The primary objective of this study is to test whether a beta blocker, propranolol, lowers the overnight heart rate sleep in obstructive sleep apnea (OSA) during CPAP withdrawal. The secondary objectives are to test whether propranolol influences sleep architecture, morning blood pressure, and vascular function including reactive hyperemia index (RHI) and a marker of arterial stiffness, augmentation index (AIX).
The overnight heart rate is increased in patients with obstructive sleep apnea (OSA), reflecting excessive sympathetic nervous system activity which may lead to long-term adverse cardiovascular consequences. Propranolol is a non-selective beta blocker that is used for a variety of indications including hypertension and anxiety. In this study investigators will administer propranolol or placebo to patients with OSA before sleep. Investigators will examine the effect of drug on nocturnal heart rate, morning blood pressure, and vascular health outcomes
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
24
Patients will receive Propranolol LA 80 mg PO at 7 PM before sleep (on CPAP withdrawal nights only)
Patients will receive Placebo tablet at 7 PM before sleep (on CPAP withdrawal nights only)
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States
Nocturnal Heart Rate (Beats/Min, BPM)
Average overnight heart rate (10:30 PM to 06:30 AM)
Time frame: 1 Night (approximately 4 hours post administration for each intervention), from 10:30 PM to 06:30 AM
Reactive Hyperemia Index (RHI)
Reactive Hyperemia Index (RHI) is measured by assessing the change in pulse wave amplitude in the brachial artery before and after a period of occlusion (usually 5 minutes). RHI is unitless as it reflects the ratio of pulse wave amplitude after : before occlusion. A high RHI indicates good endothelial function (values \>1.67) and healthy vascular reactivity, while a low RHI (values \<1.67) suggest endothelial dysfunction, which may be a risk factor for cardiovascular disease.
Time frame: The morning after each intervention at 7:00 AM (approximately 11.5 hours post administration for each intervention)
Systolic Blood Pressure (mmHg)
Measured in the morning (7 AM)
Time frame: The morning after each intervention at 7:00 AM (approximately 11.5 hours post administration for each intervention)
Diastolic Blood Pressure (mmHg)
Measured in the morning (7 AM)
Time frame: The morning after each intervention at 7:00 AM (approximately 11.5 hours post administration for each intervention)
Augmentation Index (%)
The Augmentation Index (AIx) is measured by analyzing the arterial pulse wave, which captures the pressure wave reflections in the arteries. A higher AIx indicates increased arterial stiffness and higher cardiovascular risk, while a lower AIx suggests more compliant, healthier arteries. AIx can theoretically range from negative values to over 100%, although clinical values usually are between -10% and +40%.
Time frame: The morning after each intervention at 7:00 AM (approximately 11.5 hours post administration for each intervention)
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