Effects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure

Norman, Daniel; Loredo, José S.; Nelesen, Richard A.; Ancoli‐Israel, Sonia; Mills, Paul J.; Dimsdale, Joel E.

doi:10.1161/01.hyp.0000217128.41284.78

Cited by 170 publications

(103 citation statements)

References 74 publications

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“…It has been suggested that hypoxia and frequent periodic arousals from sleep may underlie the increased sympathetic nervous activity in the presence of OSAS, although arousals seem to be more significant [10,30]. Consistent with a reduction of sympathetic nerve activity, the present authors found that 4 weeks of CPAP therapy decreased 24-h urine normetanephrine excretion by 26%.…”

Section: Sympathetic Activitysupporting

confidence: 82%

CPAP and measures of cardiovascular risk in males with OSAS

Kohler¹,

Pepperell²,

Casadei³

et al. 2008

Eur Respir J

175

115

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Obstructive sleep apnoea syndrome (OSAS) has been associated with hypertension, stroke and myocardial ischaemia in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but the impact of this intervention on established risk factors for cardiovascular disease remains incompletely understood.A total of 102 males with moderate-to-severe OSAS were randomised to therapeutic (n551) or subtherapeutic (n551) CPAP treatment for 4 weeks to investigate the effects of active treatment on 24-h urinary catecholamine excretion, baroreflex sensitivity (BRS), arterial stiffness (augmentation index) and 24-h ambulatory blood pressure (ABP).After 4 weeks of therapeutic CPAP, significant reductions were seen in urine normetanephrine excretion (from mean¡SD 179.7¡80.1 to 132.7¡46.5 mmol?mol -1 creatinine) and augmentation index (from 14.5¡11.3 to 9.1¡13.8%) compared with the subtherapeutic control group. Furthermore, therapeutic CPAP significantly improved BRS (from 7.1¡3.3 to 8.8¡4.2 ms?mmHg) and reduced mean arterial ABP by 2.6¡5.4 mmHg.In conclusion, treatment of obstructive sleep apnoea with continuous positive airway pressure may lower cardiovascular risk by reducing sympathetic nerve activity, ambulatory blood pressure and arterial stiffness and by increasing sensitivity of the arterial baroreflex.

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Section: Sympathetic Activitysupporting

confidence: 82%

CPAP and measures of cardiovascular risk in males with OSAS

Kohler¹,

Pepperell²,

Casadei³

et al. 2008

Eur Respir J

175

115

View full text Add to dashboard Cite

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“…Our study was primarily focused on changes in BC. We thus did not record changes in other clinically important measures such as blood pressure, which has been shown to decrease in several trials (69)(70)(71). Finally, using a prepost design, we were able to detect changes within specific age categories only.…”

Section: Discussionmentioning

confidence: 99%

Effects of long-term continuous positive airway pressure on body composition and IGF1

Münzer

Hegglin

Stannek

et al. 2010

European Journal of Endocrinology

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Objective: To investigate the long-term effects of nasal continuous positive airway pressure (CPAP) ventilation in patients with obstructive sleep apnea syndrome (OSAS) on body composition (BC) and IGF1. Design: Observational study. Subjects: Seventy-eight (11 females and 67 males) OSAS patients who were compliant with CPAP (age 51G1.1 years) participated in the study. We assessed body mass index (BMI), total body mass (TBM), total body fat (TBF; kg) and lean body mass (LBM; kg), abdominal subcutaneous (SC) and visceral (V) fat (cm 2 ), and waist circumference (WC; cm) by magnetic resonance imaging, and IGF1 (ng/ml) before and after 7.8G1.3 months of CPAP use of an average of 5.9G1.2 h. Results: Women had a higher BMI, WC; TBM, TBF, and more SC fat. Men had a higher LBM and more V fat. CPAP increased WC (C2.8G9.6 cm, PZ0.02) and LBM (2.2G0.5 kg, PZ0.006), but not IGF1. In men, CPAP increased BMI (0.5G0.2 kg/m 2 , PZ0.02), WC (1.7G6.9 cm, PZ0.002), TBM (1.7G0.4 kg, PZ0.0001), LBM (1.5G0.4 kg, PZ0.0003), SC fat (12.9G5.1 cm 2 , PZ0.02), and IGF1 (13.6G4.2 ng/ml, PZ0.002). Compliance with CPAP increased LBM in men aged !60 years, but not in those aged O60 years, and IGF1 increased in men aged 40-60 years only. Conclusions: Long-term CPAP increased LBM in both sexes and IGF1 in men, while fat mass remained unchanged, suggesting a sexually dimorphic response of IGF1 to CPAP. The role of the GH axis activity and age to this response is unclear. The metabolic consequences of changes in LBM are still to be determined. Future studies on the effects of CPAP on BC should include LBM as an outcome.

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“…On the other hand, sham CPAP is not inert and may raise BP. 40 Moreover, the BP analyses were obtained in a blind fashion.…”

Section: Drager Et Al Osa Prehypertension and Masked Hypertensionmentioning

confidence: 99%

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

et al. 2011

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Abstract-Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43Ϯ7 years; body mass index, 28.8Ϯ3.0 kg/m 2 ) with untreated severe obstructive sleep apnea (apnea-hypopnea index, 56Ϯ22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; nϭ18) or CPAP (nϭ18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126Ϯ5 to 121Ϯ7 mm Hg; Pϭ0.001) and a trend for diastolic blood pressure (from 75Ϯ7 to 73Ϯ8 mm Hg; Pϭ0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (PϽ0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; Pϭ0.02) and masked hypertension (from 39% to 5%; Pϭ0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.

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Effects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure

Cited by 170 publications

References 74 publications

CPAP and measures of cardiovascular risk in males with OSAS

CPAP and measures of cardiovascular risk in males with OSAS

Effects of long-term continuous positive airway pressure on body composition and IGF1

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

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