British Snoring & Sleep Apnoea Association

Just read this report on sleep apnoea and high blood pressure ,having been on cpap for over 4yrs now and taking a low dose blood pressure tablet (ramipril 2.5mg) my bp remains in the high normal bracket. I appreciate it would be far worser if not on therapy .

Some estimate that 70%-83% of people with resistant hypertension have obstructive sleep apnea as defined by the apnea-hypopnea index -- generally over 5, but usually much more than that. It is defined as apnea for at least 10 seconds with no flow or hypopnea for 10 seconds with reduced flow, with a reduced oxygen saturation of about 3%. This has been associated with obesity, but not everybody with sleep apnea is obese. You can usually figure it out clinically when people report snoring or daytime sleepiness. This seems to be a much more common issue than we realized, and it's likely to get even more common as we go along.

The treatments for obstructive sleep apnea are disappointing. The thing that seems to work best at lowering blood pressure is continuous positive airway pressure (CPAP). Many patients, even with the newer machines that are much easier to use, have trouble tolerating CPAP even though they feel better when they do it. They're not sleepy all day and don't snore as much, but you have to lie on your back, and not everybody can sleep that way. Is this really good for blood pressure? This was recently studied in a Spanish study[1] of about 35 people who got conventional therapy and 35 who got CPAP. The study lasted 3 months. Ambulatory blood pressure monitoring (ABPM) was done at the beginning and at the end. What you get is a sense of a dose response, because you look at how many hours the CPAP was used and what the results were in the apnea-hypopnea index.

Like any therapy, not everybody can tolerate it. Only 20 of the 29 people who were in the CPAP group were able to complete the study. The comparison group received conventional therapy. These were truly resistant hypertensive patients. Most were on 3 drugs, some were on 4, some were on 5, and they weren't at goal blood pressure. We can accept that as an appropriate cohort. About 37 people were randomized to conventional therapy with no sham-CPAP. Some of us would say that if you don't put something on, maybe it's not really a control group. Of those who were randomized to CPAP (originally 37), 9 of them wouldn't even accept it or couldn't tolerate it, and there was 1 that was lost to follow-up. Of the 29 people who were in the CPAP group, 20 were bona fide resistant hypertensive patients when you used ambulatory monitoring. The other 9 weren't.

At the end of 3 months, they repeated the ABPM study and found something quite interesting. Overall, there really was no benefit in blood pressure to CPAP unless you used it long enough. The median time of CPAP use was about 5.5 hours. Those who were above the median had a substantial drop in blood pressure, both on ABPM and in the office, but those who didn't use it as much did not. Like any drug, there's a dose response. There are adverse reactions, but this looks like a potentially promising therapy for resistant hypertension, although by no means is this the definite answer. We have to look further into this and maybe try to develop some better therapies. The best is probably to try to prevent the obesity that is so often related to obstructive sleep apnea. Thank you very much.



Regards,

Ive found this one in similar vein.

http://www.bestsyndication.com/Articles ... _heart.htm

I think I need to print it out and show my GP.

NM

Having just had my latest spell in hospital and being told I have high blood pressure. The relationship of osa and high blood pressure you have posted makes sense.

The other thing is having had my heart flip to AF instead of Sinus is also linked to osa.

OSA has a lot of unknown factors

Mac

I have High Blood pressure and also slight breathlessness (which could be linked) my GP has no idea why, he keeps blaming my previous smoking from years ago, but as my wife pointed out to him I was still cycling and was climbing mountains after I gave up, the breathing problems came afterwards. I did see a post somewhere where a girl had to start coming off her BP medication after a year then after 2 years it was normal without drugs. My GP is going to send me for a heart scan to see if my heart is enlarged so see what that brings.

David

David

Having had all sorts of problem over the years due to a heart problem from birth. I am still here at 50 years of age (longer than the doctors told my mother when I was about 15)

My most recent problem which put me in critical coronary care was to do with blood pressure. The other problem was my heart had gone into Atrial Fibrilliation (AF). Now on medication the heart is beating in sinus mode again and can at any point go back into Sinus mode.

Atrial fibrillation causes a fast and erratic heartbeat. It is a complication of various diseases. Medication can slow the heart rate back to normal, and ease symptoms. In some cases, treatment can restore the heart back to a normal rhythm. In addition, a drug such as warfarin is usually advised to reduce the risk of having a stroke

I am now left with shortness of breath, chest discomfort and high blood pressure. Here is a typical night at work.

01.45 AM (167/116) (62 BPM) )(CHEST DISCOMFORT)
02.35 AM (200/127) (61 BPM) (CHEST DISCOMFORT)
03.30 AM (199/122) (62 BPM) (CHEST DISCOMFORT)
04.15 AM (208/106) (70 BPM) (CHEST DISCOMFORT)
04.55 AM (210/118) (67 BPM) (CHEST DISCOMFORT)
05.30 AM (180/118) (68 BPM) (CHEST DISCOMFORT)

I have been put on medication to lower the blood pressure which seems to be working. Ask for the 24 hour monitor to see what your blood pressure is over one day

I asked the consultant last week a series of questions and two of these were to do with Blood Pressure, AF and the connection with OSA . His answer was yes there is evidence to show this is the case.

