Uncontrolled Hypertension from Inappropriate Ventilator Settings in Obstructive Sleep Apnea: A Case Report

Abstract: This case report explores a typical instance of poorly controlled secondary hypertension associated with obstructive sleep apnea (OSA), specifically exacerbated during bilevel positive airway pressure (PAP) therapy, which was an inappropriate ventilator mode. The patient exhibited uncontrolled blood pressure and a high residual apnea-hypopnea index (AHI) while on bilevel therapy. Following a guided retitration of PAP therapy, both blood pressure control and residual AHI improved substantially. This report aims to provide an in-depth analysis of pathophysiological mechanisms underlying PAP therapy interactions with hypertension in OSA patients and to summarize key points for ventilator management in clinical practice. Keywords: obstructive sleep apnea, bilevel, central sleep apnea, positive airway pressure, hypertension, case report