Position paper on the management of patients with obstructive sleep apnea and hypertension: Joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on Obstructive Sleep Apnea

Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
Journal of Hypertension (Impact Factor: 4.72). 03/2012; 30(4):633-46. DOI: 10.1097/HJH.0b013e328350e53b
Source: PubMed


This article is aimed at addressing the current state of the art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnea (OSA) in cardiovascular (particularly hypertensive) patients, as well as for the management of cardiovascular diseases (particularly arterial hypertension) in OSA patients. The present document is the result of the work done by a panel of experts participating in the European Union COST (COoperation in Scientific and Technological research) ACTION B26 on OSA, with the endorsement of the European Respiratory Society (ERS) and the European Society of Hypertension (ESH). These recommendations are particularly aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are at the same time aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

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    • "However, it has only been in the past decade that these effects have been more rigorously tested using randomized control trial (RCT) designs. To date, there have been at least 19 RCTs with over 1600 patients examining the effects of OSA treatment on BP.86 In these studies, the control involved sham (subtherapeutic) devices, placebo pills, or no treatment. "
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    ABSTRACT: Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.
    Full-text · Article · May 2013 · Nature and Science of Sleep
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    • "OSA is characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which is associated with increasing respiratory efforts and intermittent arterial oxygen desaturation. Nocturnal arousals, loud intermittent snoring, and increased daytime sleepiness are the main symptoms [2]. Obstructive apneas and hypopneas are considered significant if they last for more than 10 seconds. "
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    ABSTRACT: Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications.
    Full-text · Article · Apr 2013 · Pulmonary Medicine

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