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Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

A nocturnal non-dipping or rise in blood pressure (BP) is associated with poor cardiovascular outcome. This study aimed to test whether continuous positive airway pressure (CPAP) therapy can reduce nocturnal BP and normalize the 24-h BP profile in patients with severe obstructive sleep apnea (OSA) and erectile dysfunction as a surrogate for endothelial dysfunction (ED).

Patients and methods

Eighteen consecutive patients with OSA and ED on stable antihypertensive medication (age 55.8 ± 9.5 years, body mass index 35.5 ± 3.8 kg/m2, apnea-hypopnoea index 66.1 ± 27.4/h) were treated with CPAP for 6 months (average daily use 5.8 ± 2.3 h). Twenty-four hour BP recordings were performed using a portable monitoring device. Rising was defined as an increase, whereas non-dipping was defined as a fall in nocturnal BP of less than 10% compared to daytime values. Serum noradrenaline levels as markers of sympathetic activity were measured at baseline and at 6 month follow up.

Results

Compared to baseline, nocturnal systolic and diastolic BP were significantly reduced after CPAP therapy (128.5 ± 14 to 122.9 ± 11 mmHg, p = 0.036; 76.2 ± 9 to 70.5 ± 5 mmHg, p = 0.007). The frequency of non-dipping and rising nocturnal systolic BP, as well as mean nocturnal heart rate, was reduced after CPAP treatment (73 to 27%, p = 0.039; 20 to 7%, p = 0.625; from 81.5 ± 10 to 74.8 ± 8 beats per minute p = 0.043). Serum levels of noradrenaline were significantly lower after CPAP therapy (398 ± 195 ng/l vs. 303 ± 135 ng/l, p = 0.032).

Conclusion

In patients with severe OSA and clinically apparent ED, CPAP therapy was associated with a decrease in nocturnal BP and serum noradrenaline levels, as well as a normalization of the 24-h BP profile.

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References

  1. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239

    Article  PubMed  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, ESC Scientific Document Group, de Backer G, Heagerty AM, Agewall S, Bochud M, Borghi C, Boutouyrie P, Brguljan J, Bueno H, Caiani EG, Carlberg B, Chapman N, Cífková R, Cleland JGF, Collet J-P, Coman IM, de Leeuw PW, Delgado V, Dendale P, Diener H-C, Dorobantu M, Fagard R, Farsang C, Ferrini M, Graham IM, Grassi G, Haller H, Hobbs FDR, Jelakovic B, Jennings C, Katus HA, Kroon AA, Leclercq C, Lovic D, Lurbe E, Manolis AJ, McDonagh TA, Messerli F, Muiesan ML, Nixdorff U, Olsen MH, Parati G, Perk J, Piepoli MF, Polonia J, Ponikowski P, Richter DJ, Rimoldi SF, Roffi M, Sattar N, Seferovic PM, Simpson IA, Sousa-Uva M, Stanton AV, van de Borne P, Vardas P, Volpe M, Wassmann S, Windecker S, Zamorano JL, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet J-P, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh TA, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Zamorano JL, Tsioufis C, Lurbe E, Kreutz R, Bochud M, Rosei EA, Jelakovic B, Azizi M, Januszewics A, Kahan T, Polonia J, van de Borne P, Williams B, Borghi C, Mancia G, Parati G, Clement DL, Coca A, Manolis A, Lovic D, Benkhedda S, Zelveian P, Siostrzonek P, Najafov R, Pavlova O, de Pauw M, Dizdarevic-Hudic L, Raev D, Karpettas N, Linhart A, Olsen MH, Shaker AF, Viigimaa M, Metsärinne K, Vavlukis M, Halimi J-M, Pagava Z, Schunkert H, Thomopoulos C, Páll D, Andersen K, Shechter M, Mercuro G, Bajraktari G, Romanova T, Trušinskis K, Saade GA, Sakalyte G, Noppe S, DeMarco DC, Caraus A, Wittekoek J, Aksnes TA, Jankowski P, Polonia J, Vinereanu D, Baranova EI, Foscoli M, Dikic AD, Filipova S, Fras Z, Bertomeu-Martínez V, Carlberg B, Burkard T, Sdiri W, Aydogdu S, Sirenko Y, Brady A, Weber T, Lazareva I, Backer TD, Sokolovic S, Jelakovic B, Widimsky J, Viigimaa M, Pörsti I, Denolle T, Krämer BK, Stergiou GS, Parati G, Trušinskis K, Miglinas M, Gerdts E, Tykarski A, de Carvalho Rodrigues M, Dorobantu M, Chazova I, Lovic D, Filipova S, Brguljan J, Segura J, Gottsäter A, Pechère-Bertschi A, Erdine S, Sirenko Y, Brady A (2018) 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 39(33):3021–3104. https://doi.org/10.1093/eurheartj/ehy339

