The acute effect of continuous positive airway pressure titration on blood pressure in awake overweight/obese patients with obstructive sleep apnoea

Objectives: Continuous positive airway pressure (CPAP) improves upper airway obstruction in patients with obstructive sleep apnoea (OSA), who often are overweight-obese. Although it is thought that CPAP improves long-term blood pressure control (BP), the impact of acute and short-term CPAP use on the cardiovascular system in obese patients has not been described in detail.Methods: Obese patients (body mass index, BMI>25kg/m(2)) with OSA were studied awake, supine during incremental CPAP titration (4-20cmH(2)O, +2cmH(2)O/3mins). BP was measured continuously with a beat-to-beat BP monitor (Ohmeda 2300, Finapres Medical Systems, Amsterdam/NL), BP variability (BPV) was calculated as the standard deviation of BP at each CPAP level, the 95% confidence interval (95%CI) was calculated and changes in BP and BPV were reported.Results: 15 patients (12 male, 4810) years, BMI 38.9 +/- 5.8kg/m(2)) were studied; the baseline BP was 131.0 +/- 10.2/85.1 +/- 9.1mmHg. BP and BPV increased linearly with CPAP titration (systolic BP r=0.960, p<.001; diastolic BP r=0.961, p<.001; systolic BPV r=0.662, p=.026; diastolic BPV r=0.886, p<.001). The systolic BP increased by +17% (+23.15 (7.9, 38.4) mmHg; p=.011) and the diastolic BP by +23% (+18.27 (2.33, 34.21) mmHg; p=.009), when titrating CPAP to 20cmH(2)O. Systolic BPV increased by+96% (+5.10 (0.67, 9.53) mmHg; p<.001) and was maximal at 14cmH(2)O, and diastolic BPV by+97% (+3.02 (0.26, 5.78) mmHg; p<.001) at 16cmH(2)O.Conclusion: Short-term incremental CPAP leads to significant increases in BP and BPV in obese patients with OSA while awake. Careful titration of pressures is required to minimise the risk of nocturnal awakenings while improving BP control.