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    Game Changing Information in the Field of Obstructive Sleep Apnea

    AWARE OF THE LIMITATIONS OF CPAP

    1) CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea

    N Engl J Med 2016; 375:919-931

    CONCLUSIONS
    Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and Medical Research Council of Australia and others; SAVE ClinicalTrials.gov number, NCT00738179; Australian New Zealand Clinical Trials Registry number, ACTRN12608000409370.)

    AND, THAT ARTERIAL STIFFNESS IS LIKELY A MAJOR CONTRIBUTING CAUSE THEREOF AND NOT COMPLETELY AMELIORATED BY CPAP THERAPY:

    Review Article
    Journal of Sleep Medicine & Disorders

    2) Arterial Stiffness in Obstructive Sleep Apnea
    Thomas Balanis* and Bernd Sanner
    Department of Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Germany

    Abstract
    Obstructive sleep apnea is a very common disease and is associated with an increased risk of cardiovascular disease, cardiac arrhythmia, and stroke. Arterial stiffness is an emerging risk factor and may be involved in the cardiovascular complications of obstructive sleep apnea. The purpose of this review was to demonstrate the correlation between arterial stiffness and obstructive sleep apnea. Arterial stiffness was increased in obstructive sleep apnea patients compared to controls or increased in severe compared to mild sleep apnea. Although there are relatively few interventional studies that have incorporated a control group, there are two randomized trials showing short-term improvements in arterial stiffness with CPAP treatment. Obstructive sleep apnea seems to play an essential role in arterial stiffness, which may be one of the mechanisms accounting for sleep apnea-associated cardiovascular risk. Therefore, arterial stiffness may have a role in the increased risk of cardiovascular complications in OSA. Although there are relatively few interventional studies that have incorporated a control group, there are two randomized trials showing short-term improvements in arterial stiffness with CPAP treatment.

    AND IS EAGER TO INITIATE AN EXERCISE PRESCRIPTION FOR AEROBIC INTERVAL TRAINING TO DECREASE ARTERIAL STIFFNESS AND LOSE WEIGHT BY EXERCISING FOR 40 MINUTES BETWEEN 66% - 75% OF MAX HR FOUR TIMES WEEKLY.

    3) http://www.cbass.com/IntervalsArterialStiffness.htm

    Interval Training Reduces Arterial Stiffness
    To recap briefly, continuous and interval training reduced blood pressure about the same, but only intervals significantly improved arterial stiffness. Add that intervals improve fitness in less time and are more appealing, and it’s a slam dunk for intervals.

    4) Effects of Exercise Modalities on Arterial Stiffness and Wave Reflection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
    Ammar W. Ashor,1,2,* Jose Lara,1 Mario Siervo,1 Carlos Celis-Morales,1 and John C. Mathers1; Yan Li, Editor
    (This article has been cited by other articles in PMC.)

    Background and Objectives
    Physical activity is associated with lower cardiovascular and all-cause mortality. However, the effects of different exercise modalities on arterial stiffness are currently unclear. Our objectives were to investigate the effects of exercise modalities (aerobic, resistance or combined) on pulse wave velocity (PWV) and augmentation index (AIx), and to determine whether the effects on these indices differed according to the participants' or exercise characteristics.

    Methods
    We searched the Medline, Embase and Cochrane Library databases from inception until April 2014 for randomized controlled trials lasting ≥4 weeks investigating the effects of exercise modalities on PWV and AIx in adults aged ≥18 years.

    Results
    Forty-two studies (1627 participants) were included in this analysis. Aerobic exercise improved both PWV (WMD: −0.63 m/s, 95% CI: −0.90, −0.35) and AIx (WMD:−2.63%, 95% CI: −5.25 to −0.02) significantly. Aerobic exercise training showed significantly greater reduction in brachial-ankle (WMD: −1.01 m/s, 95% CI: −1.57, −0.44) than in carotid-femoral (WMD: -0.39 m/s, 95% CI: −0.52, −0.27) PWV. Higher aerobic exercise intensity was associated with larger reductions in AIx (β: −1.55%, CI −3.09, 0.0001). In addition, aerobic exercise had a significantly larger effect in reducing PWV (WMD:−1.0 m/s, 95% CI: −1.43, −0.57) in participants with stiffer arteries (PWV ≥8 m/s). Resistance exercise had no effect on PWV and AIx. There was no significant effect of combined exercise on PWV and AIx.

    Conclusions
    We conclude that aerobic exercise improved arterial stiffness significantly and that the effect was enhanced with higher aerobic exercise intensity and in participants with greater arterial stiffness at baseline.

    5) Hypertension Research (2010) 33, 627–632; doi:10.1038/hr.2010.42; published online 9 April 2010

    Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension

    Abstract
    Exercise is an effective intervention for treating hypertension and arterial stiffness, but little is known about which exercise modality is the most effective in reducing arterial stiffness and blood pressure in hypertensive subjects. Our purpose was to evaluate the effect of continuous vs. interval exercise training on arterial stiffness and blood pressure in hypertensive patients. Sixty-five patients with hypertension were randomized to 16 weeks of continuous exercise training (n=26), interval training (n=26) or a sedentary routine (n=13). The training was conducted in two 40-min sessions a week. Assessment of arterial stiffness by carotid–femoral pulse wave velocity (PWV) measurement and 24-h ambulatory blood pressure monitoring (ABPM) were performed before and after the 16 weeks of training. At the end of the study, ABPM blood pressure had declined significantly only in the subjects with higher basal values and was independent of training modality. PWV had declined significantly only after interval training from 9.44±0.91 to 8.90±0.96 m s−1, P=0.009 (continuous from 10.15±1.66 to 9.98±1.81 m s−1, P=ns; control from 10.23±1.82 to 10.53±1.97 m s−1, P=ns). Continuous and interval exercise training were beneficial for blood pressure control, but only interval training reduced arterial stiffness in treated hypertensive subjects.

    ESPECIALLY NOW THAT WE HAVE THERAPEUTIC TARGETS TO TRACK IN THE PULMONARY LAB:

    6) Association of pulse wave velocity with total lung capacity: A cross-sectional analysis of the BOLD London study André F.S. Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK Highlights

      - TLC is inversely associated with pulse wave velocity (i.e. arterial stiffness).
      - FVC, which is a proxy for TLC, is also inversely associated with pulse wave velocity.
      - Systolic blood pressure is inversely associated with FEV1.

    Background
    Low lung function, measured using spirometry, has been associated with mortality from cardiovascular disease, but whether this is explained by airflow obstruction or restriction is a question that remains unanswered.

    Conclusion
    The inverse association of pulse wave velocity, which is a marker of cardiovascular disease, with TLC suggests that the association of the former with low FVC is independent of airflow obstruction. The association between FEV1 with systolic blood pressure after adjustment for FVC suggests an association with airflow obstruction rather than with restricted spirometry. The upshot of these two pivotal papers in thoracic medicine is that while CPAP cannot prevent the cardiovascular & and cardio – cerebral complications of OSA, the PFT lab provides us all with readily available therapeutic targets to assess and help us decrease arterial stiffness, a major pathophysiology in OSA and one that can be treated with interval training, medication, or both. This is crucial for our patients.