The acute effect of continuous positive airway pressure titration on blood pressure in awake overweight/obese patients with obstructive sleep apnoea.

Autor: Ratneswaran C; a Faculty of Life Sciences and Medicine , King's College London , London , UK.; b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK., Pengo MF; b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK.; c Clinica dell'Ipertensione Arteriosa - Department of Medicine (DIMED) , University of Padua , Padova , Italy., Xiao S; b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK.; d State Key Laboratory of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical School , Guangzhou , China., Luo Y; d State Key Laboratory of Respiratory Disease , The First Affiliated Hospital of Guangzhou Medical School , Guangzhou , China., Rossi GP; c Clinica dell'Ipertensione Arteriosa - Department of Medicine (DIMED) , University of Padua , Padova , Italy., Polkey MI; e NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute , London , UK., Moxham J; a Faculty of Life Sciences and Medicine , King's College London , London , UK., Steier J; a Faculty of Life Sciences and Medicine , King's College London , London , UK.; b Lane Fox Unit/Sleep Disorders Centre , Guy's & St Thomas' NHS Foundation Trust , London , UK.
Jazyk: angličtina
Zdroj: Blood pressure [Blood Press] 2018 Aug; Vol. 27 (4), pp. 206-214. Date of Electronic Publication: 2018 Feb 23.
DOI: 10.1080/08037051.2018.1443391
Abstrakt: Objectives: Continuous positive airway pressure (CPAP) improves upper airway obstruction in patients with obstructive sleep apnoea (OSA), who often are overweight-obese. Although it is thought that CPAP improves long-term blood pressure control (BP), the impact of acute and short-term CPAP use on the cardiovascular system in obese patients has not been described in detail.
Methods: Obese patients (body mass index, BMI > 25 kg/m 2 ) with OSA were studied awake, supine during incremental CPAP titration (4-20 cmH 2 O, +2 cmH 2 O/3 mins). BP was measured continuously with a beat-to-beat BP monitor (Ohmeda 2300, Finapres Medical Systems, Amsterdam/NL), BP variability (BPV) was calculated as the standard deviation of BP at each CPAP level, the 95% confidence interval (95%CI) was calculated and changes in BP and BPV were reported.
Results: 15 patients (12 male, 48 ± 10) years, BMI 38.9 ± 5.8 kg/m 2 ) were studied; the baseline BP was 131.0 ± 10.2/85.1 ± 9.1 mmHg. BP and BPV increased linearly with CPAP titration (systolic BP r = 0.960, p < .001; diastolic BP r = 0.961, p < .001; systolic BPV r = 0.662, p = .026; diastolic BPV r = 0.886, p < .001). The systolic BP increased by +17% (+23.15 (7.9, 38.4) mmHg; p = .011) and the diastolic BP by +23% (+18.27 (2.33, 34.21) mmHg; p = .009), when titrating CPAP to 20 cmH 2 O. Systolic BPV increased by +96% (+5.10 (0.67, 9.53) mmHg; p < .001) and was maximal at 14 cmH 2 O, and diastolic BPV by +97% (+3.02 (0.26, 5.78) mmHg; p < .001) at 16 cmH 2 O.
Conclusion: Short-term incremental CPAP leads to significant increases in BP and BPV in obese patients with OSA while awake. Careful titration of pressures is required to minimise the risk of nocturnal awakenings while improving BP control.
Databáze: MEDLINE
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