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Pulse wave analysis in a pilot randomised controlled trial of auto-adjusting and continuous positive airway pressure for obstructive sleep apnoea

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Abstract

Purpose

Non-invasive measurements of arterial stiffness including the augmentation index (AIx) and central blood pressure (BP) have been used to assess the cardiovascular health of patients with obstructive sleep apnoea (OSA), a well-established independent risk factor of cardiovascular disease. Continuous positive airway pressure (CPAP) can significantly reduce the AIx, but no studies have analysed the effect of auto-adjusting PAP (APAP) or studied morbidly obese patients with severe OSA at higher risk of cardiovascular disease. In this randomised, single-blinded crossover pilot trial, we aimed to compare the efficacy of CPAP with APAP (ResMed S8 Autoset II) in improving peripheral BP, central BP and the AIx, using SphygmoCor technology.

Methods

Twelve severe OSA patients (mean±SD; apnoea–hypopnoea index, 75.8 ± 32.7; BMI, 49.9 ± 5.2 kg/m2) were consecutively recruited and received CPAP (mean pressure, 16.4 cm H2O) or APAP in random order for four nights at home, separated by a four-night washout. Cardiovascular measurements were taken at baseline, post-washout and following each treatment arm.

Results

The polysomnographically recorded residual apnoea–hypopnoea index and compliance to treatment were not significantly different between arms (p > 0.05). There were no significant differences in peripheral or central BP between arms (p > 0.05). The AIx was lower with CPAP than APAP (by 5.8%), with a large effect size not reaching statistical significance (r = 0.61, p = 0.14).

Conclusion

The large effect size evident when comparing the AIx following CPAP and APAP indicates the need to perform an adequately powered trial in order to determine if APAP improves arterial stiffness to the same extent as CPAP.

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Abbreviations

AHI:

Apnoea–hypopnoea index

AIx:

Augmentation index

APAP:

Auto-adjusting positive airway pressure

BMI:

Body mass index

BP:

Blood pressure

CPAP:

Continuous positive airway pressure

HR:

Heart rate

MAP:

Mean arterial pressure

OSA:

Obstructive sleep apnoea

PP:

Pulse pressure

PSG:

Polysomnography

SD:

Standard deviation

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Acknowledgements

The authors are grateful to the Asthma and Respiratory Foundation of New Zealand for funding the trial, the Capital Cardiovascular Research Trust for providing the SphygmoCor equipment and the University of Otago Research Committee for providing a postgraduate publishing bursary. We thank the participants who donated a substantial period of their time to attend appointments. Special thanks to Dr. John Delahunt, Associate Professor Stewart Mann, Dr. Daniel Fung, WellSleep technical staff members Helen Hills, Michi Imazu, Karyn O’Keeffe, Isabelle Paulsen and Deidre Sheppard, and all referring physicians.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand

    Jessie P. Bakker, Angela J. Campbell & Alister M. Neill

  2. WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, P.O. Box 7343, Wellington, 6242, New Zealand

    Jessie P. Bakker

Authors
  1. Jessie P. Bakker
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  2. Angela J. Campbell
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  3. Alister M. Neill
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Correspondence to Jessie P. Bakker.

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Bakker, J.P., Campbell, A.J. & Neill, A.M. Pulse wave analysis in a pilot randomised controlled trial of auto-adjusting and continuous positive airway pressure for obstructive sleep apnoea. Sleep Breath 15, 325–332 (2011). https://doi.org/10.1007/s11325-010-0385-9

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  • DOI: https://doi.org/10.1007/s11325-010-0385-9

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