Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension

Muxfeldt, Elizabeth Silaid; Margallo, Victor; Costa, Leonardo; Guimarães, Gleison M.; Cavalcante, Aline H.; Azevedo, João Carlos Moreno de; Souza, Fábio de; Cardoso, Claudia R.L.; Salles, Gil F.

doi:10.1161/hypertensionaha.114.04852

Cited by 127 publications

(88 citation statements)

References 32 publications

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“…However, the beneficial effect of CPAP on BP in patients with OSA and resistant hypertension is inconsistent. [16][17][18][19][20] Therefore, we conducted a metaanalysis to evaluate the efficacy of CPAP in patients with OSA and resistant hypertension.…”

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confidence: 99%

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

Liu

Cao

Guo

et al. 2015

J of Clinical Hypertension

132

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2This study aimed to analyze the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. Randomized controlled trials (RCTs) that evaluated the effect of CPAP on BP in patients with OSA and resistant hypertension, indexed in MEDLINE, Embase, and the Cochrane Library from inception until March 20, 2015, were included in the meta-analysis. A total of five RCTs were identified to meet the inclusion criteria. The pooled changes after CPAP treatment for 24-hour ambulatory systolic BP and diastolic BP (DBP) were À4.78 mm Hg (95% confidence interval [CI], À7.95 to À1.61) and À2.95 mm Hg (95% CI, À5.37 to À0.53) in favor of the CPAP group. CPAP was also associated with reduction in nocturnal DBP (mean difference, À1.53 mm Hg, 95% CI, À3.07 to 0). The results indicated a favorable reduction in BP with CPAP treatment in patients with OSA and resistant hypertension. J Clin Hypertens (Greenwich). 2016;18:153-158. ª

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confidence: 99%

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

Liu

Cao

Guo

et al. 2015

J of Clinical Hypertension

132

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“…[16][17][18][19] Randomized clinical trials have demonstrated modest antihypertensive benefits of treatment of SDB with CPAP, with mild reductions in BP of 3 to 5 mm Hg 20,21 compared with more substantive reductions in RHTN, namely 7 to 10 mm Hg. 22 Notwithstanding the vast interventional trial data published on SDB and HTN, relatively fewer randomized studies [23][24][25] have investigated the effect of CPAP on control of BP in patients with OSA and RHTN, and none have examined the effect of CPAP in real-world clinical practice settings. 22,26,27 The limited data available in the "real-world" clinical practice setting suggests a reduction in mean arterial pressure (MAP) in a small sample of patients with resistant hypertension, and a negligible effect on hypertensive patients with controlled BP.…”

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confidence: 99%

Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort

Walia

Griffith

Foldvary‐Schaefer

et al. 2016

Chest

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“…18 However, not all studies showed similar results; in recent RCTs 3-6 months of CPAP had no impact on BP in patients with moderate to severe OSA and resistant hypertension. 19,20 Furthermore, in an 8-week RCT with a crossover design, both CPAP and valsartan resulted in a significant reduction in mean 24-hour BP but valsartan was superior to CPAP (−7.0 mm Hg, 95 % CI −10.9 to −3.1 mm Hg; p<0.001). 21 The impact of CPAP on incident hypertension was assessed in one RCT, in which 723 patients with AHI ≥20 and ESS ≤10 were randomised to CPAP versus no CPAP.…”

Section: Impact Of Obstructive Sleep Apnoea Treatmentmentioning

confidence: 98%

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

Tahrani¹

2015

US Endocrinology

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Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D. KeywordsType 2 diabetes, obstructive sleep apnoea, vascular disease, vascular risk Diabetes-related macro-and microvascular complications contribute significantly to the increased morbidity, mortality, worsened quality of life and social and financial burden observed in patients with diabetes. [1][2][3][4][5] Hence, reducing the development and/or the progression of these complications is one of the main aims of treatment in patients with diabetes.Over the last 2 decades, strategies resulting in the improvements of glycaemic control, blood pressure (BP) and lipids and the use of renin angiotensin aldosterone inhibitors, resulted in reductions in cardiovascular disease (CVD) in patients with diabetes, but there was little impact on diabetic microvascular complications. 6 Nonetheless, both CVD and microvascular complications remain common and a better understanding of the pathogenesis of these complications is needed in order to identify new treatment strategies.Obstructive sleep apnoea (OSA) is common in patients with type 2 diabetes (T2D) (up to 86 % prevalence), which is not surprising considering that increasing age and obesity are common risk factors to both conditions. 7,8 OSA is characterised by upper airway instability during sleep that results in recurrent upper airway obstruction resulting in either complete or partial cessation of airflow (i.e. apnoea and hypopnoea, respectively). 9The recurrent obstructions of the upper airway usually result in recurrent oxygen desaturations/re-saturations, cyclical changes in intrathoracic pressure (as the patient attempts to breath against a blocked airway) and recurrent micro arousals that cause sleep fragmentation and reduction in slow wave and rapid eye movement (REM) sleep and result in termination of the apnoea/hypopnoea episodes. 9Several large epidemiological studies and randomised controlled trials (RCTs) have shown that OSA was ...

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Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension

Cited by 127 publications

References 32 publications

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

Longitudinal Effect of CPAP on BP in Resistant and Nonresistant Hypertension in a Large Clinic-Based Cohort

Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

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