Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea

Shirahama, Ryutaro; Tanigawa, Takeshi; Ida, Yoshifumi; Fukuhisa, Kento; Tanaka, Rika; Tomooka, Kiyohide; Lan, Fan-Yun; Ikeda, Ai; Wada, Hiroo; Kales, Stefanos N.

doi:10.1038/s41598-021-98553-0

Cited by 10 publications

(16 citation statements)

References 39 publications

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“…PAP regulation of the neurovegetative and hormonal determinants of HTN explains its beneficial effect on BP levels and the circadian pattern, especially in patients with resistant hypertension [ 59 , 60 ]. However, a recent report also noted improvement in BP values in normotensive patients, suggesting that PAP adherence could modulate the baroreflex threshold [ 61 ]. Furthermore, PAP therapy seems to have a more robust effect on the diastolic BP value [ 61 ], which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…However, a recent report also noted improvement in BP values in normotensive patients, suggesting that PAP adherence could modulate the baroreflex threshold [ 61 ]. Furthermore, PAP therapy seems to have a more robust effect on the diastolic BP value [ 61 ], which is consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…A 1-year retrospective follow-up of 121 patients showed that improvement in sleep quality, ESS and BP occurs only in PAP-adherent patients [ 7 ]. After 2 years, PAP use is associated with a significant decrease in DBP but not in weight [ 61 ], and a recent 5-year follow-up study found that PAP significantly reduces cerebrovascular and hypertensive event incidence but not coronary event risk [ 8 ]. Although medium-term (6 months) PAP use can prevent further arterial stiffening in patients with OSA and resistant hypertension [ 63 ], a 7.5-year follow-up observational study showed that PAP compliance does not prevent arterial stiffness progression in obese OSA patients [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

et al. 2023

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Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate–severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate–severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate–severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

et al. 2023

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“…Weight loss and CPAP use were not significantly associated (= 0.02, p = 0.59). Lowered DBP without appreciable weight reduction was linked to long-term, good CPAP therapy adherence [ 21 ]. The most extraordinary sample size was used in a multicenter, RCT by Barbé et al which demonstrated a modest drop in blood pressure.…”

Section: Reviewmentioning

confidence: 99%

From Snoring to Soaring: Unveiling the Positive Effects of Continuous Positive Airway Pressure Ventilation on Cardiovascular Health in Patients With Obstructive Sleep Apnoea Through a Systematic Review

Swami,

Aye,

Trivedi

et al. 2023

Cureus

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Increased cardiovascular (CV) morbidity and death are linked to obstructive sleep apnoea (OSA). The primary method of treating OSA is continuous positive airway pressure (CPAP). CPAP has some debatable outcomes on CV events in people suffering from OSA. The current study investigates how CPAP affects CV outcomes. The goal is to evaluate CPAP's effectiveness in lowering CV outcomes in OSA patients. We used a computer to search the PubMed, PubMed Central Library, Science Direct, and Google Scholar databases for studies comparing the effects of CPAP and a control group on CV outcomes in OSA patients. These included randomised control trials (RCT), narrative reviews, systematic reviews, case-control studies, observational studies and meta-analyses. A total of 52,937 patients were included in the final analysis of six RCTs, four observational studies, 10 meta-analyses, one case-control study, two systematic reviews and one narrative review. The weighted mean follow-up lasted for a period of between three months and nine years. The risk of major cardiovascular adverse events (MACE) was the same for both the CPAP and control groups. According to subgroup analysis, patients with lower MACE adherence rates (four hours per night) were more likely to use CPAP. The risk of all-cause mortality, CV-related complications causing mortality, acute myocardial infarction acute stroke, or hospitalisations for angina was the same in the CPAP and control groups. The primary outcome was that in patients with therapy with CPAP in addition to usual care and usual care alone did not prevent CV events in patients with moderate-to-severe OSA and existing CV illness. Patients with OSA who utilise CPAP may not experience fewer CV events. Patients who use CPAP consistently (four hours per night) could benefit from improved CV results. Future research must assess how well-adherent patients with severe OSA and low CV event rates respond to CPAP therapy. In patients who use CPAP for more than four hours each night, CPAP therapy may minimise the risk of MACE and stroke. Additional randomised trials requiring adequate CPAP time adherence are needed to support this perception. Despite the fact that there is no evidence to support the claim that CPAP therapy improves CV outcomes, bias difficulties, CPAP adherence problems, and the patient groups included in each RCT may have made it more difficult to generalise the findings to all patients. Future research is therefore needed to look at these relevant results.

