Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

Abstract

Obstructive sleep apnea (OSA), is a common clinical inexpensive method for avoiding the supine posture during sleep, namely the tennis ball technique. condition affecting at least 2-4% of the adult population. Hypertension is found in about half of all OSA Of the 13 patients, all had a reduction in 24-h mean BP (MBP). The mean 24-h systolic/diastolic (SBP/DBP) fell by patients, and about one-third of all patients with essential hypertension have OSA. There is growing 6.4/2.9 mm Hg, the mean awake SBP/DBP fell by 6.6/3.3 mm Hg and the mean sleeping SBP/DBP fell by 6.5/2.7 evidence that successful treatment of OSA can reduce systemic blood pressure (BP). Body position appears mm Hg, respectively. All these reductions were significant (at least P Ͻ 0.05) except for the sleeping DBP. The to have an important influence on the incidence and severity of these sleep-related breathing disturbmagnitude of the fall in SBP was significantly greater in the hypertensive than in the normotensive group for the ances.We have investigated the effect of avoiding the supine 24 h period and for the awake hours. In addition, a significant reduction in BP variability and load were found. position during sleep for a 1 month period on systemic BP in 13 OSA patients (six hypertensives and seven Since the majority of OSA patients have supine-related breathing abnormalities, and since about a third of all normotensives) who by polysomnography (PSG) were found to have their sleep-related breathing disturbances hypertensive patients have OSA, avoiding the supine position during sleep, if confirmed by future studies, could mainly in the supine position. BP monitoring was performed by 24-h ambulatory BP measurements before and become a new non-pharmacological form of treatment for many hypertensive patients. after a 1 month intervention period. We used a simple, Keywords: obstructive sleep apnea; ambulatory blood pressure monitoring; sleep position; body posture ous positive airway pressure (nCPAP). [1][2][3] However, Introductionthe long term compliance with nCPAP is often disObstructive sleep apnea (OSA) is a clinical entity appointing. 28 Other methods of treatment of OSA characterised by intermittent partial or complete include weight reduction, 29 use of oral devices that collapse of the upper airway during sleep. [1][2][3] Studies advance the mandible and/or the tongue 30 and difover the last few years have shown that the prevaferent surgical interventions of which the most lence of essential hypertension is much higher in popular is uvulopalatopharyngoplasty (UPPP). 31 patients with OSA (50%) 4-7 than it is in the general Although weight reduction, when achieved, is effecpopulation (20%). 8 Conversely, the prevalence of tive in improving or even curing many overweight OSA is much higher in patients with essential OSA patients, 29 the long term compliance with this hypertension (30%) 9-12 than it is in the general form of therapy is often poor. 32 There is insufficient population (2-4%). 13 As summarised by ourselves long term data avai...

Sleep Apnea and Hypertension: Interactions and Implications for Management

“…Whether any specific antihypertensive drug class has superior blood pressure control in OSA is unclear. Sleep apnea treatments, including positional therapy, 24 oral appliances, 25,26 and bariatric surgery, 27 have been suggested to improve hypertension in OSA patients. Presumably, the primary antihypertensive effect is achieved via relief of concomitant OSA.…”

Sleep {middle dot} 9: An approach to treatment of obstructive sleep apnoea/hypopnoea syndrome including upper airway surgery

“…41 The effect on systemic blood pressure of promoting the lateral sleep position for 1 month was studied in 13 patients with OSAHS, six of whom were hypertensive. 42 Mean 24 hour, awake and sleeping blood pressure fell significantly (systolic/diastolic 6.4/2.9, 6.6/3.3, 6.5/2.7 mm Hg, respectively). The reduction in systolic blood pressure was greater in the hypertensive patients than in those who were normotensive.…”

Therapeutic Options for Obstructive Sleep Apnea

“…37 A secondary advantage of positional therapy may be the effect on hypertension that was demonstrated by a small study (n = 13) that showed that sleeping in the nonsupine position lowered the mean blood pressure (BP) in 100% of the study population after 1 month. 38 …”