The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

Abstract

Abstract-Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43Ϯ7 years; body mass index, 28.8Ϯ3.0 kg/m 2 ) with untreated severe obstructive sleep apnea (apnea-hypopnea index, 56Ϯ22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; nϭ18) or CPAP (nϭ18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126Ϯ5 to 121Ϯ7 mm Hg; Pϭ0.001) and a trend for diastolic blood pressure (from 75Ϯ7 to 73Ϯ8 mm Hg; Pϭ0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (PϽ0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; Pϭ0.02) and masked hypertension (from 39% to 5%; Pϭ0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

“…Some previous studies have shown that PAP therapy was associated with lower BPs in individuals with prehypertension9 or clinical hypertension,43, 44 although results were inconsistent,45, 46 likely attributable to the effects of confounding variables, such as age, severity and duration of OSA, severity of hypertension, and other factors that affect OSA severity and arterial injury as discussed in the Introduction.…”

“…Because obesity and insulin resistance tend to accompany OSA as comorbidities, it has been difficult to isolate the independent effect of OSA and its treatments on the development and consequences of hypertension. Several studies have postulated that increased sympathetic tone and endothelial dysfunction cause hypertension in OSA 8, 9, 10…”

The effect of continuous positive airway pressure therapy on the prevalence of masked hypertension in obstructive sleep apnea patients

“…To date few studies have evaluated the prevalence of MH in patients with OSA (ref. [15][16] ). Common finding of these studies was that the prevalence of MH is higher in OSA patients than the general population [15][16] .…”

“…[15][16] ). Common finding of these studies was that the prevalence of MH is higher in OSA patients than the general population [15][16] . Continuous positive airway pressure (CPAP) ventilator is considered to be the most effective treatment modality for obstructive sleep apnea.…”

Screening for Severe Obstructive Sleep Apnea Syndrome in Hypertensive Outpatients

“…2 Several trials have indicated that treatment of OSAS can lead to reductions in hypertension and prehypertension. [3][4][5] The question then arises of how this is best accomplished. Diagnosis of obstructive sleep apnea (OSA) can be limited by availability, accessibility, and the cost of in-laboratory polysomnography: the gold standard for diagnosis.…”