scholarly journals Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy

2021 ◽  
Vol 12 ◽  
Author(s):  
Pattaraporn Panyarath ◽  
Noa Goldscher ◽  
Sushmita Pamidi ◽  
Stella S. Daskalopoulou ◽  
Robert Gagnon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Hypertensive Disorders Of Pregnancy ◽  
Adjusted Analysis ◽  
Nocturnal Blood Pressure ◽  
Hypertensive Disorders ◽  
Obstructive Sleep ◽  
The Impact

Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness.Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses.Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis.Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.

Abstract 2462: Obstructive Sleep Apnea Treatment Improves the Blood Pressure Behavior in Normotensive Patients: A Randomized Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Luciano F Drager ◽  
Patrícia M Diniz ◽  
Luzia Diegues-Silva ◽  
Roberta B Couto ◽  
Rodrigo P Pedrosa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Study ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Impact ◽  
Current Guidelines ◽  
Concomitant Hypertension

Introduction: Obstructive sleep apnea (OSA) promotes significant alterations on blood pressure during sleep. In patients with concomitant hypertension, the treatment with continuous positive airway pressure (CPAP) promotes significant reductions on blood pressure. However, the impact of CPAP on 24 hour blood pressure in normotensive patients is poorly understood. Methods: We included 22 apparently healthy patients with severe OSA defined by polysomnography (apnea/hypopnea index (AHI) >30 events/hour). We excluded hypertension according current guidelines by office measurements. They were randomized to no treatment (control) or CPAP for 3 months. At baseline and at the end of the protocol, we performed 24 hour blood pressure (BP) monitoring evaluating daytime and nighttime BP as well as the morning surge (average of systolic BP during the 2 hours after awakening minus the average of systolic BP during the 1 hour that included the lowest nighttime BP) and highest systolic nighttime BP (mean of 3 BP measurements, centered on the highest nighttime reading). Results: After 3 months, patients randomized to CPAP (mean CPAP usage: 6 hours) presented a significant reduction on daytime (80.3±6.3 to 75.3±6.9 mmHg; P=0.02) and nighttime diastolic BP (67.8±9.5 to 61.4±7.5 mmHg; P=0.03). In addition, we observed a significant reduction on highest nighttime systolic BP (120.0±13.6 to 112.0±.9 mmHg; P=0.02) with a trend for a reduction on morning surge (22.3±9.2 to 17.3±.4 mmHg; P=0.08). No significant alterations occurred in the control group. Conclusion: Even in the absence of established hypertension, CPAP therapy improved the behavior of 24 hour BP in patients with severe OSA.

Lateral pharyngoplasty reduces nocturnal blood pressure in patients with obstructive sleep apnea

2013 ◽  
Vol 124 (1) ◽  
pp. 311-316 ◽  
Author(s):  
Carolina F. Paula Soares ◽  
Luciano Cavichio ◽  
Michel B. Cahali
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nocturnal Blood Pressure ◽  
Obstructive Sleep ◽  
Lateral Pharyngoplasty

scholarly journals Arterial stiffness and obstructive sleep apnea in patients with arterial hypertension and continuous positive airway pressure therapy

HYPERTENSION ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 39-49
Author(s):  
Yu.M. Sirenko ◽  
O.L. Rekovets ◽  
N.A. Krushynska ◽  
O.O. Torbas ◽  
S.M. Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Airway Pressure ◽  
Pulse Wave ◽  
Positive Airway Pressure ◽  
Obstructive Sleep

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.

scholarly journals Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?

Hypertension ◽  
2018 ◽  
Vol 72 (2) ◽  
pp. 399-407 ◽  
Author(s):  
Fernanda Fatureto-Borges ◽  
Raimundo Jenner ◽  
Valéria Costa-Hong ◽  
Heno F. Lopes ◽  
Sandra H. Teixeira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Antihypertensive Treatment ◽  
Obstructive Sleep
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