Treating Sleep Apnea May Lower Hard-to-Control Blood Pressure

By Steven Reinberg
HealthDay Reporter

TUESDAY, Dec. 10 (HealthDay News) — People with sleep apnea and hard-to-control high blood pressure may see their blood pressure drop if they treat the sleep disorder, Spanish researchers report.
Continuous positive airway pressure (CPAP) is the standard treatment for sleep apnea, a condition characterized by disrupted breathing during sleep. The sleep disorder has been linked to high blood pressure.
Patients in this study were taking three or more drugs to lower their blood pressure, in addition to having sleep apnea. Participants who used the CPAP device for 12 weeks reduced their diastolic blood pressure (the bottom number in a blood pressure reading) and improved their overall nighttime blood pressure, the researchers found.

“The prevalence of sleep apnea in patients with resistant [high blood pressure] is very high,” said lead researcher Dr. Miguel-Angel Martinez-Garcia, from the Polytechnic University Hospital in Valencia.
“This [sleep apnea] treatment increases the probability of recovering the normal nocturnal blood pressure pattern,” he said. Patients with resistant high blood pressure should undergo a sleep study to rule out obstructive sleep apnea, Martinez-Garcia said. “If the patient has sleep apnea, he should be treated with CPAP and undergo blood pressure monitoring.”

The report, published in the Dec. 11 issue of the Journal of the American Medical Association, was partly funded by Philips-Respironics, maker of the CPAP system used in the study.

The CPAP system consists of a motor that pushes air through a tube connected to a mask that fits over the patient’s mouth and nose. The device keeps the airway from closing, and thus allows continuous sleep.
Sleep apnea is a common disorder. The pauses in breathing that patients experience can last from a few seconds to minutes and they can occur 30 times or more an hour.

As a result, sleep quality is poor, making sleep apnea a leading cause of excessive daytime sleepiness, according to the U.S. National Heart, Lung, and Blood Institute.

Dr. Gregg Fonarow, a spokesman for the American Heart Association and professor of cardiology at the University of California, Los Angeles, agrees that most patients with hard-to-control high blood pressure also suffer from sleep apnea.

“Close to three out of four patients with resistant [high blood pressure] have been found to have obstructive sleep apnea, and this sleep apnea may contribute to the difficulty to control the blood pressure in these patients,” he said.

Although this study showed a benefit from CPAP in controlling blood pressure, questions remain about the treatment’s overall effectiveness, Fonarow said.

“Whether these improvements in blood pressure can be sustained in the long term and will translate to improved health outcomes will require additional studies,” he said. According to the chief medical liaison for Philips Respironics, Dr. Teofilo Lee-Chiong, the CPAP device allows the patient to sleep, and thus lets the blood pressure drop normally as it would at night.

“Patients have to get used to it, and most patients do,” said Lee-Chiong, who is also a professor of medicine at National Jewish Health at the University of Colorado Denver.

The sound of the device is akin to a fan and can be lessened by placing the device under the bed or using earplugs, he added.

The cost of CPAP machines vary but can range from a few hundred dollars to $1,000, Lee-Chiong said. CPAP is covered by most insurance, including Medicare, he noted.

For the study, Martinez-Garcia and colleagues randomly assigned 194 patients with sleep apnea and high blood pressure to CPAP or no CPAP. During the study the patients continued to take their blood pressure medications.

The researchers found that those receiving CPAP lowered their 24-hour average blood pressure 3.1 mm Hg more than those not receiving CPAP.

In addition, those treated with CPAP had a 3.2 mm Hg greater reduction in 24-hour average diastolic blood pressure.

The difference in systolic pressure wasn’t statistically significant between the two treatment groups, the researchers noted.

Over the 12 weeks of the study, about 36 percent of those receiving CPAP had at least a 10 percent drop in nighttime blood pressure, compared with 22 percent of patients not receiving CPAP, they added.
The systolic pressure, the top number, measures the pressure in the arteries when the heart beats. The diastolic pressure, the bottom number, measures the pressure in the arteries between beats.

More information

For more information on sleep apnea, visit the U.S. National Heart, Lung, and Blood Institute.

Resources: http://news.health.com/2013/12/10/treating-sleep-apnea-may-lower-hard-to-control-blood-pressure/

CPAP Testimonials: 3 Patients' Honest Opinions of Sleep Apnea Treatment

It may be hard to believe that something described as "a hurricane blowing up my nose" could also be considered a lifesaver. But that's exactly how Mike Miner, whose obstructive sleep apnea causes him to routinely stop breathing during the night, feels about his continuous positive airway pressure (CPAP) machine.

For many patients, CPAP is a blessing
After being diagnosed with sleep apnea, Miner, 58, became one of the hundreds of thousands of Americans who regularly use air pressure machines to improve their oxygen levels while they sleep. Even napping without it would be pointless, says the golf course irrigation salesman in Jupiter, Fla., because he'd wake up every few minutes gasping for breath.

Miner admits that he was reluctant to try the clumsy-looking device, and that the blast of air up his nose felt awkward at first, but within the first week of using it, he was a convert. "Now if I don't wear it, I can feel what they were seeing in the sleep lab: I can feel that I wasn't breathing."

To others, it's a hassle
Virginia Arguello, 44, agrees that the benefits of CPAP are life-changing. When she spent her first night with a CPAP machine in 2000, she woke up feeling like a new person.

"It was the first time in years that I didn't have this recurring nightmare of being trapped underwater, never reaching the top," explains Arguello, a medical transcriptionist in Hayward, Calif. "I used to wake up gasping for air. The change was like night and day; I never realized how sleep deprived I'd been until I got the machine. It gave me back my sanity!"

Arguello used her CPAP machine religiously for more than seven years, but eventually started to feel burdened by the machine—wearing it every night, hauling it on vacation, and struggling to get by without it when she went camping with her family. So at 44, she underwent surgery to have her tonsils, uvula, and soft palate removed—a procedure that so far (six months after her operation) has allowed her to sleep without CPAP.

"That machine changed my life, but at my age, I just want to be free of it," she says. "My doctors told me that as my body changes I may need to go back to the machine, but I just need to know that I've tried everything."

And to some, an impossibility
Some people never get used to CPAP, no matter how many models they try. Matt Hanover, 44, was given a machine after his apnea diagnosis about four years ago. For more than nine months, he tried countless pressure levels, masks, and machines with sophisticated features like humidifiers and self-regulating airflow. But his narrow nasal passages and an oversize tongue, his doctors explained, caused a problem.

"I've been a mouth breather all my life," says Hanover, a digital media producer in Santa Monica, Calif. "Wearing the CPAP machine felt equivalent to sticking my head out of a car window going 30 miles an hour. And I just couldn't keep my mouth shut for more than an hour to breathe through my nose."

Hanover eventually found treatment with an oral breathing device that moved his jaw forward while allowing him to breathe through his mouth. He later cured his apnea completely, with surgery to repair a deviated septum.

Source: CPAP Testimonials: Health.Com