Long-term Effect of Continuous Positive Airway Pressure on BP in Patients With Hypertension and Sleep Apnea

Campos‐Rodríguez, Francisco; Pérez-Ronchel, José; Reina, A; Lima-Alvarez, Jorge; Benitez, Maria A.; Almeida‐González, Carmen V.

doi:10.1378/chest.07-1478

Cited by 95 publications

(50 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because our patients were under antihypertensive therapy and blood pressure levels were controlled at baseline, this may be the reason for negative results. Consistent with our findings, Campos-Rodriguez et al (3) reported that 24 mo of therapeutic nCPAP reduced 24-h ambulatory blood pressure measurements only in a subgroup of patients with incompletely controlled hypertension at baseline. They suggest that, in a group of controlled hypertensive patients, nCPAP therapy failed to reduce blood pressure.…”

Section: Discussionsupporting

confidence: 93%

Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome

Carneiro

Togeiro²,

Hayashi³

et al. 2008

American Journal of Physiology-Endocrinology and Metabolism

View full text Add to dashboard Cite

Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. The aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. In OSAS patients, the percentage of fall in systolic blood pressure at night (P ϭ 0.027) and salivary cortisol suppression postdexamethasone (P ϭ 0.038) were lower, whereas heart rate (P ϭ 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P ϭ 0.036) and a greater cortisol suppression after dexamethasone (P ϭ 0.001). No difference in arterial blood pressure (P ϭ 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r ϭ 0.799, P ϭ 0.010). In conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP. sleep disorders; low-dose dexamethasone test; ambulatory blood pressure monitoring OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) is receiving increased attention because it seems to be associated with a variety of long-term consequences, such as high rates of morbidity and mortality, mostly due to cardiovascular disease (23). Although obesity is the main risk factor for OSAS (39), it has been demonstrated that OSAS may increase the risk for hypertension, myocardial infarction, congestive heart failure, and stroke independently of obesity. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for patients with moderate-to-severe OSAS, since it is highly effective in improving nocturnal hypoxia and sleep fragmentation, enhancing the quality of life and reducing many cardiovascular complications related to OSAS. However, the lack of acceptance and inadequate adherence to CPAP therapy remain the major causes of sleep apnea treatment failure (10,20,21,31,32).The mechanisms proposed to explain the increased cardiovascular disease in obstructive sleep apnea are under assessment. It is speculated that recurrent episodes of upper airway constriction, progressive hypoxemia, and sleep fragmentation may result in neural and metabolic changes, including activation of peripheral sympathetic activity, inflammatory pathways, and hypothalamic-pituitary-adrenal (HPA) axis, impairment of insulin sensitivity, and generation of reactive oxygen species, which could predispose to vascular damage (16,26,27,34).Sympathetic nervous system has been well demonstrated to be activated in sleep ap...

show abstract

Section: Discussionsupporting

confidence: 93%

Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome

Carneiro

Togeiro²,

Hayashi³

et al. 2008

American Journal of Physiology-Endocrinology and Metabolism

View full text Add to dashboard Cite

show abstract

“…It is true that greater levels of use have been demonstrated to result in greater improvements. This does not mean, however, that limited use carries with it no benefi t. In fact, Campos-Rodriguez and colleagues 11,12 demonstrated reduced cardiovascular morbidity and mortality in individuals using PAP 2-5 h a night compared with those using Յ 1 h a night. Additionally, Weaver et al 13 found that the Epworth Sleepiness Scale scores normalized after only 4 h of average nightly use, and Bennett and colleagues 14 found no correlation between and possibly a more sophisticated PAP device.…”

Section: Resultsmentioning

confidence: 99%

The New Local Coverage Determination Criteria for Adherence to Positive Airway Pressure Treatment

Aloia

Knoepke

Lee‐Chiong

2010

Chest

View full text Add to dashboard Cite

“…These results have also raised the question whether or not the outcomes were related with the duration of CPAP treatment. Indeed, a 24-month follow-up study demonstrated a dose dependent blood pressure response to CPAP treatment supporting that beneficial effect can be achieved in long-term even in the initially incompletely treated hypertensive OSA subjects (37). Overall, greater response to CPAP therapy was found to be associated with CPAP compliance, severity of OSA, sleepiness and the co-existence of initial HT (33).…”

Section: Impact Of Cpap On Atherosclerosismentioning

confidence: 95%

Cardiovascular consequences of sleep apnea: III-Impact of continuous positive airway pressure treatment

Celen¹,

Peker²

2010

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

Long-term Effect of Continuous Positive Airway Pressure on BP in Patients With Hypertension and Sleep Apnea

Cited by 95 publications

References 27 publications

Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome

Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome

The New Local Coverage Determination Criteria for Adherence to Positive Airway Pressure Treatment

Cardiovascular consequences of sleep apnea: III-Impact of continuous positive airway pressure treatment

Contact Info

Product

Resources

About