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Long-term Effect of Continuous Positive Airway Pressure in Hypertensive Patients with Sleep Apnea

¹ Coordinating Center, Institut de Recerca Biomèdica Lleida, Lleida; ² Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid; ³ Sleep Unit, Hospital Txagorritxu, Vitoria; ⁴ Respiratory Department, Hospital Virgen del Rocío, Sevilla; ⁵ Respiratory Department, Hospital Universitario Son Dureta, Palma de Mallorca; ⁶ Respiratory Department, Hospital Sant Joan, Alacant; ⁷ Respiratory Department, Hospital San Pedro de Alcántara, Cáceres; ⁸ Respiratory Department, Hospital Marques de Valdecilla, Santander; ⁹ Respiratory Department, Hospital Miguel Servet, Zaragoza; ¹⁰ Respiratory Department, Hospital La Paz, Madrid; ¹¹ Respiratory Department, Hospital 12 de Octubre, Madrid; ¹² Respiratory Department, Hospital General Yagüe, Burgos; ¹³ Respiratory Department, Hospital Sant Pau, Barcelona; ¹⁴ Respiratory Department, Hospital de Bellvitge, Barcelona; ¹⁵ Respiratory Department, Hospital Rio Hortega, Valladolid; ¹⁶ Respiratory Department, Hospital Clinic, Barcelona, Spain

Correspondence and requests for reprints should be addressed to Ferran Barbé, M.D., Respiratory Department, IRB Lleida, Hospital Univ Arnau de Vilanova, Rovira Roure, 80 25198 Lleida, Spain. E-mail: fbarbe{at}arnau.scs.es

Rationale: Continuous positive airway pressure (CPAP) is the current treatment for patients with symptomatic obstructive sleep apnea (OSA). Its use for all subjects with sleep-disordered breathing, regardless of daytime symptoms, is unclear.

Objectives: This multicenter controlled trial assesses the effects of 1 year of CPAP treatment on blood pressure (BP) in nonsymptomatic, hypertensive patients with OSA.

Methods: We evaluated 359 patients with OSA. Inclusion criteria consisted of an apnea–hypopnea index (AHI) greater than 19 hour^–1, an Epworth Sleepiness Scale score less than 11, and one of the following: under antihypertensive treatment or systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 mm Hg. Patients were randomized to CPAP (n = 178) or to conservative treatment (n = 181). BP was evaluated at baseline and at 3, 6, and 12 months of follow-up.

Measurements and Main Results: Mean (SD) values were as follows: age, 56 ± 10 years; body mass index (BMI), 32 ± 5 kg · m^–2; AHI, 45 ± 20 hour^–1; and Epworth Sleepiness Scale score, 7 ± 3. After adjusting for follow-up time, baseline blood pressure values, AHI, time with arterial oxygen saturation less than 90%, and BMI, together with the change in BMI at follow-up, CPAP treatment decreased systolic blood pressure by 1.89 mm Hg (95% confidence interval: –3.90, 0.11 mm Hg; P = 0.0654), and diastolic blood pressure by 2.19 mm Hg (95% confidence interval: –3.46, –0.93 mm Hg; P = 0.0008). The most significant reduction in BP was in patients who used CPAP for more than 5.6 hours per night. CPAP compliance was related to AHI and the decrease in Epworth Sleepiness Scale score.

Conclusions: In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night.

Clinical trial registered with www.clinicaltrials.gov (NCT00127348).

Key Words: blood pressure • controlled clinical trial • compliance

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Continuous positive airway pressure (CPAP) is the current treatment for patients with symptomatic obstructive sleep apnea (OSA). The effects of CPAP on blood pressure are moderate and variable. Short-term studies performed in subjects with severe OSA but without daytime sleepiness failed to show any effect of CPAP on 24-hour ambulatory blood pressure. These studies infer that CPAP in not useful in nonsleepy patients. What This Study Adds to the Field This study shows that, in hypertensive patients with severe obstructive sleep apnea but without daytime hypersomnolence, 1 year of CPAP treatment slightly reduces blood pressure.

 

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