Obstructive Sleep Apnea Clinical Trial
Official title:
Impact of CPAP Therapy in Obstructive Sleep Apnea on Parameters of Nocturnal Pulse Wave Analysis
The present study aims to document and assess changes in single parameters of pulse wave analysis (ASI single parameters) as well as to evaluate ASI cardiovascular risk assessment before initiation of CPAP therapy and after 6 months of CPAP therapy in patients with obstructive sleep apnea.
Obstructive sleep apnea (OSA) is characterized by repeated occurrence of apneas or reduced
inspiratory air flow due to obstructions of the upper airways (hypopneas). These recurring
events are accompanied by intermittent hypoxemia and sympathetic activation, leading to
hemodynamic oscillations including relevant variations of pulse wave and blood pressure.
Thus, OSA is associated with cardiovascular diseases and was identified as an independent
risk factor for hypertension.
Direct effects of obstructive respiratory events (obstructive apneas and hypopneas) include
changes of the peripheral pulse wave. The latter can easily be measured by finger
plethysmography, e.g. by using established pulse oximeters. Certain pulse wave
characteristics and their reaction towards obstructive respiratory events may provide
information on cardiovascular function and thereby help in individual cardiovascular risk
assessment.
Recently, Grote et al. published a concept for cardiovascular risk assessment based on pulse
oximetry and pulse wave analysis ("ASI" - Grote et al. 2011, CHEST). The algorithm described
herein is able to differentiate between high and low risk patients according to ESH/ESC risk
classification (high risk = 4 and 5, low risk 1-3). To that end, oxygen saturation as
measured by pulse oximetry, reductions in pulse wave amplitude, pulse rate accelerations,
pulse propagation time and cardiorespiratory coupling are taken into account to calculate a
quantitative total risk.
A successful OSA therapy applying positive airway pressure (e.g. CPAP) normalizes
sleep-related breathing disturbances and thus counterbalances hemodynamic oscillations. This
presumably results in reduced cardiovascular risk and should be detectable by measurable
changes in pulse wave. This study aims to evaluate these effects by analyzing the single
pulse wave parameters, which are part of the ASI algorithm. At the same time, established
risk factors as well as the objective therapy outcome will be documented from the established
sleep medicine viewpoint.
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