Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months

Middleton, Sally; Vermeulen, Walter J.V.; Sullivan, Colin E.; Middleton, Peter G.

doi:10.1111/j.1440-1843.2009.01510.x

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…That is, patients who used ASV for longer each night were not more likely to experience cardiovascular death than those with lower usage levels. This is in contrast to findings from trials of PAP in patients with obstructive sleep apnoea where a dose–response effect for PAP has been reported, both for cardiovascular responses [ 30 ] and symptoms [ 31 ]; this was not seen for the negative effects of ASV on mortality in this analysis. However, the lack of dose dependency may have been a result of the way usage times were measured.…”

Section: Discussioncontrasting

confidence: 99%

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis

et al. 2017

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This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies.

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Section: Discussioncontrasting

confidence: 99%

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis

et al. 2017

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“…The current study extends previous work 1, 35 by demonstrating that the sole predictor of a reduction in both SBP and DBP with PAP was the presence of uncontrolled hypertension at baseline. Although PAP level was also a significant independent predictor of the reduction in DBP, the magnitude of this trend was not strong (β values indicated that each 1 cm H 2 O increase in PAP was associated with a reduction in DBP of < 1 mm Hg).…”

Section: Discussionsupporting

confidence: 88%

Blood Pressure Improvement with Continuous Positive Airway Pressure is Independent of Obstructive Sleep Apnea Severity

Bakker

Edwards

Gautam

et al. 2014

Journal of Clinical Sleep Medicine

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“…65% of our baseline patients were available for follow-up. This rate is in the range to be expected for CPAP follow-up [39][40][41]. In the recent study by JAVAHERI et al [13], 50% of patients with In order to address this issue, interventional studies on the effect of artificially improved (e.g.…”

Section: Initial Compsamentioning

confidence: 99%

A prospective polysomnographic study on the evolution of complex sleep apnoea

Cassel¹,

Canisius²,

Becker³

et al. 2011

Eur Respir J

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Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment.In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP.12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up.CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.

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Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months

Abstract: Hypertensive OSA patients can exhibit large falls in BP with CPAP at 1 month, with further significant reductions at 3 and 6 months. Overall, the fall in BP was proportional to the initial elevation of the BP with many patients achieving normal BP at 6 months.

Cited by 13 publications

References 32 publications

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis

Blood Pressure Improvement with Continuous Positive Airway Pressure is Independent of Obstructive Sleep Apnea Severity

A prospective polysomnographic study on the evolution of complex sleep apnoea

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