Current opinion in pulmonary medicine
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Positive airway pressure devices for the noninvasive treatment of sleep-disordered breathing are being marketed that have substantially expanded capabilities. Most recently, adaptive servo-ventilation devices have become available that are capable of measuring patient ventilation continuously and use that information to adjust expiratory positive airway pressure and pressure support levels to abolish central and obstructive apneas and hypopneas, including central sleep-disordered breathing of the Hunter-Cheyne-Stokes variety. Patients with congestive heart failure are particularly prone to developing central sleep apnea and/or Hunter-Cheyne-Stokes breathing, and studies have shown that suppression of these abnormal breathing patterns may improve cardiac function and, ultimately, mortality. ⋯ As an adjunct to optimal pharmacological management, adaptive servo-ventilation shows considerable promise as a means to improve outcomes in patients with congestive heart failure complicated by central sleep apnea/Hunter-Cheyne-Stokes breathing. Larger randomized controlled trials will be necessary to demonstrate the ultimate role of this therapeutic modality in such patients.
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Hypertension (HTN) and obstructive sleep apnea (OSA) are coexistent in millions of people, and both have been associated with heart disease, stroke, and premature death. OSA is an important risk factor for HTN. However, the relationship between OSA and HTN may be bidirectional, with high blood pressure (BP) contributing to an increased risk and severity of OSA. The aim of this review is to summarize the current literature supporting a bidirectional relationship of sleep apnea and HTN. ⋯ Intensive BP and volume overload control may be a promising approach to treat OSA. Future studies examining the hormonal mechanisms and comparing the effect of different antihypertensive medications on OSA are needed.
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Review
Obstructive sleep apnea, gestational hypertension and preeclampsia: a review of the literature.
The evidence of a putative causal effect of sleep apnea-induced intermittent hypoxia on the pathogenesis of gestational hypertension and preeclampsia is mounting. The present review presents the evidence of current literature and questions whether an early diagnosis and treatment of obstructive sleep apnea during pregnancy can reduce the risk of preeclampsia. ⋯ An association between sleep-disordered breathing, gestational hypertension and preeclampsia has been demonstrated. However, there is a lack of evidence on the effect of continuous positive airway pressure treatment during pregnancy on hypertension and preeclampsia. Further studies are required to ascertain whether continuous positive airway pressure can be a useful adjunct treatment for pregnant women at risk of preeclampsia.
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The use of noninvasive ventilatory support in patients with cystic fibrosis (CF) has increased exponentially over the past 2 decades. This review examines the current knowledge and considers potential future directions for use of noninvasive ventilation in CF patients. ⋯ The role of noninvasive ventilation in CF patients in chronic respiratory failure is established, but future prospective studies are needed to determine further indications and optimal timing of this intervention. Developments in both ventilator and interface design may enhance the efficacy of ventilation in CF patients but require careful individualized assessment and regular review. The implications on treatment burden and quality of life in CF also need to be studied.