Acute Effects of Nasal Continuous Positive Airway Pressure on 24-Hour Blood Pressure and Catecholamines in Patients with Obstructive Sleep Apnea.

Minemura, Hiroshi; Akashiba, Tsuneto; Yamamoto, Hitoshi; Akahoshi, Toshiki; Kosaka, Noboru; Horie, Takashi

doi:10.2169/internalmedicine.37.1009

Cited by 73 publications

(58 citation statements)

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“…These findings mirror those of Minemura et al, 31 whose uncontrolled study demonstrated nighttime and daytime reductions in diastolic BP but only nighttime reduction in systolic BP with CPAP therapy. Some have suggested that OSA may predispose to both systolic and diastolic hypertension at night, but initially, 73 or primarily, 74 diastolic hypertension during the day.…”

Section: Discussionsupporting

confidence: 88%

“…10,39 -49 Some studies found a reduction only in nocturnal 41,50 or in daytime BP 44 with continuous positive airway pressure (CPAP) therapy. Several showed a decrease in both nocturnal and daytime BP with CPAP therapy, 10,31,[43][44][45][46]49,51,52 whereas other studies demonstrated no BP change. 40,48,53,54 Several limitations exist in many of the prior studies that examined the effects of OSA treatment on BP.…”

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confidence: 99%

“…[55][56][57] Other studies have lacked adequate CPAP placebo controls. 10,31,[43][44][45][46]48,49,[51][52][53][54] Although some investigators have used an oral tablet as placebo, 40,41 the substantial effort that patients make in using CPAP equipment may be more likely to elicit a placebo response or a nonspecific effect of therapy. Sham-CPAP, which is worn nightly like CPAP but delivers subtherapeutic pressure, is a preferable manner of performing placebocontrolled studies in OSA.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 88%

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confidence: 99%

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

et al. 2006

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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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“…7,10,11 Moreover, this altered sympathetic activity has been demonstrated to be corrected by continuous positive airway pressure treatment. 12,13 The aim of the present study is to estimate the prevalence of hypertension in patients with sleep-disordered breathing (SDB) in an Indian population, estimate the sympathetic activity in these patients as assessed by blood catecholamine levels, and assess the correlation between the catecholamine levels and BP in these patients.…”

Section: Introductionmentioning

confidence: 99%

Hypertension and catecholamine levels in sleep apnoea

Vardhan

Shanmuganandan

2012

Medical Journal Armed Forces India

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BACKGROUNDSleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association. METHODIn this sleep clinic-based study, 82 newly diagnosed patients of sleepdisordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP). RESULTSThe prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoeahypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catecholamines in both the cases. CONCLUSIONHypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.

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Acute Effects of Nasal Continuous Positive Airway Pressure on 24-Hour Blood Pressure and Catecholamines in Patients with Obstructive Sleep Apnea.

Cited by 73 publications

References 24 publications

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

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

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

Hypertension and catecholamine levels in sleep apnoea

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