SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science VIII. Medical Disorders and Sleep
0675
A RANDOMIZED, DOUBLE BLIND, PLACEBO
CONTROLLED STUDY ON THE EFFECT OF SILDENAFIL
IN AUTONOMIC NERVOUS SYSTEM RESPONSE DURING
SLEEP IN OBSTRUCTIVE SLEEP APNEA SYNDROME
Roizenblatt S, Neves C, Chediek F, Tufik S
Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São
Paulo, Brazil
Introduction: We have previously demonstrated that sildenafil can
impair sleep related respiratory parameters, in obstructive sleep apnea
syndrome (OSAS). Increase in obstructive events and desaturation of
oxyhemoglobin may influence autonomic response during sleep. The
objective of this study was to evaluate autonomic response in OSAS
patients after sildenafil 50 mg, at bedtime.
Methods: Heart rate variability (HRV) was evaluated in the group of
thirteen male OSAS patients of the previous study, who underwent
all-night polysomnography after receiving sildenafil 50mg or placebo.
Frequency-domain HRV was analyzed in 5-minute samples of stable
SWS and REM including an apnea event and in 1-minute sample after
recovery of respiration in NREM and REM sleep.
Results: Comparing to placebo, during sildenafil night, increase in central
AHI occurred in non-REM sleep, increase in obstructive AHI and
also decrease in oxyhemoglobin saturation occurred in both non-REM
and REM sleep. Additionally, arousal index and in LF/HF component of
HRV were higher in REM sleep. Increase in HF and decrease in LF/HF
in SWS and decrease in TP in REM were observed in the five-minute
samples analysis. Regarding apnea and post apnea one-minute period
evaluation, increase in HF occurred in post apnea, and TP variation
was not significant nether in NREM, nor in REM sleep, with the use
of sildenafil. Modifications of HRV and respiratory parameters of sleep
were also evaluated. Correlation was found between modification TP
in NREM sleep during apnea and AHI, between modification of HF in
REM sleep and AHI, and arousal index. Multivariate analysis showed
association of changes in LF/HF in REM sleep post apnea with modification
of mean saturation induced by sildenafil.
Conclusion: In severe OSA, the use of sildenafil 50 mg at bedtime plays
a detrimental role on respiratory parameters in both non-REM and REM
sleep, with fragmentation in REM sleep, increase in parasympathetic
activity and blunted heart rate variability during apnea and a prolonged
increase in LH/HF component of HRV after resumption of ventilation.
Support (If Any): CEPID 1998/14303-3
0676
SLEEP QUALITY AND ASTHMA CONTROL IN NON-SEVERE
AND SEVERE ASTHMA
Luyster F 1 , Strollo PJ 2 , Wenzel S 2
1
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA,
2
Division of Pulmonary, Allergy, and Critical Care Medicine,
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Introduction: Sleep disturbances are commonly reported by individuals
with asthma and are more severe in those with poorly controlled asthma.
Gastroesophageal reflux disease (GERD) is considered a probable cause
of poor sleep in asthma. We sought to determine if poor sleep quality
can be explained entirely by GERD and whether sleep quality is associated
with asthma control and asthma quality of life after controlling for
GERD and other risk factors.
Methods: Adults with severe asthma (SA), non-severe asthma (NSA),
and normal controls (NC) enrolled in the Severe Asthma Research Program
(SARP) completed the Pittsburgh Sleep Quality Index (PSQI),
Epworth Sleepiness Scale (ESS), and Asthma Quality of Life Questionnaire
(AQLQ). Asthma control consisted of items comparable those in
the Asthma Control Questionnaire. Individuals using CPAP or BiPAP
and/or were at high risk for obstructive sleep apnea were excluded.
Results: A total of 333 patients (109 SA, 164 NSA, 60 NC) were included
in the analyses. On average, SA had worse sleep quality (PSQI:
10.1±3.1) than NSA patients (8.7±3.1) and each group had worse
sleep quality than NC (6.8±2.5). SA patients had worse asthma control
(3.9±1.3) and quality of life (4.2±1.3) than NSA (5.1±1.1 and 5.1±1.1).
The majority of asthma patients had poor sleep quality regardless of
GERD (with GERD; PSQI> 5: 93.6% and without GERD; PSQI> 5:
87.7%). Poor sleep quality was associated with poor asthma control and
worse asthma quality of life, independent of age, gender, GERD, body
mass index, ESS, and oral corticosteroid use, in both NSA (β=-0.38,
p