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The Role of Oxidative Stress in the Cardiovascular Consequences of Sleep Apnea
This study is enrolling participants by invitation only.
First Received: May 15, 2008   Last Updated: June 17, 2008   History of Changes
Sponsored by: Ohio State University
Information provided by: Ohio State University
ClinicalTrials.gov Identifier: NCT00701441
  Purpose

Obstructive Sleep Apnea (OSA) is the most common sleep disorder affecting up to 9-24 % of middle aged adults, and is becoming increasingly implicated in the pathogenesis of hypertension, and other cardiovascular disorders. Up to half of patients with OSA have hypertension, and their risk of developing hypertension increases with the increasing severity of Sleep Apnea. Patients with OSA and no hypertension have endothelial dysfunction, which is believed to be the precursor for most cardiovascular disorders. The upper airway collapse, and obstruction that occur in OSA result in a pattern of intermittent hypoxia, that has been shown to be the cause of the hypertension, and endothelial dysfunction found in patients with OSA. Intermittent hypoxia results in oxidative stress, which in turn is linked to the pathogenesis of hypertension and endothelial dysfunction. This protocol evaluates the role of the oxidative stress in endothelial function and blood pressure in patients with OSA. This is a pilot clinical study that will compare oxidative stress parameters, and endothelial function in patients with OSA before and after a two week course of the either one of the antioxidant drugs Allopurinol, and vitamin C. A skin biopsy of the forearm will be done to isolate dermal arterioles, and vascular endothelial cells at baseline and again following the 2 week period. This will enable assessment of the endothelial function. Oxidative stress parameters will be assessed in the plasma by blood draw. The two drugs are widely used with a very reasonable safety profile, specifically for a limited two week course. The skin biopsy is a minimally invasive procedure. Obtaining vascular tissue with the skin biopsy is a pioneering technique that has already lead to significant findings in the field of vascular biology. The area of cardiovascular complications of sleep apnea is in great need for research to understand the mechanisms of the interaction, and provide therapeutic options to a segment of the population exceeding 24% of men, and 9 % of women. Great attention is given to this area by public and governmental organizations such as the NIH.


Condition Intervention
Sleep Apnea
Dietary Supplement: Vitamin C
Device: CPAP
Dietary Supplement: Allopurinol

MedlinePlus related topics: Dietary Supplements Diets High Blood Pressure Sleep Apnea
Drug Information available for: Ascorbic acid Allopurinol sodium Allopurinol
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study
Official Title: The Role of Oxidative Stress in the Cardiovascular Consequences of Sleep Apnea

Further study details as provided by Ohio State University:

Primary Outcome Measures:
  • Measuring levels of oxidative stress [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 70
Study Start Date: February 2007
Estimated Study Completion Date: February 2009
Estimated Primary Completion Date: February 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Control: No Intervention
OSA Vitamin C: Experimental
Vitamin C given
Dietary Supplement: Vitamin C
Vitamin C Supplements
Device: CPAP
Usage of CPAP
OSA Allopurinol: Experimental
Allopurinol given
Device: CPAP
Usage of CPAP
Dietary Supplement: Allopurinol
Allopurinol given
OSA Device: Experimental
CPAP therapy only
Device: CPAP
Usage of CPAP

Detailed Description:

Obstructive Sleep Apnea (OSA) is increasingly recognized as an important risk factor for cardiovascular morbidity and mortality (refs). The association between Obstructive Sleep apnea (OSA) and hypertension (HTN) is particularly significant, as hypertension is the most prevalent cardiovascular disease.

The World Health Organization reports that suboptimal BP (>115 mm Hg SBP) is responsible for 62% of cerebrovascular disease and 49% of ischemic heart disease (WHO 2002). OSA affects more than 24% of men and 9% of women in the middle age, and these patients have up to 50% incidence of hypertension. More recent large epidemiological studies have supported a causal relation between OSA and HTN, and identified OSA as an independent risk factor for developing HTN. The pathogenesis of HTN in patients with OSA remains much less understood. OSA is characterized by episodes of upper airway narrowing or closure occurring throughout the sleep period and resulting in a cyclic pattern of increased respiratory effort, intermittent hypoxia, and surges in sympathetic activity, and blood pressure. Both of animal models and human experiments support the conclusion that intermittent hypoxia is the only required stimulus for the hypertensive response seen in animal models of intermittent hypoxia, and sleep apnea. The pattern of hypoxia reoxygenation seen in patients with OSA is characterized by an increase in oxidative stress. In turn, oxidative stress has been clearly implicated in the pathogenesis of hypertension and other cardiovascular disorders. Therefore, evaluation of the impact of modulation of oxidative stress in patients with sleep apnea on blood pressure and endothelial function is believed by the applicant to be an important and natural direction of the work in this area. Findings of this project may provide new therapeutic options for patients with sleep apnea that could reduce their risk of developing cardiovascular disease

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Completed PSG
  • Older than 18

Exclusion Criteria:

  • Hypertension
  • Diabetes
  • CAD
  • PVD
  • High cholesterol
  • Smoking
  • Pregnancy
  • Use of ED drugs
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00701441

Locations
United States, Ohio
The Ohio State University
Columbus, Ohio, United States, 43212
Sponsors and Collaborators
Ohio State University
Investigators
Principal Investigator: Rami Khayat, MD Ohio State University
  More Information

No publications provided

Responsible Party: The Ohio State University ( Dr. Rami Khayat )
Study ID Numbers: 2005H0221
Study First Received: May 15, 2008
Last Updated: June 17, 2008
ClinicalTrials.gov Identifier: NCT00701441     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by Ohio State University:
sleep apnea,
oxidative stress

Study placed in the following topic categories:
Antimetabolites
Sleep Apnea Syndromes
Allopurinol
Antioxidants
Apnea
Respiration Disorders
Stress
Sleep Disorders
Dyssomnias
Trace Elements
Sleep Disorders, Intrinsic
Signs and Symptoms
Respiratory Tract Diseases
Vitamins
Signs and Symptoms, Respiratory
Micronutrients
Antirheumatic Agents
Ascorbic Acid

Additional relevant MeSH terms:
Antimetabolites
Allopurinol
Antioxidants
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Sleep Disorders
Gout Suppressants
Sleep Disorders, Intrinsic
Signs and Symptoms
Respiratory Tract Diseases
Vitamins
Therapeutic Uses
Free Radical Scavengers
Signs and Symptoms, Respiratory
Micronutrients
Sleep Apnea Syndromes
Apnea
Growth Substances
Nervous System Diseases
Respiration Disorders
Dyssomnias
Enzyme Inhibitors
Protective Agents
Pharmacologic Actions
Antirheumatic Agents
Ascorbic Acid

ClinicalTrials.gov processed this record on May 07, 2009