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Background: Obstructive Sleep Apnea (OSA), especially severe, is related with fatal and non-fatal cardio-vascular (CV) events. OSA and arterial hypertension (AH) have bidirectional relationship, and this comorbidity is much common and that are associated with elevated cardiovascular disease risk. One of the reasons is an increased arterial stiffness. Aortic pulse wave velocity (PWV) is a highly reproducible noninvasive measure of arterial stiffness recommended in current guidelines for evaluation of cardiovascular risk. Aim: The aim of the study was to assess the arterial stiffness changes in patients with arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: 185 patients with mild and moderate AH (49.8±0.80 years old) were enrolled in the study and divided into groups: 1-st group patients who had OSA (n=148), 2-nd group – patients without OSA (control group, n=37). They underwent clinical and special examination: unattended somnography by dualchannel portable monitor device, estimation of daily sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. In 10 months, follow-up study was included 105 patients, who were divided into 4 subgroups: A – patients with moderate to severe OSA on CPAP (n=23); B – patients with moderate to severe OSA without CPAP (n=29); C – patients with mild OSA (n=29); D – patients without OSA (controls, n=24). All patients received similar antihypertensive therapy according to 2013 ESH/ESC Guidelines. Results: Patients with AH and OSA (mean apnea-hypopnea index (AHI) 38.1±2.51 event h-1) in comparison with patients without OSA (mean AHI 3.02±0.25 event h-1) had significantly higher body mass index (35.2±0.57 vs. 30.6±0.79 kg m-2, P<0.001), blood glucose level (107.2±2.2 vs. 98.0±2.5 mg dl-1, P=0.045), uric acid level (6.17±0.1 vs. 5.5±0.3 mg dl-1, P=0.048) and left ventricular mass index (LVMI) (115.8±2.39 vs. 104.6±4.56 g m-2, P=0.035). Also, the patients with AH and OSA in comparison with patients without OSA had higher carotid-femoral pulse wave velocity (PWVcf ) (11.19±0.20 vs. 10.10 m s-1, P=0.014) and central systolic blood pressure (CSBP) (133.43±1.67 vs. 125.22±3.41 mm Hg, P=0.027). During 10-month follow-up in patients with AH and OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.2±0.63 to 10.05±0.43 m s-1, P=0.009) with achievement of normal level (<10 m s-1) in 60.9 % patients, office systolic blood pressure (from 143.8±132.7 to 132.7±2.33 mm Hg; P=0.021) and diastolic blood pressure (from 93.8±3.31 to 86.0±3.19 mm Hg; P=0.012) with achievement of target levels. In patients central systolic BP decreased (from 130.3±3.97 to 119.7±2.97 mm Hg; P=0.012) and diastolic BP decreased (from 94.7±3.31 to 87.1±2.36 mm Hg, P=0.013). Conclusion: Combination of continuous positive airway pressure (CPAP)-therapy and antihypertensive treatment improvement of arterial elasticity and helps to achieve target blood pressure in patients with AH and moderate to severe OSA. *Correspondence to: Oksana Rekovets, National Scientific Center “M.D. Strazhesko Institute of Cardiology”, Kyiv, Ukraine, E-mail: recovets@ukr.net

journal of integrative cardiology

Association between arterial stiffness and obstructive sleep apnea in patients with arterial hypertension and continuous positive airway pressure therapy