Abstract
Background
The present study aimed to investigate the predictors of changes in blood pressure
(BP) with continuous positive airway pressure (CPAP) treatment in hypertensive patients
with coronary heart disease (CHD) and obstructive sleep apnea (OSA).
Methods
Seventy-one hypertensive patients with CHD and OSA were enrolled in this study. Daytime
systolic BP (SBP), diastolic BP (DBP), Epworth Sleepiness Scale (ESS), and anthropometric
characteristics were assessed at baseline and follow-up.
Results
Sixty-six patients completed the study. The median follow-up period was 36 months
(interquartile range, 24-60 months). The mean duration of CPAP application was 4.3
± 1.2 hours per night. From baseline to follow-up, SBP and DBP were reduced by 5.6
mm Hg (95% confidence interval [CI], 3.0-8.1) and 3.0 mm Hg (95% CI, 0.8-5.3), respectively.
Daytime somnolence was significantly improved (ESS, from 9.5 ± 3.4 at baseline to
3.6 ± 2.0 at follow-up; P < 0.001); the mean improvement in ESS was 6.0 (95% CI, 5.1-6.9). Correlation analysis
of the fall in mean BP (MBP) showed that baseline MBP, change in ESS, heart rate,
and CPAP compliance showed a positive correlation, whereas the baseline body mass
index (BMI) and ESS had an inverse relationship. Stepwise multiple linear regression
analysis, however, indicated that only baseline BMI, baseline MBP, and CPAP compliance
were independently correlated with the fall in MBP.
Conclusions
Long-term CPAP treatment reduces BP in hypertensive patients with CHD and moderate/severe
OSA; baseline BMI, baseline MBP, and CPAP compliance are independent predictors of
the decrease in BP with CPAP treatment in these patients.
Résumé
Introduction
La présente étude avait pour but d’examiner les prédicteurs de changements dans la
pression artérielle (PA) par le traitement par ventilation spontanée en pression positive
expiratoire continue (CPAP : continuous positive airway pressure) des patients hypertendus souffrant de coronaropathie et d’apnée obstructive du sommeil
(AOS).
Méthodes
Soixante-et-onze (71) patients hypertendus souffrant de coronaropathie et d’AOS ont
été recrutés pour cette étude. La PA systolique (PAS) et la PA diastolique (PAD) diurnes
ainsi que l’échelle de somnolence d’Epworth (ESE) et les caractéristiques anthropométriques
ont été évaluées au début et durant le suivi.
Résultats
Soixante-six (66) patients ont mené à terme l’étude. La durée médiane de suivi a été
de 36 mois (intervalle interquartile, 24-60 mois). La durée moyenne de l’utilisation
de la CPAP a été de 4,3 ± 1,2 heures par nuit. Entre le début et la période de suivi,
la PAS et la PAD ont respectivement diminué de 5,6 mm Hg (intervalle de confiance
[IC] à 95 %, 3,0-8,1) et de 3,0 mm Hg (IC à 95 %, 0.8-5,3). La somnolence diurne s’est
significativement améliorée (ESE, de 9,5 ± 3,4 au début à 3,6 ± 2,0 durant le suivi;
P < 0,001); l’amélioration moyenne selon l’ESE a été de 6,0 (IC à 95 %, 5,1-6,9). L’analyse
de corrélation de la baisse de la PA moyenne (PAM) a montré que la PAM initiale, le
changement à l’ESE, le rythme cardiaque et l’observance de la CPAP avaient une corrélation
positive, tandis que l’indice de masse corporelle (IMC) et l’ESE au début avaient
une relation inverse. Cependant, l’analyse séquentielle de régression linéaire multiple
a indiqué que seuls l’IMC initial, la PAM initiale et l’observance de la CPAP avaient
indépendamment corrélé avec la baisse de la PAM.
Conclusions
Le traitement à long terme par CPAP réduit la PA des patients hypertendus souffrant
de coronaropathie et d’AOS modérée et grave; l’IMC initial, la PAM initiale et l’observance
de la CPAP sont des prédicteurs indépendants de la diminution de la PA de ces patients
traités par CPAP.
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Article info
Publication history
Published online: September 25, 2014
Accepted:
September 18,
2014
Received:
July 17,
2014
Footnotes
See page 858 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
