Mild Intermittent Hypoxia and CPAP: A Multi-pronged Approach to Treat Sleep Apnea in Intact and Spinal Cord Injured Humans
Wayne State University
Summary
Mild intermittent hypoxia (IH) initiates sustained increases in chest wall and upper airway muscle activity in humans. This sustained increase is a form of respiratory plasticity known as long-term facilitation (LTF). Repeated daily exposure to mild IH that leads to the initiation of LTF of upper airway muscle activity could lead to increased stability of the upper airway. In line with PI's laboratory's mandate to develop innovative therapies to treat sleep apnea, this increased stability could ultimately reduce the continuous positive airway pressure (CPAP) required to treat obstructive sleep apnea (OSA) and improve compliance with this gold standard treatment. Improved compliance could ultimately serve to mitigate those comorbidities linked to sleep apnea. Moreover, in addition to improving CPAP compliance numerous studies indicate that mild IH has many direct beneficial effects on cardiovascular, neurocognitive and metabolic function. Thus, mild IH could serve as a multipronged therapeutic approach to treat sleep apnea. In accordance with this postulation, our proposal will determine if repeated daily exposure to mild IH serves as an adjunct therapy coupled with CPAP to mitigate associated co-morbidities via its direct effects on a variety of cardiovascular, metabolic and neurocognitive measures and indirectly by improving CPAP compliance. Modifications in autonomic (i.e. sympathetic nervous system activity) and cardiovascular (i.e. blood pressure) function will be the primary outcome measures coupled to secondary measures of metabolic and neurocognitive outcomes.
Description
The dogma over the past 3 decades, particularly in the field of sleep medicine, has been that intermittent hypoxia (IH) is a detrimental stimulus that leads to a number of co-morbidities including autonomic (e.g. increased sympathetic nervous system activity), cardiovascular (e.g. hypertension, atherosclerosis, arterial fibrillation), cognitive (e.g. loss of gray matter, neural injury and impaired neural function coupled to sleepiness) and metabolic dysfunction (dyslipidemia, hyperglycemia, insulin resistance). This belief was based principally on animal studies that employed protocols that we…
Eligibility
- Age range
- 18–60 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Body mass index \< 40 kg/m\^2. * 18 to 60 years old. * Newly diagnosed sleep apnea (i.e. apnea/hypopnea index \< 100 events per hour - average nocturnal oxygen saturation \> 85 %) that has not been treated. * Diagnosed with prehypertension or Stage 1 hypertension as categorized by the American Heart Association * Not pregnant. * Normal lung function. * Minimal alcohol consumption (i.e. no more than the equivalent of a glass of wine/day) * A typical sleep/wake schedule (i.e. participants will not be night shift workers or have recently travelled across time zones). * For…
Interventions
- OtherMild intermittent hypoxia
Participants will be exposed to twelve two minute episodes of mild intermittent hypoxia 5 days a week for 3 weeks.
- OtherSham protocol
Participants will be exposed to twelve two minute episodes of sham mild intermittent hypoxia (i.e. room air) 5 days a week for 3 weeks.
- OtherContinuous positive airway pressure (CPAP)
All participants will be treated with CPAP each night for a duration of 3 weeks.
Locations (2)
- John D Dingell VA Medical CenterDetroit, Michigan
- Wayne State UniversityDetroit, Michigan