Search

Objective The effects of continuous positive airway pressure (CPAP) devices on obstructive sleep apnea (OSA) in Japanese patients have not been reported. We assessed the effects of changing CPAP devices (from the Philips Respironics device to the ResMed device) on the control of OSA. Methods We retrospectively examined 13 patients with OSA who voluntarily changed from the Philips Respironics device to the ResMed device due to a Philips Respironics CPAP device recall. Data on the apnea-hypopnea index (AHI) were obtained from the CPAP devices for three months before and after changing the devices. Results The AHI obtained from the CPAP devices significantly decreased from 4.4 (3.1-10.7) events/h to 2.0 (0.8-3.6) events/h when patients changed devices (p=0.022). The AHI decreased to <5 events/h after changing devices in 4 patients, whereas it had been ≥5 events/h before changing devices in 6 patients. Conclusion Changing CPAP devices can decrease the AHI.

Rationale: The effects of telemedicine on adherence in patients with obstructive sleep apnea with long-term continuous positive airway pressure (CPAP) use have never been investigated. Objectives: To examine effects of a telemedicine intervention on adherence in long-term CPAP users. Methods: In a prospective, randomized, multicenter noninferiority trial conducted in 17 sleep centers across Japan, patients who had used CPAP for >3 months and were receiving face-to-face follow-up by physicians every 1 or 2 months were randomized by a coordinating center in a blind manner to the following three groups: 1 ) follow-up every 3 months accompanied by a monthly telemedicine intervention (telemedicine group: TM-group), 2 ) follow-up every 3 months (3-month group: 3M-group), or 3 ) monthly follow-up (1-month group: 1M-group). Each group was followed up for 6 months. The change in percentage of days with ≥4 h/night of CPAP use from baseline to the end of the study period was evaluated. A decline of ≥5% from baseline was considered deterioration of adherence. Noninferiority of TM- and 3M-groups compared with the 1M-group according to the number of patients with deterioration of adherence was evaluated with the Farrington and Manning test (noninferiority margin 15%). Results: A total of 483 patients were analyzed (median duration of CPAP use, 29 [interquartile range, 12-71] mo), and deterioration of adherence was found in 41 of 161 (25.5%), 55 of 166 (33.1%), and 35 of 156 (22.4%) patients in the TM-, 3M-, and 1M-groups, respectively. The noninferiority of the TM-group compared with the 1M-group was verified (difference in percentage of patients with adherence deterioration, 3.0%; 95% confidence interval [CI], -4.8% to 10.9%; P  < 0.01). Conversely, the 3M-group did not show noninferiority to the 1M-group (percentage difference, 10.7%; 95% CI, 2.6% to 18.8%; P  = 0.19). In the stratified analysis, adherence in TM- and 1M-group patients with poor adherence at baseline improved (TM: 45.8% ± 18.2% to 57.3% ± 24.4%; P  < 0.01; 1M: 43.1% ± 18.5% to 53.6% ± 24.3%; P  < 0.01), whereas that of the 3M-group did not (39.3% ± 20.8% to 39.8% ± 24.8%; P  = 0.84). Conclusions: Intensive telemedicine support could help to optimize CPAP adherence even after long-term CPAP use.Clinical trial registered with www.umin.ac.jp/ctr/index.htm (trial number: UMIN000023118).

