Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea

Jason R. Carter, Ida T. Fonkoue, Daniela Grimaldi, Leila Emami, David Gozal, Colin E. Sullivan, Babak Mokhlesi

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m2) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10–20, Δ20–30, Δ30–40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin, P < 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r × 0.713, P < 0.001) and diastolic (r × 0.497, P < 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beatto-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.

Original languageEnglish (US)
Pages (from-to)R602-R611
JournalAmerican Journal of Physiology - Regulatory Integrative and Comparative Physiology
Issue number7
StatePublished - Apr 2016
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported in part by Philips/Respironics. B. Mokhlesi is supported by National Institutes of Health Grant R01HL-119161. J. R. Carter is supported by National Heart, Lung, and Blood Institute (HL-122919-01).

Publisher Copyright:
© 2016 the American Physiological Society.


  • Hypercapnia
  • Hypertension
  • Hypoxemia
  • Sleep apnea


Dive into the research topics of 'Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea'. Together they form a unique fingerprint.

Cite this