1. CPAP versus Oxygen in Obstructive Sleep Apnea Daniel J. Gottlieb, M.D., M.P.H., Naresh M. Punjabi, M.D., Ph.D., Reena Mehra, M.D., Sanjay R. Patel, M.D., Stuart F. Quan, M.D., Denise C. Babineau, Ph.D., Russell P. Tracy, Ph.D., Michael Rueschman, M.P.H., Roger S. Blumenthal, M.D., Eldrin F. Lewis, M.D., Deepak L. Bhatt, M.D., M.P.H., and Susan Redline, M.D., M.P.H. R1 전민아 N Engl J Med 2014;370:2276-85.

2. Introduction  CPAP(continuous positive airway pressure)  Forces air into the nasal passages at pressures high enough to overcome obstructions in the airway and stimulate normal breathing  Airway pressure delivered into the upper airway is continuous during both inspiration and expiration.  Treatment for moderate to severe obstructive sleep apnea

3. Introduction  Obstructive sleep apnea  Highly prevalent, chronic illness in adults  Risk factor for hypertension, coronary heart disease, stroke, and death  Screening  Berlin questionnaire : Snoring and cessation of breathing Daytime sleepiness Obesity and HTN  Epworth Sleepiness Scale : Self-reported measure of daytime sleepiness

4. Method  Four-site, randomized, parallel-group clinical trial  Patients were managed by cardiologists  Education on habits promoting sleep hygiene and a healthy lifestyle was provided to all participant  AHI 15~50/hr were randomly assigned  24-hour mean arterial pressure were measured at baseline and after 12 weeks of treatment

5. Results

6. no significant difference Forrest IA : active arterial bleeding Forrest IB : oozing bleeding Forrest IIA : Visible vessel Forrest IIB : Adherent clot

7. Results

9.  Secondary analysis  Age, sex, race, baseline body-mass index, AHI, and use or nonuse of each class of antihypertensive medication → no appreciable influence  reactive hyperemia index → no significant difference

10.  In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure  The average decrease in blood pressure resulting from CPAP was modest as compared with the effect of antihypertensive medications  sBP 2mmHg↓  ↓ Mortality from stroke by 10%  ↓ mortality from ischemic heart disease or other vascular causes by 7% Discussion

11.  The effect of CPAP appears to be greatest at night  However, treating physician should consider using supplemental oxygen in specific patients Discussion

12. Thank you for your attention