Influence of therapy continuous positive airway pressure on arterial stiffness in patients with arterial hypertension and obstructive sleep apnea

Abstract

The aim – to assess the arterial stiffness changes in patients with arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy.Materials and methods. 185 patients with mild and moderate AH (49.8±0.8 years old) were enrolled in the study and divided into groups: 1st group – patients who had OSA (n=148), 2nd group – patients without OSA (control group, n=37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, estimation of daily sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. In 10 months follow-up study were included 105 patients, who were divided into 4 subgroups: A – patients with moderate to severe OSA on CPAP (n=23); B – patients with moderate to severe OSA without CPAP (n=29); C – patients with mild OSA (n=29); D – patients without OSA (controls, n=24). All patients received similar antihypertensive therapy according to 2013 ESH/ESC Guidelines.Results and discussion. Patients with AH and OSA (mean apnea-hypopnea index (AHI) 38.10±2.51 event/h) in comparison with patients without OSA (mean AHI 3.02±0.25 event/h) had significantly higher body mass index (35.20±0.57 vs 30.60±0.79 kg/m, p<0.001), blood glucose level (107.2±2.2 vs 98.0±2.5 mg/dl, p=0.045), uric acid level (6.17±0.10 vs 5.5±0.3 mg/dl, p=0.048) and left ventricular mass index (LVMI) (115.80±2.39 vs 104.60±4.56 g/m, p=0.035). Also the patients with AH and OSA in comparison with patients without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (11.19±0.20 vs 10.10 m/s, p=0.014) and central systolic blood pressure (CSBP) (133.43±1.67 vs 125.22±3.41 mm Hg, p=0.027). During 10 month follow-up in patients with AH and OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.20±0.63 to 10.05±0.43 m/s, p=0.009) with achievement of normal level (<10 m/s) in 60.9 % patients, office systolic blood pressure (from 143.8±132.7 to 132.70±2.33 mm Hg, p=0.021) and diastolic blood pressure (from 93.80±3.31 to 86.00±3.19 mm Hg, p=0.012) with achievement of target levels. In patients central systolic BP decreased (from 130.30±3.97 to 119.70±2.97 mm Hg, p=0.012) and diastolic BP decreased (from 94.70±3.31 to 87.10±2.36 mm Hg, p=0.013).Conclusions. Combination of continuous positive airway pressure (CPAP)-therapy and antihypertensive treatment had decrease of arterial stiffness and helps to achieve target blood pressure in patients with AH and moderate to severe OSA.