    Article  PubMed  Google Scholar 

  3. Endeshaw YW, White WB, Kutner M, Ouslander JG, Bliwise DL (2009) Sleep-disordered breathing and 24-hour blood pressure pattern among older adults. J Gerontol A Biol Sci Med Sci 64(2):280–285. https://doi.org/10.1093/gerona/gln011

    Article  PubMed  Google Scholar 

  4. Yu Q, Yin G, Zhang P, Song Z, Chen Y, Zhang D, Hu W (2014) Distinct associations between hypertension and obstructive sleep apnea in male and female patients. PLoS One 9(11):e113076. https://doi.org/10.1371/journal.pone.0113076

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Pankow W, Nabe B, Lies A, Becker H, Köhler U, Kohl FV, Lohmann FW (1997) Influence of sleep apnea on 24-hour blood pressure. Chest 112(5):1253–1258

    Article  CAS  PubMed  Google Scholar 

  6. Nagai M, Hoshide S, Ishikawa J, Shimada K, Kario K (2008) Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension. J Hypertens 26(8):1636–1641. https://doi.org/10.1097/HJH.0b013e3283018333

    Article  CAS  PubMed  Google Scholar 

  7. Ip MSM, Tse H-F, Lam B, Tsang KWT, Lam WK (2004) Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 169(3):348–353. https://doi.org/10.1164/rccm.200306-767OC

    Article  PubMed  Google Scholar 

  8. Kohler M, Stradling JR (2010) Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol 7(12):677–685. https://doi.org/10.1038/nrcardio.2010.145

    Article  PubMed  Google Scholar 

  9. Pepperell JCT, Davies RJO, Stradling JR (2002) Systemic hypertension and obstructive sleep apnoea. Sleep Med Rev 6(3):157–173

    Article  PubMed  Google Scholar 

  10. Tamisier R, Pepin JL, Remy J, Baguet JP, Taylor JA, Weiss JW, Levy P (2011) 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J 37(1):119–128. https://doi.org/10.1183/09031936.00204209

    Article  CAS  PubMed  Google Scholar 

  11. Freet CS, Stoner JF, Tang X (2013) Baroreflex and chemoreflex controls of sympathetic activity following intermittent hypoxia. Auton Neurosci 174(1–2):8–14. https://doi.org/10.1016/j.autneu.2012.12.005

    Article  CAS  PubMed  Google Scholar 

  12. Kanagy NL, Walker BR, Nelin LD (2001) Role of endothelin in intermittent hypoxia-induced hypertension. Hypertension 37(2 Pt 2):511–515

    Article  CAS  PubMed  Google Scholar 

  13. Lavie L (2012) Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea. Front Biosci (Elite Ed) 4:1391–1403

    Article  Google Scholar 

  14. Levy P, Pepin J-L, Arnaud C et al (2009) Obstructive sleep apnea and atherosclerosis. Prog Cardiovasc Dis 51(5):400–410. https://doi.org/10.1016/j.pcad.2008.03.001

    Article  CAS  PubMed  Google Scholar 

  15. Hoshide S, Kario K, Hoshide Y et al (2003) Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives. Am J Hypertens 16(6):434–438

