Upper Airway Stimulation versus Positive Airway Pressure Impact on Blood Pressure and Sleepiness Symptoms in Obstructive Sleep Apnea.

Abstract:

Positive airway pressure (PAP) and upper airway stimulation (UAS) are approved obstructive sleep apnea (OSA) treatment options.. Although the effect of PAP on improvement in blood pressure (BP) and daytime sleepiness (defined by Epworth Sleepiness Scale, ESS) has been established, the impact of UAS on BP remains unclear. We hypothesize that PAP and UAS will confer improvements in BP and daytime sleepiness.Clinic-based BP and ESS were compared between 517 OSA (apnea hypopnea index (AHI), 15-65) patients with body mass index <35 kg/m2 initiating PAP therapy (2010-2014) at Cleveland Clinic and 320 patients with UAS implantation (2015-2017) via an international registry with 2-6 month follow-up. Mixed-effect models were used to compare outcomes in 201 patients in each arm after propensity matching.PAP showed greater improvement in diastolic BP (mean difference of change between groups 3.7 mmHg, p <0.001) and mean arterial pressure (mean difference of change between groups 2.8 mmHg, p=0.008) compared to UAS.UAS showed greater improvement in ESS versus PAP (mean difference of change between PAP and UAS groups -0.8, p=0.046). UAS therapy usage was 6.2 hours/week greater than PAP patients (95% CI = 3.3 to 9.0). Results were consistent after adjusting for therapy adherence.PAP showed greater improvement in BP, potentially reflecting enhanced ability of PAP to exert beneficial mechanical intrathoracic cardiac and vascular influences. BP measurement error in the UAS group may also have accounted for findings. Greater improvement in sleepiness symptoms were noted in UAS compared to PAP. Click here to read full article on original source website