Sleep Disorders |

The Role of Cortical Arousals as an Indicator of Poor Sleep Quality in the Reduction of Blood Pressure Under Long-term CPAP Therapy for Obstructive Sleep Apnea and Resistant Hypertension FREE TO VIEW

Oana-Claudia Deleanu, MD; Andra Malaut, MD; Ana Maria Nebunoiu, MD; Alexandra Roberta Sandu, MD; Valentin Caius Cosei, MD; Ruxandra Ulmeanu, PhD; Agripina Rascu, PhD; Florin Mihaltan, PhD; Paraschiva Postolache, PhD
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University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Chest. 2015;148(4_MeetingAbstracts):1057A. doi:10.1378/chest.2280075
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SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The role of arousals in blood pressure (BP) response to CPAP therapy in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH) was not studied. We evaluated patients with moderate-severe OSA (polysomnography, manual titration) monitored 48h ambulatory for BP at baseline and 12 months.

METHODS: 265 patients screened(2010-2013), 33 patients (ages 35-65 years) enrolled. Exclusion criteria: insomnia, RLS, parasomnia, acute/uncontrolled respiratory, cardiovascular or metabolic pathology, noncompliance to therapy (CPAP and antihypertensive treatment). We compared the patients with arousals index (AI-scored according to AASM 2007) <15/h with the ones who had AI>15/h at 1 year evaluation.

RESULTS: 14 patients have been evaluated at year, 8 patients with AI<15/h. 48h ambulatory BP showed no difference at baseline between groups and was significant reduced (p<0.05) after 1 year for the 14 patients: 48h systolic BP decreased with 23.9mmHg and 48h diastolic BP with 12.0mmHg. Differences statistically significant between groups, with the lower values for AI>15/h, were only: minimum 48h medium blood pressure (MBP) (69,00±12,63mmHg vs 57,83±4,95mmHg, p=0.047), minimum diurnal diastolic BP (57,88±15,18mmHg vs 42,50±2,58mmHg, p=0.024), minimum diurnal MBP (74,38±10,32mmHg vs 61,33 ± 6,68 mmHg, p=0.020). The quantitative differences (difference between 1 year and baseline) didn't show any statistical significance, therefore in many cases decreases registered for AI>15/h seems to be bigger. At the baseline a lower variability of BP (marker of cardiovascular risk) seems to be registered in the group of AI<15/h and after 1 year the reduction of the BP variability for this group seems to be bigger. All p=NS.

CONCLUSIONS: Despite the luck of statistical significance, the reduction of BP seems to be bigger in the group of patients with AI>15/h, but the variability of BP seems to be lower in the group of patients with AI<15/h.

CLINICAL IMPLICATIONS: A complete evaluation of the sleep microstructure (subcortical and autonomic arousals, cycling alternating pattern) after CPAP titration could identify patients at risk of cardiovascular events with a presumed better BP response to CPAP.

DISCLOSURE: The following authors have nothing to disclose: Oana-Claudia Deleanu, Andra Malaut, Ana Maria Nebunoiu, Alexandra Roberta Sandu, Valentin Caius Cosei, Ruxandra Ulmeanu, Agripina Rascu, Florin Mihaltan, Paraschiva Postolache

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