    Article  PubMed  Google Scholar 

  16. Dolan E, Stanton AV, Thom S, Caulfield M, Atkins N, McInnes G, Collier D, Dicker P, OʼBrien E (2009) Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients—an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens 27(4):876–885. https://doi.org/10.1097/HJH.0b013e328322cd62

    Article  CAS  PubMed  Google Scholar 

  17. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, Leung RST, Bradley TD (2001) High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 19(12):2271–2277

    Article  CAS  PubMed  Google Scholar 

  18. Schulz R, Bischof F, Galetke W, Gall H, Heitmann J, Hetzenecker A, Laudenburg M, Magnus TJ, Nilius G, Priegnitz C, Randerath W, Schröder M, Treml M, Arzt M, German Sleep Apnea Research Network (GERSAN) (2018) CPAP therapy improves erectile function in patients with severe obstructive sleep apnea. Sleep Med 53:189–194. https://doi.org/10.1016/j.sleep.2018.03.018

    Article  PubMed  Google Scholar 

  19. Pascual M, de Batlle J, Barbe F et al (2018) Erectile dysfunction in obstructive sleep apnea patients: a randomized trial on the effects of continuous positive airway pressure (CPAP). PLoS One 13(8):e0201930. https://doi.org/10.1371/journal.pone.0201930

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, Narkiewicz K, Minuz P (2014) Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest 145(4):762–771. https://doi.org/10.1378/chest.13-1115

    Article  PubMed  Google Scholar 

  21. National Heart Foundation and High blood pressure Research Council of Australia ambulatory Blood pressure monitoring consensus committee, Head GA et al (2011) Ambulatory blood pressure monitoring. Aust Fam Physician. 2011 Nov;40(11):877–80. https://www.racgp.org.au/afp/201111/44799

  22. ACC/AHA/ESC (2011) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden death. Kardiologiia 51(7):65–96

    Google Scholar 

  23. Hetzenecker A, Buchner S, Greimel T, Satzl A, Luchner A, Debl K, Husser O, Hamer OW, Fellner C, Riegger GAJ, Pfeifer M, Arzt M (2013) Cardiac workload in patients with sleep-disordered breathing early after acute myocardial infarction. Chest 143(5):1294–1301. https://doi.org/10.1378/chest.12-1930

    Article  PubMed  Google Scholar 

  24. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, de Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, de Buyzere M, de Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219. https://doi.org/10.1093/eurheartj/eht151

    Article  PubMed  Google Scholar 

  25. Dolan E, Li Y, Thijs L, McCormack P, Staessen JA, O’Brien E, Stanton A (2006) Ambulatory arterial stiffness index: rationale and methodology. Blood Press Monit 11(2):103–105. https://doi.org/10.1097/01.mbp.0000200478.19046.dd

    Article  PubMed  Google Scholar 

  26. Lenders JWM, Pacak K, Walther MM et al (2002)  Biochemical diagnosis of pheochromocytoma: which is the best? JAMA 287(11):1427–1434

  27. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830

    Article  CAS  PubMed  Google Scholar 

  28. Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJO (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359(9302):204–210. https://doi.org/10.1016/S0140-6736(02)07445-7

    Article  PubMed  Google Scholar 

  29. Baguet J-P, Barone-Rochette G, Tamisier R, Levy P, Pépin JL (2012) Mechanisms of cardiac dysfunction in obstructive sleep apnea. Nat Rev Cardiol 9(12):679–688. https://doi.org/10.1038/nrcardio.2012.141

    Article  CAS  PubMed  Google Scholar 

  30. Phillips CL, O'Driscoll DM (2013) Hypertension and obstructive sleep apnea. Nat Sci Sleep 5:43–52. https://doi.org/10.2147/NSS.S34841

    Article  PubMed  PubMed Central  Google Scholar 

  31. Portaluppi F, Provini F, Cortelli P, Plazzi G, Bertozzi N, Manfredini R, Fersini C, Lugaresi E (1997) Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension. J Hypertens 15(11):1227–1233

