Association of Night‐to‐Night Adherence of Continuous Positive Airway Pressure With Day‐to‐Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea

Hoshide, Satoshi; Yoshida, Tetsuro; Mizuno, Hiroyuki; Aoki, Hiroyoshi; Tomitani, Naoko

doi:10.1161/jaha.121.024865

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…Results of an experimental study using Canine model clearly revealed that obstructive sleep apnea increased daytime but not nighttime BP [24] probably because of increased central nervous system activity. Furthermore, findings from previous studies, namely sleep apnea was independent factor for relatively higher morning BP compared with evening BP [25] and continuous positive airway pressure therapy for patients with sleep apnea reduced morning BP [26], supporting our results. Nocturnal urination frequency strongly and positively associated with sleep BP independent of sleep efficiency [21,22].…”

Section: Discussionsupporting

confidence: 91%

Sleep-related factors associated with masked hypertension: the Nagahama study

Tabara

Matsumoto²,

Murase

et al. 2023

Journal of Hypertension

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Objectives: Masked hypertension, which is characterized by out-of-office hypertension but normal office blood pressure, is a risk factor for cardiovascular disease. However, the factors that contribute to masked hypertension are unclear. We aimed to determine the involvement of sleep-related characteristics in masked hypertension. Methods: The study included 3844 normotensive (systolic/diastolic blood pressure < 140/90 mmHg) community residents with no antihypertensive drug use at baseline (mean age 54.3 years). Home morning and evening blood pressure, oxygen desaturation during sleep (pulse oximetry), and sleep efficiency (actigraphy) were measured for 1 week. The number of nocturnal urinations during this period was obtained using a sleep diary. Results: Masked hypertension (mean morning and evening blood pressure ≥135/85 mmHg) was detected in 11.7% of study participants, and 79.0% of the participants with masked hypertension had sleep hypertension (≥120/70 mmHg). Multinominal logistic regression analysis identified different factors involved in masked hypertension with and without sleep hypertension; factors for masked hypertension with sleep hypertension included the frequency of at least 3% oxygen desaturation (coefficient = 0.038, P = 0.001), nocturia (coefficient = 0.607, P < 0.001), and carotid intima-media thickness (coefficient = 3.592, P < 0.001). Only carotid intima-media thickness and measurement season were associated with masked hypertension without sleep hypertension. Low sleep efficiency was associated with isolated sleep hypertension but not masked hypertension. Conclusion: Sleep-related factors associated with masked hypertension differed depending on the presence of sleep hypertension. Sleep-disordered breathing and nocturnal urination frequency may help identify individuals who need home blood pressure monitoring.

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Section: Discussionsupporting

confidence: 91%

Sleep-related factors associated with masked hypertension: the Nagahama study

Tabara

Matsumoto²,

Murase

et al. 2023

Journal of Hypertension

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“…In the present study, only 55.5% of the patients developed a systolic decrease of at least 5 mmHg Finally, it may be scrutinized whether the quality of treatment or the patients’ adherence was too low to produce are more robust association. Indeed, adherence to CPAP therapy is negatively associated with morning BP [ 13 ]. The decrease of daytime sleepiness from baseline to follow-up and the mean CPAP use of 4.8 h per night; however, contradict these assumptions in the present population.…”

Section: Discussionmentioning

confidence: 99%

Predictors of blood pressure response to continuous positive airway pressure treatment in patients with sleep apnea

Seidel,

Kiziler,

Matiakis

et al. 2024

Journal of Hypertension

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Background: Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea–hypopnea index (AHI) and the extent of daytime sleepiness Methods: We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP. Results: Five hundred and fifty-five patients fulfilled all inclusion and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7 h (85.4–204.1 h). BP was significantly higher at baseline than at follow-up (129.9 ± 15.5 vs. 128.3 ± 15.2, P = 0.021) resulting in mean reduction of BP of −1.5 ± 19.2 mmHg. patients with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI ≥21: 130.5 ± 15.3 vs. 128.6 ± 14.6, P = 0.06; AHI <21: 129.5 ± 15.8 vs. 127.9 ± 15.8, P = 0.18). CPAP therapy led to a significant reduction in sleepiness (8.3 ± 4.8 vs. 6.6 ± 4.5, P < 0.0001). Those subjects with higher than median sleepiness score (ESS ≥8), however, did not show a significant difference in BP response compared with those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction at least 5 mmHg revealed an AUC of 0.51 and 0.52, respectively. Conclusion: The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease at least 5 mmHg.

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“…Thus, telemedicine support could help improve the adherence to CPAP use in patients with sleep apnea. Good CPAP adherence has been negatively associated with morning home BP on the following day [44], which would result in the reduction in CVD events related to day-by-day home BP variability [45][46][47].…”

Section: Telemedicine In Other Cardiovascular Risk Factorsmentioning

confidence: 99%

Current situation of telemedicine research for cardiovascular risk in Japan

Shibata

Hoshide

2023

Hypertens Res

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Hypertension continues to be a principal risk factor for the occurrence of cardiovascular disorders, stroke, and kidney diseases. Although more than 40 million subjects suffer from hypertension in Japan, its optimal control is achieved only a subpopulation of patients, highlighting the need for novel approaches to manage this disorder. Toward the better control of blood pressure, the Japanese Society of Hypertension has developed the Future Plan, in which the application of the state-of-art information and communication technology, including web-based resources, artificial intelligence, and big data analysis, is considered as one of the promising solutions. In fact, the rapid advance of digital health technologies, as well as ongoing coronavirus disease 2019 pandemic, has triggered the structural changes in the healthcare system globally, increasing demand for the remote delivery of the medical services. Nonetheless, it is not entirely clear what evidence exists that support the widespread use of telemedicine in Japan. Here, we summarize the current status of telemedicine research, particularly in the field of hypertension and other cardiovascular risk factors. We note that there have been very few interventional studies in Japan that clearly showed the superiority or noninferiority of telemedicine over standard care, and that the methods of online consultation considerably varied among studies. Clearly, more evidence is necessary for wide implementation of telemedicine in hypertensive patients in Japan, and also those with other cardiovascular risk factors.

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Association of Night‐to‐Night Adherence of Continuous Positive Airway Pressure With Day‐to‐Day Morning Home Blood Pressure and Its Seasonal Variation in Obstructive Sleep Apnea

Cited by 7 publications

References 40 publications

Sleep-related factors associated with masked hypertension: the Nagahama study

Sleep-related factors associated with masked hypertension: the Nagahama study

Predictors of blood pressure response to continuous positive airway pressure treatment in patients with sleep apnea

Current situation of telemedicine research for cardiovascular risk in Japan

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