Respir. Crit. Care Med. 2010; 182 (7): 954–60. DOI: 10.1164/rccm.200912-1803OC
  45. Javaheri S., Javaheri S., Javaheri A. Sleep apnea, heart failure and pulmonary hypertension. Curr. Heart Fail. Rep. 2013; 10 (4): 315–20. DOI: 10.1007/s11897-013-0167-3
  46. Nieto F.J., Young T., Peppard P.E. Systemic and pulmonary hypertension in obstructive sleep apnea. Principles and Practices of Sleep Medicine. 6th ed. Elsevier: Philadelphia, PA; 2017: 1253–63.
  47. Arias M.A., García-Río F., Alonso-Fernández A., Martinez I., Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur. Heart J. 2006; 27: 1106–13.
  48. Haentjens P., Van Meerhaeghe A., Moscariello A., De Weerdt S., Poppe K., Dupont A. et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch. Intern. Med. 2007; 167 (8): 757–64. DOI: 10.1001/archinte.167.8.757

About Authors

  • Nargiz M. Magomedova, Cand. Med. Sc., Researcher, Cardiologist, orcid.org/0000-0002-9812-011Х;
  • Svetlana N. Kazanovskaya, Researcher, orcid.org/0000-0003-3357-2016

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery