Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Wednesday, September 1, 2010

HYPERTENSION, SLEEP APNEA AND CPAP COMPLIANCE. ORAL APPLIANCES ARE A CPAP ALTERNATIVE.

AN ARTICLE IN CHEST JOURNAL LOOKS AT SLEEP AND HYPERTENSION. According to the August 2010 article in Chest "even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality.". This increase in in Blood pressure "sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension.is related to many types of sleep disorders including restless legs "sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension".

Patients with sleep apneathe article states "observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence."

The problem is that CPAP compliance is poor or non-existent for the majority of patients. Due to the severe problems that can result from untreated sleep apnea more and more concerned and compassionate cardiologists and internists are turning to Oral Appliances and Dental Sleep Medicine as the Best Sleep Apnea Treatment for their patients that do not tolerate CPAP.

There is no question that CPAP therapy is very effective when it is used. There is also no longer a belief that most patients will tolerate CPAP. Because non adherence and non-compliance is the rule not the exception in sleep apnea treatment the question about "What is the Best Sleep Apnea Treatment?" is still open.

Chest. 2010 Aug;138(2):434-43.
Sleep and hypertension.
Calhoun DA, Harding SM.

Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA. dcalhoun@uab.edu
Abstract
Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.

PMID: 20682533 [PubMed - indexed for MEDLINE]PMCID: PMC2913764 [Available on 2011/8/1

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posted by Dr Shapira at 7:04 PM