Background. Obstructive sleep apnea (OSA), especially severe, is related to fatal and non-fatal cardiovascular events. OSA and arterial hypertension (AH) have significant correlations, and this comorbidity is very common and is associated with an increased risk of cardiovascular diseases. One of the causes is an increased arterial stiffness. Aortic pulse wave velocity is a highly reproducible noninvasive indicator of arterial stiffness recommended in current guidelines for evaluation of cardiovascular risk. The purpose of the study was to assess the arterial stiffness changes in patients with AH and OSA and possibilities of its correction by continuous positive airway pressure (CPAP) therapy. Materials and methods. One hundred and eighty-five patients with mild and moderate AH (49.80 ± ± 0.80 years old) were enrolled in the study and divided into groups: group 1 — those who had OSA (n = 148), group 2 — individuals without OSA (controls, n = 37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, evaluation of daytime sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and assessment of pulse wave velocity. The 10-month follow-up study included 105 patients, who were divided into 4 subgroups: A — those with moderate to severe OSA on CPAP (n = 23); B — individuals with moderate to severe OSA without CPAP (n = 29); C — patients with mild OSA (n = 29); D — people without OSA (controls, n = 24). All examinees received similar antihypertensive therapy according to 2013 European Society of Hypertension/European Society of Cardiology Guidelines. Results. Patients with AH and OSA (mean apnea-hypopnea index of 38.10 ± 2.51 events/h) compared to those without OSA (mean apnea-hypopnea index of 3.02 ± 0.25 events/h) had significantly higher body mass index (35.20 ± 0.57 kg/m2 vs 30.60 ± 0.79 kg/m2, P < 0.001), as well as blood glucose level (107.2 ± 2.2 mg/dl vs 98.0 ± 2.5 mg/dl, P = 0.045), uric acid level (6.17 ± 0.10 mg/dl vs 5.5 ± 0.3 mg/dl, P = 0.048) and left ventricular mass index (115.80 ± 2.39 g/m2 vs 104.60 ±± 4.56 g/m2, P = 0.035). During 10 months of follow-up, patients with AH and OSA on CPAP therapy reported a significant decrease in pulse wave velocity in elastic arteries (from 12.20 ± 0.63 m/s to 10.05 ± 0.43 m/s, P = 0.009), office systolic blood pressure (from 143.8 ± 132.7 mm Hg to 132.70 ± ± 2.33 mm Hg; P = 0.021) and diastolic blood pressure (from 93.80 ± 3.31 mm Hg to 86.00 ± 3.19 mm Hg; P = 0.012). Central systolic blood pressure also decreased (from 130.30 ± ± 3.97 mm Hg to 119.70 ± 2.97 mm Hg; P = 0.012). Conclusions. Combination of continuous positive airway pressure therapy and antihypertensive treatment improves arterial elasticity and helps achieve target blood pressure in hypertensive patients with moderate to severe obstructive sleep apnea.
Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity
