Paper
CHANGES IN BLOOD PRESSURE AND METABOLIC PARAMETERS IN OVERWEIGHT PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA SYNDROME AFTER 3-MONTH CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY
Published Jun 1, 2018 · F. Spannella, F. Giulietti, C. Di Pentima
Journal of Hypertension
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Abstract
Objective: Obstructive sleep apnea syndrome (OSAS) is closely related to hypertension and altered glucose and lipid metabolism. Overweight represents a key risk factor for OSAS. Aim: to describe the blood pressure (BP) and metabolic changes in overweight/obese adults with moderate to severe OSAS before and after 3-month continuous positive airway pressure (CPAP) therapy. Design and method: Prospective observational study on 56 patients (T1) of whom 13 were re-evaluated after 3-month CPAP therapy (T2). Inclusion criteria: BMI > = 25 kg/m2, age > = 18 years, CPAP therapy indication (AHI > = 15). Instrumental examinations: home sleep apnea polygraphy, 24 h ambulatory BP monitoring, 72 h metabolic monitoring (Sensewear Armband®). Laboratory examinations: glycemia, insulinemia, total cholesterol, HDL cholesterol, triglycerides. Insulin resistance (IR) was evaluated by HOMA-index. Results: Evaluation at T1: mean age 57.2 ± 10.4 years. Males: 49 (89%). Mean BMI: 31 ± 4 kg/m2; mean waist: 110.8 ± 7.7 cm. Mean AHI: 44 ± 15. Prevalence of hypertension: 87.5%; prevalence of dyslipidemia: 67.9%; prevalence of diabetes mellitus: 14.3% (IR: 78.3%); prevalence of peripheral arterial disease: 33.9%; prevalence of atrial fibrillation: 8.9%. Patients with non-dipper BP profile: 58.9%. Patients with AHI > = 30 had higher risk of having IR than patients with AHI > = 15 (OR = 4.5, p = 0.047). Considering 13 patients re-evaluated at T2, there were no significant changes in BMI or glycemic and lipid profile. There was a trend of reduction in baseline metabolism, which correlated significantly with ODI and SpO2 nadir at T1 (p = 0.007, p = 0.038, respectively). There was also a significant reduction in nighttime BP (−8 / −5 mmHg, p = 0.012 and p = 0.019), even after adjusting for antihypertensive therapy. Conclusions: Overweight/obese patients with OSAS are also often affected by hypertension and altered glucose and lipid metabolism. CPAP therapy is effective in reducing nighttime BP that mostly affects cardiovascular risk. CPAP may also reduce basal metabolism but does not significantly affect body weight nor glucose and lipid parameters, unless coupled with lifestyle changes.
Observational Study
Very Rigorous JournalCPAP therapy effectively reduces nighttime blood pressure in overweight/obese patients with obstructive sleep apnea syndrome, but does not significantly affect body weight, glucose, or lipid parameters.
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