| Abstract | Cilj: Utvrditi hoće li jednogodišnja terapija novijom verzijom CPAP uređaja (APAP) ostvariti
pozitivne učinke na parametre arterijske elastičnosti i plućne funkcije kod OSA pacijenata.
Materijali i metode: 38 ispitanika s dijagnozom teške OSA-e, podvrgnuto je redovitim
kontrolnim mjerenjima (1, 3, 6, 12 mjeseci) parametara arterijske elastičnosti i plućne
funkcije tijekom jednogodišnje terapije APAP uređajem. Mjerenje parametara arterijske
elastičnosti uključivalo je određivanje vrijednosti cfPWV, cAix-a i cSBP pomoću
SphygmoCor uređaja (Version 8.1; AtCor Medical, Inc., Sydney Australia). Plućna funkcija
evaluirana je određivanjem vrijednosti FEV1, FVC i PEF na MicroLab Desktop Spirometer
(ML3500, UK) uređaju. Podatci su analizirani dvosmjernim ANOVA testom za ponovljena
mjerenja, a rezultati su prikazani kao srednja vrijednost±SEM.
Rezultati: Dugotrajna terapija APAP uređajem ostvaruje pozitivan učinak na parametre
arterijske elastičnosti (cfPWV, cAix, cSBP), s tim da je većina napretka ostvarena tijekom
prvih 6 mjeseci terapije. Nakon godinu dana terapije, konačna poboljšanja iznose 12.6 % za
cfPWV, 7.1 % za cAix, te 7 % za cSBP. Dokazan je i pozitivan učinak na plućnu funkciju, s
povećanjem vrijednosti plućnih volumena i to za 20.1 % za FVC, 17.9 % za FEV1 i 15.8 % za
PEF. Pronađena je negativna korelacija između parametara arterijske elastičnosti i plućne
funkcije (r se proteže od -0.36 do -0.40, p < 0.05).
Zaključci: Ovo je prvo istraživanje koje proučava utjecaj APAP uređaja na parametre
arterijske elastičnosti i plućne funkcije kod OSA pacijenata. Dokazano je da se primjenom
APAP uređaja također ostvaruju pozitivni učinci na parametre arterijske elastičnosti. Za
razliku od terapije standardnim CPAP-om, koji ne ostvaruje pozitivan učinak na plućnu
funkciju, rezultati ovog istraživanja pokazuju značajno poboljšanje plućne funkcije. Razlog
tome bi mogle biti same karakteristike novijeg uređaja, ali je vjerojatnije da su klinička
obilježja ispitanika (nepušači, bez popratnih plućnih bolesti) prvenstveno omogućila
poboljšanje plućne funkcije. |
| Abstract (english) | Objectives: To assess the effect of newer CPAP device (Adaptive continuous Positive Airway
Pressure-APAP) on lung function and arterial stiffness in obstructive sleep apnea patients
during a one year follow up.
Patients and Methods: 38 severe OSA patients were involved in this study. During the one
year home treatment with APAP, arterial stiffness and lung function readings were obtained
on each control follow-up date after 1, 3, 6 and 12 months of therapy. For arterial stiffness
assessment the SphygmoCor device (Version 8.1; AtCor Medical, Inc., Sydney Australia) was
used in order to obtain cfPWV, cAix and cSBP. Pulmonary function (spirometry) was
performed with a MicroLab Desktop Spirometer (ML3500), UK and included evaluation of
FEV1, FVC and PEF values. Data were compared by two-way ANOVA for repeated
measurements. All results are expressed as mean ± SEM.
Results: In the present one year follow-up study we have found a beneficial effect of APAP
treatment on lung function and arterial stiffness in severe OSA patients. Interestingly, the
greatest part of the improvements was seen within the first 6 months of treatment. After one
year therapy definitive improvements were 12.6 % for cfPWV, 7.1 % for cAix and 7 % for
cSBP. Total improvements in lung function were 20.1 % for FVC, 17.9 % for FEV1 and 15.8 %
for PEF, compared to baseline. A significant negative correlation was found between the
percent delta change of FVC, FEV1 and PEF with PWV (r ranging from -0.36 to -0.40,
p<0.05).
Conclusions: To our knowledge this is the first APAP treatment 1-year follow-up on lung
function and arterial stiffness with 4 control examinations after 1,3,6 and 12 months of
treatment. We have shown improvements in arterial stiffness during one year treatment with
the majority of the effect taking part in the first 6 months. Unlike the greater part of older
studies on lung function during CPAP treatment we have shown an clear improvement in lung
function parameters. A possible reason for improvement seen in our trial can be due to
different/newer type of device used for treatment APAP instead of CPAP. Regardless to
possible device efficacy on lung function, we believe that solely our study design with a
sample group of OSA patients without diagnosed COPD and active smokers was able to allow
improvements in lung function in the first place. |
