Sleep Apnea Aid Eases Heart Problems in People With Prediabetes | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 7, 2020 (HealthDay News) — Continuous positive airway pressure treatment, commonly known as CPAP, can lower heart disease risk in people with prediabetes, according to a new study.

In prediabetes, blood sugar levels are above normal but not high enough to be considered diabetes. CPAP is used to treat obstructive sleep apnea, a disorder in which breathing repeatedly stops and starts during sleep. A CPAP machine uses a mask to deliver steady air pressure into a person’s airway.

This new study found that, among people with prediabetes and sleep apnea, those who used CPAP for two weeks saw their resting heart rate fall by four to five beats per minute, compared to those who didn’t use CPAP.

With optimal CPAP treatment, heart rates were not only lower at night but also during the day, according to the report published Oct. 1 in the Journal of the American Heart Association.

“That’s significant,” said study author Dr. Esra Tasali, director of sleep research at University of Chicago Medicine.

Even a drop of one beat per minute in resting heart rate can lower the future risk of heart disease and death, she noted in a university news release.

“A four- to five-beat-per-minute drop in heart rate that we observed is comparable to what you would get from regular exercise,” Tasali said. “Our breakthrough finding is the carryover of the lowered resting heart rate into the daytime and the cardiovascular benefit of that.”

About one billion people worldwide have obstructive sleep apnea, and more than 60% of them have prediabetes or diabetes. About 80% of people with apnea are undiagnosed, the researchers noted.

The findings are especially timely because people with diabetes or heart problems are among the most vulnerable to COVID-19, the study authors pointed out.

“Any way we can improve cardiovascular health is more important than ever these days,” Tasali said.

The findings show the need for people who have prediabetes, diabetes or sleeping problems to be screened for sleep apnea, said study author Dr. Sushmita Pamidi, a sleep physician-scientist at McGill University in Montreal, Quebec, Canada.

The American Academy of Family Physicians has more on prediabetes.

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Phrenic Nerve Stimulation Holds Up for Central Sleep Apnea

Five-year data supported the long-term safety and effectiveness of transvenous phrenic nerve stimulation (TPNS) for central sleep apnea (CSA), investigators said.

CSA severity decreased in patients after Remede device implantation and stayed that way out to 5 years, according to a group led by Maria Rosa Costanzo, MD, of Advocate Heart Institute in Chicago:

  • More than half of patients maintained improvement of apnea hypopnea index (AHI) at both 1 year and 5 years
  • Central apnea index remained under 1 event per hour at 1 year and 5 years alike versus a baseline of roughly 23 events per hour
  • Over half of patients achieved sustained improvement in arousals through 5 years
  • Arousals totaled 19 per hour at both 1 year and 5 years, down from a baseline of roughly 39 arousals per hour
  • Daytime sleepiness scores on the Epworth scale stayed at a median 6 points at 1 and 5 years, down from 9 points at baseline

There were no deaths attributed to the procedure or device, but 14% of patients experienced a serious adverse event, Costanzo’s team reported in a poster presented at this year’s virtual meeting of the Heart Failure Society of America.

Of note were four late events (beyond 3 years): two stimulation lead component failures requiring surgical lead replacement, one lead dislocation, and one implant site infection following an implantable pulse generator replacement procedure.

“TPNS is a viable long-term treatment option for adults with moderate to severe CSA,” the authors concluded.

Costanzo and colleagues had demonstrated the safety and effectiveness of Remede therapy in a randomized pivotal trial of 151 people. As a result, FDA approved the Remede device for moderate-to-severe CSA in 2017.

Remede is a small implantable device that regularly stimulates a phrenic nerve to induce diaphragmatic contraction, creating negative intrathoracic pressure similar to normal breathing. The implant is placed below the collar bone, with a transvenous stimulator lead extending to the target nerve.

The post-approval analysis included the 53 people in the treatment arm who had results out to 5 years. Despite the follow-up population being less than half of the original, the 5-year data are “important, as the procedure looks to have sustained effects,” commented Atul Malhotra, MD, of UC San Diego Health.

Study participants underwent central laboratory-scored polysomnography.

Outcomes with the device were consistent for the subgroup of heart failure patients. Kaplan-Meier estimated survival was 78% at 5 years in the Remede treatment arm and 68% in the heart failure subgroup, according to Costanzo’s group.

However, survivor bias may be at play, given that this subgroup included just 22 heart failure patients out of the 80 that were included at baseline, Malhotra suggested. “The follow-up group may be relatively healthy since the sickest ones may be deceased.”

Nevertheless, “it is good to raise awareness and draw attention to sleep issues in heart failure as they are very common and often overlooked,” he told MedPage Today.

“The device does not work for obstructive apnea, so the procedure is ideally done with pure