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Ciccarone Center Research
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- Meet the Authors
CPAP versus oxygen in obstructive sleep apnea.
In patients with cardiovascular disease or multiple CVD risk factors, the treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP), but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure.
Obstructive sleep apnea and diurnal non-dipping hemodynamic indices in patients at increased cardiovascular risk.
We hypothesized increasing obstructive sleep apnea (OSA) severity would be associated with nondipping blood pressure (BP) in increased cardiovascular disease (CVD) risk. In patients at cardiovascular risk and moderate-to-severe OSA, increasing AHI and/or ODI were associated with increased odds of nondipping SBP and nondipping MAP. More severe levels of AHI and ODI also were associated with nondipping DBP. These results support progressive BP burden associated with increased OSA severity even in patients managed by cardiology specialty care.
Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block!
Patients with obstructive sleep apnea (OSA) have a high burden of CVD, but a causal relationship between the two remains unclear. This study shows OSA is an independent predictor of subclinical CVD, as CVD is more likely to occur in patients with long standing and severe OSA.
Obstructive sleep apnea and diurnal nondipping hemodynamic indices in patients at increased cardiovascular risk.
Progressive blood pressure burden is associated with increased obstructive sleep apnea severity, even in patients managed by cardiology specialty care.
Relationship between the cortisol awakening response and other features of the diurnal cortisol rhythm: the Multi-Ethnic Study of Atherosclerosis.
Bedtime cortisol showed the strongest correlation with total cortisol area under the curve, suggesting it may be a marker of daily cortisol exposure.Read on Pubmed
Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA.
We assessed the association between sleep apnea, snoring, incident CV events and all-cause mortality in the Multi Ethnic Study of Atherosclerosis (MESA) cohort and concluded that sleep apnea, but not habitual snoring, was associated with high incident CV events and all-cause mortality in a multi-ethnic population-based study of adults free of clinical CV disease at baseline.
Update on obstructive sleep apnea and its associated metabolic abnormalities: Insulin resistance, The Metabolic Syndrome, and type 2 diabetes mellitus.
Obstructive sleep apnea is characterized by repeated episodes of upper airway collapse during sleep, leading to apneic and hypopneic episodes, oxygen desaturation, and sleep fragmentation. This condition is closely associated with features of “metabolic syndrome” as well as overt diabetes. Although the association of metabolic abnormalities clearly portend increased cardiovascular risk, it remains unclear to what extent obesity confounds these associations. Attempts to demonstrate a causal relationship between obstructive sleep apnea and insulin resistance have yielded conflicting results. Although several recent studies have demonstrated a relationship between obstructive sleep apnea and diabetes mellitus independent of obesity, there are currently limited data demonstrating a strong causative link. The currently proposed pathophysiology involves intermittent hypoxia, sleep fragmentation, sympathetic activation, oxidative stress, an increase in proinflammatory adipocytokines, and hyperleptinemia and leptin resistance. Although continuous positive airway pressure has shown promise in treating obstructive sleep apnea and its associated metabolic derangements, two recent large, randomized controlled trials have redoubled the emphasis on weight loss in treating the triad of metabolic syndrome, diabetes, and obstructive sleep apnea. Weight loss and aggressive lifestyle intervention remain a common treatment modality for all of these conditions and should always be considered first-line treatment for this clinical construct.