Obstructive sleep apnea and blood pressureInteraction between the blood pressure-lowering effects of positive airway pressure therapy and antihypertensive drugs

Börgel, Jan; Sanner, Bernd; Keskin, Fatıh; Bittlinsky, A.; Bartels, Nina Karen; Büchner, Nikolaus; Huesing, Anika; Rump, Lars Christian; Mügge, Andreas

doi:10.1016/j.amjhyper.2004.06.026

Cited by 54 publications

(46 citation statements)

References 26 publications

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“…Although previous analyses have addressed some aspects of the effects of PAP on measures of cardiac and vascular function,16, 42 to the best of our knowledge, our results are the first to identify early changes in vascular stiffness, endothelial function, and cardiac hemodynamics in young individuals with moderate‐to‐severe OSA and identify their changes in response to PAP treatment and its withdrawal. A major strength of our study is the robustness and consistency of our data, as well as the use of objective PAP compliance information.…”

Section: Discussionmentioning

confidence: 91%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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BackgroundThe cardiovascular effects of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients are not clear because of confounding by comorbid conditions.Methods and ResultsProspective interventional study of PAP therapy and withdrawal. Apnea Hypopnea Index (AHI; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (BPs), Aortic Augmentation Index (AAIx), and central (PWV c‐f) and peripheral pulse wave (PWV c‐r) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of PAP therapy, and 1 week after PAP withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5) AHI events/hour. After 4 weeks post‐PAP initiation and sustained after 12 weeks, subjects experienced decreases in central systolic BP (P=0.008), diastolic BP, mean BP, AAIx, and PWV c‐r, and brachial artery dilation (all P<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models, PAP use (hours/night) predicted reductions in diastolic BP (β=−0.65 [SE, 0.32] mm Hg/hour; P=0.045), AAIx (β=−0.53 [0.27] %/hour; P=0.049) and PWV c‐r (β=−0.13 [0.05] m·s−1/hour; P=0.007), and improved brachial artery flow‐mediated dilation (β=0.31 [0.14] %/hour use; P=0.015). After 1 week of PAP withdrawal, brachial diameter, diastolic BP, mean BP, AAIx, and heart rate increased (P≤0.05).Conclusions PAP therapy reduces arterial tone and improves endothelial and diastolic function in young to middle‐aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with PAP withdrawal.Clinical Trial RegistrationURL: https://clinicaltrials.gov/. Unique identifier: NCT01317329.

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Section: Discussionmentioning

confidence: 91%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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“…There have been four reports illustrating a long-term (more than 6 months) effect of nasal CPAP on OSAS parameters [7,[30][31][32]. As noted above, the use of CPAP in this patient was on 85.7% of the days, and the mean measured use time was 5 hr 51 min.…”

Section: Discussionmentioning

confidence: 97%

“…Several investigators have reported a reduction of plasma and/or urinary NE and systemic blood pressure as early as the first night on CPAP [28,29]. Recent controlled studies demonstrated that nasal CPAP therapy for 4-9 weeks reduced blood pressure by 1-10 mmHg [4][5][6][7], in that the degree of blood pressure reduction appeared to be dependent on the severity of established hypertension. In agreement with this notion, Heitmann et al found that blood pressure and plasma NE levels were reduced in hypertensive, but not normotensive, OSAS patients after a minimum of 4 weeks of home use of nasal CPAP therapy [15].…”

Section: Discussionmentioning

confidence: 99%

“…Nasal CPAP therapy is recommended not only to improve hypertension and catecholamine excess but also to distinguish the condition from pheochromocytoma. THERE is a growing body of evidence showing that patients with obstructive sleep apnea syndrome (OSAS) have a high prevalence of hypertension [1][2][3] and that treatment with nasal positive airway pressure (CPAP) successfully lower blood pressure [4][5][6][7]. A major cause of hypertension in OSAS is thought to be the increased sympathetic activity due to apnea-related episodic hypoxemia and repeated arousal [8,9].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Sleep Apnea Syndrome Manifesting Severe Hypertension with High Plasma Norepinephrine Levels