I have just read this

http://www.talkaboutsleep.com/sleep-disorders/archives/Snoring_apnea_bloodpressure.htm

People with obstructive sleep apnea (OSA) are likely to have a blood vessel impairment that may cause daytime blood pressure elevation and may lead to heart disease, according to a new Mayo Clinic study published this week in Circulation. An estimated 15 million Americans -- three-fourths of them men -- suffer from sleep apnea, but only about ten percent have been diagnosed and treated.

The study, conducted in collaboration with University of Iowa researchers, compared endothelial function in healthy obese subjects with sleep apnea with a closely matched control group without sleep apnea. The endothelium is a layer of cells that lines blood vessels and regulates blood pressure by causing vessels to dilate.

"We know that high blood pressure, diabetes, congestive heart failure and high cholesterol levels damage the endothelium, and that this endothelial impairment in turn may lead to blood pressure elevation and further vessel damage," says Virend Somers, M.D., a Mayo Clinic cardiologist and the senior investigator in the study. "This study shows that sleep apnea also is an independent cause of endothelial impairment, even in the absence of other factors. It suggests that sleep apnea in otherwise healthy individuals may set in motion a long-term cycle of endothelial damage, hypertension and heart disease."

The study introduction in the journal Circulation 2000;102:2607-2610 summarizes the key points:

Obstructive sleep apnea (OSA) has been linked to hypertension, heart failure, and stroke and to increased mortality.
The mechanisms underlying the association between OSA and cardiovascular disease are not fully understood.
Patients with OSA have a heightened sympathetic drive during wakefulness, which may increase even further during sleep.
During sleep, these patients experience severe repetitive hypoxemic stress, with reflex sympathetic activation and consequent marked increases in blood pressure.
Hypoxemia, sympathetic activation, and increased arterial pressure may impair endothelial function, suggesting a possible mechanism for the development of cardiovascular disease in OSA patients.
People with sleep apnea typically stop breathing dozens or even hundreds of times during the night as their airway collapses like a wet soda straw. Researchers believe the combination of oxygen deprivation and the extremely high nighttime blood pressure caused by sleep apnea may be responsible for the endothelial damage observed in the study.

Results showing restoration of endothelial function by correcting other risk factors lead researchers to believe that treating OSA may have a similar effect. "Since treating high blood pressure and hypertension has been shown to improve endothelial function, it seems likely that eliminating the nightly blood pressure spikes and oxygen shortages caused by OSA also will help," says Dr. Somers. "Patients who receive treatment also typically feel better rested and are more alert, and therefore are less likely to get in an accident than those who continue to suffer sleep deprivation."

The study was conducted with a small group of closely matched subjects, all males. There were 8 patients with sleep apnea and 9 patients in the control group. The OSA patients were newly diagnosed and not yet treated for their sleep apnea. The control subjects were tested for sleep apnea as well. but the mean AHI (apnea-hypopnea index) for the controls was 1 per hour, compared to the 52 per hour for the apnea patients.

There were no significant differences between the two groups in age, body mass index, body fat, or cholesterol levels. None of the patients was taking any medication

Dr. Somers says the study highlights the widespread cardiovascular effects of sleep apnea and the need for people to learn about it and watch for its symptoms. "Most cases of sleep apnea are first noticed when the patient falls asleep during the day, or by a woman seeing her husband stop breathing at night.

The good news is that in many cases patients can reduce or eliminate the problem by losing weight, sleeping on their side, and avoiding alcohol and sleeping pills. Others find relief through a continuous positive airway pressure (CPAP) device, which keeps the airway from collapsing. (Editor's note: Most sleep specialists and apnea patients indicate that CPAP is the "gold standard" treatment for sleep apnea) While these treatments are not perfect, they can help the majority of sleep apnea sufferers. This new study gives one more important reason for people who suspect they have sleep apnea to seek medical attention."

Hope this helps

Mac

Errrrrr, that is a wee bit high Mac!!
Take care of yourself.

Yes I thought the same, they worry about me being 140 to 160 / 85 to 95

Yes high

Consultant aware and gp.


Mac

I have also a sleep apnea. I always aware in my blood pressure because I'm scared in knowing that my blood pressure is high. So everyday I go to my specialist for consultation.

Hi Mac,

Those are high figures (As you are obviously aware), but have you been tried on a variety of medication for the hypertension? I only ask, because at long last I have changed GPs, largely because of the incompetence they exhibited when treating my high blood pressure and sleep apnoea.
I was on Lisinopril for a few years, but my blood pressure was not coming down (170/120 typical). When I changed GPs the first thing the new doctor did, was to put me on a minimal dose (15mg) of Amlodipine, and hey presto, my BP is now in the region of 140/85.

Andy

Andy

I have birth defect in the coronary arteries of my heart and this causes angina whist I am asleep.

I was on Amlodipine for a few years and stopped taking it 7 years ago.

Over Christmas I have had severe chest pains.

It was strange reading your post as I have just been put back on this medication and the chest pains have gone.

Not sure about the blood pressure at the moment. Just gald the pains have gone

Mac

I've tried beet juice for hypertension and it worked miracles. My docs jaw dropped at results I got. Twice a week about 8oz of beet juice should be fine for most people. simvastatin depression quotes