Dados do Trabalho

Título

Impact of Obstructive Sleep Apnea Treatment with Continuous Positive Airway Pressure on Arterial Stiffness in Patients with Uncontrolled Hypertension: A Randomized Clinical Trial.

Introdução

Obstructive sleep apnea (OSA) is common in patients with hypertension (HTN) and may induce target-organ damage. Arterial stiffness is independently associated with cardiovascular risk. However, the impact of OSA treatment with continuous positive airway pressure (CPAP) on arterial stiffness in patients with OSA and HTN is unclear.

Objetivo

To evaluate the impact of OSA treatment with CPAP on arterial stiffness and on carotid arterial thickness.

Métodos

This is a sub-study of the MORPHEOS trial (clinicaltrials.gov: NCT02270658), a randomized controlled study designed to test the impact of CPAP on blood pressure (BP) and vascular parameters in patients with OSA + uncontrolled HTN. This sub-study was designed to compare the 6-months effects of CPAP or placebo (nasal dilator strips, NDS) on arterial stiffness and carotid intima-media thickness (CIMT) in adult patients with uncontrolled hypertension (HTN) using at least one anti-hypertensive medication and moderate-to-severe OSA. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hours ambulatory BP monitoring (ABPM) and ≥80% medication adherence evaluated by pill counting after the run-in period (4 weeks). The primary endpoint was carotid-femoral pulse wave velocity (PWV), a validated marker of arterial stiffness. CIMT was the secondary outcome.

Resultados

Seventy-three patients with uncontrolled HTN and OSA were randomized to NDS (n=37) or CPAP (n=36). respectively. Baseline clinical variables were similar between the groups and PWV in the NDS and CPAP groups were similar (9±1.5 vs 9.1±1.3m/s, respectively). CPAP promoted a greater reduction in PWV then NDS at 6 months (Δ Delta PWV: NDS -0.02±0.53 vs. CPAP -0.82±1.48m/s, p=0.011). CIMT did not change significantly in both groups (Δ CIMT: NDS 0±0.09 vs. CPAP -0.01±0.08mm, p=0.524).

Conclusões

The treatment for 6 months of OSA with CPAP in patients with uncontrolled HTN and OSA reduces arterial stiffness significantly.

Palavras -chave

arterial stiffness, carotid arterial thickness, hypertension, obstructive sleep apnea, continuous positive airway pressure