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Sun L, Chang YF, Wang YF, Xie QX, Ran XZ, Hu CY, Luo B, Ning B. Effect of Continuous Positive Airway Pressure on Blood Pressure in Patients with Resistant Hypertension and Obstructive Sleep Apnea: An Updated Meta-analysis. Curr Hypertens Rep 2024; 26:201-211. [PMID: 38460066 DOI: 10.1007/s11906-024-01294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 03/11/2024]
Abstract
PURPOSE OF REVIEW The effect of continuous positive airway pressure (CPAP) on resistant hypertension in patients at high risk with obstructive sleep apnea (OSA) needs further investigation. We aimed to determine the effect of CPAP on blood pressure in patients with resistant hypertension and OSA. Databases including PubMed, EMBASE, MEDLINE, the Cochrane Library, and CMB were searched. Data were pooled using a random-effects or fixed-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs). RECENT FINDINGS A total of 12 trials and 718 participants were included. Compared with control, CPAP significantly reduced 24-h systolic blood pressure (SBP) (WMD: - 5.92 mmHg [ - 8.72, - 3.11]; P<0.001), 24-h diastolic blood pressure (DBP) (WMD: - 4.44 mmHg [- 6.26 , - 2.62]; P <0.001), daytime SBP (WMD: - 5.76 mmHg [ - 9.16, - 2.36]; P <0.001), daytime DBP (WMD: - 3.92 mmHg [- 5.55, - 2.30]; nighttime SBP (WMD: - 4.87 mmHg [ - 7.96 , - 1.78]; P = 0.002), and nighttime DBP (WMD: - 2.05 mmHg [- 2.99, - 1.11]; P<0.001) in patients with resistant hypertension and OSA. CPAP improved the blood pressure both in the short (<3 months) and long term (≥ 3 months). No significant impact on mean heart rate was noted (WMD: -2.76 beats per min [- 7.50, 1.97]; P = 0.25). CPAP treatment was associated with BP reduction in patients with resistant hypertension and OSA.
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Affiliation(s)
- Ling Sun
- Fuyang Tumor Hospital, Fuyang, China
| | - Ya-Fei Chang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yun-Fei Wang
- The 90th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, Chine
| | | | | | - Chun-Yang Hu
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Bin Luo
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
| | - Bin Ning
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China.
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2
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Shirahama R, Tanigawa T, Ida Y, Fukuhisa K, Tanaka R, Tomooka K, Lan FY, Ikeda A, Wada H, Kales SN. Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea. Sci Rep 2021; 11:19101. [PMID: 34580352 PMCID: PMC8476592 DOI: 10.1038/s41598-021-98553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common cause of hypertension. Previous studies have demonstrated beneficial short-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure. However, long-term antihypertensive effects of CPAP have not been properly verified. This study examined the longitudinal effect of CPAP therapy adherence on blood pressure among OSA patients. All patients diagnosed with OSA and undergoing subsequent CPAP therapy at a Kanagawa-area sleep clinic were clinically followed for 24 months to examine CPAP adherence, as well as longitudinal changes in blood pressure and body weight because it may become a confound factor for changes in blood pressure. The hours of CPAP usage were collected over the course of 30 nights prior to each follow-up visit (1st, 3rd, 6th, 12th, and 24th month). The relationship between CPAP adherence and blood pressure was analyzed using mixed-effect logistic regression models. A total of 918 OSA patients were enrolled in the study. We found a significant reduction in diastolic blood pressure among patients with good CPAP adherence during the 24-month follow-up period (β = − 0.13, p = 0.03), when compared to the group with poor CPAP adherence. No significant association was found between CPAP adherence and weight loss (β = − 0.02, p = 0.59). Long-term, good CPAP therapy adherence was associated with lower diastolic blood pressure without significant weight loss.
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Affiliation(s)
- Ryutaro Shirahama
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yoshifumi Ida
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kento Fukuhisa
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Rika Tanaka
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Fan-Yun Lan
- Environmental and Occupational Medicine and Epidemiology, Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ai Ikeda
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroo Wada
- Department of Public Health, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Stefanos N Kales
- Environmental and Occupational Medicine and Epidemiology, Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.,Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
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Kario K, Hettrick DA, Prejbisz A, Januszewicz A. Obstructive Sleep Apnea-Induced Neurogenic Nocturnal Hypertension: A Potential Role of Renal Denervation? Hypertension 2021; 77:1047-1060. [PMID: 33641363 DOI: 10.1161/hypertensionaha.120.16378] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a bidirectional, causal relationship between obstructive sleep apnea (OSA) and hypertension. OSA-related hypertension is characterized by high rates of masked hypertension, elevated nighttime blood pressure, a nondipper pattern of nocturnal hypertension, and abnormal blood pressure variability. Hypoxia/hypercapnia-related sympathetic activation is a key pathophysiological mechanism linking the 2 conditions. Intermittent hypoxia also stimulates the renin-angiotensin-aldosterone system to promote hypertension development. The negative and additive cardiovascular effects of OSA and hypertension highlight the importance of effectively managing these conditions, especially when they coexist in the same patient. Continuous positive airway pressure is the gold standard therapy for OSA but its effects on blood pressure are relatively modest. Furthermore, this treatment did not reduce the cardiovascular event rate in nonsleepy patients with OSA in randomized controlled trials. Antihypertensive agents targeting sympathetic pathways or the renin-angiotensin-aldosterone system have theoretical potential in comorbid hypertension and OSA, but current evidence is limited and combination strategies are often required in drug resistant or refractory patients. The key role of sympathetic nervous system activation in the development of hypertension in OSA suggests potential for catheter-based renal sympathetic denervation. Although long-term, randomized controlled trials are needed, available data indicate sustained and relevant reductions in blood pressure in patients with hypertension and OSA after renal denervation, with the potential to also improve respiratory parameters. The combination of lifestyle interventions, optimal pharmacological therapy, continuous positive airway pressure therapy, and perhaps also renal denervation might improve cardiovascular risk in patients with OSA.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | | | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., A.J.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.P., A.J.)
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Posadas T, Campos-Rodriguez F, Sapiña-Beltrán E, Oscullo G, Torres G, Martinez-Garcia MA. Obstructive Sleep Apnea and Arterial Hypertension: Implications of Treatment Adherence. Curr Hypertens Rep 2020; 22:12. [DOI: 10.1007/s11906-020-1015-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Resistant/Refractory Hypertension and Sleep Apnoea: Current Knowledge and Future Challenges. J Clin Med 2019; 8:jcm8111872. [PMID: 31694223 PMCID: PMC6912579 DOI: 10.3390/jcm8111872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
Hypertension is one of the most frequent cardiovascular risk factors. The population of hypertensive patients includes some phenotypes whose blood pressure levels are particularly difficult to control, thus putting them at greater cardiovascular risk. This is especially true of so-called resistant hypertension (RH) and refractory hypertension (RfH). Recent findings suggest that the former may be due to an alteration in the renin-angiotensin-aldosterone axis, while the latter seems to be more closely related to sympathetic hyper-activation. Both these pathophysiological mechanisms are also activated in patients with obstructive sleep apnoea (OSA). It is not surprising, therefore, that the prevalence of OSA in RH and RfH patients is very high (as reflected in several studies) and that treatment with continuous positive airway pressure (CPAP) manages to reduce blood pressure levels in a clinically significant way in both these groups of hypertensive patients. It is therefore necessary to incorporate into the multidimensional treatment of patients with RH and RfH (changes in lifestyle, control of obesity and drug treatment) a study of the possible existence of OSA, as this is a potentially treatable disease. There are many questions that remain to be answered, especially regarding the ideal combination of treatment in patients with RH/RfH and OSA (drugs, renal denervation, CPAP treatment) and patients' varying response to CPAP treatment.
