Obstructive sleep apnoea: PAP tops upper airway stimulation for BP decrease

  • Walia HK & al.
  • Chest
  • 9 Jul 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Positive airway pressure (PAP) therapy for obstructive sleep apnoea (OSA) bests upper airway stimulation (UAS) for BP reductions, especially in patients with higher baseline BP.

Why this matters

  • Results underscore the cardiovascular relevance of therapy for OSA and suggest PAP might be an appropriate choice for patients with hypertension. 
  • Comparative effectiveness of PAP vs UAS for BP in these patients was not clear. 

Key results

  • Diastolic BP improved more steeply with PAP (by 3.7 mmHg over UAS; P<.001>
  • UAS patients did not have significant BP changes.
  • No systolic improvements seen in either group.
  • Mean arterial pressure (MAP) also improved more with PAP: by 2.8 mmHg over UAS (P=.008).
  • Among patients with baseline BP ≥130/80 mmHg, improvements seen across BP measures with PAP and in systolic BP and MAP with UAS.
  • Sleep symptoms improved more with UAS (P=.046).
  • Patients used UAS treatment 6.2 hours/week (95% CI, 3.3-9.0) more than patients used PAP, but adherence was not linked to BP effects in either treatment group.

Study design

  • 837 patients with OSA (517 PAP, 2010-2014; 320 UAS implantation, 2015-2017), Cleveland Clinic; 402 propensity-matched. 
  • Funding: Cleveland Clinic. 

Limitations

  • Even with propensity matching, undetected differences still possible.
  • Retrospective study, antihypertensive therapy history not known.