Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Nov 1;37(11):1863-70.
doi: 10.5665/sleep.4186.

CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial

Monique Mendelson  1 , Isabelle Vivodtzev  1 , Renaud Tamisier  1 , David Laplaud  2 , Sonia Dias-Domingos  1 , Jean-Philippe Baguet  3 , Laurent Moreau  4 , Christian Koltes  5 , Léonidas Chavez  6 , Gilles De Lamberterie  6 , Frédéric Herengt  7 , Patrick Levy  1 , Patrice Flore  1 , Jean-Louis Pépin  1
Affiliations
Randomized Controlled Trial

CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial

Monique Mendelson et al. Sleep. .

Abstract

Study objectives: Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients.

Design: A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention.

Setting: Sleep clinics in France.

Patients or participants: 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention).

Interventions: Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages.

Measurements: The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life.

Results: Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention.

Conclusions: CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients.

Clinical trials registration: ClinicalTrials.gov identifier: NCT01226641.

Keywords: blood pressure; cardiovascular risk; obstructive sleep apnea; telemedicine.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Design of telemedicine intervention.
Figure 2
Figure 2
Flow chart of patient recruitment.
Figure 3
Figure 3
Box plots of changes in morning and evening self-measured blood pressure in telemedicine and standard care.
Figure 4
Figure 4
Changes in self-measured blood pressure in patients presenting primary and secondary cardiovascular risk. Dark gray line represents telemedicine and light gray standard care. * P = 0.0075.
See this image and copyright information in PMC

References

    1. Douglas NJ, Polo O. Pathogenesis of obstructive sleep apnoea/hypopnoea syndrome. Lancet. 1994;344:653–5. - PubMed
    1. Jaffe LM, Kjekshus J, Gottlieb SS. Importance and management of chronic sleep apnoea in cardiology. Eur Heart J. 2013;34:809–15. - PubMed
    1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur Heart J. 2013;34:2159–219. - PubMed
    1. Pepin JL, Tamisier R, Levy P. Obstructive sleep apnoea and metabolic syndrome: put CPAP efficacy in a more realistic perspective. Thorax. 2012;67:1025–7. - PubMed
    1. Brooks D, Horner RL, Kozar LF, Render-Teixeira CL, Phillipson EA. Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. J Clin Invest. 1997;99:106–9. - PMC - PubMed

Publication types

Associated data