Utjecaj prvotne primjene kontinuiranoga pozitivnoga tlaka zraka u dišnim putevima na REM spavanje u bolesnika sa sindromima apneje u spavanju

doctoral thesis

• Title (english): Influence of the initial continuous positive airway pressure treatment on REM sleep in patients with sleep apnea syndromes
• Author: Hrvoje Puretić
• Mentor: Marko Jakopović (mentor)
• Committee member: Sanja Popović-Grle (predsjednik povjerenstva)
• Committee member: Radovan Radonić (član povjerenstva)
• Committee member: Danilo Hodoba (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-11-27, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Na temelju dosadašnjih istraživanja postavili smo hipotezu da prvotna primjena kontinuiranoga pozitivnoga tlaka zraka u dišnim putevima (CPAP) dovodi do normalizacije respiracijskih parametara i oporavka REM-a u bolesnika s apnejom u spavanju. Centralna apneja u spavanju (CSA) do sada nije istraživana u tome smislu. Pretpostavili smo veći učinak CPAP-a na REM u bolesnika s opstruktivnom apnejom u spavanju (OSA), osobito u podskupini OSA-e s predominacijom mješovitih epizoda, a manji u bolesnika s CSA-om. Retrospektivno smo analizirali demografske i komorbiditetne podatke te usporedili polisomnografske izvještaje prije i nakon CPAP-a u odraslih bolesnika s umjerenom i teškom apnejom u spavanju evaluiranih u našem laboratoriju. U studiju je uključeno dvjestošezdeset bolesnika (183 s predominacijom opstruktivnih epizoda apneje, 61 s predominacijom
mješovitih epizoda, 16 s predominacijom centralnih epizoda). Hipertenzija je bila jedina značajna razlika u karakteristikama među trima skupinama. Statistički značajan oporavak REM-a nakon CPAP-a ustanovljen je u svih bolesnika s apnejom u spavanju, osobito u opstruktivnoj i mješovitoj skupini (bez značajne međusobne razlike), no nedovoljan u centralnoj – usprkos uspješnoj korekciji apneja-hipopneja indeksa (AHI) u sve tri skupine. Predloženi su drugi čimbenici odgovorni za nedovoljan oporavak REM-a u CSA-e nakon CPAP-a. Zaključujemo da je povećanje REM-a u apneje u spavanju nakon prvotne primjene CPAP-a snažno povezano s korekcijom AHI-ja.

Abstract (english)

Regarding former studies, we hypothesized that initial continuous positive airway pressure (CPAP) treatment is leading to the respiratory normalization and rapid eye movement (REM) rebound in patients with sleep apnea. Central sleep apnea (CSA) was not evaluated in this regard so far. We anticipated better effect of CPAP on REM in obstructive sleep apnea (OSA) patients, especially in OSA with mixed apnea-predominant subgroup, and lesser in CSA patients. We retrospectively analyzed data regarding demographics and comorbidities and compared polysomnography reports before and after initial CPAP of moderate and severe sleep apnea patients evaluated in our sleep lab. Two hundred and sixty patients (183 obstructive apnea-predominant, 61 mixed apnea-predominant, 16 central apnea-predominant) were included in the study. Hypertension was the only significantly different characteristic among three groups. Statistically significant REM rebound after CPAP was found in all sleep apnea patients, especially in obstructive and mixed apnea groups (without the difference between the groups), but insignificant in central apnea group – regardless of successful apneahypopnea index (AHI) reduction in all three groups. Other factors responsible for lack of REM rebound in CSA after CPAP were proposed. We conclude that REM rebound in sleep apnea following first CPAP usage strongly correlated with AHI reduction.

• Keywords: REM; apneja u spavanju; polisomnografija; CPAP; AHI
• Keywords (english): REM; sleep apnea; polysomnography; CPAP; AHI
• Language: croatian
• URN:NBN: urn:nbn:hr:105:264237
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 92 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-12-14 11:45:00