Blood Pressure Variability in Obstructive Sleep Apnoea: Data from 4 Randomised Controlled CPAP Withdrawal Trials.
- Lettau F Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
- Schwarz EI
- Stradling JR
- Kohler M
- 2017-03-29
Published in:
- Respiration; international review of thoracic diseases. - 2017
Aged
Blood Pressure
Continuous Positive Airway Pressure
Female
Heart Rate
Humans
Male
Middle Aged
Sleep Apnea, Obstructive
Withholding Treatment
English
BACKGROUND
Increased daytime blood pressure variability (BPV) is associated with cardiovascular risk. Preliminary data suggest that obstructive sleep apnoea (OSA) might contribute to increased daytime BPV.
OBJECTIVE
The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) therapy withdrawal on daytime BPV.
METHODS
A total of 183 patients previously diagnosed with OSA and treated with CPAP were randomised to either continue or withdraw from CPAP within 4 trials. Office morning BP was measured in triplicate at baseline and at follow-up (day 14). In addition, the participants performed BP measurements at home on a daily basis (days 1-13). The main outcome of interest was the treatment effect on within-visit BPV expressed as the standard deviation (SD) of the triplicate measurements. Additional outcomes included morning home BPV and day-to-day home BPV.
RESULTS
Within-visit variability in systolic BP significantly increased in response to recurrence of OSA in the CPAP withdrawal group (difference between groups in SD of systolic BPV, +1.14 mm Hg, 95% CI +0.20/+2.09, p = 0.02). There was no statistically significant effect on within-visit variability in diastolic BP (p = 0.38) or heart rate (p = 0.07). Neither morning home BP variability (systolic BPV, p = 0.81; diastolic BPV, p = 0.46) nor day-to-day variability in home BP measurements (systolic BPV, p = 0.61; diastolic BPV, p = 0.58) differed significantly between the groups.
CONCLUSION
CPAP withdrawal results in a minor increase in within-visit variability in office systolic BP, but it has no effect on home BPV or day-to-day BPV. Although the treatment effect may be blunted by antihypertensives, it is unlikely that OSA contributes to cardiovascular risk via elevated daytime BPV.
Increased daytime blood pressure variability (BPV) is associated with cardiovascular risk. Preliminary data suggest that obstructive sleep apnoea (OSA) might contribute to increased daytime BPV.
OBJECTIVE
The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) therapy withdrawal on daytime BPV.
METHODS
A total of 183 patients previously diagnosed with OSA and treated with CPAP were randomised to either continue or withdraw from CPAP within 4 trials. Office morning BP was measured in triplicate at baseline and at follow-up (day 14). In addition, the participants performed BP measurements at home on a daily basis (days 1-13). The main outcome of interest was the treatment effect on within-visit BPV expressed as the standard deviation (SD) of the triplicate measurements. Additional outcomes included morning home BPV and day-to-day home BPV.
RESULTS
Within-visit variability in systolic BP significantly increased in response to recurrence of OSA in the CPAP withdrawal group (difference between groups in SD of systolic BPV, +1.14 mm Hg, 95% CI +0.20/+2.09, p = 0.02). There was no statistically significant effect on within-visit variability in diastolic BP (p = 0.38) or heart rate (p = 0.07). Neither morning home BP variability (systolic BPV, p = 0.81; diastolic BPV, p = 0.46) nor day-to-day variability in home BP measurements (systolic BPV, p = 0.61; diastolic BPV, p = 0.58) differed significantly between the groups.
CONCLUSION
CPAP withdrawal results in a minor increase in within-visit variability in office systolic BP, but it has no effect on home BPV or day-to-day BPV. Although the treatment effect may be blunted by antihypertensives, it is unlikely that OSA contributes to cardiovascular risk via elevated daytime BPV.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1159/000465528
- PMID 28351060
- Persistent URL
- https://sonar.ch/global/documents/191261
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