Effect of CPAP, Weight Loss, or CPAP Plus Weight Loss on Central Hemodynamics and Arterial Stiffness

Snigdha Jain, Indira Gurubhagavatula, Raymond Townsend, Samuel T. Kuna, Karen Teff, Thomas A. Wadden, Jesse Chittams, Alexandra L. Hanlon, Greg Maislin, Hassam Saif, Preston Broderick, Zeshan Ahmad, Allan I. Pack, Julio A. Chirinos

Research output: Contribution to journalArticle

Abstract

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.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00371293.

Original languageEnglish (US)
Pages (from-to)1283-1290
Number of pages8
JournalHypertension (Dallas, Tex. : 1979)
Volume70
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Vascular Stiffness
Continuous Positive Airway Pressure
Weight Loss
Obstructive Sleep Apnea
Hemodynamics
Pulse Wave Analysis
Blood Pressure
Thigh
Arterial Pressure
Arteries
Obesity
Confidence Intervals
Heart Rate
Manometry
Therapeutics
Body Mass Index
Clinical Trials
Pressure
Population

Keywords

  • arterial pressure
  • blood pressure
  • continuous positive airway pressure
  • obesity
  • sleep apnea, obstructive
  • weight loss

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effect of CPAP, Weight Loss, or CPAP Plus Weight Loss on Central Hemodynamics and Arterial Stiffness. / Jain, Snigdha; Gurubhagavatula, Indira; Townsend, Raymond; Kuna, Samuel T.; Teff, Karen; Wadden, Thomas A.; Chittams, Jesse; Hanlon, Alexandra L.; Maislin, Greg; Saif, Hassam; Broderick, Preston; Ahmad, Zeshan; Pack, Allan I.; Chirinos, Julio A.

In: Hypertension (Dallas, Tex. : 1979), Vol. 70, No. 6, 01.12.2017, p. 1283-1290.

Research output: Contribution to journalArticle

Jain, S, Gurubhagavatula, I, Townsend, R, Kuna, ST, Teff, K, Wadden, TA, Chittams, J, Hanlon, AL, Maislin, G, Saif, H, Broderick, P, Ahmad, Z, Pack, AI & Chirinos, JA 2017, 'Effect of CPAP, Weight Loss, or CPAP Plus Weight Loss on Central Hemodynamics and Arterial Stiffness', Hypertension (Dallas, Tex. : 1979), vol. 70, no. 6, pp. 1283-1290. https://doi.org/10.1161/HYPERTENSIONAHA.117.09392
Jain, Snigdha ; Gurubhagavatula, Indira ; Townsend, Raymond ; Kuna, Samuel T. ; Teff, Karen ; Wadden, Thomas A. ; Chittams, Jesse ; Hanlon, Alexandra L. ; Maislin, Greg ; Saif, Hassam ; Broderick, Preston ; Ahmad, Zeshan ; Pack, Allan I. ; Chirinos, Julio A. / Effect of CPAP, Weight Loss, or CPAP Plus Weight Loss on Central Hemodynamics and Arterial Stiffness. In: Hypertension (Dallas, Tex. : 1979). 2017 ; Vol. 70, No. 6. pp. 1283-1290.
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