Influence of sampling interval on the evaluation of nocturnal blood pressure in subjects with and without obstructive sleep apnoea

Marrone, Oreste; Romano, Salvatore; Insalaco, Giuseppe; Bonsignore, Maria R.; Salvaggio, Adriana; Bonsignore, G

doi:10.1034/j.1399-3003.2000.16d15.x

Cited by 17 publications

(10 citation statements)

References 24 publications

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“…To identify a white coat hypertension phenomenon as well as to investigate the day and night BP profile, ambulatory BP monitoring (ABPM), which improves prediction of cardiovascular risk in hypertensive patients, should be considered in every OSA patient, in particular when resistance to drug treatment is suspected. When using ABPM, the impact of sampling interval in reliably assessing night-time BP has been studied by MARRONE et al [105], with BP measurements set at intervals of 5, 10, 15, 20 and 30 min. A larger number of inaccurate nocturnal mean BP estimates were obtained in OSAS patients than in control subjects.…”

Section: Patient History and Questionnairesmentioning

confidence: 99%

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Parati

Lombardi²,

Hedner³

et al. 2013

Eur Respir J

207

132

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on behalf of the EU COST Action B26 members ABSTRACT: This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of cardiovascular diseases (in particular arterial hypertension) in OSA patients. The present document is the result of work performed by a panel of experts participating in the European Union COST (Cooperation in Scientific and Technological research) Action B26 on OSA, with the endorsement of the European Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

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Section: Patient History and Questionnairesmentioning

confidence: 99%

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Parati

Lombardi²,

Hedner³

et al. 2013

Eur Respir J

207

132

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“…Although such instruments are accurate for diurnal measurements of absolute BP values in isolated heart beats, they have limitations in that they cannot detect the very rapid BP changes occurring in apnoea-ventilation cycles in OSA. Furthermore, the high short-term variability of nocturnal BP in OSA lessens the accuracy of the assessment of mean nocturnal BP values at usual rates of BP sampling [19]. For the nocturnal measurements, a device (Finapres) that is able to monitor beat-by-beat BP noninvasively was used, which is invaluable for the detection of the fast BP changes occurring in apnoea-ventilation cycles.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…Importantly, this approach may affect nocturnal results: the extent of which a nocturnal decrease in BP is due to acute rather than chronic apnoea prevention is not clear, because CPAP, applied acutely, may decrease systolic nocturnal BP values in patients with sleep respiratory disorders [17,18]. Besides, intermittent BP sampling during the night in untreated subjects with severe OSA may lead to an important over-or underestimation of average BP [19].In this study, nocturnal BP swings, recorded beat-by-beat in patients with OSA, in nonrapid eye movement (NREM) apnoeas and hypopnoeas before and after chronic CPAP treatment at CPAP withdrawal were compared to verify whether chronic prevention of respiratory disturbances may be followed by a variation in the responsiveness of BP to the respiratory events. In addition, this study could help clarify whether the previously reported nocturnal BP decrease during chronic CPAP treatment may be attributed just to apnoea prevention or also to the effects of prolonged regularisation of nocturnal breathing.…”

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Blood pressure responsiveness to obstructive events during sleep after chronic CPAP

et al. 2003

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The aim of this study was to investigate whether chronic continuous positive airway pressure (CPAP) affects blood pressure (BP) responsiveness to obstructive events occurring on the first night of CPAP withdrawal in obstructive sleep apnoea (OSA) after chronic treatment.Thirteen male subjects with severe OSA underwent nocturnal polysomnography with beat-by-beat BP monitoring before treatment and after 4.9¡3.4 months of home CPAP (mean daily use 5.1¡1.7 h). Variations in oxyhaemoglobin saturation (DSa,O 2 ), systolic (DPs), and diastolic (DPd) BP within nonrapid eye movement apnoeas and hypopnoeas were measured on a sample of pre-and post-treatment events. In addition, a pretreatment sample was selected for DSa,O 2 to match post-treatment events.The higher the mean DSa,O 2 was in the full pretreatment sample, the more DSa,O 2 , DPs and DPd were attenuated after treatment. Mean DPs decreased from 47.3¡8.5 in the full pretreatment sample to 42.2¡6.9 in the selected pretreatment sample, to 31.5¡5.9 mmHg in the post-treatment sample. The post-treatment value differed significantly from both the pretreatment values. The corresponding values for mean DPd were 27.0¡3.5, 24.0¡3.1 and 19.6¡3.7 mmHg, with all values differing significantly from each other.Chronic continuous positive airway pressure is followed by a decrease in apnoea/ hypopnoea-related blood pressure swings, possibly secondary to both reduced severity of event-related hypoxaemia and decreased responsiveness to obstructive events secondary to chronic prevention of nocturnal intermittent hypoxaemia. Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnoea (OSA). It abolishes upper airway obstruction during sleep for as long as it is applied, but its withdrawal is promptly followed by a reappearance of obstructive sleep-disordered breathing events, although with a lesser severity than before CPAP initiation [1][2][3][4][5]. Recent trials have demonstrated the efficacy of CPAP in improving daytime somnolence [6,7]. However, other studies have shown that even a one-night withdrawal is followed by a sudden increase in sleepiness, as demonstrated by the multiple sleep latency test [3,4].The effects of CPAP on systemic blood pressure (BP) are less well understood. Despite contrasting results, most investigations demonstrate some decrease in BP after prolonged treatment [8][9][10][11][12][13]. In most studies, the effect of prolonged OSA treatment on BP was explored by comparing BP values recorded in the 24 h before CPAP initiation with those after treatment, by means of ambulatory intermittent BP monitoring [9][10][11][12][13][14][15][16]. CPAP was withdrawn in only one study [14] during BP monitoring performed after home treatment, while in most other studies CPAP was applied during the night [8,9,11,12]. Importantly, this approach may affect nocturnal results: the extent of which a nocturnal decrease in BP is due to acute rather than chronic apnoea prevention is not clear, because CPAP, applied acutely, ma...

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“…23 Although controversial, there are studies suggesting that the time between ambulatory blood pressure monitoring measurements should be less in patients with OSA. 58 On the other hand, age-related differences have been described, suggesting that severe apnea may cause nondipping blood pressure only in young OSA patients, whereas, in the elderly, impaired sleep quality was more prevalent. 59 In general, the nondipping blood pressure pattern during sleep results from increased sympathetic activity during this period, due to four main stimuli, ie, intermittent hypoxemia, hypercapnia, lack of proper inflation of the lungs, and awakenings at the end of episodes of apnea.…”

Section: 45mentioning

confidence: 99%

Cardiac function and hypertension in patients with obstructive sleep apnea

Bertolami¹,

Gonzaga²,

Amodeo³

2014

RRCC

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Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA) is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed.

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Influence of sampling interval on the evaluation of nocturnal blood pressure in subjects with and without obstructive sleep apnoea

Cited by 17 publications

References 24 publications

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Blood pressure responsiveness to obstructive events during sleep after chronic CPAP

Cardiac function and hypertension in patients with obstructive sleep apnea

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