Effects of CPAP on "vascular" risk factors in patients with obstructive sleep apnea and arterial hypertension

Abstract

BackgroundThe aim of this study was to assess the effects of continuous positive airway pressure (CPAP) on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA) and stage 2–3 arterial hypertension.MethodsForty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30) received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5–10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP < 140/90 mmHg or after adjusting triple treatment in patients with resistant arterial hypertension. The patients were randomized to effective CPAP (4–15 mm H2O) or placebo CPAP (pressure 4 mm H2O) for three weeks, then crossed over to the alternative treatment in a single-blind manner. Office blood pressure (BP), ambulatory BP monitoring, ambulatory arterial stiffness index (AASI), aortic BP, carotid-femoral pulse wave velocity (cfPWV), and systolic wave augmentation index were measured using a Sphygmocor® device at baseline, after antihypertensive treatment, placebo CPAP, and effective CPAP.ResultsBaseline cfPWV was above the normal range in 94% of patients. After reaching target BP, the cfPWV decreased by 1.9 ± 1.0 msec (P = 0.007). Effective CPAP achieved a further cfPWV reduction of 0.7 msec (P = 0.03). Increased arterial stiffness (pulse wave velocity > 12 msec) persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP.ConclusionEffective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.

Treating Arterial Stiffness Associated with Features of Metabolic Syndrome Not Included in its Diagnostic Criteria: Cutting Off the Heads of Lernaean Hydra, Keeper of the Underworld

“…About 24% of men aged 30-60 years and 9% of adult women are estimated to have OSA and most of these patients also have MetS [79]. The independent association of overweight/obesity-associated OSA with CVD morbidity and mortality consists a major health problem [80].…”

“…Data indicate a causal relationship between overweight/obesity, hypertension, T2DM, CVD and OSA, while the relative risk for allcause mortality in patients with OSA is 1.5 compared with those without OSA [80]. One of the possible mechanisms for these sequelae of OSA is increased AS [79,81]. It has been shown that the severity of OSA correlates with the severity of MetS and AS in obese patients [82].…”

“…Moreover, even short-term weight loss improves not only metabolic dysfunction but also the severity of OSA and AS [82]. Interventional studies showed a substantial improvement in symptoms associated with OSA (daytime sleepiness, snoring, morning headaches) as well as a reduction in BP in patients receiving continuous positive airway pressure therapy (CPAP) [79,80]. Moreover, the benefits of CPAP on reduction of fatal and nonfatal CVD events have been established in multiple large trials [82].…”

Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

“…Particularly, OSA is a risk factor for stroke and hypertension [7,8]. Further, continuous positive airway pressure (CPAP) decreases death and cardiovascular events and ameliorates hypertension control [9,10]. Moreover, OSA has been shown to be independently associated with AF development [9], with a prevalence rate as high as 50% [11].…”

Derived Arterial Stiffness is Increased in Patients with Obstructive Sleep Apnea and Periodic Limb Movements during Sleep

“…[18][19][20] More recently, a number of authors have demonstrated the effectiveness of continuous positive airway pressure (CPAP) treatment in decreasing the arterial stiffness derived either from PWV or DVP in subjects with OSA. 15,17,21,22 In this retrospective study, we aimed to generate from oximetry recordings and measure the nocturnal SI DVP in patients with PLMS and compare with age-and BMI-matched controls. As a secondary objective, we compared the SI DVP between patients with OSA or PLMS or a combination of these conditions.…”