latter evidence shows that obstruct...

latter evidence shows that obstructive nap apnea (OSA) increases nocturnal vital current pressure and is a risk factor for arterial hypertension during the day. While nasal continuous positive airway crushing (nCPAP) has been shown to improve symptoms in patients with OSA, its part in reducing blood pressure is questionable. Becker and colleagues performed a prospective randomized inquiry involving 60 patients with moderate to harsh OSA to evaluate the import of nCPAP on blood pressure

Inclusion criteria for the subject of attention were five or more apneas or hypopneas for hour of sleep and excessive daytime sleepiness according to the Epworth sleepiness scale. Exclusion criteria were central be still apnea, respiratory failure, heart failure, latter myocardial infarction, arrhythmias, and being a professional driver. Polysomnography and continuous noninvasive descendants pressure monitoring were performed before and with treatment. Patients were treated with effective (preventing apneas, hypopneas, snoring in all doze stages in supine position; 9 cm [Hsub2]O of urgency on average) or subtherapeutic (lowest possible hurry for nCPAP device; 3 to 4 cm [Hsub2]O) nCPAP for about nine weeks. Hypertensive patients who had a change in medication were considered dropout and simply 32 patients (16 in the effective treatment dispose and 16 in the subtherapeutic group) without of 118 completed the meditation The primary measurement of the subject of attention was change in mean arterial house pressure; the secondary measurements were changes in systolic and diastolic pressures; the tertiary measurements were the apnea-hypopnea index (AHI) and sleepiness.

The mean arterial vital current pressure decreased about 10 mm Hg in the effective nCPAP collection while it increased in the subtherapeutic dispose The diastolic and systolic vital fluid pressures also significantly decreased in the effective form into groups (approximately 10 mm Hg and 95 mm Hg respectively). In addition, the AHI and measures of sleepiness were significantly better in the effective treatment collection The AHI was reduced from 50 percent in the subtherapeutic assign places to The authors conclude that level though AHI is reduced with subtherapeutic nCPAP, optimal superintend of blood pressure is achieved with effective nCPAP treatment.

SUMI M SEXTON, MD

Becker HF et al. issue of nasal continuous positive airway squeezing treatment on blood pressure in patients with obstructive lie in the grave apnea. Circulation January 2003; 107:68-73

EDITOR'S NOTE: A similar contemplation performed by Pepperell and colleagues (Pepperell JC et al. Ambulatory posterity pressure after therapeutic and subtherapeutic nasal continuous positive airway squeezing for obstructive sleep apnoea: a randomised parallel trial. Lancet January 19 2002; 359:204-10) also demonstrated that children pressures were significantly reduced in the therapeutic versus the subtherapeutic assemblage However, the differences in descendants pressure were lower (mean squeezing decreased 2.5 mm Hg). Perhaps the discrepancies can be explained through the shorter treatment period in this studious mood one month versus nine weeks in the trial at Becker and colleagues. Another explanation is the larger number of patients (118) in the contemplation suggesting that Becker's results in 32 patients lack power. Regardless, nCPAP appears to lessen blood pressure consistently.--S.M.S.

COPYRIGHT 2003 American Academy of Family Physicians

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