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Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden.
Messineo, Ludovico; Sands, Scott A; Schmickl, Christopher; Labarca, Gonzalo; Hu, Wen-Hsin; Esmaeili, Neda; Vena, Daniel; Gell, Laura; Calianese, Nicole; Malhotra, Atul; Gottlieb, Daniel J; Wellman, Andrew; Redline, Susan; Azarbarzin, Ali.
Affiliation
  • Messineo L; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Sands SA; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Schmickl C; Division of Pulmonary, Critical Care, and Sleep Medicine University of California San Diego (C.S., A.M.).
  • Labarca G; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Hu WH; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Esmaeili N; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Vena D; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Gell L; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Calianese N; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Malhotra A; Division of Pulmonary, Critical Care, and Sleep Medicine University of California San Diego (C.S., A.M.).
  • Gottlieb DJ; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Wellman A; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Redline S; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
  • Azarbarzin A; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.M., S.A.S., G.L., W.-H.H., N.E., D.V., L.G., N.C., D.J.G., A.W., S.R., A.A.).
Hypertension ; 81(5): 1106-1114, 2024 May.
Article in En | MEDLINE | ID: mdl-38506074
ABSTRACT

BACKGROUND:

Obstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea's physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in post-treatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB).

METHODS:

ΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB.

RESULTS:

A high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0-10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9-7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5-10.4) mm Hg drop in SBP.

CONCLUSIONS:

A high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sleep Apnea Syndromes / Sleep Apnea, Obstructive / Hypertension Limits: Humans Language: En Journal: Hypertension Year: 2024 Document type: Article
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sleep Apnea Syndromes / Sleep Apnea, Obstructive / Hypertension Limits: Humans Language: En Journal: Hypertension Year: 2024 Document type: Article