Circulation. 2003;107:68-73
Published online before print December 9, 2002, doi: 10.1161/01.CIR.0000042706.47107.7A
Published online before print December 9, 2002, doi: 10.1161/01.CIR.0000042706.47107.7A
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(Circulation. 2003;107:68.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea
From the Department of Respiratory Medicine, Philipps-University Marburg, Marburg, Germany, and the Department of Medicine, David Read Laboratory, University of Sydney, Australia (C.E.S.).
Correspondence to Heinrich F. Becker, Innere Med, Pneumologie, Baldingerstr D-35033 Marburg, Germany. E-mail HF.Becker{at}mailer.uni-marburg.de
Background— There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA.
Methods and Results— Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by 
95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9±11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by 10 mm Hg, both at night and during the day.
Conclusions— Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.
Key Words: hypertension • cardiovascular diseases • sleep • blood pressure
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P. Lavie Pro: Sleep Apnea Causes Cardiovascular Disease Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 147 - 148. [Full Text] [PDF]
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J. Stradling Con: Sleep Apnea Does Not Cause Cardiovascular Disease Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 148 - 149. [Full Text] [PDF]
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N. J. Douglas and J. Black Modafinil and Sleepiness Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1538 - 1539. [Full Text] [PDF]
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R. Wolk, A. S.M. Shamsuzzaman, and V. K. Somers Obesity, Sleep Apnea, and Hypertension Hypertension, December 1, 2003; 42(6): 1067 - 1074. [Abstract] [Full Text] [PDF]
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
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 A. S. M. Shamsuzzaman, B. J. Gersh, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease JAMA, October 8, 2003; 290(14): 1906 - 1914. [Abstract] [Full Text] [PDF]
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R. Wolk, T. Kara, and V. K. Somers Sleep-Disordered Breathing and Cardiovascular Disease Circulation, July 8, 2003; 108(1): 9 - 12. [Full Text] [PDF]
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