SAHS2-3: CPAP in SAHS Patients With Hypertension
Study Details
Study Description
Brief Summary
Study objective: To assess the nocturnal changes in mechanosensitivity and chemosensitivity in hypertensive sleep apnea-hypopnea syndrome (SAHS) patients and in SAHS patients with isolated nocturnal hypertension. To value the continuous positive airway pressure (CPAP) effect on these parameters.
Design: Controlled cross-over longitudinal study. Settings: Madrid metropolitan area. Patients: Day-night sustained hypertensive and isolated nocturnal hypertensive patients with SAHS without previous treatment. At least 30 patients are needed.
Interventions: Patients will allocate in each treatment arm (CPAP vs. sham CPAP) during three months. Explorations will perform before and immediately after sleep at 0-, 3-, and 6-months of trial.
Measurements: 24-h urinary catecholamine, local vascular factors, angiotensin and aldosterone levels. Diaphragmatic tension-time index, metabolic rate, hypoxic withdrawal test, and ventilatory and inspiratory neural drive responses to progressive isocapnic hypoxia.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: CPAP nasal Nasal continuous positive airway pressure, during the night |
Device: CPAP nasal
During the night
Other Names:
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Sham Comparator: sham CPAP nasal Nasal sham continuous positive airway pressure, during the night |
Device: sham CPAP nasal
During the night
Other Names:
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Outcome Measures
Primary Outcome Measures
- Effect of CPAP on the night-morning change in the withdrawal response and in the ventilatory and central drive responses to progressive isocapnic hypoxia. [3 months]
To compare the effect of three months of CPAP therapy versus sham CPAP on the night-morning (pre- vs. post-sleep) change in the withdrawal response (decrease in ventilation caused by two breaths of 100% oxygen, %ΔV'I) and in the ventilatory and inspiratory neural drive responses to progressive isocapnic hypoxia (ΔV'I/arterial oxygen saturation (SaO2)/body surface area (BSA)] and Δ occlusion pressure at 0.1 s (P0.1)/arterial oxygen saturation (SaO2), respectively).
Secondary Outcome Measures
- CPAP effect on the night-morning change in the sniff diaphragmatic tension-time index [3 months]
To compare the effect of three months of CPAP therapy versus sham CPAP on the night-morning (pre- vs. post-sleep) change in the sniff diaphragmatic tension-time index (TTdi)
- CPAP effect on blood pressure [3 months]
To compare the effect of three months of CPAP therapy on the blood pressure in SAHS patients with isolated nocturnal hypertension and SAHS patients with day-nigh sustained hypertension
- CPAP effect on the serum levels of endothelin-1 and vascular endothelial cell adhesion molecule (VCAM)-1 [3 months]
To compare the effect of three months of CPAP therapy versus sham CPAP on the serum levels of endothelin-1 and VCAM-1 in SAHS patients with isolated nocturnal hypertension and SAHS patients with day-nigh sustained hypertension
- CPAP effect on the night-morning change in the rest metabolic rate [3 months]
To compare the effect of three months of CPAP therapy versus sham CPAP on the night-morning (pre- vs. post-sleep) change in the rest metabolic rate (carbon dioxide production/oxygen uptake ratio, RER)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Recent diagnosis of sleep apnea-hypopnea syndrome with an apnea-hypopnea index (AHI) > 10 h-1
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No previous treatment for SAHS or hypertension
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Diagnosis by 24-h ambulatory monitoring of blood pressure (AMBP) of isolated nocturnal hypertension (nighttime blood pressure of ≥120 mm Hg systolic or 70 mm Hg diastolic and a daytime blood pressure <135/85 mm Hg) or day-night sustained hypertension (nighttime blood pressure of ≥120 mm Hg or 70 mm Hg diastolic and a daytime blood pressure of ≥135 mm Hg systolic).
Exclusion Criteria:
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Severe hypertension (> 180/120 mmHg).
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Previous diagnosis of secondary hypertension.
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Myocardial infarction or stroke in the last three months.
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Severe diurnal sleepiness (Epworth score > 15)
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Previous diagnosis of chronic obstructive pulmonary disease, asthma, bronchiectasis, lung cancer, restrictive lung disease, chest wall disease or thoracic surgery.
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Previous diagnosis or clinical evidence of heart disease, neuromuscular disease or thyroid dysfunction.
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Morbid obesity (BMI > 40 Kg/m2)
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Respiratory infection in the last two months.
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Treatment with theophylline or systemic corticosteroids in the last two years.
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Excessive alcohol intake (>40 g/day)
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Absence of social or familiar support.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Hospital Universitario La Paz | Madrid | Spain | 28034 |
Sponsors and Collaborators
- Hospital Universitario La Paz
Investigators
- Principal Investigator: Francisco Garcia-Rio, MD, Hospital Universitario La Paz, IdiPAZ
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 99/0252