Key result
CPAP therapy in severe OSA is associated with ~2 mmHg lower nocturnal diastolic BP.
Why the study?
Autonomic nervous system dysregulation is an important mechanism in cardiovascular disease development in obstructive sleep apnea, but the autonomic response to long-term CPAP therapy required further investigation.
Does long-term CPAP therapy improve autonomic nervous system function in patients newly diagnosed with severe OSA?
Cohort (n=57)
Does long-term CPAP therapy improve autonomic nervous system function in patients newly diagnosed with severe OSA?
Six months of adherent CPAP therapy in patients with severe OSA significantly improves autonomic nervous system balance, particularly reducing sympathetic predominance at night.
Supports nocturnal BP and autonomic improvements with CPAP in severe OSA; leaves open causal effects pending randomized trials.
Obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease (CVD) with increasing prevalence. An important mechanism of CVD development is a dysregulation of the autonomic nervous system (ANS). This prospective and controlled cohort study aimed to investigate ANS function in OSA including the response to long-term continuous positive airway pressure (CPAP) therapy by analyzing 24 h Holter electrocardiogram and 24 h Holter ambulatory blood pressure recording parameters. The study enrolled 57 patients who were newly diagnosed with severe OSA. After 6 months of CPAP therapy, 37 patients had a good therapy adherence (usage of CPAP device >4 h per night), and their data were analyzed. The difference in nocturnal diastolic blood pressure values before and after CPAP therapy reached statistical significance (76 (68–84) vs. 74 (63–80) mmHg, p = 0.0439). Lower nocturnal values after CPAP therapy of SDNN (101.5 vs. 95 ms, p = 0.0492) and RMSSD (29.5 vs. 26 ms, p = 0.0193) were found. An increase in diurnal spectral power (1742 vs. 2112 ms2, p = 0.0282) and a decrease in nocturnal spectral power (3256 vs. 2124 ms2, p = 0.0097), nocturnal VLF band (2493 vs. 1485.4 ms2, p = 0.0176), nocturnal LF band (638.7 vs. 473 ms2, p = 0.0097), and nocturnal HF band (234.9 vs. 135.7 ms2, p = 0.0319) was found. The results showed an imbalance of the ANS with a sympathetic predominance, especially during the night hours and in those with arterial hypertension. The impact of CPAP therapy on the improvement in ANS parameters was more pronounced at night, in men, and those with arterial hypertension.
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Friščić et al. (2023) conducted a cohort in Severe obstructive sleep apnea (OSA) (n=57). Continuous positive airway pressure (CPAP) therapy vs. Baseline (before CPAP therapy) was evaluated on Nocturnal diastolic blood pressure (p=0.0439). Six months of CPAP therapy in patients with severe OSA significantly reduced nocturnal diastolic blood pressure (76 vs. 74 mmHg, p=0.0439) and improved autonomic nervous system parameters.
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