Optimal continuous positive airway pressure treatment of obstructive sleep apnea reduces daytime resting heart rate in prediabetes: a randomized controlled study
Open accessAbstract
Background It has been widely recognized that obstructive sleep apnea (OSA) is linked to cardiovascular disease. Yet, randomized controlled studies failed to demonstrate a clear cardiovascular benefit from OSA treatment, mainly because of poor adherence to continuous positive airway pressure (CPAP). To date, no prior study has assessed the effect of CPAP treatment on daytime resting heart rate, a strong predictor of adverse cardiovascular outcomes and mortality. Methods and Results We conducted a randomized controlled study in 39 participants with OSA and prediabetes, who received either in‐laboratory all‐night (ie, optimal) CPAP or an oral placebo for 2 weeks. During daytime, participants continued daily activities outside the laboratory. Resting heart rate was continuously assessed over 19 consecutive days and nights using an ambulatory device consisting of a single‐lead ECG and triaxis accelerometer. Compared with placebo, CPAP reduced daytime resting heart rate (treatment difference, −4.1 beats/min; 95% CI, −6.5 to −1.7 beats/min; P =0.002). The magnitude of reduction in daytime resting heart rate after treatment significantly correlated with the magnitude of decrease in plasma norepinephrine, a marker of sympathetic activity ( r =0.44; P =0.02), and the magnitude of decrease in OSA severity (ie, apnea‐hypopnea index [ r =0.48; P =0.005], oxygen desaturation index [ r =0.50; P =0.003], and microarousal index [ r =0.57; P <0.001]). Conclusions This proof‐of‐concept randomized controlled study demonstrates, for the first time, that CPAP treatment, when optimally used at night, reduces resting heart rate during the day, and therefore has positive cardiovascular carry over effects. These findings suggest that better identification and treatment of OSA may have important clinical implications for cardiovascular disease prevention. Registration URL: https:/// www.clinicaltrials.gov ; Unique identifier: NCT01156116.
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Patients with OSA typically have higher resting heart rate, which reduces with treatment.
“Patients with OSA typically have higher resting heart rate (RHR), which reduces with treatment (7).”
From Obstructive Sleep Apnea, Resting Heart Rate, and Glycemic Variability in Adults With Maturity-Onset Diabetes of the Young (2026) · cites this paper as [7]
The Methods and Results report that two weeks of CPAP reduced daytime resting heart rate versus placebo in 39 participants with OSA and prediabetes (page unavailable). The paper does not establish that patients with OSA typically have higher resting heart rates than people without OSA, and its Discussion cautions against generalizing the treatment result to more diverse OSA populations. (LLM, conf=0.87)
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Cites
Sympathetic neural mechanisms in obstructive sleep apnea.
Somers, V. K., Dyken, M. E., Clary, M. P., & Abboud, F. M. (1995) · Journal of Clinical Investigation · doi:10.1172/jci118235 · Cited by 2,527 · see citing works
Impact of Reduced Heart Rate Variability on Risk for Cardiac Events: The Framingham Heart Study
Tsuji, H., Larson, M. G., Venditti, F. J., Manders, E. S., Evans, J. C., Feldman, C. L., & Levy, D. (1996) · Circulation · doi:10.1161/01.cir.94.11.2850 · Cited by 1,762 · see citing works
Javaheri, S., Barbe, F., Campos-Rodriguez, F., Dempsey, J. A., Khayat, R., Javaheri, S., Malhotra, A., Martinez-Garcia, M. A., Mehra, R., Pack, A. I., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.11.069 · Cited by 1,434 · see citing works
Heart rate variability: measurement and clinical utility.
Kleiger, R. E., Stein, P. K., & Bigger, J. T. (2005) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2005.10101.x · Cited by 1,290 · see citing works
Karantonis, D. M., Narayanan, M. R., Mathie, M. J., Lovell, N. H., & Celler, B. G. (2006) · IEEE Transactions on Information Technology in Biomedicine · doi:10.1109/titb.2005.856864 · Cited by 1,239 · see citing works
Umetani, K., Singer, D. H., McCraty, R., & Atkinson, M. (1998) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00554-8 · Cited by 1,145 · see citing works
Resting Heart Rate in Cardiovascular Disease
Fox, K., Borer, J. S., Camm, A. J., Danchin, N., Ferrari, R., Lopez Sendon, J. L., Steg, P. G., Tardif, J.-C., Tavazzi, L., & Tendera, M. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.04.079 · Cited by 1,062 · see citing works
Malík, M. (1996) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.1996.tb00275.x · Cited by 991 · see citing works
Dekker, J. M., Crow, R. S., Folsom, A. R., Hannan, P. J., Liao, D., Swenne, C. A., & Schouten, E. G. (2000) · Circulation · doi:10.1161/01.cir.102.11.1239 · Cited by 860 · see citing works
Dekker, J. M., Schouten, E. G., Klootwijk, P., Pool, J., Swenne, C. A., & Kromhout, D. (1997) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009049 · Cited by 510 · see citing works
Narkiewicz, K., Kato, M., Phillips, B. G., Pesek, C. A., Davison, D. E., & Somers, V. K. (1999) · Circulation · doi:10.1161/01.cir.100.23.2332 · Cited by 485 · see citing works
Tamisier, R., Pépin, J. L., Rémy, J., Baguet, J. P., Taylor, J. A., Weiss, J. W., & Lévy, P. (2011) · European Respiratory Journal · doi:10.1183/09031936.00204209 · Cited by 323 · see citing works
