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Treating Apnea May Help BP
Treating Apnea May Help BP
By Chris Kaiser, Cardiology Editor, MedPage Today - Published: May 22, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania.

Treating obstructive sleep apnea in patients who have daytime sleepiness as a symptom may have an additional benefit -- a reduction in the risk of hypertension.

A pair of studies published in the May 23/30 issue of the Journal of the American Medical Association point to a possible link between a reduction in hypertension and the use of continuous positive airway pressure (CPAP), but only one of the studies -- an observational one -- found a significant reduction in new onset hypertension.

The second study, a randomized controlled trial, reported an observed treatment effect that did not reach statistical significance.

In the first study patients on CPAP therapy had an average 29% decreased risk of new-onset hypertension versus controls with obstructive sleep apnea who were ineligible for CPAP (HR 1.33), refused CPAP (HR 1.96), or were nonadherent to CPAP (HR 1.78), reported José M. Marin, MD, Hospital Universitario Miguel Servet in Zaragoza, Spain, and colleagues.

Marin's study followed 1,889 patients referred to a sleep center in Spain and followed for a median of 12.2 years. All participants were normotensive at baseline.

The patients had been referred to the sleep center by their primary care physicians because of complaints such as snoring and daytime sleepiness.

Mild obstructive sleep apnea was defined as an apnea-hypopnea index from 5 to 14.9, moderate was 15 and 29.9, and severe when was more than 30. Those with an apnea-hypopnea index of less than five events per hour served as controls (n=310).

The mean age of patients was 50 and the majority were men.

Marin and colleagues found that in unadjusted and adjusted analyses all untreated obstructive sleep apnea patients had a greater risk for new-onset hypertension compared with controls.

The risk of developing hypertension for those treated with CPAP was similar to that of controls.

All patients who developed hypertension had a significant increase in body mass index during follow-up, researchers reported.

In the second study, Ferran Barbé, MD, of Hospital Universitari Arnau de Vilanova in Lleida, Spain, and colleagues randomized 725 patients with obstructive sleep apnea to CPAP or no CPAP to assess the impact of treatment on the incidence of hypertension and/or the rate of cardiovascular events.

Patients were from 14 teaching hospitals in Spain and were recruited between 2004 and 2005.

The mean age of patients was 51 and the majority were men. The mean body mass index was 31 and mean blood pressure was 130/80 mm Hg. None of the patients had daytime sleepiness.

Cardiovascular events included hospitalizations for unstable angina or arrhythmia, nonfatal stroke, heart failure, nonfatal myocardial infarction, transient ischemic attack, and cardiovascular death.

Barbé and colleagues found no difference in the incidence of new hypertension or the rate of cardiovascular events at a median follow-up of 4 years between the two groups.

The incidence density rate of hypertension or cardiovascular events in the CPAP group was 11.02 per 100 person-years compared with 9.20 in the control group (P=0.20).

The investigators found that those who used CPAP less than 4 hours per night had more new-onset hypertension and cardiovascular events than those who used the therapy longer than 4 hours per night (incident density rate 1.13 versus 0.72) compared with controls. The difference was not significant.

However, during the study period, those with worse oxygen saturation who used CPAP for less 4 hours per night had a greater risk of hypertension and cardiovascular events than those who adhered to the therapy for more than 4 hours per night (incident density rate 1.89 versus 0.71) compared with controls.

The authors concluded that the use of CPAP in obstructive sleep apnea patients without daytime sleepiness may not reduce the incidence of hypertension or cardiovascular events. They suggested, however, that a larger study or longer follow-up might reveal some differences as their study may not have had the statistical power to show differences.

Both the observational study and Barbé's randomized controlled trial had a number of limitations.

Marin and colleagues noted their study was limited by its observational design, and they cautioned that the results cannot be interpreted as causal. Also, those who adhered to CPAP had better adherence to their drug therapy, which might suggest they are more health conscious.

Barbé and colleagues cited higher apnea-hypopnea index scores and worse oxygen saturation in the CPAP group at baseline, the potential "white coat" effect of blood pressure measurements at the clinic, and CPAP titration protocols that may have resulted in elevated residual AHI in CPAP treatment.

In an accompanying editorial, Edward M. Weaver, MD, MPH, and Vishesh K. Kapur, MD, MPH, from the University of Washington in Seattle, agreed that taken together the studies do not provide definitive evidence that CPAP therapy may reduce risk.

That said, they did agree that data "generally support a causal link with hypertension. Treatment may not only reduce blood pressure (although modestly on average), but if confirmed by future studies also may prevent hypertension in at-risk patients."

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I read that article. The entire time I'm going, "Duh, I could have told them that!".

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(05-22-2012, 10:28 PM)PaulaO2 Wrote: I read that article. The entire time I'm going, "Duh, I could have told them that!".

ROFL, yeah, me too. Big Grin

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That is most stupid thing I have ever heard. They spend time and money on this BS research? Any first year med student or OSA patient could tell you that! Not only does it shoot BP up at times during the sleep cycle.... it increases chances for stroke exponentially if left untreated. Ditto myocardial infarction (pardon). It gives you gas. It scares small children at night. It replaces snoring with face farts. I could go on. I just wanted to make a point that WE... the sleep apnea sufferers ourselves... are best equipped to learn, diagnose, titrate pressures, analyze data, proscribe improvements in treatment, etc. I discovered, after the myriad of doctors had run me through a myriad of tests, for example, that I had aFib and damaged lungs and a simple CPAP machine was doing diddly for me. I needed an APAP machine at least and I needed infused O2 into the air line (which I also titrated myself using data collection nightly). Presto. OSA AHI=0.00 every darned night. Problem is that it got boring and I have let the supervision of my own problem slip.... I am now analyzing data again and will re-titrate both CPAP/APAP pressure range and oxygen infusion. My aFib is in remission thanks to TIKOSYN med and I have been in Normal Sinus Rhythm since December.... with a full load of oxygenated blood being pumped about my body. It's a whole new world. Still .... need to study and learn is huge if one has sleep apnea or aFib or WHATEVER! The MD's, contrary to popular opinion, know not everything. And they make lots of boo boos. My first cardiologist passed me in the hospital yesterday. Had he said hello I probably would have whacked him in the nose. Long story but he should not be practising cardiology any longer but one is afraid to rock the boat for fear of repurcussions in treatment down the road from others.

It never ceases to amaze me. If I could say but one thing to a newbie? It would be EDUCATE YOURSELF CONSTANTLY, TAKE EVERYTHING WITH A GRAIN OF SALT, ADVOCATE FOR YOURSELF and above all know what your body needs and provide it.

Over and out..... Up and Awayyyyyyy!
Educate, Advocate, Contemplate.
Herein lies personal opinion, no professional advice, which ALL are well advised to seek.

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Quote: WE... the sleep apnea sufferers ourselves... are best equipped to learn, diagnose, titrate pressures, analyze data, proscribe improvements in treatment, etc.

Thats all well and good but what about the simple folk or the pensioners? They need the docs to sort their problems out otherwise the machine will sit in the cubard. Any fool can collect data but understanding it is another matter. For these people going it alone isnt an option.
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