Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis

Lin, Xin; Chen, Gongping; Qi, Jia-Chao; Chen, Xiaofang; Jiang-ming, Zhao; Lin, Qi‐Chang

doi:10.1007/s00405-016-3914-8

Cited by 24 publications

(23 citation statements)

References 33 publications

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“…Brachial ankle pulse wave velocity (baPWV), which is considered a surrogate marker of CVD, has been increasingly used in clinical as well as population-based studies owing to its simplicity and ease of measurement 8 . Unsurprisingly, substantial data from clinical or community-based studies demonstrated that pulse wave velocity (PWV) in patients with OSA is significantly high, but decreases after continuous positive airway pressure (CPAP) treatment 9 – 11 . Moreover, recent systemic reviews also revealed a significant association between OSA and PWV, suggesting that increased PWV might be an independent predictor of OSA-related cardiovascular complications 10 , 12 .…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: A KoGES Prospective Cohort Study

Kim

Lee

Yoon

et al. 2018

Sci Rep

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Accumulating evidence shows that obstructive sleep apnoea (OSA) is associated with an increased risk of cardiovascular disease. However, there are no published prospective studies on the relationship between OSA and the progression of arterial stiffness. We hypothesised that OSA would increase the risk of arterial stiffness progression, independent of obesity. In the present large cohort study, 1921 participants were randomly selected and underwent polysomnography. The brachial ankle pulse wave velocity (baPWV) was measured at baseline and during the follow-period using a standard protocol. Elevated baPWV was defined as a value greater than the cut-off of highest tertile level in the complete study cohort. The percentage of elevated baPWV and the ΔbaPWV significantly increased with OSA severity. After adjusting for potential confounding factors, participants with moderate-to-severe OSA without hypertension had a significantly higher risk of elevated ΔbaPWV than those without OSA. More importantly, using multivariate mixed-effect models, we found that the ΔbaPWV over 6 years significantly differed according to OSA severity. Therefore, moderate-to-severe OSA in participants without hypertension was a predictor of future burden of arterial stiffness progression, independent of obesity, suggesting that it may contribute to the increased risk of cardiovascular disease.

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Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: A KoGES Prospective Cohort Study

Kim

Lee

Yoon

et al. 2018

Sci Rep

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“…So, vascular stiffness may be a precursor rather than the result of hypertension. In our study we show that CPAP can improve arterial stiffness in patients with OSA and hypertension, and we speculated that it might be beneficial to delay or prevent the occurrence of cardiovascular disease in patients with OSA and hypertension [36]. As in the study of Kartali [28], the PWV is reduced at first night and further decreased after 3 months of treatment compared to baseline which implies that not only a functional, but also a structural change is taking place in the arteries..…”

Section: Discussionmentioning

confidence: 58%

Early Variations in Augmentation Index and Pulsed Wave Velocity in Patients with Obstructive Sleep Apnea and Arterial Hypertension Post CPAP Treatment

2017

JCCR

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Background: Obstructive sleep apnea (OSA) is a risk factor for hypertension and if left untreated, is associated with high cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is considered the therapy of choice for moderate and severe OSA. (CPAP) reduces peripheral blood pressure and arterial stiffness. Arterial stiffness is measurable and evaluated by pulse wave velocity (PWV) and augmentation index as early markers of atherosclerosis and cardiovascular (CV) risk. The aim of this study was to assess the early effects of (CPAP) on augmentation index and pulsed wave velocity of arterial stiffness in patients with (OSA) and arterial hypertension. Patients and Methods: The study conducted at Zagazig Cardiology and Chest Departments. Sixty patients divided into two groups: each group was thirty patients, the first group: moderate OSA with hypertension, the second group: severe OSA with hypertension. Inclusion criteria: Patients referred to the Sleep Clinic of the Chest Department, because of snoring or sleepiness with confirmed moderate-to-severe OSA (apnea/hypopnea index >15/h and >30 /h) and known to have hypertension on continuous antihypertensive treatment with BP less than 140/90 mmHg. Exclusion criteria: Patients with severe chronic diseases, peripheral vascular disease, and diabetes. Sleep study was done to confirm the diagnosis of OSA. Ambulatory blood pressure monitoring was done to confirm the diagnosis of hypertension. Non-invasive assessment of central aortic pressure and measuring pulse wave velocity and augmentation index .Standard CPAP intervention was done. Follow-up was done after 12 weeks of standard CPAP intervention. Results: The effective CPAP treatment after 12 weeks showed significant BP reduction, in central systolic BP (6.2 ± 1.6 mmHg, P < 0.005), diastolic BP (4.4 ± 0.7 mmHg, P < 0.001) and, brachial sys¬tolic BP (5.4 ± 1.4 mmHg, P < 0.03) and diastolic BP (4.2 ± 0.8 mmHg, P < 0.05) and achieved PWV reduction by 1.7 ± 1.2 m/sec (P < 0.005) and a significant reduction in augmentation index (the augmentation index was 24.8% ± 11.9%) and the significant reduction in augmentation index up to 6.1% (P <0.05). Conclusion: The effective CPAP therapy reduces both central aortic and peripheral blood pressure and improvements in arterial stiffness parameters. The effective reduction of augmentation index and arterial stiffness will prevent cardiovascular morbidity and mortality.

