Wednesday, September 7, 2016

High blood pressure medications and obstructive sleep apnea severity

Obstructive sleep apnea (OSA) is associated with high blood pressure (HTN). Studies have shown that OSA is independently associated with resistant HTN and it is believed that untreated OSA may worsen HTN. However, studies involving treatment of OSA with continuous positive airway pressure (CPAP) have demonstrated only modest improvement in daytime blood pressure in randomized control trials. some research first speculate that the relationship between OSA and HTN may be bidirectional.

With OSA, the muscles that make up the throat lose their home causing collapse of that area and reduction in airflow to the lungs. Research her as hypothesized that intensive blood pressure control may influence always say I stabilizing the upper airway. There is also evidence for the role of volume status affecting the severity of OSA. What this means is that some people have worse OSA when they have too much blood volume from conditions like heart failure or kidney failure.

This study theorized that it is at least plausible that intensive treatment of HTN may bring about improvement in the severity of OSA, either by volume control, stabilization of upper airway muscles, or perhaps because of some direct effect of blood pressure medications. The researchers conducted a systematic review and meta-analysis on this topic.

Although there were limited number of studies and the studies were not of high quality, though results revealed that there was a decrease in OSA severity after treatment with blood pressure medications. Of note, the decrease reached statistical significance but the researchers doubted if it would be clinically significant.

I wanted to blog about this study in part because because throughout my career as a sleep physician I have thought of the OSA-HTN relationship as more one way, with OSA contributing to HTN, rather than the opposite as suggested by the authors of this study. Certainly more studies will be required before any definitive conclusions can be made.

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