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Belyavskiy E, Pieske-Kraigher E, Tadic M. Obstructive sleep apnea, hypertension, and obesity: A dangerous triad. J Clin Hypertens (Greenwich) 2019; 21:1591-1593. [PMID: 31532571 PMCID: PMC8030381 DOI: 10.1111/jch.13688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Oscullo G, Sapiña-Beltrán E, Torres G, Zaldivar E, Barbé F, Martinez-Garcia MA. The Potential Role of Obstructive Sleep Apnoea in Refractory Hypertension. Curr Hypertens Rep 2019; 21:57. [PMID: 31183617 DOI: 10.1007/s11906-019-0963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review seeks to present an overview of the recently found association between refractory hypertension (RfH) and obstructive sleep apnoea (OSA). RECENT FINDINGS RfH was recently defined as an extreme phenotype of resistant hypertension characterized by the lack of blood pressure control despite using ≥ 5 antihypertensive drugs at optimal doses. Current data support that the pathophysiological pathway of both types of hypertension is different. The main mechanism involved in resistant hypertension is fluid retention whereas in the case of RfH is the sympathetic over-activity. OSA is now recognized as a cause of hypertension (especially in the case of difficult-to-treat hypertension). It seems that the biological mechanism linking OSA and arterial hypertension is the sympathetic over-activity related to the respiratory events (apnoeas and hypopnoeas) during the night. So, it is not surprising that, although the literature is scarce, some studies have found a very high prevalence of OSA and an excess of sympathetic activity in patients with RfH. Finally, a very recent study demonstrated that continuous positive airway pressure (CPAP) treatment, which controls sympathetic activation in OSA patients, achieves very significant reductions in blood pressure levels in RfH patients, even greater than in those with resistant (non-refractory) hypertension. The prevalence of OSA in patients with RfH is very high. CPAP treatment achieves a clinically significant reduction in blood pressure levels in those patients with RfH (especially in night readings). Patients with RfH must be sent to a sleep unit for a study.
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Affiliation(s)
- Grace Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46012, Valencia, Spain
| | - E Sapiña-Beltrán
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Cataluña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gerard Torres
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Cataluña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Enrique Zaldivar
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46012, Valencia, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Cataluña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Culebras A, Anwar S. Sleep Apnea Is a Risk Factor for Stroke and Vascular Dementia. Curr Neurol Neurosci Rep 2018; 18:53. [DOI: 10.1007/s11910-018-0855-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Sankari A, Martin JL, Badr MS. Sleep Disordered Breathing and Spinal Cord Injury: Challenges and Opportunities. CURRENT SLEEP MEDICINE REPORTS 2017; 3:272-278. [PMID: 29177130 DOI: 10.1007/s40675-017-0093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose of review This paper focuses on the sleep disorders in patients with spinal cord injury (SCI/D), particularly mechanism of sleep disordered breathing (SDB) and challenges in diagnosis and management. Based on a review of recent literatures and studies the paper summarizes some main challenges with respect to management of SDB in patients with SCI; and what are the responsible mechanisms of disease? What are the barriers in diagnosing and treating SDB using standard treatment such as positive airway pressure (CPAP)?. Recent findings Previous studies have shown that most SCI/D patients have SDB with heterogeneity in prevalence mainly related to using different definition or methods of diagnosing SDB, while recent studies using new definition of SDB based on recommended criteria from the American Academy of Sleep Medicine (AASM) and also include the data on effect of SCI/D level on prevalence and describe different type of SDB. Furthermore, recent data describes simplified method of diagnosing SDB by using a combination of home sleep apnea testing and transcutaneous CO2 monitoring. Finally, emerging data has been pointing at strong relationship between SDB and cardiovascular disease including nocturnal hypertension in patients with SCI/D. Summary The findings indicate that early testing for SDB and associated cardiovascular disease in patients with SCI is recommended and could be beneficial in reduced the high morbidity and mortality in this group of patients with disability. In addition, studies on treatment of other sleep disorders in SCI/D are not available to inform clinical decision making. Understanding the pathophysiology of sleep disorders in SCI/D is critical for the development of new effective therapies. This review provides evidence for best practices; highlights new discoveries for the diagnosis and management of sleep disorders in SCI/D, and discuss challenges and future directions.
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Affiliation(s)
- Abdulghani Sankari
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer L Martin
- VA Greater Los Angeles Healthcare System, North Hills, CA, USA.,David Geffen School of Medicine at the University of California, Los Angeles
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Medicine, Wayne State University, Detroit, MI, USA
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10
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Sleep Apnea and Hypertension. Chest 2017; 152:742-750. [DOI: 10.1016/j.chest.2017.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/16/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
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Review of and Updates on Hypertension in Obstructive Sleep Apnea. Int J Hypertens 2017; 2017:1848375. [PMID: 29147581 PMCID: PMC5632858 DOI: 10.1155/2017/1848375] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities.
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Liu T, Li W, Zhou H, Wang Z. Verifying the Relative Efficacy between Continuous Positive Airway Pressure Therapy and Its Alternatives for Obstructive Sleep Apnea: A Network Meta-analysis. Front Neurol 2017; 8:289. [PMID: 28701992 PMCID: PMC5487413 DOI: 10.3389/fneur.2017.00289] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/06/2017] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder, and continuous positive airway pressure (CPAP) therapy together with its alternatives has been developed to treat this disease. This network meta-analysis (NMA) was aimed to compare the efficacy of treatments for OSA. Cochrane Library, MEDLINE, and Embase were searched for eligible studies. A conventional and NMA was carried out to compare all therapies. Sleeping characteristics, including Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), arterial oxygen saturation, and arousal index (AI), and changes of blood pressure were selected as outcomes. A total of 84 studies were finally included after rigorous screenings. For the primary outcomes of AHI and ESS, the value of auto-adjusting positive airway pressure (APAP), CPAP, and oral appliance (OA) all showed statistically reduction compared with inactive control (IC). Similar observation was obtained in AI, with treatments of the three active interventions. A lower effect of IC in SaO2 was exhibited when compared with APAP, CPAP, and OA. Similar statistically significant results were presented in 24 h systolic blood pressure and 24 h DBP when comparing with CPAP. Our NMA identified CPAP as the most efficacious treatment for OSA patients after the evaluation of sleeping characteristics and blood pressures. In addition, more clinical trials are needed for further investigation due to the existence of inconsistency observed in this study.
