Nav: Home

CPAP may reduce resting heart rate in prediabetic patients

May 20, 2018

People with prediabetes have blood sugar levels higher than normal but below Type 2 diabetes levels. People with OSA experience times during sleep when air is obstructed from flowing normally into the lungs. CPAP is considered the "gold standard" treatment for OSA.

According to Sushmita Pamidi, MD, lead study author and a sleep physician-scientist at McGill University, previous studies have found that OSA is associated with increased sympathetic activity, which activates our "fight or flight" response. This response, in turn, raises our heart rate.

"Both prediabetes and higher resting heart rates have been linked to cardiovascular disease," she said. "We wanted to see if CPAP would lower resting heart rates both during the day and at night in this group of patients with abnormal glucose metabolism."

Of 39 participants in this study, twice as many were randomly assigned to CPAP as an oral placebo for 14 days. All-night adherence to CPAP was assured by monitoring all participants in a sleep lab throughout the two weeks. Resting heart rates were measured 24 hours a day for the two weeks using a portable monitoring device.

The study found that those using CPAP had significantly lower resting heart rates throughout the day and night than those in the placebo arm of the study. The differences between the two groups were more pronounced during the second week of the trial.

"The effect of CPAP on resting heart rate is comparable to using beta blockers," said Esra Tasali, MD, senior study author and director of the Sleep Research Center at the University of Chicago. Commonly prescribed for heart problems, beta blockers block stress hormones, such as adrenaline that raise heart rates.

"OSA is exceedingly common among individuals with abnormal glucose tolerance," Dr. Tasali added, noting recent estimates indicate that 80 percent of those with OSA in the general U.S. population are undiagnosed. "Our study is a first step in demonstrating that optimal treatment of sleep apnea reduces cardiovascular risk in those with prediabetes."
-end-
Abstract 13808

All-Night CPAP Treatment Reduces 24-Hour Resting Heart Rate in Prediabetes: A Randomized Placebo- Controlled Study

Authors: S. Pamidi1, F. Chapotot2, K. Wroblewski3, A. Khalyfa1, M. Stepien3, K. Sharif-Sidi3, G. Tremblay1, H. Whitmore3, E. Tasali3;1McGill University, Montreal, QC, Canada, 2PhiTools, Strasbourg, France, 3University of Chicago, Chicago, IL, United States.

Introduction/Rationale: Patients with prediabetes are at substantially greater risk for cardiovascular disease. Higher resting heart rate has been linked to increased cardiovascular mortality. Obstructive sleep apnea (OSA) is an important mediator of adverse cardiometabolic outcomes. We have previously reported (Pamidi et al. AJRCCM 2015) that in a randomized placebo-controlled study involving prediabetics, continuous positive airway pressure (CPAP) treatment of OSA during the entire night improves glucose metabolism and reduces plasma norepinephrine levels (a marker of sympathetic activity). In the same cohort, we have now examined how all-night CPAP treatment affects resting heart rate during 14 consecutive days and nights.

Methods: Adults with prediabetes and OSA (apnea-hypopnea index [AHI] >5) were randomized to either 2 weeks of in-laboratory CPAP or oral placebo tablet. Sleep was recorded by polysomnography and all-night CPAP use was ensured by continuous supervision. Participants were allowed to leave the laboratory during the daytime and engage in their routine activities. Physical activity and heart rate were monitored for 24-hours at baseline (i.e. prior to any CPAP or placebo use) and during 14 consecutive treatment days using an ambulatory device (Actiwave Cardio, CamNtech) consisting of tri-axial accelerometer and one-lead ECG. All data processing (e.g. motion, posture, ECG artifact and R-wave detection, sleep state classification) and data analyses were performed using PRANA software (PhiTools, France). In order to control for the effects of physical activity on heart rate, we have analyzed daytime data from rest periods only. Nighttime data (bedtimes 11:00pm to 7:00am) included only the sleep period excluding all wake epochs. Mixed-effects linear modelling was used to determine the impact of CPAP (vs. placebo) over 14 consecutive treatment days on activity and resting heart rate, while adjusting for baseline values and gender.

