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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

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Systemic hypertension in obstructive sleep apnea.

Carolina Lombardi^1,2, Martino F Pengo¹, Gianfranco Parati^1,2

¹Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, S.Luca Hospital, Milan, Italy.

Journal of Thoracic Disease

|January 29, 2019

Summary

Obstructive sleep apnea (OSA) is linked to hypertension through complex mechanisms. While OSA treatment may slightly lower blood pressure, large trials haven't confirmed significant antihypertensive effects or improved cardiovascular outcomes.

Keywords:

Arterial hypertension cardiovascular diseases continuous positive airway pressure (CPAP)sleep apnea

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Area of Science:

Cardiology
Sleep Medicine
Hypertension Research

Background:

Sleep disordered breathing and systemic arterial hypertension share a complex bidirectional relationship.
Mechanisms involve autonomic nervous system, inflammation, hormonal, and hemodynamic factors.

Purpose of the Study:

To review the latest evidence on the relationship between obstructive sleep apnea (OSA) and hypertension.
To discuss unanswered pathophysiological questions and the impact of OSA treatment on blood pressure.
To identify future research needs for improved diagnosis, phenotyping, and treatment adherence.

Main Methods:

Literature review of epidemiological and clinical studies.
Analysis of existing data on OSA treatment effects on blood pressure.
Discussion of pathophysiological pathways and clinical trial outcomes.

Main Results:

Consistent epidemiological evidence links OSA and hypertension.
Some studies suggest a modest blood pressure reduction with OSA treatment, particularly in hypertensive patients.
Large trials have not definitively confirmed significant antihypertensive effects or improved cardiovascular endpoints.

Conclusions:

The relationship between OSA and hypertension is multifactorial and requires further investigation.
Clarifying the precise impact of OSA treatment on blood pressure and cardiovascular health is crucial.
Future research should focus on early diagnosis, patient phenotyping, and enhancing treatment adherence.