    Article  CAS  PubMed  Google Scholar 

  32. Lozano L, Tovar JL, Sampol G, Romero O, Jurado MJ, Segarra A, Espinel E, Ríos J, Untoria MD, Lloberes P (2010) Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 28(10):2161–2168. https://doi.org/10.1097/HJH.0b013e32833b9c63

    Article  CAS  PubMed  Google Scholar 

  33. Minoguchi K, Yokoe T, Tazaki T, Minoguchi H, Tanaka A, Oda N, Okada S, Ohta S, Naito H, Adachi M (2005) Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 172(5):625–630. https://doi.org/10.1164/rccm.200412-1652OC

    Article  PubMed  Google Scholar 

  34. Hui DS, Shang Q, Ko FW, Ng SS, Szeto CC, Ngai J, Tung AH, To KW, Chan TO, Yu CM (2012) A prospective cohort study of the long-term effects of CPAP on carotid artery intima-media thickness in obstructive sleep apnea syndrome. Respir Res 13:22. https://doi.org/10.1186/1465-9921-13-22

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jenkinson C, Davies RJ, Mullins R et al (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105. https://doi.org/10.1016/S0140-6736(98)10532-9

    Article  CAS  PubMed  Google Scholar 

  36. Giles TL, Lasserson TJ, Smith BJ et al (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 1:CD001106. https://doi.org/10.1002/14651858.CD001106.pub2

    Article  Google Scholar 

  37. Turnbull F (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362(9395):1527–1535

    Article  CAS  PubMed  Google Scholar 

  38. Law MR, Morris JK, Wald NJ (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665. https://doi.org/10.1136/bmj.b1665

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Gersan Investigators:

Richard Schulz: Department of Pneumology, Hospital Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany

Winfried J. Randerath: Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany

Wolfgang Galetke: HELIOS-Klinik Hagen-Ambrock, University Hospital Witten/Herdecke, Solingen, Germany

Stephan Budweiser: Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Center Rosenheim, Rosenheim, Germany

Georg Nilius: Department of Pneumology and Allergology, Hospital Essen Mitte, Germany

Michael Arzt: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany

Hans-Dietrich Heitmann: AGAPLESION Pneumologische Klinik Waldhof Elgershausen, Greifstein, Germany

Michael Pfeifer: Department of Pneumology, Klinik Donaustauf, Donaustauf, Germany

Joachim H. Ficker: Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nuernberg, Germany

Author information

Authors and Affiliations

  1. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany

    Fabian Bischof, Jozsef Egresits & Michael Arzt

  2. Department of Pneumology, Hospital Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany

    Richard Schulz

  3. Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany

    Winfried J. Randerath

  4. HELIOS-Klinik Hagen-Ambrock, University Hospital Witten/Herdecke, Solingen, Germany

    Wolfgang Galetke

  5. Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Center Rosenheim, Rosenheim, Germany

    Stephan Budweiser

  6. Department of Pneumology and Allergology, Hospital Essen Mitte, Essen, Germany

    Georg Nilius

  7. Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany

    Andrea Hetzenecker

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  1. Fabian Bischof
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Consortia

for the GERSAN Investigators

  • Richard Schulz
  • , Winfried J. Randerath
  • , Wolfgang Galetke
  • , Stephan Budweiser
  • , Georg Nilius
  • , Michael Arzt
  • , Hans-Dietrich Heitmann
  • , Michael Pfeifer
  •  & Joachim H. Ficker

Corresponding author

Correspondence to Andrea Hetzenecker.

Ethics declarations

The study protocol was approved by the local ethics committees and registered at www.ClinicalTrials.gov (NCT01600066) prior to initiation. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendment.

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Written informed consent was obtained from all individual participants included in the study.

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Bischof, F., Egresits, J., Schulz, R. et al. Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction. Sleep Breath 24, 941–951 (2020). https://doi.org/10.1007/s11325-019-01926-z

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