A new study shows a strong association between severe, untreated obstructive sleep apnea and the risk of elevated blood pressure despite the use of high blood pressure medications.
The study involved patients who had cardiovascular risk factors or established heart disease and moderate or severe obstructive sleep apnea. Among participants prescribed at least three antihypertensives including a diuretic, resistant elevated blood pressure was more prevalent in those with severe sleep apnea (58.3 %) compared with moderate sleep apnea (28.6%). Further analysis found that the odds of resistant elevated blood pressure were four times higher in participants with severe, untreated obstructive sleep apnea even after adjusting for potential confounders such as body mass index, smoking status, diabetes mellitus, and cardiovascular disease (adjusted odds ratio = 4.12).
“Our findings suggest that severe obstructive sleep apnea contributes to poor blood pressure control despite aggressive medication use,” said first author Dr. Harneet Walia, assistant professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. “This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk.”
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Continuous positive airway pressure (CPAP), the most widely prescribed therapy for treatment of obstructive sleep apnea, resulted in significantly lower blood pressure compared to either nocturnal supplemental oxygen or an educational control treatment, according to a new study from Brigham and Women’s Hospital (BWH).
The study is published in the June 12, 2014 issue of The New England Journal of Medicine.
“The effect of CPAP on blood pressure in this study is important for both physicians and their patients,” said Daniel Gottlieb, MD, MPH, lead study author and a physician-scientist in BWH’s Division of Sleep and Circadian Disorders. “Previous studies have demonstrated that a decrease in blood pressure of this magnitude is associated with up to a 20 percent reduction in mortality from stroke and a 15 percent reduction in cardiovascular mortality.”
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The link between stroke and obstructive sleep apnea (OSA) has been established by several clinical studies in recent years, with the most significant risks attributed to male patients. Now, a new study by researchers from Boston says the link between OSA and stroke may be just as strong among women.
According to the study, because men tend to develop OSA earlier than women, studies that have evaluated the link between OSA and stroke among age-matched groups of men and women may have underestimated associations.
People whose brainstems are affected by their stroke have a significantly higher prevalence of sleep apnea than those who have stroke-related injury elsewhere in the brain, according to research presented at the American Stroke Association’s International Stroke Conference 2014.
Sleep apnea is marked by interrupted breathing during sleep and can lead to serious health problems including heart disease and stroke.
“This is the largest population-based study to address the issue of the location of the brain injury and its relationship to sleep apnea in post-stroke patients,” said Devin L. Brown, M.D., M.S., lead author of the study and associate professor of neurology and associate director of the stroke program at the University of Michigan in Ann Arbor.
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Obstructive sleep apnea (OSA) generally is associated with increased risk for cardiovascular (CV) disease. OSA is usually measured using the apnea-hypopnea index (AHI), the number of times that breathing pauses or severely slows per hour of sleep. However, sleep studies using to diagnose OSA produce a number of other measures.
Whether those measures are associated with CV disease, and whether they predict CV disease as well or better than AHI, is not known. Tetyana Kendzerska (University of Toronto) and colleagues conducted a large cohort study of 10,149 participants referred for suspected OSA who underwent diagnostic polysomnography at the sleep laboratory at St Michael’s Hospital (Toronto, Canada) between 1994 and 2010. The patients were followed up through provincial health administrative data (Ontario, Canada) until May 2011 for CV disease (myocardial infarction, stroke, congestive heart failure, revascularization procedures) and death from any cause, analyzed as a composite outcome.
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