Treatment of Obstructive Sleep Apnea in Young and Middle-Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Claudia E Korcarz, Ruth Benca, Jodi H Barnet, James H Stein, Claudia E Korcarz, Ruth Benca, Jodi H Barnet, James H Stein

Abstract

Background: The cardiovascular effects of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients are not clear because of confounding by comorbid conditions.

Methods and results: Prospective interventional study of PAP therapy and withdrawal. Apnea Hypopnea Index (AHI; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (BPs), Aortic Augmentation Index (AAIx), and central (PWVc-f) and peripheral pulse wave (PWVc-r) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of PAP therapy, and 1 week after PAP withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5) AHI events/hour. After 4 weeks post-PAP initiation and sustained after 12 weeks, subjects experienced decreases in central systolic BP (P=0.008), diastolic BP, mean BP, AAIx, and PWVc-r, and brachial artery dilation (all P<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models, PAP use (hours/night) predicted reductions in diastolic BP (β=-0.65 [SE, 0.32] mm Hg/hour; P=0.045), AAIx (β=-0.53 [0.27] %/hour; P=0.049) and PWVc-r (β=-0.13 [0.05] m·s(-1)/hour; P=0.007), and improved brachial artery flow-mediated dilation (β=0.31 [0.14] %/hour use; P=0.015). After 1 week of PAP withdrawal, brachial diameter, diastolic BP, mean BP, AAIx, and heart rate increased (P≤0.05).

Conclusions: PAP therapy reduces arterial tone and improves endothelial and diastolic function in young to middle-aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with PAP withdrawal.

Clinical trial registration: URL: https://ichgcp.net/clinical-trials-registry/NCT01317329" title="See in ClinicalTrials.gov">NCT01317329.

Keywords: echocardiography; endothelial function; obstructive sleep apnea; positive airway pressure ventilation compliance; pulse wave velocity.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram for enrollment, intervention, follow‐up, and data analysis. AHI indicates Apnea‐hypopnea Index; PAP, positive airway pressure; PSG, .
Figure 2
Figure 2
Changes in carotid‐to‐radial pulse wave velocity with positive airway pressure therapy. Changes between baseline PWV c‐r and different study visits, separated by PAP compliance. Noncompliant=used PAP therapy <4 hours a night (blue diamonds). Compliant=used PAP therapy ≥4 hours/night (red boxes). PAP indicates positive airway pressure; PWV, pulse wave velocity.
Figure 3
Figure 3
Changes in diastolic function category with positive airway pressure therapy treatment and withdrawal. Stacked bars represent the percentage distribution of diastolic function categories by study visit. Percentage of study subjects with normal function (blue), progressively increased to week 4, and continued to week 12 of PAP use, but declined after 1 week of withdrawal. Percentage of subjects with diastolic dysfunction (green and red) decreased during treatment. PAP indicates positive airway pressure.

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