Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea: Possible Relationship with Counteracting Oxidative Stress

Abstract

This work is aimed at exploring the clinical efficacy of continuous positive airway pressure (CPAP) in treatment of patients with arrhythmias combined with obstructive sleep apnea (OSA). Through evaluating serum native thiol, malonaldehyde (MDA) and nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months, we confirmed the impact of oxidative stress on arrhythmias. A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information. Patients were divided into two groups (paired experiment design): 32 patients in group A (control group), who received unchanged anti-arrhythmia treatment and 32 patients in group B, who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. OSA related parameters were compared between the two groups after 3-month therapy. And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy. After 3 months of CPAP therapy, compared with the control group, the percentage of sage N3 (NREM 3) and stage R (REM) in total sleep time was significantly increased, while apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS) score were evidently decreased. Meanwhile, the lowest oxygen saturation (LSpO₂) was also elevated after CPAP treatment for 3 months. The CPAP therapy significantly prevented the occurrence of arrhythmias (P<0.05). Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A (P<0.05). But serum native thiol was improved by CPAP treatment (P<0.05). In conclusion, proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

Keywords

obstructive sleep apnea / arrhythmias / oxidative stress / polysomnography / continuous positive airway pressure

References

[1] OzcelikH, KayarY, DanaliogluA, et al.. Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA. Eur Arch Otorhinolaryngol, 2017, 274(3): 1223-1229

[2] PeppardPE, YoungT, BarnetJH, et al.. Increased prevalence of sleep–disordered breathing in adults. Am J Epidemiol, 2013, 177(9): 1006-1014

[3] AgrawalA, VermaI, ShahV, et al.. Cardiac manifestations of idiopathic pulmonary fibrosis. Intractable Rare Dis Res, 2016, 5(2): 70-75

[4] PatelN, DonahueC, ShenoyA, et al.. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol, 2017, 228: 967-970

[5] VianelloA, BisogniV, RinaldoC, et al.. Recent advances in the diagnosis and management of obstructive sleep apnea. Minerva Med, 2016, 107(6): 437-451

[6] MancusoM, BonanniE, LoGerfoA, et al.. Oxidative stress biomarkers in patients with untreated obstructive sleep apnea syndrome. Sleep Med, 2012, 13(6): 632-636

[7] YamamotoH, TeramotoS, YamaguchiY, et al.. Effect of nasal continuous positive airway pressure treatment on plasma adrenomedullin levels in patients with obstructive sleep apnea syndrome: roles of nocturnal hypoxia and oxidant stress. Hypertens Res, 2007, 30(11): 1065-1076

[8] JordanW, CohrsS, DegnerD, et al.. Evaluation of oxidative stress measurements in obstructive sleep apnea syndrome. J Neural Transm (Vienna), 2006, 113(2): 239-254

[9] XuLF, ZhouXF, HuK, et al.. Establishment of a Rabbit Model of Chronic Obstructive Sleep Apnea and Application in Cardiovascular Consequences. Chin Med J (Engl), 2017, 130(4): 452-459

[10] CarratuP, ZitoA, DragonieriS, et al.. Effect of CPAP on cardiovascular risks in OSA patients. A 4–year followup, preliminary data. Sleep Breath, 2017, 21(1): 143-144

[11] YuJ, ZhouZ, McEvoyRD, et al.. Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta–analysis. JAMA, 2017, 318(2): 156-166

[12] JacksonML, McEvoyRD, BanksS, et al.. Neurobehavioral Impairment and CPAP Treatment Response in Mild–Moderate Obstructive Sleep Apneas. J Clin Sleep Med, 2018, 14(1): 47-56

[13] TothB, AuthA, RomposL, et al.. Effect of feed deprivation on selected parameters of lipid mobilisation and hepatic function in healthy Akhal Teke horses. Equine Vet J, 2018, 50(1): 98-103

[14] NieuwenhuijsenK, HulshofCT, SluiterJK. The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations. Patient Educ Couns, 2018, 101(7): 1291-1297

[15] WuMN, LaiCL, LiuCK, et al.. Basal sympathetic predominance in periodic limb movements in sleep after continuous positive airway pressure. Sleep Breath, 2018, 22(4): 1005-1012

[16] YeL, QianY, LiQ, et al.. Serum Romo1 is significantly associated with disease severity in patients with obstructive sleep apnea syndrome. Sleep Breath, 2018, 22(3): 743-748

[17] DragerLF, McEvoyRD, BarbeF, et al.. Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation, 2017, 136(19): 1840-1850

[18] LinzD, LinzB, HohlM, et al.. Atrial arrhythmogenesis in obstructive sleep apnea: Therapeutic implications. Sleep Med Rev, 2016, 26: 87-94

[19] HongKL, GloverBM. The impact of lifestyle intervention on atrial fibrillation. Curr Opin Cardiol, 2018, 33(1): 14-19

[20] MehraR, BenjaminEJ, ShaharE, et al.. Association of nocturnal arrhythmias with sleep–disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med, 2006, 173(8): 910-916

[21] LatshangTD, KaufmannB, Nussbaumer–OchsnerY, et al.. Patients with Obstructive Sleep Apnea Have Cardiac Repolarization Disturbances when Travelling to Altitude: Randomized, Placebo–Controlled Trial of Acetazolamide. Sleep, 2016, 39(9): 1631-1637

[22] SforzaE, RocheF. Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach. Hypoxia, 2016, 4: 99-108

[23] GoudisCA, KetikoglouDG. Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications. Int J Cardiol, 2017, 230: 293-300

[24] DragerLF, McEvoyRD, BarbeF, et al.. Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation, 2017, 136(19): 1840-1850

[25] BagaiK. Obstructive sleep apnea, stroke, and cardiovascular diseases. Neurologist, 2010, 16(6): 329-339

[26] LinX, ChenG, QiJ, et al.. Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta–analysis. Eur Arch Otorhinolaryngol, 2016, 273(12): 4081-4088

[27] LiraAB, de Sousa RodriguesCF. Evaluation of oxidative stress markers in obstructive sleep apnea syndrome and additional antioxidant therapy: a review article. Sleep Breath, 2016, 20(4): 1155-1160

[28] GulF, MuderrisT, YalcinerG, et al.. A novel method for evaluation of oxidative stress in children with OSA. Int J Pediatr Otorhinolaryngol, 2016, 89: 76-80

[29] HoffmannMS, SinghP, WolkR, NarkiewiczK, SomersVK. Obstructive sleep apnea and intermittent hypoxia increase expression of dual specificity phosphatase 1. Atherosclerosis, 2013, 231(2): 378-383

[30] DeeringS, LiuL, ZamoraT, et al.. CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA. J Clin Sleep Med, 2017, 13(12): 1423-1428

[31] DengG, QiuZD, LiDY, et al.. Effects of continuous positive airway pressure therapy on plasma aldosterone levels in patients with obstructive sleep apnea: A meta-analysis. J Huazhong Univ Sci Technolog Med Sci, 2016, 36(5): 619-625