LAUSR

Objective: In Guadeloupe, a cross- sectional study was realized in 204 adult patients identified obstructive sleep apnea (OSA)/ non-OSA. Our data highlighted raised frequency of cardiovascular metabolic factors in patients with OSA. Hypertension frequency and non dipper pattern evaluated by 48 hour-ambulatory blood pressure monitoring (ABPM) was 84.5 and 77.5 respectively in OSA group. The aim of this prospective follow-up study was:To evaluate the effect of continuous positive airways pressure (CPAP) on BP and non dipper pattern evaluated by ABPM in OSA group.To compare the incidence of cardiovascular events in the two groups OSA/ non-OSA. Design and method:48 hour-ABPM was performed after at least 3 months of uninterrupted CPAP therapy in patients with severe OSA in OSA group.Follow up was at least 3 years to assess and compare the incidence of cardiovascular events in the two groups OSA/ non-OSA. Results:57 patients suffering from severe OSA underwent 48 hour-ABPM. 56% of men, mean age 56.4 ± 9.9 years, BMI 31.8 ± 5.5 kg/m2, homa-IR index 4.43 ± 3.01, dyslipidemia 42%, and 26% type 2 diabetes, mean AHI 39.2 ± 13.1. Forty patients had antihypertensive medications (mean 1.74) and 8 were normotensive. Daytime and night time BP were 137/84 and 131/78 mmHg respectively. The mean duration of adherence of CPAP therapy was 3.30 hours per night. After a period of 3 months under CPAP, BP decreased by 5.82 and 4.48 mmHg during the day, by 6.02 and 4.48 mmHg during the night, and by 5.74 and 4.48 mmHg over 48 hours, respectively for systolic and diastolic BP. Dipper profile was 28 vs 19.25% for systolic BP, and 44 vs 42% for diastolic BP.-After a follow-up of three years 6 cardiovascular events occurred in OSA group: 4 ischemic strokes and 2 distal arterial thrombosis (8.46%) and 2 deaths by pneumopathies. One ischemic stroke was related to non-OSA group. Conclusions: Antihypertensive medications and CPAP have additional benefits on BP in hypertensive patients with severe OSA and influence cardiovascular morbidity-mortality in these high risk patients.