INSOMNIA AND RISK OF CARDIOVASCULAR DISEASE: A META-ANALYSIS (Sofi et al. Eur J Prev Cardiol 2014: 21:57-64)
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This is a review of 13 prospective studies looking at the incident of vascular events over a 3-20 year follow up in patients with insomnia and no cardiovascular disease. Patients with insomnia have a relative risk of developing/dying from cardiovascular disease (p<0.00001)
Final statement: Insomnia is associated with an increased risk of cardiovascular disease
EFFECT OF INTENSIFIED DIURETIC THERAPY ON OVERNIGHT ROSTRAL FLUID SHIFT AND OBSTRUCTIVE SLEEP APNOEA IN PATIENTS WITH UNCONTROLLED HYPERTENSION (Kasai T et al. J Hypertens 2014: 32:673-80)
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This study looked at 16 subjects with an AHI at baseline of at least 20 events/hr before and after 14 days of intensive diuretic therapy (metolazone 2.5mg, spironolactone 25mg for the first 7 days then doubled for the next 7 days). There were significant reductions in AHI (p=0.005), leg fluid volume (p<0.001), neck circumference (p<0.001) morning systolic (p=0.004) and diastolic blood pressure (p<0.001).
Final statement: Intensive diuretic therapy lead to reduced AHI, leg oedema, neck circumference and blood pressure.
CPAP VERSUS OXYGEN IN OBSTRUCTIVE SLEEP APNEA (Gottlieb DJ. N Engl J Med 2014: 370:2276-85)
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This was RCT in patients with an AHI of 15-50 who were randomly assigned to 12 weeks of education on sleep hygiene and healthy lifestyle (control), education and CPAP, and education and nocturnal supplemental oxygen. 318 patients were randomised, and 281 completed the study. The 24 hour mean BP was significantly lower in the CPAP group compared to either the oxygen or control group and there was no difference between control and oxygen
Final statement: Nocturnal oxygen therapy was inferior to CPAP in improving mean blood pressure.
UPPER-AIRWAY STIMULATION FOR OBSTRIVE SLEEP APNEA (Strollo PJ et al. N Engl J Med 2014: 370:139-49)
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This was an uncontrolled multicentre cohort study. 126 patients underwent unilateral hypoglossal stimulator implantation and were followed for 12 months. The 12 month AHI was significantly less than baseline AHI (p<0.001). 66% of patients had a 50% reduction in AHI and had an AHI on treatment <20. These patients had further randomisation to continuation and withdrawal of treatment and there was a significant difference in AHI between these two groups (p<0.001).
Final statement: Unilateral hypoglossal stimulation can be effective in treating obstructive sleep apnoea in patients with poor CPAP compliance.