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“…The gold standard therapy for moderate to severe OSA is overnight continuous positive airway pressure (CPAP) delivered via a nasal or facial mask (8), which prevents pharyngeal collapse. In addition to markedly reducing the number of apnea and hypopnea events during sleep, treatment of OSA with CPAP has been shown to have several beneficial effects, including improvements in sleepiness, cognition and mood, and reductions in blood pressure (9)(10)(11)(12). Treatment with CPAP has also been shown to reduce hospitalization rates and healthcare costs (13), and may also reduce mortality (14).…”

Section: Introductionmentioning

confidence: 99%

Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study

Palot¹,

Nguyên²,

Launois³

et al. 2023

J Thorac Dis

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Background: Issues with tolerability and side effects can decrease continuous positive airway pressure (CPAP) device usage and the benefits of therapy. Different positive airway pressure (PAP) therapy modes providing expiratory pressure relief or using a different pressure during inspiration vs. expiration (bilevel PAP) may alleviate some of these issues. This multicenter, prospective study evaluated the effects of switching from CPAP to bilevel PAP (VAuto mode) on respiratory parameters, device usage, side effects and patientreported outcomes in patients with obstructive sleep apnea (OSA).Methods: Eligible OSA patients had started CPAP ≥3 months previously, had good compliance (mean 6.1±2.0 h/night) and well-controlled OSA [residual apnea-hypopnea index (AHI) 4.9±3.1/h] but had pressure tolerance issues or persistent side effects/discomfort. All were switched from CPAP to bilevel PAP (AirCurve 10 VAuto; ResMed). Effectiveness (residual AHI), sleep quality, daytime sleepiness, fatigue, therapy-related side effects, and patient satisfaction/preference were assessed after 3 months and 1 year.Results: Forty patients were analyzed (68% male, age 64±11 years, body mass index 30.7±5.8 kg/m 2 ). At 3 months and 1 year after switching to bilevel PAP, median [interquartile range] residual AHI was 4/h [2-5.3] and 3.7/h [1.8-5], respectively, and device usage was 7.0 [4.9-7.5] and 6.4 [4.4-7.3] h/night, respectively.Device switch was associated with significant reductions from baseline in expiratory to 8 [7-9] cmH 2 O at 3 months (P<0.001) and 9 [8-12] cmH 2 O at 1 year (P=0.005)}, 95 th percentile pressure {from 14 [12][13][14] to 10 [9-11] and 10 [8-11] cmH2O; P<0.001 and P=0.001, respectively} and leak {from 1 [0][1][2][3][4][5][6] to 0 [0-1] and 0 [0-2] L/min; P=0.049 and P=0.033, respectively}. The Pittsburgh Sleep Quality Index score decreased significantly from baseline to 3 and 6 months [7.2±4.0 to 5.0±3.2 (P=0.005) and 4.5±2.7 (P<0.001), respectively]. CPAP-related mouth dryness, choking sensation and aerophagia were significantly improved one year after switching to bilevel PAP. Bilevel PAP was preferred over CPAP by 90% of patients.Conclusions: Switching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.

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Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea

Cited by 10 publications

References 39 publications

Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

From Snoring to Soaring: Unveiling the Positive Effects of Continuous Positive Airway Pressure Ventilation on Cardiovascular Health in Patients With Obstructive Sleep Apnoea Through a Systematic Review

Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study

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