TY - JOUR
T1 - Effect of CPAP, weight loss, or CPAP plus weight loss on central hemodynamics and arterial stiffness
AU - Jain, Snigdha
AU - Gurubhagavatula, Indira
AU - Townsend, Raymond
AU - Kuna, Samuel T.
AU - Teff, Karen
AU - Wadden, Thomas A.
AU - Chittams, Jesse
AU - Hanlon, Alexandra L.
AU - Maislin, Greg
AU - Saif, Hassam
AU - Broderick, Preston
AU - Ahmad, Zeshan
AU - Pack, Allan I.
AU - Chirinos, Julio A.
N1 - Funding Information:
This study was supported by grants from the American Heart Association Award No. 0885031N (J.A. Chirinos) and National Heart, Lung, and Blood Institute HL-R01080076 (J.A. Chirinos), 01 HL094307 (A.I. Pack). J.A. Chirinos is also supported by National Institutes of Health grants R01 HL-121510-01A1 and R56 HL-124073-01A.
Funding Information:
J.A. Chirinos has received consulting honoraria from Bristol Myers Squibb, OPKO Healthcare, Fukuda Denshi, Microsoft, and Merck. He received research grants from National Institutes of Health, American College of Radiology Network, Fukuda Denshi, Bristol Myers Squibb, Microsoft, and CVRx Inc; and device loans from Atcor Medical. He is named as inventor in a University of Pennsylvania patent application for the use of inorganic nitrates/nitrites for the treatment of Heart Failure and Preserved Ejection Fraction. S.T. Kuna receives grant support from Philips Respironics, Inc. The other authors report no conflicts.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017
Y1 - 2017
N2 - Obesity and obstructive sleep apnea tend to coexist. Little is known about the effects of obstructive sleep apnea, obesity, or their treatment on central aortic pressures and large artery stiffness. We randomized 139 adults with obesity (body mass index >30 kg/m2) and moderate-to-severe obstructive sleep apnea to (1) continuous positive airway pressure (CPAP) therapy (n=45), (2) weight loss (WL) therapy (n=48), or (3) combined CPAP and WL (n=46) for 24 weeks. We assessed the effect of these interventions on central pressures and carotid-femoral pulse wave velocity (a measure of large artery stiffness), measured with arterial tonometry. Central systolic pressure was reduced significantly only in the combination arm (-7.4 mm Hg; 95% confidence interval, -12.5 to -2.4 mm Hg; P=0.004), without significant reductions detected in either the WL-only (-2.3 mm Hg; 95% confidence interval, -7.5 to 3.0; P=0.39) or the CPAP-only (-3.1 mm Hg; 95% confidence interval, -8.3 to 2.0; P=0.23) arms. However, none of these interventions significantly changed central pulse pressure, pulse pressure amplification, or the central augmentation index. The change in mean arterial pressure (P=0.008) and heart rate (P=0.027) induced by the interventions was significant predictors of the change in carotid-femoral pulse wave velocity. However, after adjustment for mean arterial pressure and heart rate, no significant changes in carotid-femoral pulse wave velocity were observed in any group. In obese subjects with obstructive sleep apnea, combination therapy with WL and CPAP is effective in reducing central systolic pressure. However, this effect is largely mediated by changes in mean, rather than central pulse pressure. WL and CPAP, alone or in combination, did not reduce large artery stiffness in this population.
AB - Obesity and obstructive sleep apnea tend to coexist. Little is known about the effects of obstructive sleep apnea, obesity, or their treatment on central aortic pressures and large artery stiffness. We randomized 139 adults with obesity (body mass index >30 kg/m2) and moderate-to-severe obstructive sleep apnea to (1) continuous positive airway pressure (CPAP) therapy (n=45), (2) weight loss (WL) therapy (n=48), or (3) combined CPAP and WL (n=46) for 24 weeks. We assessed the effect of these interventions on central pressures and carotid-femoral pulse wave velocity (a measure of large artery stiffness), measured with arterial tonometry. Central systolic pressure was reduced significantly only in the combination arm (-7.4 mm Hg; 95% confidence interval, -12.5 to -2.4 mm Hg; P=0.004), without significant reductions detected in either the WL-only (-2.3 mm Hg; 95% confidence interval, -7.5 to 3.0; P=0.39) or the CPAP-only (-3.1 mm Hg; 95% confidence interval, -8.3 to 2.0; P=0.23) arms. However, none of these interventions significantly changed central pulse pressure, pulse pressure amplification, or the central augmentation index. The change in mean arterial pressure (P=0.008) and heart rate (P=0.027) induced by the interventions was significant predictors of the change in carotid-femoral pulse wave velocity. However, after adjustment for mean arterial pressure and heart rate, no significant changes in carotid-femoral pulse wave velocity were observed in any group. In obese subjects with obstructive sleep apnea, combination therapy with WL and CPAP is effective in reducing central systolic pressure. However, this effect is largely mediated by changes in mean, rather than central pulse pressure. WL and CPAP, alone or in combination, did not reduce large artery stiffness in this population.
KW - Arterial pressure
KW - Blood pressure
KW - Continuous positive airway pressure
KW - Obesity
KW - Obstructive
KW - Sleep apnea
KW - Weight loss
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U2 - 10.1161/HYPERTENSIONAHA.117.09392
DO - 10.1161/HYPERTENSIONAHA.117.09392
M3 - Article
C2 - 29038203
AN - SCOPUS:85037710093
SN - 0194-911X
VL - 70
SP - 1283
EP - 1290
JO - Hypertension
JF - Hypertension
IS - 6
ER -