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The Effect of CPAP Therapy on Resistant Hypertension in Obstructive Sleep Apnea Syndrome Patients with Chronic Kidney Disease

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Resistant Hypertension in Chronic Kidney Disease

Abstract

Obstructive sleep apnea syndrome (OSAS) is caused by repeated episodes of apnea–hypopnea due to upper airway obstruction leading to oxygen desaturation. OSAS is an independent risk factor for cardiovascular disease including hypertension, coronary artery disease, and stroke. OSAS is common affecting 5–20% of the general population, and it is still underdiagnosed in many cases.

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References

  1. Peker Y, Kraiczi H, Hedner J, et al. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J. 1999;14:179–84.

    Article  CAS  PubMed  Google Scholar 

  2. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.

    Article  CAS  PubMed  Google Scholar 

  3. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.

    Article  PubMed  Google Scholar 

  4. Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  5. Fletcher ED, DeBehnke RD, Lovoi MS, et al. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med. 1985;103(2):190–5.

    Article  CAS  PubMed  Google Scholar 

  6. Lavie P, Ben-Yosef R, Rubin AE. Prevalence of sleep apnea syndrome among patients with essential hypertension. Am Heart J. 1984;108(2):373–6.

    Article  CAS  PubMed  Google Scholar 

  7. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    Article  CAS  PubMed  Google Scholar 

  8. Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994;120(5):382–8.

    Article  CAS  PubMed  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  PubMed  Google Scholar 

  10. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association professional education Committee of the Council for high blood pressure research. Hypertension. 2008;51:1403–19.

    Article  CAS  PubMed  Google Scholar 

  11. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press. 2009;18:308–47.

    Article  CAS  PubMed  Google Scholar 

  12. Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307:2169–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. O’Connor GT, Caffo B, Newman AB, et al. Prospective study of the association between sleep-disordered breathing and hypertension: the sleep Heart health study. Am J Respir Crit Care Med. 2009;179(12):1159–64.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Baguet JP, Hammer L, Levy P, Pierre H, Rossini E, Mouret S, Ormezzano O, Mallion JM, Pepin JL. Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients. J Hypertens. 2005;23:521–7.

    Article  CAS  PubMed  Google Scholar 

  15. Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M. Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin sleep cohort study. Sleep. 2008;31:795–800.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19:2271–7.

    Article  CAS  PubMed  Google Scholar 

  17. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–7.

    Article  CAS  PubMed  Google Scholar 

  18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  PubMed  Google Scholar 

  19. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 guidelines for the Management of Arterial Hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology. J Hypertens. 2007;25:1105–87.

    Article  CAS  PubMed  Google Scholar 

  20. Loredo JS, Ancoli-Israel S, Dimsdale JE. Sleep quality and blood pressure dipping in obstructive sleep apnea. Am J Hypertens. 2001;14:887–92.

    Article  CAS  PubMed  Google Scholar 

  21. Yu HT. Progression of chronic renal failure. Arch Intern Med. 2003;163:1417–29.

    Article  PubMed  Google Scholar 

  22. Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421–31.

    Article  CAS  PubMed  Google Scholar 

  23. Abdel-Kader K, Dohar S, Shah N, et al. Resistant hypertension and obstructive sleep apnea in the setting of kidney disease. J Hypertens. 2012;30:960–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial. 1997;13:88–92.

    CAS  PubMed  Google Scholar 

  25. Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, et al. Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest. 2007;131:453–9.

    Article  CAS  PubMed  Google Scholar 

  26. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest. 2004;125(1):112–7.

    Article  CAS  PubMed  Google Scholar 

  27. Gaddam K, Pimenta E, Thomas SJ, et al. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010;24:532–7.

    Article  CAS  PubMed  Google Scholar 

  28. Moller DS, Lind P, Strunge B, Pedersen EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstruc- tive sleep apnea. Am J Hypertens. 2003;16:274–80.

