Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Tuesday, May 11, 2010

Structural Changes to Brain from Sleep Apnea and Correction with Treatment.

Can the brain recover from damage caused by Sleep Apnea. The answer is yes according to a study done in Italy that showed that in addition to clinical improvement there was also brain-structural recovery. The study emphasizes that adherence to CPAP therapy is key. Unfortunately 60% of patients are not adherent to CPAP therapy and even those that are adherent average only 4-5 hours of use a night which has been shown to be far less that ideal. A recent article "Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea."in Am J Respir Crit Care Med. 2010 Apr 1;181(7):650-2 showed that treatment of hypertension with CPAP required an average of 5.6 hours of nightly CPAP use. The actual conclusion was " In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night."

if 5.6 hours of nightly use is necessary for improvement and if the typical patient only uses cpap 4-5 nights for 4-5 hours than we should not expect improvement in hypertension. Does the same hold true for repair of structural damage from sleep apnea?

THE REAL ADVANTAGE TO ORAL APPLIANCES IN TREATING APNEA IS THAT PATIENTS GENERALLY USE THEM ALL NIGHT LONG. IF ORAL APPLIANCE ARE NOT EFFECTIVE IN A SMALL NUMBER OF CASES CPAP SHOULD BE UTILIZED. PATIENTS WHO USE THEIR CPAP ALL NIGHT/EVERY NIGHT NEED NOT CONSIDER THE ORAL APPLIANCE ALTERNATIVE.

This interesting study published in abstract form in sleep explains the importance of treatment of sleep apnea. The study "BRAIN STRUCTURAL CHANGES IN OSA PATIENTS BEFORE AND AFTER TREATMENT" by Ferini Strambi L, Canessa N, Castronovo V,Alemanno F, Aloia MS5, Marelli S1, Falini A6, Cappa SF2,3,4 concludes that "Conclusion: Our study provide evidence of a neuro-structural damage in OSA patients (decrease of grey-matter volume compared with controls) affecting specific cerebral regions and an increase of grey-matter volume in specific hippocampal and frontal brain regions with treatment. This study offers hope to patients and physicians that adherence to CPAP therapy can lead not only to clinical, but also to brain-structural recovery.

Am J Respir Crit Care Med. 2010 Apr 1;181(7):718-26. Epub 2009 Dec 10.
Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea.
Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM; Spanish Sleep and Breathing Group.

Collaborators (16)
Coordinating Center, Institut de Recerca Biomèdica Lleida, Lleida, Spain. fbarbe@arnau.scs.es
Comment in:

Am J Respir Crit Care Med. 2010 Apr 1;181(7):650-2.
Abstract
RATIONALE: Continuous positive airway pressure (CPAP) is the current treatment for patients with symptomatic obstructive sleep apnea (OSA). Its use for all subjects with sleep-disordered breathing, regardless of daytime symptoms, is unclear. Objectives: This multicenter controlled trial assesses the effects of 1 year of CPAP treatment on blood pressure (BP) in nonsymptomatic, hypertensive patients with OSA. METHODS: We evaluated 359 patients with OSA. Inclusion criteria consisted of an apnea-hypopnea index (AHI) greater than 19 hour(-1), an Epworth Sleepiness Scale score less than 11, and one of the following: under antihypertensive treatment or systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 mm Hg. Patients were randomized to CPAP (n = 178) or to conservative treatment (n = 181). BP was evaluated at baseline and at 3, 6, and 12 months of follow-up. MEASUREMENTS AND MAIN RESULTS: Mean (SD) values were as follows: age, 56 +/- 10 years; body mass index (BMI), 32 +/- 5 kg x m(-2); AHI, 45 +/- 20 hour(-1); and Epworth Sleepiness Scale score, 7 +/- 3. After adjusting for follow-up time, baseline blood pressure values, AHI, time with arterial oxygen saturation less than 90%, and BMI, together with the change in BMI at follow-up, CPAP treatment decreased systolic blood pressure by 1.89 mm Hg (95% confidence interval: -3.90, 0.11 mm Hg; P = 0.0654), and diastolic blood pressure by 2.19 mm Hg (95% confidence interval: -3.46, -0.93 mm Hg; P = 0.0008). The most significant reduction in BP was in patients who used CPAP for more than 5.6 hours per night. CPAP compliance was related to AHI and the decrease in Epworth Sleepiness Scale score. CONCLUSIONS: In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night. Clinical trial registered with www.clinicaltrials.gov (NCT00127348).

PMID: 20007932 [PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 8:04 AM