María José Jurado

Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial.

Objectives This controlled trial assessed the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH). Methods We evaluated 96 patients with resistant hypertension, defined as clinic BP at least 140/90 mmHg despite treatment with at least three drugs at adequate doses, including a diuretic. Patients underwent a polysomnography and a 24-h ambulatory BP monitoring (ABPM). They were classified as consulting room or ABPM-confirmed resistant hypertension, according to 24-h BP lower or higher than 125/80 mmHg. Patients with an apnea-hypopnea index at least 15 events/h (n = 75) were randomized to receive either CPAP added to conventional treatment (n = 38) or conventional medical treatment alone (n = 37). ABPM was repeated at 3 months. The main outcome was the change in systolic and diastolic BP. Results Sixty-four patients completed the follow-up. Patients with ABPM-confirmed resistant hypertension treated with CPAP (n = 20), unlike those treated with conventional treatment (n = 21), showed a decrease in 24-h diastolic BP (−4.9 ± 6.4 vs. 0.1 ± 7.3 mmHg, P = 0.027). Patients who used CPAP > 5.8 h showed a greater reduction in daytime diastolic BP {−6.12 mmHg [confidence interval (CI) −1.45; −10.82], P = 0.004}, 24-h diastolic BP (−6.98 mmHg [CI −1.86; −12.1], P = 0.009) and 24-h systolic BP (−9.71 mmHg [CI −0.20; −19.22], P = 0.046). The number of patients with a dipping pattern significantly increased in the CPAP group (51.7% vs. 24.1%, P = 0.008). Conclusion In patients with resistant hypertension and OSA, CPAP treatment for 3 months achieves reductions in 24-h BP. This effect is seen in patients with ABPM-confirmed resistant hypertension who use CPAP more than 5.8 h.

Obstructive sleep apnoea and 24-h blood pressure in patients with resistant hypertension.

Obstructive sleep apnoea (OSA) is common in patients with resistant hypertension, but understanding of the pathogenic mechanisms linking both conditions is limited. This study assessed the prevalence of OSA and the relationships between OSA and 24‐h blood pressure (BP) in 62 consecutive patients with resistant hypertension, defined as clinic BP values ≥ 140/90 despite the prescription of at least three drugs at adequate doses, including a diuretic. In order to exclude a ‘white coat effect’, only patients with ambulatory 24‐h BP values ≥ 125/80 were recruited. Patients underwent polysomnography, 24‐h ambulatory BP monitoring and completed the Epworth sleepiness scale (ESS). OSA was defined as an apnoea–hypopnoea index (AHI) ≥ 5 and excessive daytime sleepiness (EDS) by an ESS ≥ 10. A multiple linear regression analysis was used to assess the association of anthropometric data, OSA severity measures and ESS with 24‐h systolic and diastolic BP. Mean 24‐h BP values were 139.14/80.98 mmHg. Ninety per cent of patients had an AHI ≥ 5 and 70% had an AHI ≥ 30. Only the ESS was associated with 24‐h diastolic BP [slope 0.775, 95% confidence interval (CI) 0.120–1.390, P < 0.02); age was associated negatively with 24‐h diastolic BP (slope −0.64, 95% CI −0.874 to −0.411, P < 0.001). Compared with those without EDS, patients with EDS showed a significantly higher frequency of diastolic non‐dipping pattern (69.2% versus 34.7%, P < 0.032). Our results demonstrate a high prevalence of severe OSA in patients with resistant hypertension and suggest that EDS could be a marker of a pathogenetic mechanism linking OSA and hypertension.

Análisis de coste-eficacia de la graduación automática de la presión positiva continua de la vía aérea en el domicilio: ¿una o 2 noches?

OBJETIVO: Evaluar el coste-eficacia de la graduacion automatica de la presion positiva continua de la via aerea (CPAP) en el domicilio, en una y 2 noches consecutivas, en pacientes con sindrome de apneas-hiponeas durante el sueno. PACIENTES Y METODOS: Se practico un estudio de graduacion domiciliaria con un equipo de CPAP automatica (APAP) durante 2 noches consecutivas a 100 pacientes con sindrome de apneas-hipopneas durante el sueno e indicacion de tratamiento con CPAP. Se evaluaron el numero de estudios satisfactorios y el coste resultante de la primera noche y de las 2 noches. Se compararon las necesidades de presion durante cada noche y la concordancia entre la presion seleccionada visualmente por 2 observadores. RESULTADOS: La graduacion de CPAP fue satisfactoria en el 85 y el 80% de los pacientes en la primera y la segunda noches, respectivamente, y en el 88% despues de las 2 noches. No hubo diferencias significativas entre las 2 noches en la presion percentil 95% (media ± desviacion estandar: 10,2 ± 1,8 y 10,2 ± 1,6 cmH2O), la presion media (7,8 ± 1,7 y 7,7 ± 1,7 cmH2O) y la presion visual (9,4 ± 1,5 y 9,4 ± 1,4 cmH2O). Se obtuvo un buen grado de concordancia entre 2 observadores en la seleccion de presion (kappa = 0,956 para la noche 1; kappa = 0,91 para la noche 2). El coste de los estudios fue 232,63 ? para la primera noche y 227,93 ? para las 2 noches consecutivas. CONCLUSIONES: Con un coste similar, la adopcion de un protocolo de graduacion automatica de la CPAP una noche en el domicilio permite incrementar sustancialmente el numero de pacientes estudiados, respecto a 2 noches consecutivas.

