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Upper Airway Stimulation vs Positive Airway Pressure Impact on BP and Sleepiness Symptoms in OSA.
Walia, Harneet K; Thompson, Nicolas R; Strohl, Kingman P; Faulx, Michael D; Waters, Tina; Kominsky, Alan; Foldvary-Schaefer, Nancy; Mehra, Reena.
Afiliación
  • Walia HK; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH. Electronic address: waliah@ccf.org.
  • Thompson NR; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
  • Strohl KP; Division of Pulmonary Critical Care and Sleep Medicine, University Hospital, Cleveland, OH.
  • Faulx MD; Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
  • Waters T; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Kominsky A; Department of Otolaryngology, Cleveland Clinic, Cleveland, OH.
  • Foldvary-Schaefer N; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Mehra R; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
Chest ; 157(1): 173-183, 2020 01.
Article en En | MEDLINE | ID: mdl-31299245
BACKGROUND: Positive airway pressure (PAP) and upper airway stimulation (UAS) are approved OSA treatment options. Although the effect of PAP on improvement in BP and daytime sleepiness (defined according to the Epworth Sleepiness Scale [ESS]) has been established, the impact of UAS on BP remains unclear. This study hypothesized that PAP and UAS will confer improvements in BP and daytime sleepiness. METHODS: Clinic-based BP and ESS scores were compared between 517 patients with OSA (apnea-hypopnea index, 15-65) and BMI ≤ 35 kg/m2 initiating PAP therapy (2010-2014) at the Cleveland Clinic and 320 patients with UAS implantation (2015-2017) via an international registry with 2- to 6-month follow-up. Mixed effect models were used to compare outcomes in 201 patients in each arm following propensity matching. RESULTS: PAP showed greater improvement in diastolic BP (mean difference of change between groups, 3.7 mm Hg; P < .001) and mean arterial pressure (mean difference of change between groups, 2.8 mm Hg; P = .008) compared with UAS. UAS showed greater improvement in ESS scores vs PAP (mean difference of change between PAP and UAS groups, -0.8; P = .046). UAS therapy usage was 6.2 h/week greater than PAP-treated patients (95% CI, 3.3-9.0). Results were consistent following adjustment for therapy adherence. CONCLUSIONS: PAP showed greater improvement in BP, potentially reflecting an enhanced ability of PAP to exert beneficial mechanical intrathoracic cardiac and vascular influences. BP measurement error in the UAS group may also have accounted for findings. Greater improvement in sleepiness symptoms was noted with UAS compared with PAP.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Terapia por Estimulación Eléctrica / Apnea Obstructiva del Sueño / Presión de las Vías Aéreas Positiva Contínua / Somnolencia Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Chest Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Terapia por Estimulación Eléctrica / Apnea Obstructiva del Sueño / Presión de las Vías Aéreas Positiva Contínua / Somnolencia Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Chest Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos