Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA) has been associated with atrial enlargement in response to high arterial and pulmonary pressures and increased sympathetic tone. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; its impact on atrial electrical remodeling has...

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Main Author: PANG, HELEN WAI KIU
Other Authors: Queen's University (Kingston, Ont.). Theses (Queen's University (Kingston, Ont.))
Language:en
en
Published: 2011
Subjects:
Online Access:http://hdl.handle.net/1974/6625
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spelling ndltd-LACETR-oai-collectionscanada.gc.ca-OKQ.1974-66252013-12-20T03:40:01ZReverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep ApneaPANG, HELEN WAI KIUatrial remodelingobstructive sleep apneaBackground: Obstructive sleep apnea (OSA) has been associated with atrial enlargement in response to high arterial and pulmonary pressures and increased sympathetic tone. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; its impact on atrial electrical remodeling has not been investigated however. Signal-averaged p-wave (SAPW) is a non-invasive quantitative method to determine p-wave duration, an accepted marker for atrial electrical remodeling. The objective was to determine whether CPAP induces reverse atrial electrical remodeling in patients with severe OSA. Methods: Prospective study in consecutive patients attending the Sleep Clinic at Kingston General Hospital. All patients underwent full polysomnography. OSA-negative and severe OSA were defined as apnea-hypopnea index (AHI) < 5 events/hour and AHI ≥ 30 events/hour, respectively. In severe OSA patients, SAPW was determined pre- and post-intervention with CPAP for 4 - 6 weeks. In OSA-negative controls, SAPW was recorded at baseline and 4 - 6 weeks thereafter without any intervention. Results: A total of 19 severe OSA patients and 10 controls were included in the analysis. Mean AHI and minimum O2 saturation were 41.4 ± 10.1 events/hour and 80.5 ± 6.5% in severe OSA patients and 2.8 ± 1.2 events/hour and 91.4 ± 2.1% in controls. Baseline BMI was different between severe OSA patients and controls (34.3 ± 5.4 vs 26.6 ± 4.6 kg/m2; p < 0.001). At baseline, severe OSA patients had a greater SAPW duration than controls (131.9 ± 10.4 vs 122.8 ± 10.5 ms; p = 0.02). After CPAP intervention, there was a significant reduction of SAPW duration in severe OSA (131.9 ± 10.4 to 126.2 ± 8.8 ms; p < 0.001). In controls, SAPW duration did not change within 4 - 6 weeks. Conclusion: CPAP induced reverse atrial electrical remodeling in patients with severe OSA as represented by a significant reduction in SAPW duration.Thesis (Master, Physiology) -- Queen's University, 2011-07-29 12:53:09.134Queen's University (Kingston, Ont.). Theses (Queen's University (Kingston, Ont.))2011-07-29 12:53:09.1342011-08-10T21:09:35Z2011-08-10T21:09:35Z2011-08-10Thesishttp://hdl.handle.net/1974/6625enenCanadian thesesThis publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
collection NDLTD
language en
en
sources NDLTD
topic atrial remodeling
obstructive sleep apnea
spellingShingle atrial remodeling
obstructive sleep apnea
PANG, HELEN WAI KIU
Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
description Background: Obstructive sleep apnea (OSA) has been associated with atrial enlargement in response to high arterial and pulmonary pressures and increased sympathetic tone. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; its impact on atrial electrical remodeling has not been investigated however. Signal-averaged p-wave (SAPW) is a non-invasive quantitative method to determine p-wave duration, an accepted marker for atrial electrical remodeling. The objective was to determine whether CPAP induces reverse atrial electrical remodeling in patients with severe OSA. Methods: Prospective study in consecutive patients attending the Sleep Clinic at Kingston General Hospital. All patients underwent full polysomnography. OSA-negative and severe OSA were defined as apnea-hypopnea index (AHI) < 5 events/hour and AHI ≥ 30 events/hour, respectively. In severe OSA patients, SAPW was determined pre- and post-intervention with CPAP for 4 - 6 weeks. In OSA-negative controls, SAPW was recorded at baseline and 4 - 6 weeks thereafter without any intervention. Results: A total of 19 severe OSA patients and 10 controls were included in the analysis. Mean AHI and minimum O2 saturation were 41.4 ± 10.1 events/hour and 80.5 ± 6.5% in severe OSA patients and 2.8 ± 1.2 events/hour and 91.4 ± 2.1% in controls. Baseline BMI was different between severe OSA patients and controls (34.3 ± 5.4 vs 26.6 ± 4.6 kg/m2; p < 0.001). At baseline, severe OSA patients had a greater SAPW duration than controls (131.9 ± 10.4 vs 122.8 ± 10.5 ms; p = 0.02). After CPAP intervention, there was a significant reduction of SAPW duration in severe OSA (131.9 ± 10.4 to 126.2 ± 8.8 ms; p < 0.001). In controls, SAPW duration did not change within 4 - 6 weeks. Conclusion: CPAP induced reverse atrial electrical remodeling in patients with severe OSA as represented by a significant reduction in SAPW duration. === Thesis (Master, Physiology) -- Queen's University, 2011-07-29 12:53:09.134
author2 Queen's University (Kingston, Ont.). Theses (Queen's University (Kingston, Ont.))
author_facet Queen's University (Kingston, Ont.). Theses (Queen's University (Kingston, Ont.))
PANG, HELEN WAI KIU
author PANG, HELEN WAI KIU
author_sort PANG, HELEN WAI KIU
title Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
title_short Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
title_full Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
title_fullStr Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
title_full_unstemmed Reverse Atrial Electrical Remodeling Induced by Continuous Positive Airway Pressure in Patients with Severe Obstructive Sleep Apnea
title_sort reverse atrial electrical remodeling induced by continuous positive airway pressure in patients with severe obstructive sleep apnea
publishDate 2011
url http://hdl.handle.net/1974/6625
work_keys_str_mv AT panghelenwaikiu reverseatrialelectricalremodelinginducedbycontinuouspositiveairwaypressureinpatientswithsevereobstructivesleepapnea
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