Neurophysiological two-channel polysomnographic device in the diagnosis of sleep apnea.

STUDY OBJECTIVE Our objective was to evaluate a portable device (Somté, Compumedics, Australia), which incorporates 2 neurophysiological channels (electroencephalography and electrooculography) with cardiorespiratory monitoring for the diagnosis of obstructive sleep apnea (OSA). METHOD Full polysomnography (PSG) and Somté recordings were simultaneously performed in 68 patients with suspected OSA. Data were analyzed blindly by 2 scorers. RESULTS A good agreement between methods in sleep efficiency was observed (68.8% [18.4] with PSG vs 68% [19.1] with Somté [p: n.s.] for scorer 1, and 67.5% [19.1] vs 68.4% [18.5; p: n.s.] for scorer 2). The apnea-hypopnea index (AHI) obtained with Somté was lower than with PSG: 19 (17.8) vs 21.7 (19) (p < 0.001) for scorer 1, and 16.6 (16.7) vs 20 (18.8) (p < 0.001) for scorer 2. The sensitivity of Somté for a PSG-AHI > 5 was 91% for scorer 1 and 90% for scorer 2, while specificity was 77% and 90%, respectively. The areas under the receiver operating curve for different PSG-AHI cutoff points (≥ 5, ≥ 15, and ≥ 30) were 0.81, 0.90, and 0.86, respectively, for scorer 1, and 0.90, 0.88, and 0.83 for scorer 2. CONCLUSIONS These data suggest that Somté is an effective device to identify sleep and respiratory variables in patients with suspected OSA.

Cost-Effectiveness Analysis of Automatic Titration of Continuous Positive Airway Pressure at Home in 1 Night Versus 2 Nights

OBJECTIVE To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titration at home on 1 night or 2 consecutive nights in patients with the sleep apnea-hypopnea syndrome (SAHS). PATIENTS AND METHODS A home titration study was performed using automatic CPAP for 2 consecutive nights on 100 patients with SAHS and an indication for CPAP. The number of successful studies and the costs of the first night and both nights were analyzed. The pressure requirements on each night and the agreement between the pressures selected visually by 2 different observers were compared. RESULTS CPAP titration was successful in 85% and 80% of patients on the first night and second night, respectively, and in 88% of patients after both nights. No significant differences between the 2 nights were found for the following parameters: 95th percentile pressure (mean [SD], 10.2 [1.8] cm H(2)O and 10.2 [1.6] cm H(2)O on the first and second nights, respectively), mean pressure (7.8 [1.7] cm H(2)O and 7.7 [1.7] cm H(2)O), or the pressure selected visually (9.4 [1.5] cm H(2)O and 9.4 [1.4] cm H(2)O). Interobserver agreement on the pressure selected was good: the k statistics were 0.956 for the first night and 0.91 for the second night. The 1-night study cost euro232.63 and the 2-night study cost euro227.93. CONCLUSIONS Automatic CPAP titration at home for 1 night enables a substantially greater number of patients to be studied at a similar cost than is possible when titration is accomplished in 2 consecutive nights.

Effect of adjunctive perampanel on the quality of sleep and daytime somnolence in patients with epilepsy

This prospective uncontrolled study evaluated the effect of low-dose adjunctive perampanel therapy (4 mg/day for 3 months) on the sleep-wake cycle and daytime somnolence in adult patients (n = 10) with focal seizures. A > 50% reduction in the number of seizures was reported in 80% of the study patients; treatment had no significant effect on any sleep parameters as evident by the Maintenance of Wakefulness Test, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores. Two patients reported dizziness with treatment. In conclusion, low-dose perampanel may improve seizure control without affecting the sleep characteristics or daytime somnolence in patients with epilepsy.