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Vol 22, No 3 (2018)
ORIGINAL PAPERS
Published online: 2018-08-16
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Hemodynamic phenotypes and its association with blood pressure changes at continuous positive airway pressure therapy in obstructive sleep apnoea hypertensive patients

Raissa Khursa, Margarita Voitikova, A Stefański, Jacek Wolf, Krzysztof Narkiewicz
DOI: 10.5603/AH.a2018.0011
·
Arterial Hypertension 2018;22(3):113-119.

open access

Vol 22, No 3 (2018)
ORIGINAL PAPERS
Published online: 2018-08-16

Abstract

Background. The goal of our study was to define the hemodynamic phenotypes in hypertensive patients with newly diagnosed obstructive sleep apnoea (OSA) using the individual modelling of hemodynamics derived from ambulatory blood pressure monitoring (ABPM), a method proposed by our group previously, and to assess its validity in blood pressure alterations secondary to continuous positive airway pressure (CPAP).

Material and methods. Thirty-three hypertensive patients with moderate-to-severe OSA were investigated. All patients underwent ABPM on two occasions: at baseline and after one week CPAP. The sets of BP indexes at first ABPM were used for individual modelling to define the hemodynamic phenotype (class) based on regression analyses; specifically, the phenotypes were defined for daytime, nighttime and for 24 hours. The CPAP therapy efficacy was predefined as improvement in BP nighttime decrease for additional 5% as compared to baseline ABPM. With reference to this criterion, patients were further classified as responders (who achieved this target), and non-responders.

Results. Only 21.2% of hypertensive patients with OSA had optimal hemodynamic phenotype (class H2), despite comprehensive antihypertensive therapy; most of the other patients were classified either as harmonic type (class H3; 39.4%), or of diastolic dysfunctional type (class D3; 15.2%). In the daytime period 18.2% of patients with OSA were classified as D1-class, which is associated with high risk of acute hypotensive episodes. Responders were more frequently characterized by phenotype H3 (daytime) vs. nonresponders: 53.3% and 5.6% respectively; P < 0.05. At nighttime non-responders were more likely to transform the different baseline classes into H3 and D2; P < 0.05 vs. responders.

Conclusion. Our study suggest utility of newly developed modelling based on hemodynamic BP indexes in the prediction of BP alterations secondary to CPAP in OSA hypertensive patients.

Abstract

Background. The goal of our study was to define the hemodynamic phenotypes in hypertensive patients with newly diagnosed obstructive sleep apnoea (OSA) using the individual modelling of hemodynamics derived from ambulatory blood pressure monitoring (ABPM), a method proposed by our group previously, and to assess its validity in blood pressure alterations secondary to continuous positive airway pressure (CPAP).

Material and methods. Thirty-three hypertensive patients with moderate-to-severe OSA were investigated. All patients underwent ABPM on two occasions: at baseline and after one week CPAP. The sets of BP indexes at first ABPM were used for individual modelling to define the hemodynamic phenotype (class) based on regression analyses; specifically, the phenotypes were defined for daytime, nighttime and for 24 hours. The CPAP therapy efficacy was predefined as improvement in BP nighttime decrease for additional 5% as compared to baseline ABPM. With reference to this criterion, patients were further classified as responders (who achieved this target), and non-responders.

Results. Only 21.2% of hypertensive patients with OSA had optimal hemodynamic phenotype (class H2), despite comprehensive antihypertensive therapy; most of the other patients were classified either as harmonic type (class H3; 39.4%), or of diastolic dysfunctional type (class D3; 15.2%). In the daytime period 18.2% of patients with OSA were classified as D1-class, which is associated with high risk of acute hypotensive episodes. Responders were more frequently characterized by phenotype H3 (daytime) vs. nonresponders: 53.3% and 5.6% respectively; P < 0.05. At nighttime non-responders were more likely to transform the different baseline classes into H3 and D2; P < 0.05 vs. responders.

Conclusion. Our study suggest utility of newly developed modelling based on hemodynamic BP indexes in the prediction of BP alterations secondary to CPAP in OSA hypertensive patients.

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Keywords

obstructive sleep apnoea, blood pressure, regression modelling, hemodynamic phenotypes, CPAP-therapy

About this article
Title

Hemodynamic phenotypes and its association with blood pressure changes at continuous positive airway pressure therapy in obstructive sleep apnoea hypertensive patients

Journal

Arterial Hypertension

Issue

Vol 22, No 3 (2018)

Pages

113-119

Published online

2018-08-16

DOI

10.5603/AH.a2018.0011

Bibliographic record

Arterial Hypertension 2018;22(3):113-119.

Keywords

obstructive sleep apnoea
blood pressure
regression modelling
hemodynamic phenotypes
CPAP-therapy

Authors

Raissa Khursa
Margarita Voitikova
A Stefański
Jacek Wolf
Krzysztof Narkiewicz

References (11)
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