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Affiliation(s)
- Tingwei Liu
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenyang Li
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui Zhou
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zanfeng Wang
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked: An Update for Advanced Practice Registered Nurses. CLIN NURSE SPEC 2016; 30:347-362. [PMID: 27753673 DOI: 10.1097/nur.0000000000000247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE/OBJECTIVES Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. DESCRIPTION OF THE PROJECT We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. OUTCOMES Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. CONCLUSIONS This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.
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Rogers A, Necola O, Sexias A, Luka A, Newsome V, Williams S, McFarlane SI, Jean-Louis G. Resistant Hypertension and Sleep Duration among Blacks with Metabolic Syndrome MetSO. ACTA ACUST UNITED AC 2016; 5. [PMID: 28066790 DOI: 10.4172/2325-9639.1000183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Resistant hypertension (RHTN) is an important condition affecting 29% of the hypertensive population in the U.S., especially among blacks. Sleep disturbances, like obstructive sleep apnea, insomnia, and short sleep duration, are increasingly recognized as underlying modifiable factors for RHTN. We evaluated associations of RHTN with short sleep duration among blacks with metabolic syndrome. METHODS Data from the Metabolic Syndrome Outcome Study (MetSO), a NIH-funded cohort study characterizing metabolic syndrome (MetS) among blacks were analyzed. MetS was defined according to criteria from the Adult Treatment Panel (ATP III). RHTN was defined according to guidelines from the American Heart Association. Short sleep was defined as self-reported sleep duration <7 hrs experienced during a 24-hour period. RESULTS Analysis was based on 1,035 patients (mean age: 62±14years; female: 69.2%). Of the sample, 90.4% were overweight /obese; 61.4% had diabetes; 74.8% had dyslipidemia; 30.2% had a history of heart disease; and 48% were at high risk for obstructive sleep apnea. Overall, 92.6% reported physician-diagnosed hypertension (HTN) and 20.8% met criteria for RHTN. Analyses showed those with RHTN were more likely to be short sleepers (26.8% vs. 14.9%, p< 0.001). Based on logistic regression analysis, adjusting for effects of age, sex, and medical comorbidities, patients with metabolic syndrome and RHTN had increased odds of being short sleepers (OR = 1.95, 95% CI: 1.28-2.97, p = 0.002). CONCLUSION Among blacks with metabolic syndrome, patients meeting criteria for resistant hypertension showed a twofold greater likelihood of being short sleepers, prompting the need for sleep screening in this vulnerable population.
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Affiliation(s)
- April Rogers
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Olivia Necola
- Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Azizi Sexias
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Alla Luka
- Department of Medicine, Division of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Valerie Newsome
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Stephen Williams
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
| | - Samy I McFarlane
- Department of Medicine, Division of Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, NY 10016, USA
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Bhandari SK, Shi J, Molnar MZ, Rasgon SA, Derose SF, Kovesdy CP, Calhoun DA, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ. Comparisons of sleep apnoea rate and outcomes among patients with resistant and non-resistant hypertension. Respirology 2016; 21:1486-1492. [PMID: 27427469 DOI: 10.1111/resp.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE We directly compared sleep apnoea (SA) rates and risk of cardiovascular and mortality outcomes among SA patients with resistant hypertension (RH) and non-RH within a large diverse hypertension population. METHODS A retrospective cohort study between 1 January 2006 and 31 December 2010 among hypertensive adults (age ≥ 18 years) was performed within an integrated health system. Rates of SA in RH and non-RH were determined. Multivariable logistic regression analyses were used to calculate OR for SA. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) for cardiovascular and mortality outcomes between SA in RH versus SA in non-RH adjusting for age, gender, race, BMI, chronic kidney disease and other comorbidities. RESULTS SA was identified in 33 682 (7.2%) from 470 386 hypertensive individuals. SA in RH accounted for 5806 (9.6%) compared to SA in non-RH 27 876 individuals (6.8%). Multivariable OR (95% CI) for SA was 1.16 (1.12, 1.19), 3.57 (3.47, 3.66) and 2.20 (2.15, 2.25) for RH versus non-RH, BMI ≥ 30, and males, respectively. Compared to SA in non-RH individuals, SA in RH had a multivariable adjusted HR (95% CI) of 1.24 (1.13, 1.36), 1.43 (1.28, 1.61), 0.98 (0.85, 1.12) and 1.04 (0.95, 1.14) for ischaemic heart event (IHE), congestive heart failure (CHF), stroke and mortality, respectively. CONCLUSION We observed a modest increase in likelihood for SA among RH compared to non-RH patients. Risks for IHE and CHF were higher for SA in RH compared to SA in non-RH patients; however, there were no differences in risk for stroke and mortality.
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Affiliation(s)
- Simran K Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
| | - Jiaxiao Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Scott A Rasgon
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Stephen F Derose
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David A Calhoun
- Department of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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Wu Y, Hu G, Pan F, Liu J, Mo X, Xie Y, Liang D, Lei Z, Liang B. Obstructive sleep apnea hypopnea syndrome was a risk factor for uncontrolled hypertension in adult snorers in South China. Clin Exp Hypertens 2016; 38:429-34. [PMID: 27359186 DOI: 10.3109/10641963.2016.1151525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The association of obstructive sleep apnea hypopnea syndrome (OSAHS) with uncontrolled hypertension has not been fully investigated to date. The present article will investigate the associated factors of uncontrolled hypertension in South China Method: A total of 668 patients (531 males, 137 females) in South China were enrolled in this study. All patients completed questionnaires and then underwent an in-hospital polysomnography. RESULT Univariate analysis showed that drinking, apnea-hypopnea index, Epworth Sleepiness Scale (ESS) index, the presence of OSAHS, MSaO2 and the lowest SaO2, circumference of neck and waist were predictors of uncontrolled hypertension. Multiple logistic regression analysis showed that ESS, presence of OSAHS, and the lowest SaO2 was independently associated with the risk for uncontrolled hypertension. CONCLUSION The lowest SaO2, ESS index, and OSAHS were risk factors for uncontrolled hypertension.
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Affiliation(s)
- Yankui Wu
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Guoping Hu
- b Department of Respiratory Disease of the Third Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Fengjin Pan
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Jianhong Liu
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Xiaoyun Mo
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Yuping Xie
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Dahua Liang
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Zhijian Lei
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
| | - Bifang Liang
- a Sleep-Disordered Breathing Center of Guangxi , People's Hospital of Guangxi Zhuang Autonomous Region , Guangxi Zhuang Autonomous Region, P R China
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Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens 2016; 32:2341-50; discussion 2350. [PMID: 25243523 DOI: 10.1097/hjh.0000000000000372] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA). METHODS Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment. RESULTS A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I² 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I² 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I² 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I² 76%), respectively, in favor of the CPAP group. CONCLUSION The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
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Abstract
There is a bidirectional association between OSA and systemic hypertension. The strengths of this relationship appear to be modulated by factors such as age, sex, and somnolence. The 24-h BP circadian pattern also appears to be influenced by OSA. Patients with this syndrome exhibit a high prevalence of nondipping or riser circadian patterns, which are related to clinical and subclinical organ damage in the heart and brain. However, the influence of OSA on nocturnal hypertension development has not yet been clarified. A special area of interest is the recognized relationship between OSA and resistant hypertension. The majority of patients with resistant hypertension suffer OSA. CPAP treatment significantly reduces BP in such patients and could play a clinical role in the management of BP in these patients. Several meta-analyses have demonstrated a concordant mild effect of CPAP on systemic hypertension. This effect is related to CPAP compliance, somnolence status, and baseline BP. The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials. In the absence of additional data reported by clinical studies on other antihypertensive drug treatments, diuretics, particularly antialdosteronic diuretic agents, should be considered the first-line antihypertensive drug treatment in patients with OSA. By reducing parapharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.
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Affiliation(s)
- Gerard Torres
- From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia
| | - Manuel Sánchez-de-la-Torre
- From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain..
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Impact of Continuous Positive Airway Pressure on Cardiovascular Risk Factors in High-Risk Patients. Curr Atheroscler Rep 2015; 17:62. [DOI: 10.1007/s11883-015-0540-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kallianos A, Panoutsopoulos A, Mermigkis C, Kostopoulos K, Papamichail C, Kokkonouzis I, Kostopoulos C, Nikolopoulos I, Papaiwannou A, Lampaki S, Organtzis J, Pitsiou G, Zarogoulidis P, Trakada G. Sex differences of continuous positive airway pressure treatment on flow-mediated dilation in patients with obstructive sleep apnea syndrome. Clin Interv Aging 2015; 10:1361-6. [PMID: 26316731 PMCID: PMC4547653 DOI: 10.2147/cia.s84199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There is growing research evidence suggesting the presence of endothelial dysfunction and systemic inflammation in patients with obstructive sleep apnea syndrome (OSAS). Continuous positive airway pressure (CPAP) is the most effective method for treating OSAS; nonetheless, the effects of CPAP on the aforementioned pathophysiologic pathways as well as on the systemic disease that result or coexist with the OSAS remain elusive. AIM To assess the effect of 3-month CPAP therapy on endothelial-dependent dilation, plasma levels of inflammatory markers, blood pressure (BP), and glucose control on male and female patients with OSAS. METHODS Our study group consisted of 40 (24 males and 16 females) patients with no prior history of cardiovascular disease, with an apnea-hypopnea index ≥15, who were assigned to receive CPAP treatment. Measurements of flow-mediated dilation (FMD), 24-hour ambulatory BP, and blood analysis were performed at baseline and 3 months after CPAP therapy. RESULTS Baseline FMD values were negatively correlated with the apnea-hypopnea index (r=-0.55, P=0.001). After 3 months of CPAP, there was an increase in the FMD values (5.40%±2.91% vs 3.13%±3.15%, P<0.05) and a significant reduction in the patients' 24-hour systolic BP (122.82±11.88 mmHg vs 130.24±16.75 mmHg, P<0.05), diastolic BP (75.44±9.14 mmHg vs 79.68±11.09 mmHg, P<0.05), and pulse pressure (47.38±9.77 mmHg vs 52.72±11.38 mmHg, P<0.05); daytime systolic BP (125.76±12.69 mmHg vs 132.55±17.00 mmHg, P<0.05) and diastolic BP (77.88±10.39 mmHg vs 82.25±11.01 mmHg, P<0.05); nighttime systolic BP (118.17±13.16 mmHg vs 126.22±17.42 mmHg, P<0.05) and pulse pressure (46.61±10.76 mmHg vs 52.66±11.86 mmHg, P<0.05); and C-reactive protein and HbA1c levels (0.40 [0.40-0.70] mg/L vs 0.60 [0.40-0.84] mg/L and 5.45%±0.70% vs 5.95%±1.08%, respectively; P<0.05). When divided by sex, only male patients produced similar statistically significant results, while female patients failed to show such associations. CONCLUSION Our results suggest that CPAP therapy improves the endothelial function, the BP, and the glucose control in male patients with OSAS. Further research is warranted in order to verify these results and to further elucidate the impact of CPAP on the cardiovascular risk of male and female patients with OSAS.
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Affiliation(s)
- Anastasios Kallianos
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
| | - Athanasios Panoutsopoulos
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
| | | | - Konstantinos Kostopoulos
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
| | - Chrysanthi Papamichail
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
| | - Ioannis Kokkonouzis
- Pulmonary Department, 251 Hellenic Air Force General Hospital, Athens, Greece
| | - Christoforos Kostopoulos
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
| | - Ioannis Nikolopoulos
- Sleep Disorders Unit, "Sotiria" Regional Chest Diseases Hospital of Athens, Athens, Greece
| | - Antonis Papaiwannou
- Pulmonary Department - Oncology Unit, George Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Lampaki
- Pulmonary Department - Oncology Unit, George Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Organtzis
- Pulmonary Department - Oncology Unit, George Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- Pulmonary Department - Oncology Unit, George Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department - Oncology Unit, George Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Trakada
- Sleep Disorders Unit, Department of Clinical Therapeutics, "Alexandra" General Hospital, Athens School of Medicine, Athens, Greece
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Gonzaga C, Bertolami A, Bertolami M, Amodeo C, Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J Hum Hypertens 2015; 29:705-12. [DOI: 10.1038/jhh.2015.15] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/07/2015] [Accepted: 01/23/2015] [Indexed: 11/09/2022]
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Huang Z, Liu Z, Luo Q, Zhao Q, Zhao Z, Ma X, Liu W, Yang D. Long-term effects of continuous positive airway pressure on blood pressure and prognosis in hypertensive patients with coronary heart disease and obstructive sleep apnea: a randomized controlled trial. Am J Hypertens 2015; 28:300-6. [PMID: 25125635 DOI: 10.1093/ajh/hpu147] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) can result in hypertension and significantly increase cardiovascular morbidity and mortality. There are few reports on the long-term effects of continuous positive airway pressure (CPAP) on blood pressure in patients with uncontrolled hypertension with coronary heart disease (CHD) and OSA. METHODS We conducted a prospective, long-term follow-up study in 83 patients with uncontrolled hypertension, CHD, and OSA randomized to control or CPAP groups. Daytime systolic blood pressure (SBP), diastolic blood pressure (DBP), and severe cardiovascular and cerebrovascular events (SCCEs) were recorded at baseline and follow-up. RESULTS Seventy-three patients completed the study with a median follow-up of 36 (interquartile range = 24-54) months. The 2 groups had similar characteristics at baseline. CPAP was used for 4.5±1.1 hour/night. SBP in the CPAP group was significantly reduced at follow-up (143±7 mm Hg vs. 139±7 mm Hg, P = 0.04), and SBP decreased by 8mm Hg (95% confidence interval = 1.4-9.9; P = 0.01). Hypertension control was improved (CPAP, 69.4% for CPAP users vs. 43.2% for control subjects; P = 0.02); however, DBP did not reach statistical difference between the groups (81±10 mm Hg vs. 79±8 mm Hg; P = 0.49). In the CPAP group, the Epworth Sleepiness Scale was markedly reduced (7.0±3.4 vs. 3.7±2.3; P < 0.001). There was 1 SCCE in the CPAP group (heart failure), and 5 SCCEs in the control group (acute myocardial infarction: 2 (with 1 death); stroke: 3), but there was no significant difference identified. CONCLUSIONS Long-term CPAP application in uncontrolled hypertension with CHD and OSA significantly reduced daytime SBP, improved hypertension control and daytime sleepiness, and decreased the trend in SCCEs compared with control subjects. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02059993.
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Affiliation(s)
- Zhiwei Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihong Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qin Luo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuping Ma
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aggarwal S, Jan MF, Agarwal A, Tajik AJ. Hypertrophic cardiomyopathy associated with sleep apnea: serious implications and cogent management strategy. Expert Rev Cardiovasc Ther 2015; 13:277-84. [PMID: 25634133 DOI: 10.1586/14779072.2015.1004314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) affects an estimated 20 million adult Americans and is present in a large proportion of patients with hypertension and in those with other cardiovascular disorders, including hypertrophic cardiomyopathy (HCM). This review seeks to highlight concepts and evidence important to understanding the interactions between OSA and HCM, with particular attention to more recent advances in patient-oriented research. Studies of patients with HCM have found the prevalence of sleep-disordered breathing to range from 40 to 80%. Increased sympathetic activity, impaired vagal activity, increased afterload, insulin resistance and endothelial dysfunction have been proposed as potential mechanisms for the association. Specific questions include whether OSA is important in unmasking symptoms in hitherto undiagnosed patients with HCM, whether OSA in patients with established HCM accelerates disease progression and whether treatment of OSA results in clinical improvement, fewer cardiovascular events and reduced mortality. Because obesity, cardiovascular disease, metabolic syndrome, and diabetes are often present in patients with OSA, it can be difficult to attribute abnormalities evident in the sleep apnea patient with HCM to the effects of OSA, the effects of HCM or synergies between these conditions. Although further research is needed to answer these specific questions, recent investigations have clearly shown the coexistence of OSA and HCM, as well as elucidated the contribution of heightened sympathetic nerve activity in OSA to drug-refractory symptoms and worsening left ventricular outflow tract obstruction. This review aims to highlight the current literature available on the association of OSA and HCM, provide directions for future research and summarize the key features related to this association based on the authors' best understanding and experience.
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Aggarwal S, Nadeem R, Loomba RS, Nida M, Vieira D. The effects of continuous positive airways pressure therapy on cardiovascular end points in patients with sleep-disordered breathing and heart failure: a meta-analysis of randomized controlled trials. Clin Cardiol 2014; 37:57-65. [PMID: 24567977 DOI: 10.1002/clc.22201] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In patients with sleep-disordered breathing and heart failure, continuous positive airway pressure has been found to be associated with an improvement in cardiovascular end points. We conducted a systematic review of the current literature and a meta-analysis to pool data from 15 published randomized controlled trials. End points analyzed were left ventricular ejection fraction, diastolic blood pressure, systolic blood pressure, heart rate, and mortality. A fixed effects model was used for end points demonstrating homogeneity among included studies, whereas a random effects model was used for end points demonstrating heterogeneity among included studies. A significant improvement in left ventricular ejection fraction was noted with continuous positive airway pressure (mean difference, 5.05%; 95% confidence interval [CI]: 3.72 to 6.38), diastolic blood pressure (mean difference, −1.67; 95% CI: −3.09 to −0.25), and heart rate (mean difference, −5.92; 95% CI: −10.12 to−1.72). No significant changes in mortality (odds ratio, 0.63; 95% CI: 0.40 to 1.00) and systolic blood pressure were noted (mean difference, −6.35; 95% CI: −16.11 to 2.41). The analysis also revealed the need for additional studies to clarify the associations noted and the presence of publication bias with small studies with a paucity of small studies with negative results. In this meta-analysis, treatment with continuous positive airways pressure was associated with improvements in ejection fraction, diastolic blood pressure, and heart rate in patients with sleep-disordered breathing and congestive heart failure.
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de Oliveira AC, Martinez D, Massierer D, Gus M, Gonçalves SC, Ghizzoni F, Steinhorst AM, Moreira LB, Fuchs SC, Fuchs FD. The antihypertensive effect of positive airway pressure on resistant hypertension of patients with obstructive sleep apnea: a randomized, double-blind, clinical trial. Am J Respir Crit Care Med 2014; 190:345-7. [PMID: 25084263 DOI: 10.1164/rccm.201403-0479le] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ana Claudia de Oliveira
- 1 Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul Porto Alegre, Brazil
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A randomized controlled study of CPAP effect on plasma aldosterone concentration in patients with resistant hypertension and obstructive sleep apnea. J Hypertens 2014; 32:1650-7; discussion 1657. [DOI: 10.1097/hjh.0000000000000238] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jhamb M, Brown LK, Unruh M. Resistant Hypertension in Obstructive Sleep Apnea: Is Continuous Positive Airway Pressure the Next Step? Am J Kidney Dis 2014; 64:13-5. [DOI: 10.1053/j.ajkd.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/11/2022]
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Genta-Pereira DC, Pedrosa RP, Lorenzi-Filho G, Drager LF. Sleep Disturbances and Resistant Hypertension: Association or Causality? Curr Hypertens Rep 2014; 16:459. [DOI: 10.1007/s11906-014-0459-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Varounis C, Katsi V, Kallikazaros IE, Tousoulis D, Stefanadis C, Parissis J, Lekakis J, Siristatidis C, Manolis AJ, Makris T. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: a systematic review and meta-analysis. Int J Cardiol 2014; 175:195-8. [PMID: 24841834 DOI: 10.1016/j.ijcard.2014.04.240] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Christos Varounis
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece; 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece.
| | - Vasiliki Katsi
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece; Cardiology Department, Hippokration Hospital, Athens, Greece
| | | | | | | | - John Parissis
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Lekakis
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | | | - Thomas Makris
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece
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Gómez García MT, Troncoso Acevedo MF, Rodriguez Guzmán M, Alegre de Montaner R, Fernández Fernández B, del Río Camacho G, González-Mangado N. Can pulse transit time be useful for detecting hypertension in patients in a sleep unit? Arch Bronconeumol 2014; 50:278-84. [PMID: 24468130 DOI: 10.1016/j.arbres.2013.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/30/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulse transit time (PTT) is the time that a pulse wave takes to travel between two different arterial points, and may be useful in estimating blood pressure. This noninvasive technique, which does not add any cost to the procedure, offers the advantage of avoiding 'arousals' during sleep measurement as occurs with ambulatory blood pressure monitoring (ABPM). We aim to confirm the usefulness of PTT for the detection of hypertension, and to study the correlation between both measurements. METHODS Prospective observational study in a multidisciplinary sleep unit. We recruited 30consecutive patients attending a sleep clinic and ran a baseline polysomnography followed by an ABPM the following day. Average systolic and diastolic blood pressure (SBP, DBP) by PTT were calculated and compared with ABMP results. In accordance with international guidelines, patients with mean nocturnal ABMP ≥ 120/70 mmHg were diagnosed as having arterial hypertension. RESULTS Mean age of 60years; 66% male, 80% suffered from sleep apnoea (OSAS). Taking the ABPM as the reference technique, we found that the diagnostic sensitivity of PTT is 85% with a specificity of 88% in the case of SBP, with a positive predictive value of 85% and negative predictive value of 88%. By studying the relationship between mean SBP measured by ABPM and PTT, we found a linear correlation coefficient (R) of 0.88, showing a distribution of all subjects with a difference of between ±15mmHg between tests. There is also a positive correlation between mean DBP measured for the two tests, with a weaker linear correlation. CONCLUSIONS Pulse transit time shows a strong correlation with blood pressure (measured by ABPM). PTT provides continuous, non-invasive, cuffless blood pressure monitoring free of additional cost and could be an alternative for screening hypertension.
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Affiliation(s)
- Maria Teresa Gómez García
- Servicio de Neumología, Respiratory Research Group-CIBERES, IIS Fundación Jiménez Díaz, Madrid, España.
| | | | - Marcel Rodriguez Guzmán
- Servicio de Neumología, Respiratory Research Group-CIBERES, IIS Fundación Jiménez Díaz, Madrid, España
| | | | | | | | - Nicolás González-Mangado
- Servicio de Neumología, Respiratory Research Group-CIBERES, IIS Fundación Jiménez Díaz, Madrid, España
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Pedrosa RP, Drager LF, de Paula LKG, Amaro ACS, Bortolotto LA, Lorenzi-Filho G. Effects of OSA treatment on BP in patients with resistant hypertension: a randomized trial. Chest 2014; 144:1487-1494. [PMID: 23598607 DOI: 10.1378/chest.13-0085] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND OSA is extremely common among patients with resistant hypertension (HTN). However, the impact of the treatment of OSA with CPAP on BP in patients with resistant HTN is not well established. METHODS In the current study, 40 patients with confirmed resistant HTN and moderate to severe OSA confirmed by full polysomnography were randomized to medical therapy or to medical treatment plus CPAP for 6 months. Patients were evaluated at study baseline and after 6 months by 24-h ambulatory BP monitoring (ABPM). RESULTS Thirty-five patients (77% men; age, 56 ± 1 years; BMI, median 32 kg/m² [25%-75%, 28-39 kg/m²]; apnea-hypopnea index, 29 events/h [24-48 events/h]; Epworth Sleepiness Scale, 10 ± 1; systolic/diastolic office BP, 162 ± 4/97 ± 2 mm Hg; taking four [four to five] antihypertensive drugs) completed the study. CPAP was used for 6:01 ± 0:20 h/night (3:42-7:44 h/night). Compared with the control group, awake systolic/diastolic ABPM decreased significantly in the CPAP group (Δ: +3.1 ± 3.3 /+2.1 ± 2.7 mm Hg vs -6.5 ± 3.3/-4.5 ± 1.9 mm Hg, respectively, P < .05). Interestingly, the BP changes were observed only while patients were awake, but not during nocturnal ABPM (Δ: +2.8 ± 4.5/+1.8 ± 3.5 mm Hg vs +1.6 ± 3.5/+0.8 ± 2.9 mm Hg, P = NS). CONCLUSIONS The treatment of OSA with CPAP significantly reduces daytime BP in patients with resistant HTN. Therefore, our study reinforces the importance of recognizing and treating OSA in patients with resistant HTN. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00812695; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Rodrigo P Pedrosa
- Sleep Laboratory, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil
| | - Luciano F Drager
- Sleep Laboratory, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo; Pulmonary Division, and the Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo
| | - Lílian K G de Paula
- Sleep Laboratory, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo
| | - Aline C S Amaro
- Sleep Laboratory, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo
| | - Luiz A Bortolotto
- Pulmonary Division, and the Hypertension Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo.
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Marcus JA, Pothineni A, Marcus CZ, Bisognano JD. The Role of Obesity and Obstructive Sleep Apnea in the Pathogenesis and Treatment of Resistant Hypertension. Curr Hypertens Rep 2013; 16:411. [DOI: 10.1007/s11906-013-0411-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Stopford E, Ravi K, Nayar V. The association of sleep disordered breathing with heart failure and other cardiovascular conditions. Cardiol Res Pract 2013; 2013:356280. [PMID: 24455403 PMCID: PMC3877588 DOI: 10.1155/2013/356280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 10/07/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022] Open
Abstract
An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.
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Affiliation(s)
- Elizabeth Stopford
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Karthik Ravi
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Vikrant Nayar
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
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Calhoun DA. Resistant hypertension. Hypertension 2013. [DOI: 10.2217/ebo.12.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- David A Calhoun
- David A Calhoun is Professor of the Medicine, Vascular Biology and Hypertension Program and Center for Sleep/Wake Disorders at the University of Alabama at Birmingham (AL, USA). He is an active clinical investigator. He has an extensive bibliography in clinical hypertension, including over 175 journal articles and book chapters. His major research focus has been on defining the causes of resistant hypertension
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Resistant hypertension and obstructive sleep apnea. Int J Hypertens 2013; 2013:193010. [PMID: 23781329 PMCID: PMC3679807 DOI: 10.1155/2013/193010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/21/2013] [Accepted: 04/27/2013] [Indexed: 12/17/2022] Open
Abstract
Hypertension (HTN) is a modifiable, highly prevalent risk factor for cardiovascular morbidity and renal dysfunction worldwide. In the United States, HTN affects one in three adults, contributes to one out of every seven deaths and to nearly half of all cardiovascular disease-related deaths. HTN is considered resistant when the blood pressure remains above goal despite lifestyle modification and administration of three antihypertensive agents of different classes including a diuretic. Large population-based studies have suggested that obstructive sleep apnea (OSA) is a risk factor for resistant HTN. The mechanism proposed is a pattern of intermittent hypoxia associated with hyperaldosteronism, increased sympathetic tone, endothelial dysfunction, and inflammation. In this review we discuss the association between OSA and resistant HTN, the physiologic mechanisms linking OSA with resistant HTN, and the effect of continuous positive airway pressure therapy (CPAP) on blood pressure in patients with resistant HTN. While the reduction in blood pressure with CPAP is usually modest in patients with OSA, a decrease of only a few mmHg in blood pressure can significantly reduce cardiovascular risk. Patients presenting to a center specializing in management of hypertension should be screened and treated for OSA as a potentially modifiable risk factor.
