Obstructive sleep apnea syndrome and arterial hypertension--a complicated relationship? The role of controlling blood pressure values in patients with OSAS.

BACKGROUND: Arterial hypertension (HT) and obstructive sleep apnea syndrome (OSAS) are associated through cause-effect relationship. We aimed to study the effect of medication controlled hypertension on OSAS patients. METHODS: From 483 followed patients with OSAS, 252 associating HT; 142 patients of them (56.34%) received antihypertensive medication, 59 patients (41.54%) had controlled HT, 83 patients (58.46%) had uncontrolled HT. Demographic and anthropometric data, OSAS symptoms, comorbidities, apnea index (IA), apnea-hypopnea index (IAH), desaturation index, CPAP titration, CPAP failure rate were studiated regarding differences between patients with controlled and uncontrolled HT. RESULTS: Fifty nine patients with controlled HT were: 20 women (33.9%), 39 men (66.1%), with mean age of 56.08 years +/- 11.33, with an average AHI of 53.61 +/- 34.42/hour, an average of CPAP pressure prediction of 10.15 +/- 243 cm H2O. Eighty three patients with uncontrolled HT were: 18 women (21.7%), 65 men (78.3%), with mean age 55 +/- 9.06 years, with an average AHl of 61.91 +/- 43.61/hour, an average of CPAP pressure prediction of 10.47 +/- 2cm H2O. Comparing with the controlled HT group, patients with uncontrolled HT reported morning headaches, morning fatigue and impotency in a higher rate (p = 0.020, 0.018, 0.011 respectively); Epworth Sleepiness Scale was under 10 (cut-off for daytime sleepiness) in patients with controlled HT(p = 0.001) and higher in those with uncontrolled HT. Patients with uncontrolled HT were diagnosed with HT for a longer period (p = 0.006), had higher values of systolic and diastolic blood pressure at the time of the presentation. Statistically significant differences were found only for AHI post-CPAP (11.89/h vs. 22.30/h, p = 0.013) and nocturnal desaturation index post-CPAP (6.03/h vs. 16.55/h, p = 0.017), both higher in patients with uncontrolled HT. The hypothesis regarding existing differences related to the cardiovascular comorbidities was not supported. CONCLUSIONS: Controlled blood pressure deletes sleepiness, a defining symptom for OSAS and reduces remaining symptoms (headaches, impotency and morning fatigue). Presence of OSAS symptoms is less common in the controlled HT group, making the OSAS more difficult to suspect. These patients may have a grater benefit from CPAP therapy--they have AHI post-CPAP and desaturations post-CPAP significantly lower than patients with uncontrolled HT.

Long-term gender-specific evolution of blood pressure under CPAP therapy in hypertensive patients with obstructive sleep apnea syndrome.

INTRODUCTION: Reduction of blood pressure (BP) under CPAP treatment in patients with obstructive sleep apnea syndrome (OSAS) associating hypertension (HT) is controversial and short-term evolution is often measured using the sphygmomanometer. PURPOSE: To study the variation in BP (sphygmomanometer and Holter) after 3 and 6 months of CPAP in OSAS patients associating hypertension. METHODS: We applied the exclusion criteria (hypoventilation, respiratory diseases, secondary hypertension, antihypertensive treatment modification during study, non-compliance) on 96 consecutive patients (SPSS 17.0: Chi test, T-test). RESULTS: 15 hypertensive patients (8.53 years from diagnosis) with OSAS succeeded six months of following: 3 women (20%), 12 men (80%) were comparable as age, body mass index and Epworth score; women had more severe OSAS. Sphygmomanometer measuring in men showed a decrease in systolic BP (SBP) (142 ± 8.9 to 128.7 ± 11.7 mmHg, p = 0.005) and diastolic BP (DBP) (82 ± 17.19 to 69.1 ± 6.6 mmHg, p = 0.040) at three months of treatment. Women had no changes at 3 and 6 months of assessment using the sphygmomanometer. BP Holter showed no significant changes in men; women exhibit a significant increase in maximum DBP/24 hours (104 ± 13.4 to 169.5 ± 27.5 mmHg, p = 0.034) and mean daytime DBP/24 hours (100 ± 14.1 to 166 ± 32.5 mmHg, p = 0.046) from 3 to 6 months. No group presents dipper status change to 3 or 6 months. CONCLUSIONS: The trend in both groups of increase in BP for 3 to 6 months is explained by the natural evolution of an old HT history. Long time monitoring using Holter device is more accurate in assessing cardiovascular risk.