The role of compliance with PAP use on blood pressure in patients with obstructive sleep apnea: is longer use a key-factor?

Abstract

Scientific data about the effects of positive airway pressure (PAP) treatment on blood pressure (BP) control are continuously increasing; however, they are controversial. We aimed to determine the long-term effects of compliance with PAP therapy on BP in both hypertensive and normotensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). One thousand one hundred sixty eight consecutive patients with newly diagnosed OSAHS, who had been recommended PAP therapy, were followed up for a minimum of 2 years. Patients with previous cardiovascular disease were excluded. BP was measured at baseline and after 2 years of PAP treatment. In addition, the correlation between the changes in BP with different levels of PAP compliance was assessed. At the end of the follow-up period, in the hypertensive group of patients (n=586), a significant decrease was shown in systolic (-11.2 mm Hg, P<0.001) and diastolic BP (-4.2 mm Hg, P<0.001). Furthermore, in the patients without hypertension (n=528), a significant decrease was noted both in systolic and diastolic BP (-3.6, P<0.001 and -2.4, P<0.001, respectively). A correlation between the magnitude of change in systolic and diastolic BP and hours of use of PAP (r=0.14, P=0.002 and r=0.1, P=0.025, respectively) was observed in all patients. Long-term use of PAP treatment, as well as increased hours of PAP in patients with OSAHS use showed significant reductions in BP not only in patients with hypertension, but also in normotensive patients. Therefore a significant potential reduction in cardiovascular mortality and morbidity should be expected in these patients.

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

“…In previous study, the data was shown of the 2-year effects of CPAP treatment on blood pressure with OSA patients. The mean BMI of previous studies were over 30 kg/m 2 , the study population was different from our study 19 .…”

“…The follow up period was 59 months and comprised of 161 patients. In a previous study the 2-year effects of CPAP treatment on blood pressure with OSA patients was shown 19 . The mean BMI of this previous study were over 30 kg/m 2 .…”

Blood pressure control in hypertensive sleep apnoea patients of the European Sleep Apnea Database cohort - effects of positive airway pressure and antihypertensive medication

“…Indeed treatment duration was an independent predictor for favourable BP response to PAP treatment, confirming previous results by Bouloukaki et al . 44 Our data suggest that long-lasting, rather than instant adaptive, processes are operative in OSA-associated hypertension.…”