Continuous positive airway pressure treatment increases bronchial reactivity in obstructive sleep apnea patients.
BACKGROUND
The effects of continuous positive airway pressure (CPAP) treatment on the function of the lower airways are poorly understood. One of the methods used to determine the influence of positive pressure breathing on lower airways is the bronchial hyperreactivity test. Some authors report that CPAP increases bronchial hyperreactivity, while others report decreases.


OBJECTIVE
To assess the influence of CPAP treatment on bronchial reactivity and the effects of bronchial hyperreactivity on compliance to CPAP treatment.


METHODS
The study group consisted of 101 obstructive sleep apnea syndrome patients (88 men and 13 women) with a mean age of 51 ± 11 years, mean apnea-hypopnea index of 53 ± 20 and mean body mass index of 32.6 ± 5.4. Patients were randomly assigned to a treatment group that received 3 weeks of CPAP therapy (group 1) or to a nontreatment control group (group 2). Pulmonary function tests and the methacholine bronchial provocation test were performed at baseline and 3 weeks later.


RESULTS
There were no statistically significant differences between treated and control groups in anthropometry and polysomnography variables. At baseline, bronchial hyperreactivity was found in 6 patients from group 1 and 5 patients from group 2. A significant increase in bronchial reactivity was observed after CPAP treatment. Log PC20M decreased from 1.38 ± 0.30 at baseline to 1.26 ± 0.50 (p < 0.05). In group 2, changes were statistically insignificant. Patients with bronchial hyperreactivity during CPAP treatment were characterized by significantly lower FEV1, FVC and MEF50 values.


CONCLUSIONS
CPAP produces statistically significant bronchial hyperreactivity. However, there were no clinical symptoms and it is not necessary to withdraw previous therapies.
Korczynski
Piotr
P
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, PL–02-097 Warsaw, Poland. piotr.korczynski@wum.edu.pl
Gorska
Katarzyna
K
Przybylowski
Tadeusz
T
Bielicki
Piotr
P
Zielinski
Jan
J
Chazan
Ryszarda
R
D000328:Adult; D000368:Aged; D016535:Bronchial Hyperreactivity / Q000209:etiology*; D016085:Bronchoconstrictor Agents; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D012129:Respiratory Function Tests; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride