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Am. J. Respir. Crit. Care Med., Volume 163, Number 2, February 2001, 344-348

Randomized Placebo-controlled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep Apnea-Hypopnea Syndrome

JACQUELINE F. FACCENDA, THOMAS W. MACKAY, NICHOLAS A. BOON, and NEIL J. DOUGLAS

Respiratory Medicine Unit and Cardiovascular Unit, University of Edinburgh, Royal Infirmary, Edinburgh, Scotland, United Kingdom

Arterial blood pressure rises at apnea termination, and there is increasing evidence that the sleep apnea-hypopnea syndrome (SAHS) is associated with daytime hypertension but no randomized controlled trial evidence of whether SAHS treatment reduces blood pressure exists. We, therefore, conducted a randomized placebo-controlled cross-over study of the effects of 4 wk of continuous positive airway pressure (CPAP) or oral placebo on 24-h blood pressure in 68 patients (55 males, 13 females; median apnea-hypopnea index [AHI], 35) not receiving hypotensive medication. Ambulatory blood pressure was recorded for the last 48 h of each treatment. Epworth Sleepiness Score (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ) were also recorded. All patients were normotensive. There was a small decrease in 24-h diastolic blood pressure (placebo, 79.2 [SE 0.9] mm Hg; CPAP, 77.8 [SE 1.0] mm Hg; p = 0.04) with the greatest fall occurring between 2:00 A.M. and 9:59 A.M. The observed decrease in 24-h diastolic blood pressure was greater in two a priori groups, CPAP use >=  3.5 h per night (81.5 [SE 1.2] mm Hg; 79.6 [SE 1.2] mm Hg; p = 0.03) and those with more than twenty 4% desaturations per hour (82.4 [SE 2.1] mm Hg; 77.4 [SE 2.1] mm Hg; p = 0.002). Systolic pressure also fell in the latter group (133.1 [SE 2.8] mm Hg; 129.1 [SE 2.1] mm Hg; p = 0.009). Desaturation frequency was the best predictor of diastolic blood pressure fall with CPAP (r = 0.38; p = 0.002). Both ESS and FOSQ domains improved. Thus, CPAP can reduce blood pressure in patients with SAHS, particularly in those with nocturnal oxygen desaturation, but the decrease is small.




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[Abstract] [Full Text] [PDF]


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CirculationHome page
H. F. Becker, A. Jerrentrup, T. Ploch, L. Grote, T. Penzel, C. E. Sullivan, and J. H. Peter
Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea
Circulation, January 7, 2003; 107(1): 68 - 73.
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Am. J. Respir. Crit. Care Med.Home page
C. A. Massie, N. McArdle, R. W. Hart, W. W. Schmidt-Nowara, A. Lankford, D. W. Hudgel, N. Gordon, and N. J. Douglas
Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home
Am. J. Respir. Crit. Care Med., January 1, 2003; 167(1): 20 - 23.
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Eur Respir JHome page
W.T. McNicholas and J. Krieger on behalf of the Ta and Members of the Task Force: W.T. McNicholas , P. Le
Public health and medicolegal implications of sleep apnoea
Eur. Respir. J., December 1, 2002; 20(6): 1594 - 1609.
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Eur Respir JHome page
M. Alchanatis, G. Tourkohoriti, E.N. Kosmas, G. Panoutsopoulos, S. Kakouros, K. Papadima, M. Gaga, and J.B. Jordanoglou
Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome
Eur. Respir. J., November 1, 2002; 20(5): 1239 - 1245.
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JAMAHome page
S. T. Kuna
A 54-Year-Old Man With Obstructive Sleep Apnea
JAMA, October 23, 2002; 288(16): 2032 - 2039.
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ChestHome page
N. A. Collop
Silent Bedpartners : Obstructive Sleep Apnea and Hypertension, 6 Years Later
Chest, October 1, 2002; 122(4): 1111 - 1112.
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ChestHome page
K. M. Hla, J. B. Skatrud, L. Finn, M. Palta, and T. Young
The Effect of Correction of Sleep-Disordered Breathing on BP in Untreated Hypertension
Chest, October 1, 2002; 122(4): 1125 - 1132.
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ChestHome page
D. S.C. Hui, D. K.L. Choy, L. K.S. Wong, F. W.S. Ko, T. S.T. Li, J. Woo, and R. Kay
Prevalence of Sleep-Disordered Breathing and Continuous Positive Airway Pressure Compliance* : Results in Chinese Patients With First-Ever Ischemic Stroke
Chest, September 1, 2002; 122(3): 852 - 860.
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Am. J. Respir. Crit. Care Med.Home page
M. R. Bonsignore, G. Parati, G. Insalaco, O. Marrone, P. Castiglioni, S. Romano, M. Di Rienzo, G. Mancia, and G. Bonsignore
Continuous Positive Airway Pressure Treatment Improves Baroreflex Control of Heart Rate during Sleep in Severe Obstructive Sleep Apnea Syndrome
Am. J. Respir. Crit. Care Med., August 1, 2002; 166(3): 279 - 286.
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Clin. DiabetesHome page
S. Boyer and V. Kapur
Obstructive Sleep Apnea: Its Relevance in the Care of Diabetic Patients
Clin. Diabetes, July 1, 2002; 20(3): 126 - 132.
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Am. J. Respir. Crit. Care Med.Home page
T. Young, P. E. Peppard, and D. J. Gottlieb
Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective
Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1217 - 1239.
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Am. J. Respir. Crit. Care Med.Home page
H. M. Engleman
When Does `Mild' Obstructive Sleep Apnea/Hypopnea Syndrome Merit Continuous Positive Airway Pressure Treatment?
Am. J. Respir. Crit. Care Med., March 15, 2002; 165(6): 743 - 745.
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Am. J. Respir. Crit. Care Med.Home page
M. BARNES, D. HOUSTON, C. J. WORSNOP, A. M. NEILL, I. J. MYKYTYN, A. KAY, J. TRINDER, N. A. SAUNDERS, R. D. MCEVOY, and R. J. PIERCE
A Randomized Controlled Trial of Continuous Positive Airway Pressure in Mild Obstructive Sleep Apnea
Am. J. Respir. Crit. Care Med., March 15, 2002; 165(6): 773 - 780.
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Am. J. Respir. Crit. Care Med.Home page
M. J. TOBIN
Sleep-Disordered Breathing, Control of Breathing, Respiratory Muscles, and Pulmonary Function Testing in AJRCCM 2001
Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 584 - 597.
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Am. J. Respir. Crit. Care Med.Home page
N. J. Douglas, H. M. Engleman, J. F. Faccenda, and N. McArdle
THE SCIENCE OF DESIGNING ETHICAL CPAP TRIALS
Am. J. Respir. Crit. Care Med., January 1, 2002; 165(1): 132a - 134.
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ThoraxHome page
N J Douglas and C F P George
Treating sleep apnoea is cost effective
Thorax, January 1, 2002; 57(1): 93 - 93.
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Am. J. Respir. Crit. Care Med.Home page
R. S. T. LEUNG and T. DOUGLAS BRADLEY
Sleep Apnea and Cardiovascular Disease
Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165.
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ThoraxHome page
J R Stradling, J C T Pepperell, and R J O Davies
Sleep apnoea and hypertension: proof at last?
Thorax, September 1, 2001; 56(90002): ii45 - 49.
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