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“…There are at least two meta-analysis [ 6 , 7 ] identifying a decrease in arterial stiffness after CPAP treatment in patients with OSA, and in patients with OSA and hypertension; only four from the selected studies evaluated the effect on cf-PWV.…”

Section: Discussionmentioning

confidence: 99%

“…OSA is associated with increased arterial stiffness, with an improvement after continuous positive airway treatment (CPAP) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

The role of sleepiness on arterial stiffness improvement after CPAP therapy in males with obstructive sleep apnea: a prospective cohort study

et al. 2017

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BackgroundObstructive sleep apnea (OSA) is associated with increased cardiovascular risk. This study aim to assess differences in changes in arterial stiffness of two groups of patients, defined as having daytime sleepiness or not, after continuous positive airway pressure (CPAP) treatment.MethodsA selected cohort of consecutive male patients, under 65 years old, with moderate to severe OSA and without great number of comorbidities was studied. The diagnosis was confirmed by home respiratory poligraphy. Sleepiness was considered with an Epworth Sleepiness Scale (ESS) > 10.An ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (cf-PWV) measurements were performed, before and after four months under CPAP. Compliant patients, sleepy and non-sleepy, were compared using linear mixed effects regression models. A further stratified analysis was performed with non-sleepy patients.ResultsThirty-four patients were recruited, with mean age 55.2 (7.9) years, 38.2% were sleepy, 79.4% with hypertension, 61.8% with metabolic syndrome and 82.4% with dyslipidaemia.In univariable analysis, cf-PWV was strongly related to systolic BP parameters and age, but also to antihypertensive drugs (p = 0.030), metabolic syndrome (p = 0.025) and daytime sleepiness (p = 0.004). Sleepy patients had a more severe OSA, with AHI 44.8 (19.0) vs 29.7 (15.7) events/h (p = 0.018), but sleep study parameters were not associated with cf-PWV values. On multivariable regression, a significant interaction between time (CPAP) and sleepiness (p = 0.033) was found.There was a weak evidence of a cf-PWV reduction after CPAP treatment (p = 0.086), but the effects of treatment differed significantly between groups, with no changes in non-sleepy patients, while in sleepy patients a significant decrease was observed (p = 0.012).Evaluating non-sleepy patients group under CPAP therapy, results showed that both higher pulse pressure (p = 0.001) and lower LDL-cholesterol levels (p = 0.015) at baseline were associated to higher cf-PWV changes.ConclusionsPatients with daytime sleepiness had a more severe OSA and presented a greater arterial stiffness improvement after CPAP therapy, independently from age and BP. Besides sleepiness, cf-PWV reduction after CPAP therapy was mainly associated to CV risk factors, and less to sleep study parameters.Trial registrationClinicaltrials.gov NCT02273089 23.10.2014 retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0518-z) contains supplementary material, which is available to authorized users.

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Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis

Cited by 24 publications

References 33 publications

Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: A KoGES Prospective Cohort Study

Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: A KoGES Prospective Cohort Study

Early Variations in Augmentation Index and Pulsed Wave Velocity in Patients with Obstructive Sleep Apnea and Arterial Hypertension Post CPAP Treatment

The role of sleepiness on arterial stiffness improvement after CPAP therapy in males with obstructive sleep apnea: a prospective cohort study

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