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Published online before print February 2, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00062805
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ORIGINAL ARTICLE

CPAP does not reduce blood pressure in non-sleepy hypertensive OSA patients

G.V. Robinson 1*, D.M. Smith 1, B.A. Langford 1, R.J.O. Davies 1, J.R. Stradling 1

1 Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital Site, Oxford, OX3 7LJ, UK

* To whom correspondence should be addressed. E-mail: gracevrobinson{at}yahoo.co.uk.


  Abstract

OSA is associated with high cardiovascular morbidity and mortality. Several randomised controlled trials have shown that CPAP treatment of OSA reduces blood pressure. This randomised, sham-placebo controlled cross-over trial assesses whether CPAP produces a similar clinically significant fall in blood pressure in hypertensive OSA patients, but without hypersomnolence.

Thirty-five, non-sleepy, hypertensive patients with OSA were treated with CPAP for one month, randomised first to either therapeutic or sham-placebo (sub-therapeutic CPAP, about 1 cm H2O pressure). The second months' alternative treatment followed a two-week washout period. 24 h BP was measured before, and at the end of, the two treatment periods: Mean 24hr BP was the primary outcome variable.

There was no overall significant difference in mean 24 h BP: change in mean 24 h BP on therapeutic CPAP -2.1 mmHg (SD 8.1), and -1.1 mmHg (SD 8.1) on sub-therapeutic CPAP; a difference of 0.7 mmHg (95% CI +2.9 to -4.4). There was a small significant fall in Epworth Sleepiness Score (ESS), therapeutic (-1.4) versus sham (-0.3), difference -1.2 (95% CI -2.0 to -0.4), p<0.02, but no change in objective sleepiness.

In non-hypersomnolent hypertensive patients with OSA, there is no significant fall in mean 24 h blood pressure with CPAP, in contrast to the fall seen in hypersomnolent patients with OSA.

Keywords:  Cardiovascular risk, CPAP, hypertension, obstructive sleep apnoea




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