Cardiovascular Diseases Clinical Trial
Official title:
Oxidative Stress in Sleep Apnea and Cardiac Disease
Sleep-disordered breathing (SDB) is a condition in which a person experiences frequent breathing pauses during sleep, also known as sleep apnea. There is evidence that the recurrent sleep arousal and associated shortage of oxygen in the body may increase risk for cardiovascular disease (CVD). It is believed that treatment with continuous positive airway pressure (CPAP) may reduce certain risk factors for heart disease, including markers of inflammation and oxidative stress. This study will evaluate the effectiveness of CPAP in reducing CVD risk factors in people with SDB.
It is estimated that 18 million Americans are affected by SDB. SDB involves repeated sleep
arousal caused by breathing difficulties. These frequent sleep disruptions may cause a
person to experience daytime drowsiness, impaired mental functioning, and trouble
concentrating or staying alert. SDB is also associated with an increased risk of certain
cardiovascular diseases, such as high blood pressure and heart disease. Researchers believe
that increased oxidative stress and inflammation associated with SDB may play a role in the
physiologic pathway linking SDB and CVD. However, more information on the SDB-CVD
relationship is needed to be able to identify risk factors for CVD and to discover the best
means of treatment. CPAP, a current treatment for SDB, acts by delivering air through a mask
during sleep. CPAP helps improve overnight breathing and quality of sleep and may, in turn,
decrease oxidative stress and associated CVD risks. This study will compare the
effectiveness of CPAP versus placebo CPAP in reducing CVD risk factors, such as oxidative
stress markers, in people with SDB.
Participation in this study will last between 2.5 and 4 months and will include four to five
study visits. During the first study visit, participants will undergo a CPAP titration
study, which will involve appropriate CPAP mask fitting and an overnight sleep test to
determine the best CPAP pressure, as well as a lower placebo pressure, for each participant.
Participants will also be provided educational information on diet, sleep, and the use of
CPAP as a treatment for sleep apnea. After the titration study, participants will be asked
to wear their fitted CPAP mask every night for the next 2 weeks, during which they will use
the lower (placebo) pressure one week and use the higher pressure the other week. During
this time, a technician will contact participants every 3 to 4 days to address any questions
or problems with the CPAP equipment.
One month later, participants who were able to tolerate and use CPAP most nights will attend
Visit 2. This second visit will include an overnight sleep study without wearing the CPAP
mask; blood and saliva collection; cheek brushing for genetic material; tests on diabetes,
artery stiffness, and circulation; body fat measurements; and questionnaires. Participants
will then be randomly assigned to use either the higher pressure CPAP or the lower pressure
CPAP for 8 weeks. Visit 3 will occur 1 week after beginning CPAP treatment and will include
a fasting blood test. During treatment, participants will be periodically contacted by a
technician to check on equipment status.
Upon completing treatment, participants will undergo repeat tests from Visit 2, except that
they will wear the CPAP mask in the overnight sleep test. This fourth study visit will mark
the completion of treatment for participants assigned to the lower pressure CPAP.
Participants assigned to the higher pressure CPAP will be asked to use CPAP for 4 more
weeks. These participants will return at the end of the 4 weeks for a final visit, which
will include a repeat sleep study and other testing.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
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