Purpose: In this report, we examined the association between obstructive sleep apnea (OSA) and upper and lower airway inflammation based on nitric oxide (NO) measurements., Methods: Study subjects included 51 consecutive participants. Sleep-disordered breathing was evaluated by a type 3 portable monitor and quantified by respiratory disturbance index (RDI). Airway inflammation was noninvasively analyzed by the measurement of nasally and orally exhaled NO; nasal value was presented as nasally exhaled NO minus orally exhaled NO. In 15 patients prescribed nasal continuous positive airway pressure (nCPAP) therapy, exhaled NO was re-evaluated in 10.7 ± 6.3 months after nCPAP therapy., Results: Nasal NO was significantly higher in patients with severe OSA (RDI ≥ 30/h) than those with non-OSA (RDI < 10/h) (76.9 ± 26.0 ppb vs. 47.9 ± 22.0 ppb, respectively, p = 0.016) and correlated with RDI (rho = 0.36, p = 0.0099), whereas orally exhaled NO did not differ between non-OSA and OSA patients and was not correlated with RDI. In 15 patients, nasal NO after nCPAP therapy was significantly decreased than that before nCPAP therapy (81.9 ± 31.2 ppb vs. 53.7 ± 27.2 ppb, respectively, p = 0.0046); in 11 patients having good compliance to nCPAP therapy (nCPAP use >4 h per night on more than 70% of nights), this association was more remarkable., Conclusions: In OSA, upper but not lower airway inflammation can be increased by repetitive collapse of the upper airway. Future studies are required to determine the role of nasal NO in OSA.

Rationale: Disrupted energy homeostasis in obstructive sleep apnea (OSA) may lead to weight gain. Paradoxically, treating OSA with continuous positive airway pressure (CPAP) may also promote weight gain, although the underlying mechanism remains unclear., Objectives: To explore the underlying mechanism by which patients with OSA gain weight after CPAP., Methods: A comprehensive assessment of energy metabolism was performed in 63 newly diagnosed OSA study participants (51 men; 60.8 ± 10.1 yr; apnea-hypopnea index >20 h(-1)) at baseline, CPAP initiation, and at a 3-month follow-up. Measurements included polysomnography, body weight, body composition, basal metabolic rate (BMR), hormones (norepinephrine, cortisol, leptin, ghrelin, insulin-like growth factor-1), dietary intake, eating behavior, and physical activity., Measurements and Main Results: BMR significantly decreased after CPAP (1,584 kcal/d at baseline, 1,561 kcal/d at CPAP initiation, and 1,508 kcal/d at follow-up; P < 0.001), whereas physical activity and total caloric intake did not significantly change. In multivariate regression, baseline apnea-hypopnea index, Δurine norepinephrine, and CPAP adherence were significant predictors of ΔBMR. The weight gainers had higher leptin levels, lower ghrelin levels, and higher eating behavior scores than the non-weight gainers, indicating a positive energy balance and disordered eating behavior among the weight gainers. Among the parameters related to energy metabolism, increased caloric intake was a particularly significant predictor of weight gain., Conclusions: Although a reduction in BMR after CPAP predisposes to a positive energy balance, dietary intake and eating behavior had greater impacts on weight change. These findings highlight the importance of lifestyle modifications combined with CPAP. Clinical trial registered with http://www.umin.ac.jp/english/ (UMIN000012639).

Introduction: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders in humans. The most frequent CAH variant is 21-hydroxylase deficiency. Patients with 21-hydroxylase deficiency require long-term glucocorticoid replacement treatment. Although sleep disturbance is frequently observed under glucocorticoid replacement treatment, a case of obstructive sleep apnea(OSA) in patients with CAH has not been reported., Case Report: A 43-year-old man with CAH who complained about sleep disturbance and sleep bruxism was diagnosed as obstructive sleep apnea (OSA) by polysomnography (PSG). Following the introduction of nasal continuous positive airway pressure (nCPAP), his sleep disturbance with symptoms also improved; in addition, he was able to reduce the dose of glucocorticoid replacement therapy without any adverse consequences on his sleep pattern., Conclusions: Physicians who treat a patient with CAH should know the possibility in the existence of OSA in their patients. Because symptoms with OSA in CAH patient may increase the dosage of long-term glucocorticoid treatment for the patient, which may induce several adverse effects including body weight gain on the patient.

