The Effect of Continuous Positive Airway Pressure (CPAP) in Treatment of Patients with Refractory High Blood Pressure Associated with Severe Obstructive Sleep Apnea (OSA)

Introduction: Obstructive sleep apnea is very common in patients with high blood pressure (HBP), especially in whom with refractory HBP (R-HBP). It has been suggested treatment with continuous positive airway pressure (CPAP) might ameliorate the blood pressure in these patients. This study was planned to evaluate the effect of CPAP for treatment of R-HBP patients with severe OSA. Methods: It was a cross-sectional and descriptive study. All patients with R-HBP associated with clinical symptoms of OSA were included in this study. They underwent polysomnography (PSG) for diagnosis severe OSA. The patients with severe OSA (apnea-hypopnea index (AHI) >30/hour) were treated with CPAP. They had been followed-up during 3 months. Result: There was 48 patients with R-HBP and symptoms of OSA had PSG. Thirty-nine patients had severe OSA (81.2%) and 32/39 (82.1%) accepted to treat with CPAP. The mean age was 54 ± 8 years (45-64 years) with male-female ratio was 1.6; mean BMI was 27.5 ± 4.6 kg/m2 (23.2-32.5 kg/m2); mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 160 ± 15 mmHg and 105 ± 10 mmHg, respectively. Epworth score was 16 ± 4 with AHI was 37 ± 5/hour. There were a significant reduction of SBP and DBP before and after 3 months treated with CPAP (P<0.01 and P<0.01; respectively). Epworth score was significant lower after 3 months with CPAP than at inclusion (P<0.01). Fasting glucose and total and LDL cholesterol were significantly reduced after treatment with CPAP (P<0.05 and P<0.05). Conclusion: The prevalence of severe OSA is high in patients with R-HBP having clinical symptoms of OSA. This high prevalence is usually associated with overweight, a high risk factor for R-HBP and OSA. The treatment with CPAP might help to control of blood pressure in patients with R-HBP associated with severe OSA.