- 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.
- 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.
- 837 patients with OSA (517 PAP, 2010-2014; 320 UAS implantation, 2015-2017), Cleveland Clinic; 402 propensity-matched.
- Funding: Cleveland Clinic.
- Even with propensity matching, undetected differences still possible.
- Retrospective study, antihypertensive therapy history not known.