Sleep & breathing = Schlaf & Atmung
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Residual excessive sleepiness (ES) and impaired cognition can occur despite effective and regular nasal continuous positive airway pressure (nCPAP) therapy in some patients with obstructive sleep apnea (OSA). A pooled analysis of two 12-week, randomized, double-blind studies in nCPAP-adherent patients with ES associated with OSA evaluated the effect of armodafinil on wakefulness and cognition. Three hundred and ninety-one patients received armodafinil (150 or 250 mg) and 260 patients received placebo once daily for 12 weeks. ⋯ Armodafinil did not adversely affect desired nighttime sleep, and nCPAP use remained high (approximately 7 h/night). Adjunct treatment with armodafinil significantly improved wakefulness, long-term memory, and patients' ability to engage in activities of daily living in nCPAP-adherent individuals with ES associated with OSA. Armodafinil also reduced patient-reported fatigue and was well tolerated.
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We hypothesized that an improvement in systemic blood pressure (BP) during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) would be related to severity of hypertension (HTN), morphometric parameters such as body mass index, and level of CPAP adherence. We tested this hypothesis with a retrospective review of 85 consecutive OSA patients who had completed diagnostic and CPAP titration polysomnograms and were equipped with a CPAP-adherence monitoring system for a minimum of 1 month of observation. Sphygmomanometer-obtained BP readings were compared at baseline and after 4-6 weeks of CPAP therapy. ⋯ Those with a BP below the hypertensive range of 140/90 on presentation did not have a significant drop in BP with CPAP. There were no significant changes in systolic, diastolic, or mean BP when patients were categorized by the severity of HTN, as determined by the number of antihypertensive medications prescribed or if they were categorized by the degree of CPAP adherence, objectively determined by the average use of more or less than 4 h/night. We conclude that HTN at initial presentation is among the most important indicators of potential benefit of CPAP administration on BP.
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The obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular abnormalities including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction. The present study evaluated whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and peak oxygen consumption (peak VO(2)), both integral markers of cardiovascular function, are related to OSAS severity. In addition, we tested whether NT-proBNP levels depend on body composition in OSAS patients, similar to what has been reported in patients without OSAS. ⋯ The lack of a relationship between NT-proBNP and OSAS severity is not due to a significant influence of body composition on NT-proBNP. There is an association between higher NT-proBNP and lower peak VO(2), indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too weak to be clinically useful.