Long-term effect of obstructive sleep apnoea management on blood pressure in patients with resistant hypertension: the SARAH study

医学 四分位间距 阻塞性睡眠呼吸暂停 动态血压 血压 抵抗性高血压 持续气道正压 回廊的 气道正压 呼吸暂停 睡眠研究 儿科 心脏病学 内科学 多导睡眠图
作者
Gerard Torres,Manuel Sánchez‐de‐la‐Torre,Esther Gràcia‐Lavedan,Iván D. Benítez,Dolores Martínez,Mireia Dalmases,Lucía Pinilla,Olga Mínguez,Rafaela Vaca,Lydia Pascual,María Águilà,Anunciación Cortijo,Clara Gort,Miguel Ángel Martínez‐García,Olga Mediano,Sofía Romero-Peralta,Ana Maria Fortuna-Gutiérrez,P. Ponte,Luciano F. Drager,Mayara Longui Cabrini
出处
期刊:The European respiratory journal [European Respiratory Society]
卷期号:64 (2): 2400269-2400269 被引量:2
标识
DOI:10.1183/13993003.00269-2024
摘要

Background There is a close relationship between obstructive sleep apnoea (OSA) and resistant hypertension (RH). However, studies assessing the long-term effect of diagnosing and treating OSA on blood pressure (BP) control in these patients are lacking. Methods To address this gap, we recruited 478 RH patients from hypertension units and followed them prospectively after they were screened for OSA through a sleep study. By performing 24-h ambulatory BP monitoring (ABPM) annually, the effect of OSA management was assessed. Results The patients had a median (interquartile range (IQR)) age of 64.0 (57.2–69.0) years, 67% were males and most were nonsleepy, with a median (IQR) apnoea–hypopnoea index (AHI) of 15.8 (7.9–30.7) events·h −1 . The median (IQR) follow-up time was 3.01 (2.93–3.12) years. At baseline, severe OSA was associated with uncontrolled BP, nocturnal hypertension and a nondipper circadian BP pattern. Moreover, these patients had higher BP values during follow-up than did patients in the other groups. However, among patients with moderate and severe OSA, the management of sleep disordered breathing, including the implementation of continuous positive airway pressure treatment, was associated with a reduction in 24-h ABPM parameters, especially night-time BP values, at the 1-year follow-up. These benefits were attenuated over time and only subjects with severe OSA maintained an ABPM night-time reduction at 3 years. Furthermore, clinical variables such as uncontrolled BP, sex and age showed a predictive value for the BP response at 1 year of follow-up. Conclusion A favourable long-term decrease in BP was detected by diagnosing and treating OSA in a cohort of RH patients from hypertension units, but over time this decrease was only partially maintained in severe OSA patients.
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