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Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure.
MedLine Citation:
PMID:  21477566     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Obstructive Sleep Apnoea Syndrome (OSAS) patients may develop hypertension and Positive Airway Pressure (PAP) is an effective treatment in blood pressure (BP) control. OBJECTIVES: Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance. METHODS: Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5 mmHg in systolic (SBP) and/or diastolic BP (DBP), after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient. RESULTS: Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58 ± 10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1 ± 18.68). After PAP usage, mean blood pressure (MBP), Systolic BP (SBP) and Diastolic BP (DBP) variation was 16 ± 15 mmHg, 20 ± 25 mmHg and 6 ± 19.4 mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS) value decreased 8.9 ± 5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance. CONCLUSIONS: No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of β1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response.
C Chaves Loureiro; M Drummond; J C Winck; J Almeida
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Publication Detail:
Journal Detail:
Title:  Revista portuguesa de pneumologia     Volume:  17     ISSN:  0873-2159     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9813736     Medline TA:  Rev Port Pneumol     Country:  -    
Other Details:
Languages:  ENG; POR     Pagination:  53-58     Citation Subset:  -    
Serviço de Pneumologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Vernacular Title:
Reacção paradoxal da pressão arterial ao tratamento com pressão positiva na via aérea em doentes com apneia do sono.
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