Hossein Sharafkhaneh

Weight and metabolic effects of cpap in obstructive sleep apnea patients with obesity

BackgroundObstructive sleep apnea (OSA) is associated with obesity, insulin resistance (IR) and diabetes. Continuous positive airway pressure (CPAP) rapidly mitigates OSA in obese subjects but its metabolic effects are not well-characterized. We postulated that CPAP will decrease IR, ghrelin and resistin and increase adiponectin levels in this setting.MethodsIn a pre- and post-treatment, within-subject design, insulin and appetite-regulating hormones were assayed in 20 obese subjects with OSA before and after 6 months of CPAP use. Primary outcome measures included glucose, insulin, and IR levels. Other measures included ghrelin, leptin, adiponectin and resistin levels. Body weight change were recorded and used to examine the relationship between glucose regulation and appetite-regulating hormones.ResultsCPAP effectively improved hypoxia. However, subjects had increased insulin and IR. Fasting ghrelin decreased significantly while leptin, adiponectin and resistin remained unchanged. Forty percent of patients gained weight significantly. Changes in body weight directly correlated with changes in insulin and IR. Ghrelin changes inversely correlated with changes in IR but did not change as a function of weight.ConclusionsWeight change rather than elimination of hypoxia modulated alterations in IR in obese patients with OSA during the first six months of CPAP therapy.

Sleep disorders and their management in patients with COPD

Chronic obstructive pulmonary disease (COPD) is a prevalent progressive condition that adversely affects quality of life and sleep. Patients with COPD suffer from variety of sleep disorders including insomnia, sleep disordered breathing and restless leg syndrome. The sleep disorders in COPD patients may stem from poor control of primary disease or due to side effects of pharmacotherapy. Thus, optimization of COPD therapy is the main step in treating insomnia in these patients. Further, pharmacotherapy of sleep disorders may result in respiratory depression and related complications. Therefore, clear understanding of respiratory physiology during transition from wakefulness to sleep and during various stages of sleep plays an important role in therapies that are recommended in patients with significant airway obstruction. In this publication, we review respiratory physiology as it relates to sleep and discuss sleep disorders and their management in patients with COPD.

Review: Pharmacotherapy of obstructive sleep apnea

Obstructive sleep apnea (OSA) is associated with serious comorbid illnesses and diminished quality of life. At this time, continuous positive airway pressure (CPAP) therapy is the treatment of choice. However, only half of those individuals who accept CPAP are still using it at the end of one year. Furthermore, efficacy for improving self-reported sleepiness appears to be greater for patients with severe sleep apnea and severe sleepiness than other patient groups. Some patients, notwithstanding optimized therapy and therapeutic adherence continue experiencing excessive daytime somnolence. Consequently, other treatment modalities have developed, including oral appliances, surgery and pharmacotherapy. It is widely believed, albeit not empirically demonstrated, that an effective medication to treat OSA would elicit better acceptance and adherence than having to use a machine for many hours on a nightly basis. Nonetheless, paucity of data (i.e. lack of large-scale randomized controlled trials), variability of perceived and actual benefits, and adverse side-effects of the drugs thus far tested have prevented the use of pharmacotherapy until now. In this paper we review the outcome data from published trials designed to evaluate efficacy and safety of various medications proposed for treating obstructive sleep apnea.

Severity of hypoxia modulates effect of CPAP on myocardial stress as measured by highly sensitive troponin T

Competing interests Dr. C.M. Ballantyne and Dr. V. Nambi are co-investigators on a provisional patent filed along with Roche diagnostics for the use of biomarkers in the prediction of heart failure. Dr. C.M. Ballantyne has received research support from Roche diagnostics. Other authors do not report any conflict of interest. Authors’ contribution AS designed the study, analyzed the data, conducted statistical analysis and prepared the manuscript. JK analysed the data and prepared the manuscript. MH designed the study and analysed the data and prepared the manuscript. HS designed the study and analysed the data and prepared the manuscript. SPS analyzed the data and prepared the manuscript. CMB analyzed the data and prepared the manuscript. BB analyzed the data and prepared the manuscript. VN analyzed the data and prepared the manuscript. All authors read and approved the final manuscript.

General Management Issues in COPD: Sleep, Travel and Preoperative Management

Sleep disorders in chronic obstructive pulmonary disease (COPD) Sleep disorders are prevalent in patients with COPD. Insomnia is reported in as much as 50% of patients with COPD. Optimal airway targeted pharmacotherapy of COPD may improve sleep in these patients. Attention should be paid to use of sedatives and narcotics in patients with COPD and insomnia as some of the medications may affect ventilation. OSA is not more frequent in COPD compared to a matched population without COPD, however, the severity of hypoxia or prevalence of hypoxia without OSA is more in COPD patients. Travel and COPD Travel to high altitude or air travel may result in hypoxia in patients with COPD. Severity of hypoxia during the flight not only depends on the baseline arterial partial pressure of O2 but also on severity of airflow obstruction and presence of other comorbid conditions. O2 need during the flight or travel to high altitude can be determined either empirically or by hypoxia-altitude simulation test (HAST). Guidelines recommend having PaO2 of 50–55 mmHg at high altitude and during the flight. Perioprative care of COPD A comprehensive assessment by various practitioners involved in the operation is needed. Patient education and smoking cessation plays an important role in outcome of a surgery in these patients. Optimization of pharmacologic and non-pharmacologic therapies for COPD and other co-morbidities will improve outcomes of a surgery. Implementation of early post-op mobilization, incentive spirometry, and avoidance of shivering may help to avoid complications post surgery.