CPAP progressively reduces BP over 6 mos: New Study

[Captain_Midnight]

Hi folks!

File this under good news.

Here's a Pub Med abstract (brief summary)of a new study that shows just how effectively CPAP reduces blood pressure. Noteworthy is that the highest bp subgroup saw the biggest improvements from CPAP.


Treatment of obstructive sleep apnoea in Samoa progressively reduces daytime blood pressure over 6 months.
Middleton S, Vermeulen W, Byth K, Sullivan CE, Middleton PG.

David Read Laboratory, Department of Medicine, University of Sydney, Sydney, Australia.

BACKGROUND AND OBJECTIVE: While recent meta-analyses suggest that OSA elevates daytime blood pressure (BP), most studies have included patients with mild hypertension, so CPAP treatment has only reduced BP by 2-3 mm Hg. To determine the strength of the OSA-BP relationship, this study examined the effect of CPAP in a cohort where severe OSA and under-treated hypertension coexist. METHODS: Baseline demographic and sleep study data were recorded in 221 consecutive patients referred for sleep studies in Samoa. OSA was treated with CPAP and BP recorded for 6-7 months in 180 patients. A subgroup of 64 patients, representative of the entire group, but with regular follow-up, is also described. RESULTS: OSA was diagnosed in 218/221 patients; of those who commenced CPAP, 180 returned for follow-up at least once within 7 months. Following CPAP, BP decreased by 7.1/5.9 mm Hg at 1 month and 12.9/10.5 mm Hg at 6 months (n = 180, P < 0.0001). In the 64 patients with regular follow-up, those with the highest baseline BP had the greatest fall in BP with CPAP; BP in the hypertensive subgroup (32/64) decreased 21.5/13.1 mm Hg at 6 months (P < 0.0001). CONCLUSIONS: Hypertensive OSA patients can exhibit large falls in BP with CPAP at 1 month, with further significant reductions at 3 and 6 months. Overall, the fall in BP was proportional to the initial elevation of the BP with many patients achieving normal BP at 6 months.

Hey, doesn't Rooster normally post this stuff?


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[Catnap]

Boy is this good news for me! I have very refractive hypertension, and I've already been encouraged that in the couple months since I started CPAP, it has come under control (albeit with a high drug dosage) and seems to be leveling out. Even though I'm on a max dosage of one drug and take a second, this is the first time in -- I don't remember how long -- that at least some combo works. I'd love to think I might continue to see it dropping for 6 months or so, and I'd love to shave off those kinds of numbers! Can't help wondering whether living in the South Pacific (Samoa) might trim off a good 10 points all by itself.

[OldLincoln]

Can't imagine the DME experiences I read around here allow for lower blood pressure!

[Marietjie]

shows just how effectively CPAP reduces blood pressure

Ja, I'm very glad to report that MY BP dropped from 1x 50mg tablet to 1x25mg tablet per day after 10months on CPAP ! ! !
I was just wondering about high cholesterol - will cpap therapy help for this as well ? - I think it will. I see the specialist in July and will ask him about cpap and high cholesterol. This is the specialist (Dr Stern, PE) that told me that doctors all over the world now believe that sleep apnea plays a big part in patient's heart (etc) problems. Bye for now and a very Blessed Easter to you all.

[Captain_Midnight]

Marietjie asks… I was just wondering about high cholesterol - will cpap therapy help for this as well ?

Annnndd, a recent paper confirms that, yes, it will.

Please see… http://tinyurl.com/d9mwgt for the PubMed abstract, which I paste below.

Cuhadaroğlu C, Utkusavaş A, Oztürk L, Salman S, Ece T., 2009. Effects of Nasal CPAP Treatment on Insulin Resistance, Lipid Profile, and Plasma Leptin in Sleep Apnea. Lung. 2009 Jan 7.

