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CPAP and measures of cardiovascular risk in males with OSAS

¹ Oxford Centre for Respiratory Medicine, Churchill Hospital, ³ Dept of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, and, ² Dept of Respiratory Medicine, Musgrove Park Hospital, Taunton, UK, ⁴ Both authors contributed equally to this study, and ⁵ Both authors contributed as senior authors.

CORRESPONDENCE: M. Kohler, Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospitals, Churchill Hospital Campus, Headington, Oxford, OX3 7LJ, UK. Fax: 44 1865225221. E-mail: Malcolm.K{at}bluewin.ch

Keywords: Arterial stiffness, baroreflex, catecholamines, continuous positive airway pressure, obstructive sleep apnoea

Received: February 20, 2008
Accepted July 9, 2008

Obstructive sleep apnoea syndrome (OSAS) has been associated with hypertension, stroke and myocardial ischaemia in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but the impact of this intervention on established risk factors for cardiovascular disease remains incompletely understood.

A total of 102 males with moderate-to-severe OSAS were randomised to therapeutic (n = 51) or subtherapeutic (n = 51) CPAP treatment for 4 weeks to investigate the effects of active treatment on 24-h urinary catecholamine excretion, baroreflex sensitivity (BRS), arterial stiffness (augmentation index) and 24-h ambulatory blood pressure (ABP).

After 4 weeks of therapeutic CPAP, significant reductions were seen in urine normetanephrine excretion (from mean±SD 179.7±80.1 to 132.7±46.5 µmol·mol^–1 creatinine) and augmentation index (from 14.5±11.3 to 9.1±13.8%) compared with the subtherapeutic control group. Furthermore, therapeutic CPAP significantly improved BRS (from 7.1±3.3 to 8.8±4.2 ms·mmHg^–1) and reduced mean arterial ABP by 2.6±5.4 mmHg.

In conclusion, treatment of obstructive sleep apnoea with continuous positive airway pressure may lower cardiovascular risk by reducing sympathetic nerve activity, ambulatory blood pressure and arterial stiffness and by increasing sensitivity of the arterial baroreflex.

This article has been cited by other articles:

				M. Enoz and H. M. Inancli CPAP and measures of cardiovascular risks in patients with OSAS Eur. Respir. J., June 1, 2009; 33(6): 1520 - 1520. [Full Text] [PDF]

				S. D West, H. A McBeath, and J. R Stradling Obstructive sleep apnoea in adults BMJ, April 7, 2009; 338(apr07_1): b1165 - b1165. [Full Text]