Effects of Renal Sympathetic Denervation on Blood Pressure, Sleep Apnea Course, and Glycemic Control in Patients With Resistant Hypertension and Sleep Apnea
Adam Witkowski,Aleksander Prejbisz,Elżbieta Florczak,Jacek Kądziela,Paweł Śliwiński,Przemyslaw Bielen,Ilona Michałowska,Marek Kabat,E. Warchol,Magdalena Januszewicz,Krzysztof Narkiewicz,Virend K. Somers,Paul A. Sobotka,Andrzej Januszewicz +13 more
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TLDR
Catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructiveSleep apnea, which was accompanied by improvement of sleep apnea severity, and Interestingly, there are also accompanying improvements in glucose tolerance.Abstract:
Percutaneous renal sympathetic denervation by radiofrequency energy has been reported to reduce blood pressure (BP) by the reduction of renal sympathetic efferent and afferent signaling. We evaluated the effects of this procedure on BP and sleep apnea severity in patients with resistant hypertension and sleep apnea. We studied 10 patients with refractory hypertension and sleep apnea (7 men and 3 women; median age: 49.5 years) who underwent renal denervation and completed 3-month and 6-month follow-up evaluations, including polysomnography and selected blood chemistries, and BP measurements. Antihypertensive regimens were not changed during the 6 months of follow-up. Three and 6 months after the denervation, decreases in office systolic and diastolic BPs were observed (median: -34/-13 mm Hg for systolic and diastolic BPs at 6 months; both P<0.01). Significant decreases were also observed in plasma glucose concentration 2 hours after glucose administration (median: 7.0 versus 6.4 mmol/L; P=0.05) and in hemoglobin A1C level (median: 6.1% versus 5.6%; P<0.05) at 6 months, as well as a decrease in apnea-hypopnea index at 6 months after renal denervation (median: 16.3 versus 4.5 events per hour; P=0.059). In conclusion, catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructive sleep apnea, which was accompanied by improvement of sleep apnea severity. Interestingly, there are also accompanying improvements in glucose tolerance. Renal sympathetic denervation may conceivably be a potentially useful option for patients with comorbid refractory hypertension, glucose intolerance, and obstructive sleep apnea, although further studies are needed to confirm these proof-of-concept data.read more
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Catheter-Based Renal Nerve Ablation as a Novel Hypertension Therapy: Lost, and Then Found, in Translation.
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Effect of renal sympathetic denervation on apnea-hypopnea index in patients with obstructive sleep apnea: a systematic review and meta-analysis.
TL;DR: RDN is associated with significant improvement in OSA severity, however, the results need validation in RCTs that assess effect of RDN in patients with OSA, which can potentially broaden the clinical applicability ofRDN.
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Neurobiology and neuropathophysiology of obstructive sleep apnea.
Yanpeng Li,Sigrid C. Veasey +1 more
TL;DR: Recent studies in both humans with sleep apnea and animal models of the disorder have increased the understanding of the molecular mechanisms underlying both the disorder and its sequelae, providing great insight into the significance of the Disorder and bringing us closer to finding therapies to prevent or reduce both obstructive sleep Apnea and it morbidities.
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Reduced renal sympathetic nerve activity contributes to elevated glycosuria and improved glucose tolerance in hypothalamus-specific Pomc knockout mice.
Kavaljit H. Chhabra,Donald A. Morgan,Benjamin P. Tooke,Jessica M. Adams,Kamal Rahmouni,Malcolm J. Low +5 more
TL;DR: It is concluded that ArcPomc is essential in maintaining basal RSNA and that elevated glycosuria is a possible mechanism to explain improved glucose tolerance after renal denervation in drug resistant hypertensive patients.
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Sleep Apnea, Hypertension and the Sympathetic Nervous System in the Adult Population.
TL;DR: The epidemiology of sleep apnea and hypertension and the pathogenic mechanisms contributing to neurogenic hypertension are discussed and recent management strategies in addition to continuous positive airway pressure (CPAP), such as upper airway stimulation and renal denervation, are discussed.
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