BACKGROUND: Obstructive sleep apnea has been linked with metabolic syndrome characterized by dyslipidemia, dyscoagulation, hypertension, and diabetes mellitus type 2 and their cardiovascular consequences. This study was designed to determine the effects of 8 weeks of therapy with continuous positive airway pressure (CPAP) on insulin resistance, glucose, and lipid profile, and the relationship between leptin and insulin-resistance parameters in patients with moderate-to-severe obstructive sleep apnea. METHODS: In 44 patients, serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, leptin, and insulin parameters were measured at baseline and after 8 weeks of CPAP. Insulin resistance index was based on the homeostasis model assessment (HOMA-IR) method. Insulin sensitivity (HOMA-S) and insulin secretion capacity (HOMA-beta) also were calculated. Thirteen patients were excluded from statistical analyses due to noncompliant CPAP usage (<4 h night(-1)). RESULTS: In 31 patients who used CPAP for >/=4 h night(-1), CPAP therapy reduced total cholesterol (P < 0.05), low-density lipoprotein (P < 0.05), and leptin (P < 0.05). Circulating leptin levels showed significant correlation with both HOMA-S and HOMA-IR at baseline and follow-up (P = 0.03 for all). In addition, there was no correlation between HOMA-IR and the severity of sleep apnea, which was shown by apnea-hypopnea index. CONCLUSIONS: In patients with moderate-to-severe obstructive sleep apnea, compliant CPAP usage may improve insulin secretion capacity, reduce leptin, total cholesterol, and low-density lipoprotein levels. Leptin showed significant relationship with insulin resistance, and this relationship remained after 8 weeks of CPAP therapy.


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[sleepisgood]

Poster child for the study right here. I'm at 6 mo on cpap and just got taken off my bp med. Now running 122/62 at the docs office, and I get white coat hypertension to boot.

[Marietjie]

http://tinyurl.com/d9mwgt for the PubMed abstract

THANK YOU, my friend.....I printed the article re above : put it in my CPAP file. I have friends who also snore (probably because of OSA) but when I tell them about the therapy they go in denial ! ! !
Next time I will give them a copy of the article explaining the serious complications caused by OSA ! ! !

[Gerryk]

My blood pressure dropped significantly after about two months on cpap. My doc was telling me for a while that I needed to get it down or I would have to go on meds.

My cholesterol was also creaping up and finally got to the point that I was put on meds and I started cpap a couple weeks later. Two months down the road my cholesterol was now really low but I was kept on the meds. Three months later I my cholesterol levels were checked again and were extremely low. My doc took me off the meds for a couple weeks and I am starting back on it next week but only every other day then another test in a few weeks. My doc says it has to be the meds not just the cpap but I am thinking differently. We will see.

Gerry

[RipVW]

Yes, this is great to know! I've experienced BP drop as well as a CPAP user.

[DreamStalker]

Yep ... only took 2 or 3 months CPAP use for my hypertension to decrease enough to begin lowering BP meds. I would start to feel dizzy about an hour after taking my BP meds and soon realized that my hypertension had turned into hypotension. So about 3 months into CPAP treatment I had to cut my BP meds in half. About 6 months later I had to cut dosage in half again but by then I had also lost about 45 lbs so that probably had an effect on my BP as well.

Same goes for cholesterol. Prior to CPAP treatment I was hanging out in the mid 300's and that was while taking 10 mg of Zocor. About 6 months after CPAP treatment my cholesterol was in the 170's so my doc took me off statins altogether. My cholesterol is now usually in the 150's.

With CPAP treatment, a low carb diet, and a little exercise, people can recover 10 to 20 years of their lives back ... well at least for me anyhow.

[WearyOne]

You know, I always seem to be one who falls outside all the good studies!

My AHI is consistently under 2 (had a couple of zeros this week, actually), two consecutive overnight pulse/ox studies showed excellent results, I've been 100% compliant for over two years, and my blood pressure has actually gone UP a little in that time period. I'm overweight, but haven't gained any in the last two years. My diet is even better now that it was then. But just started back on a diet plan that I know works for me and have lost five pounds this week, so if I can keep that up, maybe THAT will get the pressure down. (I am on BP meds, but had to increase the diuretic a month ago. Pressure isn't THAT high, but is higher than before I started on cpap.)

Pam

[lebowski8]

i'm hoping that my cpap works well enough that i can go off the meds.
I'm 34, and overweight, all of it at my belly.
My new doctor had me track my BP for 4 weeks and it ranged from around 130/88 to around 145/93-- i took it about every 48-72 hours.
Anyway, she prescribed a low dose of BP medication. It moved down a bit-- I haven't seen it over 140/90 since...

But I remember the 2nd night in the Sleep Clinic, the night i got the pressure titration, and my BP was 110/75 in the morning.
I've been on CPAP for a week (going great!), and taking the meds.

Now i'm concerned, since i was borderline high BP anyway, that i could go too low.

Anyhow, i think i'm going to get my own cuff-- I hate driving out to WalMart just to check it.

But i saw it work, for me anyway.