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Variables affecting the change in systemic blood pressure in response to nasal CPAP in obstructive sleep apnea patients

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Abstract

We hypothesized that an improvement in systemic blood pressure (BP) during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) would be related to severity of hypertension (HTN), morphometric parameters such as body mass index, and level of CPAP adherence. We tested this hypothesis with a retrospective review of 85 consecutive OSA patients who had completed diagnostic and CPAP titration polysomnograms and were equipped with a CPAP-adherence monitoring system for a minimum of 1 month of observation. Sphygmomanometer-obtained BP readings were compared at baseline and after 4–6 weeks of CPAP therapy. Presentation BP was significantly and strongly associated with the change in BP seen with treatment. Those with an elevated systolic and diastolic BP and those with an elevation of either systolic or diastolic BP showed a significant fall in BP on CPAP. Those with a BP below the hypertensive range of 140/90 on presentation did not have a significant drop in BP with CPAP. There were no significant changes in systolic, diastolic, or mean BP when patients were categorized by the severity of HTN, as determined by the number of antihypertensive medications prescribed or if they were categorized by the degree of CPAP adherence, objectively determined by the average use of more or less than 4 h/night. We conclude that HTN at initial presentation is among the most important indicators of potential benefit of CPAP administration on BP.

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References

  1. Akashiba T, Kurashina K, Minemura H, Yamamoto H, Horie T (1995) Daytime hypertension and the effects of short-term nasal continuous positive airway pressure treatment in obstructive sleep apnea syndrome. Intern Med 34:528–532

    PubMed  CAS  Google Scholar 

  2. Blondet MC, Perez J, Rodriguez W (2001) Continuous positive airway pressure and obstructive sleep apnea in an Hispanic population. Sleep Breath 5:109–114

    Article  PubMed  CAS  Google Scholar 

  3. Borgel J, Sanner BM, Keskin F, et al (2004) Obstructive sleep apnea and blood pressure. Interaction between the blood pressure-lowering effects of positive airway pressure therapy and antihypertensive drugs. Am J Hypertens 17:1081–1087

    Article  PubMed  Google Scholar 

  4. Minemura H, Akashiba T, Yamamoto H, Akahoshi T, Kosaka N, Horie T (1998) Acute effects of nasal continuous positive airway pressure on 24-hour blood pressure and catecholamines in patients with obstructive sleep apnea. Intern Med 37:1009–1013

    PubMed  CAS  Google Scholar 

  5. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359:204–210

    Article  PubMed  Google Scholar 

  6. Sanner BM, Tepel M, Markmann A, Zidek W (2002) Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. Am J Hypertens 15:251–257

    Article  PubMed  Google Scholar 

  7. Akashiba T, Minemura H, Yamamoto H, Kosaka N, Saito O, Horie T (1999) Nasal continuous positive airway pressure changes blood pressure “non-dippers” to “dippers” in patients with obstructive sleep apnea. Sleep 22:849–853

    PubMed  CAS  Google Scholar 

  8. Jennum P, Wildschiodtz G, Christensen NJ, Schwartz T (1989) Blood pressure, catecholamines, and pancreatic polypeptide in obstructive sleep apnea with and without nasal Continuous Positive Airway Pressure (nCPAP) treatment. Am J Hypertens 2:847–852

    PubMed  CAS  Google Scholar 

  9. Logan AG, Tkacova R, Perlikowski SM, et al (2003) Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Eur Respir J 21:241–247

    Article  PubMed  CAS  Google Scholar 

  10. Tun Y, Hida W, Okabe S, et al (2003) Can nasal continuous positive airway pressure decrease clinic blood pressure in patients with obstructive sleep apnea? Tohoku J Exp Med 201:181–190

    Article  PubMed  Google Scholar 

  11. Voogel AJ, van Steenwijk RP, Karemaker JM, van Montfrans GA (1999) Effects of treatment of obstructive sleep apnea on circadian hemodynamics. J Auton Nerv Syst 77:177–183

