there was no overall significant difference in mean 24-h bp: the change in mean 24-h bp on therapeutic cpap was -2.1 mmhg (sd 8.1), and -1.1 mmhg (sd 8.1) on subtherapeutic cpap, with a difference of 0.7 mmhg (95% confidence interval (ci) +2.9– -4.4). due to the high incidence of cardiovascular complications in patients with osa, some now advocate cpap treatment for all these patients 22, regardless of daytime symptoms. the 24-h bp recording was only performed on potential subjects if a casual clinic bp was >140/90 mmhg, and if they were not already on antihypertensive drugs. patients were not aware which cpap pressure they had received, and the nurse who assigned the patients to each treatment arm did not take part in outcome assessments. the correlation between the change in bp and the two potential predictors, baseline bp and osa severity, were examined, as was any correlation with therapeutic cpap compliance.
two of the patients treated in the therapeutic cpap arm first were withdrawn before completing the first months’ treatment period, one because of intolerance of the bp cuff, and one because the bp data collected were inadequate. the median baseline dip rate in sa,o2 of >4% was 28.1. there was no significant overall mean bp change on therapeutic or subtherapeutic cpap depending on baseline osa severity. this is in contrast to the bp fall seen in hypersomnolent patients with osa treated with cpap 13–15, 17. it also suggests that hypersomnolence might in some way be important for the pathogenesis of the hypertension of sleep apnoea. this current group of subjects had a median >4% sa,o2 dip rate of 28.1. the present authors’ previously studied osa population had a baseline median >4% sa,o2 dip rate of 33 13. in these earlier subjects, the majority of the bp falls with therapeutic cpap was in those subjects with >33 dips in sa,o2 of >4% per hour. despite 77% of the present subjects being on antihypertensive drugs, there was no fall in bp, further suggesting that a fall in bp should have been seen if nonhypersomnolent patients with osa behave similarly to hypersomnolent patients. at present, based on the present study and that of barbe et al.
a comparison of the treatments — continuous positive airway pressure (cpap) and mandibular advancement devices (mads) — showed that each produces a modest reduction in both systolic and diastolic blood pressure rates, the researchers found. “both treatments have similar positive effects on blood pressure, but the treatment effect of cpap seems to be larger in patients who have more hours of sleep,” he said. according to the u.s. national heart, lung, and blood institute, sleep apnea is a common and chronic condition in which breathing stops or becomes shallow during sleep. sleep apnea is the leading cause of excessive daytime sleepiness, and can cause high blood pressure, which raises heart disease risk, the agency says. in continuous positive airway pressure, patients wear a face mask hooked up to a device that produces mild air pressure to keep the airway open.
“mads are to be considered as an alternative treatment to the more widely used cpap, especially in patients who fail to adapt to cpap treatment,” kohler added. for the study, kohler and colleagues looked at the ability of cpap and mads to lower blood pressure in 51 previously published studies that included a total of nearly 5,000 patients. mads were associated with a reduction in systolic blood pressure of 2.1 mm hg and 1.9 mm hg in diastolic blood pressure, the researchers reported. although no statistically significant difference between cpap and mads in lowering blood pressure was found, cpap was more likely to have a strong association with lowering systolic blood pressure, kohler said. “cpap is the tried-and-true method of treating sleep apnea and it’s effective across the whole spectrum of severity,” rajan said. rajan said that the reductions in blood pressure seen with both devices were modest.
among patients with osa and resistant hypertension, cpap treatment for 12 weeks, compared to control, resulted in a decrease in 24-hour mean and randomized trials have demonstrated consistently that osa therapy with cpap lowers blood pressure by 2-3 mm hg. this effect is clinically significant in that there’s a wealth of research suggesting that sleep apnea and high blood pressure are a dangerous pair. obstructive sleep apnea, which occurs, .
darien, il u2013 a new study suggests that continuous positive airway pressure (cpap) therapy rapidly improves blood pressure and arterial tone in adults with obstructive sleep apnea (osa). several randomised controlled trials have shown that continuous positive airway pressure (cpap) treatment of osa reduces blood pressure (bp). studies investigating the effects of cpap in patients with hypertension and osa have shown that treatment with cpap lowers blood pressure during they found that cpap was associated with a reduction in systolic blood pressure (top number of a reading) of 2.5 mm hg and a reduction of 2.0 mm, .
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