Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial

Pepperell, Justin; Ramdassingh-Dow, Sharon; Crosthwaite, Nicky; Mullins, Rebecca; Jenkinson, Crispin; Stradling, John; Davies, Robert J. O.

doi:10.1016/s0140-6736(02)07445-7

Cited by 918 publications

(575 citation statements)

References 38 publications

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“…2 At the time of study commencement, concerns had been raised about the use of sibutramine in obese patients with hypertension, including those on treatment. 31 Given the high prevalence of hypertension in patients with OSA, 32 and the causative role that OSA may play in this hypertension, 33,34 it was considered more meaningful to first establish whether theoretical concerns about the risk of sibutramine use in OSA were valid. Importantly, despite these concerns, there was no overall rise in blood pressure in this study and no patients developed overt hypertension (BP 4140/90 mm Hg).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated that complete elimination of OSA with CPAP reduces blood pressure, 33,34 an effect that is particularly pronounced in OSA subjects with drug-resistant hypertension. 39 Given that SIB-WL only achieved partial resolution of OSA in the present study and that patients with persistent hypertension were excluded, any beneficial effects may not have occurred within this time frame.…”

Section: Discussionmentioning

confidence: 99%

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The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea

et al. 2006

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Objective: Obstructive sleep apnoea (OSA) occurs frequently in obese patients and may be reversible with weight loss. Obstructive sleep apnoea and obesity are both independent risk factors for hypertension and increased sympathetic activity. Sibutramine has been increasingly used in the management of obesity, but is relatively contraindicated in patients with hypertension. No studies have investigated the effect of sibutramine on OSA, blood pressure and heart rate. We aimed to assess the changes in OSA and cardiovascular parameters in obese men with OSA enrolled in a sibutramine-assisted weight loss programme (SIB-WL). Design: Open uncontrolled cohort study of obese male subjects with OSA in an SIB-WL. Subjects: Eighty-seven obese (body mass index ¼ 34.272.8 kg/m 2 ) middle-aged (46.379.3 years) male subjects with symptomatic OSA (Epworth score 13.473.6; respiratory disturbance index (RDI) 46.0723.1 events/h) completed the study. Results: At 6 months, there was significant weight loss (8.374.7 kg, Po0.0001), as well as a reduction in waist and neck circumference and sagittal height (all Po0.0001). These changes were accompanied by a reduction in OSA severity (RDI fell by 16.3719.4 events/h and Epworth score by 4.574.6), both Po0.0001). There was no significant change to systolic (P ¼ 0.07) or diastolic blood pressure (P ¼ 0.87); however, there was a mild rise in resting heart rate (Po0.0001). Conclusion: Moderate (B10%) weight loss with SIB-WL results in improvement in OSA severity without increase in blood pressure in closely monitored OSA subjects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea

et al. 2006

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“…The apneas disappear, the cardiovascular changes disappear and the sleep fragmentation is reversed. Studies on the treatment effect of CPAP could prove a reversal of daytime sleepiness (Jenkins et al, 1999) and of arterial hypertension even during daytime (Pepperell et al, 2002). This pneumatic method has to be used continuously and regularly during each night with sleep.…”

Section: Obstructive Sleep Apnea As a Model Sleep Disordermentioning

confidence: 99%

Dynamics of Heart Rate and Sleep Stages in Normals and Patients with Sleep Apnea

Penzel

Kantelhardt

et al. 2003

Neuropsychopharmacol

146

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Sleep is not just the absence of wakefulness but a regulated process with an important restorative function. Based on electroencephalographic recordings and characteristic patterns and waveforms we can distinguish wakefulness and five sleep stages grouped into light sleep, deep sleep, and rapid-eye-movement (REM) sleep. In order to explore the functions of sleep and sleep stages, we investigated the dynamics of sleep stages over the night and of heart-rate variability during the different sleep stages. Sleep stages and intermediate wake states have different distri butions of their duration and this allows us to create a model for the temporal sequence of sleep stages and wake states. Heart rate is easily accessed with a high precision by the recording and analysis of the electrocardiogram (ECG). Heart-rate regulation is part of the autonomous nervous system and sympathetic tone is strongly influenced by the sleep stages.

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“…Those studies showed that patients who had more severe and symptomatic sleep apnea and hypertension experienced more benefit from the longer use of CPAP. 110,121,122 Patients less likely to experience benefit were those with asymptomatic mild OSA who had normal blood pressure at baseline. 123,124 In a doubleblind, randomized trial comparing therapeutic airway pressurization with sham CPAP, therapeutic airway pressurization was associated with a reduction of 3 to 7 mm Hg in mean 24-hour systemic arterial blood pressure.…”

Section: Early Treatment Of Obstructive Sleep Apnea In Cardiovascularmentioning

confidence: 99%

“…123,124 In a doubleblind, randomized trial comparing therapeutic airway pressurization with sham CPAP, therapeutic airway pressurization was associated with a reduction of 3 to 7 mm Hg in mean 24-hour systemic arterial blood pressure. 122 In extrapolating from pharmacologic antihypertensive trials, this blood pressure reduction, in itself, is expected to result in a 20% stroke risk reduction. 125 To date, there are very few data available about the treatment of OSA in the context of cardiac rehabilitation and, overall, the data supporting the treatment of OSA in patients with CAD are less robust than for systemic hypertension.…”

Section: Early Treatment Of Obstructive Sleep Apnea In Cardiovascularmentioning

confidence: 99%

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

Jafari

2017

Sleep Medicine Clinics

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Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial

Cited by 918 publications

References 38 publications

The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea

The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea

Dynamics of Heart Rate and Sleep Stages in Normals and Patients with Sleep Apnea

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

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