    Article  CAS  PubMed  Google Scholar 

  29. Imadojemu VA, Gleeson K, Quraishi SA, Kunselman AR, Sinoway LI, Leuenberger UA. Impaired vasodilator responses in obstructive sleep apnea are improved with continuous positive airway pressure therapy. Am J Respir Crit Care Med. 2002;165:950–3.

    Article  PubMed  Google Scholar 

  30. Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162:2166–71.

    Article  CAS  PubMed  Google Scholar 

  31. Phillips BG, Narkiewicz K, Pesek CA, Haynes WG, Dyken ME, Somers VK. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens. 1999;17:61–6.

    Article  CAS  PubMed  Google Scholar 

  32. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47–112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Witkowski A, Prejbisz A, Florczak E, et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension. 2011;58:559–65.

    Article  CAS  PubMed  Google Scholar 

  34. O’Rourke MF, Nichols WW. Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension. 2005;45:652–8.

    Article  PubMed  Google Scholar 

  35. Doonan RJ, Scheffler P, Lalli M, Kimoff RJ, Petridou ET, Daskalopoulos ME, Daskalopoulou SS. Increased arterial stiffness in obstructive sleep apnea: a systematic review. Hypertens Res. 2011;34:23–32.

    Article  PubMed  Google Scholar 

  36. Kohler M, Pepperell JC, Casadei B, et al. CPAP and measures of cardiovascular risk in males with OSAS. Eur Respir J. 2008;32:1488–96.

    Article  CAS  PubMed  Google Scholar 

  37. Drager LF, Bortolotto LA, Figueiredo AC, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2007;176:706–12.

    Article  CAS  PubMed  Google Scholar 

  38. Jones A, Vennelle M, Connell M, et al. The effect of continuous positive airway pressure therapy on arterial stiffness and endothelial function in obstructive sleep apnea: a randomized controlled trial in patients without cardiovascular disease. Sleep Med. 2013;14:1260–5.

    Article  PubMed  Google Scholar 

  39. Vlachantoni IT, Dikaiakou E, Antonopoulos CN, et al. Effects of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea in arterial stiffness: a meta-analysis. Sleep Med Rev. 2013;17:19–28.

    Article  PubMed  Google Scholar 

  40. Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310:2407–15.

    Article  CAS  PubMed  Google Scholar 

  41. Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens. 2010;28(10):2161–8.

    Article  CAS  PubMed  Google Scholar 

  42. Dernaika TA, Kinasewitz GT, Tawk MM. Effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea. J Clin Sleep Med. 2009;5(2):103–7.

    PubMed  PubMed Central  Google Scholar 

  43. Durán-Cantolla J, Aizpuru F, Montserrat JM, Ballester E, Terán-Santos J, Aguirregomoscorta JI, Gonzalez M, Lloberes P, Masa JF, De La Peña M, Carrizo S, Mayos M, Barbé F. Spanish sleep and breathing group. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010;341:c5991.

    Article  PubMed  Google Scholar 

  44. Barbé F, Durán-Cantolla J, Capote F, De LPM, Chiner E, Masa JF, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010;181:718–26.

    Article  PubMed  Google Scholar 

  45. Pedrosa RP, Drager LF, de Paula LK, Amaro AC, Bortolotto LA, Lorenzi-Filho G. Effects of OSA treatment on BP in patients with resistant hypertension: a randomized trial. Chest. 2013;144(5):1487–94.

    Article  CAS  PubMed  Google Scholar 

  46. Muxfeldt ES, Margallo V, Costa LM, Guimarães G, Cavalcante AH, Azevedo JC, de Souza F, Cardoso CR, Salles GF. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial. Hypertension. 2015;65(4):736–42.

    Article  CAS  PubMed  Google Scholar 

  47. Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, Diaz de Atauri J, Terán J, Mayos M, de la Peña M, Monasterio C, del Campo F, Montserrat JM. Spanish sleep and breathing network. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307(20):2161–8.

