scholarly journals The effect of antihypertensive therapy and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea syndrome in association with arterial hypertension

2017 ◽  
Vol 14 (1) ◽  
pp. 37-40
Author(s):  
E M Elfimova ◽  
A V Rvacheva ◽  
M I Tripoten ◽  
O V Pogorelova ◽  
T V Balakhonova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Endothelial Dysfunction ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Adhesion Molecule ◽  
Severe Obstructive Sleep Apnea ◽  
Cpap Therapy ◽  
Obstructive Sleep

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

scholarly journals BLOOD PRESSURE AND ARTERIAL STIFFNESS DYNAMICS DEPENDING ON THE DURATION OF CPAP NIGHT SESSIONS IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA

2019 ◽  
Vol 9 (4) ◽  
pp. 280-289
Author(s):  
M. V. Gorbunova ◽  
S. L. Babak ◽  
T. V. Adasheva ◽  
A. G. Malyavin
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Resistant Hypertension ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Target Values

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

scholarly journals The effect of combined antihypertensive therapy on arterial wall rigidity in male patients with hypertension, obesity and obstructive sleep apnea

2016 ◽  
Vol 13 (4) ◽  
pp. 36-40
Author(s):  
E M Elfimova ◽  
A R Zairova ◽  
M V Andrievskaya ◽  
R M Bogieva ◽  
A N Rogoza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Fixed Combination ◽  
Target Blood Pressure ◽  
Obstructive Sleep ◽  
Target Values ◽  
Male Patients

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population

2013 ◽  
Vol 14 (9) ◽  
pp. 838-842 ◽  
Author(s):  
Mailys Guillot ◽  
Emilia Sforza ◽  
Emilie Achour-Crawford ◽  
Delphine Maudoux ◽  
Magali Saint-Martin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Older People ◽  
Arterial Hypertension ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep
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