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Randomized Controlled Trial
. 2022 Oct;19(10):1750-1759.
doi: 10.1513/AnnalsATS.202203-260OC.

Long-Term Effect of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients with Acute Coronary Syndrome: A Clinical Trial

Manuel Sánchez-de-la-Torre  1   2 , Esther Gracia-Lavedan  2   3 , Iván David Benítez  2   3 , Andrea Zapater  1   2 , Gerard Torres  2   3 , Alicia Sánchez-de-la-Torre  2   3 , Albina Aldoma  4 , Jordi de Batlle  2   3 , Adriano Targa  2   3 , Jorge Abad  2   5 , Joaquín Duran-Cantolla  2   6 , Amaia Urrutia  7 , Olga Mediano  2   8 , María José Masdeu  2   9 , Estrella Ordax-Carbajo  10 , Juan Fernando Masa  2   11 , Mónica De la Peña  12 , Mercè Mayos  2   13 , Ramon Coloma  14 , Josep María Montserrat  2   15 , Eusebi Chiner  16 , Olga Mínguez  3 , Lydia Pascual  3 , Anunciación Cortijo  3 , Dolores Martínez  3 , Mireia Dalmases  2   3 , Chi-Hang Lee  17 , R Doug McEvoy  18 , Ferran Barbé  2   3 ; Spanish Sleep Network
Collaborators, Affiliations
Randomized Controlled Trial

Long-Term Effect of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients with Acute Coronary Syndrome: A Clinical Trial

Manuel Sánchez-de-la-Torre et al. Ann Am Thorac Soc. 2022 Oct.

Abstract

Rationale: Obstructive sleep apnea (OSA) is prevalent in patients with acute coronary syndrome (ACS) and is a cause of secondary hypertension. Objectives: To explore the long-term effects of OSA and continuous positive airway pressure (CPAP) treatment on blood pressure (BP) in patients with ACS. Methods: Post hoc analysis of the ISAACC study (Continuous Positive Airway Pressure in Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea; NCT01335087) included 1,803 patients admitted for ACS. Patients with OSA (apnea-hypopnea index [AHI], ⩾15 events/h) were randomly assigned to receive either CPAP or usual care and were seen in follow-up for 1-5 years. Office BP was determined at each visit. Results: We included 596 patients without OSA, 978 patients in the usual care or poor CPAP adherence group, and 229 patients in the good CPAP adherence group. At baseline, 52% of the patients were diagnosed with hypertension. Median (25th to 75th percentile) age and body mass index were 59 (52.0 to 67.0) years and 28.2 (25.6 to 31.2) kg/m2, respectively. After a median (25th to 75th percentile) follow-up of 41.2 (18.3 to 59.6) months, BP changes were similar in the OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI, >40 events/h), with a maximum difference in mean BP of +3.3 mm Hg at 30 months. Patients with OSA with good CPAP adherence (⩾4 h/night) reduced mean BP after 18 months compared with patients with usual care/poor CPAP adherence, with a maximum mean difference (95% confidence interval) of -4.7 (-6.7 to -2.7) mm Hg. In patients with severe OSA, we observed a maximum mean difference of -7.1 (-10.3 to -3.8) mm Hg. Conclusions: In patients with ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT01335087).

Keywords: acute coronary syndrome; blood pressure; cardiovascular diseases; hypertension; obstructive sleep apnea.

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