Blood pressure reduction following treatment with positive airway pressure in sleep apnea – data from the ESADA

Abstract

Introduction: Positive airway pressure (PAP) treatment reduces blood pressure (BP) in patients with obstructive sleep apnea (OSA).

Aims: We investigated factors that predict the BP response to PAP therapy in the European Sleep Apnea Database (ESADA).

Methods: A total of 2662 OSA patients with PAP therapy ≥ 90 days were included in the analysis (74% male, age 55±11 years, body mass index 32.3±6.1 kg/m², 47% hypertensives, apnea-hypopnea index 40±24 events/h, treatment duration 1.0±1.1 years, PAP compliance 5.2±1.9 h/day). Anthropometric data, concomitant medications and office BP were assessed at the baseline and follow-up visits.

Results: Systolic and diastolic BP were significantly reduced after PAP therapy compared with baseline (133±17 vs. 134±17 mmHg, 78±11 vs. 81±11 mmHg, p<0.001, respectively). In a generalized linear model controlling for anthropometrics, PAP compliance and follow-up time, severe OSA at baseline (β [95% CI] -3.2 [-5.1 – -1.3], p=0.001), hypertension status (-2.0 [-3.3 – -0.7], p=0.003), weight reduction >2 kg at follow-up (-2.0 [-3.7 – -0.4], p=0.016), and use of auto-adjusted PAP (-1.3 [-2.5 – -0.02], p=0.046) were associated with a lower systolic BP at follow-up.

Conclusions: PAP treatment caused a mild reduction of BP in patients with moderate to severe OSA. We identified several predictors of a favorable BP response including the use of auto-adjusted PAP. Our findings suggest that weight reduction strategies in addition to PAP treatment may be useful to obtain adequate BP control in patients with OSA.