    Article  PubMed  CAS  Google Scholar 

  12. Wilcox I, Grunstein RR, Hedner JA, et al (1993) Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea. Sleep 16:539–544

    PubMed  CAS  Google Scholar 

  13. Davies RJ, Crosby J, Prothero A, Stradling JR (1994) Ambulatory blood pressure and left ventricular hypertrophy in subjects with untreated obstructive sleep apnoea and snoring, compared with matched control subjects, and their response to treatment. Clin Sci (Lond) 86:417–424

    CAS  Google Scholar 

  14. Kellner (1993) (Continuous noninvasive blood pressure measurement in obstructive sleep apnea syndrome without and with CPAP therapy). Pneumologie 47:178–180

    PubMed  Google Scholar 

  15. Suzuki M, Otsuka K, Guilleminault C (1993) Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients. Sleep 16:545–549

    PubMed  CAS  Google Scholar 

  16. Faccenda JF, Mackay TW, Boon NA, Douglas NJ (2001) Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 163:344–348

    PubMed  CAS  Google Scholar 

  17. Hla KM, Skatrud JB, Finn L, Palta M, Young T (2002) The effect of correction of sleep-disordered breathing on BP in untreated hypertension. Chest 122:1125–1132

    Article  PubMed  Google Scholar 

  18. Becker HF, Jerrentrup A, Ploch T, et al (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107:68–73

    Article  PubMed  Google Scholar 

  19. Dimsdale JE, Loredo JS, Profant J (2000) Effect of continuous positive airway pressure on blood pressure: a placebo trial. Hypertension 35:144–147

    PubMed  CAS  Google Scholar 

  20. Ali NJ, Davies RJ, Fleetham JA, Stradling JR (1992) The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest 101:1526–1532

    Article  PubMed  CAS  Google Scholar 

  21. Mayer J, Becker H, Brandenburg U, Penzel T, Peter JH, von Wichert P (1991) Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy. Cardiology 79:84–92

    Article  PubMed  CAS  Google Scholar 

  22. Pickering TG, Hall JE, Appel LJ, et al (2005) Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 111:697–716

    Article  PubMed  Google Scholar 

  23. Hedner J, Darpo B, Ejnell H, Carlson J, Caidahl K (1995) Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications. Eur Respir J 8:222–229

    Article  PubMed  CAS  Google Scholar 

  24. Kumiyoshi (2006) Sleep apnea in hypertension. When, how, and why should we treat? Hypertension 47:818–819

    Article  CAS  Google Scholar 

  25. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al (2006) Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest 129:1459–1467

    Article  PubMed  Google Scholar 

  26. Barbe (2001) Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness, a randomized, controlled trial. Intern Med 134:1015–1023

    CAS  Google Scholar 

  27. Norman D, Loredo JS, Nelesen RA, et al (2006) Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension 47:840–845. Epub 2006 Apr 2003

    Article  PubMed  CAS  Google Scholar 

  28. Engleman HM, Gough K, Martin SE, Kingshott RN, Padfield PL, Douglas NJ (1996) Ambulatory blood pressure on and off continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in “non-dippers”. Sleep 19:378–381

    PubMed  CAS  Google Scholar 

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Acknowledgment

Financial support for this study was provided by Henry Ford Hospital Sleep Disorders and Research Center.

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Authors and Affiliations

  1. Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA

    Junaid Malik, Christopher L. Drake & David W. Hudgel

  2. Sleep Disorders Center, CFP 3 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    David W. Hudgel

Authors
  1. Junaid Malik
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  2. Christopher L. Drake
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  3. David W. Hudgel
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Correspondence to David W. Hudgel.

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Malik, J., Drake, C.L. & Hudgel, D.W. Variables affecting the change in systemic blood pressure in response to nasal CPAP in obstructive sleep apnea patients. Sleep Breath 12, 47–52 (2008). https://doi.org/10.1007/s11325-007-0139-5

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