Results: A total of 39 subjects were randomized to either CPAP (n=26) or placebo tablet (n=13). Daytime activity counts at rest were not significantly different between groups (p=0.77). Mean daytime resting heart rate profiles were significantly lower in CPAP vs. placebo groups (p=0.04), with the largest differences during the second week of treatment (Figure). Similar effects of CPAP were also observed during nighttime (p=0.002).

Conclusion: All-night CPAP treatment markedly reduced 24-hour (daytime and nighttime) resting heart rate in individuals with OSA and prediabetes, a population that is at increased risk for cardiovascular morbidity. The magnitude of these reductions in resting heart rate is comparable to that of beta-blockers, and thus may have significant clinical cardiovascular benefit.

American Thoracic Society

Related Sleep Articles:

Wind turbine noise affects dream sleep and perceived sleep restoration
Wind turbine noise (WTN) influences people's perception of the restorative effects of sleep, and also has a small but significant effect on dream sleep, otherwise known as REM (rapid eye movement) sleep, a study at the University of Gothenburg, Sweden, shows.
To sleep deeply: The brainstem neurons that regulate non-REM sleep
University of Tsukuba researchers identified neurons that promote non-REM sleep in the brainstem in mice.
Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.
'Short sleep' gene prevents memory deficits associated with sleep deprivation
The UCSF scientists who identified the two known human genes that promote 'natural short sleep' -- nightly sleep that lasts just four to six hours but leaves people feeling well-rested -- have now discovered a third, and it's also the first gene that's ever been shown to prevent the memory deficits that normally accompany sleep deprivation.
Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.
Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.
Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.
Sleep tight! Researchers identify the beneficial role of sleep
Why do animals sleep? Why do humans 'waste' a third of their lives sleeping?
Does extra sleep on the weekends repay your sleep debt? No, researchers say
Insufficient sleep and untreated sleep disorders put people at increased risk for metabolic problems, including obesity and diabetes.
Kicking, yelling during sleep? Study finds risk factors for violent sleep disorder
Taking antidepressants for depression, having post-traumatic stress disorder or anxiety diagnosed by a doctor are risk factors for a disruptive and sometimes violent sleep disorder called rapid eye movement (REM) sleep behavior disorder, according to a study published in the Dec.
More Sleep News and Sleep Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Our Relationship With Water
We need water to live. But with rising seas and so many lacking clean water – water is in crisis and so are we. This hour, TED speakers explore ideas around restoring our relationship with water. Guests on the show include legal scholar Kelsey Leonard, artist LaToya Ruby Frazier, and community organizer Colette Pichon Battle.
Now Playing: Science for the People

#568 Poker Face Psychology
Anyone who's seen pop culture depictions of poker might think statistics and math is the only way to get ahead. But no, there's psychology too. Author Maria Konnikova took her Ph.D. in psychology to the poker table, and turned out to be good. So good, she went pro in poker, and learned all about her own biases on the way. We're talking about her new book "The Biggest Bluff: How I Learned to Pay Attention, Master Myself, and Win".
Now Playing: Radiolab

Uncounted
First things first: our very own Latif Nasser has an exciting new show on Netflix. He talks to Jad about the hidden forces of the world that connect us all. Then, with an eye on the upcoming election, we take a look back: at two pieces from More Perfect Season 3 about Constitutional amendments that determine who gets to vote. Former Radiolab producer Julia Longoria takes us to Washington, D.C. The capital is at the heart of our democracy, but it's not a state, and it wasn't until the 23rd Amendment that its people got the right to vote for president. But that still left DC without full representation in Congress; D.C. sends a "non-voting delegate" to the House. Julia profiles that delegate, Congresswoman Eleanor Holmes Norton, and her unique approach to fighting for power in a virtually powerless role. Second, Radiolab producer Sarah Qari looks at a current fight to lower the US voting age to 16 that harkens back to the fight for the 26th Amendment in the 1960s. Eighteen-year-olds at the time argued that if they were old enough to be drafted to fight in the War, they were old enough to have a voice in our democracy. But what about today, when even younger Americans are finding themselves at the center of national political debates? Does it mean we should lower the voting age even further? This episode was reported and produced by Julia Longoria and Sarah Qari. Check out Latif Nasser's new Netflix show Connected here. Support Radiolab today at Radiolab.org/donate.