Sleep disordered breathing (SDB), mainly obstructive sleep apnea (OSA), constitutes a major health problem due to the large number of patients. Intermittent hypoxia caused by SDB induces alterations in metabolic function. Nevertheless, metabolites characteristic for SDB are largely unknown. In this study, we performed gas chromatography-mass spectrometry-based targeted metabolome analysis using data from The Nagahama Study (n = 6373). SDB-related metabolites were defined based on their variable importance score in orthogonal partial least squares discriminant analysis and fold changes in normalized peak-intensity levels between moderate-severe SDB patients and participants without SDB. We identified 20 metabolites as SDB-related, and interestingly, these metabolites were frequently included in pathways related to fructose. Multivariate analysis revealed that moderate-severe SDB was a significant factor for increased plasma fructose levels (β = 0.210, P = 0.006, generalized linear model) even after the adjustment of confounding factors. We further investigated changes in plasma fructose levels after continuous positive airway pressure (CPAP) treatment using samples from patients with OSA (n = 60) diagnosed by polysomnography at Kyoto University Hospital, and found that patients with marked hypoxemia exhibited prominent hyperfructosemia and their plasma fructose levels lowered after CPAP treatment. These data suggest that hyperfructosemia is the abnormality characteristic to SDB, which can be reduced by CPAP treatment. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is an established factor in the pathogenesis and exacerbation of fatty liver disease. However, randomized controlled trials have failed to demonstrate decreases in liver fat content in OSA patients by continuous positive airway pressure (CPAP) performed for several months. The aim of this study is to investigate the impact of long-term CPAP therapy on liver fat content in OSA patients with fatty liver. Liver fat content in 61 male OSA patients was evaluated by computed tomography performed because of abdominal obesity before and after CPAP initiation. At baseline, there were 25 participants with fatty liver. Their apnea-hypopnea index and percent sleep time with oxygen saturation < 90% were greater than those in the 36 participants who did not have fatty liver (52.3 vs. 41.8/h and 30.4 vs. 14.8%, respectively). The average therapy duration was 31 months. In the analysis of the entire participant group, liver fat content did not change after CPAP therapy. In those without fatty liver, liver fat content increased accompanied by increases in BMI, whereas in the participants with fatty liver, liver fat content decreased despite stable BMI, abdominal fat distribution, and insulin resistance. In male OSA patients with abdominal obesity, decreases in liver fat content were observed after long-term CPAP therapy only when fatty liver was present at baseline. This implies that there are some conditions, such as OSA-related hypoxemia and others, which may exacerbate fatty liver and that fatty liver may improve with CPAP therapy. [ABSTRACT FROM AUTHOR]

Rationale: Disrupted energy homeostasis in obstructive sleep apnea (OSA) may lead to weight gain. Paradoxically, treating OSA with continuous positive airway pressure (CPAP) may also promote weight gain, although the underlying mechanism remains unclear.Objectives: To explore the underlying mechanism by which patients with OSA gain weight after CPAP.Methods: A comprehensive assessment of energy metabolism was performed in 63 newly diagnosed OSA study participants (51 men; 60.8 ± 10.1 yr; apnea-hypopnea index >20 h(-1)) at baseline, CPAP initiation, and at a 3-month follow-up. Measurements included polysomnography, body weight, body composition, basal metabolic rate (BMR), hormones (norepinephrine, cortisol, leptin, ghrelin, insulin-like growth factor-1), dietary intake, eating behavior, and physical activity.Measurements and Main Results: BMR significantly decreased after CPAP (1,584 kcal/d at baseline, 1,561 kcal/d at CPAP initiation, and 1,508 kcal/d at follow-up; P < 0.001), whereas physical activity and total caloric intake did not significantly change. In multivariate regression, baseline apnea-hypopnea index, Δurine norepinephrine, and CPAP adherence were significant predictors of ΔBMR. The weight gainers had higher leptin levels, lower ghrelin levels, and higher eating behavior scores than the non-weight gainers, indicating a positive energy balance and disordered eating behavior among the weight gainers. Among the parameters related to energy metabolism, increased caloric intake was a particularly significant predictor of weight gain.Conclusions: Although a reduction in BMR after CPAP predisposes to a positive energy balance, dietary intake and eating behavior had greater impacts on weight change. These findings highlight the importance of lifestyle modifications combined with CPAP. Clinical trial registered with http://www.umin.ac.jp/english/ (UMIN000012639). [ABSTRACT FROM AUTHOR]