RESUMEN
Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55±9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mm Hg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9±11.8 versus -0.3±10.3 mm Hg; 18 months, -6.7±11.1 versus -1.2±10.6 mm Hg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3±1.9 versus 9.2±1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.
Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Hipertensión/tratamiento farmacológico , Apnea Obstructiva del Sueño/etiología , Rigidez Vascular/fisiología , Presión Sanguínea/efectos de los fármacos , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Polisomnografía , Pronóstico , Análisis de la Onda del Pulso , Estudios Retrospectivos , Apnea Obstructiva del Sueño/fisiopatología , Factores de Tiempo , Rigidez Vascular/efectos de los fármacosRESUMEN
Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid-femoral pulse wave velocity, 24-hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30-day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non-OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1±2.2 vs 12.7±2.4 m/s, P=.04; women: 11.8±2.4 vs 13.2±2.2 m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non-OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (ß=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08-8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.
Asunto(s)
Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Hipertensión/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Rigidez Vascular/fisiología , Adulto , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodos , Brasil/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Diuréticos/normas , Diuréticos/uso terapéutico , Ecocardiografía/métodos , Enalapril/administración & dosificación , Enalapril/uso terapéutico , Femenino , Humanos , Hidroclorotiazida/administración & dosificación , Hidroclorotiazida/normas , Hidroclorotiazida/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Losartán/administración & dosificación , Losartán/uso terapéutico , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Análisis de la Onda del Pulso/métodos , Factores de Riesgo , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
INTRODUCTION: The impact of obstructive sleep apnoea (OSA) treatment with CPAP on weight is not clear. This meta-analysis was designed to assess whether OSA treatment with CPAP promotes changes in body mass index (BMI) and weight. METHODS: We searched PubMed, SCOPUS and Cochrane Central Register electronic databases through 1 October 2013 (including papers in press at that time), without language restrictions. We identified randomised trials of CPAP versus controls with a minimum treatment duration of 4â weeks that objectively measured BMI. Data were independently abstracted and reviewed by two investigators using a standardised protocol. RESULTS: We included a total of 3181 patients from 25 randomised trials that measured BMI and weight. All studies enrolled mainly overweight and obese patients. The fixed-effects meta-analysis revealed that CPAP promoted significant increase on BMI (Hedges' g=0.14, 95% CI 0.07 to 0.21, I(2)=16.2%) and weight (Hedges' g=0.17, 95% CI 0.10 to 0.24, I(2)=0%). The funnel plot revealed low risk of publication bias. Meta-regression analyses including age, gender, baseline BMI, baseline weight, OSA severity, CPAP compliance, use of sham CPAP, study duration, study design (crossover/parallel), study origin (Western/Eastern), recommendation for dietary changes or physical activity, revealed that no single predictor influenced the main outcome for weight. Baseline weight was a predictor of increased BMI after CPAP. CONCLUSIONS: OSA treatment with CPAP promotes significant increase in BMI and weight. Additional therapies for body weight reduction must be recommended for overweight or obese patients with OSA initiated on CPAP.
Asunto(s)
Índice de Masa Corporal , Presión de las Vías Aéreas Positiva Contínua , Apnea Obstructiva del Sueño/terapia , Aumento de Peso , Humanos , Obesidad/complicaciones , Ensayos Clínicos Controlados Aleatorios como Asunto , Apnea Obstructiva del Sueño/complicacionesRESUMEN
Obstructive sleep apnea (OSA) is a common disease characterized by recurrent upper airway obstruction, intermittent hypoxemia and sleep fragmentation. OSA is considered to be predominantly a disease of obese middle-aged men, and it is generally accepted that this disorder is at least twice more common in men than in women. Consistent evidence suggests that OSA is independently associated with cardiovascular risk; however, a significant proportion of the evidence relates to men with OSA. In this brief editorial, we will discuss if markers of cardiovascular risk and cardiovascular events observed in OSA are modulated by gender. We will then examine the evidence regarding the impact of OSA treatment on cardiovascular events in men and women.