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Pinto P, Bárbara C, Montserrat JM, Patarrão RS, Guarino MP, Carmo MM, Macedo MP, Martinho C, Dias R, Gomes MJM. Effects of CPAP on nitrate and norepinephrine levels in severe and mild-moderate sleep apnea. BMC Pulm Med 2013; 13:13. [PMID: 23497046 PMCID: PMC3602188 DOI: 10.1186/1471-2466-13-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 02/28/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Reduced plasma nitrate (NO(x)) levels and increased urinary norepinephrine (U-NE) levels have been described in severe obstructive sleep apnea (OSA), and are reverted by continuous positive airway pressure (CPAP). The effect of CPAP on these biomarkers in mild-moderate OSA is not well understood. The aim of this study was to compare NO(x) and U-NE levels and blood pressure (BP) between male patients with mild-moderate and severe OSA and determine the impact of 1 month of CPAP therapy on these parameters. METHODS We undertook a prospective study of 67 consecutive OSA patients (36 mild-moderate, 31 severe). Measurements of plasma NO(x) at 11 pm, 4 am and 7 am, 24-h U-NE and ambulatory BP were obtained at baseline and after 1 month of CPAP. RESULTS At baseline, NO(x) levels showed a significant decrease during the night in both groups (p < 0.001). U-NE level and BP were significantly higher in the severe OSA group. After 1 month of CPAP, there was a significant increase in NO(x) levels and a reduction in U-NE level and BP only in patients with severe OSA. CONCLUSIONS One month of CPAP results in significant improvements in NO(x) levels, 24-h U-NE level and BP in patients with severe OSA, but not in patients with mild-moderate OSA. TRIAL REGISTRATION ClinicalTrials.gov: NCT01769807.
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Affiliation(s)
- Paula Pinto
- Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte-Hospital Pulido Valente, Lisbon, Portugal
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estudos de Doenças Crónicas, Lisbon, Portugal
| | - Cristina Bárbara
- Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte-Hospital Pulido Valente, Lisbon, Portugal
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estudos de Doenças Crónicas, Lisbon, Portugal
| | | | - Rita S Patarrão
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria P Guarino
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel M Carmo
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria P Macedo
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Cristina Martinho
- Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte-Hospital Pulido Valente, Lisbon, Portugal
| | - Rita Dias
- Serviço de Pneumologia II, Centro Hospitalar Lisboa Norte-Hospital Pulido Valente, Lisbon, Portugal
| | - Maria JM Gomes
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estudos de Doenças Crónicas, Lisbon, Portugal
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Therapeutic strategies for sleep apnea in hypertension and heart failure. Pulm Med 2013; 2013:814169. [PMID: 23509623 PMCID: PMC3590754 DOI: 10.1155/2013/814169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/06/2012] [Indexed: 01/19/2023] Open
Abstract
Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30-50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2 therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF.
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Abstract
PURPOSE OF REVIEW One of the underappreciated causes of hypertension is disordered sleep. There have been a number of studies evaluating sleep in the context of blood pressure control, and these will be reviewed. RECENT FINDINGS Original novel articles document that disruption of deep sleep stage, regardless of cause, if chronic, contributes to an increased risk for development of hypertension. Studies have evaluated disrupted sleep especially in older people requiring use of the bathroom at night and demonstrate higher risk of hypertension in such people. Correction of sleep apnea with continuous positive airway pressure (CPAP) reduces blood pressure in those who are adherent; however, as the reduction is only from 2 to 5 mmHg systolic, adjunctive medications are almost always needed. Use of angiotensin receptor blockers and some β-blockers has shown some improvement in blood pressure. Renal denervation has also been shown in a pilot study to offer benefit on blood pressure reduction. SUMMARY Innovations of combined use of devices with certain classes of antihypertensive medications help reduce blood pressure in people with sleep disorders. CPAP alone provides only modest reduction in blood pressure; however, restoration of deep sleep reduces blood pressure and reduces variability.
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Abstract
Although continuous positive airway pressure, oral appliances and surgical modifications of the airway are considered as part of the routine management of patients with obstructive sleep apnea, many new and unconventional therapies exist. Many of the trials using these new alternatives have been limited by insufficient data, poor trial design, small sample size, unclear inclusion criteria, lack of randomization, and lack of blinding, and on occasion are biased by retrospective design. Bariatric surgery, positional therapy, auto-titrating positive airway pressure, serotonin agents, wake promoting agents, genioglossus stimulation surgery, supplemental oxygen, nasal dilators, nasal expiratory resistor devices and oropharyngeal exercises will be reviewed. As obstructive sleep apnea impacts the individual and society at large, further research is needed to explore new therapeutic treatment options for obstructive sleep apnea. Therapeutic trials for obstructive sleep apnea must be of rigorous design to prove clinical effectiveness while taking into account both patient satisfaction and cost effectiveness.
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Affiliation(s)
- Jose Angelo A. De Dios
- Department of Pulmonary, Critical Care & Sleep Medicine, UC Davis Medical Center, Sacramento, CA USA
- The Medical Group, Carolina Pines Regional Medical Center, 701 Medical Park Drive, Suite 303, Hartsville, SC 29550 USA
| | - Steven D. Brass
- Department of Neurology, UC Davis Health System, 4860 Y Street — Suite 3700, Sacramento, CA 95817 USA
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Abstract
Obstructive sleep apnea (OSA) is a common disorder that has been associated with many cardiovascular disease processes, including hypertension and arrhythmias. OSA has also been identified as an independent risk factor for stroke and all-cause mortality. OSA is highly prevalent in patients with transient ischemic attacks and stroke. Routinely screening patients with transient ischemic attacks or stroke for sleep apnea is becoming more common. In stroke patients with OSA, treatment with continuous positive airway pressure may prevent subsequent cardiovascular events and improve neurologic outcomes. This review explores the pathophysiology of the association between OSA and stroke, and the clinical implications of identification and treatment of OSA in patients with stroke.
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Affiliation(s)
- Aneesa M Das
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, The Ohio State University, 201 Davis Heart and Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43209, USA
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Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens 2012; 26:281-7. [PMID: 21654850 PMCID: PMC3748801 DOI: 10.1038/jhh.2011.47] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/10/2022]
Abstract
Obstructive sleep apnoea (OSA) and hypertension commonly coexist. Observational studies indicate that untreated OSA is strongly associated with an increased risk of prevalent hypertension, whereas prospective studies of normotensive cohorts suggest that OSA may increase the risk of incident hypertension. Randomized evaluations of continuous positive airway pressure (CPAP) indicate an overall modest effect on blood pressure (BP). Determining why OSA is so strongly linked to having hypertension in cross-sectional studies, but yet CPAP therapy has limited BP benefit needs further exploration. The CPAP studies do, however, indicate a wide variation in the BP effects of CPAP, with some patients manifesting a large antihypertensive benefit such that a meaningful BP effect can be anticipated in some individuals. OSA is particularly common in patients with resistant hypertension (RHTN). The reason for this high prevalence of OSA is not fully explained, but data suggest that it may be related to the high occurrence of hyperaldosteronism in patients with RHTN. In patients with RHTN, it has been shown that aldosterone levels correlate with severity of OSA and that blockade of aldosterone reduces the severity of OSA. Overall, these findings are consistent with aldosterone excess contributing to worsening of underlying OSA. We hypothesize that aldosterone excess worsens OSA by promoting accumulation of fluid within the neck, which then contributes to increased upper airway resistance.
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Affiliation(s)
- T Dudenbostel
- Vascular Biology and Hypertension Program, Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294,USA.
