Hasthi U Dissanayake1, Kate Sutherland2, Craig L Phillips3, Ronald R Grunstein4, Anastasia S Mihailidou5, Peter A Cistulli2. 1. Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia. Electronic address: hasthi.dissanayake@sydney.edu.au. 2. Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia. 3. Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia. 4. Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia; Woolcock Institute of Medical Research, Sydney, Australia. 5. Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Abstract
BACKGROUND:Obstructive sleep apnoea (OSA) is associated with increased blood pressure variability (BPV) and are risk factors for cardiovascular disease. We aimed to assess the comparative effects of two OSA therapies, continuous positive airway pressure (CPAP) and mandibular advancement splint (MAS), on BPV. METHODS: This is a secondary analysis of data collected as part of a previously published randomised crossover trial of one month each of CPAP and MAS therapy. BPV was determined from 24-h-ambulatory blood pressure recordings in 92 patients with moderate to severe OSA at baseline and after one month of optimised treatment with each modality. BPV was assessed by three measures: Standard deviation of the mean (SD), Coefficient of variation (CoV), and the Average Real Variability (ARV) index. RESULTS: Neither CPAP nor MAS therapy improved BPV, with no difference between treatments. BPV did not change in hypertensive OSA patients, however, there was a reduction in ARV of diastolic blood pressure in the effectively treated compared to ineffectively treated CPAP patients, Δ ARV 24-h-DBP (mmHg), -0.72 ± 2.14, 0.34 ± 1.52, P = 0.02, respectively. There was no difference between effective versus ineffective MAS treatment, Δ ARV 24-h-DBP (mmHg), -0.04 ± 2.4, 0.02 ± 1.9, P = 1.00, respectively. CONCLUSIONS: One month of optimised CPAP or MAS therapy did not improve short term BPV in patients with moderate to severe OSA. The subgroup of patients on effective CPAP showed some improvement in BPV with CPAP but not MAS. Further work on the effect of OSA therapy on BPV following long-term therapy is needed.
RCT Entities:
BACKGROUND:Obstructive sleep apnoea (OSA) is associated with increased blood pressure variability (BPV) and are risk factors for cardiovascular disease. We aimed to assess the comparative effects of two OSA therapies, continuous positive airway pressure (CPAP) and mandibular advancement splint (MAS), on BPV. METHODS: This is a secondary analysis of data collected as part of a previously published randomised crossover trial of one month each of CPAP and MAS therapy. BPV was determined from 24-h-ambulatory blood pressure recordings in 92 patients with moderate to severe OSA at baseline and after one month of optimised treatment with each modality. BPV was assessed by three measures: Standard deviation of the mean (SD), Coefficient of variation (CoV), and the Average Real Variability (ARV) index. RESULTS: Neither CPAP nor MAS therapy improved BPV, with no difference between treatments. BPV did not change in hypertensive OSA patients, however, there was a reduction in ARV of diastolic blood pressure in the effectively treated compared to ineffectively treated CPAP patients, Δ ARV 24-h-DBP (mmHg), -0.72 ± 2.14, 0.34 ± 1.52, P = 0.02, respectively. There was no difference between effective versus ineffective MAS treatment, Δ ARV 24-h-DBP (mmHg), -0.04 ± 2.4, 0.02 ± 1.9, P = 1.00, respectively. CONCLUSIONS: One month of optimised CPAP or MAS therapy did not improve short term BPV in patients with moderate to severe OSA. The subgroup of patients on effective CPAP showed some improvement in BPV with CPAP but not MAS. Further work on the effect of OSA therapy on BPV following long-term therapy is needed.
Authors: Winfried Randerath; Jan de Lange; Jan Hedner; Jean Pierre T F Ho; Marie Marklund; Sofia Schiza; Jörg Steier; Johan Verbraecken Journal: ERJ Open Res Date: 2022-06-27
Authors: Marijke Dieltjens; Olivier M Vanderveken; Bharati Shivalkar; Gilles Van Haesendonck; Chloé Kastoer; Hein Heidbuchel; Marc J Braem; Caroline M Van De Heyning Journal: J Clin Sleep Med Date: 2022-03-01 Impact factor: 4.062