Aune, D., Sen, A., ó'Hartaigh, B., Janszky, I., Romundstad, P. R., Tonstad, S., & Vatten, L. J. (2017) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.04.004 · Cited by 284 · see citing works
Reimers, A. K., Knapp, G., & Reimers, C.-D. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm7120503 · Cited by 236 · see citing works
Pamidi, S., Wroblewski, K., Stepien, M., Sharif-Sidi, K., Kilkus, J., Whitmore, H., & Tasali, E. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201408-1564oc · Cited by 185 · see citing works
Self-citationAcute and chronic cardiovascular effects of intermittent hypoxia in C57BL/6J mice
Campen, M. J., Shimoda, L. A., & O'Donnell, C. P. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00411.2005 · Cited by 155 · see citing works
Drager, L. F., Polotsky, V. Y., O'Donnell, C. P., Cravo, S. L., Lorenzi-Filho, G., & Machado, B. H. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00094.2015 · Cited by 124 · see citing works
QRS detection based ECG quality assessment
Hayn, D., Jammerbund, B., & Schreier, G. (2012) · Physiological Measurement · doi:10.1088/0967-3334/33/9/1449 · Cited by 106 · see citing works
West, S. D., Kohler, M., Nicoll, D. J., & Stradling, J. R. (2009) · Sleep Medicine · doi:10.1016/j.sleep.2008.11.007 · Cited by 97 · see citing works
Heart rate as a predictor of cardiovascular risk
Tadic, M., Cuspidi, C., & Grassi, G. (2018) · European Journal of Clinical Investigation · doi:10.1111/eci.12892 · Cited by 97 · see citing works
Kufoy, E., Palma, J., Lopez, J., Alegre, M., Urrestarazu, E., Artieda, J., & Iriarte, J. (2012) · PLoS ONE · doi:10.1371/journal.pone.0033769 · Cited by 96 · see citing works
Heart rate variability in adults with obstructive sleep apnea: a systematic review
Sequeira, V. C. C., Bandeira, P. M., & de Azevedo, J. C. M. (2019) · Sleep Science · doi:10.5935/1984-0063.20190082 · Cited by 96 · see citing works
Roche, F., Court‐Fortune, Pichot, V., Duverney, Costes, Emonot, Vergnon, Geyssant, Lacour, & Barthélemy, J. (1999) · Clinical Physiology · doi:10.1046/j.1365-2281.1999.00163.x · Cited by 93 · see citing works
Intermittent hypoxia, cardiovascular disease and obstructive sleep apnoea
Turnbull, C. D. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2017.10.33 · Cited by 71 · see citing works
Craig, S., Pepperell, J., Kohler, M., Crosthwaite, N., Davies, R. J. O., & Stradling, J. R. (2009) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00726.x · Cited by 70 · see citing works
Chen, X.-J., Barywani, S. B., Hansson, P.-O., Östgärd Thunström, E., Rosengren, A., Ergatoudes, C., Mandalenakis, Z., Caidahl, K., & Fu, M. L. (2019) · Open Heart · doi:10.1136/openhrt-2018-000856 · Cited by 54 · see citing works
Impact of CPAP on Activity Patterns and Diet in Patients with Obstructive Sleep Apnea (OSA)
Batool‐Anwar, S., Goodwin, J. L., Drescher, A. A., Baldwin, C. M., Simon, R., Smith, T. W., & Quan, S. F. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3686 · Cited by 44 · see citing works
Chrysostomakis, S. I., SIMANTIRAKIS, E. N., Schiza, S. E., et al. (2006) · PubMed · Cited by 37 · see citing works
Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk?
Gottlieb, D. J. (2017) · JAMA · doi:10.1001/jama.2017.7966 · Cited by 11 · see citing works
Correia, F. D. J., Martins, L. E. B., Barreto, D. M., et al. (2019) · Sleep Science · doi:10.5935/1984-0063.20190068 · Cited by 5 · see citing works
Novel Pathways for Regulation of Sinoatrial Node Plasticity and Heart Rate
Mohler, P. J., & Hund, T. J. (2017) · Circulation Research · doi:10.1161/circresaha.117.311922 · Cited by 3 · see citing works
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Arosemena, M., Chopra, K., Salguero, M. V., Reyes, D., Naylor, R. N., Wroblewski, K., Tasali, E., & Philipson, L. H. (2026) · Diabetes · doi:10.2337/db24-0787 · Cited by 2 · see citing works
Self-citation
- Authors
- Pamidi, S., Chapotot, F., Wroblewski, K., Whitmore, H., Polonsky, T., & Tasali, E.
- Affiliations
- McGill University Health Centre (CA)
- PhiTools Strasbourg France
- University of Chicago (US)
- Corresponding author
- Pamidi, Sushmita
- Venue
- Journal of the American Heart Association
- Published
- 2020-10-06
- Volume
- 9
- Issue
- 19
- Pages
- e016871-e016871
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7792375
- OpenAlex
- W3089468541
- Cited by
- 10
- References
- 31
- Citations by year
- 2025: 6 · 2024: 1 · 2023: 1 · 2021: 2
- FWCI
- 0.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- University of Chicago
- National Institutes of Health (UL1TR000430)
- National Institute on Aging (P01AG011412)
- National Heart, Lung, and Blood Institute (RC1HL100046)
- National Center for Research Resources (P41RR013642)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea, continuous positive airway pressure, prediabetes, norepinephrine, sympathetic activity, apnea-hypopnea index, oxygen desaturation index, microarousals, cardiovascular disease prevention
- MeSH terms
- Proof of Concept Study, Cardiovascular Diseases, Female, Heart Rate, Humans, Male, Middle Aged, Monitoring, Physiologic, Outcome and Process Assessment, Health Care, Patient Compliance, Prediabetic State, Rest, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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