Makino¹,

Iwata²,

Fujiwara³

et al. 2006

Endocr J

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Abstract.A 55-year-old female was admitted to our hospital with severe hypertension (274/140 mmHg). Endocrinological examination revealed that her plasma levels of norepinephrine (NE) was elevated with high levels of urinary NE, normetanephrine and vanillylmandelic acid (VMA), suggesting the presence of pheochromocytoma. However, neither computed tomography nor MIBG scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. She was screened with full polysomnography because of heavy snoring, and the diagnosis of severe obstructive sleep apnea syndrome (OSAS) was made. She was treated with calcium channel blocker for three weeks, but severe hypertension persisted. After treatment with nasal continuous positive airway pressure (CPAP) was added, her blood pressure gradually lowered week by week. Concomitantly, the levels of plasma and urinary NE, urinary normetanephrine and urinary VMA were normalized following nasal CPAP therapy for 2 weeks. Additional treatments with alphaadrenergic blocker further decreased her home blood pressure. After a year, she continued nasal CPAP therapy and her blood pressure was nearly below 160/100 mmHg. Urinary NE level was slightly above normal range and other catecholamines stayed within the normal range. This case shows that patients with OSAS could develop severe hypertension through elevated sympathetic tone, mimicking pheochromocytoma. Nasal CPAP therapy is recommended not only to improve hypertension and catecholamine excess but also to distinguish the condition from pheochromocytoma. THERE is a growing body of evidence showing that patients with obstructive sleep apnea syndrome (OSAS) have a high prevalence of hypertension [1][2][3] and that treatment with nasal positive airway pressure (CPAP) successfully lower blood pressure [4][5][6][7]. A major cause of hypertension in OSAS is thought to be the increased sympathetic activity due to apnea-related episodic hypoxemia and repeated arousal [8,9]. There are a number of studies demonstrating the elevated plasma or urinary norepinephrine (NE) or epinephrine (E) levels during sleep and wakefulness in OSAS [10][11][12]. Although it has been reported that nasal CPAP therapy reduces sympathetic activity [10,[13][14][15], the detailed analysis of catecholamine metabolites and the detailed time course of biochemical normalization during nasal CPAP therapy have not been fully examined. Recently, Hoy et al. reported 5 cases of OSAS with drug-resistant hypertension [16]. Catecholaminesecreting tumor could not be identified in any of these subjects, despite high urinary NE levels. Furthermore, treatment of OSAS with nasal CPAP led to normalization of both systemic blood pressure and urinary NE levels. The authors have proposed that pseudopheochromocytoma is a rare, but treatable, presentation of OSAS. Here, we present a similar rare case of the severe hypertensive OSAS patient showing high plasma and urinary catecholamine levels without evidence of catecholamine-secreting tumor. We examined the detailed profil...

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“…Although these studies vary somewhat in their designs, all 3 allowed the subset of hypertensive patients in their studies to remain on antihypertensive medications. This makes their divergent results difficult to interpret, because use of antihypertensive medications has been reported by some authors as a positive predictor 50 but by others a negative predictor 60 of the potential blood pressure-lowering effects of CPAP therapy.…”

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confidence: 80%

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

et al. 2006

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Abstract-Obstructive sleep apnea (OSA) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension. Prior studies have been limited, however, in their ability to show reduction in blood pressure after continuous positive airway pressure (CPAP) therapy, and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated. We performed a randomized, double-blind, placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA. We found that 2 weeks of CPAP therapy resulted in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic, mean, and diastolic blood pressure (all Ps Ͻ0.05). Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation, it did not affect blood pressure. We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA, perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation. (Hypertension. 2006;47:840-845.)

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Obstructive sleep apnea and blood pressureInteraction between the blood pressure-lowering effects of positive airway pressure therapy and antihypertensive drugs

Abstract: This study confirms an independent relationship between the severity of OSA and BP/HR. Absence of BP-lowering medication and BP values before treatment are independent predictors for the reduction of BP with Bi-/CPAP therapy.

Cited by 54 publications

References 26 publications

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

A Case of Sleep Apnea Syndrome Manifesting Severe Hypertension with High Plasma Norepinephrine Levels

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

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