    Article  PubMed  Google Scholar 

  48. Drager LF, Pedrosa RP, Diniz PM, Diegues-Silva L, Marcondes B, Couto RB, Giorgi DM, Krieger EM, Lorenzi-Filho G. The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea. Hypertension. 2011;57(3):549–55.

    Article  CAS  PubMed  Google Scholar 

  49. Alajmi M, Mulgrew AT, Fox J, Davidson W, Schulzer M, Mak E, Ryan CF, Fleetham J, Choi P, Ayas NT. Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea: a meta-analysis of randomized controlled trials. Lung. 2007;185(2):67–72.

    Article  CAS  PubMed  Google Scholar 

  50. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  51. Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, Martinez-Alonso M, Martinez-García MÁ, Barceló A, Lloberes P, Campos-Rodriguez F, Capote F, Diaz-de-Atauri MJ, Somoza M, González M, Masa JF, Gozal D, Barbé F. Spanish sleep network. Precision Medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment. J Am Coll Cardiol. 2015;66(9):1023–32.

    Article  PubMed  Google Scholar 

  52. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009;373:82–93.

    Article  PubMed  Google Scholar 

  53. Hedner J, Darpo B, Ejnell H. Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications. Eur Respir J. 1995;8:222–9.

    Article  CAS  PubMed  Google Scholar 

  54. Narkiewicz K, Kato M, Phillips BJ. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation. 1999;100:2332–5.

    Article  CAS  PubMed  Google Scholar 

  55. Heitmann J, Ehlenz K, Penzel T, Becker HF, Grote L, Voigt KH, et al. Sympathetic activity is reduced by nCPAP in hypertensive obstructive sleep apnoea patients. Eur Respir J. 2004;23:255–62.

    Article  CAS  PubMed  Google Scholar 

  56. Schulz R, Mahmoudi S, Hattar K. Enhanced release of super oxide from polymorphonuclear neutrophils in obstructive sleep apnea: impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med. 2000;162:566–70.

    Article  CAS  PubMed  Google Scholar 

  57. Chin K, Nakamura T, Shimizu K. Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med. 2000;109:562–7.

    Article  CAS  PubMed  Google Scholar 

  58. Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007;50(2):417–23.

    Article  CAS  PubMed  Google Scholar 

  59. Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167(8):757–64.

    Article  PubMed  Google Scholar 

  60. Montesi SB, Edwards BA, Malhotra A, Bakker JP. The effect of continuous positive airway pressure treatment on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J Clin Sleep Med. 2012;8(5):587–96.

    PubMed  PubMed Central  Google Scholar 

  61. Hu X, Fan J, Chen S, Yin Y, Zrenner B. The role of continuous positive airway pressure in blood pressure control for patients with obstructive sleep apnea and hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich). 2015;17(3):215–22.

    Article  CAS  Google Scholar 

  62. Liu L, Cao Q, Guo Z, Dai Q. Continuous positive airway pressure in patients with obstructive sleep apnea and resistant hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens (Greenwich). 2015;18(2):153–8.

    Google Scholar 

  63. Schein AS, Kerkhoff AC, Coronel CC, Plentz RD, Sbruzzi G. Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients. J Hypertens. 2014;32(9):1762–73.

    Article  CAS  PubMed  Google Scholar 

  64. Iftikhar IH, Valentine CW, Bittencourt LR, Cohen DL, Fedson AC, Gíslason T, Penzel T, Phillips CL, Yu-sheng L, Pack AI, Magalang UJ. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens. 2014;32(12):2341–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, Narkiewicz K, Minuz P. Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest. 2014;145(4):762–71.

    Article  PubMed  Google Scholar 

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Özkök, A., Kanbay, A., Köktürk, O. (2017). The Effect of CPAP Therapy on Resistant Hypertension in Obstructive Sleep Apnea Syndrome Patients with Chronic Kidney Disease. In: Covic, A., Kanbay, M., Lerma, E. (eds) Resistant Hypertension in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-56827-0_20

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