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Cano-Pumarega I, Durán-Cantolla J, Aizpuru F, Miranda-Serrano E, Rubio R, Martínez-Null C, de Miguel J, Egea C, Cancelo L, Alvarez A, Fernández-Bolaños M, Barbé F. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med 2011; 184:1299-304. [PMID: 21868499 DOI: 10.1164/rccm.201101-0130oc] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Obstructive sleep apnea and systemic hypertension (SH) are highly prevalent. Although their association has been suggested in cross-sectional studies, conflicting evidence has emerged from longitudinal studies. OBJECTIVES To assess the association between obstructive sleep apnea and SH in the middle-aged general population. METHODS A total of 2,148 subjects were included in a longitudinal study of the Vitoria Sleep Cohort, a general population sample aged 30-70 years. We analyzed data on office blood pressure, anthropometric measures, health history, and home polygraphy. Out of 1,557 subjects who completed the 7.5-year follow-up, 377 were excluded for having SH at baseline. The odds ratios for the incidence of SH, according to the respiratory disturbance index (RDI) at baseline, were estimated in 1,180 subjects (526 men and 654 women) after adjustment for age; sex; body mass index; neck circumference; fitness level; and alcohol, tobacco, and coffee consumption. The RDI was divided into quartiles (0-2.9, 3-6.9, 7-13.9, and ≥ 14), using the first quartile as reference. MEASUREMENTS AND MAIN RESULTS The crude odds ratio for incident hypertension increased with higher RDI category with a dose-response effect (P < 0.001), but was not statistically significant after adjustment for age (P = 0.051). Adjustments for sex (P = 0.342), body mass index (P = 0.803), neck circumference (P = 0.885), and fitness level and alcohol, tobacco, and coffee consumption (P = 0.708) further reduced the strength of the association between RDI and SH. No differences were observed between men and women. CONCLUSIONS Our findings do not suggest an association between obstructive sleep apnea and the incidence of SH in the middle-aged general population. Long-term follow-up longitudinal studies are needed to better ascertain this association.
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Demede M, Pandey A, Zizi F, Bachmann R, Donat M, McFarlane SI, Jean-Louis G, Ogedegbe G. Resistant hypertension and obstructive sleep apnea in the primary-care setting. Int J Hypertens 2011; 2011:340929. [PMID: 21755035 PMCID: PMC3132606 DOI: 10.4061/2011/340929] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/28/2011] [Indexed: 01/13/2023] Open
Abstract
We ascertained the prevalence of resistant hypertension (RH) among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA) than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO), a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ± 13 years; female = 61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES), defining high risk as a total ARES score ≥6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension (OR = 2.46, 95% CI: 1.03-5.88, P < .05). Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3-29%). However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension.
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Affiliation(s)
- M. Demede
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - A. Pandey
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - F. Zizi
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - R. Bachmann
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - M. Donat
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Department of Family Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - S. I. McFarlane
- Department of Endocrinology, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - G. Jean-Louis
- Brooklyn Center for Health Disparities, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
- Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1199, Brooklyn, NY 11203-2098, USA
| | - G. Ogedegbe
- Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, NY 10016, USA
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Ahmed MI, Guichard JL, Calhoun DA. Resistant Hypertension. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens 2011; 2011:236239. [PMID: 21423678 PMCID: PMC3057025 DOI: 10.4061/2011/236239] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/11/2011] [Indexed: 12/20/2022] Open
Abstract
Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, George Washington University, VAMC 50 Irving Street NW, Washington, DC 20422, USA
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47
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Breuer HW. Hypertension, metabolic syndrome, prediabetes, and diabetes associated with obstructive sleep apnea syndrome. SOMNOLOGIE 2011. [DOI: 10.1007/s11818-011-0503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Williams SK, Ravenell J, Jean-Louis G, Zizi F, Underberg JA, McFarlane SI, Ogedegbe G. Resistant hypertension and sleep apnea: pathophysiologic insights and strategic management. Curr Diab Rep 2011; 11:64-9. [PMID: 21104207 DOI: 10.1007/s11892-010-0161-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea-associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered.
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Affiliation(s)
- Stephen K Williams
- Center for Healthful Behavior Change, Division of General Internal Medicine, New York University School of Medicine, New York, NY 10010, USA.
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Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 2011; 28:2161-8. [PMID: 20577130 DOI: 10.1097/hjh.0b013e32833b9c63] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This controlled trial assessed the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH). METHODS We evaluated 96 patients with resistant hypertension, defined as clinic BP at least 140/90 mmHg despite treatment with at least three drugs at adequate doses, including a diuretic. Patients underwent a polysomnography and a 24-h ambulatory BP monitoring (ABPM). They were classified as consulting room or ABPM-confirmed resistant hypertension, according to 24-h BP lower or higher than 125/80 mmHg. Patients with an apnea-hypopnea index at least 15 events/h (n = 75) were randomized to receive either CPAP added to conventional treatment (n = 38) or conventional medical treatment alone (n = 37). ABPM was repeated at 3 months. The main outcome was the change in systolic and diastolic BP. RESULTS Sixty-four patients completed the follow-up. Patients with ABPM-confirmed resistant hypertension treated with CPAP (n = 20), unlike those treated with conventional treatment (n = 21), showed a decrease in 24-h diastolic BP (-4.9 ± 6.4 vs. 0.1 ± 7.3 mmHg, P = 0.027). Patients who used CPAP > 5.8 h showed a greater reduction in daytime diastolic BP {-6.12 mmHg [confidence interval (CI) -1.45; -10.82], P = 0.004}, 24-h diastolic BP (-6.98 mmHg [CI -1.86; -12.1], P = 0.009) and 24-h systolic BP (-9.71 mmHg [CI -0.20; -19.22], P = 0.046). The number of patients with a dipping pattern significantly increased in the CPAP group (51.7% vs. 24.1%, P = 0.008). CONCLUSION In patients with resistant hypertension and OSA, CPAP treatment for 3 months achieves reductions in 24-h BP. This effect is seen in patients with ABPM-confirmed resistant hypertension who use CPAP more than 5.8 h.
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Thomopoulos C, Michalopoulou H, Kasiakogias A, Kefala A, Makris T. Resistant hypertension and obstructive sleep apnea: the sparring partners. Int J Hypertens 2011; 2011:947246. [PMID: 21274434 PMCID: PMC3025360 DOI: 10.4061/2011/947246] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/08/2010] [Indexed: 11/20/2022] Open
Abstract
Enhanced target organ damage and cardiovascular morbidity represent common issues observed in both resistant hypertension and obstructive sleep apnea. Common pathophysiological features and risk factors justify their coexistence, especially in individuals with increased upper-body adiposity. Impaired sodium handling, sympathetic activation, accelerated arterial stiffening, and impaired cardiorenal hemodynamics contribute to drug-resistant hypertension development in obstructive sleep apnea. Effective CPAP therapy qualifies as an effective "add-on" to the underlying antihypertensive pharmacological therapy, and emerging evidence underlines the favorable effect of mineralocorticoid antagonists on both resistant hypertension and obstructive sleep apnea treatment.
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Affiliation(s)
- Costas Thomopoulos
- Department of Cardiology, Elena Venizelou Hospital, 2 Elena Venizelou Sqr., Athens 11521, Greece
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