title: Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.
abstract: Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m(2)) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10-20, Δ20-30, Δ30-40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin, P < 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r = 0.713, P = 0.001) and diastolic (r = 0.497, P = 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beat-to-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, Illinois; Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan;
authors.forename: Jason R
authors.initials: JR
authors.lastname: Carter
authors.affiliation: Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan;
authors.forename: Ida T
authors.initials: IT
authors.lastname: Fonkoue
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, Illinois;
authors.forename: Daniela
authors.initials: D
authors.lastname: Grimaldi
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, Illinois;
authors.forename: Leila
authors.initials: L
authors.lastname: Emami
authors.affiliation: Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, The University of Chicago, Chicago, Illinois; and.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.affiliation: The David Read Laboratory, Discipline of Sleep Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Colin E
authors.initials: CE
authors.lastname: Sullivan
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, Illinois; bmokhles@medicine.bsd.uchicago.edu.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
mesh_terms: D001794:Blood Pressure; D002641:Chicago; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: hypercapnia; hypertension; hypoxemia; sleep apnea
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