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VOLUME 34, ISSUE 12

CPAP FOR SEVERE OSA REDUCES PAIN SENSITIVITY
Continuous Positive Airway Pressure in Severe Obstructive Sleep Apnea Reduces Pain Sensitivity

http://dx.doi.org/10.5665/sleep.1436

Imran Khalid, MD1; Timothy A. Roehrs, PhD2; David W. Hudgel, MD3; Thomas Roth, PhD2

1King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; 2Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI; 3Sleep Centre, University of Manitoba, Winnipeg, MB, CA



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Study Objective:

To evaluate effects of CPAP on pain sensitivity in severe OSA patients.

Design:

Within-subject treatment study.

Setting:

Hospital-based sleep disorders center.

Patients:

Twelve severe OSA patients (7 men, 5 women), 50.2 ± 12.5 years, with no pain.

Interventions:

The morning after a diagnostic nocturnal polysomnogram (NPSG), patients underwent a training session of finger withdrawal latency (FWL) testing to a radiant heat stimulus, a validated human behavioral model of thermal nociception. Baseline FWL in seconds was obtained after the training session. CPAP pressure was titrated on a second night in the laboratory. Two nights after titration, patients returned to sleep in the laboratory on CPAP. FWL was tested in the morning after awakening, after 6-8 wks of CPAP use, and finally (within 6-8 weeks) after 2 nights of discontinuation of CPAP. Mean FWL in seconds (sec) was compared using MANOVAs with nights as the within subject variable.

Results:

Apnea-hypopnea index (AHI) decreased from 50.9 ± 14.5 to 1.4 ± 1.0 with CPAP, and sleep continuity improved. In parallel, FWL increased significantly from a mean baseline of 9.8 ± 1.3 sec to 13.7 ± 5.1 sec (P = 0.01) and with continued CPAP use (5.1 ± 2.3 h nightly) for 6-8 weeks FWL remained elevated (21.1 ± 16.2 sec). After the 2-night CPAP discontinuation, apnea/hypopneas returned and sleep was fragmented (AHI = 32.6 ± 19.8). FWL decreased to 11.6 ± 5.9 sec relative to intermediate-term CPAP use (P = 0.03).

Conclusion:

CPAP treatment reduces pain sensitivity in OSA patients. Future studies will focus on patients with OSA and chronic pain and identify mediating mechanisms.

Citation:

Khalid I; Roehrs TA; Hudgel DW; Roth T. Continuous positive airway pressure in severe obstructive sleep apnea reduces pain sensitivity. SLEEP 2011;34(12):1687-1691.

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